To the Editor:
As a community health nurse, it was refreshing and reinforcing to read the desired characteristics of a new health care system in Dr. de Tornyay's report of the Pew Health Professions Commission in the September 1992 issue of the Journal of Nursing Education. These characteristics included an orientation to health, a focus on individual responsibility, a population-based system, and a focus on consumers. In addition, number one on the list of actions required by schools of nursing was: "Increase their emphasis on the community's health." However, the seven strategies for nursing education were disappointing as they do not embody the nine characteristics of a new health care system.
These characteristics, "oriented to health, emphasizing disease prevention and health promotion," "individual responsibility for health-related behavior, "and "populationbased [system] with more attention to risk factors in the physical and social environment at the community level," are not incorporated in the strategies. Once again, nursing has neglected the promotion of health; the focus of the strategies is on patients rather than on health, health promotion, disease prevention, and population-specific social and environmental needs. Throughout the narrative regarding strategies, patients and patient-care systems are the focal point; even the reference to needs of communitybased care is in relation to patients and illness. If the intention was to include all persons, sick or well, in the category of patients, I think it is an unfortunate choice that perpetuates an emphasis on illness rather than on promoting health and preventing disease.
The Pew Commission's work will strongly influence nursing education. I suggest development of additional strategies and revision of the existing seven to ensure an orientation to health, health promotion, and disease prevention.
Sally L. Lusk, PhD, RN, FAAN
Associate Professor, School of Nursing
Director, Occupational Health Nursing
The University of Michigan
Ann Arbor, Michigan
Dr. de Tornyay's response:
Dr. Sally Lusk's helpful comments were shared with Dr. Edward CKNeil, executive director of the Pew Health Commission, and his staff Let me respond in two ways to the concern expressed that the nursing strategies do not embody the characteristics of the emerging health care system.
First, the Commissions deliberations on nursing fully acknowledged the profession's solid tradition in community care where the profession expanded its responsibilities early on to include public health, school health, occupational health, and home care. The Commission points out that as the health care needs of the public have evolved, the nursing education community was quick to respond by producing nurses who are patient advocates, patient care coordinators, nurse midwives, nurse practitioners, home and community-based nurses, and patient educators. As the demand for generalist health care workers continues to grow in the emerging health care system, the Commission recognizes that nurses will continue to be an important source for the delivery of primary health care and a valuable resource to the other health professions striving to meet primary health care needs. The strategies for nursing were developed and embraced by the Commission within this context.
Second, the Commission's approach within its first report, "Healthy America: Practitioners for the Year 2005," and in its second report, "Health Professions Education for the Future: Schools in Service to the Nation," has been to encourage and assist the disciplines and professions to interpret the Commission's vision for themselves and in different ways. We believe that the Commission's strategies will evolve as the health care system and education respond to the changing world. Thus, the reports are not the final word but the beginning of a decade-long commitment to change. The Commission expects institutional leaders to further refine the strategies as they apply them at the institutional level. Dr. Lusk's comments will be particularly helpful to the Commission in phase two of our work as we focus efforts on implementing change at the institutional level, and we thank her for responding to my early report of our work.
Rheba de Tomyay, EdD, FAAN
Professor, Department of Community Health Care Systems
University of Washington School of Nursing
Commissioner, Pew Health Professions Commission