Chapter 02 History of Public Health and Public and Community Health Nursing

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 02

History of Public Health and Public and Community Health Nursing


Objectives

1. Interpret the focus and roles of public health nurses (PHNs) through a historical approach.

2. Trace the ongoing interaction between the practice of public health (PH) and that of nursing.

3. Discuss the dynamic relationship between changes in social, political, and economic contexts and nursing practice in the community.


Objectives, Cont’d

4. Outline the professional and practice impact of individual leadership on population-centered nursing.

5. Identify structures for delivery of nursing care in the community.

6. Recognize major organizations that contributed to the growth and development of population-centered nursing.


Colonial Period Household members (usually women) tend to

the sick Urbanization in the early 1800s causes this

system to became insufficient England’s Elizabethan Poor Law of 1601

1751 Pennsylvania Hospital founded Early colonial PH efforts After American Revolution

First PH committee was established


After American Revolution Public Health Service (PHS)

Established in 1798 as the Marine Hospital Service

Early experiments in providing nursing care at home Ladies Benevolent Society of Charleston (1813) Philadelphia lay nurses Roman Catholic Sisters of Charity (1854)

Shattuck Report (1850) by the Massachusetts Sanitary Commission


Nightingale and the Origins of Trained Nursing

Need for nurses Origins of organized nursing

Pastor Theodor Fliedner Crimean War

• Improved soldiers’ health using a population-based approach

Principles of nursing• “Health of the unity is the health of the community”• Differentiated “sick nursing” for “health nursing• Proper nutrition, rest, sanitation, and hygiene necessary


Nightingale and the Origins of Trained Nursing, Cont’d

William Rathbone Founded first district nursing association in

Liverpool, England Rathbone and Nightingale recommended steps to

provide nursing in the home, and district nursing was organized throughout England

Florence Sarah Lees Craven “Guide to District Nurses”


America Needs Trained Nurses Need for PH nursing

Increase of women in workforce More economical to have home-visiting nurses

Origins of organized nursing 1870s – First Nightingale model nursing schools

started 1877 – Women’s Board of the New York City

Mission hired Frances Root 1878 – Ethical Culture Society of New York hired

four nurses to work in dispensaries 1885-1886 – Visiting nurse associations were

established


District Nursing and Settlement Houses

Deplorable environmental conditions in immigrant tenement housing and sweatshops

District nursing and settlement houses established

Rural Nursing Service Occupational Health


School Nursing in America Grew out of school absences caused by the

prevalence of infections and communicable diseases

Lina Rogers—first United States school nurse Worked with children in New York City schools She and her other school nurses found illness was

often not the reason for absence. Significant and positive impact

More nurses hired School nursing soon implemented in Los Angeles,

Philadelphia, Baltimore, Boston, Chicago, and San Francisco


The Profession Comes of Age in the United States in the Twentieth Century National Organization for PHN (NOPHN)

Sought to standardize PHN education 1914 – First post-training school course in PHN

offered at Teachers College in New York City 1920s to 1930s – Many newly hired PHNs had to

verify completion in a certificate program in PHN, American Public Health Association (APHA)

Established in 1872 Sought to facilitate interprofessional efforts and

promote the “practical application of public hygiene”


PHN in Official Health Agencies and in WWI

Late 1800s – local health departments formed

Federal role in PH gradually expanded 1912 – U.S. Public Health Service role defined NOPHN loaned a nurse to the U.S. Public Health

Service• First federal government sponsorship of nurses

WWI depleted the ranks of PHNs 1918 worldwide influenza pandemic


Paying the Bill for PHNs Metropolitan Life

Insurance Company Sheppard-Towner Act Individual commitment

and private financial support Frontier Nursing

Service


African-American Nurses in PHN 1919: National Health Circle for Colored People

Bessie M. Hawes 1936: PHN certificate program for African-American nurses Wage discrimination in the South Nursing education segregated until 1960s


Between the Two World Wars Economic depression

Agencies and communities not prepared to address the increased needs and numbers of impoverished• Decreased funding

Agencies that helped to support nurse employment• Federal Emergency Relief Administration (FERA)• Works Progress Administration (WPA)• Relief Nursing Service• Civil Works Administration (CWA) programs

1932 survey found only 7% of nurses working in PH were adequately prepared


Increasing Federal Action for the Public’s Health

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


World War II Accelerated need for nurses, both for war

effort and at home Nursing Council on National Defense Many nurses joined the Army and Navy Nurse

Corps. Bolton Act of 1943 established Cadet Nurses

Corps Some expansion of PHN scope of practice

Emergency Maternity and Infant Care Act of 1943 Job opportunities


Rise in Chronic Illness National crude mortality rate decreased by

47% Change in leading cause of death from

communicable diseases to chronic diseases Aged population grew as did prevalence of

chronic disease Some visiting nurse associations provide

home-care programs Reimbursable by commercial health insurance and

later by Medicare and Medicaid Resurgance in combination agencies


Declining Financial Support for Practice and Professional Organizations

Hospitals preferred for illness and childbirth Funding stopped for visiting nurse services Consolidation of national nursing

organizations National League for Nursing American Nurses Association


Professional Nursing Education for PHN

National League for Nursing adopted Esther Lucile Brown’s Nursing for the Future (1948) Recommended to establish basic nursing

preparation colleges and universities• Included PHN concepts in all baccalaureate programs;

however, these were very brief components of the curricula

1950s – PHN practice increased focus on the psychological elements of client, family, and community care


1960s Medicare and Medicaid

Did not include coverage for preventive services Home health care only reimbursed 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


Community Organization and Professional Change

Civil Rights Movement Funding increases in certain areas Economic Opportunity Act


1970s Nurses made significant contributions to:

The hospice movement The development of birthing centers Day care for older adults and disabled persons Drug abuse programs Rehabilitation services in long-term care


1980s Concern about high health care costs Funding shifted away from health promotion

and disease prevention to acute care National Center for Nursing Research

(NCNR) established in 1985 Gained official status within National Institutes of

Health in 1993, becoming National Institute of Nursing Research (NINR)

IOM’s Report The Future of Public Health (1988)

Healthy People initiative began


1990s Health care debate focused on cost, quality,

and access to direct care services Nursing organizations joined to support health

care reform


2000s Health Care Reform finally passed in 2010

with the federal Patient Protection and Affordable Care Act

PHN organizations develop position papers on: Graduate education for advanced practice PHN Faculty qualifications for community/public health

nursing educators Importance of PHN within PH systems

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Chapter 02 History of Public Health and Public and Community Health Nursing

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