CASE STUDIES
CASE # 1
History of Public Health and Public and Community Health
Nursing
Michael works as a home health nurse in his suburban community. He visits 7-10 clients each day. On
today’s visitations, Michael will provide care for four clients who are recovering from hip replacement
surgery and three clients who are recovering from heart surgery, and he will provide intravenous (IV)
antibiotics for a man with an infected wound.
Among this list of clients, Michael visits Mrs. T., an 87-year-old white woman who lives alone and is
recovering from triple bypass surgery that she underwent a month ago. Michael’s goals are to check on
her recovery progress, reload her medications in her weekly medication container, and administer an
influenza vaccine.
Upon entering Mrs. T.’s small house, Michael finds the house in disarray: clothes are scattered about,
dirty dishes with crusted food line the kitchen counters, and no lights are on. Michael finds Mrs. T. lying
in bed watching television. Mrs. T. complains to Michael of feeling too tired to do anything; she eats
only what is already prepared (e.g., frozen dinners or snack foods like potato chips) because cooking
requires too much effort. She spends most of her days lying in bed and has not bathed in a week.
Michael helps Mrs. T. out of bed and assists her with a bath. After the bath, Michael fixes Mrs. T. a
quick lunch and refills her medication box while she eats. Michael encourages Mrs. T. to start getting
some exercise by doing the household chores so that her heart can get stronger. “The stronger your heart
is, the more energy you will have,” Michael tells Mrs. T. Michael also enlists several services for Mrs.
T.: A home health aide will come to the house three times a week to help Mrs. T. bathe, and Meals-on-
Wheels will bring her breakfast and lunch. Finally, Nurse Michael administers the influenza vaccine.
During Nurse Michael’s visit the following week, Mrs. T. is showing improvement. She tells Michael, “I
just love that little girl who comes to help me; she is just so sweet. And the Meals-on-Wheels program is
a blessing, I now have more energy to keep this place clean the way I like it.”
1
Questions
1. What challenges did Nurse Michael face in his first visit with Mrs. T. that
public health nurses (PHNs) in the late 1800s also faced?
Nurse Michael faced several challenges during his first visit with Mrs. T. that were also faced by
public health nurses (PHNs) in the late 1800s. These challenges include:
Poor living conditions: Nurse Michael found Mrs. T.'s home in disarray, with dirty dishes
and scattered clothes. Similarly, PHNs in the late 1800s often encountered unsanitary
living conditions, such as overcrowding, lack of ventilation, and poor hygiene.
Limited access to healthcare: Mrs. T. lived alone and may have had limited access to
healthcare, which is also a challenge that PHNs faced in the late 1800s. Many people in
rural areas had little access to healthcare, and even in urban areas, healthcare was often
expensive and not easily accessible to the poor.
Lack of resources: Nurse Michael had to enlist several services for Mrs. T., such as a
home health aide and Meals-on-Wheels, to improve her living conditions and overall
health. Similarly, PHNs in the late 1800s often had limited resources and had to work
with what they had to improve public health, such as educating the public on hygiene and
sanitation practices.
Lack of education: Mrs. T. was not aware of the importance of exercise and was not
engaging in physical activity. Similarly, in the late 1800s, many people were not aware of
the importance of hygiene and sanitation in preventing the spread of disease. PHNs had
to educate the public on these topics to improve public health.These challenges faced by
Nurse Michael and PHNs in the late 1800s highlight the importance of addressing social
determinants of health and taking a holistic approach to healthcare. It is not enough to
treat an illness or disease; healthcare professionals must also address the underlying
social and environmental factors that contribute to poor health outcomes.
Lack of support systems: Mrs. T. was living alone and had limited social support, which
