The field of community health nursing has evolved through four distinct stages. The early home care nursing stage dates back to before the mid-1800s. During this stage, nursing and religion were closely related. Religious groups took on the roles and responsibilities of caring for those in need of healthcare. The first representation of nursing was apparent in 1617 with the Sisters of Charity. They were a religious group primarily composed of nuns. The main focus of these women was to direct their care towards the sick poor population. They wanted to help those who were ill but were unable to access proper care. They would visit the sick at their homes and provide any necessary treatment. Following the successful actions of the Sisters of Charity, community health nursing was temporarily put on hold. The setback was due to the Reformation and the Industrial Revolution. These major historical events lead to fewer religious groups and an increase in epidemics. Infant mortality rates, mental illnesses, communicable diseases, and work related injuries were on the rise. During these miserable living conditions, Florence Nightingale became noticed for her improvements in nursing care. Her work during the Crimean War greatly impacted the direction of community health nursing. She saved many lives by controlling the spread of infectious disease. She was the first leader of health prevention and health promotion (Allender & Spradley, 2005).
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The district nursing stage occurred from the mid-1800s to 1900. William Rathbone largely impacted this stage. His wife benefited from a home health nurse while she was sick. He decided to hire the nurse that cared for his wife to work in the community and provide care to all poor individuals as necessary. Due to insufficient sanitation and unsafe working conditions, the need for nurses in the community was very demanding. Therefore, William Rathbone hired many more nurses to work in the community. In 1861, Rathbone founded the first training school for visiting nurses. Once the nurses completed their education, they were sent out to work in a specific district in the community. These nurses were responsible for taking care of the poor and teaching them proper hygiene and health-related habits. They taught new mothers how to prevent infant diarrhea to reduce the risk of infant mortality. This area of nursing gained more attention from the government and became financed from public money instead of from religious and charitable donations (Allender & Spradley, 2005).
The public health nursing stage took place between the years of 1900-1970. The nurse role extended beyond treating only the poor; therefore, Lillian D. Wald coined the term ‘public health nursing’. These nurses worked outside of the traditional hospital settings and were required to treat the general population. There were many different areas for nurses to provide their care in the public; such as, infant welfare, venereal disease control, school health, and mental health programs. In 1903, Robert Koch proved that tuberculosis is communicable. This discovery led to more nurses working in tuberculosis clinics trying to minimize outbreaks. Nurses were responsible for teaching the public in the hopes of promoting healthy habits and preventing illness. Wald began implementing policies, laws, and standards within the public to improve the health of the population. In 1912, she founded the National Organization for Public Health Nursing. The career path was gaining popularity and finally considered a respectable profession (Allender & Spradley, 2005).
The community health nursing stage is the final stage. It began in 1970 and presently exists. It is difficult to distinguish between the public health nursing stage and the community health nursing stage. The two terms are very similar and used interchangeably. Community health refers to all nurses who practice in the community. They may not necessarily focus on public health practices; such as, health promotion and prevention. Community health nurses were seen working at senior centres, community-health clinics, doctor’s offices, schools, and occupational environments. They began working in collaboration with many other health professionals; such as, physicians, physiotherapists, social workers, and nutritionists. Community health nursing has advanced significantly throughout the past century (Allender & Spradley, 2005).
The field of community health nursing is very diverse. The current practice of community health nursing includes primary prevention, secondary prevention, and tertiary prevention. A community health nurse may work for an official public health agency concentrating on primary prevention. They may work towards implementing policies; such as, a smoke-free Ontario. They can organize programs within the community to educate the public; such as, participACTION, fall prevention, and well baby program. These nurses can work in occupational settings trying to prevent work-related injuries. They may also be seen working for telephone help lines where they give advice and referrals for those who need assistance. An important mechanism of primary prevention is vaccination clinics. The goal of primary prevention is to prevent illness from occurring in the first place. The purpose of secondary prevention is to diagnose illness as early as possible. Nurses can work for screening clinics and help with early treatment plans. Tertiary prevention aims to provide the community with rehabilitation facilities. Nurses can have important roles promoting and maintaining good health (Stamler & Yiu, 2005).
Community health nursing is a very valuable nursing specialty. There have been many successes leading to positive outcomes for communities around the world. A current strength is giving vaccinations. Vaccinations are extremely important in preventing serious illness. They save the health care system significant amounts of money each year by preventing disease. Vaccinations have completely removed certain diseases that were once considered fatal. A second strength is the maintenance of sanitary living conditions which reduce the risk of spreading infectious diseases. A third strength is the multiple programs organized through public health agencies. There are education programs that create awareness of sexually transmitted diseases and prompt treatment with medication. Other programs promote the use of seat-belts, car seats, and helmets, causing motor-vehicle related injuries to drastically reduce. Public health nurses have helped reduce the amount of deaths related to cardiovascular accidents by encouraging smoking cessation and running blood pressure clinics. There are nurses who have promoted healthy eating to reduce diseases related to malnutrition; such as, rickets. Public health nursing has created a safer and healthier community (Thornbory, 2009).
There are three main challenges in the field of community health nursing. The first challenge is that there is a lack of evidence based research to guide the practice and form new policies. The majority of current research studies are used to guide nursing practice within the hospital setting but not within the community setting. There is a very minimal amount of objective data and statistics within community-based research. The problem associated with lack of scientific research is that it creates a communication barrier. It makes it almost impossible to create new policies. A second challenge is related to policy implementation. Nurses can spend a great deal of time explaining to the public why it is important to exercise and eat healthy, but education is not enough. The environment plays a large role and impedes much of what nurses try to educate (Thornbory, 2009). For example, public health nurses can encourage children to eat fruits and vegetables but the school cafeteria only sells junk food. Policies can be created to make fruits and vegetables more affordable but there are more fast-food restaurants than grocery stores. The third challenge is avoiding ethical dilemmas. A community health nurse may be responsible for providing care to an individual while simultaneously protecting the health of the community. It is possible that these two obligations may come into conflict with one another and the nurse is left with a tough decision. For example, a nurse counsels a client who just found out he has tuberculosis. The client decides he does not want treatment. He has the right to autonomy, confidentiality, and freedom of choice but his decision puts the community at risk. This example demonstrates an ethical dilemma that a community health nurse may face. She must decide if she wants to defend her individual patient or go against his wishes for the greater good of the public (CNA, 2006). There are a few challenges in the community health nursing field but they do not outweigh the successes.
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Community health nursing is expected to expand even further throughout the next several years. It may begin to include forensic nursing and disaster nursing. If current trends continue, those specific areas within the community may be in demand. Sexual assault and domestic violence has been on the rise and nurses have the potential to help the situation. These nurses would have to have very good assessment skills and be able to collect physical evidence from a victim’s body. There have also been many disasters the past few years; such as, the terrorist attack on 911 and hurricane Katrina. Nurses will be needed in the future if similar situations arise (Stamler & Yiu, 2005).
I am interested in becoming a community health nurse. I do not want to work a high stress job in a hospital atmosphere. Important skills for a community health nurse to acquire are communication, teaching, and management (Hunt & Zurek, 1997). I can communicate effectively to clients and show empathy when appropriate. I have very good time management skills as well as being organized. I can work in collaboration with others or independently. I think I am most interested in becoming a home health nurse or a public health nurse. I feel that I could assess a community’s needs and create a productive plan. I am looking forward to the reward of helping people from diverse populations.
This paper has examined the various aspects of community health nursing. Community health nursing has progressed from religious and charitable organisations to many more career options being funded by the government. There are many opportunities for community health nurses. They may experience a variety of work environments and roles. The role of the nurse may be to prevent disease, promote healthy living, or take care of those who are sick in their homes. This specialty of nursing has progressed immensely since the 1600s and will most likely continue to advance into the future.
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