Category Archives: Public health
Pamela A. Kulbok, DNSc, RN, PHCNS-BC, FAAN, is a Robert Wood Johnson Foundation Executive Nurse Fellow. She is the Theresa A. Thomas Professor of Nursing and a professor of public health sciences at the University of Virginia, chair of the Department of Family, Community, and Mental Health Systems, and coordinator of the public health nursing leadership track of the master’s in nursing program.
With the recent release of second edition of the Public Health Nursing: Scope and Standards of Practice (American Nurses Association, 2013), now is a perfect time to reflect on the past and look toward the future of public health nursing (PHN). Public health nurses have always focused on improving the health of populations through health promotion and disease prevention. Since the establishment of visiting nursing in Boston and the Henry Street Settlement in New York City in the late 1800s, public health nurses have worked with families and communities in schools and homes, with immigrant populations in industrialized cities, and with rural communities to address challenging social conditions and to promote the health of the public.
It was evident with the founding of the National Organization of Public Health Nurses in 1912 that “something must be done” to prepare nurses with a broader education and emphasis on social conditions and prevention. Today, more than ever before, when health care in the United States is shifting its emphasis from an illness care system to one focused on health promotion and prevention, we need public health nurse generalists and advance practice public health nurses prepared to lead health care reform.
Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.
With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.
Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.
It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.
Marni Storey, BSN, MS, is interim director of Clark County Public Health in Vancouver, Washington, chair-elect of the Washington State Association of Local Public Health Officials, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2013-2016).
I am often asked if I recommend public health nursing as a career option. My enthusiastic answer is ABSOLUTELY! I have been a public health nurse for more than 25 years and am one of a very few Americans who wakes up every day believing I have the best job in the world. There are many reasons I enjoy this profession, but three important pillars of public health nursing have kept me engaged for more than 25 years, and will keep me enthusiastic for many years to come.
The first pillar is that public health nursing services—including nursing assessment, intervention, and evaluation—are focused on a population, not on individuals. Whether you are interested in women, children, ethnic or cultural groups, or if you are interested in conditions such as HIV/AIDS, communicable diseases or obesity, the strategies used by public health nurses affect entire communities. While challenging, this population focus is also rewarding because, as a public health nurse, you are developing an understanding of an entire group of people or community in order to effectively carry out your nursing duties. This is very different from the individual relationships you develop in other nursing fields. Also rewarding is the chance to witness community transformation as a result of the collective impact of communities working together.
Cassandra Standifer, BSN, PHN-NFP, is a public health nurse working in the Nurse Family Partnership program in Renton.
When I think about public health, I don’t think only of my nursing practice. I think about where I came from and how I got here. When I sit with my clients I can see in their situations my own mother, my aunt, my cousins and myself.
I work with first-time teen moms in a program called the Nurse Family Partnership. Today I met my client, Sarah*, at her transitional housing. As I sat outside waiting for her, I thought back to 1990 when I was seven years old and living with my mother and sister in transitional housing. My mother was addicted to cocaine and attempting recovery—again. Transitional housing was an improvement from the hotel we had been living in, but I was well aware, even then, that there had to be something better out there than this halfway house.
During our home visit we chatted about Sarah’s daughter. She exclaimed, “She has eight teeth on the bottom and eight teeth on the top, no cavities!”
Anneleen Severynen, RN, MN, PHN, is a public health nurse working on the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State.
I work as a public health nurse on King County’s mobile medical unit, traveling south of Seattle in a van, providing for the health care needs of homeless individuals. I perform many “nursing” tasks in my job – taking blood pressures, getting health histories, dressing wounds. But my most important nursing skill is my ability to listen.
This morning I met Charlie. Charlie is a 60-year-old Native American man who reported that he began drinking at age 12, while being passed around to various foster families.
At 17, he went to Vietnam to get away from abuse and neglect, only to be traumatized further by the war.
He called himself a “lost cause” and said he would probably never stop drinking, and knows that he “will die soon.” As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.
Lisa Campbell, DNP, RN, APHN-BC, is an associate professor at Texas Tech University Health Sciences Center, and director of Population Health Consultants, LLC in Victoria, Texas—a company that works to build human capital to improve population health. She serves as newsletter co-editor for the American Public Health Association, Public Health Nursing Section.
With 36 percent of the public health nursing workforce reporting age 56 or older, according to the new report from the Robert Wood Johnson Foundation, strategic planning by state and local health departments must include creative strategies to recruit. In order to increase the numbers of nurses in public health, hiring practices will require a paradigm shift. Public health nurses new to the field bring a unique perspective that will assist in bridging the gap between public and private partnerships. Furthermore, public health is charged with adaptive practice innovations to implement programs outlined in the Affordable Care Act. To illustrate this point, I would like to share my public health nursing journey.
I decided to become a public health nurse after being a nurse practitioner for more than 25 years. When I embarked on this journey, I had no idea where it would take me.
Laura Anderko, an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows (ENF) program (2005-2008), received a prestigious honor from the White House last week for her work to protect health in a changing climate.
The Robert and Kathleen Scanlon Endowed Chair in Values Based Health Care at the School of Nursing & Health Studies at Georgetown University, Anderko was named a “Champion of Change” by the White House. On July 9, she and 10 other “champions” who work at the intersection of the climate and public health attended an event with top government officials to discuss their work.
Anderko, PhD, RN, said in an interview that she was “honored, thrilled, and surprised” to receive the recognition and added that the honor will help raise awareness of the health implications of climate change. My hope, she said, is that this award helps this issue gain “more prominence in the minds of society, not just in America, but globally.”
The ENF program had a “huge impact” on my career, she added. It allowed me to “really immerse myself in environmental health” and taught me to “think big and consider unusual and unlikely partners”—a theme she addressed during the July 9 event at the White House.
“Champions of Change” are recognized by the White House for their work in a wide range of fields. The program was created as an opportunity for the administration to recognize American individuals, businesses and organizations that are “doing extraordinary things to empower and inspire members of their communities.”
“Laura Anderko is making strong efforts to change her community’s ways on treating the environment and is leading the way on climate and health,” a White House release stated.
Learn more about Champions of Change here.
Six libraries in downtown Tucson, Arizona, have some unexpected new employees: public health nurses. In what many believe to be a first-of-its-kind program, Pima County libraries teamed up with the county Health Department to start a jointly-funded “library nurse program.”
Libraries across the country often serve patrons living without shelter, health insurance, medical care or computer access, the Arizona Daily Star reports. As the need for health care and social services has grown in recent years due to a faltering economy and high unemployment, leaders in Pima County were inspired to provide more than just books to their patrons.
Now, five Pima County public health nurses divide the equivalent of one full-time public health nurse position among themselves, working weekdays at six local libraries. The nurses wear stethoscopes so they can be easily identified, but mostly provide health education and referrals to other health care resources in the area rather than actual medical care.
In addition to helping patrons get the health information they need, the program has also reduced the number of 911 calls from the libraries, “partly because nurses trained library staff to recognize when behavioral issues are escalating and to intervene appropriately,” Nurse.com reports.
“If I weren’t here, I think a lot of these individuals would fall through the cracks,” Daniel Lopez, one of the “library nurses” told Nurse.com. “I can open doors for them and they can walk on through. Overall, I think it makes for a healthier Pima County.”
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the final of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Addressing Social Determinants of Health: Given the current state of the clinical delivery system, it may seem unrealistically burdensome to ask health care institutions to address the social determinants of health (SDH). “In this country it’s an accomplishment if you can reward value for delivery,” noted Arnold Milstein, MD, MPH, “and social determinants approaches are a step or two beyond that.”
Examples of clinical engagement in social determinants, however, can be quite impactful:
· Lloyd Michener, MD, and Bob Lawrence, MD, described how Duke and Johns Hopkins both invested in SDH initially in order to repair or promote their public image. For example, Duke invested in some SDH programs and community partnerships in part to help repair their image in the setting of poor relationships with a minority, low-income community in Durham—though these investments have grown into more lasting partnerships.
· David Stevens, MD, pointed out the example of the 16th St Community Health Center in Milwaukee, where an environmental wing of the health center was created to combat lead poisoning—and then expanded over years into broader projects, such as combatting brownfields and creating green spaces for exercise.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the fourth of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
The Role of Primary Care and Clinical Incentives: Most discussants agreed that primary care and the patient-centered medical home (PCMH) movement are important foundations upon which to build broad-based population health activities. While acknowledging that these systems are already over-burdened with clinical responsibilities—and that current incentive structures are poorly aligned to accomplish this goal—many cited the degree of overlap in the missions of primary care and public health institutions as a starting point.
Community Care of North Carolina (CCNC), for example, evolved slowly and steadily over 25 years from a clinical quality network to a statewide multi-sectoral public-private partnership based on the PCMH. Allen Dobson, MD, described the key components as: the formation of cooperative provider networks; introduction of population management tools; case management; and data infrastructure with rapid feedback to providers. “Community Care is bottom-up and physician-led with respect to quality improvement…but because the collaboration includes the public health department, we are also looking at population metrics regardless of whether or not we’re managing that population.” Financing is organized using flexible per-member-per-month allotments that allow networks to put resources into quality measurement. Dobson cited external evaluations demonstrating that the overall project is cost-saving, with CCNC responsible for nearly $1.5 billion in lower costs from 2007-09.