Public health nursing interventions: surveillance, case finding, outreach, screening, referral, advocacy and more
- Fundamental
The public health intervention wheel lists 17 actions that public health nurses use, from surveillance and screening to advocacy and policy, at three levels.
What it is
The public health intervention wheel is a model from the Minnesota Department of Health in the United States, built from the real work of public health nurses and later revised. It names 17 population-based interventions and says that each one can be used at three levels: with individuals and families, with communities and with systems. The interventions are grouped in five sets of related actions, from finding and monitoring health problems to changing policies. Nurses in many countries use it as a common language to plan, describe and teach community work. This page describes the interventions in our own words; it does not reproduce the model's figure or its official definitions.
Key points
- The model was first described by Keller and colleagues (1998) at the Minnesota Department of Health and has been revised since.
- Surveyed community health nurses have used it to describe which interventions they actually perform.
- Health teaching shares information and experiences to improve knowledge, attitudes, behaviours and skills.
- Counselling builds a supportive relationship that increases a person's capacity to cope with a stressful situation.
- Consultation seeks to generate alternative solutions to a problem.
Components
- Finding and monitoring problems: surveillance, disease and health event investigation, outreach and screening.
- Case finding: locating individuals and families with risk factors and linking them to care.
- Coordinating care: referral and follow-up, case management and delegated functions.
- Teaching and counselling: health teaching, counselling and consultation.
- Partnering with the community: collaboration, coalition building and community organising.
- Changing systems: advocacy, social marketing, and policy development and enforcement.
What it is for
- Gives the team a shared vocabulary to plan and record community work.
- Helps the nurse check whether a plan acts only on individuals or also on the community and on systems.
- Serves to analyse cases and to teach students what public health nursing does.
Example (illustrative): one problem, several interventions and levels. Low vaccination coverage in a rural district
| Intervention | Level | What the nurse does |
|---|---|---|
| Surveillance | Community | Reviews coverage data by district and finds the gap. |
| Outreach and case finding | Individual and family | Visits homes, checks vaccination cards and finds children who are behind. |
| Referral and follow-up | Individual and family | Books the vaccination, then checks that the child was vaccinated. |
| Health teaching | Community | Runs a session with parents and the school about why vaccines matter. |
| Collaboration and advocacy | Systems | Works with the school, leaders and the local authority on transport and schedules. |
In nursing practice
- Before planning, ask at which level the problem lives: one family, the whole community or a rule or service.
- Pair each individual action with a community or systems action when the cause is shared by many people.
- Record the interventions by name; it makes the team's work visible and easier to evaluate.
- Advocacy and policy work are nursing interventions too, done with the community and within institutional channels.
Common mistakes
- Using only health teaching for every problem.
- Making referrals without following them up.
- Forgetting the systems level when the same problem repeats in many families.
- Copying the model's official definitions or figure instead of explaining it in one's own words.
Test yourself
Think of the answer, then tap the question to see it.
At which three levels can each intervention of the wheel be used?
With individuals and families, with communities and with systems.
Which intervention locates at-risk groups and tells them how to reach services?
Outreach.
Which interventions belong to the group that coordinates care?
Referral and follow-up, case management and delegated functions.
What is the difference between policy development and policy enforcement?
Development puts an issue on decision-makers' agenda so a rule is created; enforcement makes those who deal with the population comply with it.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Applying the Public Health Nursing Intervention Wheel to a Paternal Perinatal Mental Health Case Study (Philpott LF, Mulcahy H) (Public Health Nursing (PubMed Central), 2026); Nursing interventions in a newly established community health nursing system: A cross sectional survey (Kovacevic RM, Behrens DA, Hyll W) (International Journal of Nursing Studies Advances (PubMed Central), 2024); Nursing: Mental Health and Community Concepts, 16.2 Community Health Concepts (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022).
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Representative model, for educational purposes only.