Nursing has come a long way since the profession first rose to the fore in the mid-1800s. The nursing profession continues to evolve as members of the healthcare community analyze and spearhead opportunities for improvement. Changes in patient behavior, healthcare standards, and the public’s overall knowledge of health and hygiene were largely driven by healthcare documents that urge other members of the healthcare community to rethink their approach to patient care. These documents spur change by turning people’s attention to systemic issues in the healthcare community. By looking back on how the nursing industry has changed, we can make better sense of how the industry will continue to evolve going forward.
District Nursing and At-Home Care
Throughout history and before the start of the twentieth century, the nursing industry was focused on at-home care and district nursing, a localized approach to treating severe illnesses and chronic conditions. Instead of having patients travel to the closest hospital, district nurses would typically visit patients in their home to relieve their condition. They would also educate their family members on how to care for the patient during this time. Medical care was fairly limited back in the day, so in many cases, caring for the patient was just about making them feel comfortable until they reached the end of their life.
The Public Health Campaign
Healthcare became an increasingly alarming concern at the turn of the twentieth century. The industrial revolution brought many changes to urban life, including increasing smog, pollution, waste, and cramped living spaces as immigrants and those looking for work would congregate in small apartments and brownstones. This led to a rapid rise in the spread of disease as cities struggled to accommodate such a high concentration of people.
With infections on the rise, nurses and those working in healthcare started focusing on preventative care as a way of helping patients avoid germs and the spread of illness. Dr. C. E. Winslow, then a leading voice in healthcare reform, was one of the main proponents of the public health campaign, which was designed to educate the public on hygiene, sanitation, and preventative medicine. The campaign talked about how germs spread from person to person and steps individuals should take to protect themselves. Dr. C. E. Winslow also stated that nurses should play a central role in terms of educating patients when it comes to issues of sanitation and hygiene.
The Goldmark Report
In the second decade of the twentieth century, nurses continued to play an increasingly vital role in public and private life, but the industry was lacking specific standards and procedures. To combat this issue, the Rockefeller Foundation organized a meeting with public officials and healthcare workers to come up with a system of standards for public health nurses. This meeting eventually spurred the Goldmark Report, which outlined specific skills and training that all public health nurses would need to achieve before practicing medicine. This created a system of accountability in the nursing industry to ensure patients are cared for by those with the proper credentials.
Ruth Hubbard’s Public Health Nursing
By the 1950s, the nursing industry was again in the middle of an intense period of change. The industry was growing quickly during this time because of the dramatic rise in births after WWII. As more families moved to suburbia, new healthcare centers were being created all over the country. Ruth Hubbard, the president of the National Organization for Public Health Nursing, examined the rise of the nursing profession from the beginning of the century to the 1950s, stressing the need for the healthcare community to look at its past in order to understand its future. The work addressed current needs and issues prevalent in the nursing community, using history as reference for how these problems could be solved. It also highlighted the need to make public health information accessible across all aspects of life, including the home, school, work and public spaces.
The Affordable Care Act
The ACA was a landmark piece of legislation that changed the healthcare industry dramatically. It established what became known as essential health benefits, mandating that all insurance providers include certain health benefits in a patient’s health insurance policy, including access to mental health, prenatal care, and other vital services. Insurers could no longer deny someone health insurance coverage for having a preexisting condition such as a chronic illness. This made it easier for patients to receive the care they need, helping nurses and healthcare providers care for patients in a comprehensive way instead of limiting their services based on the patient’s insurance coverage.
The healthcare industry continues to grapple with all kinds of issues and concerns. Some patients still struggle to find and pay for the care they need. Rural areas continue to face nursing shortages. To meet these challenges and further improve the country’s healthcare system, we must fully understand the history of healthcare and how the industry came to be as we know it today.