1. Gibson, Mary PhD, RN
  2. Keeling, Arlene PhD, RN, FAAN

Article Content

Since the inception of the profession, nurses have been instrumental in shaping family and community health. Clear evidence of their influence is abundant in nursing's history, particularly in the realm of public health and community health nursing-first labeled "district nursing." Rooted in the work of the Catholic Sisters of Charity and Sisters of Mercy, as well as in that of the Lutheran Deaconesses, district nursing emerged in England under William Rathbone in the mid-19th century and spread to major cities in the United States a few decades later. With the establishment of the National Organization of Public Health Nursing in 1912 and the subsequent growth of the American Red Cross Town and Country Nursing Service, nurses' influence in communities throughout the United States strengthened during the Progressive era and continued throughout the 20th century. Public health nursing efforts and programs emerged to keep pace with the growing needs of specific populations in the United States and abroad. This issue provides examples of historical topics that shaped family and community health in a variety of contexts.


The articles in this issue of Family & Community Health, all using historical research methods, begin with the rise of Public Health Nursing Education in the early 20th century and follow several cases of community nursing in the decades that followed, identifying and describing how nurses influenced the health of the communities in which they practiced. In "Something Must be Done!" authors Pamela Kulbok and Doris Glick note the profession's early recognition that public health nurses needed specialized, advanced knowledge to be effective leaders within the sphere of community health and describe the changes that occurred in educational preparation of Public Health Nurses in the years 1900 to 1950. Picking up the story in the war years of the 1940s, nurse historian Nena J. Powell demonstrates how nurses working in the Fort Lewis maternity project in Tacoma, Washington, played a critical role in meeting the maternal/child health care needs for military families there. She also shows how the project served as a model of care delivery to meet similar needs for US military families in other areas of the country. Juxtaposed to the support provided to military families in Tacoma, comes a story of nurses containing contagion in a US Japanese American Internment camp in the article "No Communicable Diseases This Month: Public Health Nursing at the Colorado River Relocation Center, 1942-1945." In this article, author Rebecca A. Coffin shows how US public health nurses relied on their knowledge of health promotion and disease prevention, as well as their collaboration with the Japanese American physicians and nurse aides, to prevent or mitigate outbreaks of typhoid, measles, and tuberculosis within the camp.


Traveling next to sub-Saharan Africa after 1945, authors Barbra Mann Wall and Lauren Johnson challenge the conventional narrative of medical missionaries as agents of European imperialism and, instead, demonstrate how the Catholic Medical Mission Sisters addressed the need for maternity care in rural Ghana. On the same continent, our next authors' exploration of nurses' roles in shaping community health spotlights a case in Uganda in the 1970s. In "Resistance and Religion: Health Care in Uganda, 1971-1979," authors Barbra Mann Wall and Madeline Reckart examine how religious women in Uganda worked with local individuals and families during periods of genocide and displacement in their war-torn country. During Idi Amin's violent 8-year rule in Uganda, these Catholic missionary sisters provided wide-ranging humanitarian relief as well as medical and nursing care, focusing efforts on vaccination as well as maternal/infant care. Situated in a period of war and violence, this article emphasizes the importance of context in shaping nurses' work.


Crossing the Atlantic, we return to the United States, where "Civil Unrest Does Not Stop Ovulation" authors Pamela B. DeGuzman, Donna L. Schminkey, and Emily A. Koyen describe the work of young, white public health nurse Nancy Milio in Detroit in the 1960s. Amidst volatile racial tensions in the primarily African American Kercheval district of the city, Milio worked with the underserved population to identify health needs and assist the community in establishing the Mom and Tots Center. Here, residents could receive needed prenatal, women's and children's health care, child care, and family planning services. This participatory community action project, spearheaded by a public health nurse, created access to health care for a highly vulnerable population during a turbulent time.


Some of the factors influencing maternity care in Detroit can also be seen in the next case study, in Philadelphia, where author Linda Maldonado explores the means through which the Maternity Care Coalition used grassroots activism to dismantle the power structures that contributed to a high rate of infant mortality in Philadelphia's Health Districts 5 and 6 during the 1980s. Examining issues of race, class, and gender, the author described how a Catholic nun and midwife, Sister Teresita Hinnegan, became the intellectual force behind the Maternity Care Coalition, considering factors that influenced pregnancy outcomes in Lower North Central Philadelphia and working to address these health disparities.


Moving to a rural setting in Virginia, Audrey Snyder shares the account of a single Catholic sister's work in rural Appalachia beginning in the 1980s. In her Volkswagen Beetle and armed with her skills as a nurse and midwife, she struck out to meet the needs of the widely scattered and underserved population in southwest Virginia. Her tireless efforts resulted in improved access to care for many and national attention to the needs of this rural population.


Actually, the importance of understanding context cannot be overestimated, as can be seen in each of these case studies. Place matters. Time matters. Political context matters. Individual nurses matter. Nurses shape family and community health in the rural or urban context in which they work, creatively using available resources, whether publicly or privately supported. As Linda Maldonado states in her article, "...history allows us to look back; consider how a community's sociopolitical context affected health and ultimately develop strategies for the present based on our lessons from the past."


-Mary Gibson, PhD, RN


-Arlene Keeling, PhD, RN, FAAN


University of Virginia School of Nursing


Charlottesville, Virginia