Working Toward a Community-Oriented Healthcare SystemEditorial: by Meredith King-Jensen, MSN, MA, RN; Dana Deravin Carr, DrPH, MS, MPH, RN, BC, CCM; Caroline Mosca, PhD-c, MSN, RN; Coreen Simmons, DNP, MSN, MPH, RN; Audrey Graham-O’Gilvie, DNP; Anne Bové, MSN, RN-BC, CCRN, ANP; and Seth Dressekie, MSN, RN, PMHNP-BC

n EDITOR IAL Working Toward a Community-Oriented Healthcare System

We are all cognizant of the fact that the provision of healthcare is ever changing. Driving those changes is the ever-increasing cost of healthcare.

New York’s recent effort to transform the state’s expensive, inefficient, and ineffective healthcare system into one that achieves the triple aim of healthcare reform—increased quality of care, improved population health, and decreased per-capita costs of care—is the Delivery System Reform Improvement Project (DSRIP). DSRIP’s purpose is to fundamentally restructure the healthcare delivery system by reinvesting in New York’s Medicaid program, with the primary goal of accomplishing healthcare system transformation, clinical management, and population health. The overarching goal of DSRIP is to facilitate a paradigm shift in the delivery of healthcare from hospital-based care to community health, while addressing the disparities in the accessibility and delivery of healthcare in the Medicaid population. New York nurses have thus far played a meaningful role in the DSRIP process and shared in the goals of improved quality care for Medicaid patients, improving actual health outcomes, and lowering costs of care per patient by reducing unnecessary hospital usage.

The National League for Nursing has recently suggested that nurses at all educational levels be prepared to work in a community-oriented healthcare system. New York schools of nursing have thus far facilitated this initiative and have played a meaningful role in the DSRIP process by recognizing that community nursing is necessary to the overall health of populations, and by presenting nursing students with unique opportunities to care for entire communities. In addition to providing nursing students with a community-based experience, New York schools of nursing have also recognized the need for students to learn the process of recognizing cultural differences within ethnic communities and to integrate understanding of cultural diversity into nursing practice.

The performance of the community health nurse in New York depends on a combination of scientific and practical competencies acquired through educational experiences during nursing curricula. By providing nursing students with meaningful and diverse New York community-based experiences, students begin to recognize that a number of neighborhood and communitylevel issues can foster an environment of inefficient care delivery and inadequate care receipt. Many New York neighborhoods, often those of a lower socioeconomic level, simply lack the number of providers needed to accommodate the healthcare needs of a population. By contrast, by providing nursing students with meaningful and diverse global-community-based experiences, students begin to recognize that there are a number of neighborhood and community-level models of healthcare that can foster environments of efficient care delivery and optimize care receipt.

In this issue of The Journal, readers are offered insights into the healthcare-delivery systems of other countries, and, through comparative analyses, can begin to correlate positive health outcomes to the fundamental healthcare delivery model that has been adopted by those countries to the biomedical model currently existing in the United States. By engaging in these comparative analyses, each reader can inform her or his own opinion on which model can facilitate a more efficient and effective healthcare delivery system.

Additionally, as you read this Journal’s article on ethics, you will be offered an opportunity to reevaluate your professional values and to reflect upon how much professional ethics influence your practice.

Meredith King-Jensen, MSN, MA, RN Dana Deravin Carr, DrPH, MS, MPH, RN-BC, CCM Caroline Mosca, PhD-c, MSN, RN Coreen Simmons, DNP, MSN, MPH, RN Audrey Graham-O’Gilvie, DNP Anne Bové, MSN, RN, BC, CCRN, ANP Seth Dressekie, MSN, RN, PMHNP-BC