Community-oriented primary care: A model for public health nursing

The American Public Health Association defines public health nursing as the "practice of promoting and protecting the health of populations using know ledge from nursing, social, and public health sciences." In 1993, celebrati ng the centennial anniversary of its founding, nurse leaders recognized sys temic changes have required nurses to function in clinical, illness-oriente d roles rather than in their more traditional community and public health r oles. With nurses' public health skills atrophying, these leaders urged mem bers of the profession to eschew specialization and return to their general ist roots founded on the principles of community-based prevention and healt h promotion. Soon the Public Health Functions Project, designed in part to identify skills and curriculum needs of an array of practicing public healt h workers, examined the public health nursing profession. Its recommendatio ns seek to ensure that public health nurses are trained to respond to curre nt challenges that face public health. In this essay, we describe how a fel lowship program that predated this national project by almost a decade anti cipated the recommendations for shaping public health nursing by enrolling midcareer nurses in a program that taught the principles and practice of co mmunity-oriented primary care. Such principles represent a merger of clinic al care with population health sciences; its more recent expressions teach clinicians to work as partners with communities to identify and address hea lth problems. In reporting on this program, we show how nurses in practice can embrace their generalist roots, melt current challenges, and play a lea d role in realizing the nation's goals for the year 2010. These aims incorp orate recent recommendations for preparing public health nurses for change in the health care system.