1. Chapter 2 Evolution of Community Health Nursing

3. SOCIETAL INFLUENCES ON THE DEVELOPMENT OF COMMUNITY HEALTH NURSING::
Many factors have influenced the growth of community health nursing. To better understand the nature of this field, the forces that began and continue to shape its development must be recognized.
Six are particularly significant: advanced technology, progress in causal thinking, changes in education, demographic changes and the role of women, the consumer movement, and economic factors.

4. Advanced Technology
For example, technologic innovation has greatly improved health care, nutrition, and lifestyle and has caused a concomitant increase in life expectancy, community health nurses direct an increasing share of their effort toward meeting the needs of the elderly population and addressing chronic conditions.
Advanced technology also has been a strong force behind industrialization, large-scale employment, and urbanization.

5. Population density leads to many health-related problems, particularly the spread of disease and increased stress. In addition, changes in transportation, new products, equipments, methods and energy sources in industry also have increased environmental pollution and industrial hazards.

6. Progress in Causal Thinking
Relating disease or illness to its cause is known as causal thinking in the health sciences. Progress in the study of causality, particularly in epidemiology, has significantly affected the nature of community health nursing. The germ theory of disease causation is the best example.

7. A second advance in causal thinking was initiated by the tripartite view that called attention to the interactions among a causative agent, a susceptible host, and the environment. For example: nurses could decrease the vulnerability of individuals (host) by teaching them healthier lifestyles.
Further progress in causal thinking led to the recognitions that not just one single agent, but many factors – a multiple causation approach – contribute to a disease or health disorder.
Community health nurses can control health problems by examining all possible causes and then attacking strategic causal points.

8. Nursing’s contribution to public health adds a further application of causal thinking. Nurses promote healthier lifestyle practices such as eating low-fat diets, exercising and maintaining social support systems; promote healthy conditions in schools and work sites; and design meaningful activities for adolescents and the elderly.

9. Changes in Education
Changes in education, especially those in nursing education, have had and important influence on community health nursing practice.
For the community health nurse, health teaching had steadily assumed greater importance in practice. For the learner, education ahs led to more responsibility. As a result, people behind the care they receive.
Scientific inquiry considered basic to progress, has created a dramatic in crease in knowledge.

10. Now, community health nurses needs skills in such areas as population assessment, policy making political advocacy, research, management, collaborative functioning, and critical thinking. As the result of expanding education, community health nurse have has to reexamine their practice, sharpen their knowledge and skills, and clarify their roles.

11. Demographic changes
The changing demographic in country and the changing role of women have profoundly affected community health nursing. Women achieved the right to vote and gained greater economic independence by moving into the labor force.

12. Salaries for nurses compare favorably with those for other workers who have four years of education in fields other than health care, such as education.
Changing demographics, such as shifting patterns in immigration, varying numbers of births and deaths, and rapidly increasing population of elderly persons, affect community health nursing planning and programming efforts. Monitoring these changes s essential for relevant and effective nursing services

13. The consumer movement
Health care consumers are viewed as active members of the health team rather than as passive recipients of care.

14. The consumer movement also has contributed to increased concern for the quality of health services, including a demand for more humane, personalized health care. Dissatisfied with fragmented services offered by an array of health workers, consumers seed more comprehensive, coordinated care.
Community health nurse seek to provide holistic care by collaborating with others to offer more coordinated, comprehensive, and personalized services a case management approach.

15. Economic Forces
Unemployment and the rising cost of living, combined with mounting health care costs, have resulted in numerous people carrying little or no health insurance. With limited or no access to needed health services, these populations are especially vulnerable to health problems and further economic stress. Global economic forces also influence community health nursing practice.

16. PREPARTATION FOR COMMUNITY HEALTH NURSING:

17. Academic Preparation:
The minimum preparation for community health nurses is graduation from a baccalaureate- level nursing program:
A comprehensive nursing education that is rich in leadership, management, research, health maintenance and promotion, disease prevention, and community health experience is needed to meet the demands of this specialty.

18. Professional Development
Completion of a baccalaureate education may not be sufficient educational preparation for the more demanding community health nursing settings. It is mandated that nurses participate in continuing education programs and receive continuing education units.
A master’s degree program in nursing is a longer commitment and gives the nurse greater marketability.

19. A master’s degree in business, public health, education, or epidemiology can lead to management positions, private community health agency ownership, agency teaching, or research positions.
A doctoral program may be the next educational step for those wanting academic university teaching, research, or upper-level administrative positions.