Cornerstones of Public Health Nursing

Revised 2007 1 Minnesota Department of Health Adpated from Original by Center for Public Health Nursing, 2004

Public Health Nursing Practice:

Focuses on the health of entire populations

Reflects community priorities and needs

Establishes caring relationships with communities, systems, individuals and families

Grounded in social justice, compassion, sensitivity to diversity,

and respect for the worth of all people, especially the vulnerable

Encompasses mental, physical, emotional, social, spiritual, and environmental aspects of health

Promotes health through strategies driven by epidemiological

evidence

Collaborates with community resources to achieve those strategies, but can and will work alone if necessary

Derives its authority for independent action from the Nurse

Practice Act

Cornerstones from Public Health Cornerstones from Nursing Population based Relationship based Grounded in social justice Grounded in an ethic of caring Focus on greater good Sensitivity to diversity Focus on health promotion and prevention Holistic focus Does what others cannot or will not Respect for the worth of all Driven by the science of epidemiology Independent action Organizes community resources Long-term commitment to the community

Definitions Public Health

Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.1

"Public Health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for the sanitation of the environment, the control of communicable disease, and the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity."2

Nursing

“[Nursing is defined to have] charge of the personal health of somebody… and what nursing has to do… is to put the patient in the best condition for nature to act upon him.”3

“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to his health or recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible… [The nurse] is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, the [voice] for those too weak or withdrawn to speak.”4

Public Health Nursing

Public health nursing is the synthesis of the art and science of public health and nursing.5

One good community nurse will save a dozen policemen. Herbert Hoover

Revised 2007 2 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

1 Adapted from The Future of Public Health. National Academy Press, 1988. 2 C.E.A. Winslow. The Untilled Field of Public Health, Modern Medicine, Vol. 2. pp. 183-191, 1920. 3 Nightingale, Florence. Notes on Nursing: What It Is and What It Is Not. London: Harrison and Sons, 1859, preface and p.75 (Commemorative Edition, Lippincott, 1992). 4 Henderson, VA. Basic principles of nursing care. London: International Council of Nurses, 1961. 5 Cornerstones of Public Health Nursing. Minnesota Department of Health, 1999.

Revised 2007 3 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

Applying the Cornerstones to Public Health Nursing Practice

FOCUSES ON THE HEALTH OF ENTIRE POPULATIONS

Population • A population is a collection of individuals who have one or more personal or

environmental characteristics in common. • Population-based interventions are not limited to only those who seek service or who

are poor or otherwise vulnerable. A population-of-interest is a population that is essentially healthy but who could improve factors which promote or protect health. A population-at-risk is a population with a common identified risk factor or risk-exposure that poses a threat to health Examples of populations include: • All families of newborn infants • All older adults at risk for falls • Everyone who drinks well water • All children at risk for vaccine-preventable disease • All adolescents at risk for depression

REFLECTS COMMUNITY PRIORITIES AND NEEDS

Population-based practice reflects the priorities of the community. Community priorities are determined through an assessment of the population’s health status and a prioritization process. Community assessment is defined as: The regular and systematic collection, analysis, and dissemination of information on the health of the community; including statistics on health status, awareness of community health needs, and epidemiologic and other studies of health problems. A community assessment process: • Assesses the health status of all populations and for all health-related areas in the

community, regardless of whether the public health agency has responsibility or programmatic efforts in those areas

• Produces results that serve as the foundation for planning how public health and the community will address public health problems

ESTABLISHES CARING RELATIONSHIPS WITH COMMUNITIES, SYSTEMS, INDIVIDUALS AND FAMILIES

Caring is often considered the “art of nursing, that part of nursing which creates the circumstances under which the “curative” parts can happen. More than just words, intents, beliefs, or values; it encompasses stance, touch, orientation thoughts and feelings fused with physical presence and action.1

Relationships The foundation of any therapeutic or healing activity is the interactions among people, which may be described as relationship-centered care. All public health nursing interventions are provided in the context of a relationship. The relationships that public health nurses establish with the communities, families, individuals and systems they serve are grounded in personal integrity, honesty, consistency, and trustworthiness.

“Nobody cares how much you know until they know how much you care.”

GROUNDED IN SOCIAL JUSTICE, COMPASSION, SENSITIVITY TO DIVERSITY, AND RESPECT FOR THE WORTH OF ALL PEOPLE,

ESPECIALLY THE VULNERABLE

Social Justice Public health nurses’ commitment to the communities, families, and individuals they serve emanate from a combination of the passion underlying their social justice beliefs that all persons regardless of circumstances are entitled equally to a basic quality of life. “Social justice is the foundation of public health… that invincible human spirit that led so many of us to enter the field of public health in the first place: a spirit of that has a compelling desire to make the world a better place, free of misery, inequity, and preventable suffering, a world in which we all can live, love, work, play, ail, and die with our dignity intact and our humanity cherished.”2

Compassion “The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, the (voice) for those too weak or withdrawn to speak.”3

Revised 2007 4 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

1 Patricia Benner, Christine Tanner, Catherine Chesla. Adapted from Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics. New York: Springer, 1996: p.233. 2 Krieger and Birn, Editorial, AJPH, November 1997 3 Henderson, VA. Basic principles of nursing care. London: International Council of Nurses, 1961.

Revised 2007 5 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

Sensitivity to Diversity • Values cultural diversity in communities • Possesses capacity for cultural self-assessment and competence in adapting to

diversity. Respect for the worth of all people, especially the vulnerable Vulnerable populations are populations at risk of poor physical, psychological, or social health.

ENCOMPASSES MENTAL, PHYSICAL, EMOTIONAL, SOCIAL, SPIRITUAL, AND ENVIRONMENTAL ASPECTS OF HEALTH

Definition of holistic nursing: “All nursing practice that has healing the whole person as its goal.”1

Historical precedents: “The work we are speaking of has to do with maintaining health by removing things which disturb it… dirt, drink, diet, damp, and drains.”2

“Appalled at the conditions she found among the wives of the soldiers she tended, i.e., respectable women, living in 3-4 rooms of the damp basement of a hospital, where a fever broke out. In this place the sick were attended and 22 babies born.” Ms. Nightingale: • Procured a house • Had it cleaned and furnished • Organized a plan to give employment to soldiers’ wives • Started a school for the children • Got a chaplain to visit the families and help them • Advocated in her writings that the wives and children not be forgotten when

planning for the soldiers3 Lillian Wald envisioned the Henry Street Settlement as an opportunity to “unite people through their human and spiritual interests.” As a result, the Settlement continually expanded to meet the needs of its community by supplementing the nursing activities with social programs that included: • Dramatic activities • Vocational training for boys and girls • Three kindergartens • Classes in carpentry, sewing, art, diction, music, and dance • Clubs for boys, girls, men, young women, and mothers • A drama club with its own theater • Summer camps for children at a Settlement-owned farm

1 American Holistic Nurses Association. 2 Florence Nightingale. 3 Whall. The Family as the Unit of Care. Public Health Nursing. Volume 3. December, 1986.

Revised 2007 6 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

• Two large scholarship funds • Study rooms staffed with people to help children with their homework • Playgrounds for children • A neighborhood library1

PROMOTES HEALTH THROUGH STRATEGIES DRIVEN BY EPIDEMIOLOGICAL EVIDENCE

Levels of prevention • Primary – promotes health and prevents problems before they occur • Secondary – detects and treats problems early • Tertiary – limits further negative effects from a problem Epidemiology • Describes the health status of populations • Explains the causes of diseases • Predicts the occurrence of disease • Controls the distribution of disease

COLLABORATES WITH COMMUNITY RESOURCES TO ACHIEVE THOSE

STRATEGIES, BUT CAN AND WILL WORK ALONE IF NECESSARY

Can and will work alone if others are unable or choose not to work on an issue • Protecting the health of the public is a fundamental responsibility of government • Core government functions of public health: Assessment, Policy Development &

Assurance

DERIVES ITS AUTHORITY FOR INDEPENDENT ACTION FROM THE NURSE PRACTICE ACT

• Legally established scope of practice • Broad authority for action • Professionally guided standards and expectations Cornerstones • Endure across time and place • Underlying meaning of our work • Provides guidance and direction for our practice

1 www.jwa.org/Jwa-1999/exhibit98/wald

Revised 2007 7 Minnesota Department of Health Adapted from Original by Center for Public Health Nursing, 2004

For additional information:

Sue Strohschein, MS, BSN, APRN, BC Office of Public Health Practice Minnesota Department of Health

PO Box 64975 St. Paul, MN 55164-0975

Phone: 320-223-7344 [email protected]