Introduction to

community health
nursing
Lily L. Hsu
School of Nursing
Shanghai Jiao Tong University

History of Community Health Nursing

Before mid 1800s-Early Home Care with focus in Sick and
Poor individual.
Orientation: curative
agencies: lay & religious orders
*St. Phoebe
Mid 1800s to 1900-district Nursing with focus in Sick and
poor individual
Orientation: curative/less in prevention
agencies: voluntary & some government
*William Rathbone

History of Community Health Nursing

1900-1970 public health nursing- Pubic Health Needs,

focus in family and orientation in Curative and

Prevention
agencies: government & some voluntary
*Lilliam Wald

1970 to present-Community Health Nursing, focus in total

community and oriented to population health, services address
health promotion; illness prevention
agencies: many kinds; some independent practice
*Ruth Freedman

Public Health Nursing

Development in China

Early Stages:
1925 Beijing Union Hospital-Public Health Agency
(Dr. Gland).
1930 rural Health Education
2000 Pay attention to city and rural areas
community center development and practice model
2006-2007 Government emphasize the
importance of Community health, improve
community health centers, functions, farmer health
insurances

Challenge for Chinas

Community Health Nursing

Elderly care issues

2000 Population

2050

China Adult Population

National Health Statistics

40 11.30%
13.15
10 35
40
2007 3000 WHO
2010 4

880

National Health Statistics

Maternal Mortality Rate 48.3/10 2004

Skillful Professional Handle delivery 97
2003
Female : male children attending school 1
1 Junior school admission 0.92 2002
Female children attending elementary school
95.8% (2002)
15 25 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

The Top Five Major Cause

of Death in China

Cardiovascular Diseases
Malignant Tumor
Cerebrovascular Disease
Disease of Respiratory System
Injury Intoxication
(National data, 2004)

Issues in Chronic Diseases

DM
Hypertension
Stroke
Cardiovascular diseases
Obese
Smoking
TB

Health Beyond Acute Care

Settings-Community Care
and Public Health

Public Health Definition

Public health is the Science and Art of :

preventing disease,

prolonging life,

promoting health and efficiency

through organized community effort.

(Winslow, 1920)

Definition of Community
Health (ANA,2000

Community health nursing is a synthesis of

nursing and public health practice applied to
promoting and preserving the health of
populations.
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 meeting
population needs.

Characteristics of
Community Health Nursing
It is a field of nursing
It combines public health and
nursing
It focus in population and
environment factors that may
impact to peoples health
It emphasize in health promotion,
illness prevention, and wellness

Characteristics of
Community Health Nursing
It promotes client responsibility and
self-care
It uses aggregate measurement and
analysis
It use principle of organizational
theory
It involves inter-professional
collaboration.

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 for The
early diagnosis and preventive treatment of disease, and
The development of the social machinery to insure
everyone a standard of living adequate for the
maintenance of health ,
Healthy Life Style and Longevity .

Community Health
Practice
Health Promotion

1. Increase the
span of healthy
life for all citizens

2. Reduce health 3. Achieve access to

disparities among preventive services
population groups
for everyone.

Roles of Community Health Nurses

Clinician
Educator

Researcher

Nurses
Advocate

Leadership

Collaborator

Manager

Health Prevention
Tertiary Prevention

Secondary Prevention

Primary Prevention

Primary Prevention for Health

Promotion

Health Education
Adequate Nutrition
Individual Development
Adequate working environment and
recreation, resting
Pre-marriage counseling and education
Genetic Counseling
Regular Physical Examination

Primary Prevention for Health

Protection

Comply with immunization

Individual hygiene
Improve environment sanitary
Occupational Safety
Prevent Accident in all ages
Adequate nutrition
Avoid cancer cause agents
Avoid allergic

Secondary Prevention

Identify cases in the community

Screen and test
Conduct special physical examination
Treat and prevent the progress of
illness
Avoid the spreading of disease
Reduce the disability time

Tertiary Prevention

Treat and stop the disease progress

and avoid complication and side effect
Limit the chance for disability
Provide rehabilitation for physical and
psychological well-being, occupational
therapy, availability of long-term care

Characteristics of
community 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
self care

Setting for community health

nursing practice

homes
ambulatory service settings
schools
occupational health setting
residential institutions
the community at large

Opportunity for Future

Community 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
role and function of community health sector