Course: NURS 3000 Community Health Nursing Theory
The Evolution of Community Health Nursing in Canada
Only five of the 30 years gained in life expectancy over the past century are due to medical interventions (Bunker et al., 1994).
Medicine's impact on global mortality is minor compared to environmental improvements (Naidoo & Wills, 2000).
Early Public Health Efforts
History of public health nursing
Developments Post-WWI and Post-WWII
Changes from the 1970s to present
Establishment of Boards of Health
Lack of formal public health training
Quarantines during outbreaks
Epidemics including small pox & cholera
Development of vaccination programs for tuberculosis
Chart depicts death rate from tuberculosis in Ontario over ten years ranging from 1899 to 1908.
Death rate varied from 1.2 to 1.3 per 1,000.
Total deaths each year ranging from 2,511 to 3,484.
Focus on prevention of communicable diseases.
Addressing sanitation concerns
Emphasis on maternal and child health
Managing outbreaks including tuberculosis
Introduction of nursing education specific to public health.
Implementation of regulations and legislation.
Growth of immunizations and tuberculosis containment efforts.
Advances in clinical medicine for disease treatment.
Majority of health funding allocated to personal health services.
Increased emphasis on immunizations and less on health promotion.
Shift towards prevention and health promotion (fitness, smoking cessation, nutrition).
Key reports:
Lalonde Report (1974)
Ottawa Charter for Health Promotion (1986)
Growing focus on chronic disease and increased surveillance.
Development of population health strategies (1994).
Key actions include:
Strengthening community action
Enabling and mediating health strategies
Advocating for supportive environments
Developing personal skills
Reorienting health services
Building healthy public policies
Enhancements in public health capacity and emergency preparedness.
Management of outbreaks (SARS, H1N1, Ebola, COVID-19).
Formation of the Mental Health Commission of Canada.
Addressing the opioid crisis and implementing harm reduction strategies.
Focus on health equity and determinants of health.
Engaging with the Truth and Reconciliation Commission initiatives.
Public health promotion initiatives targeting obesity and sodium intake.
Challenges with rising STI rates.
Climate change implications.
Measles and monkeypox outbreaks.
Need for robust public health infrastructure.
Origins of community health nursing in Canada.
Reflection on how little has changed structurally in community health nursing.
Transition towards generalist roles.
Emphasis on prevention and health promotion.
Addressing chronic disease and injury prevention.
Development of Nurse Practitioner roles.
Tackling funding challenges for prevention.
Expansion of home care services.
Increased focus on public health capacity.
A voluntary association providing a unified voice for CHNs.
Monitoring trends and issues related to public health nursing.
Setting standards for practice, certification, and competencies.
Control of infectious diseases
Safer and healthier foods
Vaccination efforts
Healthy environments
Enhanced workplace safety
Tobacco recognition as a health hazard
Improvements in motor vehicle safety
Decline in deaths from coronary heart disease and stroke
Establishment of universal health policies
Advancements in family planning
Healthier mothers and babies
Addressing social determinants of health.