By Maryjoan D. Ladden, PhD, RN, FAAN

For more than a century, nurses have gone beyond the walls of clinics and hospitals to visit crowded tenements, rural homesteads, schools, and factories in order to improve the health of their communities. In fact, nurses were among those who pioneered the practice of working to improve the conditions that lead to illness or injury, and providing care in underserved communities. That tradition continues today, as nurses reach out to people in need, visiting them in their homes, public libraries, barbershops, beauty salons, and elsewhere.

The latest issue of the Charting Nursing’s Future policy brief series, from the Robert Wood Johnson Foundation (RWJF), focuses on the many roles nurses play in building a Culture of Health in a wide variety of settings.

From 1893 New York City to Present-Day Camden

How Nurses Are Building a Culture of Health (Part 1): Reaching Beyond Traditional Care Settings to Promote Health Where People Live, Learn, and Play,” traces nurses’ role in “cultivating the health of individuals by changing the culture of a community” to 1893, when Lillian Wald began the Henry Street Settlement on New York’s Lower East Side after seeing first-hand the negative health effects of living in poverty.

The policy brief also cites a series of present-day examples, including nurses’ groundbreaking “hotspotting” work through the Camden Coalition of Healthcare Providers to identify “super-utilizers” of emergency departments, and to link them to primary care and other supports, including health insurance. Such efforts hold the promise of better and more timely care, particularly with regard to management of chronic conditions and more efficient use of resources.

Other nurse-driven programs highlighted in the brief include:

  • A nurse home-visiting program in Durham, N.C., has resulted in reduced maternal anxiety, healthier home environments, more positive parenting, and 50 percent fewer emergency room visits and overnight hospital stays for infants during their first year of life. Durham Connects offers free visits by registered nurses to parents of newborn children. Nurses check the overall health of both mothers and infants, offer assistance with breastfeeding and infant care, and provide guidance in finding such community resources as parenting classes, high-quality child care, and financial assistance. Nurses are also able to address issues such as postpartum depression, family violence, and substance abuse.
  • A number of local chapters of the National Association of Hispanic Nurses (NAHN) are working to help Hispanics gain health insurance—a gateway to better health for a community suffering from disproportionately high rates of obesity, diabetes, uncontrolled high blood pressure, and dental disease. NAHN recently trained nurses from 70 local chapters in eight states to provide education about health insurance, free preventive services, and obtaining coverage through the Affordable Care Act. In some instances, NAHN nurses provide such guidance while conducting free blood pressure screenings and body mass index assessments in churches, schools, and senior centers. Families are referred to enrollment counselors who can guide them through the process of qualifying for Medicaid or buying insurance on state marketplaces. “People trust nurses,” says Adriana Perez, PhD, ANP-BC, president of the Phoenix NAHN chapter. “We present them with the facts. We don’t say, ‘You should do this’ but rather, ‘Here are things we know can help you and your family stay healthy.’”

The new Charting Nursing’s Future brief also notes the important roles nurse leaders play in building a Culture of Health by serving at local and county public health departments across the nation. Nearly one-third of these departments are nurse-led.

Similarly, school nurses help make schools an efficient setting for prevention and health promotion, playing a pivotal role in creating healthy school environments and bridging the gaps between education, health care, and public health. In communities and health care settings across the United States, nurses play a key role building a national Culture of Health, helping individuals, families, and communities lead healthier lives now and in the future.

Read the brief, “How Nurses Are Building a Culture of Health (Part 1): Reaching Beyond Traditional Care Settings to Promote Health Where People Live, Learn, and Play,” and sign up to receive future editions of Charting Nursing’s Future.

The author is a senior program officer at the Robert Wood Johnson Foundation, and executive editor of the Charting Nursing’s Future series.

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