Page 444 - Encyclopedia of Nursing Research

POPUlATIONS AND AGGReGATeS n 411

paper, Williams pointed out the conceptual The conceptual shift from a focus on
and sematic muddle that surrounded what individual patients, the thrust in the clinical
was then referred to as either community preparation of nurses, to a focus on popula- P
health nursing or public health nursing, tions, which is the concern of public health,
terms which were used interchangeably. can be difficult. The basic idea in popula-
Williams suggested that community and tion-focused practice, the essence of public
public health nursing were defined primar- health practice, is that problems are defined
ily in terms of where care was provided and at the population level using a variety of
that the majority of the efforts of nurses assessment strategies and solutions (inter-
who were identified as public health nurses ventions) such as policy development and/
or community health nurses were actually or the implementation of particular services
individualistic in focus, directed to specific or programs for a defined population or sub-
individuals or families. Williams recom- population as opposed to diagnoses or inter-
mended that to increase effectiveness, public ventions at the level of the individual client
health nurses needed to adopt a population or patient (Williams, 1996, 2005). Since the
perspective in defining problems and merge 1970s, public health nursing has incorporated
the population focus with their understand- a strong population perspective as evidenced
ing of the needs of individuals and families by the Scope and Standards of Public Health
in proposing and implementing interven- Nursing published by the American Nurses
tions (Williams, 1977). Association (2007) and supported by public
In discussing what population-focused health specialty organizations.
nursing meant, Williams (1977) introduced Numerous changes have taken place in
the term aggregate to the public health nurs- health care in the last 30 years, particularly in
ing literature to broaden the idea of a popula- financing and in the science underlying prac-
tion to denote groups of people who had one tice. One of the most significant drivers of
or more characteristic in common but might change has been what Starr (1982) described
not be part of a defined community, geograph- as the industrialization of health care, the
ically or sociologically. In other words, it was massive introduction of private capital to
meant to expand the idea of a population finance health care provider organizations,
to be more flexible in grouping individuals and the development of various technologies
to see patterns that would be missed if one used in health care. Other drivers have been
looked only at the individual and not a mean- of federal-level decision about the use of the
ingful groupings (aggregates) of individuals. public dollar in paying for health care for
Williams also reflected on the importance those with Medicare and Medicaid coverage
of preparing nurses with other areas of spe- and decisions by health insurance compa-
cialization in aggregate-level skills and in nies, which led to the adoption and spread of
developing practice models, which clearly various prospective payment schemes. Such
demonstrate effective integration of clinical schemes have brought the population perspec-
approaches and strategies for dealing with tive front and center in health care decision
aggregate-level data. making. This is so because so many decisions
What happened to the term aggregate? are made using aggregate or population-level
Although it is still used by some, particu- data. Such decisions include the following:
larly in the international health literature what services will be provided to whom, for
(see Mackenbach, Bouvier-Colle, & Jougla, what types of problem, in what setting (e.g.,
1990), the term population has emerged as in hospital, home, primary care office), by
the term most frequently used in the United whom (which provider groups), and who will
States. pay (private payers, government payers, self-