Public Health Nursing Education for Primary Health Care

This article examines several issues relevant to the education of nurses for roles in primary health care. The basic premises of education for community-based public health practice are put forth. The World Health Organization's seven key principles for primary health care and their cur-ricular implications for various levels of nursing programs are discussed. Examples are given of nursing education programs in which aspects of primary health care are used; finally, the continuing education needs of nurses are explored.     

Public Health Nursing in Primary Care: Impact on Home Visits

A public health management data system was used by a country public health nursing administration to assess the impact of integrating primary care and public health nursing services on the allocation of nursing time to home visits. Two areas of the county were shown to be comparable in proxy indicators of need for these services. The t test of differences in means and calculation of confidence intervals were the methods of analysis. There was a significant decrease in the numbers of and time for home visits after integration of the two kinds of services. Using routinely collected personnel activity reports to indicate staff and client needs is discussed.     

Public Health Nursing Initiatives: Guideposts for Future Practice

Nursing's position in local health care has reportedly been undermined by role confusion and fragmented delivery of services. A review of public health nursing history uncovered a strong model for relevant practice, role expansion, and program definition. This research considered current practice in relation to the time-honored model developed by Lillian Wald. The study described public health nursing practice in 15 municipal and district health departments in Connecticut that have primary foci of health promotion and disease prevention. We found that wide diversity in program responsibility followed variable local health care delivery patterns and resulted in disparate breadth and depth of service components. However, there was general recognition of factors that affect service delivery, such as increased numbers of children attending day-care; growing populations of elderly, chronically ill, and handicapped persons; and the mainstreaming of special-education students. The educational level of nursing personnel was close to the national average. Characteristics of current practice were then correlated to those of the past. The essence of public health nursing remained strong, and the initiatives of the early pioneers were relevant guide-posts for strengthening contemporary practice and community leadership.     

Public Health Nursing and The Future of Public Health

The recent Institute of Medicine report, The Future of Public Health, reviews the history, current status, and potential of the public health system in the United States, and makes detailed recommendations for its revitalization. Although public reports such as this risk speedy obscurity, many are used by planners and legislators and a few exert significant influence. Public health nursing is inadequately represented in this potentially influential document, and this has unfortunate implications for public health nursing.     

Primary Health Care and Public Health: Foundations of Universal Health Systems

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable.Key Words: Health systems, Primary health care, Public health, Universality, Program integration, Social-ecological model, Professional education, Policy, Planning, Human resources     

The Dialogue Continues: The Future of Public Health Nursing

This editorial reflects upon the current discussion among nursing academics and educators about the division between individual level care and population health and its implications for the subdiscipline of public health nursing, from the perspective of a current practitioner in the field.     

Public Health Nurses' Primary Health Care Practice: Strategies for Fostering Citizen Participation

Citizen participation is heralded as a critical element of community health programs that emphasize empowerment and health promotion strategies. Although there is a growing body of research on public health nurses' primary health care practice, few studies have described how public health nurses foster citizen participation. This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation in an eastern Canadian province at a time of significant health care restructuring. The findings from this study clearly profile public health nurses as integral to the practice of fostering citizen participation.     

Public Health Nursing Costs in Home Care

This article discusses the measurement of costs, particularly the cost of public health nursing in the home health setting, and describes typical cost-accounting procedures. Alternatives are analyzed and four models for measuring costs are presented: per diem, acuity, hourly, and diagnoses. Since each model measures cost in a different way, selection of one over another will affect research results.     

Public Health Nurses' Vision of their Future Reflects Changing Paradigms

Health care over the past decade has undergone important changes that have implications for public health nursing. The focus of public health has expanded, as a result of the World Health Organization establishing the goal of "Health for All by the Year 2000," with its strategy of primary health care. To be active participants in this expansion, public health nurses must be more explicit about their current contributions to health care systems; develop nursing frameworks consistent with the systems' changing goals; and articulate their visions of the future. It is clear that the medical paradigm of health care services needs to change to one of primary health care. Based on results of a recent public health nursing research study, a conceptual framework for the future practice of public health nursing was developed .     

Elderly Clients'' Perceptions of Public Health Nursing Care

Although the health benefits of illness prevention and health promotion are accepted, little is known about the reasons for which elderly clients attend public health programs or the benefits they perceived from public health nursing care. This study reports the major reasons for which men and women age 60 and over sought care in a public health nursing program and the major benefits they perceived. The sample included 137 new and 360 returning clients. Responses to open-ended questions were content analyzed into categories of like statements, which in turn were placed into overall groups. The results suggest that most clients realized significant benefits from receiving public health care and were able to articulate these benefits. Eliciting client's perceptions can assist public health nurses to implement and market programs in a way that is acceptable and accessible to the recipients.     

Chattanooga Creek: Case Study of the Public Health Nursing Role in Environmental Health

Abstract Public health nurses have two primary roles in protecting their communities from hazardous substances: community assessment and health education. Developing assessment skills in environmental health enables public health nurses to collaborate with other federal, state, and county agencies in identifying public health hazards and making health-based recommendations at hazardous waste sites needing remedial or removal interventions. Community health education empowers communities to minimize their exposure to hazardous wastes in their environment. Methods for community environmental health assessment and interventions are demonstrated in this article by activities conducted at the Chattanooga Creek site in Chattanooga, Tennessee. A thorough assessment and collaborative approach between government agencies, local health professionals, and community members resulted in a successful community health education program and this site's placement on the National Priorities List.     

The UP College of Nursing Collaborating Center for Nursing Development in Primary Health Care

Officially designated as one of WHO's Collaborating Centers for Nursing Development (CCND), the UP College of Nursing in the Philippines will take on a leading role in achieving "health for all" through primary health care (PHC). The 1978 Declaration of Alma-Ata called for the goal of health for all by the year 2000, and recognized the key role of the nursing profession in this effort. In order to be designated a WHO collaborating center, an institution must be able to provide scientific and technical leadership at the national and international level, must be a stable institution, and must have the capacity to contribute to WHO programs. A WHO collaborating center forms part of an international network of institutions. Having become such a center, the UP College will form part of the Global Network for Nursing Development, organized in March 1987. The Global Network's functions include: 1) coordinating activities and promoting technical cooperation; 2) disseminating and exchanging informational; 3) monitoring trends in health services development and assessing their implications for nursing development; 4) supporting research; 5) gathering support and resources; and 6) promoting the goals of nursing development. As part of the Global Network, the UP College has developed a 4-year plan to fulfill the network's functions. During the June 1989 inauguration of the CCND, the Philippine Secretary of Health, Dr. Alfredo R. A. Bengzon, noted the country's lopsided ratio of health personnel per population, and issued a challenge to the UP College to lead the country in accelerating nursing development.     

Gerontologic Primary Care: A Community-Centered Experience for Nursing Students

The mismatch between the American health care system and the health care needs of our older adults is well documented (Butler, 1975; Schwab, 1977). All too often, available services are oriented to acute care, fragmented, poorly coordinated, and not readily accessible. Meeting the complex health care needs of our older adults is a major challenge to our ingenuity and resourcefulness, especially in light of the fact that American health care expenditures have reached 10 percent of our gross national product. This article tells of one approach to help alleviate this problem.     

A Public Health Nursing Model

Abstract Public health nurses are in a strategic position to maintain, promote, and protect the health of populations both now and in the future. In the changing health care environment of the 1990s, defining the expanding and evolving role of public health nursing assists in the effective utilization of public health nurses. During a time when the health care environment is emphasizing the protection and promotion of health, access to health services, and prevention of illness, it is necessary for public health nurses to be in the forefront in the changing focus to primary prevention. Therefore, a model for public health nursing is proposed to provide a framework for defining public health nursing roles and practice. A flowering tree is one symbol of public health nursing. The tree consists of seven parts symbolizing nine public health nursing concepts. This model is proposed to articulate clearly the capacity of public health nursing within today's ever-changing environment and to provide a framework for public health nursing theory, public health nursing practice, policy development, and public health research.