The History of Public Health and the Role of the Community/Public Health Nurse
NURS 4010 Section 04, Family, Community, and Population-Based Care 10 / 21 / 2012
The History of Public Health and the Role of the Community/Public Health Nurse Overview
Public health, a population-centered nursing had been in existence since the late 1880s under the guise of different names. The focus of public health nursing was on sanitation, communicable disease control, disease prevention and disability, and education. The purpose of this paper is to summarize the history of public health nursing and how it impacts the practice of nursing in the community.
History of Public Health Nursing
In the past, public health, which is population-centered nursing had different names. Names like visiting nurse, school nurse, district nurse, home health nurse, and occupational health nurse were all associated with public health. Nurses worked in communities to improve the health of the population. These challenging roles began in the late 1800s with a focus on sanitation, communicable disease control, disease prevention and disability, and health education.
National interest to address public health issues increased in the mid nineteenth century to improve urban living conditions due to increasing outbreak of smallpox, yellow fever, cholera, malaria, and tuberculosis. Florence Nightingale’s vision of trained nurses and nursing education model influenced the development of public health nursing to meet the urban health needs. Settlement houses were established later as neighborhood centers for health care, education, and social welfare programs. For instance, Lilian Wald, the first public health nurse, established the Henry Street settlement in New York which helped to influence the growth of community nursing. Today, this population-focused practice that emphasizes on health protection, health promotion and disease prevention are the fundamentals that differentiate public health nursing from other nursing specialties. For more than 125 years, public health nurses have worked to develop strategies to attend to prevailing health
problems of the public in the United States (Stanhope & Lancaster, 2012). The core functions of the public health nurse are three folds; assessment, policy development, and assurance. The nurse collects data, identifies potential hazards in the environment, and monitors the health status of the population. The nurse uses scientific knowledge base in decision making about policies that support the health of the population. In his or her role, the nurse informs, educates, and empowers the community regarding health issues. To provide essential health services, the nurse ensures that competent public health and personnel are available. Also quality of services that are provided are monitored for better outcomes. Health planning that includes early intervention and primary prevention is ensured. Laws and regulations are also enforced to protect health and safety of the population. In relation to the core functions, in 1994, Centers for Disease Control and prevention (CDC) developed ten essential public health services to provide a working definition and guidance framework for local public health services. They include monitoring, diagnosing and investigating, mobilizing enforcing, linking, evaluating, and researching. Impact on Nursing Practice
The health of the general population in the community is the goal of the public health nurse. The nurse strives to prevent the outbreak of diseases through teaching and various interventions to improve health . The public health nurse cares for all the people in the community irrespective of race, religion, or ethnicity. Interventions focus on disease prevention, health promotion and protection, and on primary, secondary, and tertiary health care services. Primary prevention protects against threat to health. It prevents the prospects of potential health problems before they occur. Example is immunizations against communicable diseases. Secondary prevention is the effective treatment of a health problem when detected. Tertiary prevention is implemented after injury or diagnoses of a disease. This prevents existing problems from getting worse. Example is periodic blood glucose checks to monitor an existing diabetic condition. Public health nurses not only share the nursing profession’s tradition to uphold the fights of individuals, but have other goals of maximizing the health of the population at risk (Oberle & Tenove, 2000). Situations seen as raising most
ethical issues are the patient’s rights and the rights of the nurses to act in accordance with their professional values. Inter-professionally, ethical problems exist particularly with physicians when they tend to devalue nursing knowledge. For instance, a physician actively denigrating a nurse’s advice to a client on breast feeding. The nurse’s ethical concern is to ensure the client gets the best information without undermining the physician’s confidence. The attempt to work collaboratively yields only one-way communication. The nursing role to provide to the client the best care possible is compromised when there are diminishing resources. The inability to provide the kind of care expected causes moral distress on the nurse. Summary
Public health nursing became a challenging nursing practice in the late 1800s with increased national concern for the improvement of urban sanitation and spread of communicable diseases. The core functions of the public health nurse help in the identification of potential community health problems for immediate solution towards prevention and health promotion. Despite all the ethical issues confronting the public health nurses, they nonetheless manage to make decisions and carry out their mandates for the best of the community they serve.
Oberle, K. & Tenove, S. (2000). Ethical issues in public health nursing. Vol. 7, Issue 5, p 425-439. Retrieved from http://web.ebscohost.com/ehost.delivery. Stanhope, M. & Lancaster, J. (2012). Public health nursing. Population-centered health care in the community. Imprint of Elsevier inc. Maryland Height, Missouri. U.S. Centers for Disease Control and Prevention (CDC), 1994. National Public Health Performance Standards. Retrieved from http://www.cdc.gov/nphpsp/
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