Historical Context of Community Health Nursing

colonial period and early republic

-health care responsibility of the family (usually women) tended to the sick

-England’s Elizabethan Poor Law of 1601

-low population density and poor transportation

-1751 Pennsylvania Hospital founded by Ben Franklin

-Early colonial public health effects

U.S. Public health service (PHS)

established in 1798 as the Marine Hospital Service

early experiments of home nursing

-Ladies Benevolent Society of Charleston (1813)

-Philadelphia lay nurses

-Roman Catholic Sisters of Charity (1854)

Shattuck report

-by the Massachusetts Sanitary Commission in 1850

-reviewed seriousness of health problems in factories at the time, how to improve health of children in school, how to train nurses to prevent diseases, improving sanitation in specific areas

industrial revolution

-economic growth

-air and water pollution

-health issues among the factory workers

-infectious disease with immigration and travel

-hospitals become “poor” or “pest” houses

-most people were cared for by physicians in their homes

-nurses cleaned and did laundry

florence nightingale

-first phase of community health nursing

-focused on sick poor

-need for “trained” nurses

-Crimean War: improved using a population-based approach

-developed district nursing

-principles of nursing:

• health of the unity is the health of the community

• sick nursing vs. health nursing

• proper nutrition, rest, sanitation, and hygiene

environmental theory

-Florence Nightingale in the 19th Century

-a healthy environment improve pt’s health

-link between a pt’s environment and health outcomes

-concepts of theory:

• ventilation and warming

• adequate light

• noise control

• cleanliness of the area

• health of houses (pure water, efficient drainage system)

• bed and bedding quality

• personal cleanliness

• variety (providing a pt w/ diverse stimuli and activities within their environment)

• food/nutrition

• offering hope and advice

• observation (monitoring)

william rathbone

-first distinct nursing association in Liverpool, England

-with Nightingale, created nursing in the home and district nursing throughout England

florence sarah craven

created guide to district nurses

need for PHN

-trained nurses usually worked private duty or as admin

-economic advantage of home visiting nurses

origins of organized nursing

-1870s: first nightingale model nursing schools

-1877: womens board of the New York City Mission hired Frances Root to visit the sick and poor

-1885-1886: visiting nurses association

• Buffalo District Nursing Association

• Boston Instructive District Visiting Nurse Association

-Roles of visiting nurses: assess health needs, provide treatment, and educate families on hygiene and disease prevention

district nursing and settlement houses

-deplorable immigrant tenement housing and sweatshops

-focused on health promotion and education (Lillian Wald)

-Henry St. settlement in NYC

• first American community health agency

• nurse provided free or low-cost nursing care to the poor in their homes

• helped with PH in rural areas

Henry Street Settlement Accomplishments

-provided free or low-cost nursing care to the poor in their homes

-influenced the New York City Board of Education to pay for the city’s first public school nurse in 1902

-New York City’s first off-street playgrounds in 1902

-established one of the first transitional housing facilities for the homeless in 1972

-provided public health education to shelter residents during pandemic crisis

-provided meals to shelter residents

-provided case management services to residents of its transitional shelters

-still exists as a social service agency

mary breckenridge

formed Frontier Nursing Services (provides healthcare to rural, underserved populations, educates nurse-midwives)

margaret sanger

provided contraceptive services for women

clara barton

civil war nurse, founder of the American Red Cross

Dorothea Dix

improved conditions for inmates

lina rogers

first U.S. school nurse, illness was often not the reason for absence

national organization for PHN (NOPHN)

standardize PHN education

-1914: first post-training school course in PHN

-1920s-1930s: many newly hired PHN had to verify completion in a certificate program in PHN

American Public Health Association (APHA)

promoted “practical application of public hygiene”

-1872: sought interprofessional teamwork

PHN in Official Health Agencies

-Late 1800s: local health departments

-federal role in PH gradually expanded

-World War I depleted the ranks of PHN

-1918: worldwide influenza pandemic

African-American nurses in PHN

-1919: National Health Circle Bessie M. Hawes

-1936: PHN certificate program for African-American nurses

-wage discrimination in the south

-nursing education segregated until the 1960s

social security act of 1935

funded opportunities for education and employment of PHNs

-funded assistance to states, counties, and medical districts in establishing adequate health services

-provided funds for research and investigation of disease

WWII

-accelerated need for nurses

-nursing council on national defense

-rise in army and navy nurse corps

-bolton act of 1943: cadet nurse corps

-expansion of PHN scope of practice

rise of chronic illness

-national crude mortality rate drops 47%

-change in leading cause of death:

• from communicable to chronic diseases

• aged population increases with chronic diseases

-more home care programs:

• reimbursable by commercial health insurance and later by Medicare and Medicaid

-resurgence in combination agencies

declining support for practice and professional organization

-hospitals preferred for illness and childbirth

-funding stopped for visiting nurse services

-consolidation of national nursing organizations (NLN, ANA)

1960s nursing

-medicare and medicaid

• didn’t include coverage for preventive services

• home health care reimbursed only if ordered by a physician

-increase in for-profit home health agencies

-reduction in health promotion and disease prevention by local and state health departments

1970s nursing

-hospice movement

-birthing centers

-drug abuse programs

-long-term rehab care

-day care for older adults and disabled persons

1980s nursing

-funding challenges

-high health care costs

-shift from health promotion/disease prevention to acute care

national center for nursing research (NCNR)

-national institute of nursing research (NINR)

-the institute of medicine’s report: the future of public health (1988)

-health people initiative begins

1990s nursing

-cost

-quality of care provided

-access to direct care services

present PHN

-increase elderly, disability, chronic disease

-focus on health promotion behaviors

-emphasis on nursing education

-nurse managed clinics/health programs

-many communicable diseases are controlled in the US

• diphtheria

• cholera

• typhoid fever

-other diseases affecting lives around the globeP: HIV, TB, poliomyelitis

-emerging/re-emerging communicable diseases (H1N1 influenza and Ebola virus) underscore global nature of health concerns

PHN current challenges

-needs of new populations (immigrants)

-nurses leaving PHN for higher salaries

• Association of Community health nurse educators calls for increase graduate programs to educate public health nurse leaders, educators, and researchers

-natural disasters require innovative responses

• floods, hurricanes, tornadoes

-manmade disasters and bioterrorism

• increase demand for well-prepared nurses