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  1. 1. Introduction to communityhealth nursingLily L. HsuSchool of NursingShanghai Jiao Tong University
  2. 2. History of Community Health NursingBefore mid 1800s-Early Home Care with focus in Sick andPoor individual.Orientation: curativeagencies: lay & religious orders*St. Phoebe Mid 1800s to 1900-district Nursing with focus in Sick andpoor individualOrientation: curative/less in preventionagencies: voluntary & some government*William Rathbone
  3. 3. History of Community Health Nursing 1900-1970 public health nursing- Pubic Health Needs,focus in family and orientation in Curative andPreventionagencies: government & some voluntary*Lilliam Wald1970 to present-Community Health Nursing, focus in totalcommunity and oriented to population health, services addresshealth promotion; illness preventionagencies: many kinds; some independent practice*Ruth Freedman
  4. 4. Public Health NursingDevelopment in China Early Stages:1925 Beijing Union Hospital-Public Health Agency(Dr. Gland).1930 rural Health Education2000 Pay attention to city and rural areas communitycenter development and practice model2006-2007 Government emphasize the importanceof Community health, improve community healthcenters, functions, farmer health insurances 。
  5. 5. Challenge for China’sCommunity Health Nursing Elderly care issues2000 Population 2050 Population
  6. 6. China Adult Population
  7. 7. National Health Statistics 现有宫颈癌患者 40 万人,死亡率达 11.30% ;宫颈癌每年新发病例约 13.15 万 目前的乳腺癌发病率也已经达到了每 10 万人口 35—40 。 2007 年中国糖尿病人约有 3000 万。据 WHO 最新数据预测,到 2010 年中国糖尿病人将达到目前的 4 倍。 世界卫生组织预测,中国每年确诊的新增结核病例为 880 万。
  8. 8. National Health Statistics Maternal Mortality Rate 48.3/10 万 ( 2004 ) Skillful Professional Handle delivery 97 %( 2003 ) Female : male children attending school 1 :1 , Junior school admission 0.92 ( 2002 ) Female children attending elementary school95.8% (2002) 15 - 25 岁妇女识字率 98 % ( 2004 ) Newborn mortality rate 15.4/1000, 2004 < 1 year old infant death rate : 30/1000( 2003 ) <5 years old children mortality : 37/1000( 2003 )
  9. 9. The Top Five Major Cause ofDeath in China Cardiovascular Diseases Malignant Tumor Cerebrovascular Disease Disease of Respiratory System Injury 、 Intoxication(National data, 2004)
  10. 10. Issues in Chronic Diseases DM Hypertension Stroke Cardiovascular diseases Obese Smoking TB
  11. 11. Health Beyond Acute CareSettings-Community Care andPublic Health
  12. 12. Public Health DefinitionPublic health is the Science and Art of : preventing disease, prolonging life, promoting health and efficiency throughorganized community effort.(Winslow, 1920)
  13. 13. Definition of CommunityHealth (ANA,2000 ) Community health nursing is a synthesis ofnursing and public health practice applied topromoting and preserving the health ofpopulations. Treat “ Population as a Whole” Focus on individual, family, groups, community Utilizing Health promotion, health maintenance,health education, and management,coordination, and continuity of care for meetingpopulation needs.
  14. 14. Characteristics of CommunityHealth Nursing It is a field of nursing It combines public health andnursing It focus in population andenvironment factors that mayimpact to people’s health It emphasize in health promotion,illness prevention, and wellness
  15. 15. Characteristics of CommunityHealth Nursing It promotes client responsibility andself-careIt uses aggregate measurement andanalysisIt use principle of organizationaltheory It involves inter-professionalcollaboration.
  16. 16. Pubic Health is for: The sanitation of environment, The control of communicable infections, The education of the individual in personal hygiene, The organization of medical and nursing services forThe early diagnosis and preventive treatment ofdisease, and The development of the social machinery to insureeveryone a standard of living adequate for themaintenance of health ,Healthy Life Style and Longevity .
  17. 17. Community Health PracticeHealth Promotion1. Increase thespan of healthylife for all citizens2. Reduce healthdisparities amongpopulation groups3. Achieve access topreventive servicesfor everyone.
  18. 18. Roles of Community Health NursesResearcherLeadershipCollaborator ManagerAdvocateEducatorClinicianNurses
  19. 19. Health PreventionTertiary PreventionSecondary PreventionPrimary Prevention
  20. 20. Primary Prevention for HealthPromotion Health Education Adequate Nutrition Individual Development Adequate working environment andrecreation, resting Pre-marriage counseling and education Genetic Counseling Regular Physical Examination
  21. 21. Primary Prevention for HealthProtection Comply with immunization Individual hygiene Improve environment sanitary Occupational Safety Prevent Accident in all ages Adequate nutrition Avoid cancer cause agents Avoid allergic
  22. 22. Secondary Prevention Identify cases in the community Screen and test Conduct special physical examination Treat and prevent the progress ofillness Avoid the spreading of disease Reduce the disability time
  23. 23. Tertiary Prevention Treat and stop the disease progress andavoid complication and side effect Limit the chance for disability Provide rehabilitation for physical andpsychological well-being, occupationaltherapy, availability of long-term care
  24. 24. Characteristics ofcommunity health nursing it is a field of nursing it combines public health with nursing it is population-focused it emphasizes wellness it involves interdisciplinary collaboration it promotes clients’ responsibility and selfcare
  25. 25. Setting for community healthnursing practice homes ambulatory service settings schools occupational health setting residential institutions the community at large
  26. 26. Opportunity for FutureCommunity Health Nursing Chronic Disease management Home Care Extended care from Acute care setting Elderly care Rehabilitation care in different population Health promotion in every level Health system referral, emphasize individual roleand function of community health sector