Chapter 2: Historical Factors: Community Health Nursing in Context

Question 1

Understanding of Historical factors that have influenced evolution of population health may help explain current health challenges
Humans created ecological imbalance by altering environment to accommodate group living; states of human disease can provide a frame of reference to aid and determining relationship among humans, disease, and enviornment
Growing populations, increased population density and imbalanced human ecology – resulted in changes in cultural adaptation and influenced aggregate health.
Public health and Community nurses must recognize that the environment, population’s health risks, and host culture’s strengths and challenges all affect the health status of each particular group

Answer 1

Aggregate impact on health

Question 2

Hunting and gathering phase (before 10,000 BCE)
Settled villages stage (10,000 to 6000 BCE)
Preindustrial cities stage (6000 BC to 1600 CE)
Industrial cities stage (1700 to 1800 CE)
Present period (1900 to 2000 CE)

Answer 2

Stages of the disease: History of humankind

Question 3

People avoided many contagious diseases – in small nomadic, that were separated from other groups
Disposal of human feces and waste not great prob because most likely abandoning caves for shelter once waste accumulated
Abandoned caves used for shelter when waste accumulated

Answer 3

Hunting and gathering phase (before 10,000 BCE)

Question 4

Wandering people became More sedentary; formedsmall villages
Began Domesticated animals and plants - lived close to heards - prac that transmitted diseases; plants: deficiency diseases
Cross-contamination of water supply when learning to remove wastes - set up water-supply which lead to cross-contantamination and spread of water-borne diseases

Answer 4

Settled villages stage (10,000 to 6000 BCE)

Question 5

Large urban centers formed to support the expanding population
Resource increased amounts of food and water and remove increased amounts of waste products; waste removal via water supply led to disease
Rodent infestation increased and facilitated spread of the plague
People had more Frequent close contact with one another; transmission of diseases spread by close contact increase; some diseases became endemic

Answer 5

Preindustrial cities stage (6000 BC to 1600 CE)

Question 6

Urban areas became denser and more heavily populated
Increased industrial wastes, air and water pollution, and harsh working conditions
Increase in respiratory diseases and epidemics of infectious diseases because individuals moved from one location to another

Answer 6

Industrial cities stage (1700 to 1800 CE)

Question 7

Leading causes of death changed from infectious disease to chronic illness

Answer 7

Present period (1900 to 2000 CE)

Question 8

Based on severity of spread of the disease - not on severity of disease itself
Based on rate and severity of the spread; can change; can have an epidemic become a pandemic and vice versa
Endemic
Epidemic
Pandemic

Answer 8

Disease definitions

Question 9

Diseases that are always present in a pop; in community all the time; disease/outbreak that is consistently present but limited to certain area
EX: Cold and pneumonia; sometimes malaria in diff countries

Answer 9

Endemic

Question 10

Diseases that are not always present in a pop but flare up on occasion; spread beyond community and in sev states/across countries; sudden increase in certain disease in certain geographical area - not always present in pop but flare up on occasion
EX: diphtheria and measles; initially with Flu; see one part country and then spreads

Answer 10

Epidemic

Question 11

Existence of disease in a large proportion of pop - global epidemic
Crossed into other countries, international borders, widespread; worldwide
Outbreak of disease across sev countries/continents - GLOBAL
EX: COVID, HIV, AIDS, annual outbreaks of influenza type A - eventually that strain gets here

Answer 11

Pandemic

Question 12

Prerecorded historic times
Classical times
Middle Ages
Renaissance (15th, 16th, 17th centuries)
18th century
19th century

Answer 12

Evolution of early public health efforts

Question 13

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

Answer 13

Prerecorded historic times

Question 14

Devised ways to flush water and constructed drainage systems
Developed pharmaceutical preparations
Embalmed the dead
Dealt with pollution
First written hygienic code to protect water and food by creating laws that governed personal and community hygiene: contagion, disinfection, sanitation
Greeks and Romans impacted public health

Answer 14

Classical times

Question 15

Monasteries promoted collective activity to protect public health
Churches enforced hygienic codes
A pandemic (known as the bubonic plague/black death) ravaged the world in the 14th century: claimed ½ world pop
Modern public health agencies/practices emerged: isolation, disinfection, quarantine
Clergymen often acted as physicians
Monks and nuns provided nursing care in small houses

Answer 15

Middle Ages

Question 16

A theory about the cause of infection evolved
Leeuwenhoek described microscopic organisms
Elizabethan Poor Laws were enacted; held the church parishes responsible for providing relief for the poor

Answer 16

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

Question 17

Unsanitary conditions remained a huge problem
Poor children were forced into labor
Vaccination was major discovery of the time; discovered by Edward Jenner
Sanitary Revolution’s public health reforms were beginning to taking place; survey methods were used to study public health problems
Health education movement provided books and pamphlets on health to the middle and upper classes - was not concerned with working classes

Answer 17

18th century

Question 18

Communicable diseases raviged pop that lived in unsanitary conditions
Edwin Chadwick - examined death rates by occupation and class in England and death rates extremely high; results: clean water, sewers, fire plugs, sidewalks
Public health laws were enacted in 1849:
John Snow demonstrated the transmission of cholera via the public water source in the U.S.

Answer 18

19th century

Question 19

Healthy mental and physical development of citizens
Prevention of all dangers to health
Control of disease

Answer 19

Public health laws were enacted in 1849:

Question 20

Shut down the source by removing a handle from a well and cholera cases fell
In US waves of epidemics cont to spread
Lemuel Shattuck published vital statistics; called for modern public health reform - keeping stats and providing enviornmental, food, drug and communicable disease info; called for well-infant, well-child and school age child care, mental health care, vaccinations, edu; report did not go anywhere and little done improve pop health for many yrs
The first Board of Health was finally formed in response – 19 years later
The advent of “modern” health care occurred

Answer 20

John Snow demonstrated the transmission of cholera via the public water source in the U.S.

Question 21

Credited with establishing “modern nursing” - began work in mid-19th century
Contributed to the health of British soldiers during the Crimean War and establishing nursing education
Other work:

Answer 21

Florence Nightingale (1820-1910)

Question 22

Concern for environmental determinants of health
Focus on British soldiers through emphasis on sanitation, community assessment, and analysis
Development of the use of graphically depicted statistics and the gathering of comparable census data
Political advocacy

Answer 22

Other work: - Florence Nightingale (1820-1910)

Question 23

Sig to development of pub health and med
Louis Pasteur
Joseph Lister
Robert Koch

Answer 23

Impact of imp scientists

Question 24

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

Answer 24

Louis Pasteur

Question 25

surgical outcomes

Answer 25

Joseph Lister

Question 26

Discovered causative agent for cholera and the tubercle bacillus in 1882

Answer 26

Robert Koch

Question 27

Emergence of germ theory - focused diagnosis and treatment on indiv organisms and indiv disease
Was a Community outcry for social reforms which forced governments to take action of the deplorable living conditions in the cities - state health departments formed and TB surveillance began
New York Metropolitan Board of Health formed in 1866 and state health departments thereafter
TB surveillance began in 1889
Flexner Report (1910) outlined shortcomings of some U.S. medical schools – funding withdrawn ensuring their closure
Philanthropic foundations influenced health care efforts
Rockefeller Foundation established first school of public health at Johns Hopkins in 1916 - early 1900s; focus of institution: preservation and improvement of indiv and community health, prevention of disease through multidisciplinary activities

Answer 27

Establishment of “Modern” medical care and pub health prac

Question 28

In England
In the United States

Answer 28

Establishment of pub health nursing

Question 29

District Nursing in England, 1850s
Trained selected poor women to provide nursing care to the disadvantaged families within a community
Nurses instrumental in establishing pub health nursing in 1850s and home care in late 1800s
Rathbone divided the community into districts and assigned a nurse and a social worker to each district to provide nursing, social work, and health education
Health Visiting in Manchester, England, 1862

Answer 29

In England

Question 30

Worked with Nightingale to educate “health nurses,” 1859

Answer 30

Rathbone divided the community into districts and assigned a nurse and a social worker to each district to provide nursing, social work, and health education

Question 31

Enlisted home visitors to distribute health information to the poor

Answer 31

Health Visiting in Manchester, England, 1862

Question 32

In 1877, a graduate nurse was sent into homes to provide care for the sick and innovation spread
Visiting nurse associations were then implemented in 1885 in Boston and 1886 in Philadelphia
In 1893, a district nursing service in New York City was established called the House on Henry Street

Answer 32

In the United States

Question 33

Established a district nursing service with Mary Brewster-the House on Henry Street in 1893 (along with Mary Brewster) - lower E side of NYC; served all unemployed and homeless immigrants who needed healthcare; imp role in establishing pub health nursing in US
Established public health nursing in the United States - later were called “Visiting Nurses Association of NYC”
Provided home care visits, paid car/care/fee, physicians consulted, fams could arrange visit by calling nurse directly or physician call nurse on pats behalf
Nursing service adopted philosophy of meeting health needs of pop and empowering the community
Role was one of “helping people to help themselves” through the development of centers of social action aimed at meeting the needs of the community and individual
This Led to the formation of variety programs, including youth clubs, a juvenile program, sex education for local schoolteachers, and support programs for immigrants

Answer 33

Lillian Wald (1867-1940)

Question 34

First school nurse, Linda Rogers, 1902
Metropolitan Life Insurance Company-home nurses for policyholders, 1909
Department of Nursing and Health-Teachers College of Columbia University in NYC, 1910
National Organization of Public Health Nurses, 1912 (Lillian Wald was first president)
Los Angeles Department of Health formed the first Bureau of Public Health Nursing and appointed its first public health nurse, 1913
All done in early 1900s

Answer 34

Other key dates in the establishment of pub health nursing

Question 35

Since Mid-20th Century - focus of disease has changed from infectious diseases to chronic conditions - increased food production and better nutrition in early 19th and 20th century contributed to decline of infectious disease related deaths
Better sanitation and nutrition occurred through water purification, sewage disposal, improved food handling, and milk pasteurization
Antibiotics little effect on health until well into 20th century

Answer 35

Consequences for the health of pops

Question 36

During 20th Century - health client, nursing, and enviornment influenced by the development of health insurance and an emphasis on population-based focus - health insurance dramatically altered healthcare delivery
During the 1920’s and 1930’s, costs of health care rose - as pop moved from rural to urban settings health care delivery settings moved
Delivery moved from private homes to hospitals
hospitals organized formed - American Hospital Association formed - leaders encourage development of health insurance plans
How the Blue Cross evolved
Improvements in med tech and growing prac of employers offering health insurance supported expansion of health insurance
During the 1960’s, politicians supported development of fed and state health insurance plans for elderly and poor pops: Medicare and Medicaid enacted
In 2010, the ACA was then passed

Answer 36

Social challenges and pub health nursing

Question 37

During 20th century, health life expectancy of people living in US improved dramatically; 30 year increase and 25 of that due to pub health efforts
Vaccination/vaccine-preventable diseases
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Tobacco control

Answer 37

10 great pub health achievements - US, 1900-2010

Question 38

Promoting health of populations - accomplish goal with broadened understanding of multiple causes of morbidity and mortality
Need broad understanding on the multiple causes of morbidity and mortality
must/Be aware of increased technological advances - and how specialization of med and nursing effected delivery of healthcare
Understand the community need for a focus on prevention, health promotion, and home care may become more widespread with changing pattern in healthcost reimbursement
Focus on holistic care - requires multiple dimensions and must have more attention in future
need for edu in pub health nursing must have curriculum that prepares students to meet needs of aggregates with Emphasis on population-based focus nursing

Answer 38

Challenges for community and pub health nursing

Question 39

Understanding of statistical data and epidemiology
Move the focus from the individual to a broader population approach
Understand social determinants of health
Work on behalf of aggregates
Gather information and statistics to make decisions
Emphasize society’s responsibility for health
Empower people to help themselves

Answer 39

need for edu in pub health nursing must have curriculum that prepares students to meet needs of aggregates with Emphasis on population-based focus nursing