Introduction to community health

nursing

Lily L. HsuSchool of Nursing

Shanghai Jiao Tong University

History of Community Health Nursing

Before mid 1800s-Early Home Care with focus in Sick and Poor individual.

Orientation: curative agencies: lay & religious orders *St. Phoebe

Mid 1800s to 1900-district Nursing with focus in Sick and poor individual

Orientation: curative/less in prevention agencies: voluntary & some government *William Rathbone

History of Community Health Nursing

1900-1970 public health nursing- Pubic Health Needs, focus in family and orientation in Curative and Prevention

agencies: government & some voluntary *Lilliam Wald

1970 to present-Community Health Nursing, focus in total community and oriented to population health, services address

health promotion; illness prevention agencies: many kinds; some independent practice *Ruth Freedman

Public Health Nursing Development in China

Early Stages: 1925 Beijing Union Hospital-Public Health Agency (Dr. Gland).

1930 rural Health Education

2000 Pay attention to city and rural areas community center development and practice model

2006-2007 Government emphasize the importance of Community health, improve community health centers, functions, farmer health insurances 。

Challenge for China’s Community Health Nursing

Elderly care issues

2000 Population 2050 Population

China Adult Population

National Health Statistics 现有宫颈癌患者 40 万人，死亡率达 11.30% ；宫

颈癌每年新发病例约 13.15 万 目前的乳腺癌发病率也已经达到了每 10 万人口 35

—40 。 2007 年中国糖尿病人约有 3000 万。据 WHO 最

新数据预测，到 2010 年中国糖尿病人将达到目前的 4 倍。

世界卫生组织预测，中国每年确诊的新增结核病例为 880 万。

National Health Statistics Maternal Mortality Rate 48.3/10 万 （ 2004 ） Skillful Professional Handle delivery 97 ％ （ 200

3 ） Female : male children attending school 1 ： 1 ，

Junior school admission 0.92 （ 2002 ） Female children attending elementary school

95.8% (2002) 15 － 25 岁妇女识字率 98 ％ （ 2004 ） Newborn mortality rate 15.4/1000, 2004 < 1 year old infant death rate ： 30/1000 （ 200

3 ） <5 years old children mortality ： 37/1000 （ 200

3 ）

The Top Five Major Cause of Death in China

Cardiovascular Diseases Malignant Tumor Cerebrovascular Disease Disease of Respiratory System Injury 、 Intoxication

(National data, 2004)

Issues in Chronic Diseases

DM Hypertension Stroke Cardiovascular diseases Obese Smoking TB

Health Beyond Acute Care Settings-Community Care and Public Health

Public Health Definition

Public health is the Science and Art of :

preventing disease,

prolonging life,

promoting health and efficiency through organized community effort.

(Winslow, 1920)

Definition of Community Health (ANA,2000 ）

Community health nursing is a synthesis of nursing and public health practice applied to promoting and preserving the health of populations.

Treat “ Population as a Whole” Focus on individual, family, groups, community Utilizing Health promotion, health

maintenance, health education, and management, coordination, and continuity of care for meeting population needs.

Characteristics of Community Health Nursing

It is a field of nursing It combines public health and

nursing It focus in population and

environment factors that may impact to people’s health

It emphasize in health promotion, illness prevention, and wellness

Characteristics of Community Health Nursing It promotes client responsibility and

self-care

It uses aggregate measurement and analysis

It use principle of organizational theory

It involves inter-professional collaboration.

Pubic Health is for: The sanitation of environment, The control of communicable infections, The education of the individual in personal hygiene, The organization of medical and nursing services for

The early diagnosis and preventive treatment of disease, and

The development of the social machinery to insure everyone a standard of living adequate for the maintenance of health ,

Healthy Life Style and Longevity .

Community Health Practice

Health Promotion

1. Increase the span of healthy life for all citizens

2. Reduce health disparities among population groups

3. Achieve access to preventive services

for everyone.

Roles of Community Health Nurses

Researcher

Leadership

Collaborator Manager

Advocate

Educator

Clinician

Nurses

Health Prevention

Tertiary Prevention

Secondary Prevention

Primary Prevention

Primary Prevention for Health Promotion Health Education Adequate Nutrition Individual Development Adequate working environment and

recreation, resting Pre-marriage counseling and education Genetic Counseling Regular Physical Examination

Primary Prevention for Health Protection Comply with immunization Individual hygiene Improve environment sanitary Occupational Safety Prevent Accident in all ages Adequate nutrition Avoid cancer cause agents Avoid allergic

Secondary Prevention

Identify cases in the community Screen and test Conduct special physical

examination Treat and prevent the progress of

illness Avoid the spreading of disease Reduce the disability time

Tertiary Prevention

Treat and stop the disease progress and avoid complication and side effect

Limit the chance for disability Provide rehabilitation for physical and

psychological well-being, occupational therapy, availability of long-term care

Characteristics of community health

nursing

it is a field of nursing it combines public health with nursing it is population-focused it emphasizes wellness it involves interdisciplinary

collaboration it promotes clients’ responsibility and

self care

Setting for community health nursing practice

homes ambulatory service settings schools occupational health setting residential institutions the community at large

Opportunity for Future Community Health Nursing

Chronic Disease management Home Care Extended care from Acute care setting Elderly care Rehabilitation care in different population Health promotion in every level Health system referral, emphasize individual

role and function of community health sector