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Lessons learned from a funeral for a dear friend

March 20, 2020

I recently returned from the funeral of Thelma Elizabeth Brown Allison, the mother of a childhood friend. I attended with my sister and cousin, for whom Mrs. Allison was also like a second mother. The people attending the funeral represented several communities from Kansas City, South Bend and the little township in which we were raised, Calvin Center, Michigan.

The occasion reminded all of us of the importance of Mrs. Allison in our lives and how she was important in our development. It also provided the opportunity for many of us to reconnect and rediscover how we made an impact on one another’s lives. As a result of this experience I have been thinking about nursing and, specifically, about community health nursing. 

As noted by Phylllis Meadows, Ph.D., RN, in the American Journal of Nursing, “nurses in community health work with diverse partners and providers to address complex challenges in the community.” Now a senior fellow for health with the Kresge foundation, Dr. Meadows, was formerly the director and health officer of the City of Detroit Department of Health and Wellness Promotion.

While I agree with her statement, I think of the nursing profession more broadly, in that we should all be “community health nurses.”

We care for patients who, like Mrs. Allison, are members of communities that have an impact on -- and are an integral part of -- the health and welfare of others. As nurses, we have learned how to do community assessments to learn how to use that information, and to also become part of the community in order to enhance nursing care, including health maintenance and promotion. While this may seem easier if we are working in community agencies, the responsibility is still a component of the care that we provide in settings where the care is considered “inpatient,” whether that is in a hospital or extended care facility.

Some may ask how is this different than population health? For me, perhaps this begins with the definition contained in “Preparing Nurses for the New Roles in Population Health Management”: “Population health can be defined as ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group.’ In this concept, the population, as a whole, is viewed as the patient.”

The key difference is identifying the entire population as the patient rather than the patient as one member of a population. This also gets to the difference between a population and a community. In my mind, community includes the richness described above. The concept of population, as described above, is an abstract concept, and is different from working in, and being a part, of a community in which we provide nursing care and services. In one, the nurse “works on” (population health) in the other, the nurse “works in and with” (community health). While this discussion isn’t definitive, I do wish to raise the opportunity to consider how we, as nurses, think of population health and community health, and the role of the nurse in these different, but related, areas of operation.

I begin this piece with the funeral of Mrs. Allison. One of the individuals my sister and I reconnected with was Paul Mayhew, the director of the funeral service. For my family, Mr. Mayhew has overseen the funerals and, except in one instance, the burials of our family’s grandparents, parents, aunts and uncles, cousins and friends and neighbors. In thinking of Mr. Mayhew, I am reminded of my work as a public health, home health and community health nurse and the funeral directors I had the opportunity of working alongside. Those funeral directors were collaborators in the nursing care that we provided bereaved family members, helping them to identify community resources. Because of their work with families, they were able to advise my fellow nurses on others who were potentially in need of nursing and other health care services. 

As nurses, we learn to consider the community, and communities, that our patients are a part of, partly because we, too, are members of these same groups. It is my hope that as we grow in our individual and group approaches to practice, we reconsider how we are a part of communities and how that impacts our role in providing nursing care, including health maintenance and health promotion. 

Yours in Spartan Spirit,

Randolph F. R. Rasch, PhD, RN, FNP, FAANP

Dean and Professor

College of Nursing

Michigan State University