PUBLIC
HEALTH,
NURSING
AND
MEDICAL
SOCIAL
WORK
MYRON E. WEGMAN, M.D., Contributing Editor
ROLE
OF
THE
PUBLIC
HEALTH
NURSE
IN
THE
PREVENTION
OF
INFANT
MORTALITY
P
UBLIC health nursing offers service in the health field to the individual, the family and the community. When first started it was confined mainly to the nursing care of the sick in their homes but it has now expanded to include the teaching of positive health.These activities are carried out with qualified medical guidance and advice. All over the world, therefore, public health nurses have many contacts with pediatricians because of
their special interest in health protection and education.
Since this function demands experience beyond the standard education of the
regis-tered nurse, public health nurses, or as they are called in some countries, health visitors, should be fully qualified nurses who have in addition received special preparation. This preparation should cover the public health aspects of such specific subjects as maternal and child health, tuberculosis, venereal diseases, nutrition, school health, problems of chronic
disease and so forth. In addition to the theory there must be field observation and
experi-ence so that the nurse has an opportunity to apply her knowledge under supervision. Em-phasis on health teaching is of fundamental importance ; not only is it necessary to know what to teach but the nurse must understand how people learn, and she must know the
most appropriate technic to make that learning as effective as possible. For example, just telling a mother that her child needs vitamin D does not necessarily mean that the mother
has learned this fact and will put her learning into action by giving the child foods which
supply vitamin D. There must be further follow-up either at the nurse’s center or in the home with demonstration, if needed, of the foods necessary, the best way to preserve the
vitamin and the most effective way to administer it to the child.
The public health nurse must be acutely aware of the social welfare aspects of ill health.
Health, both physical and mental, and social welfare are very closely related and to con-sider the one without the other leaves a great and important gap. To work successfully,
therefore, the nurse must be familiar with the social agencies of her community and be
able to work closely with them.
Public health nurses may render their services either on a ‘‘generalized’ ‘ or “specialized”
basis. In recent years there has been a steady trend towards the former pattern, under
which a single nurse has responsibility for all the families and individuals in a certain area with regard to all their public health problems, maternal and child health,
corn-municable diseases, tuberculosis, venereal disease, school health, occupational health and
so on. In a ‘‘specialized service” a nurse will work only in one field, tuberculosis for
in-stance, and will have a much larger geographic area to serve.
Experience in many countries has shown that the ‘‘generalized’ ‘ service is more
effec-tive since it avoids unnecessary duplication of several visitors to one home, and thereby
486 MYRON E. WEGMAN
eliminates confusion which frequently occurs when instruction is given by more than
one person. The chief function of the nurse, in whichever type of service she is engaged,
is the teaching of health. She does this through her contact with individuals in the home,
in clinic conferences and through group classes.
In the prevention of infant mortality the nurse has an important role in several specific activities. Deaths from prematurity, birth injuries and congenital anomalies can be
de-creased greatly through good prenatal care. By means of home visiting, group teaching, or in her conferences at prenatal clinics the nurse is able to emphasize the importance of regular medical supervision. She is able to instruct the expectant mother in the many details necessary for physical as well as mental preparation for the new baby. These details
are frequently the very things which cause the most worry and yet the mother considers
them too trivial to ask the doctor in his busy clinic. Nutrition is most important in the prenatal period and it is in this field that the nurse can do very effective teaching through group and individual conferences and demonstrations. In carrying out her role in
pre-natal education the nurse does not supplant the doctor, but rather supplements the advice he has to give.
Careful delivery technic is an important factor in the prevention of birth injuries. In countries where there is a great shortage of doctors the majority of babies are delivered in
the home, with or without the assistance of a midwife who may or may not be trained. In
such cases the public health nurse should be in a position to give instruction and super-vision to the midwives working in her area. Unfortunately in countries where this super-vision is most needed there are few, if any, public health nurses.
A home visit in the immediate neonatal period helps to overcome the frequent early difficulties and to get prompt medical attention for anything serious. Areas with facilities for the case of the premature infant in hospital or home usually depend on the public
health nurse as the one to arrange for prompt and proper hospital placement or for
de-tailed instruction in the intricacies of home care. With the general decline in infant mortality prematurity has become relatively more important as a cause of infant death and
public health nurses have correspondingly become more concerned with arranging for the provision of the superior nursing care so necessary to the premature infant’s chances of survival. Through her home visits and child health conferences, the nurse advises the mother in the care of the child, and in good health practices, which will help to prevent
respiratory and gastrointestinal infections.* She emphasizes the importance of early immunization and encourages the mother to take the child to the doctor for this service. The public health nurse teaches the methods of protecting the child from becoming
in-fected by other persons who may have a communicable disease.
The nurse is in a position to be of service to both the obstetrician and the pediatrician.
To the obstetrician she frequently refers expectant mothers who might not seek medical
supervision until late in pregnancy. She helps to make his teaching more effective by actual demonstration to the mother in the home or in the clinic. For the mother who is to
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK 487
lus resulted. The obstetrician and the pediatrician in turn find her ready to follow up
in the home or school the cases for which public health nursing supervision is needed. It is generally agreed that because of many individual and sustained contacts with the
public the most effective teacher of health in the health agency is the well-qualified nurse. It is, of course, not possible to estimate the extent to which the public health nur’se con-tributes to the reduction in infant mortality, but it is a fact that in those countries where public health programs, including public health nursing, are well developed infant
mor-tality is lower.
LYLE CREELMAN, R.N., MA.
Nursing Consultant, WHO
