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Practicing
Primary Health Care
in Nursing
Caring for Populations
Edited by
Sandra B. Lewenson, EdD, RN, FAAN
Professor
Lienhard School of Nursing
Pace University
Pleasantville, NY
Marie Truglio-Londrigan, PhD, RN

Professor
Lienhard School of Nursing
Pace University
Pleasantville, NY
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Library of Congress Cataloging-in-Publication Data
Names: Lewenson, Sandra, editor. | Truglio-Londrigan, Marie, editor.
Title: Practicing primary health care in nursing: caring for populations / [edited by] Sandra B.
Lewenson, Marie Truglio-Londrigan.
Description: Burlington, MA: Jones & Bartlett Learning, [2017] | Includes bibliographical references
and index.
Identifiers: LCCN 2015048786 | ISBN 9781284078107 (pbk.: alk. paper)
Subjects: | MESH: Nursing Care | Primary Health Care | Nurse’s Role | Nursing
Classification: LCC RT51 | NLM WY 100.1 | DDC 610.73—dc23
LC record available at http://lccn.loc.gov/2015048786
6048
Printed in the United States of America

20 19 18 17 16 10 9 8 7 6 5 4 3 2 1
Contents
Design element: © Libi Ostrovsky/Shutterstock

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Chapter 1 Historical Exemplars in Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Sandra B. Lewenson
Chapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Chapter Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Chapter 2 Awakening of an Idea: Principles of Primary

Health Care in the Declaration of Alma-Ata . . . . . . . . . . . . . . . . . . . . 21
Kathleen M. Nokes
Chapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
iii
iv | Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Reflections and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 3 Nursing’s Role in Building a Culture of Health . . . . . . . . . . . . . . . . . . 33

Susan B. Hassmiller
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Case Studies: Nurses Promoting a Culture of Health . . . . . . . . . . . 45
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 4 Social Justice, Nursing Advocacy, and Health Inequities:

A Primary Health Care Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Selina Mohammed, Christine A. Stevens,
Mabel Ezeonwu, and Cheryl L. Cooke
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Case Example: Moving Together in Faith and Healing (Boutain,
McNees, & MTFH Collaborative, 2013) . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Chapter 5 The Economics of Caring for Populations:

Donna M. Nickitas
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Chapter 6 Coalitions, Partnerships, and Shared Decision-Making:

Marie Truglio-Londrigan
Contents | v
Coalitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Case Study: Developing a Community Coalition . . . . . . . . . . . . . . . 93
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Chapter Activity 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Chapter 7 “I Told Them, Leave It Alone; It’s OUR Center”:

Advocacy and Activism in Primary Health Care . . . . . . . . . . . . . . . 109
Linda Maldonado
Chapter Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Chapter Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Chapter 8 Integrated Health Care Without Walls:

Technology-Assisted Primary Health Care . . . . . . . . . . . . . . . . . . . . . 125
Judith Lloyd Storfjell, Lucy N. Marion, and Emily Brigell
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter 9 Global Nursing: Primary Health Care Perspective in

Caring for Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Majeda M. El-Banna and Carol Lang
Chapter Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Case Study 1: Primary Health Care Mission to Haiti . . . . . . . . . . . 152
Case Study 2: Primary Health Care Mental Health
Clinic in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
vi | Contents
Case Study 3: Primary Health Care Nurse-Led Mobile

Chemotherapy Clinic in the United Kingdom . . . . . . . . . . . . . . . . . 153
Case Study 4: Nurse-Led Open Access Iron Deficiency
Anemia Primary Health Care Clinic in the United Kingdom . . . . . 154
Case Study 5: Primary Health Care Nurses Training in
South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Case Study 6: Nurses Nutritional Advice to
Pregnant Women in Saudi Arabia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Chapter 10 Culturally Sensitive Primary Health Care Interventions:

Three Exemplars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Arlene W. Keeling, Brigid Lusk, and Pamela K. Kulbok
Nurses on the Navajo Reservation, 1920s–1950 . . . . . . . . . . . . . . . 162
Nurses Caring for Women Following
Radical Mastectomy, 1950–1960 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Case Study: Nursing Care of Post-Mastectomy
Patients, 1950–1960 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Community Participatory Strategies in Rural America Today . . . . 170
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Chapter 11 Community-Based Participatory Research and

Primary Health Care: Working with the People . . . . . . . . . . . . . . . . 181
Carol Roye and Marie Truglio-Londrigan
The Interaction Between Research and Practice:
A Personal Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Foreword
Throughout my career as a nurse, educator, and researcher two main goals

have been foundational to my work. These goals stem from my personal and
professional experiences, and are framed from the perspective of my Latina
background and my work in and with underserved communities. Specifi-
cally, my goals are (1) to increase public and community understanding of
the scope and contributions of nursing in advancing health, and (2) to
realize the potential of nursing in caring for the health of individuals and
populations, especially those confronted with social, political, and eco-
nomic challenges. In Practicing Primary Health Care in Nursing: Caring for
Populations, Lewenson and Truglio-Londrigan comprehensively address
these goals. They integrate their historical, public and community health,
and shared decision-making expertise and lenses throughout the book to
bring clarity to the issues of “who” and “how” to care for populations. In
addition, they have amassed a number of contributors with a diversity of
expertise and perspectives (e.g., historical, economic, public health, educa-
tion, community, and social justice and advocacy) who address these goals
by discerning the scope, issues, and approaches in caring for populations
from a primary health care nursing perspective.
This book is timely as terms such as population health, social determi-
nants, health equity, primary care, primary health care, public health, com-
munity health, international health, global health, and culture of health—to
vii
viii | Foreword
name a few—are being used interchangeably in contemporary social,

health, and policy discourse. Although these concepts are related and dif-
ferences may appear to be subtle nuances, how they are used to frame policy
debates is of critical importance. Consistent with the perspective of the
World Health Organization, primary health care is at the essence of health
for all populations and is the organizing framework for this book. Chapter
authors use this framework to illustrate the synergies among elements of
primary care, primary health care, public health, global health, and promot-
ing health equity locally and nationally, and demonstrate advocacy at the
micro level (individuals and communities) and the macro level (national
and global policy).
This book is timely as elements of the Affordable Care Act are being
implemented. Policy debates and questions about “who” is best positioned
to lead primary health care are made abundantly clear in this book—nurses!
The chapters in this book examine the historical roots of primary health
care and the role of nurses in both the United States and global context. We
see the principles found within the Declaration of Alma-Ata in early public
health nursing experiences, from Lillian Wald’s Henry Street Settlement in
New York City, to the American Red Cross Town and Country Nursing
Service, to the work of public health nurses in the Indian Health Services
on the Navajo reservation. Throughout the 20th century, nurses have shown
leadership in primary health care in communities and at policy levels.
Primary health care is not a shift for nursing; rather, it is part of a broader
continuum of the professional role of nurses today. Contemporary nurses
have led and designed models, including those designated as Edge Runners
by the American Academy of Nursing—such as the Transitional Care
Model and the Nurse Family Partnership—which are exemplars of nursing’s
continued commitment and success toward advancing primary health care.
Historical and contemporary models incorporate core values of social
justice, advocacy, interdisciplinary and multisectoral collaboration, and
shared decision-making. In addition, these successful models and
approaches incorporate strategies to address the multiple determinants of
health including the environment, education, and housing within a
community context. Further, many contemporary models have amassed
extensive evidence to demonstrate that nurse-led approaches positively
affect financial, patient, and family outcomes, indicating their value to both
health care and population health. The numerous case studies and exem-
plars embedded in each chapter further demonstrate that nurses consistently
have been, and are now, well positioned to lead efforts to advance primary
health care through exemplary practice models, taking the lead in social
and political advocacy.
While convincingly demonstrating the leadership of nurses in advanc-
ing primary health care, the authors also challenge nursing and its stated
commitment to advocacy and social justice and the lack of ability, commit-
ment, or action on these fronts. A number of useful frameworks and
Foreword | ix
approaches, including economic and social value frameworks and

community-based participatory action research, are presented in depth.
Further, specific strategies to advance primary health care, such as com-
munity coalitions, partnerships, shared decision-making, advocacy, social
justice, and cultural competency, provide a roadmap and skill set for
addressing contemporary issues and challenges.
Each chapter contains a list of learning objectives, an exemplar or case
study, and a set of reflective questions or learning activities. As such, this
book is both foundational and an ideal reference for nursing and health-
related history and policy-related courses. However, it also has great utility
outside of the classroom. The historical perspective, links to contemporary
context, and the multiple exemplars provide all nurses with the ability to
articulate the scope and contributions of nursing in advancing health and
to better prepare all nurses to advance primary health care for all.
Antonia M. Villarruel, PhD, RN, FAAN

Professor and Margaret Bond Simon Dean of Nursing
University of Pennsylvania School of Nursing
Preface
Practicing Primary Health Care in Nursing: Caring for Populations provides

a unique examination of primary health care from a nursing perspective.
The book presents the enduring relationship that nurses have had in pio-
neering primary health care with a population-based, interprofessional, and
global perspective throughout the 20th and 21st centuries. Primary health
care, as seen through the lens of nursing academics, historians, economists,
and practitioners, places the profession’s past practice and current visions
into the ongoing health care debate in the United States. The multidimen-
sional lens applied to the meaning of primary health care affords a way to
educate nurses to understand and assume their rightful role in practicing
within a primary health care framework, whether advocating health care
policy in the political arena, developing coalitions with other professionals
and community leaders, or engaging in shared decision-making activities
in the community.
Practicing Primary Health Care in Nursing fills a void in the literature
that all too often omits a nursing presence, a historical framework, and a
philosophical perspective. In addition, it addresses the confusion surround-
ing the use of the term primary health care, which will help those engaged
in education, practice, or research articulate and advocate better health care
options and access for all. Building on nursing’s central but often invisible
role in primary health care, we provide a theoretical framework firmly rooted
xi
xii | Preface
within the practice of nursing, both historically and contemporarily. Each

chapter presents a view of primary health care from the contributing author’s
experience and uses a case study to explain the particular foci of that chapter.
Defining Primary Health Care

It is important to clarify the differences between the terms primary health
care, primary care, public health, and population-based care—terms fre-
quently used interchangeably in current healthcare debates. These terms
serve as a guiding force for those seeking to implement the ideas of primary
health care. Public health has a long tradition in the practice of social justice
and population-based care. Population-based care, also a part of public
health, is fundamental to the philosophy of primary health care. Primary
care practitioners may use a population-based focus (Greenhalgh, 2007).
The definition of primary health care continues to evolve within the context
of health care in the United States as we struggle to separate these concepts.
The World Health Organization (WHO) first described primary health
care in the Declaration of Alma-Ata in 1978. WHO’s definition reflects a
broader philosophical and holistic approach to health care that includes the
contributing determinants of health that affect the health of populations.
The Institute of Medicine (IOM, 2003) further describes primary health care
as an intersectoral collaborative, which includes members from a variety of
sectors in the community that have a stake in health care. These stakeholders
may include members of the community, multiple disciplines, community
organizations, public officials, academic settings, and corporations, with
nurses participating equally. Representation from a population of interest
may also serve as a participative member of this collaborative, informing
the multiple players about the needs of their specific population. Primary
health care uses shared decision-making and communication strategies that
lead to improved population-based health outcomes. The health disparities
identified in Healthy People 2020 and addressed in the Patient Protection
and Affordable Care Act (ACA), which seeks health equity for the entire
U.S. population, resonates with the 1978 WHO definition of primary health
care and the idea of “health for all.” Nurses have had and continue to have
a role in the development, practice, and evolution of providing primary
health care services.
Primary Care Versus Primary Health Care

The term primary health care is often misunderstood and, as a result,
misused. The term is used synonymously with “primary care,” is blurred
with “public health,” and overlaps with “population-based care.” Primary
care does not reflect the totality of primary health care; rather, it is a point-
of-care service model in which a health care provider, such as a nurse
practitioner, midwife, or physician, meets with a patient in any setting in
which care is rendered. Primary care owns “cultural authority and social
Preface | xiii
legitimacy” (De Ville & Novick, 2011, p. 106), making this term more
acceptable and used more often than primary health care in health
care debates. As a result, it is difficult to shift our views to the broader and
more abstract definition of primary health care (Truglio-Londrigan, Single-
ton, Lewenson, & Lopez, 2013). Public health nursing shares many of the
underpinnings of primary health care and has been conceived as a “cousin”
of primary health care (Greenhalgh, 2007, p. xi). A public health model,
however, is not as abstract as primary health care seems to be and is more
of a point-of-care model, albeit the point of care may be with a population.
Various models of care may fit within and aspire to provide primary
health care. The concepts embedded in the philosophy of primary health
care—shared decision-making, collaboration, social justice, community ori-
entation, access for all citizens, and equity of services—may permeate
primary care, public health, and population-based care, depending on how
and if they are operationalized. A nurse practitioner may be caring for
individuals and families but may not make the connection that those indi-
viduals and families are part of a larger population and as such miss valuable
opportunities to develop initiatives to address population-based issues. For
example, the nurse who makes home visits to a vulnerable older adult and
sees depression in the client, if practicing with a primary health care per-
spective, would frame the intervention accordingly. This would include
framing this one person’s issue as a population-based issue. By looking at
this as a population-based issue, the nurse may also work toward strength-
ening social supports and networks in the community. More importantly,
without using the social determinants of health in the intervention, the
practitioner may not address where the patient lives, works, and plays
(Lavizzo-Mourey, 2015).
In the institution where we work now as academics, we offer master’s-
and doctoral-level courses in primary health care. Explaining the definition
and practice of primary health care nursing can be challenging, but by the
end of the semester we see the larger and more inclusive definition of
primary health care become meaningful to our students and integrated into
their practice. To help our students and the larger nursing audience who
will read this book, we provide a variety of perspectives in each chapter
highlighting various parts of the definition and meanings that reflect
primary health care. The case studies, as well as the activities at the end of
the chapters, provide real-life examples that foster creative and critical
thinking toward achieving health for all. Each contributing author places
her or his own perspective and experience on this broad concept, thus
allowing for intellectual and practical flexibility.
The Editors’ Perspectives

Both of us bring our unique understanding and perspective to the topic of
primary health care. Sandra B. Lewenson brings a historical dimension to
xiv | Preface
this discussion, examining how nurses have addressed health disparities in

populations that led to changes in intervention strategies and better health-
care outcomes. She uses historical research to understand the ways nurses
have participated in healthcare reform efforts over time. For example, she
describes the early public health nursing leader Lillian Wald and her nursing
colleagues’ response to the human condition during the early part of the
20th century. Wald wrote in 1915 about her transformative experience
while teaching a class on the Lower East Side of New York City that led to
the development of nurse-managed intervention strategies in urban and
rural settings in this county and abroad. Wald (1915) wrote:
The child led me on through a tenement hallway where open and

unscreened closets were promiscuously used by men and women, up
into a rear tenement, by slimy steps whose accumulated dirt was aug-
mented that day by the mud of the streets and finally into the sick-
room . . . the odors which assailed me from every side. Through Hester
and Division streets we went to the end of Ludlow; past odorous fish-
stands, for streets were a market place, unregulated, unsupervised,
unclean; past evil-smelling, uncovered garbage cans; and perhaps
worst of all, where so many little children played . . . although the family
of 7 shared their two rooms with boarders . . . and although the sick
woman lay on a wretched, unclean bed, soiled with a hemorrhage two
days old, they were not degraded human beings. (p. 6)
Wald’s commitment to the underserved in the Lower East Side tene-

ments of New York City permeated the early 20th century efforts of public
health nurses to improve health for all. Her work and that of her colleagues
serves as a beacon for Lewenson. History frames Lewenson’s conception of
primary health care and offers depth and breadth to enduring and contem-
porary health care issues. Many of the authors selected to contribute to this
work use their own historical research to exemplify a particular current
issue in primary health care.
Marie Truglio-Londrigan’s vision of primary health care has grown out
of her long career in public health nursing. Her practice has been based on
a belief that health care is truly a working partnership, whether that partner-
ship is between her and an individual, a family, or a population. The signifi-
cance of this partnership is in the work that builds up to shared
decision-making as the collective engages in identification of the problem
and in building interventions toward the resolution. Her research in a com-
munity setting study on shared decision-making with older adults highlights
these ideas. Truglio-Londrigan saw the importance of joining with the older
adults in identification of the population-based problems as seen by the
population, exploration of the needed interventions as seen by the popula-
tion, and the implementation of the interventions driven by the population,
as well as the evaluation. Truglio-Londrigan saw the need for community-based
Preface | xv
participatory research with the key word being action. Action by the people
serves to enhance their own personal capital and empowerment.
We both share similar stories in our practice as public health nurses.
We have witnessed the effects of poverty in single-family households, food
insecurity when families lack money for food or live in neighborhoods where
food sources are scarce, and inadequate housing for families who live in
communities with an absence of affordable living options. These are just
three of the social determinants of health many of the most vulnerable
among us face. A primary health care focus explores different kinds of solu-
tions than those typically applied within a primary care or population-based
care point-of-service delivery model. Nurses who practice with a primary
health care focus recognize that to ensure healthy nutrition, for example,
might mean more than educating the family about healthy nutrition. It may
mean helping the family obtain the food by working with communities to
encourage ways to bring food stores into the neighborhood that carry healthy
options such as fresh fruits and vegetables and other sustainable food sources
found in local gardens developed and nurtured by people in the community,
and also supporting legislation that continues to provide healthy food for
those under a certain income level. The context in which care is provided
becomes part of the nursing assessment, plan, intervention, and evaluation.
Our understanding of primary health care also informs our practice as
nurse educators. The ideas related to primary health care have always been
a part of the philosophy and curriculum of the Lienhard School of Nursing.
Both undergraduate and graduate courses in some ways infused the ideas
of primary health care. When the graduate faculty developed a new master’s
core curriculum, there was a conscious effort to use the terms embedded in
primary health care in each of the core courses, as well as to develop a
signature course devoted solely to this concept.
Yet the paucity of scholarship on a nursing perspective in this area
made the process of teaching these courses challenging. We saw a need for
clear definitions and recognition that nursing plays an important role in the
implementation of primary health care, especially as the Affordable Care
Act expands opportunities for nurses. In fact, while finishing the second
edition of Public Health Nursing: Practicing Population-Based Care, we real-
ized we needed to include a chapter about primary health care. Truglio-
Londrigan, Singleton, Lewenson, and Lopez (2013) saw this chapter as a
conversation that enabled us to articulate the meaning of primary health
care in relation to nursing practice in the United States. What began as
a conversation later morphed into this book, which brings together our
ideas about practice, teaching/learning, research, and primary health care.
Audience
Practicing Primary Health Care in Nursing offers nursing educational pro-
grams a way to broaden their curricula to encompass the concepts of
xvi | Preface
primary health care and population-based care within their coursework.

Chapters include a nursing focus within a perspective of primary health
care. The integral role of nursing as a member of the intersectoral collab-
orative resonates throughout this text, emphasizing the essential role and
value of nursing as recognized by the WHO, the IOM, and the current U.S.
healthcare reform legislation. In addition, nurses and other healthcare
providers may find this book useful as they use the language of primary
health care to inform their practice. They will see their work framed in a
broader perspective, which in turn provides the tools and terms needed in
political advocacy.
Practicing Primary Health Care in Nursing

Chapter 1, “Historical Exemplars in Nursing,” by Sandra B. Lewenson,
explores the relatively unknown American Red Cross Town and Country
Nursing Service, which provided public health nursing services to small
cities and towns in rural America. Nurses built coalitions and collaborated
with community leaders in rural settings to provide health care in the com-
munity. This chapter illustrates how the actions of one community between
1915–1917 reflects the practice of primary health care today.
In Chapter 2, “Awakening of an Idea,” Kathleen M. Nokes describes how
the philosophy of primary health care (PHC) emerged in South Africa prior
to the 1940s. The country was plagued by apartheid policies, poor infrastruc-
ture, and little access to care, which produced poor health outcomes. Two
physicians were influential in establishing comprehensive health service
centers in South Africa that used a team-based approach. These centers were
an early precursor to the World Health Organization’s (WHO) Declaration of
Alma-Ata in 1978 where the term primary health care was formalized.
In Chapter 3, “Nursing’s Role in Building a Culture of Health,” Susan
B. Hassmiller discusses the disparities of health care in the United States
and presents an idea for addressing these disparities in an alternative way.
The Robert Wood Johnson Foundation promotes the campaign for a Culture
of Health, which Hassmiller describes in this chapter. Hassmiller explores
the leadership role of nurses in the evolving U.S. healthcare system as they
individually and collectively engage in the process of leading change and
advancing the health of all of the people.
Chapter 4, “Social Justice, Nursing Advocacy, and Health Inequities,”
by Selina A. Mohammed, Christine A. Stevens, Mabel Ezeonwu, and Cheryl
L. Cooke, focuses on social justice and nursing advocacy. Throughout the
chapter, the authors clarify the role of health professionals in primary health
care and underscore the need for healthcare providers to work toward
health equity through social justice, advocacy, collaboration, and ethical
decision-making. Social, political, economic, and environmental factors are
determinants of health that can be barriers to social justice. Advocacy facili-
tates social justice, and nursing practice is pivotal in ensuring these gains.
Preface | xvii
In Chapter 5, “The Economics of Caring for Populations,” Donna M.

Nickitas discusses the economic implications of caring for populations
using a nursing social and economic value framework. Introducing the
social determinants of health, she challenges us to focus on the vulnerable
and access to care with three aims: (1) improving the experience of care,
(2) improving the health of populations, and (3) reducing per capita costs
of health care. Nickitas illustrates the need for nursing to understand and
apply an economic perspective when examining primary health care.
In Chapter 6, “Coalitions, Partnerships, and Shared Decision-Making,”
Marie Truglio-Londrigan introduces various types of community coalitions
and describes the outcomes of these initiatives, with specific emphasis on
the Community Coalition Action Theory (CCAT). She illustrates the impor-
tance of coalitions from the perspective of the active engagement of the
people in the communities, which leads to their empowerment. Truglio-
Londrigan introduces multiple case studies to highlight the meaning of
coalitions in health care.
In Chapter 7, “I Told Them, Leave It Alone; It’s OUR Center,” nurse
historian Linda Maldonado brings history to life when recounting nurse-
midwife Ruth Lubic’s lifelong advocacy in developing community-based
primary health care birthing centers in New York in the 1970s, and more
recently advocating for the Family Health and Birth Center in Washington,
D.C. The skills Lubic needed to create these centers included the ability to
work collaboratively within the community, to be responsive to the various
stakeholders, to keep data related to health care outcomes and cost effective-
ness, and above all, the ability to create a safe and healthy environment for
mothers and babies. This chapter reflects how advocacy intersects with a
primary health care philosophy in action.
In Chapter 8, “Integrated Health Care Without Walls,” Judith Lloyd
Storfjell, Lucy N. Marion, and Emily Brigell describe using telehealth with
the seriously mentally ill to support this population. Through a collabora-
tion between the University of Illinois at Chicago College of Nursing (UIC
CON) and Thresholds, the leading freestanding psychiatric rehabilitation
agency in Illinois, integrated primary and mental health care has been pro-
vided to individuals with serious mental illness since 1998. What started as
a half-day clinic at one Thresholds site evolved into three full-time, nurse-
managed health clinics staffed primarily by UIC CON faculty advanced
practice nurses. The health care team uses a primary health care approach
with comprehensive, evidence-based, integrated primary and mental health
care strategies that includes telehealth technology.
Any text about primary health care would be remiss without including
a global perspective. In Chapter 9, “Global Nursing,” Majeda M. El-Banna
and Carol Lang provide a global perspective starting with the United Nations
Millennium Development Goals, introduced in 2000, which were specifi-
cally developed to reduce poverty, hunger, and disease by the year 2015.
They introduce us to the Institute for Health Metrics and Evaluation’s Global
xviii | Preface
Burden of Disease (GBD) database, which compiles comparative data to

identify trends in health worldwide. Compelling case studies reflect the
needs of both developed and developing countries. The call for global health
nurses requires curriculum infused with the ideas of primary health care,
which “are key components in delivering health services to all.”
In Chapter 10, “Culturally Sensitive Primary Health Care Interven-
tions,” Arlene W. Keeling, Brigid Lusk, and Pamela K. Kulbok explore the
meaning of culture both historically and contemporarily. On a Navajo res-
ervation from the 1920s until 1950 nurses learned how to work together
with the Navajo population to build trust that led to acceptance of care. The
second exemplar looks at the care provided for cancer patients post-
mastectomy in the mid-20th century. Both historical exemplars took place
almost 30 years prior to the Declaration of Alma-Ata, yet the nurses’ care
addressed gender inequalities as well as racial inequalities in American
culture. The third exemplar illustrates a community participation model
built on principles of community-based participatory research that is syn-
ergistic with primary health care. In addition, current technologies such as
mapping and photovoic enabled public health nurses and their community
partners to identify geographic trends over time and to target interventions.
These three examples trace the importance of cultural competence in a PHC
practice over time and space.
In Chapter 11, “Community-Based Participatory Research and Primary
Health Care,” Carol Roye and Marie Truglio-Londrigan describe a research
project Roye completed in the 1980s. The findings of her project provided
data for her practice, but it raised additional questions. If participants had
assumed a more active role, she realized that her outcomes might have been
different. This chapter defines the steps involved in community-based par-
ticipatory research (CBPR) and explains how it supports nurses working
within a philosophy of primary health care. Ethical challenges researchers
using this method may encounter are also discussed. Although some may
argue that health care providers know best as a result of their education,
this chapter illustrates how both the consumer of health care and the pro-
vider, working in concert, can learn from each other throughout the
research process.
Primary health care serves as a philosophical beacon for our practice,
research, and education. Each of these chapters reflects the essential ele-
ments of primary health care as outlined in the Declaration of Alma-Ata.
As you read these chapters, we ask you to reflect on your ideas, beliefs, and
values about health care. We encourage you to become fluent in the broader
conversation and comfortable with the actions needed to create a healthier
nation.
Sandra B. Lewenson
Preface | xix
References
De Ville, K. & Novick, L. (2011). Swimming upstream? Patient Protections and
Affordable Care Act and the cultural ascendancy of public health. Journal of
Public Health Management and Practice, 17(2), 102–109.
Greenhalgh, T. (2007). Primary health care: Theory and practice. Malden, MA:
Blackwell Publishing.
Institute of Medicine. (2003). The future of the public’s health in the 21st century.
Washington, DC: National Academies Presss.
Lavizzo-Mourey, R. (2015). In it together—Building a culture of health. Retrieved from
http://www.rwjf.org/en/about-rwjf/annual-reports/presidents-message-2015
.html
Truglio-Londrigan, M., Singleton, J., Lewenson, S. B., & Lopez, L. (2013). Conversa-
tion about primary health care. In Public health nursing: Practicing population-
based care (2nd ed., pp. 399–411). Burlington, MA: Jones & Bartlett Learning.
Wald, L. D. (1915). The house on Henry Street. New York, New York: Henry Holt
and Company.
Acknowledgments
Sandra B. Lewenson
Acknowledging all that came before the planning and writing of this book
is daunting. My colleague Marie Truglio-Londrigan, who was willing to
meet on a weekly basis, deserves credit for her endurance, vision, and
insight. Thank you to our publishers at Jones & Bartlett Learning who risked
publishing a book devoted solely to primary health care. Our students who
every semester learned to reconceive their worldview about health care have
contributed greatly to the genesis and design of this book. To Donna
Avanecean, our graduate assistant and herself a student in the Doctor of
Nursing Practice program at our school, we appreciate your expertise and
support. To our colleague Andréa Sonenberg, who participated in the early
conceptualization of the book, and to our outstanding contributors, we owe
a great debt for helping us to realize this text. Each and every author rose
to the challenge of creating a chapter that examined this particular way of
envisioning health care for all. They gave of their time, their ideas, and their
faith in us generously to create a book that we hope will resonate with
nurses, educators, and students in the years ahead. I also must acknowledge
all the nurses of the past who saw the need to provide access to care for all,
even before the term primary health care was coined. The ideas for this book
come from so many sources, and as my colleague and coeditor Marie notes,
xxi
xxii | Acknowledgments
the ideas about primary health care have emanated from the work of our
graduate department faculty as well.
Finally, I could not have participated in this project without the love
and support of my family. My husband, Richard, a dentist who shares my
views about health care, has supported this project from its very beginning.
My daughters, my sons-in-law, and our sweet granddaughters, Georgia,
Sarah, Pearl, and Mira, have contributed to my understanding about health
care. Thank you all.
The idea for this book is the result of decades of wondering about primary
health care. My awareness of the essential elements of what became known
as primary health care began prior to the Declaration of Alma-Ata as I
embarked on my preparation for nursing at The City University of New
York, Lehman College. Integration of these essential elements into this
nursing program occurred because of the vision of the nursing faculty1 at
that time. I have been fortunate in my professional life to continually come
in contact with men and woman who not only practice according to these
central elements but live their lives that way.
The faculty at Pace University, the College of Health Professions, Lien-
hard School of Nursing saw and continues to see the ideas and values of
primary health care as critical to the profession and to the health of the
people of this nation, and because of this has placed primary health care at
the core of their vision and mission. Thus, the stage was set for development
of a text on primary health care. I thank Sandra B. Lewenson, my partner
in writing this book. Her ideas and support throughout this project were
invaluable, and she is an extraordinary mentor. I also wish to acknowledge
my colleagues as the conversations we have shared over the years continu-
ally astound me. The ideas that are born in conversation truly exemplify the
essential elements of primary health care and provide our students with
the knowledge and skills to change our health care system—not only on the
individual level but on family, community, and population levels as well—as
we work to achieve health for all.
Finally, I wish to thank my husband, Michael Londrigan, and my chil-
dren, Leah Pariso, Christopher Pariso, Paul Londrigan, and Jacqueline
Jeselnik-Londrigan, for their constant support. They listen to me talk—on
and on—about what I am writing even when they do not want to.
1
Graduate faculty who developed the core courses using primary health care concepts included
Catherine Concert, Martha Kelly, Lucille Ferrara, Marie Truglio-Londrigan, Sandra B. Lewenson,
Joanne K. Singleton, Jason Slyer, Andréa Sonenberg, Renee McCloud-Sordjan, and Winifred
C. Connerton.
Contributors
Donna Avanecean, RN, FNP-BC, CNRN

APRN Comprehensive Epilepsy Center
Department of Neurology Hartford Hospital
Hartford, Connecticut
Yaa Boatemaa, MSN, FNP
Veterans Affairs
Brooklyn, New York
Emily Brigell, MS, RN
Director, Nurse Managed Clinics
Clinical Instructor
Department of Health Systems Science
University of Illinois at Chicago College of Nursing
Chicago, Illinois
Cheryl Cooke, PhD, RN
Associate Professor
Adjunct Associate Professor in Women and Gender Studies
University of Washington Bothell School of Nursing and Health Studies
Bothell, Washington
xxiii
xxiv | Contributors
Majeda M. El-Banna, PhD, MSN, BSN, RN

Director of Nursing Advancement Program
Assistant Professor
The George Washington University School of Nursing
Ashburn, Virginia
Mabel Ezeonwu, PhD, RN
Assistant Professor
University of Washington Bothell School of Nursing and Health Sciences
Bothell, Washington
Susan B. Hassmiller, PhD, RN, FAAN
Robert Wood Johnson Foundation Senior Adviser for Nursing, and
Director, Future of Nursing Campaign for Action
Princeton, New Jersey
Arlene W. Keeling, PhD, RN, FAAN
Centennial Distinguished Professor of Nursing
Director of the Eleanor Crowder Bjoring Center for Historical Inquiry
University of Virginia School of Nursing
Charlottesville, Virginia
Pamela K. Kulbok, DNSc, RN, PHCNS-BC, FAAN
Theresa A. Thomas Professor of Nursing and Professor of Public Health Sciences
Coordinator of the Public Health Nursing Leadership Program
University of Virginia School of Nursing
Charlottesville, Virginia
Carol Lang, PhD, DHScN, MSN, BSN, RN
Associate Director Global Initiative Assistant Professor
The George Washington University School of Nursing
Ashburn, Virginia
Brigid Lusk, RN, PhD, FAAN
Adjunct Clinical Professor
Director, Midwest Nursing History Research Center
Department of Health Systems Science
University of Illinois at Chicago College of Nursing
Chicago, Illinois
Linda Maldonado PhD, RN
Assistant Professor
Villanova University College of Nursing
Villanova, Pennsylvania
Lucy N. Marion, PhD, RN, FAAN, FAANP
Dean, Professor, and Kellette Distinguished Chair of Nursing
Augusta University College of Nursing
Augusta, Georgia
Another random document with
no related content on Scribd:
sold in 1830 for one half cent, and issued in New York in a
somewhat proselyting manner by the American Tract Society. It was
a red-letter day in our lives if we could find some curious example to
flaunt before the amused face of Uncle Moses. But the occasion was
rare, indeed, when we found a book which he did not already own.
It was many years ago that I took Uncle Moses’ tip to start collecting
early American children’s books. Hence I am some leagues ahead of
those who got a later start. Many collectors are only now beginning
to rub their eyes and to wake up to the fascination which these tiny
volumes offer to book lovers. Early American juveniles are unusually
interesting for several reasons. To begin with, they give such naïve
samples of the mental food our poor ancestors lived upon in the dim
days of their childhood.
Take, for instance, a small volume published in 1738 by Samuel
Phillips, called History of Our Lord and Savior, Jesus Christ,
Epitomized; for the Use of Children in the South Parish at Andover.
The author says that “his great Lord and Master had commanded his
Ministers to feed his Lambs as well as his Sheep.” But what anæmic
feeding! He sets before his particular lambs sixty pages of the most
indigestible food ever concocted, consisting of questions on and
answers to the most abstruse metaphysical, philosophical, and
controversial subjects! Subjects which are no nearer solution to-day
than when the Rev. Samuel Phillips propounded them for the benefit
of his bewildered little lambs of Andover Parish one hundred and
eighty-nine years ago!
You will find early American children’s books difficult to obtain. There
are but few left in good condition to-day, but it is great fun tracking
them. In the first place, very few were published by our Colonial
presses. Such venerable gentlemen as Cotton Mather and Governor
Winthrop kept the printers too busily occupied issuing theological
works or acts of provincial assemblies; too seriously engaged with
statutes, laws, almanacs, prayer books, catechisms, and sermons, to
print many books for children. Lost in a theological web of their own
weaving, the leaders of the day cared little about the intellectual
amusement of their girls and boys.
But most of the young book fanciers, lucky enough to obtain the few
books issued, mauled them about or destroyed them entirely. They
are generally found with torn and missing leaves—these charming
atrocities have made many copies quite worthless to the collector. I
have been told that it is but normal for a bouncing bibliophile of
twelve months to teethe on the hard board corners of, for instance, a
copy of Cinderella. Indeed, a young child’s attitude toward a book is
not unlike that of a cannibal toward a missionary. Very young
children—this is on record, if you doubt me—have been known to
eat their books, literally devouring their contents.
When I was about seven years old another little boy of the same age
came from a suburb of Philadelphia to spend the day with me. We
quickly struck up a friendship. Although it was raining and we were
forced to remain indoors, we played together quite happily.
Everything went smoothly until late in the afternoon, when our
inventive faculties began to give out. It was then, after we had taken
apart most of my toys, that my little friend’s eyes lighted upon my
books. I watched him cross the room to the low shelf which held
them so neatly, and I remained quiet even as he began to paw them
over. But when I saw him take a pencil from his pocket to write crude
letters of the alphabet along the margins, I flew at him like a wildcat.
Only the immediate intervention of our combined families saved him
from annihilation. We have met many times since, and we always
laugh at the story of my juvenile wrath.
He still insists, after forty years, that his was a perfectly normal
action in a child. I believed in treating a book as something sacred,
even at that age. The germ had evidently entered my system with
my first vaccination!
In 1902 my uncle gave me his wonderful collection of children’s
books.
Among them was his “damn rare” pamphlet, A Legacy for Children,
being Some of the Last Expressions and Dying Sayings of Hannah
Hill, Junr. Of the City of Philadelphia in the Province of Pennsylvania,
in America, Aged Eleven Years and near Three Months, which was
printed by Andrew Bradford, at the sign of the Bible, in Philadelphia,
in 1717. Little Hannah took several days to die, and she insisted
upon having the undivided attention of every member of her family.
She gave them moral advice, told them what they should do and
what they should not do after she had departed. “The Council which
she gave, to her Dear and only Sister and Cousin Loyd Zachary,
whom she dearly loved, was very grave and pithy....”
To-day I have nearly eight hundred volumes, which date from 1682
to 1840. They reveal with amazing fidelity the change in juvenile
reading matter, the change, too, in the outward character of the
American child. They depict the slow but determined growth from the
child of Puritan New England to that of our own day. It is a delightful
change from Virtuous William the Obedient Prentice, and Patty
Primrose, to Tom Sawyer, Huck Finn, Penrod, and Winnie-the-pooh.
If Robert Louis Stevenson had had the temerity to publish Treasure
Island in the good old days of Governor Winthrop he would have
been a fit subject for the common hangman! I do not mean to imply
that the New England boy of the seventeenth century was the
goody-goody thing which his parents tried to make him. If he was
choked with the Bible and threatened with the catechism and the
prayer book, if the creed and Bunyan were ruthlessly thrust down his
innocent young throat, he nevertheless could think of Captain Kidd,
Sir Henry Morgan, the Indians, and the whole machinery of the
boyhood imagination. Free thought was permitted him because there
was no way to suppress it.
The little Puritans! My heart aches for them when I read an example
such as The Rule of the New-Creature. To be Practiced every day in
all the Particulars of which are Ten. This is the earliest book in my
collection. It was published in Boston for Mary Avery, who sold books
near the Blue Anchor, 1682. Imagine the weary little child who had to
listen throughout a long Sunday afternoon to the contents of a book
which started off in this manner:—
“Be sensible of thy Original Corruption daily, how it inclines thee to
evil, and indisposeth thee to good; groan under it, and bewail it as
Paul did.... Also take special notice of your actual sins, or daily
infirmities, in Thought, Word, Deed. Endeavor to make your peace
with God for them before you go to bed.”
There is, too, one of the most famous of all juveniles, the equally
inspiriting and nourishing Spiritual Milk for Boston Babes. In either
England: Drawn out of the breasts of both Testaments for their Souls
nourishment. But may be of like use to any Children. Printed at
Boston, 1684. My copy is the only one known of this date. John
Cotton, the great and influential Puritan minister, had written this
many years before, and it was first published in England in 1646, to
settle a growing dissension among the Puritans, who could not
decide which catechism of the many then in use was best for their
children. This volume grew very popular and from it the little ones
learned to die with much grace, and, therefore, eternal glory. Yet it
was found very difficult to teach the young of New England the
proper way to die; of all knowledge it is the most difficult to impart, as
there are no really good textbooks.
TITLE PAGE OF “SPIRITUAL MILK FOR BOSTON BABES”
Spiritual
MILK
FOR
Boston Babes.
In either ENGLAND:
Drawn out of the breasts of both
TESTAMENTS for their
Souls nourishment.
But may be of like use to any

CHILDREN.
By John Cotton, B. D. Late

Teacher to the Church of Boston in
New England.
Printed at BOSTON,
1684.
The ecstasy over the departure of a pure young child is one of the
most remarkable manifestations of the Puritan spirit. No book shows
this more clearly than the Rev. James Janeway’s A Token for
Children, being an Exact Account of the Conversion, Holy and
Exemplary Lives and Joyous Deaths of several Young Children. This
book passed through edition after edition in England and her
colonies, and was the certain means of saving many children from
hell and damnation. My copy is the only one extant from Benjamin
Franklin’s press, and is dated 1749. Janeway states in his Preface,
which is addressed “to all Parents, School Masters and School
Mistresses or any who have any Hand in the Education of Children:
—
“Remember the Devil is at work hard, wicked Ones are industrious,
and corrupt Nature is a rugged, knotty Piece to hew. But be not
discouraged.”
The author then goes on to relate the wicked bringing into this world
of little children, and dwells lovingly and tenderly upon their wise and
glorious deaths at the age of six or seven or even ten years. An early
death in purity and virtue was a thing to be coveted and desired, and
Janeway requests in his Preface that the teacher should impress
upon the little ones the advisability of imitating the early demise of
these sweet children whose short and devout lives are narrated by
him. Cotton Mather, who wrote a continuation of Janeway, and
described the brilliant, joyous, matchless deaths of New England
children—Janeway described the demise of the children of Old
England—died at the age of sixty-five years, thus prudently
neglecting to follow the example of his beautiful and obedient pupils
who passed away, in all holiness, at the hoary age of six. We shall
select a passage from the celebrated little book, which bears this
title:—
A Token for the Children of New England, or some Examples of
Children, in whom the Fear of God was remarkably budding before
they died; in several parts of New England. Preserved and Published
for the Encouragement of Piety in other children.
The selected passage is as follows:—
Elizabeth Butcher, Daughter of Alvin and Elizabeth Butcher, of Boston,
was born July 14th, 1709. When she was about Two Years and half
Old; as she lay in the Cradle she would ask her self that Question,
What is my corrupt Nature? and would make answer again to herself,
It is empty of Grace, bent unto Sin, and only to Sin, and that
continually. She took great delight in learning her Catechism, and
would not willingly go to Bed without saying some Part of it.
She being a weakly Child, her Mother carried her into the Country for
Health; And when she was about Three Years old, and at Meeting,
she would set with her Eyes fix’d on the Minister, to the Admiration of
all that Sat about her, who said that grown up People might learn and
take Example of her. She took great Delight in reading, and was ready
and willing to receive Instruction.
She was not contented with the bare reading of God’s Word, but
would frequently ask the meaning of it. And when she was at her
work, she would often ask where such and such Places in Scripture
were, and would mention the Words that she might be directed to find
them.
It was her Practice to carry her Catechism or some other good Book
to Bed with her, and in the Morning she would be sitting up in her Bed
reading before any of the Family were awake.
Such goodness could not last, and on the thirteenth of June, 1718,
poor little Elizabeth departed this life, “being eight years and just
eleven months old.”
It is related of another child, Daniel Bradley, the son of Nathan and
Hester Bradley of Guilford, Connecticut, that when the said child was
about three years old, “he had one Night an Impression of the Fears
of Death, which put him into Crying; his Mother told him, if he died he
would go to Heaven; unto which he replied, He knew not how he
would like that Place, where he would be acquainted with no body!”
It is curious how you run unexpectedly upon things which you have
long desired. I always wanted a copy of George Fox’s Instructions
for Right Spelling, printed by Reinier Jansen, in Philadelphia, in
1702. One day I stopped at Travers’s Bookshop in Trenton, New
Jersey. Now Clayton L. Travers is a true bookman; he knows the
business thoroughly. In fact he was an old crony of my uncle. I said
to him that I had been looking several years for Fox’s book. When I
told him the title, he thought for a moment, then disappeared to the
back of the shop. Two minutes later he returned with a little volume
which was in an old sheep binding, the title page decorated with an
elaborate woodcut border. I opened it and read the great Friend’s
simple description of a comma:—
“Comma,” wrote George Fox, “is a little stop or breathing; as Behold
O Lord.” Please note that he placed no comma after Behold! The
discovery of Fox’s old spelling book was a delight to me, but what
made it still more pleasant was Travers’s generosity in letting me
have it for about one quarter its worth. Collector’s luck!
“They be darned small, but the flavor am delicious,” said an old
Southerner to me of the quail in his part of the country. The same
can also be applied to these children’s books. I suppose many
people will wonder why I, an old bachelor, prefer them? I can only
answer with another question. Why is it that old bachelors also write
the best children’s stories? There is no answer. But, thank heaven, I
am not alone in my crime. Another confirmed bachelor, a dear friend
of mine, is quite as enthusiastic on this youthful theme. Dr.
Wilberforce Eames, of New York, one of the greatest students of
books this country ever had, abets me; especially when he casually
informs me of the probable whereabouts of some rarity that I have
been seeking for years.
WILBERFORCE EAMES
Another bookman, my genial colleague, Mr. Lathrop C. Harper, also
of New York, and a great specialist in Americana, has been as much
interested in these little books as I myself. Instead of selling them to
me, Mr. Harper gives me all the tiny juveniles that he can find. He
has just presented to me a little book published in Boston in 1714,
which contains embedded in a waste of theological discussion for
infants, the following priceless gem:—
“O Children of New England, Poor Hearts; You are going to Hell
indeed: But will it not be a dreadful thing to go to Hell from New
England?”
TITLE OF “THE GLASS OF WHISKEY”

THE
GLASS OF WHISKEY.
PHILADELPHIA:
AMERICAN SUNDAY-SCHOOL UNION,
No. 146 Chestnut Street.
Mr. Eames, with generosity equaling Mr. Harper’s, has filled many of
the crevices of my collection with the most interesting gifts. I can’t
say that I altogether approve of the generous impulses of these two
gentlemen—except when it applies to myself! It is very bad for the
book business. If bookmen were encouraged to go about giving
away their precious finds, what would we poor booksellers do?
This reminds me of the long chase I had for Heavenly Spirits for
Youthful Minds some time ago. A customer in Yonkers wrote to me
saying he had this very rare book, supposed to have been issued by
an old Kentucky press in 1800. I was very keen to see it, so I
motored to his home at my first opportunity. When I arrived he
pointed toward the shelves at one end of his library. I saw with
delight and envy the long-sought volume, but when I took hold of it I
was chilled. It felt decidedly clammy. Then, as my friend burst out
laughing, I realized it was a porcelain jug made in the exact shape of
a book! The joke was on me.
My disappointment was not too great, however, as the Heavenly
Spirits was filled with mundane ones—Old Crow whiskey. I accepted
it as gracefully as I could, but I no longer use this imitation volume
for whiskey—I want something larger. Nor would I want to fill it from
the Glass of Whiskey, a tract published for youthful minds in
Philadelphia in 1830. This tiny yellow-covered pamphlet is but two
inches square. The artist who drew the illustrations indicated, with
his picture of a bunch of grapes beneath the title, that he knew little
or nothing of the inspirational sources of whiskey. Perhaps his
innocence secured him the job. Small boys freely imbibing, and the
resultant fruits thereof, are neatly portrayed. With what fascination
and horror little children must have read:—
There is a bottle. It has something in it which is called Whiskey. Little
reader, I hope you will never taste any as long as you live. It is a
poison. So is brandy, so is rum, so is gin, and many other drinks. They
are called strong drink. They are so strong that they knock people
down and kill them. They are sometimes called ardent spirits, that is
burning spirits. They burn up those who drink them.
The appropriate ending must have sent many a tot in search of a
pencil to sign the pledge: “O, how shall I keep from being a
drunkard? I will tell you. Never drink a drop of anything that makes
people drunk.”
I made my first find in children’s books when I was but a child myself.
A playmate of mine had an aunt who lived on Broad Street in
Philadelphia. We passed her house daily, on the way to and from
school. Sometimes we were invited to stop for lunch. One day I
happened to notice a pile of small books on her sitting-room table.
She said she kept them there to amuse the younger children of her
family. Although she knew I came from bookish people, she seemed
surprised that I, a boy of twelve, should be interested in old volumes.
As I could hardly put them down, she was evidently impressed; she
offered them to me. You may well believe that I took them and
rushed out of the house, lest she change her mind. When I reached
home and my uncle saw what I had been lucky enough to receive,
he exclaimed at their rarity. My treasure trove comprised three
wonderful little volumes. They were Black Giles, The Cries of
Philadelphia, and a rare edition of Babes in the Wood.
For thirty years I tried to obtain Benjamin Franklin’s The Story of a
Whistle. “Le grand Franklin,” as they called him abroad, wrote and
published this fascinating story in 1779, when he had his press at
Passy, just outside of Paris. He had printed it in French and in
English, on opposite pages, in a charming pamphlet which he
presented to his friends. He used the little Passy press mainly to run
off official documents and other matters connected with his mission
as the American Minister to the Court of France. In 1923, I bought
one of the two copies that have survived, at an auction sale in
London. It had been briefly catalogued—lucky for me!—as A printed
sheet in French and English, “On Paying too much for a Whistle.”
Although I would have gladly paid £1000 for it, it was knocked down
to me for less than one tenth of this sum.
When discussing printing in this country, it is impossible not to refer
to Benjamin Franklin. He originated almost everything original in
America. His projects are more talked about to-day than when he
lived. Franklin, as a child in Boston, had had a taste of the dull
literary offering of the Pilgrim Fathers. The New England Primer was
then the best seller. When he became a printer he published edition
after edition of it. Although Franklin himself records the sale of
37,100 of these primers, there is but one copy known to exist to-day.
Mr. William S. Mason, of Evanston, Illinois, is the owner of this
unique copy. Surely, in some New England attic there must be
another. The collector can but hope! I have the only one known
printed by his successor, David Hall—shall I ever obtain one from
Benjamin’s own press?
In 1749 Franklin wrote and published Proposals Relating to the
Education of Youth in Pensilvania. This work greatly interests me
and all those who claim the University of Pennsylvania as their Alma
Mater. It was soon after Franklin issued this that he and twenty-three
other citizens of Philadelphia banded together as an association
which soon completed plans to establish an academy for young
men. It opened in 1751. So this little book is a part of the actual
foundation of the University of Pennsylvania. When he was an old
man, eighty-two, to be exact, Franklin was still keenly interested in
new books for children. He had already given his favorite grandson,
Benjamin Franklin Bache, a fine printing press with types, and set
him up as a printer. Under the guidance of his celebrated
grandfather, young Bache printed Lessons for Children from Two to
Five Years Old.
The older man was so delighted with his efforts that he decided, with
a business acumen not diminished with the years, to market the
books for him. Believing Boston to be a good commercial outlet, he
wrote, on November 26, 1788, to his nephew Jonathan Williams:—
Loving Cousin:—
I have lately set up one of my grandchildren, Benja. F. Bache, as a
Printer here, and he has printed some very pretty little books for
children. By the sloop Friendship, Capt. Stutson, I have sent a Box
address’d to you, containing 150 of each volume, in Sheets, which I
request you would, according to your wonted goodness, put in a way
of being dispos’d of for the Benefit of my dear Sister. They are sold
here, bound in marbled Paper at 1 s. a volume; but I should suppose it
best, if it may be done, to Sell the whole to some Stationer, at once,
unbound as they are; in which case, I imagine that half a Dollar a
Quire may be thought a reasonable price, allowing usual Credit if
necessary.
My love to your Family, and Believe me ever,
Your affectionate Uncle
B. Franklin.
The original of this letter is in the collection of Miss Rosalie V.

Halsey.
Competitors and collectors have often complained that I have
frequently purchased at auction rare books that they especially
desired and that I did not give them a chance. Quite true! But I have
often tasted the same bitter medicine myself. I recall, very vividly, a
certain day in May 1913, when the Crane sale was being held in
New York and there was a tiny Royal Primer included among the
items, which I felt belonged to my collection of children’s books.
Printed in Philadelphia in 1753 by James Chattin, this Royal Primer
was the only one of its kind in existence. In the good old days when
George D. Smith was czar of the auction rooms, all other dealers
and collectors were under a terrific strain the moment he appeared.
We knew it was almost hopeless to bid against him.
At that time Mr. Smith represented Mr. Henry E. Huntington. He
entered the auction room armed with as many unlimited bids as a
porcupine has quills. Mr. Smith seemed to take a peculiar delight in
running up bids on the little juvenile books I craved. And I had set my
heart on the Royal Primer from the moment it was shown to the
audience—a beautiful copy in its original sheep cover. I was
prepared to pay as high as $200 for it, but as I watched Smith, the
very shadow and auction voice of Mr. Huntington himself, I had
serious doubts of obtaining it. The bidding started at ten dollars.
Imagine my emotion when it rose rapidly to $1000! I felt a complete
bankrupt. It was no small task to bid against this octopus of the
game, and when the Royal Primer was finally mine at the absurdly
high sum of $1225 I arose quickly and went out for air.
The contents of the primers are generally the same. They begin with
a rhymed alphabet with illustrations, words, and syllables for spelling
lessons. Many of the earliest ones contain verses which were
supposed to have been written by the English martyr, John Rogers,
just before his execution, for the benefit of his “nine small children,
and one at the breast.” Mrs. Rogers and the children are depicted
calmly watching the head of the family at the stake as he is about to
go up in flames. Their little faces are like so many cranberries.
Later primers are equally amusing, sometimes with frontispieces of
George III, and others have dubious likenesses of Our President.
Not even the mother of George Washington could have recognized
her boy’s features in these crude pictures. But the primers were very
popular, and the Puritans continued to issue them. The Beauties of
the Primer was followed by the Primer Improved and the Progressive
Primer, a more elaborate departure, which boasts colored
illustrations.
It was during the early part of the eighteenth century that the Puritan
taste began to broaden a bit. In addition to the early primers and
catechisms, children were encouraged to read the Holy Bible in
verse and semireligious books which had come into fashion. A friend
—Mr. Thomas E. Streeter, of New York, a most discriminating
collector—found in a volume of pamphlets, Some Excellent Verses
for the Education of Youth, to which is added Verses for Little
Children, by a Friend, Boston, printed by Bartholomew Green, 1708.
It was the only copy extant, having miraculously escaped the rough
usage of tiny hands. I despaired of obtaining it, when one day Mr.
Streeter generously sent it to me with his compliments. Here is a
sample of the Biblical verse as it was written to impress the small
reader. Imagine the youth of New England, born with all the lively
desires of a modern child, spending a Sunday afternoon memorizing
such rhythms as:—
Though I am Young, yet I may Die,

And hasten to Eternity.
Another melancholy book of poetry for children was printed in 1740

in New Haven by T. Green. My copy is the only one known to-day. Its
pleasant beginning must have charmed the small reader; thus:
“Children, you must die in a short time. You will soon go to a Heaven
of Joy or a burning Hell.” There are seven poems in each. The
author cannot resist depicting a lugubrious future. Imagine your own
child memorizing this sample, called “The Play”:—
Now from School I haste away,

And joyful rush along to play;
Eager I for my marbles call,
The whistling top or bouncing Ball.
The changing marbles to me show,
How mutable all things below.
My fate and theirs may be the same
Dasht in an instant from the Game.
The Hoop, swift rattling on the Chase,
Shows me how quick Life runs its Race.
My hoop and I like turnings have.
So fast Death drives me to my Grave.
TWO PAGES FROM “THE INFANT’S GRAMMAR”

THE VERBS.
Some Actors of eminence made their appearance,

And the servants, Nouns common, with speed made a clearance
Of tables, chairs, stools, and such moveable things,
As, wherever it goes, the Noun always brings.
And these actors the Verbs, when they’d room to display,
Both wrestled and tumbled; and gambol’d away;
They play’d and they ran, they jump’d and they danc’d,
frisk’d, ambled, and kick’d, laugh’d, chatter’d and pranc’d.
VERBS ACTIVE AND PASSIVE.
The company, laughing, now stood up in ranks,

Whilst the Active Verbs play’d on the Passive their pranks.
But some were so lazy they slept on the floor,
And some were so stupid they stood by the door.
In short, all the actions that mortals can do,
Were done by these Verbs, and endur’d by them too.
Among all the books I have seen that were published at this period in
the Colonies, I have found but one which might be taken seriously if
issued to-day. It treats upon an international problem, good behavior,
which, alas, is the bugaboo of children the world over. Personally I
have always felt that it is the most terrible and obnoxious of all the
moralities—but then, I’m only an old bachelor! The School of Good
Manners Composed for the Help of Parents in teaching their
Children how to carry it in their places during their Minority was
brought out in Boston, reprinted and sold by T. and J. Fleet at the
Heart and Crown, in Cornhill, 1772. It begins with “Twenty mixt
Precepts,” such as “Honour the Magistrates,” and tells little children
plainly what and what not to do. Under a heading of “Behaviour at
the Table,” it admonishes: “Spit not, cough not, nor blow thy nose at
the table, if it may be avoided.” “Behaviour When in Company” is a
little less stringent, perhaps, than one might expect. It reads: “Spit
not in the room, but in the corner.” Further: “Let thy countenance be
moderately cheerful, neither laughing nor frowning.” “For Behaviour
at School” one must “Bawl not aloud in making complaints,” and “Jog
not the table or desk on which another writes.”
It is not probable that these righteously exemplary books could be all
things to all children. What a welcome change the Prodigal Daughter
must have been! Isaiah Thomas, of Worcester, printed her history in
1771, in Boston, before he became famous as the publisher of
simpler children’s books such as Goody Two Shoes. In many of
these early books the title page relates practically the entire story in
scenario form. A case in point is the Prodigal Daughter, or a strange
and wonderful relation, shewing how a gentleman of vast estates in
Bristol, had a proud and disobedient Daughter, who, because her
parents would not support her in all her extravagance, bargained
with the Devil to poison them. How an Angel informed her Parents of
her design. How she lay in a trance four days; and when she was put
in the grave, she came to life again. Quite a happy ending for an
eighteenth-century prodigal!
The gradual change which took place in juvenile literature was
brought about partly by the captivating whimsicalities of Oliver
Goldsmith. The finest collection of Goldsmith’s books is in the
beautiful library of my dear friend, William M. Elkins, but I have a few
of Goldsmith’s juveniles that even he has been unable to obtain.
Goldsmith’s delightful books for children, which his publisher, John
Newbery, had bound in gilt paper and adorned with woodcuts, were
sent over here from his far-famed shop at the corner of Saint Paul’s
Churchyard in London. When they were reprinted in staid New
England, they were a startling innovation to the book trade. Then old
ballads began to return to the market, each with some striking
change also. Contrast the stern outpourings of the learned Cotton
Mather with Doctor Goldsmith’s “Elegy on that Glory of her Sex, Mrs.
Mary Blaize”:—
Good people, all, with one accord

Lament for Madame Blaize,
Who never wanted a good word—
From those who spoke her praise....
She strove the neighborhood to please

With manners wondrous winning;
And never followed wicked ways—
Unless when she was sinning!...
The Royal Battledoor, the Mother Goose Melodies, A Pretty Book for
Children, and some of the best verse ever written for juveniles then
came into being. “Bah, Bah, Black Sheep,” “Pease-Porridge Hot,”
“Little Tommy Tucker”—have they since been improved upon? I
doubt it.
Bah, Bah, Black Sheep
Bah, bah, black sheep, have you any wool?

Yes, sir; yes, sir, I have three bags full.
One for my master, one for his dame,
But none for the little boy who cries in the lane.
Pease-Porridge Hot
Pease-porridge hot,
Pease-porridge cold,
Pease-porridge in the pot,
Nine days old.
Can you spell that with four letters?
Yes, I can: T-H-A-T.
Little Tommy Tucker
Little Tommy Tucker

Sings for his supper;
What song will he sing?
White bread and butter.
How will he cut it
Without e’er a knife?
How will he be married
Without e’er a wife?
I was spending a week-end last summer with some friends who have
a large library consisting chiefly of the classical English authors. I
had been out one afternoon, and as I returned to the house, was met
halfway by my hostess. She had a distraught look, and before I could
inquire what had happened, she said, “I am frightfully upset! What do
you think I found Tommy doing just now in the library? Reading that
nasty old book, Fielding’s Tom Jones!”
Her son Tommy was twelve years old. “What have you done about
it?” I asked, trying to suppress a smile.
“I took it from him and put it in the stove!”
She refused to believe me when I told her that Tom Jones, Clarissa
Harlowe, and Pamela were read aloud in the evening to all members
of the family in Puritan New England, and Miss Rosalie V. Halsey
relates that when certain passages became too affecting, the more
sensitive listeners retired to their rooms to weep! Sometime later I
showed her my copy of Tom Jones, abridged especially for youthful
reading, with its crude little woodcut facing the title page, and this
explanatory verse beneath:—
This print describes a good man’s heart

Who meant to take the orphan’s part,
And may distress forever find
A friend like him to be so kind.

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Community/Public Health Nursing; Promoting the Health

Marie Truglio-Londrigan, PhD, RN

Printed in the United States of America

Chapter 1 Historical Exemplars in Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Awakening of an Idea: Principles of Primary

Chapter 3 Nursing’s Role in Building a Culture of Health . . . . . . . . . . . . . . . . . . 33

Chapter 4 Social Justice, Nursing Advocacy, and Health Inequities:

Chapter 5 The Economics of Caring for Populations:

Chapter 6 Coalitions, Partnerships, and Shared Decision-Making:

Chapter 7 “I Told Them, Leave It Alone; It’s OUR Center”:

Chapter 8 Integrated Health Care Without Walls:

Chapter 9 Global Nursing: Primary Health Care Perspective in

Case Study 3: Primary Health Care Nurse-Led Mobile

Chapter 10 Culturally Sensitive Primary Health Care Interventions:

Chapter 11 Community-Based Participatory Research and

Throughout my career as a nurse, educator, and researcher two main goals

name a few—are being used interchangeably in contemporary social,

approaches, including economic and social value frameworks and

Antonia M. Villarruel, PhD, RN, FAAN

Practicing Primary Health Care in Nursing: Caring for Populations provides

within the practice of nursing, both historically and contemporarily. Each

Defining Primary Health Care

Primary Care Versus Primary Health Care

The Editors’ Perspectives

this discussion, examining how nurses have addressed health disparities in

The child led me on through a tenement hallway where open and

Wald’s commitment to the underserved in the Lower East Side tene-

primary health care and population-based care within their coursework.

Practicing Primary Health Care in Nursing

In Chapter 5, “The Economics of Caring for Populations,” Donna M.

Burden of Disease (GBD) database, which compiles comparative data to

Donna Avanecean, RN, FNP-BC, CNRN

Majeda M. El-Banna, PhD, MSN, BSN, RN

But may be of like use to any

By John Cotton, B. D. Late

TITLE OF “THE GLASS OF WHISKEY”

The original of this letter is in the collection of Miss Rosalie V.

Though I am Young, yet I may Die,

Another melancholy book of poetry for children was printed in 1740

Now from School I haste away,

TWO PAGES FROM “THE INFANT’S GRAMMAR”

Some Actors of eminence made their appearance,

VERBS ACTIVE AND PASSIVE.

The company, laughing, now stood up in ranks,

Good people, all, with one accord

She strove the neighborhood to please

Bah, bah, black sheep, have you any wool?

Little Tommy Tucker

Little Tommy Tucker

This print describes a good man’s heart

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