Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 2, 1993 TAG: 9304280453
SECTION: NURSES PAGE: 2 EDITION: METRO
SOURCE: By SARAH COX
DATELINE: LENGTH: Long
Linda Hudgins of the Roanoke City Health Department says that public health nursing is the circulatory system of nursing.
Sue Leitch, the public health nursing supervisor for the Allegheny District, says its emphasis is on health prevention and maintenance.
And Judy Williams of the New River Health District explains the public health philosophy as "a component of community health, which provides healthy changes for a whole community, with the ultimate goal of making a healthy community. And we deal with individuals in order to achieve that."
One thing's for certain: No two days are alike in this multipurpose, but oh-so-necessary arm of the health system, which just may be coming into its own in the near future of national health care reform.
Hudgins questioned our propensity to just treat acute illnesses - a question which may be on the mind of the entire nation during as our attention is focused on health care reform - and suggested that what we need to do is to "focus on what we can do to prevent disease in the first place. People see public health nurses as not having a sound scientific basis, but that's not true. We must be able to investigate."
She gives as an example the way public health nurses track communicable diseases through contact persons; the way they venture into parts of the community many others would not dare to tread; and the way they are constantly evaluating and teaching.
Whether the setting is in a clinic, a home or in a community center, the public health nurse's focus is health prevention.
"In home health, we treat acute illnesses,` said Hudgins, who finds community work the most exciting.
"When you see a patient in the doctor's office or hospital, you have no idea if they can follow up on treatment. A lot of times we redo the whole teaching process to make it fit and make sense."
This includes teaching the patients' significant others, she said.
"I see home health as futuristic care, because of the cost of insurance. It's cheaper to send nurses into homes than having patients stay in the hospital," Hudgins aid.
The home health nurse, because of rapid advancements in technology, can now do much more in a home. They are also responsible for assessing the situation, conveying those anatomical, physiological and symptomatic assessments to the physician, and carrying out his decision which has been based upon her evaluations. Hudgins calls her role a "strong link - we can often treat them without putting them back into the hospital."
Hudgins gave an example of a situation a public health nurse might encounter in a home setting. There may be no care givers for the patient so the nurse may link the patient up with Meals-On-Wheels through the League of Older Americans. The nurse could also talk to neighbors, find out what services they can offer such as shopping, fixing breakfast or simply checking in with the patient.
If there are emotional problems or dementia, Hudgins said the nurses can contact social health organizations. And if there is a need for socialization, they will put the patient in touch with Family Services, with the Diners Club, or perhaps Catholic Family Services' Full Circle program.
"I have worked for other home health agencies, and they don't have this public health knowledge. My ears are tuned to any agency, and when I have a patient with a need, I pull out my file," she said.
Because of the increasing need for home health care, Hudgins says these nurses will continue to need more and more scientific knowledge through more in-service workshops and classes. Also, the public health nurse will continue to combine the roles of health maintenance, disease prevention and community referral.
"Public health is not just for people on welfare. We are there to serve, teach, prevent disease and promote health for every client in the Valley - no matter what economic or social level," she said.
And the face of public health, according to Hudgins, will continue to change. She said it has to become a more important health component in our nation, for cost containment necessitates prevention.
Sue Leitch has been in public health for more than 19 years, and now serves a district which includes Clifton Forge, Covington, Allegheny and Craig Counties. She said that the emphasis of public health has changed through the years from one of acute care to a present status of health maintenance.
"Now we're very involved with mother and infant care coordination - it could be a high-risk pregnancy or a child from birth to age two with social, physical, or mental risks."
Her work keeps her in the clinic, where they offer clinic services, family planning and well-child care. One of Leitch's greatest concerns is missed immunizations. She wants immunizations to be made more accessible through more available hours.
In her district in particular, Leitch said, there is an acute care for maternity services, as well as care for the indigent who do not have Medicaid or Medicare.
Sometimes, she said, people fall through the cracks, "because of a lack of resources. There's nothing like the Bradley Free Clinic [in Roanoke] here. We don't treat acute or chronic illnesses, and there's no clinician available on a daily basis."
A nurse practitioner helps run the clinic on a daily basis, and there's a medical director for the entire district.
No two days in a public health nurse's schedule are alike. One may be involved in clinics, another in school, or home health care, and yet another in children specialty services or community education classes, for tuberculosis prevention or AIDS counseling.
Judy Williams, who also has been in the public health sector for 19 years, said she believes in the philosophy of public health.
"I have found that we do respond to community needs." For an example she cited the process by which they help prevent preterm births (and therefore costly aftercare): Maternity clinics are given for early prenatal care; they use role-model mothers as resources; and teach postnatal infant care. The goal is for all pregnancies to go to term.
The most dramatic change Williams has seen in public health nursing since the 1960s is the increased needs of persons with chronic diseases, and the need for more home health care.
"Families cannot afford to put elders in nursing homes, and DRGs are limiting hospital stays," she explained.
Williams looks to the future for answers to health care.
"The strategy by which we accomplish prevention are health promotion activities, and I believe our new health care system will include this. I hope the masterminds of this system see public health figuring in this. We're heavy into education, counseling, case management and advocacy of our clients. The goal of prevention has not changed. Public health is a constant assessing of the community - of listening to community leaders, looking at statistical data and looking at demographics," Williams said.
by CNB