1 Copyright © 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

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

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

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

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

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

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

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 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  – Visiting nurse associations were established

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

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

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

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

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Paying the Bill for PHNs  Metropolitan Life Insurance Company  Sheppard-Towner Act  Individual commitment and private financial support  Frontier Nursing Service

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

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

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

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

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

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

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

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

22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community Organization and Professional Change  Civil Rights Movement  Funding increases in certain areas  Economic Opportunity Act

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

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

25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 1990s  Health care debate focused on cost, quality, and access to direct care services  Nursing organizations joined to support health care reform

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