Public Health Quiz 1: Chapter 2

In 1912, the federal government redefined the role of the U.S. Public Health Service, empowering it to

"investigate the causes and spread of diseases and the pollution and sanitation of navigable streams and lakes"

Principles of Nursing

- "Health of the unity is the health of the community" - "Sick nursing" versus "health nursing" - Proper nutrition, rest, sanitation, and hygiene

WWII: Extension and Retrenchment in PHN

- Accelerated need for nurses - Nursing Council on National Defense - Rise in Army and Navy Nurse Corps - Bolton Act of 1943: Cadet Nurses Corps - Expansion of PHN scope of practice - Emergency Maternity and Infant Care Act of 1943 - Job opportunities

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.

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)

The Future of Public Health, Institute of Medicine (IOM, 1988)

- Found the United State's PH system in disarray and concluded that, although there was widespread agreement about what the mission of PH should be, there was little consensus on how to translate that mission into action. - Reported that the mix and level of PH services varied extensively across the United States.

Social Security Act of 1935

- Funded opportunities for education and employment of PHNs - Funded assistance to states, counties, and medical districts in establishing adequate health services - Provided funds for research and investigation of disease

2000s PHN

- Health care reform passed in 2010 with the federal Patient Protection and Affordable Care Act - PHN organizations develop position papers on the following: - Graduate education for advanced practice PHN - Faculty qualifications for community/public health nursing educators - Importance of PHN within PH systems

National League of Nursing Education and the Association of Collegiate Schools of Nurses dissolved because

- National League for Nursing - American Nurses Association - both merging with National Association of Colored Graduated Nurses and continued as the second national nursing organization

NLN adopted Esther Lucile Brown's Nursing for the Future (1948)

- Recommended to establish basic nursing preparation colleges and universities - Included PHN concepts in all baccalaureate programs; however, these were very brief components of the curricula

National Organization for PHN

- Sought "to improve the educational and services standards of the public health nurse, and promote public understanding of and respect for her work" (Rosen, 1958, p 381). Lillian Wald elected as its first president. - Helped to standardize PHN education

Economic Depression between the two World Wars

- agencies and communities not prepared to address the increased needs and numbers of impoverished (decreased funding) - decreased funding meant decreased number of employed nurses in hospitals and in the community

1990s PHN concerns

- cost - quality - access to direct care services

1980s funding challenges

- high health care costs - shifted funding from health promotion/disease prevention to acute care

1970s PHN

- hospice movement - birthing centers - day care for older adults and disabled persons - drug abuse programs - long-term rehabilitation care

Declining Financial Support for Practice and Professional Organizations

- hospitals were preferred for illness and childbirth - funding stopped for visiting nurse services

Impact of school nursing

- more nurses were hired - school nursing spread to major cities

New Challenges for Public Health Nursing Today

- needs of new populations (immigrants) - nurses leaving PHN for higher salaries - natural disasters require innovative responses (floods, hurricanes, tornadoes) - man made disasters and bioterrorism (increased demand for well-prepared nurses)

School Nursing in America

- school absences due to infections and communicable diseases - children suffered from pediculosis, ring worm, scabies, inflamed eyes, discharging ears, and infected wounds - school nurses also found that children were absent because of lack of clothing, malnourishment, or they were babysitters for families - to combat this, Lillian Wald set up school nurses - Lina Rogers was the first US school nurse

American Public Health Association

- sought inter professional teamwork - promoted the practical application of public hygiene

1918 Influenza Pandemic

Houses, churches, and social halls were turned into hospitals to care for immense numbers of sick and dying.

Need for nurses

Previous caregiving structures, which relied on assistance of family, neighbors, and friends, became inadequate in the early 19th century because of human migration, urbanization, changing demand, and an increasingly complex practice of medicine.

Sheppard-Towner Act (1921)

Provided federal matching funds to establish maternal and child health divisions in state health departments. Ended in 1929

Florence Sarah Lees Craven

Shaped the profession of nursing through her "Guide to District Nurses" which recommended, for example, that nursing care during the illness of one family member provided the nurse with influence to improve the health status of the whole family.

Elizabethan Poor Law

Established systems of care for sick, poor, aged, mentally ill, and dependent - 1601 in England, guaranteed medical care for poor, blind, and "lame" individuals; minimal care provided by almshouses; this care tried to regulate the poor as well as to provide care during illness.

District Nursing and Settlement Houses

These were neighborhood centers that became hubs for health care, education, and social welfare programs. - Lillian Wald and Mary Brewster established Henry Street Settlement in 1893

National Institute of Nursing Research (NINR)

Through research, nurses analyze the scope and quality of care provided by examining the outcomes and cost-effectiveness of nursing interventions. With the concerted efforts of many nurses, NCNR gained official institute status within the National Institutes of Health in 1993

increased prevalence of chronic illness also encouraged a resurgence in

combination agencies—the joint operation of official (city or county) health departments and voluntary visiting nurse agencies using a unified staff. Nurses wanted services to be provided in a coordinated, cost-effective manner respectful to the families served and to avoid duplication of care.

Leading causes of death changed from

communicable diseases (e.g., pneumonia) to chronic diseases (e.g., heart disease). - Nurses contributed to these reductions in communicable diseases through immunization campaigns, improved nutrition, and better hygiene and sanitation. - Additional factors included improved medications, better housing, and innovative emergency and critical care services.

Public Health Service

established in 1798 as the Marine Hospital Service; it provided health care for merchant seamen and protected seacoast cities from epidemics; it is still the most important federal public health agency today.

National Health Circle for Colored People

established to promote public health work in African-American communities in the South; it provided scholarships to assist African-American nurses pursue university-level public health nursing education.

Pennsylvania Hospital in Philadelphia

first hospital founded in America (1751)

Bessie M. Hawes

first recipient of the scholarship, completed the program at Columbia University (New York) and was then sent by the Circle to Palatka, Florida. In this small, isolated lumber town, Hawes' first project was to recruit school-age girls to promote health by dressing as nurses and marching in a parade while singing community songs. She conducted mass meetings, led mother's clubs, provided school health education, and visited the homes of the sick. Eventually she gained the community's trust, overcame opposition, and built a health center for nursing care and treatment.

William Rathbone

founded first district nursing association in Liverpool, England (1859)

In 1965, Congress amended the Social Security Act to include

health insurance benefits for older adults (Medicare) and increased care for the poor (Medicaid). Unfortunately, the revised Social Security Act did not include coverage for preventive services, and home health care was reimbursed only when ordered by the physician.

Early colonial public health efforts

included the collection of vital statistics, improvements to sanitation systems, and control of any communicable diseases introduced through seaports. Colonists lacked a mechanism to ensure PH efforts would be supported and enforced. Epidemics taxed the limited organization for health during the 17th, 18th, and 19th centuries.

Frontier Nursing Service

influenced the development of public health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian region of southeastern Kentucky (Browne, 1966; Tirpak, 1975). - Breckinridge introduced the first nurse-midwives to the United States when she deployed Frontier Nursing Service nurses trained in nursing, public health, and midwifery

WWI Public Health Nursing

need for public health nurses to stay in the US to care for those not serving in the military

Beginning in 1964, the federal Economic Opportunity Act provided funds for

neighborhood health centers, Head Start, and other community action programs. Neighborhood health centers increased community access for health care, especially for maternal and child care.

Florence Nightingale

organized hospital nursing practice and nursing education in hospitals to replace lay nurses with trained nurses - studied nursing "system and method" - progressively improved soldiers' health outcomes during Crimean War using a population-based approach that strengthened environmental conditions and nursing care

Healthy People Initiative

proposed a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases

Emergency Maternity and Infant Care Act of 1943

provided funding for medical, hospital, and nursing care for wives and babies of servicemen. Health services seeking EMIC funds were required to meet the high standards of the U.S. Children's Bureau, thus increasing quality of care for all.

Shattuck Report

published in 1850 by the Massachusetts Sanitary Commission with an emphasis on the public's health. The report called for major innovations: the establishment of a state health department and local health boards in every town; sanitary surveys and collection of vital statistics; environmental sanitation; food, drug, and communicable disease control; well-child care; health education; tobacco and alcohol control; town planning; and the teaching of preventive medicine in medical schools. However, these recommendations were not implemented in Massachusetts for 19 years, and in other states much later

Many local and state health departments rapidly changed their policies to allow the agencies to provide reimbursable home care as bedside nursing. This often resulted in

reduced health promotion and disease prevention activities. From 1960 to 1968, the number of official agencies providing home care services grew from 250 to 1328, and the number of for-profit agencies continued to grow

Instructive District Nursing

term created to emphasize the relationship of nursing to health education

After the American Revolution

the threat of disease, especially yellow fever, brought public support for establishing government-sponsored, or official, boards of health.

American Red Cross

through its Rural Nursing Service (later the Town and Country Nursing Service), provided a framework to initiate home nursing care in areas outside larger cities

In the late 1800s, local health departments were formed in

urban areas to target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties.

The Nursing Council on National Defense

was a coalition of the national nursing organizations that planned and coordinated activities for the war effort.

Origins of organized nursing

1870s: first Nightingale model nursing schools 1877: Women's Board of the New York City Mission hired Frances Root 1878: Ethical Culture Society of New York hired four nurses to work in dispensaries 1885-1886: visiting nurse associations

Civil Rights Movement and Funding Changes

New programs addressed economic and racial differences in health care services and delivery. Funding was increased for maternal and child health, mental health, mental retardation, and community health training.

Metropolitan Life Insurance Company

began a cooperative program with visiting nursing organizations. The nurses assessed illness, taught health practices, and collected data from policyholders

The 1960s and Nursing

Medicare and Medicaid - Did not include coverage for preventive services - Home health care reimbursed only if ordered by a physician Increase in for-profit home health agencies - Reduction in health promotion and disease prevention by local and state health departments

Early Public Health Examples

1. Ancient Babylonians: understood need for hygiene; some medical skills. 2. Egyptians: variety of pharmaceutical preparation; public drainage systems; earth privies. 3. Elizabethan Poor Law of 1601: guaranteed assistance for poor, blind, and "lame" individuals. 4. Industrial Revolution: previous care structures (family & friends) were not enough so created nursing care institutions and homes.

Health Care Reform Movement 1990s

ANA, the American Association of Colleges of Nursing, the National League for Nursing, and more than 60 other specialty nursing organizations joined to support health care reform. The coalition of nursing organizations emphasized key health care issues of access, quality, and cost and proposed a range of interventions designed to build a healthy nation through improved primary care and PH efforts

Occupational health nursing

Began as industrial nursing and was a true outgrowth of early home visiting efforts. - In 1895, Ada Mayo Stewart began working with employees and families of the Vermont Marble Company in Proctor, Vermont (free service for the employees). - As a free service for the employees, Stewart provided obstetric care, sickness care (e.g., for typhoid cases), and some post surgical care in workers' homes. Unlike contemporary occupational health nurses, Stewart provided very few services for work-related injuries.

1950s: PHN education drew closer to university schools of nursing

Broad principles of general nursing education were adopted and applied

Chronic illness rose with

aging population

Through the influence and leadership of U.S. Representative Frances Payne Bolton of Ohio

substantial funding was provided by the Bolton Act of 1943 to establish the Cadet Nurses Corps, leading to increased enrollment in schools of nursing at undergraduate and graduate levels.