Health Promotion and disease prevention is a familiar nursing refrain. In the early part of the twentieth century, prior to any identified nursing theoretical frameworks, Virginia Henderson wrote her definition of nursing:
the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or 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. (Virginia Avernal Henderson, 2010).
Known as the First Lady of Nursing, Henderson identified for us the key concepts of health promotion and disease prevention: assistance, individuality, promotion of independence and individuality and a lifespan approach which is alluded to when mentioning sick or well and death. This definition is a classic and one often referenced and ingrained into all nursing programs and skills perfected. How do we, in our roles as nurses, protect the health of our patients and clients? The evidence is out there and the articles on this topic are very comprehensive in scope, practice settings, roles, models and population groups as we consider evolving and emerging nursing roles for the new millennium.
In the article “Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention,’ Kulbok, Thatcher, Park, and Meszaros focus on the unique knowledge needed by those nurses working in the community, public health specifically, and the partnerships needed to effect care and treatment. The authors take the reader through the historical perspective of public health/community care from sanitation and an infection control perspective toward challenging resources for the poor and underserved and now to its continued emphasis on participatory partnerships (the Community Participatory Research Team) for effective intervention. The ethnographic model presented was utilized with adolescents and is ideal for replication in urban and rural settings.
Esperat and colleagues in their article, “Transformacion Para Salud: A Patient Navigation Model for Chronic Disease Self-Management,” provide a chronic illness patient navigation model that is encapsulated into a transformation for a health conceptual framework. This model is designed for behavior change and its concepts speak to a direct relationship of patient and provider. This is not new to nurses. The article example illustrates use of community health workers as the patient navigators and addresses the need for keeping patients and clients at home. Resonating is the need for cost effective care that will keep the chronically ill at home and an integral member of the community. Patient navigation, originally conceptualized in oncology, is an emerging role in the wider health care field, and one that can encompass multiple levels of providers.
Anderson, Hilare, and Flinter, in their article, “Primary Care Nursing Role and Care Coordination: An Observational Study of Nursing Work in a Community Health Center,” further redefine community care through a redesign of the primary care system and emphasis on the Patient Centered Medical Home (PCMH) concept that we have heard so much about in the recent literature. A survey analysis of nurses (LPNs and RNs) working in community centers indicated skills, communication with patients, and patient visits often comprised the major emphasis of their role to provide daily care. However, the role of care coordination is imperative in development of a patient centered home, and these authors found nursing time devoted specifically to this role to be a challenge. This concept can be incorporated into multiple work settings and similar to what was previously discussed, by Kulbok and Esperat, will impact health care reform. The concept of PCMH needs to be further refined with advanced practice nurses in the multiple settings where they practice.
Meleis’ mid-range transition theory provides the framework for the work of Rose and Lopez, discussed in the article, “Transitions in Dementia Care: Theoretical Support for Nursing Roles.” They explored the transitions in care concept, a passage between two relatively stable periods of time, with older patients diagnosed with dementia. Caregivers figure prominently in this trajectory of care and nurses play a significant role in each transitory phase. The authors stress the importance of early diagnosis to ease disease progression, managing behaviors and symptoms, as well as open communication with family during these varied transitions from home to nursing home and eventually hospice. Advanced planning and education are needed and bring us back to Henderson’s definition that mentions assisting the individual, sick or well.One may ask: what do transitions in care have to do with health promotion and disease prevention? Medical breakthroughs in the care and treatment of dementia indicate a preventive focus as well as addressing the multiple risk factors that can cause dementia. Transitions in care play a large role in prevention of caregiver burden and its ramifications for family members.
Wilson, Whitaker, and Whitford, in the article, “Rising to the Challenge of Health Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives,” challenge us to look at the entrepreneurial and intrapreneurial roles of nurses in the health care reform era that we currently live in. It is here to stay. These roles vary as per employment and practice setting, however have many similarities that exist with innovation tying them together. Innovation in providing affordable health care, access to health care, collaborative practice settings, and expanding ‘out of the box’ thinking to global partners. Nurses are the ‘leaders of the pack’ in designing innovation in patient care. This is another call to address innovation. I personally address innovation from a grant writing perspective where I can project my vision and then sustain it with a business plan once funded. My dreams and yours are limitless, and we should develop the partnerships that will further these dreams. If I can do it, so can you. This is what Wilson and her colleagues are encouraging us to do.
Lastly, Whelan brings the idea of nursing entrepreneurship full circle as she reflects on the private duty registry system and the legacy it leaves for emerging nursing roles of today in her article, “When the Business of Nursing was the Nursing Business: The Private Duty Registry System, 1900-1940.” When I was in nurses’ ‘training’ there were many private duty nurses caring for individual patients. Families paid them and when we were on the units/floors we did not have much to do with them nor with the patient they cared for. They were esteemed and seen as experts in care. Whelan states: “private duty nurses are compelling examples of early nurse entrepreneurs”. Private duty nursing was an independent practice. Will they return, or have they returned, within multiple evolving and emerging roles and settings?
Health promotion and disease prevention should exist at every level of the health care system. Healthy People 2020 (U.S. Department of Health and Human Services, 2012) has four major goals:
- attain high quality, longer lives free of preventable disease, disability; injury, and pre-mature death;
- achieve health equity, eliminate disparities and improve the health of all groups;
- create social and physical environments that promote good health for all;
- promote quality of life, healthy development, and healthy behaviors across life stages.
These goals must be our guide into the future of health care, and today’s evolving and emerging nursing roles of the new millennium will pave the way for the next century of nursing care.
The journal editors invite you to share your response to this OJIN topic addressing Evolving and Emerging Nursing Roles either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.
Virginia Burggraf, DNS, RN, C, FAAN
© 2012 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2012
U.S. Department of Health and Human Services. (2012). Healthy People.gov. About healthy people. Retrieved from www.healthypeople.gov/2020/default.aspx
Nurses.info (2010). Virginia Avernal Henderson. Retrieved from www.nurses.info/nursing_theory_person_henderson_virginia_.htm