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Letter to the Editor

Cornerstone Documents and Milestones: The Changing Landscape of Public Health Nursing 1950 - 2015

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Pamela A. Kulbok, DNSc, RN, APHN-BC, FAAN
Joan Kub, PhD, RN, PHCNS-BC, FAAN
Doris F. Glick, PhD, RN

Abstract

Part Three of this series on public health nursing (PHN) history chronicles evolving definitions from 1950 to 2015 and reflects the changing landscape of practice. In the mid-20th century, PHN shifted toward “community health” by emphasizing connection with individuals and families in the community; collaboration with agencies and professionals; and focus on health teaching. Since 1950 there were many shifts, and we begin by discussing nursing practice in the community from 1950 to 1975. We follow this by considering practice and synthesis of nursing in public health from 1975 to 2000, and then concepts such as health promotion, disease prevention, population health and PHN workforce from 2000 to 2015. Growing interest in public health, in the throes of uncertain healthcare reforms, provides an imperative for reclaiming public health roles to promote and protect the health of populations; to join with public and private partners; to utilize public health competencies and science; and to co-create a base of influence and power for social change and progress.

Citation: Kulbok, P.A., Kub, J., Glick, D.F., (April 18, 2017) "Cornerstone Documents and Milestones: The Changing Landscape of Public Health Nursing 1950-2015" OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 2.

DOI: 10.3912/OJIN.Vol22No02PPT57

This article chronicles the evolution of definitions of the public health nursing (PHN) specialty from 1950 through to 2015 and reflects the changing landscape and influences on practice. As reported in the first of this series on cornerstone documents, milestones, and policies affecting PHN from 1890 to 1950 (Kub, Kulbok, & Glick, 2015), a National Organization of Public Health Nursing (NOPHN) position statement in 1949 described the responsibilities of public health nurses, emphasizing a connection with individuals and families in the community, collaboration with other agencies and professionals, and a focus on health teaching. This was viewed as a shift toward “community health” with increasing autonomy and accountability for nursing care and health guidance (Abrams, 2004).

...currently there is confusion about the term population health... As noted in the second article in the series (Kulbok, Kub, & Glick, 2017), during the mid-twentieth century the term community health nursing (CHN) became popular. However, it was often used interchangeably with public health nursing. This use of the terms PHN and CHN led to confusion within and outside of the specialty which remains today. In addition, currently there is confusion about the term population health, which has always been a focus of PHN and is gaining emphasis within and outside of nursing with the passage of the Patient Protection Affordable Care Act (ACA) (2010).

Nursing Practice in the Community: 1950 to 1975

In 1967, the ANA Division of Practice approved a definition of CHN practice as a,…field of nursing practice for which there exists a body of knowledge and related skills which is applied in meeting the health needs of communities and of individuals and families in their normal environments such as the home, the school, the place of work. (Cited in Freeman, 1970, p. 35).

Freeman, in her classic text, Community Health Nursing Practice (1970), proposed a model of areas of responsibility, process, and interaction in CHN. Responsibilities included therapeutic nursing care, health education and counseling; public health protection, disease investigation, and environmental control; and health-related community and family development. Processes entailed relationship building, assessing, goal setting, implementing, and evaluating. Areas of interactions were with communities as a whole, with special populations, and with individuals and families. While the area of practice was viewed as outside the hospital, in the community, the practice focus was on individuals, families, aggregates, and communities. Table 1 lists landmark documents and events throughout the past 50 years.

Table 1: Landmark Documents and Events

1967

Document – American Nurses Association (ANA), Division of Practice, Definition of Community Health Nursing (CHN) Practice

1974

Document - ANA, Congress for Nursing Practice, Standards of Community Health Nursing (CHN) Practice.

1975

Document - ANA, Congress for Nursing Practice, Concepts of CHN.

1980

Document – ANA, Division on Community Health Nursing Practice, A Conceptual Model of Community Health Nursing.

1980

Document – American Public Health Association (APHA), Public Health Nursing (PHN) Section, The Definition and Role of PHN in the Delivery of Health Care.

Early 1980s

Event – Quad Council of PHN Organizations (currently Quad Council Coalition) was founded.

1984

Event - Consensus Conference on the Essentials of Public Health Nursing Practice and Education: Report of the Conference, September 5-7, 1984.

1986

Document – ANA, Council of Community Health Nurses, Standards of Community Health Nursing Practice.

1988

Document – Institute of Medicine (IOM), The Future of Public Health.

1995

Document – IOM, Nursing and the Environment: Strengthening the Relationship to Improve the Public’s Health.

1996

Document - APHA, PHN Section, Definition of Public Health Nursing.

1996

Document – American Association of Colleges of Nursing (AACN), Essentials of Master’s Education for Advanced Practice Nursing.

1997

Document - Quad Council of PHN Organizations, The Tenets of Public Health Nursing.

1999

Document – Quad Council of PHN Organizations (currently Quad Council Coalition) and ANA, Scope and Standards of Public Health Nursing Practice.

2000

Document - Association of State and Territorial Directors of Nursing (ASTDN) (currently the Association of Public Health Nurses [APHN]), Public Health Nursing: A Partner for Healthy Populations.

2004

Document - Quad Council of PHN Organizations (currently Quad Council Coalition), PHN Competencies.

2006

Event - AACN Development and promotion of clinical doctoral degree in nursing (Doctor of Nursing Practice [DNP]).

2007

Document – ANA, Public Health Nursing: Scope and Standards of Practice.

2008

Document – Advanced Practice Registered Nurse (APRN) Consensus Model.

2010

Document – IOM,

2011

Document – AACN, Essentials of Master’s Education in Nursing (revised).

2012

Document—Quad Council, Strategic Priority Brief on Advanced PHN Education.

2012

Document - Quad Council, Strategic Priority Briefs on the PHN Infrastructure.

2013

Document – APHA, PHN Section, Revised Definition of Public Health Nursing.

2013

Document – ANA, Public Health Nursing: Scope and Standards of Practice, 2nd edition.

2013

Event – Quad Council Invitational Forum on the Future of PHN.

 
Practice as Synthesis of Nursing and Public Health: 1975 to 2000

The American Nurses Association (ANA) published the first Standards of Community Health Nursing Practice in 1974 and Concepts of Community Health Nursing in 1975. By 1980, the ANA Congress for Nursing Practice Conceptual Model Task Force, proposed a definition of CHN reflecting these earlier works, but also looking forward. This definition was the basis for documents related to CHN in the 1970s and 1980s, including the Standards of Community Health Nursing Practice (ANA, 1986):

CHN is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. The practice is general and comprehensive. It is not limited to a particular age group or diagnosis, and is continuing, not episodic. The dominant responsibility is to the population as a whole; nursing directed to individuals, families, or groups contributes to the health of the total population. Health promotion, health maintenance, health education, and management, coordination, and continuity of care are utilized in a holistic approach to the management of the healthcare of individuals, families, and groups in a community (ANA, 1980, p. 2).

In 1980, an Ad Hoc Committee of the Public Health Nursing Section of APHA also developed a document responding to member concerns about the need to reconcile many definitions related to PHN. They developed a position statement that, “…clarifies the definition and role of PHN in the delivery of health care” (1980, p. 1). The PHN Section Ad Hoc Committee proposed the following definition:

PHN synthesizes the body of knowledge from the public health sciences and professional nursing theories for the purpose of improving the health of the entire community. The goal lies at the heart of primary prevention and health promotion and is the foundation for PHN practice. To accomplish this goal public health nurses work with groups, families, and individuals as well as in multidisciplinary teams and programs. Identifying subgroups (aggregates) within the population which are at high risk of illness, disability or premature death and directing resources toward these groups is the most effective approach for accomplishing the goal of PHN. Success in reducing the risks and improving the health of the community depends on the involvement of consumers, especially groups experiencing health risks, and others in the community, in health are limited, planning, and in self-help activities (p. 4).

There were both commonalities and differences between the ANA definition of CHN and the APHA, PHN Section definition of PHN. Both definitions reflected PHN as a synthesis of the practice (or knowledge) of nursing and public health “…applied to promoting and preserving the health of populations” (ANA, 1980, p. 2), “…for the purpose of improving the health of the entire community” (APHA, PHN Section, 1980, p. 4). The documents differed in focus, with the CHN definition describing nursing care “…directed to individuals, families, and groups” (ANA, 1980, p. 2) that contributed to health of the whole population; while in the PHN definition, care was directed to the total community or population including high risk subgroups, as well as groups, families and individuals in the community (APHA, PHN Section, p. 4).

Despite the attempt to reconcile definitions, agreement regarding terminology was not achieved... Despite the attempt to reconcile definitions, agreement regarding terminology was not achieved and the term CHN continued to be widely used. Several textbooks used this title (Archer & Fleshman, 1975; Freeman, 1970; Spradley, 1975; Tinkham & Voorhies, 1972) and many graduate programs in CHN were established across the country. One rationale for widespread use of the term CHN was that some nurses viewed CHN as broader and PHN as more restrictive (Abrams, 2004). To add confusion, as nursing was becoming more specialized, the term community health nurse was often adopted to refer to nurses who provided care for patients in a community (non-institution) setting, (e.g., maternal-child health, psychiatric-mental health or medical-surgical nursing). These community health nurses did not have specialized education in the care of communities or populations. In 1984, the United States Department of Health and Human Services (U.S. DHHS), Division of Nursing, sponsored a Consensus Conference of the Essentials of Public Health Nursing Practice and Education to clarify education requirements for the basic and graduate public health nurse and to differentiate between nursing “in the community” and nursing “of the community” (1985).

...CHN and PHN were (and still are) often used interchangeably. According to the Consensus Conference report (1985), the basic public health nurse was a baccalaureate graduate, who was prepared to, but may or may not, practice in an official agency; the specialist public health nurse was prepared at the graduate-level to assess and intervene with aggregates and populations. There was consensus that “community health nurses” were those nurses who practiced in the community, i.e., in homes, schools, or clinic settings, whether or not they were prepared in PHN. Unfortunately, as was the case in the early years of PHN with the terms visiting nurse, district nurse, or public health nurse, this distinction was blurred and CHN and PHN were (and still are) often used interchangeably.

Since the 1985 report, there has been a concerted effort by PHN leaders to encourage use of the term public health nursing, which encompasses both health of populations and a focus on the whole community. The gradual transition from CHN to PHN is apparent in the titles of specialty textbooks from the 1980s to 2000s. For example, Stanhope and Lancaster first published Community Health Nursing: Process and Practice of Promoting Health in 1984. They retained this title through the 4th edition (1996). The 5th and 6th editions (2000 and 2004) were titled Community and Public Health Nursing. The 7th, 8th, and 9th editions (2008, 2012, and 2016) were titled Public Health Nursing: Population-Centered Health Care in the Community. The transition was also evident in titling of the standards of practice by ANA, which changed from community health nursing in 1973 and 1986, to public health nursing in 1999 and beyond.

While revisions of definitions of CHN or PHN were not proposed in the late 1980s or early 1990s, there was discourse about the nature of public/community health nursing (P/CHN) practice; in particular, the definition of patient or client as the focus of care (Anderson, McFarlane, & Helton, 1986; Goeppinger, 1982; Rodgers, 1984; Schultz, 1987). In 1984, Goeppinger clarified the definition “community as client” and delineated a process for nursing practice with the community client. She stated “…the community is considered the client … when nursing practice, regardless of setting or unit of practice, is community oriented” (p.380). In community-oriented care, the nurse seeks healthy outcomes for the community, and focuses on the collective good, not on individual health.

Since the 1985 report, there has been a concerted effort by PHN leaders to encourage use of the term public health nursing, which encompasses both health of populations and a focus on the whole community. During the 1980s, PHN scholars analyzed the concept of community as client. Rodgers (1984) proposed the “community as client” as a multivariate model for analysis of health risks of a community or an aggregate. Anderson and colleagues (1986) described a “community-as-client” model for PHN practice. This article was the forerunner to six editions of a textbook by Anderson and McFarlane initially titled Community As Client: Application of the Nursing Process (1988) and later titled Community as Partner: Theory and Practice in Nursing (1995 to 2012). Schultz (1987) linked emerging literature on the client in P/CHN practice with the contemporary paradigm of person, environment, health and nursing. Schultz analyzed whether the use of the term aggregate was consistent with the nursing concept of client or person. Schultz proposed, “…when the ‘more than one’ client is defined as a community, the plurality of persons who comprise the unit can be characterized in terms of the geopolitical locale they have in common or in terms of their common ties or affinity” (Schultz, 1987, p. 82). Schultz suggested that the term client referred “…to both pluralities of persons and interactional units, such as families, groups, organizations, and communities” (p. 81). Schultz’ analysis reinforced views of Goeppinger (1984) and Anderson and others (1986) who described community in terms of three basic dimensions: people, place, and function.

Notably, the 1996 definition and role of PHN was one of the first PHN documents to cite landmark public policy documents, which addressed health needs of people in the United States and the role of public health. The PHN Section simplified the definition of PHN in 1996: “PHN is the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences” (APHA, PHN Section, p1). This definition was subsequently cited in the Quad Council and ANA Scope and Standards of Public Health Nursing Practice (1999), and the ANA Public Health Nursing: Scope and Standards of Practice (2007; 2013), and reaffirmed by the APHA, PHN Section (2013). Notably, the 1996 definition and role of PHN (APHA, PHN Section) was one of the first PHN documents to cite landmark public policy documents, which addressed health needs of people in the United States and the role of public health. These documents included The Future of Public Health (IOM, 1988); Healthy People 2000: National Health Promotion and Disease Prevention (USDHHS, 1990); The Core Functions Project: Health Care Reform and Public Health (Core Functions Project, 1993); and Nursing, Health and the Environment: Strengthening the Relationship to Improve the Public’s Health (IOM, 1995).

The focus of public health was beginning to shift from health promotion and disease prevention at the individual-level to community- or population-level services. With this focus and definition, leaders chose to call the practice “public health nursing” instead of “community health nursing” (Wallinder, White, & Saleveson, 1996). According to the APHA, PHN Section (1996),

The efforts to plan an effective healthcare delivery system in these documents include recognition of the unique contribution public health nurses make to the healthcare system. This definition of public health nursing is designed to provide an understanding of the practice of public health nursing in the healthcare system.

The forward-looking perspective on the unique contribution of PHN was to promote and protect the health of populations through community- or population-level services of health promotion and disease prevention.

In 1999, the Quad Council, under the auspices of ANA, developed the first Scope and Standards of PHN Practice. Recognizing that most PHN practice in local health departments across the nation was individual-focused health promotion and protection services, this document was intended to prepare the PHN workforce for a major shift. Future PHN practice would emphasize, “…local community needs, resources, and preferences of people. All public health nurses must have a broad range of population-focused skills to be strong public health team partners” (ANA, 1999, p. 1).

This scope and standards document was built upon the eight “tenets of PHN,” proposed by the Quad Council in 1997. These eight tenets form a solid foundation of PHN practice to this day and include: 1) assessment, policy development, and assurance; 2) partnerships with representatives of the people; 3) primary prevention as a priority; 4) concern for healthy environmental, social, and economic conditions; 5) an obligation to serve the whole population; 6) concern for the greater good over individual needs; 7) allocation of resources to maximize health benefit; and 8) interprofessional collaboration.

Health Promotion, Disease Prevention, Population Health and PHN Workforce: 2000 to 2015

In 2000, the Association of State and Territorial Directors of Nursing (ASTDN) (now the Association for Public Health Nurses [APHN]) pointed to the expanding role of public health nurses and highlighted the core public health functions of assessment, assurance, and policy development (IOM, 1988) as central to the Public Health Nursing Practice Model (ASTDN, 2000, p. 8). This model was one of the first to link nursing practice; the core functions and the ten essential services of public health; and population health. In this model, public health nurses interact with individuals and populations by educating; assessing health status; identifying problems and assets; planning to improve population health; and evaluating outcomes. This ASTDN document also recognized the landmark IOM report The Future of Public Health (1988) as foundational to the shift occurring in PHN from individual-focused services to population-focused care during the late twentieth century.

Progress toward the implementation of population-focused practice was slow. During the early twenty-first century, dramatic changes in the healthcare delivery system (highlighted in previous sections) necessitated that PHN return to traditional public health roles of health promotion, disease prevention, and protection of the public’s health. PHN leaders in education and practice were challenged to shift the practice focus from the individual to the community and population. Progress toward the implementation of population-focused practice was slow. Berkowitz and colleagues (2001), PHN leaders in Washington and Oregon, recognized the need to prepare leaders who “…adapt to change, are able to take risks, and have a vision for the future” (p. x), much like early PHN leaders described by Hubbard (1950).

Berkowitz and colleagues prepared a leadership guide to assist public health nurses to manage core public health functions and services. A review of the content of this guide reveals key themes and directions for PHN that are central in contemporary literature and the professional scope and standards practice. These themes include: public health core functions and essential services; performance measurement and outcomes; partnerships and collaboration; expanded PHN roles; community participation and mobilization; commitment to social justice; integrated data systems; implementing community health assessment; and quality improvement.

...advocacy was highlighted as a key PHN role to promote public health and social policies for a healthy environment... In 2010, the IOM report on The Future of Nursing: Leading Change, Advancing Health, took the position that the United States has the opportunity to transform its healthcare system and that “...nurses have great potential to lead innovative strategies...” to improve healthcare (IOM, 2010, p. 4). Although the IOM report on The Future of Nursing did not identify public health nurses specifically, their recommendations on the role of nurses in a transformed healthcare system are consistent with earlier writings of Berkowitz and colleagues (2001). In addition, key themes and directions for PHN practice identified by Berkowitz et al. (2001) were reinforced and expanded in the Public Health Nursing: Scope and Standards of Practice (ANA, 2007; 2013). Notably, advocacy was highlighted as a key PHN role to promote public health and social policies for a healthy environment and create “…conditions that improve and enhance the health of populations…” (ANA, 2007, p. 7). Ethical responsibilities were also significant in the 2007 PHN: Scope and Standards of Practice. A crucial point was made that “…public health nurses must recognize and establish professional practice in accordance with the populations’ rights and with a particular concern for social justice” (p. 11). In addition, both the 2007 and 2013 scope and standards of PHN practice affirmed the eight principles (or tenets) of PHN as key to distinguishing PHN from other nursing specialties.

Another landmark document that influenced the direction for PHN practice in the twenty-first century was the public health core competencies developed by the Council on Linkages Between Academia and Public Health Practice (2014); these competencies were originally proposed in 2001 and revised in 2010 and 2014. The Quad Council reviewed and adapted the original Council on Linkages (CoL) core competencies, and developed Public Health Nursing Competencies (2004). The Quad Council also reviewed the 2010 CoL public health core competencies and produced a revised set of Core Competencies for Public Health Nurses (2011). According to the authors, “Public health nurses practice in diverse settings and environments. Thus these competencies represent the continuum of evolving PHN practice roles, responsibilities, and functions for which PHNs may have to account” (Quad Council, 2011, p. 4).

These PHN core competencies were addressed as context and as key to PHN practice in the 2007and 2013 PHN: Scope and Standards of Practice. Adoption of the CoL core public health competencies for PHN by the Quad Council, with discussion in the 2007 and 2013 PHN: Scope and Standards of Practice, represented an expansion of themes and directions for practice in an area that Berkowitz et al. (2001) referred to as performance management and outcomes. In the 2013 Public Health Nursing: Scope and Standards of Practice document, there is a section and diagram devoted to the “synergy of systems” (ANA, 2013, p. 11-12). This systems synergy represents the art and science of PHN and a useful framework for the interaction of the public health core functions; the eight principles (tenets) of practice; the 10 essential public health services; the eight domains of the core competencies for PHN; and the ANA standards of practice and performance for PHN.

... public health nurses can be leaders in healthcare by addressing multiple determinants and striving to attain and maintain population health. As stated above, the definition of PHN was simplified in 1996, but has remained largely unchanged since the 1980s. However, the APHA, PHN Section’s document, The Definition and Practice of Public Health Nursing (2013), identified changing elements of practice, with new and renewed opportunities and challenges. Key elements of PHN practice in the 21st century include attention to whole population health with a focus on disparities and unique needs of aggregates; comprehensive and systematic assessment of population health; focus on determinants of health; importance of primary prevention; and, individual, family, community, and system level interventions. With these characteristics, public health nurses can be leaders in healthcare by addressing multiple determinants and striving to attain and maintain population health. “With a scope of practice that includes community-building, health promotion, policy reform, and system-level changes to promote and protect the health of populations; public health nurses have an essential role and responsibility as leaders in health improvement and promoting health equity” (APHA, PHN Section, 2013, p. 4).

PHN Workforce Challenges

A major PHN workforce challenge from within the discipline of nursing, the APRN Consensus Model, was finalized in 2008 and excluded public health nurses, nurse administrators, nurse educators, and nurse informatics specialists with graduate education from the ranks of advanced practice registered nurses (APRNs). The model was the product of several years of work by national nursing organizations. The APRN document includes an Appendix (C) listing participating organizations. PHN organizations were not included as participants, i.e., NCSBN APRN Committee Member 2003-2008; APRN NCSBN Round Table Participants 2006-2007; or APRN Join Dialogue Group.

Leaders of PHN organizations voiced concern about excluding the PHN specialty from an advanced practice designation. One major premise of this document was that APRNs, (i.e., Nurse Practitioners, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Midwives) provide direct care to individuals and families including diagnosis, prescription, and medical management. Leaders of PHN organizations voiced concern about excluding the PHN specialty from an advanced practice designation. The basis of this concern was that advanced practice public health nurses provide direct and indirect care to communities and populations, and promote population health through community assessment, community diagnosis, program planning, and program evaluation. The APRN working group rejected this thesis and did not include it in the final document in 2008, as it was not supported by a minority vote of one-third of the participating organizations (Kulbok & Ervin, 2012). The lack of an APRN designation for PHN appears to be related to a significant decline in well-established PHN graduate programs from 2008 to the present.

In 2012, the Quad Council recognized the seriousness of the declining PHN workforce (Kulbok et al., 2017) and published two strategic priority briefs highlighting the need for advanced PHN education and for an improved PHN infrastructure. The Quad Council acknowledged the dilemma facing the PHN specialty: a shortage of well-prepared faculty and practitioners and growing need for nurses with public health expertise and skills. In 2013, the Quad Council sponsored an invitational forum on the future of PHN. The final report highlights key recommendations related to emerging PHN roles, innovative practice models, and necessary leadership skills to advance the specialty (Swider, Levin, & Kulbok, 2014).

Back to the Future: Reclaiming Public Health Roles

Interestingly, just as in the first half of the twentieth century, since 1950 there have been several shifts -- from care of the sick, to a focus on prevention, then back to illness care. Since 1950, key documents, events, and policies have influenced the definition and practice of public and community health nursing. Significant shifts have reflected the changing identity and nature of the PHN specialty—from public health nursing, to community health nursing, and then back to public health nursing, with a continuous and unique emphasis on population health throughout our 122-year history.

Despite various definitions, PHN has consistently focused on the health of the total population. Despite various definitions, PHN has consistently focused on the health of the total population. Ironically, in the past decade there has been an intense interest in the concept of “population health” in the overall healthcare arena and among nursing educators (Fawcett & Ellenbecker, 2015; Kindig & Stoddart, 2003; Radzyminski, 2007; Reifsnider & Garcia, 2015). The term population health gained more of an emphasis with the passage of the Patient Protection Affordable Care Act (ACA, 2010). In addition, the focus on population health outcomes has been key in the development of nursing education programs such as the Clinical Nurse Leader (CNL) and the Doctor of Nursing Practice (DNP).

This current interest and focus on population health and population health management provide an imperative for public health nurses to reclaim roles within a changing healthcare environment, where confusion exists about terms such as population health. This review of the PHN history and literature from 1950 to 2015 reveals that the PHN specialty has often faced challenges and concerns about its future (Canales & Drevdahl, 2014; Chavigny & Kroske, 1983; Robertson, 2004). During the PHN centennial celebration in 1993, Marla Salmon posed an important question, “How can public health nursing best be used to advance the public health mission, particularly in the face of healthcare reform?” (Salmon, 1993, p. 1674).

Two decades later, we are again in the throes of healthcare reform. The economic, political, and social crises and prospects of the early twenty-first century, which affect population health and wellbeing of people in the United States and around the globe, provide an opportunity to reevaluate the fundamental tenets of public health and public health nursing.

Public health is positioned to reclaim its place as part of an emerging reform movement. The future will present new challenges, from global warming and industrial pollution to bioterrorism and universal health care. We can either accommodate the status quo or confront political and economic power in the name of the public’s health. "Public health must go back to the future and integrate power and agency into our models for promoting the public’s health" (Fairchild, Rosner, Colgrove, Bayer, & Fried, 2010, p. 61).

If PHN practice is a synthesis of nursing, public health, and social sciences to promote and protect the health of populations (APHA, PHN Section, 2013), this is a time to join forces and align with public and private partners, to utilize public health competencies and science, and to co-create a base of influence and power for social change and progress (Fairchild et al., 2010).

... the foundational principles of PHN and our history of resilience provide vision and strength to carry us forward to action in the coming decades. In 1950, Ms. Hubbard talked about challenges confronting PHN and the importance of vision and strength. Public health nurses have illustrated timeless resilience in the face of threats and opportunities during the past 122 years. Today, there are innumerable crises and challenges. However, the foundational principles of PHN and our history of resilience provide vision and strength to carry us forward to action in the coming decades. Public health nurses can be leaders in healthcare by addressing multiple determinants of health, striving to attain and maintain population health, and promoting health equity (APHA, PHN Section, 2013).

Authors

Pamela A. Kulbok, DNSc, RN, APHN-BC, FAAN
Email: pk6c@virginia.edu

Dr. Kulbok is the Theresa A. Thomas Professor of Primary Care Nursing and Professor of Public Health Sciences at the University of Virginia (UVa) in Charlottesville, VA. She is a recipient of the 2016 Ruth B. Freeman Distinguished Career Award from the APHA Public Health Nursing Section. She coordinated the Public Health Nursing Leadership track of the MSN Program at UVa from 1994 to 2017 and co-directed two advanced education nursing (AEN) training grants: one using distance education to prepare leaders in Health Systems Management (HSM) and Public Health Nursing (PHN); the other using distance technology to prepare rural nursing leaders in HSM, PHN, and Psychiatric Mental Health. She was Chair of the ANA workgroup to revise the Public Health Nursing: Scope and Standards of Practice (2013). Her current research is focused on sustainable wellness and health behavior transitions from adolescence to adulthood. She previously served as President-Elect and President of the Association of Community Health Nursing Educators and member and Chair of the Quad Council. She holds a BS in Nursing and an MSN in Community Health Nursing from Boston College; earned her doctorate at Boston University; and, did postdoctoral work in psychiatric epidemiology at Washington University in St. Louis, MO.

Joan Kub, PhD, RN, PHCNS-BC, FAAN
Email: kub@usc.edu

Joan Kub is an Adjunct Professor at the University of Southern California. Her research focuses on health promotion, behavioral health, and public health nursing interventions with vulnerable populations. Dr. Kub served on two revisions of the Public Health Nursing: Scope and Standards of Practice (2007 & 2013). She previously served as President-Elect and President of the Association of Community Health Nursing Educators and currently serves as Chair of the Quad Council Coalition of Public Health Nursing Organizations. Dr. Kub is certified by the American Nurses Credentialing Commission (ANCC) as a public health clinical nurse specialist. Dr. Kub holds a BS in Nursing from South Dakota State University, a MSN in Community Health Nursing from the University of Maryland and PhD from the Bloomberg School of Public Health at Johns Hopkins University. Prior to her faculty appointment at USC, Dr Kub taught public health nursing at Johns Hopkins University (1985-2017) coordinating the MSN/MPH joint degree program and undergraduate public health nursing at the University of Maryland (1976-1982).

Doris F. Glick, PhD, RN
Email: dfg6x@virginia.edu

Dr. Glick is an Associate Professor Emeritus of Nursing at University of Virginia (UVa) in Charlottesville, VA. She served as Director of the MSN program from 2002 to 2011 and as founding Director of the DNP program from 2007 to 2011. At the University of Virginia, she was PI of several nurse training grants, including: Nursing Leadership in Rural Health Care for MSN & DNP education for nursing leaders in Public Health Nursing, Health Systems Management, and Psychiatric Mental Health Nursing in rural areas (Division of Nursing, HRSA, 2009): and, Primary Care Nursing Center for Residents of Public Housing to establish two nursing clinics for low income residents of public housing (Division of Nursing, DHHS, 1993). She was the recipient of the UVA School of Nursing Distinguished Professor Award in 2006, and the Faculty Leadership Award in 2011. Dr. Glick taught public health nursing at UVa at the BSN, MSN and doctoral levels from 1981 until 2012. Prior to her faculty appointment at UVa, she taught public health nursing at the Pennsylvania State University in State College, PA, and worked as a public health nursing consultant in the State of Florida Health Program Office.

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© 2017 OJIN: The Online Journal of Issues in Nursing
Article published April 18, 2017


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