THE HISTORICAL

CONTEXT
OF
COMMUNITY HEALTH
NURSING

Significance of History
to Practice -1

The "task of the true historian is to

so relate the past with the present that
our future work is more clearly
outlined in the light of former
mistakes or seemingly feeble
beginnings" (Foley, 1985).

Significance of History
to Practice -2

Community health nursing was

created as a specialty field to meet
the health needs of society. It must
change as societal needs change in
an unfolding history.

Historical Roots
Code of Hammurabi
Ancient Egypt
Hebrew Mosaic Law
Ancient Greece
Ancient Rome
Care of the sick as a family task

Christian Influences - 1
Care of the sick was seen as an means of

serving God and redeeming ones sins.

Supporting services provided by others
was easier than caring for them yourself.
Some religious groups took on the
particular task of care of the sick.

Christian Influences - 2
Mysticism and denial of bodily needs in the
middle ages fueled disinterest in health.
The need for healthy soldiers for the Crusades
recreated a focus on health.
Crusaders brought back the concept of hospitals
as a place to care for the sick, but did not address
the Eastern concept of care by paid professionals.

The Renaissance
Advances in scientific thought permitted
interventions to control disease.
Rise of a social conscience and recognition of
social responsibility for the health and welfare of
the population led to governmental public health
initiatives.
The concept of visiting nursing was instituted in
the work of the Sisters of Charity.

Colonial America
Low population density reduced the spread
of communicable diseases and resulted in
relatively good health.
Care of the sick again became a function of
the family due to the lack of professional
providers in isolated areas.

Early Public Health Efforts

Early public health efforts were sporadic,
usually in response to an epidemic of
communicable disease.
Quarantine measures and prohibitions on
environmental pollution were enacted by
some communities.
Collection of vital statistics was initiated.

Other Early Efforts

The Act for Relief of Sick and Disabled
Seamen in 1798 was the first national effort to
address health issues.
In 1813, the Ladies Benevolent Society of
Charleston, SC provided the first organized
approach to home care of the sick in the U.S.

The Industrial Revolution - 1

The need for cheap labor to support
industrialization led to massive immigration of
European poor.
Poor living and working conditions among the
working poor in Europe and the U.S. led to
poor health and widespread disease.
Social reformers undertook changes to
promote the health and welfare of these groups.

The Industrial Revolution - 2

Members of upper socioeconomic groups
saw a need to provide health care for the
poor because of the risk of the spread of
communicable diseases to themselves. This
realization led to monetary support for
health care services for the poor.

The Industrial Revolution - 3

Several important reports raised social consciousness regarding
the working poor:
Thakrahs The Effects of Arts, Trades, and Professions . . on
Health and Longevity
Chadwicks Inquiry into the Sanitary Conditions of the
Labouring Population of Great Britain
Rumseys Essays on State Medicine
Shattucks Report of the Massachusetts Sanitary Commission

Nursing and the Publics Health

Florence Nightingale established district nursing
in England in 1859 with the help of William
Rathbone.
Lillian Wald established the Henry Street
Settlement in 1893.
Wald was also active in the initiation of school
nursing and rural nursing as well as in a variety of
political advocacy activities for poor and
underserved groups.

Standardizing Practice - England

Metropolitan and National Nursing
Association for Providing Trained Nurses
for the Sick Poor (1875)
Queen Victorias Jubilee Institute for
Nursing (1889)

Standardizing Practice - America

Victorian Order of Nursing (1897, Canada)
Cleveland Visiting Nurse Association
Public health nursing journals
National Organization of Public Health
Nurses (NOPHN) (1912, U.S.)
National League for Nursing (1952, U.S.)

Education for Practice -1

Instructive District Nursing Association of
Boston postgraduate course (1906)
First university course in public health nrusing,
Teachers College of Columbia University
( 1910)
Inclusion of public health nursing in curricula at
the University of British Columbia (1919) and
Yale and Western Reserve Universities (1923)

Education for Practice - 2

Goldmark Report (1923, U.S)
Weir Report (1932, Canada)
Brown Report (1948, U.S.)
ANA designation of the BSN as the entry level for
community health nursing (1964)
Pew Health Professionals Commission Report
(1995)

Federal Involvement - 1
Act for Relief of Sick and Disabled Seamen
(1798)
National Board of Health (1879)
Creation of USPHS (1912)
Sheppard-Towner Act (1921)
Social Security Act (1935)
Creation of the National Institutes of Health
(1930)

Federal Involvement - 2
Hill-Burton Act (1946)
Creation of the Dept. of Health, Education,
and Welfare as a Cabinet post (1953)
Comprehensive Health Planning Act (1966)
Creation of Medicare (1966)
Child Health Act (1967)
Health Maintenance Organization Act (1973)

Federal Involvement - 3
National Health Planning and Resources
Development Act (1974)
First national health objectives published (1980)
Creation of DRGs (1983)
National Center for Nursing Research (1993)
Healthy People 2010 published (2000)
Public Health Improvement Act (2000)

Future Directions
Increasing the visibility of community
health nursing
Documenting the effectiveness of
community health nursing through research
Maintaining and expanding the focus on
population health