(1) introduction to community health nursing

Introduction to Community Health

Nursing

College of nursingStage: four

Lecturer Name:Nazar Ahmed Mahmud

At the end of this chapter, the student should be able to: Define community health nursing.

Distinguish between community health nursing and community-based nursing.

Differentiate between district and program-focused community health nursing.

Identify at least five attributes of community health nursing.

Distinguish among client-oriented, delivery-oriented, and population-oriented

community health nursing roles.

Describe at least five client-oriented roles performed by community health

nurses.

Describe at least three delivery-oriented roles performed by community health

nurses.

Describe at least four population-oriented roles performed by community

health nurses.

Health: Is state of complete physical, mental, and social well-being and it is not merely the absence of disease or infirmity (WHO, 1978).  

Community: A group of people who share common interests, who interact with each other, and who function collectively within a defined social

structure to address common concerns.

Examples of some communities:

– Citizens of a town

– Group of farmers

– Prison community

– Tiny village in Appalachia

– Members of Mothers against Drug Driving

(MADD)

– Professional nurses

Three Types of Communities

1. Geographic = city, town, neighborhood

2. Common-interest = church, professional organization,

people with mastectomies

3. Community of solution = group of people who come

together to solve a problem that affects all of them.

Nursing: encompasses autonomous and collaborative care of individuals of all ages,

families, groups and communities, sick or well and in all setting. Nursing includes the

promotion of health, prevention of illness, and the care of ill, disabled, and dying

people. Advocacy, promotion of a safe environment, research, participation in shaping

health policy and in patient and health systems management, and education are also

key nursing roles (ICN, 2002).

Neighborhood: A smaller, more homogeneous group than a community that involves

interaction and a level of identification with others living near-by.

Population: The general public or society or a collection of communities.

Aggregates: Populations with some common characteristic that frequently have

common concerns, but may not interact with each other to address those concerns.

Public Health:

"Science and art of preventing disease, prolonging life, promoting

health and efficiency through organized community effort.

Aims:

1. The sanitation of the environment.

2. Control of communicable diseases.

3. The education of individuals in personal hygiene.

4. The organization of medical and nursing services for the early diagnosis

and preventive treatment of diseases.

5. The development of social machinery to ensure everyone a standard of

living adequate for the maintenance of health.

so organizing these benefits as to enable every citizen to realize his

birthright off birth and longevity” (Charles Edward A. Winslow, 1920)

Community Health:

The identification of needs and the protection and improvement of

collective health within a geographically defined area.

Community Health Nursing:

Special field of nursing that combines the skills of nursing, public

health and some phases of social assistance and functions as part of the

total public health program for the promotion of health, the improvement

of the conditions in the social and physical environment, rehabilitation of

illness and disability ( WHO Expert Committee of Nursing )

Community Health (CH) vs Public Health (PH)

• CH : “identification of needs and the protection and

improvement of collective health within a geographically

defined area”

• PH : “activities that society undertake to assure the

conditions in which people can be healthy”

Community-Based Nursing:

Application of the nurses process in caring for individuals, families and

group were they live, work or go to school or as they move through the

health care system.

Zotti and Stotts (1996) compared Community-Based Nursing and community

health nursing and explained that the goals of the two are different: Community health nursing emphasizes preservation and protection of

health, while community-based nursing emphasizes managing acute or

chronic conditions. In community health nursing, the primary client is the community while in

community-based nursing, the primary clients are the individual and the

family. Services in the community-based nursing are largely direct while in

community health nursing, services are both direct and indirect.

Population-focused Nursing: “Community” or “public” health nursing is population based. Care may be given to individuals and families, but its purpose is

the improvement of the health of the population as whole.

Population-focused practice: Focus on the entire population. Is based on assessment of the populations' health status. Considers the broad determinants of health. Emphasizes all levels of prevention. Intervenes with communities, systems, individuals, and families.

The mission of community health nursing:

The primary mission of community health nursing is improving

the overall health of the population through health promotion,

illness prevention, and protection of the public from a wide

variety of biological, behavioral, social and environmental

threats.

"promote the good life" in all of Its physical, social,

psychological, cultural, and economic aspects

(Uosukainen,2001)

HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH NURSING

Concept of Health

Health: holistic state of well-being, including soundness of

mind, body, and spirit

Wellness: health plus the capacity to develop one’s

potential, leading to a fulfilling and productive life

Illness: state of being relatively unhealthy

Characteristics of CHN:1. The client or “unit of care” is the population.

2. The primary obligation is to achieve the greatest good for the greatest number of

people or the population as a whole.

3. The processes used by public health nurses include working with the client(s) as

an equal partner.

4. Primary prevention is the priority in selecting appropriate activities.

5. Selecting strategies that create healthy environmental, social, and economic

conditions in which populations may thrive is the focus.

6. There is an obligation to actively reach out to all who might benefit from a

specific activity or service.

7. Optimal use of available resources to assure the best overall improvement in the

health of the population is a key element of the practice.

8. Collaboration with a variety of other professions, organizations, and entities is

the most effective way to promote and protect the health of people.

COMPONENT OF COMMUINTY HEALTH PRACTICE� Community health practice can be best understood by examining six

basic components, which, when combined, encompass its services

and programs. These components are:

1. Promotion of health.

Includes all efforts that seek to move people closer to optimal well-

being or higher levels of wellness.

The goal of health promotion: Is to enable people to exercise control over their well-being and

ultimately improve their health.

Is to raise levels of wellness for individuals, families, populations, and

communities.

2. Prevention of health problems. Prevention of health problems constitutes a major part of community health

practice.

Prevention means: Anticipating and averting problems or discovering them as

early as possible to minimize potential disability and impairment.

Three Levels of prevention:

1- Primary prevention: Action taken prior to the occurrence of health

problems and directed toward avoiding their occurrence. Primary

prevention includes health promotion, health protection, and illness

prevention.

2- Secondary prevention: The early identification and treatment of

existing health problems.

3- Tertiary prevention: Activity aimed at returning the client to the

highest level of function and preventing further deterioration in health.

3. Treatment of disorders. It focuses on the illness end of the continuum and is the remedial

aspect of community health practice.

This occurs by three methods:

1. Direct service to people with health problem.

2. Indirect service that helps people to obtain treatment.

3. Development programs to correct unhealthy conditions.

4. Rehabilitation. The fourth component of community health practice, involves efforts to

reduce disability and , as much as possible, restore function.

People whose handicaps are congenital or acquired through illness or

accident e.g.:Stroke, .Heart condition,.Amputation, Mental illness.

5. Evaluation.

The process by which that practices is analyzed,

judged, and improved according to established goals

and standards.

6. Research.

Is systematic investigation to discover facts affecting

community health and community health practice, solve

problems, and explore improved methods of health

services

Community Health Nursing Roles:

A. Client-oriented roles

B. Delivery-oriented roles

C. Population-oriented roles

A. Client-oriented Roles1. Caregiver

Uses the nursing process to provide direct nursing intervention to individuals, families, or

population groups

2. Educator

Facilitates learning for positive health behavior change

3. Counselor

Teaches and assists clients in the use of the problem solving process

4. Referral Resource

Links clients to services to meet identified health needs

5. Role Model

Demonstrates desired health-related behaviors

6. Advocate

Speaks or acts on behalf of clients who cannot do so for themselves

7. Primary Care Provider

Provides essential health services to promote health, prevent illness, and deal with existing

health problems

8. Case Manager

Coordinates and directs the selection and use of health care services to meet client needs,

maximize resource utilization, and minimize the expense of care

B. Delivery-oriented Roles

1. Coordinator/Care Manager

Organizes and integrates services to best meet client needs in

the most efficient manner possible

2. Collaborator

Engages in shared decision making regarding the nature of

health problems and potential solutions to them

3. Liaison

Provides and maintains connections and communication

between clients and health care providers or among providers

C. Population-oriented Roles1. Case Finder Identifies clients with specific health problems or conditions Geared toward awareness of population-level problems

2. Leader

Influences clients and others to take action regarding identified health problems

3. Change Agent

Initiates and facilitates change in individual or client behaviors or conditions or

those affecting population groups

4. Community Developer

Mobilizes residents and other segments of the population to take action regarding

identified community health problems or issues

5. Coalition Builder

Promotes the development and maintenance of alliances of individuals or groups of

people to address a specific health issue

6. Researcher

Conducts studies to explain health-related phenomena and to evaluate the

effectiveness of interventions to control them