The History of Public Health and the Role of the Community/Public Health Nurse When considering the evolution of healthcare and the role of the nurse in the United States, many people might first consider this in the context of the hospital setting. While the history of acute care is an important area to consider, it is imperative that equal attention be given to the history of public health and the role played by the nurse in this segment of the healthcare continuum.
The purpose of this paper is to outline the history of the public health nurse and to specifically look at the role of nursing in home health and hospice. History of Public Health Nursing In the late 1800’s there was a large number of people living in poverty throughout the world, with New York City being no exception. Lillian Wald was a pioneer of the public health movement whose role as a public health nurse in New York City was born out of true necessity. Wald “believed that public health nurses must treat social and economic problems, not simply take care of sick people” (Fee & Bu, 2010, p.
1206). In the latter part of the 19th century, there was an increasing understanding about the science behind communicable disease and the importance of educating people regarding disease prevention to reduce the spread of illness (Stanhope & Lancaster, 2012). Settlement houses were one avenue used to reach the community in need and teach disease prevention strategies, along with helping this population gain access to social services often including childcare, public kitchens, public baths, and shelter for the homeless.
In 1893, two trained nurses in New York City, Lillian Wald and Mary Brewster, established the Henry Street Settlement. This led into the development of the Visiting Nurse Service of New York City (Stanhope & Lancaster, 2012). Wald’s work as a nurse in the public health realm continued and she “emerged as the established leader of public health nursing during its early decades” (Stanhope & Lancaster, 2012, p. 27). PUBLIC HEALTH AND ROLE OF THE COMMUNITY HEALTH NURSE 3 Historically, public health nurses have worked to improve the quality of life of vulnerable populations by striving to optimize health and social conditions.
The population targeted by this profession is still consistent with this premise in the 21st century. Public health nurses in this day and age still work with vulnerable groups, but also with the general public. In public health nursing today, “high-risk, vulnerable populations are often the focus of care and may include the frail elderly, homeless individuals, sedentary individuals, smokers, teen mothers, and those at risk for a specific disease” (Kulbok, Thatcher, Park, & Meszaros, 2012, para 3) Impact on Nursing Practice
The role of the community or public health nurse in regards to hospice care is the position to be elaborated upon for this assignment. Generally, in order for a patient to qualify for healthcare coverage for hospice care, they must have a life expectancy of six months or less. Traditionally, people have considered patients with cancer to be the primary recipients of hospice care, but most any terminal disease process should qualify for this in home end of life care if the patient’s needs can be adequately met.
There are also hospice care facilities where the patient is either transferred to a unit specified for this level of care, or a patient with a shorter life expectancy might be considered to be receiving hospice care on a regular unit while only palliative measures are being taken. For the purposes of this assignment, the focus is being kept on hospice in the home setting. Hospice care delivered in the community is either primary care or secondary care, depending on the specific situation.
The patient’s primary physician might refer the patient to the hospice care team who may then take over the primary care role. Another scenario is that a hospice team could be consulted to assist with care, yet the primary physician would remain responsible for the routine decisions about patient care (Weckmann, 2008). The primary care PUBLIC HEALTH AND ROLE OF THE COMMUNITY HEALTH NURSE 4 provider, be it hospice care physician or primary care physician, must strive diligently to communicate clearly with the patient and family about desires and expectations for end of life care.
There are may be ethical dilemmas that arise in the hospice setting that could be worked through more easily if the patient’s wishes are made clear. The decision to provide hydration and or nutrition parenterally or enterally when a patient cannot eat or drink for themselves can often pose a dilemma. At what point should this life prolonging sustenance be stopped? At what point is this ordinary humane care, and when does it become an extraordinary measure that prolongs life and therefore perpetuates discomfort.
The home hospice nurse can play a vital role in assuring that this issue is addressed as early and thoroughly as is feasible given the individual situation. It is important to gently encourage the patient and family to have these conversations before the patient is unable to communicate their wishes (Lamers, 2013). Summary The community health nurse in a hospice care practice setting plays a key role in helping a person fulfill their wishes and face impending death with as much dignity as possible.
The evolution of hospice care has enabled terminally ill individuals to feel some sense of control over their situation, which can help afford a sense of peace for the patient and help with the grieving process (Holdsworth & King, 2011). When a patient receives end of life hospice care, the team focuses on the patient’s quality of life and comfort level, not on curing or fixing the disease process. The home hospice nurse should work toward affirming the patient’s life and help them to view death as a natural life process. PUBLIC HEALTH AND ROLE OF THE COMMUNITY HEALTH NURSE