PHN Questions

Dr. Tammy, FNP/GNP-C · Dec 16, 2008

1 could you please tell me what your job title is? police nurse

2. would this be considered an entry-, mid-, or senior-level position? senior. i report directly to the chief of police.

3. what formal training, experience, or education is required for a person in this occupation? bsn, rn, phn, police academy graduate

[color=#808080]4. could you please describe the important and essential duties and competencies for a person in this position? population at risk: police officers and lower economic members of the community-provide primary, secondary and teritary prevention services using nursing, social, occupational health, change and leadership systems, models and theory to drive, guide, inform practice.

5. could you please list a few of your specific daily activities? police officers: ptsd assessment/referral; first aid; nutrition and exercise regimen to enhance optimal performance; community: dm screens: glucometers; cholesterol screens; cpr courses; enhanced parenting education; sti education; community resource and referral information.

6. what would you say is the biggest challenge for this field? building trust and community partnerships through a program that has never been done before in the us.

semiller36545 · Dec 16, 2008

1 could you please tell me what your job title is? police nurse
2. would this be considered an entry-, mid-, or senior-level position? senior. i report directly to the chief of police.
3. what formal training, experience, or education is required for a person in this occupation? bsn, rn, phn, police academy graduate
[color=#808080]4. could you please describe the important and essential duties and competencies for a person in this position? population at risk: police officers and lower economic members of the community-provide primary, secondary and teritary prevention services using nursing, social, occupational health, change and leadership systems, models and theory to drive, guide, inform practice.
5. could you please list a few of your specific daily activities? police officers: ptsd assessment/referral; first aid; nutrition and exercise regimen to enhance optimal performance; community: dm screens: glucometers; cholesterol screens; cpr courses; enhanced parenting education; sti education; community resource and referral information.
6. what would you say is the biggest challenge for this field? building trust and community partnerships through a program that has never been done before in the us.

that sounds really fascinating. i would love to hear more about it.

coolvibesRN · Dec 16, 2008

Thanks for responding.I'm already done with the class,but thanks alot.

Dr. Tammy, FNP/GNP-C · Dec 16, 2008

That sounds really fascinating. I would love to hear more about it.

Thanks for asking. Here is the initial proposal that I wrote which launched the program. For those interested in doing the same, feel free to copy and paste and submit to your local police or sheriffs department. If you are really serious though, you do need to be part of the police department because the process that law enforcement uses is a bit different. Going through your local part time police academy will speak volumes to the leadership as to your resolve to implement the program. It will also bring you closer to your population.

EXECUTIVE SUMMARY

The Ceres Police Nurse Program is an adjunct service offered by the police department to enhance individual officer and community health and safety; decrease work-related injuries; identify occupational and community health illness in early stages; mitigate injury and illness within the community and agency, and improve overall well being of the agency and community.

The program aims to target select populations at risk within the City of Ceres in which documented disparities in health and well-being are without equivocation. These aggregates include police officers, members of the Hispanic community and those whose health care needs are underserved. Program components focus on prevention, occupational health, community-based resource referrals and ultimately, inclusive of primary care services for those without health care coverage.

BSN-PHN's and master prepared registered nurses who are nurse practitioners, cross-trained and certified as sworn peace officers administers the project. Consequently, care administered to the community is viewed as an extension of the police department thereby improving relationships between the agency and community. Ceres Police will become the first law enforcement agency in the United States to provide such a program for its officers and citizens.

PRESENT SITUATION

GEOGRAPHIC AREA SERVED

The Ceres Police Nurse Program will serve residents of Ceres. The City of Ceres is located in Central Stanislaus County (City Data.com, 2007) and is the third largest city in Stanislaus County. Ceres is composed of 6.9 square miles and can best be described in geographical shape as a pan with panhandle.

The population of Ceres in July of 2005 was 40,571 (City Data.com, 2007), which are up from 34,609 in the year 2000. Males make up 49.2% (17,039) of the population and females compose 50.8% (17,570) of the population. The median age of a Ceres resident is 29.4 years of age. The average household income in 2005 was $48,300.00, up from $40,736 in 2000.

The educational level of residents is a little on the bleak side. Only 67% of residents above the age of 18 possess a high school diploma, equivalence or GED (City Data.com, 2007). Those residents 18 years of age or older who possess a Bachelor's degree or higher: 8.3% and Graduate or professional degree: 2.5%. The unemployment rate for Ceres is 13.9%.

The poverty status for Ceres in 1999, the most current reporting period, was as follows: (1) Total families in poverty per the U.S. Federal government poverty definition was 858 families (10.1%) (U.S. Bureau of the Census, 2000).

The vast majority of Ceres residents (56.1%) are married; 26.8% have never been married; 2.3% are legally separated; 9.9% are divorced and 5% are widowed (City Data.com, 2007). Lesbian couples compose 0.4% and gay couples represent 0.3% of the population of Ceres. The most common working industry for males in 2005 was construction and for females, health care.

PHYSICAL PLANT

Primary, secondary and tertiary program services will operate through the police department. The coordinator shall establish off-site locations with community partnerships to provide direct nursing services. An example of a partnership is illustrated between the program and the Ceres Partnership for Healthy Children (CPHC). Because health and welfare are of vital importance to both Ceres Police and CPHC, CPHC as agreed to provide classroom space and a physical examination room at no charge. The Ceres Flea Market is another example of where screening services are provided.

Because of security concerns, all direct community-based care provided to residents shall take place outside of the police station. Again, community-based partnerships between Ceres Police and local community services shall dictate locations for services. For police officers, however, nursing services will take place within the confines of the police department as all officers have clearance and therefore, security is not an issue.

RESOURCES

Resources needed to establish the program are minimal and are already in place within the police department. Resources needed for the program include printing educational material, designing educational presentation and minimal diagnostic equipment. Services that are cost-intensive shall be provided by funds generated by collaborating partnerships with programs by which services move those organizations forward in obtaining their respective goals.

An example of such a relationship includes a partnership between Ceres Police and a medical supply company in performing diabetic screenings for the community. The cost to screen for diabetes is approximately $1.00 per person. The program will secure free diabetic supplies to perform such diabetic checks from organizations, which sell such supplies for Ceres residents. Organizations will see the underlying value of sponsoring such a program as this will affect their bottom line as well as bring them closer in helping the community. The organizations, in this instance, may include retailers, wholesalers or manufacturers of diabetic supplies.

SERVICE DESCRIPTION

TERMS DEFINED

1. Primary prevention avoids the development of a disease. Most population-based health promotion activities are primary preventive measures.

2. Secondary prevention activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and emergence of symptoms.

3. Tertiary prevention reduces the negative impact of an already established disease by restoring function and reducing disease-related complications.

4. Nursing is both an academic discipline and clinical-based profession that is separate and distinct from the medical profession. The process of nursing uses evidence-based practice, nursing science and nursing theory to inform, guide and direct nursing practice. Nursing and medicine are both professions that operate interdependently with the other.

The Police Nursing Program will serve as an adjunct to Ceres Police Department in providing primary, secondary and tertiary prevention services for police officers and community-based populations at risk (PAR's). Nursing science and theory will guide, direct and inform each component of the program and programmatic components.

Program and programmatic component goals will aim towards reducing morbidity and mortality of police officers and members of community-based PAR's. Specific programmatic components are categorized within their respective prevention services. These components include, but are not limited to the following:

Primary Prevention Programs

• Cardiovascular Education and Risk Reduction

• Diabetic Education and Risk Reduction

• Smoking Cessation

• Cancer Awareness and Self-Check Education

• Drug and Alcohol Awareness Education

• Sexual Health and Sexually Transmitted Disease Education

• Domestic Violence Education and Resources

• Community-Based Resources

Secondary Prevention Programs

• Cholesterol and Lipid Screening

• Hypertension Screening

• Diabetic Screening

• Prostate Cancer Screening

• Colorectal Cancer Screening

• General Nursing Exams

• Hearing and Vision Screenings

• Lead, Heavy Metal and Environmental Assessment

Tertiary Programs

• Professional Emergency Care

• CPR & First Aid training

• Elderly, Disabled and at Risk Home Visits.

• Officer Emergency Responder Training

• SWAT Nurse Intervention Program

• Critical Incident Stress Management (first responder)

BENEFITS

There are many benefits for a nursing presence within Ceres Police. Ultimately the programmatic components will serve the agency to reduce and mitigate work-related injuries, improve the health of officers and community alike, reduce officer sick days, reduce the disparity of illness in at-risk populations within the community and move officers and the community closer together in an active partnership for promoting and maintaining optimal levels of health. Moreover, the program will provide an integrated program by which many citizens may access health care where once they had no access.

OBJECTIVES

1. Services: The program aims to reduce morbidity and mortality of police officers and community-based PARs through the provision of primary, secondary and tertiary nursing prevention services.

2. Marketing: The program aims to develop and implement a marketing strategy directed towards the provision of nursing services for police officers and PARs.

3. Finances: The program, from the first day, will be financial self-sufficient and continue throughout the duration of providing program services.

4. Goals: The program will establish five partnerships with community-based entities in providing program services within the first two years. The program will offer primary care services within the first 5 years.

MANAGEMENT AND PERSONNEL

The Ceres Police Nurse Program is managed by the approved chain of command.

Nursing services are provided directly by professional registered nurses (RN's) who are certified public health nurses (PHN) and posses a baccalaureate or higher degree in nursing or public health. Those with such qualification, certification and licensure provide special program components that require advanced certification. As an example, the SWAT nurse is licensed as a RN and PHN, and due to the nature of SWAT operations, must also possess licensure as a mobile intensive care paramedic. Nurses that provide primary care services are those RN's/PHN's that possess a Masters Nursing Degree as well as California licensure as a Nurse Practitioner.

Support staff are not needed in great quantity, as nursing will coordinate most program components. Additional staff, above the present staff levels are not needed. As the program and program components grow in popularity, productivity and necessity, however, an administrative assistant working on a part time basis would become necessary.

MARKET ANALYSIS

TARGET POPULATION

The intended population for the police nursing program components are Ceres Police Officers and members of the community, particularly the Hispanic population who are at risk.

NEEDS ASSESSMENT

As Chief of Public Safety de Werk indicated, there are three categories of people residing in Ceres:

We have essentially three basic groups of people residing here. There are the long-time residents, who tend to view themselves as the biggest stakeholders in this community’s future, and wield the most political influence owing to their involvement in local affairs and long-time residency here. The second group is comprised of the people who live here, but commute to the San Francisco Bay Area, South Bay Area, Sacramento, and other metropolitan areas. They do not participate in local affairs to the same extent as the long-time residents, but they hold high expectations of local government in terms of the scope and quality of services it provides. The third group is comprised of non-English speaking people. These people make up a large percentage of the population, are relatively underrepresented in local governmental affairs, and many are isolated because of language limitations. The two predominant languages spoken in this community are English and Spanish (de Werk, 2006).

There are many areas of basic knowledge deficits related to cardiovascular disease within Ceres. Many know very little related to which risk factors predispose those to disease. Also noted is a fundamental lack of understanding within the community related to basic health system components and rudimentary physiological principles and concepts such as how the body works. Many, as an example, had no idea what impact, if any, diet exercise and smoking had on the heart and cardiovascular system. Almost everyone interviewed stated that diabetes had no impact one way or another on cardiovascular disease.

The Hispanic population in the context of a PAR is of particular concern because of the vast evidence documenting mortality and morbidity related to illness and disparity within this particular population (Allen & Szanton, 2005; Hoffmann & Cubeddu 2002; Qunibi, Abouzahr, Mizani, Nolan, Arya & Hunt, 2005) as compared with the rest of the community coupled with limited resources for addressing health promotion, education and care for this particular aggregate (Winkleby, Flora, Kraemer & Helena, 1994).

Hispanic Americans are diverse in ethnic origin coupled with data that suggests Hispanics are the fastest growing segment of the population within the United States (Haynes, Buthcer & Boese, 2007). With a 60% increase in total population since 1990, Hispanics are the fastest growing population of Americans. The population of Hispanic Americans has now outgrown the African American population, which was the largest minority population in the United States. By 2050, Hispanic Americans are expected to reach 88 million and comprise one of every 4 Americans. Moreover, the Hispanic elderly population is expected to increase by over 400% over the next decade.

The needs assessment, which forms the basis for the police nursing program was obtained through direct and indirect methods. Direct methods of community assessment included interaction with PARS and members of the community across the life span. The program constituents talked and interacted within this PAR for many weeks. Program architects visited homes, performed teaching presentations at community centers, walked through PAR neighborhoods, disseminated public health information, toured and assessed the City from the safety of Ceres Police Department cruisers, organized neighborhood watch meetings at local churches, organized and performed services at the local flea market during health fair week as well as fielded hundreds if not thousands of health related questions.

I indirect methods of community assessment included review and documentation of statistics and records from multiple agencies within the local, state and federal government as well as within a local community agency, Ceres Partnership for Healthy Children.

Ceres has had a police department since 1946 and a fire department since 1911 (City of Ceres, 2007). Instead of having one fire chief and one police chief, these positions are combined into the position of chief of public safety, which eases leadership and policy-setting functions between these two vital agencies. There are approximately 40 police officers and 35 firefighters between one police station and three fire stations. A fourth station is under construction (City of Ceres, 2007).

COMPETITION

The Ceres community is lacking in primary, secondary and tertiary prevention programs. There are no American Heart Association Chapters in Ceres. Also absent are any form of public subsidized screening program such as those that provide cholesterol screens, hypertension checks with referrals, cardiovascular risk assessment profiles and other services that provide prevention services within the community. Members of the community must make an appointment with their respective primary care provider to gain access to such services. Unfortunately, many members of PAR's are lacking funds or legal immigration status to access such services.

Also lacking are primary prevention programs such as hypertension literature, lipid and cholesterol information, peripheral vascular disease, etc. There are no services within Ceres that provide tertiary care services for cardiac rehabilitation such as those services provided by Valley Heart Associates in neighboring Modesto where a referral for a cardiologist assessment could take as long as 5 months.

Police officers have no access to prevention services other than making an appointment with their primary care provider. The department, until now, had no access to nursing or health services in house. Upon an exhaustive review, there are also no such models for police nurse programs across the country that can serve as a guide.

MARKETING STRATEGY

STEP 1

The goal of the marketing plan is to promote community-based and police officer-based acceptance of the Ceres Police Nurse programmatic goals. Promotion is driven by the philosophies that underscore the program values including conceptual relationships and ethical principles.

There is a clear linear and positive relationship between the concepts of trust and respect in establishing positive community-based partnerships (Lucky, 2008b) in the context of promoting the Ceres Police Nurse program. Additionally, there is a need to unequivocally provide a service in the context of nursing ethics (Lucky, 2008a) that will serve to inform and direct all program components. The overall marketing strategy will strive to present the program with these critical underpinnings on an agency and community-wide basis.

STEP 2

The internal and external analysis provides programmatic strengths to include highly trained and licensed RN/PHN's police officers to provide direct and community-based care to officers and members of community-based PAR's. Strengths also include the non-existence of any necessary monies to establish the program and the minimal need for monies to sustain the program. Additionally, the literature is rich with occupational health models, community care models and primary care nursing models to assist in serving as roadmaps to operations.

Weaknesses include the lack of any similar program (e.g. nursing services offered through a law enforcement agency) throughout the country. Through an exhaustive review, there are no programs in place nor under development.

Opportunities for such a program are as vast as they are helpful. From a financial standpoint, the program aims to decrease workers compensation claims through a comprehensive program to reduce officer-related work injuries; aid to reduce overtime by keeping officers healthy, thereby reducing sick call and subsequent overtime through primary, secondary and tertiary nursing interventions and reduce expenses related to hospital and primary care provider visits which demonstrate a relationship between utility and ultimately agency-based health care premium costs.

Opportunities on the community side are just as extensive as they are positive. Services are provided to PAR's within the community, which will decrease incidents of individual, family and community-based illnesses. Where there were once no such services, members of the community will now have access to health care. Additionally, there is an added benefit to Ceres Police in that communications and subsequently, relationships with the community will improve; partnerships will strengthen since care is provided directly by police officer nurses.

Threats include the lack of understanding of officers and community due to the fact that no such program has previously existed. Additionally, Change Theory (Lewin, as cited by Crotty, 1996; Marquis, Bessie , Huston, & Carol, 2006) provides evidence to illustrate that change in any form is challenging for individuals, organizations and communities alike. In keeping with elements of positive movement towards program goals, the program architects recognize there are challenges related to change in the form of passive and active resistance with regards to developing a new program, especially a program that does not exist in the country.

The program aims to reduce such resistance by using the conceptual relationships between trust and respect drive program elements. This includes having nurses that are cross-trained as police officers which will aid in components that aim to care for police officers, as well as making community members aware that care is provided directly by police officer nurses. The presence of this critical concept is provided in every facet of marketing.

STEP 3:

The first objective is to reduce the program concept including relevant theories and models with programmatic components to a PowerPoint presentation. The product is then presented to key community, city and police agency officials.

The second objective is to develop program fliers for police officers, thereby informing all of program adoption by the agency. Such fliers are presented with a short presentation of program goals, objectives and specific programmatic components. The officers, in turn, are then prepared at both the operational and dissemination level. That is, the officers are aware that the program exists and how the program can benefit the individual officer and are also aware of how members of PAR's can benefit. The individual officer can now act as a conduit for programmatic dissemination to community members, which will benefit the marketing plan in increasing PAR program access.

The third objective involves programmatic dissemination to the community. As stated above, community leaders and officers will aid in programmatic dissemination. Brochures are created to outline the program as a whole as well as develop specific program component brochures.

Posters are developed that are placed throughout the community. Each poster will have a primary intervention message (e.g. how to respond to a choking child, vaccination dates per age category, education on diabetic health, etc.) as well as contain program components that will include a list of program subcomponents in bullet point as well as information on how to access the program for services. Brochures and posters are placed in areas of high traffic areas within the community, such as business and meeting places with 50 or more visitors per day.

Lastly, a brochure is provided to both community and officers that specifically outlines key ethical values by which program components are developed, implemented and evaluated.

STEP 4:

For action strategies, please see Step #3. Because of the dynamics of the program, members of the community, officers and city leadership are consulted with regard to each and every step of development. The program will also use media outlets (TV, Radio, Newspaper) to actively disseminate programmatic information.

STEP 5:

Implementation of this plan will commence when the Ceres City council adopts the program. From this point, the objectives as listed in Step #3 of this plan will commence. Information is then solicited from officers, community leaders and members of PAR's to ascertain their perception of weakness' or barriers for the program.

STEP 6:

Ceres leadership and members of the community evaluate the plan, and changes are made as needed during all phases of programmatic development.