historical developments of community health nursing in the world

HISTORICAL DEVELOPMENTS OF COMMUNITY HEALTH

NURSING IN THE WORLD

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HISTORICAL DEVELOPMENTS OF COMMUNITY HEALTH NURSING IN THE

WORLD:-

ANCIENT PERIOD:- The history of public health and public health nursing can be traced far back in the past. In earliest

times people struggled for their survival by devising their own methods to deal with life events such as births, deaths

etc.

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WORLD:- people were concerned about diseases

and had some knowledge of its treatment. Medical carte was given by religious leaders or priests who were revered by the society.

Record history of ancient civilization such as Babylonian, Hebrew, greek and roman reveals that they possessed knowledge of personal hygiene, community responsibility and medicine.



WORLD:-They had well developed system of

environmental sanitation such as safe water supply, drainage and sewage disposal system. They also had understanding of contagious nature of diseases.



WORLD:-This resulted in rigid public health

measures like isolation of the sick, quarantine of the families and some times of the communities.

The philosophy of the time was that the individual should provide for the basic needs for himself and his family



WORLD:-his responsibility included the

provison of food,shelter and clothing and care in case of illness. The community responsibility was to protect the individual and his family against illness that might be due to communal life.


HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH

NURSING IN BRITAIN:- The development of modern public

health and nursing took place from the middle of 19th century both in England and America and various other countries as a result of occurance of great epidemics of bubonic plague, leprosy, small pox, cholera etc.



NURSING IN BRITAIN:-During 18th century and early 19th

century England faced industrial revolution which created tremendous social impacts in terms of socio-economic imbalance, exploitation of workers, slums, overcrowding, poor sanitation, broken families, child abuse, maternal and child health problems.



NURSING IN BRITAIN:-During 19th century inspite of the act

being passed and implemented to improve the environmental sanitation, these diseases continued to occur time and again in the western world. This was bcause of the fact that epidemiology of the diseases were not fully understood.



NURSING IN BRITAIN:-Ms. Florence Nightingle has been

recognized as one of the foremest pioneers in the public health and public health nursing movements in England. She is acclaimed as the founder of modern nursing. She began her work when nursing services which were established by religious order, had withered away with the decline of church power and influence



NURSING IN BRITAIN:-She began her work when nursing

services which were established by religious order, had withered away with the decline of church power and influence.

Florence Nightingle created an atmosphere of dignity and self respect for nursing.



NURSING IN AMERICA:- In America, similar developments

took place in the field of public health and public health movement gained momentum in 1850, when lemuel Shattuck, a publisher and book seller, submitted a report on sanitary conditions of Massachusetts to its legislature and also published the same.



NURSING IN AMERICA:-In his report he put forward

specific recommendations regarding a system of sanitary inspection, collection of vital statistics school health programme.



NURSING IN AMERICA:-In 1872, American health

association, a national level profession organization of community health workers was established. This association initiates various public health campaigns and has consistently worked for improving standars of community health services.



NURSING IN AMERICA:-The field of public health bradend

under the influence of scientific advances in microbiology, social and behavioral sciences. Thus in late 19th century and at the beginning of 20th century a new concept began to take impetus that state has the direct responsibility for the health of people.



NURSING IN AMERICA:-Public health activities not only

included the activities of improved sanitation and control of communicable diseases but aalso preventive and promotive services to mothers,children,school children,workers and elderly.



NURSING IN AMERICA:-The need for the application of

principles of personal hygiene, care and health teaching was felt in all these public health services for controlling mortality and morbidity among mothers, children and workers etc. and improve and promote their health.



NURSING IN AMERICA:-This phase of public health gave

origin to public health nursing. During this period, the foundation of district nursing through private, voluntary efforts was laid.



NURSING IN AMERICA:-By 1890, twenty one such

organizations existed in USA. In 1893, Lillian wald, the pioneer in public health nursing, founded the hennery street settlement, which grew in to a well organized health centre with visiting nurse services for the surrounding community.



NURSING IN AMERICA:-The rockfellers foundation of new

york established in 1913, adepted public health as one of its field of interest. This foundation assisted in establishment of schools of public health in united states and other countries.



NURSING IN AMERICA:-The American red cross society, the

common wealth fund and kelogg foundation were the other volutary and private bodies which were very active in the development of public health and public health nursing services.



NURSING IN AMERICA:-During the early part of 20th century,

there were specialized nurses in the field of public healthy like nurses in maternal and chil;d health, veneral diseases, other communicable diseases, tuberculosis control etc.



NURSING IN AMERICA:-public health had entered a newera.

It was faced with new emergent health problems which were more serious but chronic and degenerative such as cardiovascular diseases, cancer, stroke, mental illness and metasbolic disorders.



NURSING IN AMERICA:-Thus public health deal with wide

range of health problems and its activities moved beyond the traditional basic seven services which included communicable disease control, environmental sanitation, maternal and child health, health education, medical and nursing care, nutrition, & vital statistics. www.drjayeshpatidar.blogspot.in


NURSING IN AMERICA:-The field of public health, broadend,

increasing emphasis was given on primary health care and preventive and promotive services, further as a result of ALMA Ata declaration of the “ goal of health for all’ through primary health care by WHO and UNICEF in 1975.


HISTORICAL DEVELOPMENT OF PUBLIC HEALTH NURSING

IN INDIA:-ANCIENT PERIOD:- The

development of public health nursing in India started much later as compared to developed countries of the west. But public health in India was in practice much before its development in western countries.



IN INDIA:-The Indian history revealed its public

health practice as early as 5000BC. The period can be classified as vedic period and post vedic period. During the vedic period the sacred books Upanishads and Vedas- especially the atharveda documented all the knowledge about medicine,personal hygiene,prevention of sickness etc.



IN INDIA:-The post vedic period (500BC to 700)

started with the rise of Buddhism, Buddhism emboied the principles of nonviolence, helping the sick,poor and needy people, self discipline,self education, charity towards all men etc.



IN INDIA:-BRITISH PERIOD ( 18TH century

to 1947):- The british had estabilished its rule in India in 1757 by establishing civil and military services. In 1859, the administration of India was taken over by the crown from east India company.



IN INDIA:-In 1859, a royal commission which

came to India to study the problem, recommended to establish sanitary commission of five persons each in Bengal, Bombay and madras.



IN INDIA:-In1896, following the out break of

epidemic of plague, aplague commission was set up to investigate its

epidemiological aspects. As result of investigation and suggestion,



IN INDIA:-In1912, the local government bodies

were made responcible to execute various health services according to over all plans and directions of central government.



IN INDIA:-In 1939 some very important

developments took place. The madras public health act was passed for the first time in the country. The first rural health training centers was established at singur near Calcutta with the support of Rockfeller Foundations.



IN INDIA:-In 1943, health survey and

development committee existing health conditions and health organization in the country and to make recommendations about the developments in future.



IN INDIA:-DEVELOPMENT SINCE

INDEPENDENCE( 1947ONWARDS):-

Before India attained independence on 15th august 1947, some of the provinces and princely states of India were parted to constitute Pakistan.



IN INDIA:-This effected change in demographic, Political and socio-economic aspects.

At the same time, a large number of people from Pakistan migrated to India.



IN INDIA:-The government of India at that time

faced a large number of socio-economic and public health problems. But because of new constitutional policies and the enthusiastic attitude of political leaders, administrators and the people in general, the government could manage to overcome initial difficulties,implement strict public health measures to prevent epidemics.



IN INDIA:- planning commission was

constituted top help government to plan out integrated development plan for the entire country with in the available resourses for a defined period of five years for its socoi-economic progress. The planning commission has been responsible for ten “ five year plans”.


COMMUNITY HEALTH NURSING ISSUES:-

The professional issues challenging community health nursing . first of all empowered community health nurses need to be able to address the following questions.



who is assessed by community health nurses: the individual, family, group, or community ?

what do community health nurses assess ?

what nursing diagnosis do community health nurses use ?



what types of nursing interventions do community health nurses use in practice ? differ with differences in client focus ?

how do interventions differ with differences in client focus



how is community health nursing evaluated for quality of care, cost, effectiveness, and outcomes assessment?



ASSESSMENT:- the previously listed questions, which challenge community health nurses suggest that there may be wide variety of areas that are considered appropriate and necessary for assessment in community health nursing.



DIAGNOSIS:- with the lake of clarity in terms of nursing assessment in community health nursing, it follows that nursing diagnosis in community health nursing is equally undeveloped



Muecke (1984) critiques the concept of community health diagnosis and proposes the following steps to identify the community of concern

identification of the health risk of the community.



specification of the characteristics of the community and its environment that are etiologically associated with the risk

specification of the health indicators that verify the risk.



GOALS:- goeppingere (1984) examines the principles issues of community helth nursing from the perspective of the following questions

what are the goals of community health nursing practice ?

what are the target system that community health nurses intend to change ?

in what setting do community health nurses practice www.drjayeshpatidar.blogspot.in


INTERVENTIONS:- A major nursing intervention issue is that of the measurement of costs of community health nursing in the home health care setting. Kovner categorizes alternatives in to four models. Per visit, acuity of care, hourly, and by diagnosis.



The setting for community health nursing practice leads to a question of weather community health nursing is setting specific. Is it community- oriented because it emphasizes the collective need ? three newer and related delopments in nursing community setting have been the nursing entrepreneurship, and parish nursing. www.drjayeshpatidar.blogspot.in


EVALUATION:- measurement of the outcomes of community health nursing care leads to avariety of questions and issues.

what are the consequences of organizing care around reimbursement guidelines rather than a theory- based approach?

what level of focus of community health nursing is most cost-effective: individual, families, group or communities?



what are the effects of changes in referral patterns, level of illness of clients referred,intensity of services required, and quality of services delivered ?

what measures of patient outcomes in terms of behavioral or functional changes can be used to evaluate the interventions of community health nurses ?



what are the effects of different management procedures for specific types of clients ?

what is the effect of various management structures and types of agencies on the way home care is delivered ?


CURRENT ISSUESschool nurses have played a

significant part in school health programs. They need to be flexible, creative, and involved in revising their role to fit with new directions, otherwise, the role of the school nurse may be jeopardized. Economic justification for services is necessary and therefore, the value of the school nurse must be ascertained.www.drjayeshpatidar.blogspot.in

CURRENT ISSUESNational health objectives for the

year 2000 seek to increase school- based education to prevent human immunodeficiency virus infection, alcohol and other drug use, tobacco use, injury, and sexually transmitted diseases.


CURRENT ISSUESHealth education has proven to be

effective at reducing risk behaviors associated with the leading causes of death, that is heart diseases, cancer, stroke, C.O.P.D. un intentional injuries, AIDS.etc. responsibility needs to be a fundamental component of health care reform.


TRENDS IN COMMUNITY HEALTH NURSING

The major forces for shaping nursing’ role in the health care environment are considered to be.

Shifting payment system. increased proportion of the

aged population. increased competition among

health care providers.www.drjayeshpatidar.blogspot.in


increased complexity of client needs and severity of client conditions.

government intervention in cost containment.



TRENDS IN HEALTH CARE DELIVERY

CONSUMER TRENDS NURSES AND PRACTICE LEADERSHIP AND CHANGE


SCOPE OF COMMUNITY HEALTH NURSING

Areas of activities of community health falls in to four catagories described below.

those areas where activities must be on a community basis

the supervision of food, water and milk supply of a community basis.



those areas dealing with preventable illness, disabilities or premature death.

communicable diseases including infestations, for example diphtheria, pertusis, tetanus, TB, measles, poliomyelitis, worm infestation etc.



nutritional deficiences for example the conditions of mal-nutrition like marasmus, kwashiorkor, night- blindness, goiter, nutritional anaemia etc.

substance abuse, for example drug abuse and other substances abuse like alcohol.

Mental health and illness i.e. disorders of emotion, personality, behaviour etc.



Occupational health includes prevention and treatment of occupational illness & hazards.

Non-communicable diseases and conditions like cancer, cardiovascular diseases, diabetes and accidents.

Dental health



Maternal & child health Rehabilitation of victims of accidents

and illness. Problem of old age



Those areas of health , medical and nursing which need organized official leadership.

providing facilities for under graduates, postgraduates and continuing education programmes in concerned fields

promoting of equitable distribution of health man power and facilities

research. www.drjayeshpatidar.blogspot.in

HEALTH TECHNOLOGY DEFINITION:- Health technologies are

evidence-based when they meet well-defined specifications and have been validated through controlled clinical studies or rest on a widely accepted consensus by experts.


HEALTH TECHNOLOGY HEALTH TECHNOLOGY

ASSESSMENT (HTA)Basic HTA OrientationsTechnology-oriented

assessments Problem-oriented assessments Project-oriented assessments


PURPOSES OF HTA Regulatory agencies such as the

Food and Drug Administration (FDA) about whether to permit the commercial use (e.g. marketing) of a drug, device or other technology


PURPOSES OF HTA Clinicians and patients about the

appropriate use of health care interventions for a particular patient’s clinical needs and circumstances

Health professional associations about the role of a technology in clinical protocols or practice guidelines


PURPOSES OF HTA Health care payers, providers, and

employers about whether technologies should be included in health benefits plans or disease management programs, addressing coverage (whether or not to pay) and reimbursement (how much to pay)


PURPOSES OF HTA Hospitals, health care networks,

group purchasing organizations, and other health care organizations about decisions regarding technology acquisition and management


HEALTH TECHNOLOGY ASSESSMENT PROGRAM

(HTA)The primary goals are to make: Health care safer by relying on

scientific evidence and a committee of practicing clinicians

Coverage decisions of state agencies more consistent

State purchased health care more cost effective


OHTAC CRITERIA :- Technology must improve the

net health outcome and/or safety for patients and/or providers or improve health systems efficiency.

Technology must be at least as beneficial as any established alternative


OHTAC1. Technology must be licensed by

Health Canada and have received other applicable licensing or approvals from appropriate governmental or regulatory bodies (e.g. the Canadian Nuclear Safety Commission).


HEALTH TECHNOLOGIES AND DECISION MAKING:

How evidence (particularly HTA-based evidence) is produced and used in decision making.

How aspects of health-care systems facilitate or impede the implementation of decisions.


Thank you


historical developments of community health nursing in the world

Health & Medicine