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Stages in the Disease History of Humankind

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(1) Hunting and gathering (before 10,000 B.C.). (2) Settled villages (10,000 to 6000 B.C.) (new & middle stone age). (3) Pre-industrial cities (6000 B.C. to 1800 A.D.). (4) Industrial cities (1700-1800 A.D.). (5) Present period (1900-2000 A.D.)

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Aggregate Impact on Health

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1. Increased population. 2. Increased population density. 3. Imbalanced human ecology (Resulted in changes in cultural adaptation)

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Prerecorded historic times (before 5000 B.C.)

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• *Practices based on superstition* or *sanitation*. • Health practices evolved to ensure survival.

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Classical times (3000 to 200 B.C.)

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• *Devised ways to flush water*; constructed drainage systems. • Developed *pharmaceutical preparations*. • Embalmed the dead.

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Classical times (3000 to 200 B.C.)

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• *Dealt with pollution*. • *Hygienic code to protect food* and water. • *Greek* and *Roman* impact public health.

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Greeks

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• Literature contains accounts of communicable diseases. —Endemic, epidemic, and pandemic. • *Hippocratic book* on *Airs, Waters and Places.* • *Hygeia*, goddess of *health, or good living*.

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Greeks

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• *Panacea*, goddess of *curative medicine*. • Balance of human life with environmental demands

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Endemic

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Diseases that are always present in a population (e.g., colds and pneumonia).

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Epidemic

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Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and *measles*).

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Pandemic

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The existence of disease in a large proportion of the population—a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A).

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Middle Ages (500 to 1500 A.D.)

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• *Monasteries promoted collective activity* to *protect public health*. •* Churches enforced hygienic codes*. • Pandemic ravaged the world in 14th century. • *Modern public health practices* - e.g., isolation, disinfection, quarantines emerged.

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Renaissance (15th, 16th, 17th centuries)

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• *Theory about cause of infection evolved*. • *Leeuwenhoek* described *microscopic organisms*. • *Elizabethan Poor Laws* enacted (*similar to Medicaid*; guaranteed medical care for *poor, blind, and "lame" individuals*)

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18th century

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• *Industrial Revolution occurred*. Poor children forced into labor. • *Vaccination* discovered by *Edward Jenner*. • *Sanitary Revolution's* public health reforms taking place. ()

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19th century

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• Communicable diseases ravaged the population that lived in unsanitary conditions. • Edwin *Chadwick examined death rates* by *occupation and class in England*. • Establishment of the *General Board of Health* for England in 1848.

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19th century

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• *Public health laws* enacted in 1849: —Healthy mental and physical development of citizens. —Prevention of all dangers to health. —Control of disease

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19th century

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• *John Snow* demonstrated *transmission of cholera in public water source*.

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19th century

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• Waves of epidemics in United States. • *Lemuel Shattuck* published *vital statistics* in Massachusetts; called for *child health reform*.

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19th century

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• *First Board of Health* (and AMA) formed in 1848. • Efforts *focused on determinants* of health. • Advent of "modern" health care.

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Florence Nightingale (1820-1910)

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• Concern for environmental determinants of health. • *Emphasis on sanitation, community assessment, and analysis*

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Florence Nightingale (1820-1910)

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• Use of graphically depicted *statistics & comparable census data*. • Political advocate. • Education reform for nurses. • *Differentiated between sick nursing and health nursing* - promoting health and preventing illness

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Florence Nightingale: Public health

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"The health of the unity is the health of the community. Unless you have the health of the unity, there is no community health."

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Louis Pasteur

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• Theory of *existence of germs.* • *Discovered immunizations* in 1881 and the *rabies vaccine in 1885*

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Robert Koch

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*Discovered causative agent for cholera and the tubercle bacillus* in 1882

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Joseph Lister

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Surgical success with wound care

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"Modern" Medical Care

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• Emergence of germ theory focused diagnosis and *treatment on individual organism and individual disease*. • Community outcry for social reforms forced governments to take action.

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"Modern" Medical Care

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• *Boards of health and health department* began in 1866. • *TB surveillance* began in 1889. • *Rockefeller Foundation* established *first school of public health at Johns Hopkins.* (1916)

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"Modern" Medical Care

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• *Flexner Report* (1910) outlined *shortcomings of U.S. medical schools*. • Philanthropic foundations influenced health care efforts.

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Community Caregiver

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• *Traditional healer* common in *non-Western, ancient, and primitive societies*. • Societies retain folk practices due to their success.

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Community Caregiver

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• Folk healing practices are socially cohesive and involve support systems. • Although often overlooked, cultural practice affect health.

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Establishment of Public Health Nursing In England

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• District Nursing in England, 1850s (stemmed from public health nursing). • Rathbone worked with Nightingale to educate "health nurses," 1859. • Health Visiting in Manchester, England, 1862 (enlisted home visitors in Manchester to distribute health information to the poor).

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Establishment of Public Health Nursing In the United States

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• Visiting Nurses, 1977 Henry Street. • Settlement, 1893 ()

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Other Key Dates in the Establishment of PH Nursing

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• First School Nurse, *Linda Rogers*, 1902 • *Metropolitan Life Insurance Company provided home nurses* for policyholders, 1909 • Dept of *Nursing and Health at Teachers' College of Columbia* • University in NYC, 1910.

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Other Key Dates in the Establishment of PH Nursing

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• *National Organization of Public Health* Nurses formed, 1912 (*Lillian Wald was first president*). • Public Health Service appointed its first public health nurse, 1913

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Lillian Wald

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• Was also **instrumental in beginning school nursing** in New York; • **Linda Rogers was the first school nurse**. • In 1912 the *National Organization of Public Health Nursing* was formed and ___________ was elected president.

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In the US

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• Most nursing graduates worked for the *wealthy in private homes*. • The poor could not afford private duty nurses

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Lillian Wald and Mary Brewster

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*established the House on Henry Street a district nursing service*, in 1893. Their philosophy was to meet the *health needs of aggregates and help people help themselves*.

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1877 Women's Health Board

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NYC Mission *hired Frances Root, a graduate of Bellevue Hospital's* 1st nursing class to *visit sick poor person to provide nursing care* and religious instruction. (In the US)

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Lillian Wald

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• **Established Henry Street Settlement** in 1893 (along with Mary Brewster). • Played an important role in establishing public health nursing in U.S.—later called *"Visiting Nurses Association of NYC"*

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Lillian Wald

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• Role of Henry Street Settlement was "*one of helping people to help themselves*" (Wald, 1871). • *The Children's Bureau and the Social Security Act Legislation formed* as a result of these efforts

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Lillian Wald Other accomplishments

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• *Established the first community health nursing program for the employees of a company* - Metropolitan Life Insurance Co. • *Made services available to anyone desiring them, with fees graduated according to the ability to pay*. It continued for 44 years.

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Lillian Wald Other accomplishments

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• Provided *home care on a fee for service basis.* • Used *newspaper* and *radio advertisements to recruit nurses*. • Reduced mortality from infectious diseases. • *1st president of Nat. Org. for Public Health Nursing*

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Frontier Nursing Service

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Nurses *rode horses to visit their patients*. Trained nurses became midwives

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*Mary Breckinridge* and The *Frontier Nursing Service*

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•* Started in a 5 room cabin* - eventually secured water, disposing of sewage, obtained electric power, and *secured the site from land slides.* • Six outpost centers were built between 1927 and 1930

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Mary Breckinridge and The Frontier Nursing Service

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• After death of first husband, then two children, in 1918 *became devoted to helping disadvantaged women and children*. • After WWI, the *studied public health nursing for 1 year at Columbia University*

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Mary Breckinridge and The Frontier Nursing Service

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• 1925, returned to Kentucky to *establish a nursing center in the mountains*.

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Mary Breckinridge and The Frontier Nursing Service

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• Funded from family dues, philanthropy and fund-raising. • Provided *medical, surgical, dental and midwifery services 24 hours a day*

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Nursing's roots include

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• Visiting nursing. • District nursing. • Health teaching. • Care of families. • Nursing the environment

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Aggregate

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focused care *started with urban poor and military personnel and then their families*

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Aggregate Focused Care: Public health includes

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• *Providing a sanitary environment*. • *Prevention* of disease through *immunization* and *personal hygiene practices*.

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Aggregate Focused Care: Two sub-specialties emerged

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• *School populations* - crippled children (polio) partnered school nurses with public health nurses. • *Industrial workers*

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Aggregate Focused Care: Tuberculosis nursing -

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• TB was incurable and communicable. • Primary cause of death among young and middle age adults

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Changing Perspectives on Mortality in 20th Century and Beyond

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• Change from infectious diseases to chronic conditions. • Modern medical advances (vaccination programs & antibiotics)

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Changing Perspectives on Mortality in 20th Century and Beyond

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• Holistic approach to health. • Better sanitation and nutrition. • Multicausal, not unicausal, view of disease.

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Changing Perspectives on Mortality in 20th Century and Beyond

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• Social concerns affect community health nursing practice. • Insurance (public and private plans). • Increasing costs and technology. • Discrimination and racism

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Changing Perspectives on Mortality in 20th Century and Beyond

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• Feminist movement. • Disasters, genocide, and refugees. • Bioterrorism preparedness.

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Challenges for Community Health Nursing

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• Promote the health of populations. • Need for a bimodal focus on prevention, health promotion, and home care. • Education to meet the needs of the aggregate through community strategies

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Challenges for Community Health Nursing

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• A population focus for nursing to *contribute to the ethic of social justice*. • A better understanding of history

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Cultural Awareness

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determines how we interact with people from other cultures. What is considered an appropriate behavior in one culture can be misunderstood by another culture. *Problems occur when a person uses their meanings to make sense of others reality*.

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Cultural Awareness

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fundamental to communication and it involves the *ability of assessing ourselves and becoming aware of our cultural values, beliefs and perceptions*. Why do we do things in that way? How do we see the world? Why do we react a certain way?

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1903

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1st nurse practice acts

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1909

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*Metropolitan Insurance Company Reimbursement* () for nursing care

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1910

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*Public health nursing program instituted at Columbia*, Teachers College

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1935

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Passage of *Social Security Act* (education funding)

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1965

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*Establishment of Medicare* and *Medicaid*

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1984

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Diagnosis-Related Group (DRG) a *statistical system of classifying any inpatient stay into groups* for the *purposes of payment*.

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