Cornerstone documents and milestones: The changing landscape of public health nursing 1950-2015

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).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 1975In 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.Practice as Synthesis of Nursing and Public Health: 1975 to 2000The 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. …