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Public Health Nursing for the Care of Illness *

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PUBLIC HEALTH NURSING FOR THE CARE OF ILLNESS* LOUIS I. DUBLIN An essential function of the public health nurse is the care of the sick in their homes. Periodic appraisal of the requirements for this purpose is necessary in view of changing needs and resources. Collins has presented extensive data on the incidence of illness in 9,000 families surveyed by the Committee on the Cost of Medical Care.1 Based upon this study, Downes submitted a summary of facts and figures which are useful in considering the relative needs for public health nurs- ing in the United States.2 However, additional factors must be con- sidered in attempting to chart the road ahead for public health nursing, especially in view of the changes in medical practice and in the in- cidence of disease during the past fifteen years. Some of these changes are the result of war conditions; others are the product of the recent advances of medical science and the spread of insurance systems and will remain after war conditions are terminated. The present trend is more and more to direct the care of the sick away from the home toward medical centers, clinics, and hospitals. Fifteen years ago, the Blue Cross Plan was in its infancy; today, it has enrolled some twenty million members. It is estimated that five years hence, thirty-five million may be covered. Fifteen years ago, commercial insurance for hospitalization had not been devised. Today, some eight million persons are covered under Group plans while an additional million have Personal Accident and Health policies providing hospitali- zation. Altogether, about thirty million persons today are eligible for hospital care under various plans and the number is growing rapidly. The consequence of this development is to reduce the need for extensive visiting nurse care in the home. Of significance, too, is the shift in the incidence of disease. The acute communicable diseases have declined at the same time that the chronic diseases have increased in importance. The aging of the popula

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