Chapter 2

The History of Public Health and Public

and Community Health Nursing

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 Objectives
 Discuss historical events that have influenced
how current health care is delivered in the
community.
 Trace the ongoing interaction between the
practice of public health and that of nursing.
 Explain significant historical trends that have
influenced the development of public health
nursing.

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 Objectives (Cont.)
 Examine the contributions of Florence Nightingale,
Lillian Wald, and Mary Breckinridge and the
influence these three nursing leaders had on current
public health and nursing.
 Examine the ways in which nursing has been
provided in the community, including settlement
houses, visiting nurse associations, official health
organizations, and schools.
 Discuss the status of public health nursing in the
twenty-first century including the major organizations
that have contributed to the current state of public
health nursing.

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 Introduction
 One of the best ways to understand today and plan
for tomorrow is to examine the past. What worked?
What did not work?
 What past lessons can be learned about health
care, nursing, and the communities in which care is
provided?
 How have nurses developed into the professionals
they are today and what have been their supports
and obstacles?
 A historical approach can be used to increase
understanding of public and community health
nursing in the past, as well as its contemporary
dilemmas and future challenges.

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 Public and community health
nursing are products of various
social, economic, and political
forces, and incorporate public
health science, in addition to
nursing science and practice.

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 Early Public Health
 All people and all cultures have been concerned
with the events surrounding birth, death, and
illness.
 Ability to preserve health and treat illness has
depended on the civilization’s knowledge of
science, use and availability of technologies,
and degree of social organization.
 Examples: Ancient Babylonians, Egyptians,
Elizabethan Poor Law, and Industrial Revolution

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 Public Health During America’s
Colonial Period and the New
Republic
 At first it was a family/friend system of care
 Elizabethan Poor Law
 First hospital founded in America (1751)
 Shattuck Report (1850)

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 Nightingale and the Origins of
Trained Nursing
 Organized nursing practice and nursing
education in hospitals (1858)
 Florence Nightingale
 District nursing association founded (1859)
 William Rathbone
 First nursing schools opened (1870)
 Visiting nurse associations founded (1885)
 Lillian Wald and Mary Brewster established Henry
Street Settlement in 1893.
 Instructive district nursing (1886)

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 Origins of Trained Nursing
 Jessie Sleet (Scales) — first African-American
public health nurse
 American Red Cross and its Rural Nursing
Service initiated home nursing care in areas
outside larger cities.
 Occupational health nursing
 Ada Mayo Stewart (1895)
 School nursing
 Lina Rogers

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Continued Growth in Public Health
Nursing
 1909: “Visiting Nurse Quarterly” and first continuing
nursing program
 1914: First post-training-school course in public
health nursing
 1922: National Organization for Public Health
Nursing (NOPHN)
 1872: American Public Health Association (APHA)
established
 1923: the Public Health Nursing Section was formed within
APHA
 Late 1800s: local health departments formed
 1910s: targeting infectious and parasitic diseases

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 Public Health Nursing During
the Early Twentieth Century
 World War I
 1918 Influenza pandemic
 Limited funding available for public health
nursing
 1909: Metropolitan Life Insurance Company
 1921: Maternity and Infancy Act (also called the
Sheppard-Towner Act)
 1925: Frontier Nursing Services (FNS)
 Mary Breckinridge

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 African-American Nurses in
Public Health Nursing
 Challenges
 Segregated nursing education in the South until
1960s
 Lower salaries in the South than for White nurses
 National Health Circle for Colored People (1919)
 Scholarships

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 Economic Depression and the
Effect on Public Health
 1930s Depression
 Agencies and communities unable to meet the huge needs
and numbers of the poor
 Decreased funding for nursing services
 Federal Emergency Relief Administration (FERA)
 Civil Works Administration (CWA)
 1931 – First nurse employed by U.S. Pubic Health Service
• Pearl McIver
 Social Security Act of 1935
 Bolton Act of 1943, established the Cadet Nurse Corps

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From World War II Until the 1970s
 Americans living longer
 New Nursing Organizations
 National League for Nursing (NLN)
 American Nurses Association (ANA)
 Public health nursing required in most
baccalaureate nursing programs
 1952: nursing education programs began in
junior and community colleges
 1969: American Association of Colleges of
Nursing (AACN) was established.

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 Public Health Nursing From the
1970s to the Present
 1970s: hospice movement, development of birthing
centers, daycare for elderly and disabled persons,
drug-abuse treatment programs, and rehabilitation
services in long-term care
 1979: Healthy People initiative
 1980s: rising health care costs
 1985: National Center for Nursing Research (NCNR)
established;
 1993: NCNR become National Institute of Nursing
Research
 1988: Institute of Medicine report – The Future of
Public Health

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 Public Health Nursing From the
1970s to the Present
 1990s and early 2000s: focus on cost, quality,
and access to services
 Health care reform debate
 Nurse-managed centers
 Nursing shortage
 Affordable Care Act of 2010

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 Looking Toward the Future
 Nurses seek to learn from the past and to avoid
known pitfalls, even as they seek successful
strategies to meet the complex needs of today’s
vulnerable populations.
 As plans for the future are made and as unmet
public health challenges are acknowledged, the
vision of what nurses in community health can
accomplish serves as a sustaining force.

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