Tenets of Public Health Nursing

The Quad Council of Public Health Nursing Organizations (1997) developed the following eight tenets of public health nursing to advance the public health nursing goal of promoting and protecting the health of the population.

  1. Population-based assessment, policy development, and assurance processes are systematic and comprehensive. The client or unit of care is the population. Each process includes consideration of the community capacity, personal or lifestyle health practices, human biology, health services, and social, economic, physical, and environmental factors as they affect the population’s health.

    The assessment process includes a review of the needs, strengths, and expectations of all of the people and is guided by epidemiological methods. Policies are derived from assessment, are developed with a view toward the priorities set by the people, and consider subpopulations or communities where health is at greatest risk, as well as the effectiveness of interventions and program options in influencing the health goals of the people. Interventions and programs are assured through direct provision of services by public health nurses, through regulation, or by encouraging the actions of other health care professionals or organizations, and focus on availability, acceptability, access, and quality of services.
  2. All processes must include partnering with representatives of the people. This assures that the interpretation of the data, policy decisions, and planning of intervention strategies reflect the perspectives, priorities, and values of the people. By emphasizing representation from multiple communities, decisions are made with consideration of what is in the best interest of all.
  3. Primary prevention is given priority. Primary prevention includes health promotion and health protection strategies. The practice of public health nursing places emphasis on primary prevention in all assessment, policy development, and assurance processes.
  4. Intervention strategies are selected to create healthy environmental, social, and economic conditions in which people can thrive. Although all nurses are concerned about the environment in which individual clients live, public health nurses concentrate on interventions aimed at improving environments to benefit the health of the population. Interventions include education, community development, social engineering, as well as policy development and enforcement strategies. Interventions tend to emerge from the political or community participation process and result in governmental policies and laws, administrative rules, and budget priorities. Interventions also emerge from policy and resource control mechanisms within public or private organizations. Some interventions will support functions and systems that promote health, whereas others will protect the health of the people by prohibiting harmful practices.
  5. Public health nursing practice includes an obligation to actively reach out to all who might benefit from an intervention or service. Often, those most likely to benefit are those who are the most marginal recipients. Because risk factors are not randomly distributed in the population, the health of some subpopulations may be more vulnerable to the development of disease and disability, or they may have more difficulty accessing and using interventions or services. These high-risk subpopulations or communities may need special outreach or programs so they can achieve an improvement in their risk status or health. Public health nursing focuses on the whole population and not solely on those who present themselves for services.
  6. The dominant concern and obligation is for the greater good of all of the people or the population as a whole. Because the unit of care for this specialty is the population, consideration of what is in the best interest of the whole takes priority over the best interest of an individual or a group. Public health nurses also promote the health of individuals, but this responsibility is secondary to their obligation to promote the health of the population. Public health nurses recognize that it may not be possible to meet identified individual needs when those needs conflict with other priority health goals that benefit the whole population.
  7. Stewardship and allocation of available resources support the maximum population health benefit gain. This includes providing information to members of the population and leaders for the optimal use of available resources for the best overall improvement in the health of the entire population. Information should include scientific data on potential outcomes of various policy decisions, as well as the cost benefit or cost effectiveness of potential intervention strategies.
  8. The health of the people is most effectively promoted and protected through collaboration with members of other professions and organizations. Creating conditions in which people can be healthy is an extremely complex, resource-intense process. Public health nurses join with appropriate experts from multiple professions and organizations in efforts to improve population health.

Public health nursing practice includes providing leadership to assure that all of the people have their collective and individual nursing needs met. This includes (a) collaborating with other nurses in developing public policies that assure an adequate supply of well-prepared nurses to work in all health settings, (b) developing and enforcing public and organizational policies that assure access to quality nursing services, and (c) supporting nursing research and evaluation to promote quality of care by all nurses. Public health nurses also assure the availability of care to individuals and families in the community (community-based care) when their health condition creates a risk to the health of the population. In this situation, community-based care is a public health nursing strategy that directly benefits the whole population by reducing exposure to risk factors.

American Nurses Publishing. (2000). Scope and Standards of Public Health Nursing Practice

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