NSE 31A/B Chapter Notes - Chapter 7, 22: District Nurse, Lillian Wald, Jeanne Mance
13 Oct 2016
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NSE31A/B Pre-readings
Chapter 1: The history of community health nursing in Canada
INTRODUCTION
• Community health nurses (CHNs) advocate for the provision of primary health care and provide sociopolitical leadership for
the development of the health system and global health in their practice.
• Community health nursing has been challenged to fulfill its social mission in meeting the health needs of diverse
communities over time.
ORIGINS OF COMMUNITY HEALTH NURSING
• Aboriginal peoples – indigenous medicine/healing, women provided healthcare to European settlers
• Community health nursing is the earliest form of nursing practiced in Canada
• 17th century New France – ouit usig as itodued Duhesse d’Aiguillo sistes ho oked i hoes,
hospitals, and communities – focused on determinants of health, community outreach, and advocacy
• In New France – organized community health nursing as practiced by sisterhoods - nursing sisters provided health care in
remote areas, and established the first urban hospitals.
• Augustinian Hospitallers of Dieppe established a hospital and provided care in villages/homes
• The Ge Nus estalished Magueite d’Youille i as Caada’s fist ouit usig ode - provided
access to health services, food, shelter, and education for the vulnerable; began public health visits to the sick poor
• Marie Rollet Hebert worked alongside surgeon husband and established relationships with Aboriginal people
centered around health/healing
• Caada’s fist use: Jeae Mae -1673) confronted the political, social, and economic forces to establish a
range of community health services that included the founding of the Hotel-Dieu Hospital of Montreal
• Religious nursing orders contributed to nursing education, operating schools of nursing within hospitals and
establishing university level nursing programs.
• Boad fous o the soial deteiats of health ad oes fo uleale populatios’ aess to housig, food, ad the
essentials of life.
• Services included education, home visiting, clinics, and advocacy for the essentials of life and health, including
immunizations.
NATION BUILDING AND NIGHTINGALE ERA (MID-TO LATE 19TH CENTURY)
• Canada becomes a nation: increased immigration, ongoing challenges of providing basic health services to settlers, and
Aboriginals experience epidemics introduced by immigrants
• 1867 British North America Act (BNA Act)
• Made very limited provisions for establishment/maintenance of a healthcare system
• Most responsibilities devolved to the provinces – and provinces did not make effort to undertake them
• Any organized healthcare that did exist was provided at the local (municipal) level through public welfare or
charitable organizations.
• After 1850s - development of the nursing profession, influenced by Florence Nightingale. There was a rise in the dominance
of medicine and hospitals in healthcare delivery.
• Establishment of the first school of nursing in St. Catharines, Ontario, in 1874. The Nightingale Model of training nurses lead
to development of the profession.
• Health pootio: Floee Nightigale’s oeptualizatio of usig:
• She was an epidemiologist - collected and used statistics to identify population health concerns among soldiers
during the Crimean war.
• Was an environmentalist - idetified the fie essetial poits i seuig the health of houses as pue ai, pue
ate, effiiet daiage, lealiess ad light
• Lady Aberdeen, wife of Governor General of Canada, led development of the Victorian Order of Nurses in 1897 (VON)
• Mission: to supply nurses, trained in Hospital and District Nursing, and subject to one Central Authority
• He ie that skilled, patial hoe helpes taied i idife and basic care could best reach rural women
was opposed by physicians, nurses, and the National Council of Women. This opposition resulted in the creation of
the VON. This was followed by the evolution of home nursing care and resulted in the extinction of lay midwifery
and the medicalization of obstetrics.
• VON’s ogaizatioal stutue iluded loal ahes ith olutees i aious ouities - visiting nursing
services became the backbone of these local branches and offered bedside nursing care to families who could not
afford to hire private-duty nurses.
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NSE31A/B Pre-readings
EARLY 20TH CENTURY EVOLUTION OF CHN
• By the late 19th and early 20th century the nursing profession was seen as three distinct sectors: hospital nurses, private-
duty nurses, and public health and home-visiting nurses
• CHN emerged as a distinct specialty and the majority of nurses were self-employed as private-duty nurses. Public health
and home-isitig uses ee osideed aog the pofessio’s elite.
• Pioneer CHNs worked to meet the immediate needs of communities for direct care and midwifery while also providing
health education and prevention to individuals and families.
• There was a growing distinction between direct care of individuals and families in the community and the focus on the
health of the community as a whole as both district or home-visiting nursing and public nursing became specialized as
forms of community health nursing that exist today.
• PUBLIC HEALTH NURSING
• The term public health nurse (PHN) was first coined by American nurse Lillian Wald, who, with her nursing
colleague Mary Brewster, founded the Henry Street Visiting Nurse Service in the late 19th century.
• Their conception of practice was broad as they attended to the issues of poverty, culture, and living conditions of
the poor
• Established health education and preventive programs to combat communicable diseases, infant mortality, and
morbidity in school-age children.
• The first PHNs were responsible for TB control, child hygiene programs, and school inspection programs.
• The earliest maternal child health programs were the well-baby clinics, established by the Red Cross Peace
Program, and they remain a signature program of public health nursing today
o Run by nurses who assessed the growth and development of children and provided mothers and
caregivers with health teaching for the care and promotion of child health. Educating mothers about
infant feeding and hygiene became the intervention of choice.
o Visiting nurses (VNs) staffed the clinics and visited the homes of newborn infants in the early postnatal
period.
• DISTRICT AND VISITING NURSING
• Early programs were organized and operated by laywomen and charitable organizations, such as the Margaret
Scott Nursing Mission in Winnipeg, to provide care to poor, working-class and lower-middle-class families.
• District or visiting nursing provided a comprehensive array of services from bedside nursing to preventive health
teaching across geographic and cultural boundaries and complexities
• Pioee usig seies suh as Aleta’s distit using service provided essential emergency and obstetrical
care and midwifery. This was an early form of primary health care, as it encompassed access to essential curative,
preventive, and health promotion services for people in their the homes.
• Rural CHNs faced challenges of distance and climate- various modes of transportation and the dangerous road and
weather conditions
• Although the VON continued to grow during the postwar years, it was also forced to respond to the changing face
of healthcare in Canada - hospital admission became the norm for those requiring obstetrical, medical, or surgical
care; visiting nurses were more likely to give care to those who could afford to pay.
• MILITARY NURSING
• During the influenza epidemics, military nurses helped care for the sick in hospitals, medical units, and refugee
camps. Canadian nurse Elizabeth Smellie (1884–, ho poided leadeship fo the a effot, as the fist
woman in the world to become a full colonel and her later career included leadership in public health, VON, and
the CAN
• Military nursing requires a broad vision, population health approaches, ability to adapt practice in diverse settings
across the spectra of primary, secondary, and tertiary prevention; and the ethical comportment to address
complex conflicts that involve violence and human justice and rights. Today, emergency preparedness and disaster
nursing are essential competencies for military nurses.
• OUTPOST NURSING
• Refers to nurses providing services in the most remote geographic locations, serving settlers and Aboriginal
communities.
• Provided essential services, including emergency care
• The relationships of outpost nurses with the people and the communities – they had to learn from and integrate
their nursing practice with the values and cultures of the people within the political context of the time
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NSE31A/B Pre-readings
NURSING EDUCATION
- First nurse training program was established at the General and Marine Hospital in St. Catharines, Ontario, in 1874
- During early development of the nursing education program, hospital-based education had a little focus on public health
nursing.
- Red Cross helped advance the education of PHNs by providing funding for certificate courses in public health at five
Canadian universities as early as 1919
- In the same year, the first baccalaureate program in nursing was approved to begin at UBC - Education focused on maternal
child programs, communicable diseases, school health, and social welfare issues.
- Initially, diploma programs in public health nursing prepared nurses without baccalaureate degrees to practice public health
nursing. In the later part of the 20th century, the diploma programs were phased out and the baccalaureate degree became
an established requirement of entry-level public health nursing.
- In 2014, the Canadian Association of Schools of Nursing (CASN) identified the following entry-level competencies in public
health nursing practice for undergraduate nursing students:
· public health sciences in nursing practice;
· population and community health assessment and analysis;
· population health planning, implementation and evaluation;
· partnerships, collaboration and advocacy; and
· communication in public health nursing
MID-20TH CENTURY EVOLUTION OF CHN
• Increased government responsibility for the healthcare – expansion of health programs caused shift of focus from
traditional programs (child health, immunization, and communicable disease control) to focus on the reduction of
morbidity/mortality from chronic illnesses.
• No publicly insured programs for home care services existed until 1974 - Publicly funded home care programs resulted in
some growth in the number of CHNs
• Today, as it did in the past, the VON continues to function by offering a mix of services shaped by local circumstances, with
a particular focus on creating programs to respond to unmet needs among specific segments of the population.
• Community mental health nursing emerged in the 1960s and 1970s in response to the deinstitutionalization of patients
with mental illnesses
• Economic recession of the 1980s: loss of nursing positions in all sectors of healthcare, downsizing of hospitals, nurses
replaced by managers who lacked clinical leadership
• The mantra of governments was, and continues to be, replacement of hospital-based care with community health services
and home care.
• Reduction in government spending during 1980s and 1990s affected CHNs in all programs: decreased the levels of service,
negative consequences for infrastructure of communicable disease control à loss of capacity to monitor, identify, and
follow up on communicable diseases is one of the reasons for the resurgence of TB and the recent emergence of new
diseases such as AIDS, SARS, and H1N1 influenza. Deinstitutionalization of patients from acute care and psychiatric
institutions has resulted in the need for innovative and comprehensive community-based healthcare programs and
systems.
LATE 20TH CENTURY: THE NEW PUBLIC HEALTH – PRIMARY HEALTH CARE AND HEALTH PROMOTION
• 1978: WHO adopted Declaration of Alma-Ata at the 1978 International Conference on Primary Health Care and declared
primary health care as the guiding vision for achieving health for all people – gave recognition to nursing as the essential
global workforce for achieving primary health care goals.
• CHNs have provided leadership for advancing the understanding and integration of primary health care priniples in our
Canadian healthcare system - effort to endorse primary health care and health promotion
• Canadian Lalonde Report (1974) and the Ottawa Charter for Health Promotion (1986) sparked a public health movement
that focused the understanding of health and its determinants as value-based processes and identified broad health
promotion strategies
• 1987: formation of the Community Health Nurses Association of Canada (CHNAC)
• The CHNAC evolved to become the Community Health Nurses of Canada (CHNC)
• The CHNC has a mandate to advance the practice of community health nursing through role definition, the
development of standards and theory development, and research. It has also developed a professional practice
model for Canadian community health nursing. In the standards there is continuity with the early practice of
nurses working in the community to promote health, prevent illness, advocate for services, partner with
ouit ogaizatios ad oe’s goups, ad poide ouageous leadeship fo the estalishet of
essential services for vulnerable populations.
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Document Summary
Chapter 1: the history of community health nursing in canada. Community health nurses (chns) advocate for the provision of primary health care and provide sociopolitical leadership for the development of the health system and global health in their practice. Community health nursing has been challenged to fulfill its social mission in meeting the health needs of diverse communities over time. Origins of community health nursing: aboriginal peoples indigenous medicine/healing, women provided healthcare to european settlers. Community health nursing is the earliest form of nursing practiced in canada. 17th century new france (cid:272)o(cid:373)(cid:373)u(cid:374)it(cid:455) (cid:374)u(cid:396)si(cid:374)g (cid:449)as i(cid:374)t(cid:396)odu(cid:272)ed (cid:271)(cid:455) du(cid:272)hesse d"aiguillo(cid:374) siste(cid:396)s (cid:449)ho (cid:449)o(cid:396)ked i(cid:374) ho(cid:373)es, hospitals, and communities focused on determinants of health, community outreach, and advocacy. Services included education, home visiting, clinics, and advocacy for the essentials of life and health, including immunizations. Nation building and nightingale era (mid-to late 19th century) Canada becomes a nation: increased immigration, ongoing challenges of providing basic health services to settlers, and.
