Topic - History and Development of Community Health Nursing Short Notes For GNM, B.Sc.Nursing and P.B.B.Sc.Nurisng

1. HISTORY &
DEVELOPMENT OF
COMMUNITY
HEALTH NURSING
Mrs. Leena Sameep Sakpal.
Nursing Tutor

2. Historical
Developments
of Community
Health Nursing
in the World
Early Home Care Nursing (Before Mid 1800s)
• In 1244, a group of monks in Florence, Italy, known as the Misericordia
provided first-aid care for accident victims on a 24-hour basis.
• In 1600 to 1800s, the social upheaval after the Reformation caused a
decline in the number of religious orders. Concern over high maternal
mortality rates prompted efforts to better prepare midwifery program was
begun in Paris 1720 and another in London by Dr. William Smellie in
1741.
• In 1812, the Sisters of Mercy organized in Dublin to provide care for the
sick at home. Generally, however, with the status of women at an all-
time low, often only the least respectable women pursued nursing.

3. District Nursing (Mid-1800s to 1900s)
• Next stage in the development of community health
nursing was the formal organization of visiting
nursing or district nursing.
• Although district nurses primarily cared for the sick,
they also taught cleanliness and wholesome living to
their patients, even in that early period.
• The aim of the district nurse is to give first rate
nursing to the sick poor at home (Nightingale,
1876{cited in Mowbary, 1997, p.25})

4. Public Health Nursing (1900s to 1970s)
• By the beginning of the 20th century, district nursing
had broadened its focus to include the health and
welfare of the general public, not just the poor. This
new emphasis was part of a broader consciousness
about public health. The role of the district nurse
expanded during this stage. Lillian P Wald (1867-1940),
a leading figure in the expansion, first used the term
“Public Health Nursing” to describe this specialty.
• The public health nursing stage was characterized by
service to the public, with the family targeted as a
primary unit of care.

5. Community Health Nursing (1970 to the Present)
• In 1984 convened a Consensus Conference on the Essentials of Public Health Nursing
Practice and Education in Washington, DC. This group concluded that community
health nursing was the broader term, referring to all nurses practicing in the
community, regardless of their educational preparation.

6. History of Public Health and Public
health Nursing in India
Ancient Period
• The development of Public health in India started
such later as compared to developed countries of
the west. But public health in India was in practice
much before its development in western countries.
The Indian history revealed its public health
practice as early as 5000 BC.

7. Early History (Vedic Period)
• 3000 BC, India is noted for ancient civilization.
• One such in Indus Valley, showed relics of
pained cities, with drainage and houses built
with public baths. This suggests the practice of
proper baths. This suggests the practice of
proper environment sanitation by ancient people.
• 1400 BC, during this period, Ayurveda and
Siddha Systems of medicine came into
existence. This indicates and suggests the
development of the environmental sanitation by
ancient people.

8. Post Vedic Period (600BC -600 AD)
• During this time, medical education was
introduced in the ancient Universities of
Takshashila and Nallanda.
• A hospital system was developed during the
time of Budha for men, and women, and for
animals and this expanded during the reign of
kind Ashoka.

9. Moghul Period (1000 AD)
• During this time, the Arabic System of medicine,
popularly known as Unani system was
introduced.
• The origin of which is traced to Greek medicine.
Since then, Unani system has become part of
Indian Medicine. With changes in political
conditions in India the ancient universities and
hospitals disappeared.
• The torch that was lit thousands of years ago by
ancient stages became dim gradually.

10. British Period (18th century to 1947)
Significant events during this period, when the
British established their rule in India are as follow:
• 1825, Quarantine act was promulgated.
• 1859, A Royal Commission was appointed to
investigate into the causes of unhealthy conditions
prevailing in the British army stationed in India.
• This commission recommended that there was a
need in each presidency to protect the water
supply, construction of drains and prevention of
epidemics in the civil population to safeguard the
health of British Army.

11. • 1864, sanitary commissioners were appointed in
Bombay, Madras and Bengal.
• 1869, public Health Commissioner and a Statistical
Officer were appointed with the government of India.
• 1873, Birth and Death Registration Act was
promulgated.
• 1880, Vaccination Act was passed
• 1881, first Indian Factories Act was passed, and First
All India Census was taken.

12. Development of Public Health Nursing during British Period
• The concept of Public Health Nursing in India developed late 19th century.
• The ideal of training females for maternity care came in 1886.
• Missionaries felt the need of training of dais (traditional birth attendants) who assisted in the
delivery of the mothers at home.
• Madras Nursing Council was the first one who passes the act to train Nurses in midwifery to
replace the dais in 1926.
• In 1946, the Bhore committee, recommended replacement of “Lady Health Visitors” by
“Public Health Nurses” in order to promote health work efficiently. Later during the years, a
ten-month course in public health nursing for trained nurses was started in All India Institute
of hygiene and public health (Calcutta in 1952).

13. Development Since Independence (1947 onwards)
• Soon after independence, the country’s health requirements and the type
of health care services and delivery system etc. were determined by
holding of conferences by Prime Minister with Health Minister in 1947
and discussion the Bhore committee report.
• 1947, Ministries of Health were established both at the Central and at the
State Government level. The post of Director-General of Health Services
was created.
• In 1950, Planning Committee was constituted to help Government to
plan out integrated development plan for the entire country within the
available resources for a defined period of five years for its socio-
economic progress. The Planning commission has been responsible for
ten “Five Year Plan’

14. Societal Influences on the Development of Community Health Nursing
Advanced Technology
• Advanced technology has contributed in many ways to shaping the
practice of community health nursing.
• For example, technologic innovation has greatly improved health care,
nutrition, and has caused an increase in life expectancy.
• As we move deeper in to the 21st century, we move to “mobile care”,
using handheld, wireless technology tools that are nurse friendly and
compatible with the nurses’ role.
• We can “tele-visit” our clients, and we regularly use smaller and smaller
laptop computers for video conferencing.

15. Progress in Causal Thinking
• Relating disease or illness to its cause is known as causal thinking in the health sciences.
• Progress in the study of casualty, particularly in epidemiology, has significantly affected the
nature of community health nursing.
• The germ theory of disease causation established in the late 1800s, was the first real
breakthrough in control of communicable disease.

16. Changes in Education
• Changes in education, especially those in
nursing education, have had an important
influence on community health nursing
(CHN) practice.
• Practicing community health nurses must
make greater efforts to keep abreast
knowledge in their field.

17. Demographic Changes and the Pole of
Women
• The changing demographics in the country and
the changing role of women have profoundly
affected community health nursing.
• In the 20th century, the women’s rights
movement made considerable progress; women
achieved the right to vote and gained greater
economic independence by moving into the labor
force.

18. Consumer Movement
• The consumer movement also has affected the
nature of community health nursing.
• Consumers have become more aggressive in
demanding quality services and goods; they assert
their right to be informed about goods and services
and to participate in decisions that affect them
regardless of sex, race, or socioeconomic level.

19. Current Status, Trend and Challenges
Trend and Challenges Changing Practices World planning for
the 21st Century

20. • Trend and Challenges
• According to Dr. EG Megav Eran, these changes are
divided into four eras from middle of 19th century to
middle of 20th century onwards. These are as under:
• Empirical up to 1850
• Basic Science Era 1850 to 1900
• Clinical Science Era 1900 to 1950
• Public Health / community Science Era 1950
onwards

21. Empirical Era (Up to 1850)
• The focus for this era was on relieving of
“Symptoms”.
• The objective was to make diagnosis and give
treatment of symptoms.
• Symptomatic treatment like use of poultices
ointments, cupping, leaches, trephines etc. to relieve
variety of symptoms.

22. Basic Science Era (1850 to 1900)
• The focus of this era was on curing of “disease”.
• The objective was to make diagnosis and give treatment of
disease and symptoms both. It was also observed that
treatment of symptoms did not necessarily cure the patient
and the symptoms and hence the disease and not the
symptoms alone were considered.
• This was the first scientific change from “Symptom Focus”
to “Disease focus”.

23. Clinical Science Era (1900 to 1950)
• The focus of this era was “Total Patient”.
• The objective was not only the scientific diagnosis and
treatment of his disease but assessment of an individual
which includes physical, emotional, mental, social and
spiritual self to identify his health status and health needs.
• This was a second tremendous change in the field of public
health.

24. Public Health or Community Health Science Era
(1950 to 1975)
• This era is community centered era. This was yet another
tremendous change from patient centered focus to
community centered focus.
• The objective was treatment of families, groups and entire
community.

25. World Planning for the 21st Century
• World health leaders recognized the need to plan for the
twenty-first century at the 30th world health assembly of
the World Health Organization (WHO), held in 1977. At
that assembly, delegations from governments around the
world set as a target “that the level of health to be
attained by the turn of the century should be that which
will permit all people to lead a socially and economically
productive life”. This target goal becomes known as
“Health for all by the year 2000”.