Introduction to community health nursing

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

2. 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

3. 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

4. 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。 Public Health Nursing Development in China

5. Challenge for China’s Community Health Nursing • Elderly care issues 2000 Population 2050 Population

6. China Adult Population

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. 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）

9. The Top Five Major Cause of Death in China • Cardiovascular Diseases • Malignant Tumor • Cerebrovascular Disease • Disease of Respiratory System • Injury 、 Intoxication (National data, 2004)

10. Issues in Chronic Diseases • DM • Hypertension • Stroke • Cardiovascular diseases • Obese • Smoking • TB

11. Health Beyond Acute Care Settings-Community Care and Public Health

12. Public Health Definition Public health is the Science and Art of : • preventing disease, • prolonging life, • promoting healthand efficiency through organized community effort. (Winslow, 1920)

13. Definition of Community Health (ANA,2000） • Community health nursing is a synthesis of nursingand public health practice applied to promotingand 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.

14. 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

15. 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.

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 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 .

18. Community Health Practice

19. Roles of Community Health Nurses

20. Health Prevention Tertiary Prevention Secondary Prevention Primary Prevention

21. 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

22. 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

23. 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

24. 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

25. 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

26. Setting for community health nursing practice • homes • ambulatory service settings • schools • occupational health setting • residential institutions • the community at large

28. 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