PRINCIPLES OF COMMUNITY/PUBLIC
populations may thrive.
6. Target All Who Might Benefit. A public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service.
7. Promote Optimum Allocation of Resources. Optimal use of available resources to ensure the best overall improvement in the health of the population is a key element of the practice.
8. Collaborate with Others in the Community. Collaboration with a variety of other professions, populations, organizations, and other stakeholder groups is the most effective way to promote and protect the health of the people.
Adapted from American Nurses Association. (2013). Public health nursing: Scope and standards of practice (2nd ed., pp. 8–9). Silver Spring, MD: Nursesbooks.org.
Principle 1: Focus on the Community
The first principle reminds us that the ultimate responsibility of public health nursing is to direct services to the population as a whole. Even though public health nurses may intervene to address individual, family, or group needs, the entire community is the client (Kulbok, Thatcher, Park, & Meszaros, 2012).
Principle 2: Give Priority to Community Needs
The second principle deals with the ethical obligation of the public health nurse to give priority to the needs and preferences of the whole community over those of one individual.
This means that the nurse must consider interventions that will lead to the greatest good for the most people (Rushton & Broome, 2015). For example, programs that make mammograms for early detection of breast cancer available to all women regardless of income level are given priority over those that provide bone marrow transplantation for women with advanced metastatic breast cancer.
Principle 3: Work in Partnership with the People
The third principle requires the public health nurse to work in partnership with the community. The nurse and the community members (or groups) each bring their own values, beliefs, and expertise to the partnership (Kulbok et al., 2012). Policy development and assurance are more likely to be accepted and applied if there is mutual consideration of and respect for these elements. Developed policies need to be communicated in language that reflects an understanding of the community. For these reasons, an essential part of establishing a partnership with a community is getting to know the members and groups within that community.
Principle 4: Focus on Primary Prevention
The fourth principle of public health nursing underscores the importance of primary prevention in promoting the health of people. Most fields of medicine, including acute care nursing, are primarily concerned with illness and with efforts to prevent complications from and reoccurrence of the illness. In contrast, public health nursing has an obligation to prevent health problems and to promote a higher level of wellness. Public health nurses take the initiative to seek out high-risk groups, potential health problems, and situations that contribute to health problems. They then institute preventive programs (Kulbok et al., 2012). For example, if community assessment revealed a large number of new mothers with postpartum depression, public health nurses would address secondary prevention by establishing mental health programs. Equally as important, they would attend to primary prevention by working to change the conditions in the community that increase the risk for postpartum depression.
Principle 5: Promote a Healthful Environment
The fifth principle recognizes the importance of ensuring that people live in conditions conducive to health. Therefore, it is aligned with Nightingale’s Environmental Theory of Health. People are less likely to be healthy if they live in a community with high unemployment, crowded housing, and dirty air or where it is difficult to obtain inexpensive, healthful food. They are also less likely to be healthy if the community’s norms include acceptance or even encouragement of activities such as smoking, binge drinking, drug use, or unsafe sex. To change these conditions requires commitment, perseverance, patience, resourcefulness, and a long-range view. Public health nurses, along with other public health professionals, understand the effects of social determinants of health and work to improve them (Braveman & Gottlieb, 2014).
Principle 6: Target All Who Might Benefit
The sixth principle involves outreach strategies to meet the obligation to serve all people who might benefit from an intervention. This tenet requires that the nurse examine policies or programs to determine whether they are accessible and acceptable to the entire population in need and advocate for change if necessary (Maryland & Gonzalez, 2012).
Public health nurses can advocate for clients on many levels. For instance, for those clients who have limited economic resources and need regular medications to maintain normal blood pressure and other common health problems, PHNs can recommend a program available through Walmart stores that offers 30-day supplies of medications for as low as $4.00 (Maryland & Gonzalez, 2012). They can also work with local, state, and national legislators to promote health and necessary services for vulnerable populations.
The questions in Display 14–4 can help the nurse evaluate a planned program’s success in reaching people who might benefit. These questions should guide the design, implementation, and evaluation of outreach strategies.