公共卫生护理对加强社区复原力的影响

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Although there is not a universal definition of community resilience, research indicates the positive impact resilience can have on a community’s health and quality of life, particularly if it is bolstered and buffered by accessible, equitable, and sustainable systems.1 The collective resilience of an already strained public health system was tested during the COVID-19 pandemic. Beginning with the Henry Street Visiting Nurse Service in 1895, public health nursing was envisioned by Lillian Wald and Mary Brewster to promote community resilience, in cooperation with multisectoral private–public partnerships, by meeting people where they are without blaming them for their problems.2

Two articles in this supplement demonstrate the impact of public health nursing practices and policies on strengthening community resilience at multiple levels of influence: adaptive (ability to adjust), absorptive (ability to cope), anticipatory (ability to predict and be proactive), and transformative (ability to transform systems to deal with change and uncertainty).3 Guided by the Community Resiliency Model, Duva et al. (p. S271) describe the impact of a nurse-led public health intervention designed to meet population mental health needs during the COVID-19 pandemic. In partnership with cross-sector entities in Georgia, nurses trained the public to build community resilience capacity against stress from adversity or trauma. Guided by the Public Health 3.0 and community-based participatory frameworks, Austin et al. (p. S275) describe a community-validated mobile application that provided actionable data to communities to address substance use during the COVID-19 pandemic, shifting the focus of the communities from a deficit-based approach to a strength-based or resilience approach.

These holistic, asset-based practical solutions employed technology in novel ways to address existing and emerging public health issues caused by an unexpected pandemic. Nurses know better than most other health professionals where the public health safety net system works and has plasticity and where the system does not work. Public health nurses know how to improve quality of care and serve diverse populations and communities more effectively and efficiently and in an egalitarian way. Too often, public health uses unnecessarily hierarchical and siloed approaches that focus on the deficits of populations, especially vulnerable or underrepresented populations, and on how population deficits contribute to the detriment of communities. Not many people intentionally want to be sick or intentionally want to engage in unhealthful behaviors, such as substance use, that negatively affect them and their communities. Not everyone, however, believes that they have volition and autonomy over circumstances in their lives.

Community participation gives communities a collective voice to provide feedback about public health nursing interventions that will affect the health of their citizenry. Although it may feel time intensive to engage with the community on solutions instead of providing a solution to the community, such an investment could have significant multigenerational health impacts: current generational accumulated stress, adversity, and trauma could be minimized, and future generational community resilience could be maximized to prevent and protect against accumulated stress, adversity, and trauma. Sometimes grassroots public health efforts are what is needed to solve community problems and protect community assets. Sometimes it does “take a village” to strengthen community resilience. This is the essence of the work of Duva et al. and Austin et al. They provide a blueprint for public health nursing interventions that built community resilience capacity against stress from psychological trauma and substance use during the COVID-19 pandemic.

We invite public health nurses to reimagine accessible, equitable, and sustainable public health systems by developing the leadership capacity of local communities to strengthen community resilience. They can do so by such means as organizing consumer or community advisory boards, encouraging community participation in private and public partnerships, and inspiring communities to provide testimonials on their efforts to their local public health commissions and policymakers.

全文翻译（仅供参考）

虽然社区复原力没有一个普遍的定义，但研究表明，复原力可以对社区的健康和生活质量产生积极的影响，特别是如果它得到了可利用的、公平的和可持续的系统的支持和缓冲。从1895年的Henry Street Visiting Nurse Service开始，Lillian Wald和Mary Brewster设想了公共卫生护理，通过与多部门的公私伙伴关系合作，促进社区的复原力，满足人们的需求，而不责备他们的问题。

本增刊中的两篇文章展示了公共卫生护理实践和政策对加强社区复原力的影响，涉及多个层面：适应性（调整能力）、吸收性（应对能力）、预见性（预测和积极主动的能力）和变革性（改造系统以应对变化和不确定性的能力）。通过与格鲁吉亚的跨部门实体合作，护士们对公众进行了培训，以建立社区对逆境或创伤压力的复原能力。在公共卫生3.0和社区参与框架的指导下，Austin等人（第S275页）描述了一个经社区验证的移动应用程序，为社区提供可操作的数据，以解决COVID-19大流行期间的物质使用问题，将社区的重点从基于缺陷的方法转向基于力量或复原力的方法。

这些整体的、基于资产的实际解决方案以新颖的方式采用技术来解决突如其来的大流行病造成的现有和新出现的公共卫生问题。护士比其他大多数卫生专业人员更了解公共卫生安全网系统在哪些方面起作用并具有可塑性，以及该系统在哪些方面不起作用。公共卫生护士知道如何提高护理质量，并以平等的方式更有效和高效地服务于不同人群和社区。公共卫生经常使用不必要的等级和孤岛式的方法，专注于人口的缺陷，特别是弱势或代表性不足的人口，以及人口的缺陷如何导致社区的损害。没有多少人故意想生病，或故意想从事不健康的行为，如使用药物，对他们和他们的社区产生负面影响。然而，并不是每个人都认为他们对自己的生活环境有意志和自主权。

社区参与给了社区一个集体的声音，对将影响其公民健康的公共卫生护理干预措施提供反馈。虽然与社区一起讨论解决方案而不是向社区提供解决方案可能会感觉时间很紧，但这样的投资可能会对多代人的健康产生重大影响：目前这一代人积累的压力、逆境和创伤可以降到最低，未来这一代人的社区复原力可以最大化，以防止和保护积累的压力、逆境和创伤的发生。有时，基层的公共卫生工作是解决社区问题和保护社区资产所需要的。有时确实需要 "一个村庄 "来加强社区的复原力。这就是Duva等人和Austin等人工作的精髓。他们提供了一个公共卫生护理干预的蓝图，在COVID-19大流行期间，建立了社区抗压能力，以应对心理创伤和药物使用。

我们邀请公共卫生护士通过发展当地社区的领导能力来加强社区复原力，重新想象可获得的、公平的和可持续的公共卫生系统。他们可以通过组织消费者或社区咨询委员会，鼓励社区参与私人和公共伙伴关系，以及激励社区向当地公共卫生委员会和政策制定者提供有关他们努力的证词等方式来实现这一目标。

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