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 Prevent
ion
agencies: government & some voluntary
*Lilliam Wald

1970 to present-Community Health Nursing, focus in total com

munity 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 communi

ty center development and practice model

2006-2007 Government emphasize the importance

of Community health, improve community health c
enters, functions, farmer health insurances 。
Challenge for China’s
Community Health Nursing
 Elderly care issues

2000 Population 2050 Population

China Adult Population
 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。
 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 school 95.8%
(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 ）
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 nursi
ng and public health practice applied to promo
ting 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, coordinatio
n, 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 people’s 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 every
one a standard of living adequate for the maintenance of
health ,

Healthy Life Style and Longevity .

 Community Health Practice
Health Promotion

1. Increase the 2. Reduce health 3. Achieve access to

span of healthy disparities among preventive services
life for all citizens population groups for everyone.
Roles of Community Health Nurses
Clinician

Researcher Educator

Nurses

Leadership Advocate

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