"…hospitals are increasing in size, care is becoming more technical. Yet there is growing understanding that recovery could be better in the patient’s own home, a policy that is also cost effective in an era of soaring health care costs." (1)
If you guessed the midpoint of last century you are right. Yet that observation could easily be applied to the health care situation today. ‘Old’ ideas have merit and value and it would be instructive to take a look at nursing history in the US to see where we are going tomorrow.
There can be no doubt that women nurses in the US have shaped health care as we know today, bringing important principles of equality and access to many Americans. There is growing realization that the sustainability of the present system will mean switching focus from treatment to prevention especially for chronic conditions. Yet this is not a new idea but was a principle pioneered by strong nurse voices in the last two centuries. The path they set has and will inspire nurses today and in the future.
As America became more industrialized in the late 1800s cities grew. The consequences of urbanization were not positive for everyone. Poverty, disease, and overcrowding increased.
The concept of public health was subsequently initiated by Lillian Wald in New York City. She believed that people could be healthy if they were given encouragement, education, and the right environment. She blazed the trail and founded the Visiting Nurse Service of New York in 1893. Her approach was comprehensive and she never stopped advocating to better the plight of the working poor. Not only that she championed successfully for public parks, school meals, and school nurses. She knew that if students weren't sick or hungry they would get the education to better themselves. In the first year after the school nurse concept was introduced the absentee rate decreased by over 90%.
The VNSNY was as its name said they went into the homes of patients and the clinic was located in the poor neighborhood where the patients lived. She started a service for Metropolitan Life Insurance and reduced the mortality rate of policyholders. Her careful records showed that survival rates of pneumonia through the visiting nurse service were far better when patients recovered in their homes as opposed to going to the hospital, a fact that confounded many in the medical establishment of the day. VNSNY became its own entity in the 1940s and in response to a lack of specialized services for mental health patients in the 1950s established a mental health branch.
As citizens migrated westward out of the overcrowded cities the communities they established had little or no access to medical services. Many were not accessible by road only horseback. It was this segment of the population that Frontier Nursing Services wanted to reach, especially expectant mothers.
FNS was founded by Mary Breckinridge. She was married at age 23 but her husband died 2 years later. At age 29 she graduated from St. Luke’s School of Nursing. She remarried and the couple had a son, then a daughter. The daughter only lived a few hours after birth. Tragically Mary lost her son a few years later from appendicitis.
She later worked as a nurse and received further training as a nurse midwife in Britain, touring other parts of the United Kingdom to observe their rural health services. Shortly after that she decided to establish the Kentucky Committee for Mothers and Babies in East Kentucky, eventually renamed the Frontier Nursing Service. This area had no doctors. Travel was by horse or mule. Mothers had no pre or post natal care and child mortality was high. She established public health for families with a series of clinics serviced by nurse midwives. One main accomplishment of the FNS was a significantly lower child mortality rate that the rest of the country. She strongly believed that caring for and educating the whole family would enable a child born into that family to thrive. Her own personal tragedy transformed lives for many mothers, babies and families.
Fast forward to 2010 and we can see that the proportion of nurses to current population has decreased significantly. Moreover, the strides made in innovations in public health are now taken for granted. Such vital improvements as clean drinking water, safer working places, and vaccines are hardly given a second thought even thought they have been the major contributors to increased life expectancy for decades. Yet presently, only 2.8% of national health funding goes to public health. Public health has no long term strategy and is on an ad hoc basis in reaction to crises such as the H1N1 epidemic.
Advocates of public health are making their ideas known. They have proposed an office of public health nursing with its own budget and authority to put into action public health nursing, public health training and education of people so they don’t become patients. If this were to occur then the federal government would be truly serious about prevention.
Many nurses are not waiting for government action. The following are examples of nurse led initiatives that are addressing public health.
Simply instructing a diabetic patient to follow a health plan would not ensure compliance. At 11th Street Health Services in Philadelphia a nurse managed health center, nurses ascertained that many of their diabetic patients had depression. In a proactive approach to behavioral health, they started yoga and meditation classes as well as a support group. They planted a community garden and started healthy cooking and exercise classes.
Other similar models of comprehensive preventative community nurse led programs have been helping the underinsured have better access to the services they need. Some examples are: the University of St Francis Health and Wellness Center, the first nurse managed clinic in Joliet, Illinois. St Francis’ mandate is to integrate mental health with physical treatment for the working poor. Staffed by APRNs, it was recognized by the Illinois Nurses Association for innovative cost effective health care delivery.
Harambee in Louisville, Kentucky is a partnership with the University of Louisville School of Nursing. It provides primary care and various programs associated with preventive health, for example parenting programs, self management of chronic conditions such as hypertension, vaccinations, and screenings, among other health services. The center encourages participation and representation from citizens in the community.
Public health funding is an investment that pays back many times over in improved quality of life for many Americans and if implemented nationwide through all stages of life would help people manage both their physical, mental, and behavior health. An example of this is the Nurse Family Partnership, a nurse home visiting program. The NFP has been shown to decrease poor school performance, child abuse or neglect, teen pregnancy and suicide attempts, domestic and drug abuse, and criminal behavior. A public health nurse program with a long term vision would also mean the nation would be well prepared for a pandemic or natural disaster.
Notes: (1) Celebrating Nurses C. Hallett 2010 Fils Rouge Press
http://www.rwjf.org/files/research/20090408chartingnursing9.pdf
http://www.frontiernursing.org/History/MaryBreckinridge.shtm
http://www.vnsny.org/about-us/history/
Nurse, Past, Present, and Future K. Trant, S. Usher Black Dog Publishing 2010
http://www.aannet.org/custom/edgeRunner/index.cfm?pageid+3303&showTitle=1
Article © 2010 My Nursing Uniforms.com / Young Lion Incorporated.
