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Nurses Hold the Keys to Promoting a Culture of Health

 |  By Jennifer Thew RN  
   October 06, 2015

Nurses can have a profound effect on the health of patients, residents, and communities. But they need to be empowered to make connections and share their innovations, says the Robert Wood Johnson Foundation.

With all the attention it's been getting in recent years, population health may seem like it's a newfangled idea. But I, and probably any other nurse you ask, will let you in a little secret. It's nothing new.

Nurses have been immersed in population health for over a century. In 1893, nursing pioneer Lillian Wald coined the term public health nursing, which the American Public Health Association now describes as "the practice of promoting and protecting the health of populations. Wald's work with immigrant women living in New York City's Lower East Side spawned the Vising Nurse Service of New York and the Henry Street Settlement, which is still helping New Yorkers with social services and healthcare programs.


Lillian Wald

Nurses everywhere have been serving patient's needs out in the community ever since. Community health nurses, parish nurses, school nurses, and nurses in nurse-led clinics have all extended patient care beyond the confines of the hospital walls.

During its most recent First Friday Google Hangout event, "Why Nursing is Key to a Culture of Health," on Oct. 2, the Robert Wood Johnson Foundation highlighted the roles nurses continue to play in encouraging, supporting, and improving health among various communities and their members.

"With this new mission on building a culture of health, I can't think of a more perfect agenda for nurses," said Susan Hassmiller, RN, PhD, FAAN, senior nursing adviser at RWJF, during the event. "There's a lot of factors that are attributable to a person's health status and nurses really understand that."

The mission she refers to includes the action areas of making health a shared value, fostering cross-sector collaboration to improve well-being, creating healthier, more equitable communities, and strengthening integration of health services and systems.

What I took away from the discussion was that to facilitate RWJF's mission of developing a culture of health, nurses need to make authentic connections with patients, residents, and community members and to drive innovation. But in order to do this, they must feel empowered.

Making Connections
Patricia Gerrity, RN, PhD, FAAN, professor and associate dean for community programs in the College of Nursing and Health Professions at Philadelphia's Drexel University understands how making connections with community members furthers a culture of health.

When she founded what is now known as the Stephen and Sandra Sheller 11th Street Family Health Services Center in 1996, the nurse-led center's target population of low-income residents in four of North Philadelphia's public housing developments let her know they wanted someone who would be committed to the community for the long-haul.


Patricia Gerrity, RN, PhD, FAAN

"When we went there, the community members clearly told us that they were tired of being assessed and surveyed and interviewed by people who would come in and then leave," Gerrity said during the Hangout. "So what we did was develop longterm relationships and worked with the community to find out how we could—the term wasn't used at the time—build a culture of health to help them get healthy."

This includes providing services beyond just nursing care. The residents' wish list included a teaching kitchen, a fitness center, and a place to get dental care.

"We have everything you need to work with families to make them strong and resilient," Gerrity said. "Many people talk about healthcare delivery. Health really isn't delivered. It's created, and it's created by the interaction of people and their environments."

Being Innovative
Speaking of creating, nurses have an undeniable creative streak that they use to improve patient care. Anyone who's seen a patient positioned comfortably in bed with custom-made bolsters crafted from rolled up bath towels and medical tape has seen the innovation of direct-care nurses at work.


'MacGyver' Nurses Build Their Own Solutions


MakerNurse the two-year-old initiative supported by RWJF was created to promote this type of innovation in nursing and to give nurses the tools they need to create solutions to improve patient care. Anna Young, co-founder of MakerNurse, explained that the program gives nurses "tangible fabrication and materials" to help them improve patient comfort and care and nurse workflow.

In September, the program opened its first maker space for healthcare providers, MakerHealth, at The University of Texas Medical Branch at Galveston and Young says over 100 nurses have come through the space and 15 different prototypes have been made.

"Everything from wound care to NICU," she said. "[Nurses are] making custom bandages on a vinyl cutter that are actually the appropriate size for patients. Another nurse from the burn unit is building an irrigation structure with 3D printed clips that snap onto the bed."

These creations are far more than just novel solutions.

"We're seeing tremendous opportunity to document value that is created for the hospital, for the system, and for the patients," she said. "Whether that is cost savings because you're able to do something in-house or whether it is better patient outcomes and reducing the time before discharge because you're able to 3-D print a clip that attaches the ventilator to a walker so patients are getting out of bed that much faster."

Becoming Empowered
Even though nurses are vital to promoting a culture of health, they often have to be prompted to remember their value as change agents and influencers.

"Sometimes nurses have to be reminded of how innovative they are and that they do have the solutions," Hassmiller said. "They need to be tapped on the shoulder and told. 'You've been doing this for a very, very long time.'"

And just how does this empowerment happen?

"I think it does start in school when we're learning nursing and how to care for people," she said. "It comes from the faculty, it comes from leadership, it comes from the deans really empowering those students right at the get-go so, when they hit the ground running, they know how valuable they are to the team in coming up with those solutions and delivering the best care possible."

Nurses working at the bedside can also benefit from leadership support and recognition.

"Take nurses aside and say, "We know that you have a lot of people to listen to and a lot of regulations, but you're with those patients, you're with those residents 24/7, and it is you they count on,'" Hassmiller says. "It is really empowering them in that way to step forward and be the leaders that we know that they are."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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