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
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
Public Health Nursing
Development in China
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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。
Challenge for China’s
Community Health Nursing
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Elderly care issues
2000 Population
2050 Population
China Adult Population
National Health Statistics
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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
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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
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Cardiovascular Diseases
Malignant Tumor
Cerebrovascular Disease
Disease of Respiratory System
Injury 、 Intoxication
(National data, 2004)
Issues in Chronic Diseases
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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 :
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preventing disease,
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prolonging life,
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promoting health and efficiency through
organized community effort.
(Winslow, 1920)
Definition of Community
Health (ANA,2000）
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Community health nursing is a synthesis of
nursing and public health practice applied to
promoting 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, coordination,
and continuity of care for meeting population
needs.
Characteristics of Community
Health Nursing
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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
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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:
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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 .
Community Health Practice
Health Promotion
1. Increase the
span of healthy
life for all citizens
2. Reduce health
disparities among
population groups
3. Achieve access to
preventive services
for everyone.
Roles of Community Health Nurses
Clinician
Educator
Researcher
Nurses
Advocate
Leadership
Collaborator
Manager
Health Prevention
Tertiary Prevention
Secondary Prevention
Primary Prevention
Primary Prevention for Health
Promotion
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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
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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
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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
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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
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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
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homes
ambulatory service settings
schools
occupational health setting
residential institutions
the community at large
Opportunity for Future
Community Health Nursing
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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