With their focus on patient-centered care, their holistic view of patients, and their emphasis on the promotion of wellness, nurses have a long history of providing care that is consistent with the Robert Wood Johnson Foundation's vision of a Culture of Health. Recently, RWJF partnered with the American Academy of Nursing (AAN) to explore ways in which nurse-designed models of care are currently advancing a Culture of Health.
Their brief summarizes findings from case studies of three innovative nurse-designed care models, and it discusses lessons learned from these case studies that might inform our understanding of the health sector's role in building a Culture of Health.
Researchers found that nurse-designed models advance RWJF's vision of a Culture of Health by promoting equitable communities through inclusion, collaborating with diverse partners and major hospital systems, broadening society's view of health and health care, and fostering social support systems. Each model stressed the importance of responding to the unmet need for social supports in the community. Collectively, these programs look beyond the physical health care needs of their patients, taking into account the needs, stresses, and overall health of the communities they serve.
The nurse-designed care plans define health holistically and share a common goal of "demedicalizing" wellness through the integration of physical, mental, emotional, and mind/body care. They integrate health education, an emphasis on emotional health, and group discussions of topics not typically defined as medical concerns, recognizing the value of the whole patient.
The nurse-designed models displayed a commitment to improving patients' health self-efficacy — the belief in one's ability to succeed in a given situation — and support the philosophy that engaging people, families, and communities in addressing their own health needs and enabling them to be self-advocates is an essential component of making health a shared value. By addressing health disparities, both through the services they provide and by empowering community members and engaging them in the decision-making process, the models also demonstrate the role that health care providers can play in promoting and enhancing equity in their communities.
Researchers paid particular attention to the facilitators and barriers that nurse-designed care models encountered in promoting a Culture of Health. Each model has a dedicated "champion" nurse, whose vision and ability to navigate organizations at both the community and institutional levels are key to fostering a Culture of Health. Bilingual nurses were also invaluable, as it enabled care models to gain the trust of community members and understand and respond to their specific needs. Broad community support was another important common factor in the success of these models.
A persistent struggle for each model was identifying sustainable and scalable sources of funding, particularly for community-level programs, many of which have no clear funding streams. Other barriers include financial or staffing constraints that prevent community organizations from making behavioral health concerns a priority; a tendency on the part of health care providers to stay "inside the walls," rather than venture out into the community; and an inconsistently trained nurse workforce.
The nurse-designed models offer important examples of work that promotes RWJF's Culture of Health initiative among patients, families, and communities, and they represent the importance of developing close community-based partnerships. Health care providers can play an important role in advancing a Culture of Health by helping communities identify their own unique resources and by promoting individual and community self-efficacy.
Going forward, it will be important to help providers identify consistent funding sources in order to sustain the scope of their programs. Current trends in domestic health care policy that make providers responsible for overall patient outcomes, such as accountable care organizations, offer potentially promising approaches to making community-level interventions more sustainable. Health care workforce development should emphasize interdisciplinary learning and collaboration to ensure that providers are prepared to be skilled partners and leaders in building a Culture of Health.
What would your nurse-designed care model look like?