Introduction to Community Health Nursing Unit 1 Objectives Upon completion of this unit you should be able to: Define

community health nursing Describe community health practice settings Describe the importance of community health nursing education within the school of nursing curriculum Describe important historical time periods, milestones and developments of public health and community health nursing Explain the role of historical nurse leaders in the development of community/public health nursing Identify and describe the major areas of focus of public health Identify and describe future trends in community/public health nursing Definitions Community based nursing- minor acute and chronic care that is comprehensive, coordinated, and delivered outside the institutional setting (work, home, school) Public health nursing- population based practice focusing on disease and disability prevention as well as health promotion of the entire community Community health nursing- nursing care in the community setting that combines the practice of community based nursing and public health nursing The primary difference between these three terms is the focus of care either on the population of a community or on an individual or family. What Is Community Health Nursing? Delivery of care utilizing systematic processes Includes preventative, curative and rehabilitative care The client can be the individual, family or community group Care provided will in turn improve the overall health of the population Care is provided outside of the institutional setting (hospital, nursing home) The focus of care is health promotion, health maintenance, and disease prevention among a specific group of people. You will see the terms public health nursing and community health nursing used interchangeably. Even if care is provided to an individual, it is the belief of community nursing practice that improving the health of the individual ultimately improves the health of the population. Community Health Nursing Practice Scope of practice and standards for community health nursing is set by the American Nurses Association (ANA) The Quad Council of Public Health Nursing Organizations is an alliance of four national nursing organizations. Association of Community Health Nurse Educators (ACHNE) ANAs Congress of Nursing Practice and Economics (CNPE) American Public Health Association (APHA) Association of State and Territorial Directors of Nursing (ASTDN) These organizations are responsible for addressing public health nursing practice issues. The Quad Council also develops practice competencies and standards of care. Where Do Community Health Nurses Practice? Current Trends in Public Health Nursing The objectives of public health practice include: Promotion of health Prevention of disease Provision of health care services Rehabilitation from disease or injury

Core Functions of Public Health Practice To achieve the four objectives, practitioners engage in three core functions of public health nursing Assessment- regular and systematic assessment of the health needs of the community Policy Development- creating public policies that address the communitys needs Service- ensuring that the necessary services are available to met the needs identified during the assessment phase. Community Health and Curriculum A 2008 Department of Health and Human Services (DHH) survey showed that 62.2% of RNs work in the hospital setting. So while the majority of nurses work in an institutional setting, there is a large number who do not. In fact the number or nurses working outside a traditional setting is increasing ; a growing trend brought about by changes in how health care is administered (and paid for). The number of RNs working in home health increased from 3.8% in 2004 to 6.4% in 2008 The number of RNs working in public health and community health settings increased by 128% from 1980-2004. Health issues of the community have a direct impact on the patients you will care for regardless of the setting. Louisiana ranks fourth in the nation for HIV infection. Baton Rouge ranks second in infection rates for metropolitan cities (New Orleans is third). Nurses who work in the Baton Rouge area will at some point care for a patient with HIV. Community Health and Curriculum The greatest need for nurses in the future will be in some sort of community setting. Community health concepts are included in our curriculum to prepare future graduates to function in diverse community settings. Development of Public Health Nursing In order to understand the current trends in community health nursing, it is important to see how the practice developed. Evidence of early civilizations focusing on birth, health, illness and death. Early humans lived in mostly isolated tribal units. As the population grew the tribal units gave way to communal living which created health problems. Study of public health began with inquiries about disease, illness, and death. Advances in scientific inquiry during the Renaissance period marks the beginning of public health as a formal discipline. Historical MilestonesEarly Civilization Hippocrates (400 B.C.) credited with being the first to document the influence of environment, diet, and work on health and disease Hebrew writings in the Old Testament link cleanliness (hygiene) and diet with health Greeks (500 B.C.) document the first communicable disease on record- malaria Greek mythology reflects their cultural values of cleanliness and sanitation (Hygeia was the goddess of health and Panacea was the restorer of health) Egyptians developed pharmaceuticals and public sewer systems Early Christian/Roman Era Romans developed public sewer systems and aqueducts Romans were the first to document worker health, specifically that of air quality for miners Romans adopted Christianity as a religion which promoted a caring/social community (good Samaritan, love thy neighbor) Fabiola and Paula (two Christian women in Rome) create hospitals and homes for the sick Middle Ages Roman Empire declines and with it goes their values of health and hygiene Poor sanitation and hygiene practices are present resulting in epidemics Care of the ill was haphazard and provided within the home The few hospitals that did exist were located in monasteries and convents. Care was provided by monks and nuns

primarily for the residents of the monasteries and the wealthy Influenza, small pox, and the bubonic plague (which killed approximately of the population) spread across Europe Military nursing orders developed during the Crusades Renaissance Characterized by scientific thought and social consciousness Universities established Dissection of the dead became an accepted practice Statistical data collected on cause of death marking the beginning the fields of public health and epidemiology Cleanliness and sanitation rules developed for towns Formal training for physicians developed English Poor Law of 1601 is the beginning of government provided care to the poor Sisters (or Daughters) of Charity founded (they are still active today). Hospitals were established however, fatality rates were poor. They were referred to as death houses and care was provided by ward maids, the equivalent to housekeepers Sanitary Movement Small pox vaccine discovered by Edward Jenner becomes first compulsory vaccine for an infectious disease in England Louis Pasteur introduces the germ theory Joseph Lister institutes asepsis technique with surgical instruments and hand washing. Nurse Training Movement Florence Nightingale Considered the Mother of Modern Nursing During the Crimean War, she documented statistics and notes on the numbers of patients she cared for, her interventions and the patients outcomes. She is also considered the first nurse epidemiologist Published writings emphasizing the need for formal nursing training In 1859 established the district nursing association in Liverpool, England. This was the first formal group of public health nurses to visit sick patients in their homes and work with the community Opened the first school of nursing Nurse Training Movement Clara Barton established the Red Cross in the United States in 1864 Francis root became the first trained nurse in the United States to work as a visiting nurse in 1887 Nurse Training Movement Lillian Wald Coined the term public health nursing and is considered to be the Mother of Public Health Nursing. She worked to improve the education of public health nurses. Advocated for better housing and for occupational health nursing Worked to change child labor laws Founded the national Organization of Public Health Nursing which set practice standards and guidelines Assisted the Red Cross to establish visiting nursing services in rural areas In 1909 secured the first payment for visiting nurses services from Met Life Insurance Company signifying the first incidence of payment from an insurance company for nursing The Twentieth Century Early twentieth century saw a shift from community based nursing care to hospital based nursing care Growth of health insurance business resulted in the growth of hospitals and early visiting nursing programs were replaced with inpatient hospital care The labor union movements in 1920s and 1930s required employers to provide health insurance By the 1950s insurance companies attempted to decrease costs of expensive hospital stays by employing visiting nurses

Computers provided easier and more accurate record keeping of vital statistics, outcomes, and health data Discovery of antibiotics and vaccines significantly decrease mortality and morbidity in the U.S. (discovery of antibiotics and mass immunization had the greatest impact on public health) Top Ten Achievements in the Twentieth Century Immunization- mass immunization to control spread of communicable diseases Motor vehicle safety- use of seatbelts and improved design focusing on safety decrease injury and death Workplace safety- labor union movements and occupational safety legislation improve work environments Control of infectious disease- antibiotic use, immunizations and increased knowledge contain the spread of infectious diseases Community Health Nursing in the 21st Century Factors that will influence community health nursing in the 21st century Health Care Delivery System Demographics Globalization Poverty and Growing Disparity Violence, Injury, and Social Disintegration Health Care Delivery System Simply defined as how health care is provided (and financed) to a population In the US it is a complicated system involving government programs, private industry and nonprofit organizations Cost containment is presently the central focus of debate. Changes in payment policies for private insurance, Medicare and Medicaid, and loss from fraud/billing abuse affect how health care is administered Institutions (hospitals) are more likely to be places where high risk/highly technical procedures are performed. Emergency departments and ambulatory surgical centers are seeing an increase in visits Community based services (hospice, home health, wellness care in the workplace) will increase as the cost of inpatient institutions increase. In the U.S., the goal of public healthcare is to maintain and improve the health of the population as a whole, not the individual. The current system however, is focused on individual rather than community care and cure rather than prevention. Changes in government policy such as the Patient Protection and Affordability Act and the Health Care and Education Reconciliation Act will have an affect on the current health care delivery system. Demographics Cultural Diversity According to the US Census Bureau, the population of the U.S. will become more diverse. The Hispanic ethnic population will be the largest group and Asians/Pacific Islanders will show the largest growth in population. Community health nurses will need to expand their knowledge of various cultural groups Aging U.S. population Public health successes have contributed to longer life spans Elderly (age greater than 65) are currently the largest consumers of health care. The oldest Boomers in the U.S. recently turned 65 so the aging population trend in our history is just beginning. By 2040, the number of people (globally) aged 65 and older will be 1.3 billion, which is slightly less than the current population of China and slightly more than Indias current population Globalization Economically speaking, globalization is the integrated world economy marked by free trade, free flow of capital and cheaper foreign labor markets Globalization allows for the sharing of ideas, technology, philosophy and capital across national borders A global village has been created as a result of the free sharing of ideas, philosophies, technologies and capital Changes (health related, economic, political) in one country will have an effect on other countries- this can be positive or negative. Think about how the stock market is affected by world events.

Positive Effects of Globalization Free trade allows for the import of low cost consumer goods- this keeps costs down for the consumer. Technology and innovations are available to a broader range of areas Increased living standards Negative Effects of Globalization Adoption of unhealthy Western lifestyles Faster transmission of communicable diseases Loss of ideology and cultural identification for some countries While the world economy has increased, disparities still exist (the rich countries continue to get richer, poor countries remain poor) Lax trade policies can have a negative impact on consumers- for example, goods manufactured overseas may be produced at a lower cost, but due to lax regulations the product may not be high quality (Chinese drywall for example) or may contain drugs or chemicals that are banned in one country but acceptable in others Companies are moving manufacturing to areas that have lower labor costs resulting in loss of jobs in the U.S. Poverty and Growing Disparities According to the CDC Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. In 2002, influenza vaccination coverage among adults 65 years of age and older was 70.2% for whites and 46.7% for Hispanics/Latinos . The gap for pneumococcal vaccination coverage among older adults was even wider, with 60.6% for whites and 23.8% for Hispanics/Latinos . This is an example of a health disparity. Poverty Estimated that 1.3 billion people around the world live in poverty In the U.S. in 2009, 14.3 % of the population lived in poverty It is one of the greatest challenges to global health and a leading cause of health disparities in the U.S. and around the world. Violence, Injuries and Social Disintegration Violence Is increasing around the world Terrorism/bioterrorism is a worldwide threat Violence/discrimination against women is common throughout the world and its elimination is the focus of many world wide organizations Adversely impacts society Costs billions of dollars/year in the form of medical care, rehabilitation, and losses to workforce. Gang activity which has historically been present in large metropolitan areas has now reached smaller rural communities Contributing factors to increasing violence in the U.S include acceptability of violence as part of the culture racism, classism and sexism availability and accessibility of firearms lack of accountability Violence, Injury and Social Disintegration Prevention of injury is a Healthy People 2020 priority (you will learn more about Healthy People 2020 in later chapters) Injury prevention objectives include the prevention and promotion of: Firearm-related deaths Identification of improper firearm storage in homes Surveillance of external causes of injury in emergency departments Decreased incidents of homicide, child maltreatment, and physical assault Sexual assault Weapon possession by adolescents on school property