ROLES AND SETTING FOR ROLES AND SETTING FOR COMMUNITY HEALTH COMMUNITY HEALTH NURSING PRACTICENURSING PRACTICE

CHAPTER 3CHAPTER 3

Historically, community health nurse have Historically, community health nurse have engaged in many roles. From the beginning, engaged in many roles. From the beginning, nurse in this professional specialty have nurse in this professional specialty have provided care to the sick, taught positive health provided care to the sick, taught positive health habits and self-care, advocated on behalf of habits and self-care, advocated on behalf of needy populations, developed and managed, needy populations, developed and managed, health programs, provided leadership, and health programs, provided leadership, and collaborated with other professionals and collaborated with other professionals and consumer to implement changes in health consumer to implement changes in health services.services.

The settings in which theses nurses practiced The settings in which theses nurses practiced varied, too. The home certainly has been one varied, too. The home certainly has been one site for practice, but so too have clinics, schools, site for practice, but so too have clinics, schools, factories, and other community-based locations. factories, and other community-based locations.

ROLES OF COMMUNITY HEALTH ROLES OF COMMUNITY HEALTH

NURSESNURSES Community health nurses wear Community health nurses wear

many hats while conducting day-to-many hats while conducting day-to-day practice.day practice. The focus of nursing The focus of nursing includes not only the individual, but includes not only the individual, but also the family and the community, also the family and the community, meeting these multiple needs meeting these multiple needs requires multiple roles. requires multiple roles. 

The seven major roles of a The seven major roles of a community health nurse are: community health nurse are:

1. Care provider. "Clinician role". 1. Care provider. "Clinician role". 2. Educator.2. Educator. 3. Advocate.3. Advocate. 4. Manager.4. Manager. 5. Collaborator.5. Collaborator. 6. Leader.6. Leader. 7.Researcher.7.Researcher.

1. Care Provider 1. Care Provider "Clinician Role" "Clinician Role"

The most familiar role of the community The most familiar role of the community health nurse is that of clinician or care health nurse is that of clinician or care provider. The provider. The clinicianclinician role in community role in community health means that the nurse ensure that health means that the nurse ensure that health services are provided not just to health services are provided not just to individuals and families, but also to individuals and families, but also to groups and populations.groups and populations.

The role of the clinician or care provider is a The role of the clinician or care provider is a familiar one for most people. In community health familiar one for most people. In community health the clinician views clients in the context of larger the clinician views clients in the context of larger systems. The family or group must be considered systems. The family or group must be considered in totality. The community health nurse provides in totality. The community health nurse provides care along the entire range of the wellness-illness care along the entire range of the wellness-illness continuum; however, promotion of health and continuum; however, promotion of health and prevention of illness are emphasized. Skills in prevention of illness are emphasized. Skills in observation, listening, communication, observation, listening, communication, counseling, and physical care are important for counseling, and physical care are important for the community health nurse. Recent concerns for the community health nurse. Recent concerns for environment, sociocultural, psychological, and environment, sociocultural, psychological, and economic factors in community health have economic factors in community health have created a need for stronger skills in assessing the created a need for stronger skills in assessing the needs of populations at the community level. needs of populations at the community level.

For community health nurses, the For community health nurses, the clinician role involves certain clinician role involves certain emphases that are different from emphases that are different from those basic nursing. Three clinician those basic nursing. Three clinician emphases, in particular, are useful emphases, in particular, are useful to consider here:to consider here:

-- Holism.Holism. - Health promotion.- Health promotion. - Skill expansion.- Skill expansion.

Holistic PracticeHolistic Practice

Holistic nursing care encompasses Holistic nursing care encompasses the comprehensive and total care of the comprehensive and total care of the client in all areas, such as the client in all areas, such as physical, emotional, social, spiritual, physical, emotional, social, spiritual, and economic. and economic.

Focus on Wellness Focus on Wellness

The clinician role in community The clinician role in community health also is characterized by its health also is characterized by its focus on promoting wellness. The focus on promoting wellness. The community health nurse provides community health nurse provides services along the entire range of services along the entire range of the health continuum but especially the health continuum but especially emphasize promotion of health and emphasize promotion of health and prevention of illness.prevention of illness.

Nursing service includes seeking out Nursing service includes seeking out clients who are at risk for poor health and clients who are at risk for poor health and offering preventive and health promotion offering preventive and health promotion service, rather than waiting for them to service, rather than waiting for them to come for help after problems arise. come for help after problems arise.

The community health nurse may help The community health nurse may help employees of a business learns how to live employees of a business learns how to live healthier lives or work with the expected healthier lives or work with the expected changed behavior, or work with a group of changed behavior, or work with a group of people who want to quit smoking. people who want to quit smoking.

Groups and populations are identified that may Groups and populations are identified that may be vulnerable to certain health threats, and be vulnerable to certain health threats, and preventive and health promoting programs can preventive and health promoting programs can be designed. be designed. Examples includes:Examples includes:

- Immunization of preschoolers.- Immunization of preschoolers. - Family planning programs.- Family planning programs. - Cholesterol screening.- Cholesterol screening. - Prevention of behavioral problems in - Prevention of behavioral problems in

adolescents. adolescents. Protecting and promoting the health of Protecting and promoting the health of

vulnerable population is an important vulnerable population is an important component of the clinician role .component of the clinician role .

Expanded SkillsExpanded Skills Many different skills are used in the role of Many different skills are used in the role of

the community health clinician. In the the community health clinician. In the early years of community health nursing, early years of community health nursing, emphasis was placed on physical care emphasis was placed on physical care skills. With time, skills in observation, skills. With time, skills in observation, listening, communication, and counseling listening, communication, and counseling become integral to the clinician role as it become integral to the clinician role as it grew to encompass an increased emphasis grew to encompass an increased emphasis on psychological and sociocultural factors. on psychological and sociocultural factors. Recently, environmental and community-Recently, environmental and community-wide consideration wide consideration such as:such as:

Problems caused by pollution.Problems caused by pollution. - Violence and crime. - Violence and crime. - Drug abuse.- Drug abuse. - Unemployment.- Unemployment. - Poverty.- Poverty. - Homelessness.- Homelessness.

Have created a need for stronger skills in Have created a need for stronger skills in assessing the needs of groups and populations assessing the needs of groups and populations and intervening at community level.and intervening at community level.

The clinician role in population-based nursing The clinician role in population-based nursing also requires skills in:-also requires skills in:-

- Collaboration with consumers and other - Collaboration with consumers and other professionals.professionals.

- Use of epidemiology and biostatistics.- Use of epidemiology and biostatistics. - Community organization and development.- Community organization and development. - Research.- Research. - Program evaluation.- Program evaluation. - Administration and leadership. - Administration and leadership.

2. Educator Role 2. Educator Role

A second important role of the A second important role of the community health nurse is that of community health nurse is that of educatoreducator or or health teacherhealth teacher. Health . Health teaching is one of the major function teaching is one of the major function of the community health nurse. of the community health nurse.

The educator role is especially The educator role is especially usefulness in promoting the public's usefulness in promoting the public's health for at least two reasons: health for at least two reasons:

1. Community clients usually are not 1. Community clients usually are not actually ill and can absorb and act on actually ill and can absorb and act on health information.health information. For example: For example:

- A class of expectant parents, unhampered by - A class of expectant parents, unhampered by significant health problems, can grasp the significant health problems, can grasp the relationship of diet to fetal development. They relationship of diet to fetal development. They understand the value of specific exercises to understand the value of specific exercises to childbirth process, are motivated to learn, and childbirth process, are motivated to learn, and are more likely to perform those exercises.are more likely to perform those exercises.

Thus, the educator has the potential for Thus, the educator has the potential for finding greater receptivity and providing finding greater receptivity and providing higher-yield results.higher-yield results.

2. The educator role in 2. The educator role in community health nursing is community health nursing is significant because a wider significant because a wider audience can be reachedaudience can be reached. .

With an emphasis on population and With an emphasis on population and aggregates, the educational efforts aggregates, the educational efforts of community health nursing care of community health nursing care appropriately targeted to reach appropriately targeted to reach many people. many people.

Health educationHealth education

Providing information and teaching Providing information and teaching people how to behave safely and in a people how to behave safely and in a manner that promotes and maintains manner that promotes and maintains their health.their health.

A continuing process of informing A continuing process of informing people how to achieve and maintain people how to achieve and maintain good health; of motivating them to good health; of motivating them to do so; and of promoting do so; and of promoting environmental and lifestyle changes environmental and lifestyle changes to facilitate their objective.to facilitate their objective.

Goals of Health Goals of Health education:education:

1. The rational for health education is to equip 1. The rational for health education is to equip people with the knowledge, attitude, and people with the knowledge, attitude, and behaviors to live the fullest life possible for the behaviors to live the fullest life possible for the greatest length of time.greatest length of time.

2. Clients anticipate achieving their maximum life 2. Clients anticipate achieving their maximum life span.span.

3. The nurse develops partnerships with a client to 3. The nurse develops partnerships with a client to achieve a behavior change that achieve a behavior change that

promotes, maintains, or restore health. promotes, maintains, or restore health. 4. Teaching is a specialized communication 4. Teaching is a specialized communication

process in which desired behavior changes are process in which desired behavior changes are achieved.achieved.

Teaching at Three Levels of Teaching at Three Levels of PreventionPrevention

Nurses should develop teaching programs that Nurses should develop teaching programs that coincide with the level of prevention needed by coincide with the level of prevention needed by the client. The three levels primary, secondary the client. The three levels primary, secondary and tertiary. and tertiary.

Ideally , the nurse focuses teaching at the Ideally , the nurse focuses teaching at the primary level. If nurses were able to reach primary level. If nurses were able to reach more people at this level, it would help to more people at this level, it would help to diminish the years of morbidity and limit diminish the years of morbidity and limit subsequent infirmity. subsequent infirmity.

Many people experience disabilities that might Many people experience disabilities that might have been prevented if primary prevention have been prevented if primary prevention behaviors had been incorporated into their behaviors had been incorporated into their daily activities.daily activities.

Because the primary level of prevention is not Because the primary level of prevention is not possible in all cases, a significant share of the possible in all cases, a significant share of the nurse's time is spent teaching at the secondary nurse's time is spent teaching at the secondary or tertiary. or tertiary.

An example is an 88-years- old women with a An example is an 88-years- old women with a fractured hip who has returned home after 3 fractured hip who has returned home after 3 weeks of physical therapy at a skilled nursing weeks of physical therapy at a skilled nursing facility. The nurse assesses the client's facility. The nurse assesses the client's environment, gait, functional limitations, environment, gait, functional limitations, safety, and adherence to medication and safety, and adherence to medication and initiates needed referrals. The teaching initiates needed referrals. The teaching focuses on rehabilitation and prevention of focuses on rehabilitation and prevention of secondary problem that may affect the healing secondary problem that may affect the healing process and the client's health and safety in process and the client's health and safety in general.general.

Teaching – Learning Teaching – Learning Principles Principles

Teaching in community health nursing means Teaching in community health nursing means to influence, motivate, and act as catalyst in to influence, motivate, and act as catalyst in the learning process. Nurses bring the learning process. Nurses bring information and learns together and stimulate information and learns together and stimulate a reaction that leads to a change.a reaction that leads to a change.

Nurses facilitate learning when they make it Nurses facilitate learning when they make it as easy as possible for clients to change. To as easy as possible for clients to change. To do this, the nurse needs to understand the do this, the nurse needs to understand the basic principles underlying the art and basic principles underlying the art and science of teaching-learning process and use science of teaching-learning process and use of appropriate materials to influence learning.of appropriate materials to influence learning.

Seven Principles for Seven Principles for Maximizing the Teaching –Maximizing the Teaching –

Learning Process Learning Process 1. Client readiness 1. Client readiness Clients' readiness to learn influences Clients' readiness to learn influences

teaching effectiveness. The teaching effectiveness. The community health nurse must assess community health nurse must assess the clients for: the clients for:

1. Emotional readiness.1. Emotional readiness. 2. Educational background. 2. Educational background.

2. Client Perception2. Client Perception

Clients' perception also affect their learning, Clients' perception also affect their learning, individual perceptions help people interpret individual perceptions help people interpret and attach meaning to things. A wide range and attach meaning to things. A wide range of variables affects human perception. Theses of variables affects human perception. Theses variables includes:variables includes:

- Values.- Values. - Past experience.- Past experience. - Culture.- Culture. - Religion.- Religion. - Personality.- Personality. - Developmental stage- Developmental stage

- Educational level.- Educational level. - Economic level. - Economic level. - Surrounding social forces.- Surrounding social forces. - Physical environment.- Physical environment. For example:For example:The nurse working with adolescents to The nurse working with adolescents to

educate them about the dangers of educate them about the dangers of smoking should understand that smoking should understand that adolescents seeking independence adolescents seeking independence need to feel that they have options need to feel that they have options and choices and don’t want to be told and choices and don’t want to be told what to do. what to do.

Frequently, clients use selective Frequently, clients use selective perception. They screen out some perception. They screen out some statements and pay attention to those that statements and pay attention to those that fit their values or personal desires.fit their values or personal desires.

For example:-For example:- A nurse is teaching a client the various risk A nurse is teaching a client the various risk

factors in coronary disease; the individual factors in coronary disease; the individual screens out the need to quit smoking and screens out the need to quit smoking and lose weight, paying attention only to factors lose weight, paying attention only to factors that would not require a drastic change in that would not require a drastic change in lifestyle. lifestyle.

Nurse must know their clients, understand Nurse must know their clients, understand their backgrounds and values, and learn their backgrounds and values, and learn about their perceptions before health about their perceptions before health teaching can influence their behavior. teaching can influence their behavior.

3. Educational 3. Educational Environment Environment

The setting in which the educational The setting in which the educational endeavor takes place has a endeavor takes place has a significant impact on learning.significant impact on learning.

Students properly have had the Students properly have had the experience of sitting in a cold room experience of sitting in a cold room and trying to concentrate during a and trying to concentrate during a lecture or of being distracted by lecture or of being distracted by noise, heat, or uncomfortable noise, heat, or uncomfortable seating. seating.

Physical conditions such as ventilation, Physical conditions such as ventilation, lighting, decor, room temperature, view of lighting, decor, room temperature, view of the speaker, and whispering need to be the speaker, and whispering need to be controlled to provide the environment most controlled to provide the environment most conductive to learning. conductive to learning.

Equally important for learning is an Equally important for learning is an atmosphere of mutual respect and trust. The atmosphere of mutual respect and trust. The nurse needs to convey this attitude both nurse needs to convey this attitude both verbally and nonverbally. The way the nurse verbally and nonverbally. The way the nurse address clients, shows courtesies, and give address clients, shows courtesies, and give recognition makes a considerable difference recognition makes a considerable difference in establishing client's respect and trust. in establishing client's respect and trust.

Both nurse and clients need to be Both nurse and clients need to be mutually helpful and considerate of mutually helpful and considerate of one another's needs and interests.one another's needs and interests.

All participants in the educational All participants in the educational experience should feel free to experience should feel free to express ideas, should know that express ideas, should know that their views will be heard, and feel their views will be heard, and feel accepted despite differences of accepted despite differences of opinion and perspective.opinion and perspective.

4. Client Participation 4. Client Participation

The degree of participation in the The degree of participation in the educational process directly educational process directly influences the amount of learning.influences the amount of learning.

When the nurse work with clients in When the nurse work with clients in a learning context, one of the first a learning context, one of the first question to discuss is. What does the question to discuss is. What does the client wants to learn? client wants to learn?

The amount of learning is directly The amount of learning is directly preoperational to the learner's involvement. preoperational to the learner's involvement.

For example, a group of senior citizens For example, a group of senior citizens attended a class on nutrition and aging, yet attended a class on nutrition and aging, yet made few changes in eating patterns. It was made few changes in eating patterns. It was not until the members became actively not until the members became actively involved in the class, encouraged by the involved in the class, encouraged by the nurse to present problems and solutions for nurse to present problems and solutions for food purchasing and preparation on limited food purchasing and preparation on limited budget, that any significant behavioral budget, that any significant behavioral changes occurred. changes occurred.

5. Subject Relevance. 5. Subject Relevance. Subject matter that is relevant to the client Subject matter that is relevant to the client

is learned more readily and retained longer is learned more readily and retained longer than information that is not meaningful.than information that is not meaningful.

Learners gain the most from subject matter Learners gain the most from subject matter is immediately useful to their own purposes. is immediately useful to their own purposes.

Relevance also influences the speed of Relevance also influences the speed of learning . learning .

For example: - Diabetics who must give For example: - Diabetics who must give themselves daily injections of insulin to live themselves daily injections of insulin to live learn that skill quickly. learn that skill quickly.

- This is also seen in the short - This is also seen in the short period of time that is takes families period of time that is takes families to learn the skill needed to provide to learn the skill needed to provide home care for a family member in home care for a family member in need.need.

When the subject matter is relevant When the subject matter is relevant to the learner, there also is greater to the learner, there also is greater retention of knowledge. retention of knowledge.

6. Client Satisfaction 6. Client Satisfaction Clients must derive satisfaction from learning Clients must derive satisfaction from learning

to maintain motivation and increase self-to maintain motivation and increase self-direction. Learners need to feel a sense of direction. Learners need to feel a sense of steady progress in the learning process steady progress in the learning process obstacles, frustrations, and failure along the obstacles, frustrations, and failure along the way discourage and impede learning. way discourage and impede learning.

Realistic goals contribute to learner satisfaction. Realistic goals contribute to learner satisfaction. Objectives should be set within the learner's Objectives should be set within the learner's ability, thereby avoiding the frustration ability, thereby avoiding the frustration resulting from a task that is too difficult and resulting from a task that is too difficult and there loss of interest resulting from one that is there loss of interest resulting from one that is too easy. too easy.

For Example:For Example: On school nurse led a class for obese On school nurse led a class for obese

adolescents, and together they set the goal of adolescents, and together they set the goal of weight loss. The nurse helped the group to weight loss. The nurse helped the group to design a plan that included:-design a plan that included:-

- Counting calories.- Counting calories. - Reducing fat in their diets.- Reducing fat in their diets. - Increasing physical activity.- Increasing physical activity. - Buddy system to bring about the behavior - Buddy system to bring about the behavior

change.change. As members in the group achieved monthly As members in the group achieved monthly

goals, they were encouraged to reward goals, they were encouraged to reward themselves. themselves.

These students found this learning experience These students found this learning experience satisfying because goals were attainable and satisfying because goals were attainable and their progress was rewarded. their progress was rewarded.

7. Client Application 7. Client Application

Learning is reinforced through Learning is reinforced through application. Learners need as many application. Learners need as many opportunities as possible to apply opportunities as possible to apply the learning in daily life. If such the learning in daily life. If such opportunities arise during the opportunities arise during the teaching-learning process, client can teaching-learning process, client can try out new knowledge and skills try out new knowledge and skills under supervision. under supervision.

For example:For example: - A prenatal class .The learning only begins - A prenatal class .The learning only begins

with explanations of proper diet, exercise, with explanations of proper diet, exercise, breathing techniques, hygiene, avoidance of breathing techniques, hygiene, avoidance of alcohol and tobacco. alcohol and tobacco.

More learning occurs as the group members More learning occurs as the group members discuss these issues and apply them discuss these issues and apply them intellectually, exploring ways to practice them intellectually, exploring ways to practice them at home. at home.

Additional reinforcement comes by Additional reinforcement comes by demonstrating how to do these activities.demonstrating how to do these activities.

Sample diets, demonstration of exercises, Sample diets, demonstration of exercises, posters, pamphlets, or models may be used. posters, pamphlets, or models may be used.

The group can begin application in The group can begin application in the classroom by making:-the classroom by making:-

- Diet plans.- Diet plans. - Exercising.- Exercising. - Role-playing parenting behavior.- Role-playing parenting behavior. - Engaging in group problem-solving.- Engaging in group problem-solving.

Teaching Process Teaching Process

The process of teaching in The process of teaching in community health nursing follows community health nursing follows steps similar to those of the nursing steps similar to those of the nursing process:process:

1. Interaction1. Interaction

Reciprocal communication must take Reciprocal communication must take place between nurse and client. It is place between nurse and client. It is essential in helping relationship and essential in helping relationship and requisite to effective use of the nursing requisite to effective use of the nursing process. process.

Community health nurses need to Community health nurses need to develop good questioning techniques develop good questioning techniques and listening skills to determine client's and listening skills to determine client's learning needs and level of readiness.learning needs and level of readiness.

2. Assessment and 2. Assessment and diagnosis.diagnosis.

Determine client's present status and Determine client's present status and identify clients' needs for teaching.identify clients' needs for teaching.

Assessing educational needs may be Assessing educational needs may be accomplished in several ways: accomplished in several ways:

- The nurse can use surveys.- The nurse can use surveys. - Interviews. - Interviews. - Open forums. - Open forums. The principles to remember is that clients The principles to remember is that clients

should be involved in identifying what they should be involved in identifying what they want to learn. want to learn.

- For example:- For example: - When a need to learn something, - When a need to learn something,

such as the importance of immunizing such as the importance of immunizing children, is identified by the nurse children, is identified by the nurse rather than by the clients, the nurse rather than by the clients, the nurse need to "sell" clients on the importance need to "sell" clients on the importance of the topic. Nurses need to use of the topic. Nurses need to use approaches that assist clients toward approaches that assist clients toward their own awareness of the need. their own awareness of the need.

3. Setting goals and 3. Setting goals and objectives.objectives.

Once a need has been clearly Once a need has been clearly identified, the nurse and clients can identified, the nurse and clients can establish mutually agreed-on goals establish mutually agreed-on goals and objectives.and objectives.

Goals : Goals : are broad statement of are broad statement of desired end outcomes. desired end outcomes.

Objectives:Objectives: are more specific are more specific descriptions of intended outcomes. descriptions of intended outcomes.

For Example:For Example: The nurse may have identified group's The nurse may have identified group's

desire to stop smoking.desire to stop smoking. The need and teaching goals might be The need and teaching goals might be

stated as follows:stated as follows: Need:Need: A group smokers wish to stop their A group smokers wish to stop their

addiction to nicotine.addiction to nicotine. Short-term goal: Short-term goal: All members of the group All members of the group

will stop smoking within 1 month. will stop smoking within 1 month. Long-term goal: Long-term goal: 90% of group members 90% of group members

will remain tobacco-free for 6months. will remain tobacco-free for 6months.

4. Planning.4. Planning. Design a plan for the learning experience that Design a plan for the learning experience that

meets the mutually developed objectives: meets the mutually developed objectives: The plan should include the following:The plan should include the following: 1. Subject: Content to be covered, sequence of the 1. Subject: Content to be covered, sequence of the

topics.topics. 2. Intended audience. 2. Intended audience. 3. Dates, times, and places.3. Dates, times, and places. 4. Short- and long term goal statements.4. Short- and long term goal statements. 5. Teaching –learning methods.5. Teaching –learning methods. 6. Activities and assignments.6. Activities and assignments. 7. Course outline of topics.7. Course outline of topics. 8. Evaluation methods and criteria.8. Evaluation methods and criteria. A written plan is best; it may part of the written A written plan is best; it may part of the written

nursing care plan. nursing care plan.

5. Teaching.5. Teaching. The class, seminar, workshop, or small-group The class, seminar, workshop, or small-group

teaching should be conducted according to the teaching should be conducted according to the plan. Even one-on-one teaching, each eight plan. Even one-on-one teaching, each eight steps should be planned in advance, because steps should be planned in advance, because each client has:each client has:

- A different cultural background.- A different cultural background. - Education.- Education. - Intellectual level.- Intellectual level. - Learning needs. - Learning needs. Use of a variety teaching methods addresses Use of a variety teaching methods addresses

the unique needs of learners and makes the the unique needs of learners and makes the teaching interesting. Include the combine each teaching interesting. Include the combine each methods as lectures, discussions, role-playing, methods as lectures, discussions, role-playing, demonstrations, and videos. demonstrations, and videos.

6. Evaluation. 6. Evaluation.

Determine whether learning Determine whether learning objectives were met and if not, why objectives were met and if not, why not.not.

Evaluation measures progress Evaluation measures progress toward goals. Effectiveness of toward goals. Effectiveness of chosen teaching methods, or future chosen teaching methods, or future learning needs. learning needs.

Teaching Methods and Teaching Methods and Materials Materials

Teaching occurs on many levels and incorporates Teaching occurs on many levels and incorporates various types of activities. various types of activities.

It can be formal or informal, planned or unplanned.It can be formal or informal, planned or unplanned. - Formal presentations, such as lecture with groups, - Formal presentations, such as lecture with groups,

usually are planned and fairly structured.usually are planned and fairly structured. Some teaching is less formal but still planned and Some teaching is less formal but still planned and

relatively structured, as in group discussions in which relatively structured, as in group discussions in which questions stimulate exploration of ideas and guide questions stimulate exploration of ideas and guide thinking.thinking.

- Informal levels of teaching, such as counseling or - Informal levels of teaching, such as counseling or anticipatory guidanceanticipatory guidance:-in which the client is assisted :-in which the client is assisted in preparing for a future role or development stage, in preparing for a future role or development stage, require the teacher to be prepared, but there is no require the teacher to be prepared, but there is no defined plan of presentation. defined plan of presentation.

There are four teaching methods:There are four teaching methods: 1. Lectures.1. Lectures. 2. Discussion.2. Discussion. 3. Demonstration.3. Demonstration. 4. Role ply.4. Role ply.

1. Lecture 1. Lecture

The Community health nurse The Community health nurse sometimes presents information to a sometimes presents information to a large group. The lecture method, a large group. The lecture method, a formal kind of presentation, may be the formal kind of presentation, may be the most efficient way to communicate most efficient way to communicate general health information. However, general health information. However, lectures tend to create a passive lectures tend to create a passive learning environment for the audience learning environment for the audience unless strategies are devised to involve unless strategies are devised to involve the learners. the learners.

To capture their attention, slides, overhead To capture their attention, slides, overhead projections, computer-generated slide projections, computer-generated slide presentations, or videotapes can supplement presentations, or videotapes can supplement the lecture. the lecture.

Allowing time for question and dissection after Allowing time for question and dissection after lecture also actively involves the learners.lecture also actively involves the learners.

This method is best used with adults, but even This method is best used with adults, but even they have a limited attention span, they have a limited attention span,

and a break at least midway through a and a break at least midway through a presentation of 1 hour will be appreciated. presentation of 1 hour will be appreciated.

Distributing printed material that highlights Distributing printed material that highlights and summarizes the content shared, or and summarizes the content shared, or supplements it, also reinforce important points. supplements it, also reinforce important points.

2. Discussion2. Discussion Two-way communication is important feature of Two-way communication is important feature of

the learning process. Learners need an the learning process. Learners need an opportunity to raise questions , make comments, opportunity to raise questions , make comments, resound out loud, and receive feedback to resound out loud, and receive feedback to develop understanding. develop understanding.

When discussion is used in conjunction with When discussion is used in conjunction with other teaching methods such as demonstration, other teaching methods such as demonstration, lectures, and role playing, it improves their lectures, and role playing, it improves their effectiveness. effectiveness.

In group teaching, discussion enables client to In group teaching, discussion enables client to learn from one another as well as from the nurse. learn from one another as well as from the nurse.

The nurse must exercise leadership The nurse must exercise leadership in controlling and guiding the in controlling and guiding the discussion so that the learning discussion so that the learning opportunities are maximized and opportunities are maximized and objectives are met.objectives are met.

Discussion that are organized Discussion that are organized around specific questions or topics around specific questions or topics are more fruitful. are more fruitful.

3. Demonstration 3. Demonstration

The demonstration method often is used for The demonstration method often is used for teaching psychomotor skills and is best teaching psychomotor skills and is best accompanied by explanation and discussion, accompanied by explanation and discussion, with time set aside for return demonstration with time set aside for return demonstration by the client or caregiver. by the client or caregiver.

It gives clients a clear sensory image of how It gives clients a clear sensory image of how to perform the skill.to perform the skill.

Because a demonstration should be within Because a demonstration should be within easy visual and auditory range of learners, it easy visual and auditory range of learners, it is best demonstrate in front of small groups is best demonstrate in front of small groups or a single client.or a single client.

Use the same kind of equipment that Use the same kind of equipment that clients will use, show exactly how clients will use, show exactly how the skill should be performed, and the skill should be performed, and provide learners with ample provide learners with ample opportunity to practice until the skill opportunity to practice until the skill is perfected.is perfected.

Examples:Examples: - The new mother learns how to bath - The new mother learns how to bath

her baby safely in the kitchen sink.her baby safely in the kitchen sink.

4. Role-Playing4. Role-Playing At times, having clients assume and act At times, having clients assume and act

out roles maximize learning. out roles maximize learning. For example, A parenting group, , found it For example, A parenting group, , found it

helpful to place themselves in the role of helpful to place themselves in the role of their children; their feelings about various their children; their feelings about various ways to respond became more apparent.ways to respond became more apparent.

Reversing roles can effectively teach Reversing roles can effectively teach spouses in conflict about better ways to spouses in conflict about better ways to communicate.communicate.

To prevent role-playing from a becoming a To prevent role-playing from a becoming a game with little learning, plan the game with little learning, plan the proposed drama with clear objectives in proposed drama with clear objectives in mind.mind.

Teaching Materials Teaching Materials

Many different kinds of teaching Many different kinds of teaching materials are available to the nurse. materials are available to the nurse. They often are used in combination They often are used in combination and are useful during the teaching and are useful during the teaching process. process.

- Visual images:- Visual images: - Such as Power point presentations, - Such as Power point presentations,

pictures, slides, posters, chalkboards, flannel pictures, slides, posters, chalkboards, flannel boards, videotapes, CDs, bulletin boards, boards, videotapes, CDs, bulletin boards, flash cards, pamphlets, flyers, charts, and flash cards, pamphlets, flyers, charts, and gestures.gestures.

- Television and Radio:- Television and Radio: It appeals to sight and sound and grasp It appeals to sight and sound and grasp

attention. Learning of both positive and attention. Learning of both positive and negative health behaviors through television negative health behaviors through television can be more effective and efficient than can be more effective and efficient than traditional teaching methods. traditional teaching methods.

- Other tools:- Other tools: - Such as, anatomic models, and improvised - Such as, anatomic models, and improvised

or purchased equipment, provide clients with or purchased equipment, provide clients with both visual and tactile learning experience. both visual and tactile learning experience.

Selection of teaching Selection of teaching materials depends on:materials depends on:

- How well they suit learners and help - How well they suit learners and help to meet the desired objectives.to meet the desired objectives.

- Sources of teaching materials that - Sources of teaching materials that are free or inexpensive can enhance are free or inexpensive can enhance the nurse's teaching but need to the nurse's teaching but need to evaluated foe effectiveness.evaluated foe effectiveness.

The nurse needs to know how to help The nurse needs to know how to help learners with special needs, those learners with special needs, those with physical or mental disabilities. with physical or mental disabilities.

3. Advocate Role3. Advocate Role

The issue of clients' rights is important in The issue of clients' rights is important in health care. Every patient or client has the health care. Every patient or client has the right to receive, just, equal, and human right to receive, just, equal, and human treatment.treatment.

Our current health care system often is Our current health care system often is characterized by fragmented and characterized by fragmented and depersonalized services, and many clients-depersonalized services, and many clients-especially the poor, the disadvantaged, those especially the poor, the disadvantaged, those without health insurance, are denied their without health insurance, are denied their rights. They become frustrated, confused, rights. They become frustrated, confused, degraded, and unable to cope with the system degraded, and unable to cope with the system on their own.on their own.

The community health nurse often acts as The community health nurse often acts as an an advocate advocate for clients, pleading their for clients, pleading their cause or acting on their behalf, cause or acting on their behalf, Clients Clients may need some one :-may need some one :-

- To explain which services to expect, - To explain which services to expect, which services they ought to receive.which services they ought to receive.

-To make referrals as needed.-To make referrals as needed. -To write letters to agencies or health -To write letters to agencies or health

care providers for them. care providers for them. - To assure the satisfaction of their needs.- To assure the satisfaction of their needs.

Advocacy Goals:Advocacy Goals: There are two underlying goals in client advocacy.There are two underlying goals in client advocacy. 1. To help clients gain greater independence or self-1. To help clients gain greater independence or self-

administration. administration. Until they can reach the needed information and access Until they can reach the needed information and access

health and social services for themselves, the community health and social services for themselves, the community health nurse acts as an advocate for the clients by:health nurse acts as an advocate for the clients by:

- Showing them what services are available.- Showing them what services are available. - The ones to which they are entitled, and how to obtain - The ones to which they are entitled, and how to obtain

them.them. 2. To make the system more responsive and relevant to 2. To make the system more responsive and relevant to

the needs of clients. the needs of clients. By calling attention to inadequate, inaccessible, or unjust By calling attention to inadequate, inaccessible, or unjust

care, community health nurses can influence change.care, community health nurses can influence change.

Advocacy ActionsAdvocacy Actions

The advocate role incorporate four The advocate role incorporate four characteristics actions:characteristics actions:

1. Being assertive.1. Being assertive. 2. Taking risks.2. Taking risks. 3. Communicating and negating 3. Communicating and negating

well.well. 4. Identifying recourses and 4. Identifying recourses and

obtaining results. obtaining results.

4. Manager Role4. Manager Role Community health nurses, like all nurses, engage in Community health nurses, like all nurses, engage in

the role of managing health services. As a manager, the role of managing health services. As a manager, the nurse exercises administrative direction toward the nurse exercises administrative direction toward the accomplishment of specified goals by:-the accomplishment of specified goals by:-

- Assessing client's needs.- Assessing client's needs. - Planning and organizing to meet those needs.- Planning and organizing to meet those needs. - Controlling and evaluating the progress to ensure - Controlling and evaluating the progress to ensure

that goals are met.that goals are met. The nurse serves as The nurse serves as a mangera manger when:- when:- - Overseeing client care as a case manager.- Overseeing client care as a case manager. - Supervising ancillary staff.- Supervising ancillary staff. - Running clinics.- Running clinics. - Conducting community health needs assessment - Conducting community health needs assessment

projects.projects.

In each instance, the nurse engages in four In each instance, the nurse engages in four basic functions that make up the management basic functions that make up the management process.process.

The management process, like the nursing The management process, like the nursing process, incorporates a series of problem process, incorporates a series of problem solving activities or functions:solving activities or functions:

1. Planning.1. Planning. 2. Organizing.2. Organizing. 3. Leading.3. Leading. 4. Controlling and evaluating.4. Controlling and evaluating. These activities are sequential and yet also These activities are sequential and yet also

occur simultaneously for managing service occur simultaneously for managing service objectives. objectives.

1. Nurse as Planner 1. Nurse as Planner The first function in the management The first function in the management

process is planning. process is planning. A PlannerA Planner sets the sets the goals and direction for the organization or goals and direction for the organization or project and determines the means to project and determines the means to achieve them.achieve them.

Specifically, planning includes:Specifically, planning includes: - Defining goals and objectives.- Defining goals and objectives. - Determining the strategy for reaching - Determining the strategy for reaching

them.them. - Designing a coordinated set of activities - Designing a coordinated set of activities

for implementing and evaluating them. for implementing and evaluating them.

2. Nurse as Organizer2. Nurse as Organizer

The second function of the manager The second function of the manager role is that of role is that of Organizer. Organizer. This This involves:- involves:-

- Designing a structure within which - Designing a structure within which people and tasks function to reach people and tasks function to reach the desired objectives.the desired objectives.

3. Nurse as Leader 3. Nurse as Leader

In the manager role, the community In the manager role, the community health nurse also must act as health nurse also must act as A A Leader.Leader.

- As a leader the nurse directs, - As a leader the nurse directs, influences, or persuade others to influences, or persuade others to effect change so as to positively effect change so as to positively affect people's health and move affect people's health and move them towered a goal.them towered a goal.

The leading functions includes:The leading functions includes:

- Persuading and motivating people.- Persuading and motivating people. - Directing activities.- Directing activities. - Ensuring effective two-way - Ensuring effective two-way

communication.communication. - Resolving conflicts.- Resolving conflicts. - Coordinating the plan. - Coordinating the plan.

4. Nurse as Controller and 4. Nurse as Controller and Evaluator Evaluator

The fourth management function is to control The fourth management function is to control and evaluate projects or programs .and evaluate projects or programs .

A Controller A Controller monitors the plan and ensure monitors the plan and ensure that it stays on course. that it stays on course.

In this function, the community health nurse In this function, the community health nurse must realize that plans may not proceed as must realize that plans may not proceed as intended and may need adjustments or intended and may need adjustments or corrections to reach the desired results or corrections to reach the desired results or goals. - At the same time, the nurse must goals. - At the same time, the nurse must compare and judge performance and compare and judge performance and outcomes against previously set goals and outcomes against previously set goals and standards – a process that forms standards – a process that forms the the EvaluatorEvaluator aspect of this management aspect of this management function. function.

5. Collaborator Role5. Collaborator Role

Community health nurses seldom Community health nurses seldom practice in isolation. They must work practice in isolation. They must work with many people, including:-with many people, including:-

- -The clientsThe clients..Other nursesOther nurses..

Physicians teachersPhysicians teachers..Health educatorsHealth educators . .

Social workersSocial workers..Physical therapistPhysical therapist..

- -NutritionistNutritionist..Occupational therapistOccupational therapist..

PsychologistPsychologist..EpidemiologistEpidemiologist..

- -BiostatisticiansBiostatisticians.. - -AttorneysAttorneys..

- -SecretariesSecretaries..EnvironmentalistEnvironmentalist..

City plannersCity plannersCity plannersCity planners

As members of health team, As members of health team, community health nurses assume the community health nurses assume the role of role of collaborator,collaborator,

Which means to work jointly with Which means to work jointly with others in a common endeavor, to others in a common endeavor, to cooperate as partners. cooperate as partners.

Successful community health practice Successful community health practice depends on his multidisciplinary depends on his multidisciplinary collegiality and leadership. collegiality and leadership.

The community health nurse's The community health nurse's collaborator role requires:-collaborator role requires:-

- Skill in communicating.- Skill in communicating. - Interpreting the nurse's unique - Interpreting the nurse's unique

contribution to the team.contribution to the team. - Acting assertively as an equal - Acting assertively as an equal

partner.partner. The collaborator roll also may involve The collaborator roll also may involve

functioning as a consultant. functioning as a consultant.

The following example show a The following example show a community health nurse functioning as community health nurse functioning as collaborator.collaborator.

A school nurse noticed a rise in the A school nurse noticed a rise in the incidence of drug use in her schools.incidence of drug use in her schools.

She initiated a counseling program after She initiated a counseling program after joint planning with students, parents, joint planning with students, parents, teachers, the school psychologist, and a teachers, the school psychologist, and a local drug rehabilitation center. local drug rehabilitation center.

6. Leadership Role6. Leadership Role Community health nurse are becoming Community health nurse are becoming

increasingly active in the leadership role, the increasingly active in the leadership role, the leadership role focuses on affecting change, thus leadership role focuses on affecting change, thus the nurse becomes an agent of change.the nurse becomes an agent of change.

As leaders, community health nurse seek to As leaders, community health nurse seek to initiate changers that positively affect people's initiate changers that positively affect people's health. health.

They also seek to influence people to think and They also seek to influence people to think and behave differently about their health and the behave differently about their health and the factors contributing to it.factors contributing to it.

At the community level, the leadership role may At the community level, the leadership role may involve working with a team of professionals to involve working with a team of professionals to direct and coordinate such projects as a direct and coordinate such projects as a campaign to eliminate smoking in public areas . campaign to eliminate smoking in public areas .

6. Leadership Role6. Leadership Role

Community health nurse are Community health nurse are

becoming increasingly active in the becoming increasingly active in the leadership role, the leadership role leadership role, the leadership role focuses on affecting change, thus the focuses on affecting change, thus the nurse becomes an agent of change.nurse becomes an agent of change.

As leaders, community health nurse As leaders, community health nurse seek to initiate changers that seek to initiate changers that positively affect people's health. positively affect people's health.

They also seek to influence people to They also seek to influence people to think and behave differently about think and behave differently about their health and the factors their health and the factors contributing to it.contributing to it.

At the community level, the leadership At the community level, the leadership role may involve working with a team role may involve working with a team of professionals to direct and of professionals to direct and coordinate such projects as a campaign coordinate such projects as a campaign to eliminate smoking in public areas . to eliminate smoking in public areas .

7. Researcher Role7. Researcher Role

In the In the researcherresearcher role, community role, community health nurses engage in systematic health nurses engage in systematic investigation, collection, and investigation, collection, and analysis of data for solving problems analysis of data for solving problems and enhancing community health and enhancing community health practice. practice.

The Research ProcessThe Research Process

Community health nurses practice the Community health nurses practice the researcher role at several levels. In addition to researcher role at several levels. In addition to everyday inquiries, community health nurses everyday inquiries, community health nurses often participate in agency and organizational often participate in agency and organizational studies to determine such matters as job studies to determine such matters as job satisfaction among community health nurses satisfaction among community health nurses and risk associated with home visiting .and risk associated with home visiting .

The researcher role, at all levels, helps to The researcher role, at all levels, helps to determine needs, evaluate effectiveness of determine needs, evaluate effectiveness of care, and develop theoretic bases for care, and develop theoretic bases for community health nursing practice. community health nursing practice.

Research literacy means to search Research literacy means to search again – to investigate, to discover, again – to investigate, to discover, and interpret facts. All research in and interpret facts. All research in community health, from the simplest community health, from the simplest inquiry to the most complex inquiry to the most complex epidemiologic study, uses the same epidemiologic study, uses the same fundamental process. fundamental process.

The research process The research process involves the following involves the following

steps:steps: 1. Identify an area of interest. 1. Identify an area of interest. 2. Specify the research question and 2. Specify the research question and

statement.statement. 3. Review of literature.3. Review of literature. 4. Identify the conceptual framework.4. Identify the conceptual framework. 5. Select research design.5. Select research design. 6. Collect and analyze data.6. Collect and analyze data. 7. Interpret the results.7. Interpret the results. 8. Communicate the findings.8. Communicate the findings.

Research has a significant impact on Research has a significant impact on community health and nursing community health and nursing practice in three ways:practice in three ways:

1. It provides a new knowledge that 1. It provides a new knowledge that help to shape the health policy.help to shape the health policy.

2. Improve the service delivery.2. Improve the service delivery.

3. Promote the public's health3. Promote the public's health

Nurses must become responsible users of research, Nurses must become responsible users of research, keeping abreast of new knowledge and applying it keeping abreast of new knowledge and applying it in practice.in practice.

Nurses must learn to evaluate nursing research Nurses must learn to evaluate nursing research articles critically, assessing their validity and articles critically, assessing their validity and applicability to their own practice.applicability to their own practice.

Nurses should subscribe to and read nursing Nurses should subscribe to and read nursing research journals and discuss research studies with research journals and discuss research studies with colleagues and supervisors.colleagues and supervisors.

More community health nurses must also conduct More community health nurses must also conduct research studies of their own or in collaboration research studies of their own or in collaboration with other community health professionals. with other community health professionals.

A commitment to use and conduct of research will A commitment to use and conduct of research will move the nursing profession forward and enhance move the nursing profession forward and enhance its influence on the health of at-risk populations.its influence on the health of at-risk populations.

SETTING FOR COMMUNITY SETTING FOR COMMUNITY

HEALTH NURSING PRACTICEHEALTH NURSING PRACTICE The setting in which the community The setting in which the community

health nurses are practiced their different health nurses are practiced their different roles are grouped into six categories:roles are grouped into six categories:

1. Homes.1. Homes. 2. Ambulatory service settings.2. Ambulatory service settings. 3. Schools.3. Schools. 4. Occupational health settings.4. Occupational health settings. 5. Residential institutions.5. Residential institutions. 6. The community at large.6. The community at large.

1. Homes1. Homes

For long time, the most frequently For long time, the most frequently used setting for community health used setting for community health nursing practice was the home.nursing practice was the home.

In the home, all of the community In the home, all of the community health nursing role's , to varying health nursing role's , to varying degrees, are performed.degrees, are performed.

Clients who are discharged from acute Clients who are discharged from acute care institutions, such as hospitals or care institutions, such as hospitals or mental health facilities, are regularly mental health facilities, are regularly referred to community health nurses referred to community health nurses for continued care and follow-up. for continued care and follow-up. Here, the community health nurse can Here, the community health nurse can see clients in a family and environment see clients in a family and environment context, the service can be tailored to context, the service can be tailored to the client's unique needs. the client's unique needs.

For example: For example: Mr. White, 67 years of age, was Mr. White, 67 years of age, was

discharged from the hospital with a discharged from the hospital with a colostomy. The community health colostomy. The community health nurses immediately started home nurses immediately started home visits. She met with Mr. White and his visits. She met with Mr. White and his wife to discuss their needs as family wife to discuss their needs as family and plan for Mr. Whit's care and and plan for Mr. Whit's care and adjustment to living with a colostomy.adjustment to living with a colostomy.

Practicing the clinician and educator Practicing the clinician and educator roles, she reinforced and expanded on roles, she reinforced and expanded on the teaching started in the hospital for the teaching started in the hospital for colostomy care., including:colostomy care., including:

- Bowel training.- Bowel training. - Diet. - Diet. - Exercise. - Exercise. - Proper use of equipment. - Proper use of equipment.

As a part of total family care plan, community As a part of total family care plan, community health nurse provided some forms of physical health nurse provided some forms of physical care for Mr. White as well as counseling, care for Mr. White as well as counseling, teaching, and emotional support for both Mr. teaching, and emotional support for both Mr. White and his wife. White and his wife.

In addition to consulting with the physician and In addition to consulting with the physician and social service worker, she arranged and social service worker, she arranged and supervised visits from the home health aide, supervised visits from the home health aide, who gave personal care and homemaker who gave personal care and homemaker services. The community health nurse thus services. The community health nurse thus performed the manager, leader, and performed the manager, leader, and collaborator roles. collaborator roles.

The home also is a setting for health The home also is a setting for health promotion. Many community health promotion. Many community health nursing visits focus on assisting nursing visits focus on assisting families to understand and practice families to understand and practice healthier living behaviors.healthier living behaviors.

Nurses may, for example, instruct Nurses may, for example, instruct clients on parenting infant care, clients on parenting infant care, child discipline, diet, exercise, child discipline, diet, exercise, coping with stress.coping with stress.

In the home, unlike most other In the home, unlike most other health care setting, clients are on health care setting, clients are on their own turf. they feel comfortable their own turf. they feel comfortable and secure in familiarity and secure in familiarity surroundings and often are better surroundings and often are better able to understand and apply health able to understand and apply health information. Client self-respect can information. Client self-respect can be promoted, because the client is be promoted, because the client is host and the nurse is a gust.host and the nurse is a gust.

Sometimes, the thought of visiting in Sometimes, the thought of visiting in client's home can cause anxiety for the client's home can cause anxiety for the nurse. This may be the nurse's first nurse. This may be the nurse's first experience outside the acute care, long-experience outside the acute care, long-term care, or clinic setting. term care, or clinic setting.

Visiting clients in their own environment Visiting clients in their own environment can make the nurse feel uncomfortable. can make the nurse feel uncomfortable. The nurse may be asked to visit families The nurse may be asked to visit families in unfamiliar neighborhoods and must in unfamiliar neighborhoods and must walk through those neighborhoods to walk through those neighborhoods to visit the client. visit the client.

Frequently, fear of unknown is the real fear, and Frequently, fear of unknown is the real fear, and often it has been enhanced by stories from often it has been enhanced by stories from previous stories from previous nurses. This may previous stories from previous nurses. This may be the same feeling as that experienced when be the same feeling as that experienced when caring for your first client, first having a client in caring for your first client, first having a client in the ICCU. the ICCU.

The community health nurse can The community health nurse can collaborate with various types of home care collaborate with various types of home care providers, including hospitals, other nurses, providers, including hospitals, other nurses, physicians, rehabilitation therapist, and durable physicians, rehabilitation therapist, and durable medical equipment companies to ensure medical equipment companies to ensure continuous and holistic service. continuous and holistic service.

2. Ambulatory Service 2. Ambulatory Service SettingsSettings

Ambulatory Service Settings include Ambulatory Service Settings include a variety of venues for community a variety of venues for community health nursing practice in which the health nursing practice in which the clients come for day or evening clients come for day or evening services that do not include services that do not include overnight stays. overnight stays.

Example of an ambulatory service setting.Example of an ambulatory service setting. - Community health centers are an - Community health centers are an - They also may be based on comprehensive - They also may be based on comprehensive

neighborhood health centers.neighborhood health centers. - A single clinic, such as, family planning clinic or a - A single clinic, such as, family planning clinic or a

well-child clinic. well-child clinic. - Some kinds of day care centers, such as those for - Some kinds of day care centers, such as those for

physically disabled or emotionally disturbed adults.physically disabled or emotionally disturbed adults. - Additional ambulatory care settings include health - Additional ambulatory care settings include health

departments and community health nursing departments and community health nursing agencies where clients may come for assessment agencies where clients may come for assessment and referral or counseling.and referral or counseling.

- Health offices are another type of ambulatory care - Health offices are another type of ambulatory care setting. setting.

Some community health nurses provide service in Some community health nurses provide service in conjunction with a medical practice; conjunction with a medical practice;

for example:for example: A community health nurse associate with a health A community health nurse associate with a health

maintenance organization see clients in the office maintenance organization see clients in the office and undertakes:-and undertakes:-

- Screening.- Screening. - Referral.- Referral. - Counseling.- Counseling. - Health education. - Health education. - Another type of ambulatory service setting - Another type of ambulatory service setting

includes places where services are offered to includes places where services are offered to selected groups. For example: - community health selected groups. For example: - community health nurse practice in migrant camps. nurse practice in migrant camps.

In each ambulatory setting, all of the community In each ambulatory setting, all of the community health nursing roles are used to varying degrees. health nursing roles are used to varying degrees.

3. Schools3. Schools School of all levels make up a major group of School of all levels make up a major group of

settings for community health nursing practice. settings for community health nursing practice. Nurses from community health nursing agencies Nurses from community health nursing agencies frequently serve private schools at elementary and frequently serve private schools at elementary and intermediate levels. Public schools are served by the intermediate levels. Public schools are served by the same agencies or by community health nurses hired same agencies or by community health nurses hired through the public school system.through the public school system.

The community health nurse may work with groups The community health nurse may work with groups of students in preschool settings, as well as of students in preschool settings, as well as vocational or technical schools, junior colleges, and vocational or technical schools, junior colleges, and college and university settings. Specialized schools, college and university settings. Specialized schools, such as those for the developmentally disabled, are such as those for the developmentally disabled, are another setting for community health nursing another setting for community health nursing practice.practice.

Responsibilities of Responsibilities of School NurseSchool Nurse

School nurse:School nurse: A specialty branch of professional A specialty branch of professional nursing that serves the school-age population. nursing that serves the school-age population.

The National Association of School Nurses (NASN) The National Association of School Nurses (NASN) created seven roles to describe their practice. The created seven roles to describe their practice. The school nurse: school nurse:

1. Provides direct healthcare to students and staff.1. Provides direct healthcare to students and staff. 2. Provides leadership for the provision of health 2. Provides leadership for the provision of health

services.services. 3. Provides screening and referral for health conditions.3. Provides screening and referral for health conditions. 4. Promotes a healthy school environment4. Promotes a healthy school environment 5. Promotes health.5. Promotes health. 6. Serves in a leadership role for health policies and 6. Serves in a leadership role for health policies and

programs. programs. 7. Serves as a liaison between school personnel, family, 7. Serves as a liaison between school personnel, family,

community and health care providers community and health care providers

The primary responsibility of the school The primary responsibility of the school nurse are to prevent illness and to nurse are to prevent illness and to promote and maintain the health of the promote and maintain the health of the school community.school community.

The school nurse serves not only The school nurse serves not only individuals, families, and groups within individuals, families, and groups within the context of school health but also the the context of school health but also the school as an organization and its school as an organization and its membership 9students and staff) as membership 9students and staff) as aggregates. aggregates.

The school nurse is responsible for providing a The school nurse is responsible for providing a broad range of services, including the broad range of services, including the

following eight components of a coordinated following eight components of a coordinated school health program:-school health program:-

1. Health services:1. Health services: Serves as the Serves as the coordinator of the health services coordinator of the health services program, provides nursing care, and program, provides nursing care, and advocates for health rights.advocates for health rights.

- Health services include programs such as - Health services include programs such as ::

- Vision and hearing screening.- Vision and hearing screening. - Scoliosis screening.- Scoliosis screening. - Monitoring of height, weight and blood - Monitoring of height, weight and blood

pressure. pressure.

- Oral health.- Oral health. - TB screening.- TB screening. - Immunization assessment and monitoring - Immunization assessment and monitoring

medication administration.medication administration. - Care of children with specialized health - Care of children with specialized health

care needs .care needs . - First aid.- First aid. - Assessment of acute health problem.- Assessment of acute health problem. - Health examinations ( especially for - Health examinations ( especially for

athletic participation or school entry).athletic participation or school entry).

2. Health education:2. Health education: Provides Provides appropriate health information that appropriate health information that promotes informed healthcare promotes informed healthcare decisions, promotes health, prevents decisions, promotes health, prevents disease, and enhances school disease, and enhances school performance. performance.

3. Environment:3. Environment: Identifies health Identifies health and safety concerns in the school and safety concerns in the school community, promotes a safe and community, promotes a safe and nurturing school environment.nurturing school environment.

The function of the school nursing The function of the school nursing practice is the promotion of practice is the promotion of healthful school living. Emphasis on healthful school living. Emphasis on healthful physical environment healthful physical environment includes:includes:

- Proper selection, design, - Proper selection, design, organization, and maintenance of the organization, and maintenance of the physical plant. physical plant.

- Consideration should be shown for - Consideration should be shown for areas such as - adaptability to students areas such as - adaptability to students needs:-needs:-

1. Safety, safety of the school bus. 1. Safety, safety of the school bus. 2. Visual, thermal, and acoustic factors.2. Visual, thermal, and acoustic factors. 3. Aesthetic values. 3. Aesthetic values. 4. Sanitation. 4. Sanitation.

4. Nutrition:4. Nutrition: Supports school food Supports school food service programs and promotes the service programs and promotes the benefits of healthy eating patterns. benefits of healthy eating patterns. Safety of food service ,school breakfast Safety of food service ,school breakfast and lunches. and lunches.

5. Physical education/activity:5. Physical education/activity: Promotes healthy activities, physical Promotes healthy activities, physical education, and sports policies/practices education, and sports policies/practices that promote safety and good that promote safety and good sportsmanship. sportsmanship.

6. Counseling/mental health:6. Counseling/mental health: Provides Provides health counseling, assesses mental health health counseling, assesses mental health needs, provides interventions, refers needs, provides interventions, refers students to appropriate school staff or students to appropriate school staff or community agencies, and provides follow-up community agencies, and provides follow-up once treatment is prescribed. once treatment is prescribed.

7. Parent/community involvement:7. Parent/community involvement: Promotes community participation in Promotes community participation in assuring a healthy school and serves as assuring a healthy school and serves as school liaison to a health advisory school liaison to a health advisory committee. committee.

8. Staff wellness:8. Staff wellness: Provides health education Provides health education and counseling, promotes healthy activities and counseling, promotes healthy activities and environment for school staff. and environment for school staff.

4. Occupational Health Setting 4. Occupational Health Setting Business and industry provide another group Business and industry provide another group

of settings for community health nursing of settings for community health nursing practice.practice.

Employee health has long been recognized as Employee health has long been recognized as making a vital contribution to individual lives, making a vital contribution to individual lives, productivity of business, and well being of the productivity of business, and well being of the entire nation.entire nation.

Organizations are expected to provide a safe Organizations are expected to provide a safe and healthy work environment in addition to and healthy work environment in addition to offering insurance for health care. offering insurance for health care.

Occupational Health Nurses Occupational Health Nurses (OHN)s:(OHN)s:

Are registered nurses who independently Are registered nurses who independently observe and assess the worker's health observe and assess the worker's health status with respect to job tasks and status with respect to job tasks and hazards. Using their specialized hazards. Using their specialized experience and education, these experience and education, these registered nurses recognize and prevent registered nurses recognize and prevent health effects from hazardous exposures health effects from hazardous exposures and treat workers' injuries/illnesses.and treat workers' injuries/illnesses.

Occupational Health Nurses Occupational Health Nurses (OHN)s: (OHN)s:

1. Have special knowledge of 1. Have special knowledge of workplace hazards and the relationship workplace hazards and the relationship to the employee health status. to the employee health status.

2. Understand industrial hygiene 2. Understand industrial hygiene principles of engineering controls, principles of engineering controls, administrative controls, and administrative controls, and personal protective equipment. personal protective equipment.

3. Have knowledge of toxicology and 3. Have knowledge of toxicology and epidemiology as related to the epidemiology as related to the employee and the work site. employee and the work site.

The role of the occupational The role of the occupational health nursehealth nurse

Occupational health nurses work in a Occupational health nurses work in a variety of settings mainly industry, health variety of settings mainly industry, health services, commerce, and education. They services, commerce, and education. They can employed as independent practitioners can employed as independent practitioners or as part of a larger occupational health or as part of a larger occupational health service team, often attached to a personnel service team, often attached to a personnel department.department.

Occupational health nurses are considered Occupational health nurses are considered to be leaders in public health in the to be leaders in public health in the workplace setting. workplace setting. The occupational The occupational health nurse role includes:health nurse role includes:

1. The prevention of health problems, promotion of healthy 1. The prevention of health problems, promotion of healthy living and working conditions.living and working conditions.

2. Understanding the effects of work on health and health 2. Understanding the effects of work on health and health at work at work

3. Basic first aid and health screening. 3. Basic first aid and health screening. 4. Workforce and workplace monitoring and health need 4. Workforce and workplace monitoring and health need

assessment. assessment. Health promotion. 5.Health promotion. 5. 6. Education and training.6. Education and training. 7. Counseling and support. 7. Counseling and support. 8. Risk assessment and risk management 8. Risk assessment and risk management 9. Act as employee advocate, assuring appropriate job 9. Act as employee advocate, assuring appropriate job

assignments for workers, and adequate treatment for job-assignments for workers, and adequate treatment for job-related illness or injuries. related illness or injuries.

5. Residential 5. Residential InstitutionsInstitutions

Any facility where clients reside can be a setting in Any facility where clients reside can be a setting in which a community health nursing is practicedwhich a community health nursing is practiced. .

Residential institutions can include:Residential institutions can include: 1. A halfway house in which clients live temporary 1. A halfway house in which clients live temporary

while recovering from drug while recovering from drug 2. Inpatient hospice program in which terminally ill 2. Inpatient hospice program in which terminally ill

clients live.clients live. 3. A continuity care center. In this setting, residents 3. A continuity care center. In this setting, residents

usually are elderly; increasingly more usually are elderly; increasingly more dependent and have many chronic health problems.dependent and have many chronic health problems.

The community health nurse functions as advocate The community health nurse functions as advocate and collaborator to improve the service.and collaborator to improve the service.

Residential institutions provide unique settings Residential institutions provide unique settings for the community health nurse to practice health for the community health nurse to practice health promotion. promotion.

6. Community at Large 6. Community at Large The community at large for community health nursing The community at large for community health nursing

practice is not confined to a specific philosophy, location, practice is not confined to a specific philosophy, location, or building.or building.

When working with groups, population, or total When working with groups, population, or total community, the nurse may practice in many different community, the nurse may practice in many different places.places.

For example:For example: - A community health nurse, as clinician and health - A community health nurse, as clinician and health

educator, may work with a parenting group in town hall.educator, may work with a parenting group in town hall. - Another nurse, as client advocate, leader, and - Another nurse, as client advocate, leader, and

researcher, may study the health needs of a researcher, may study the health needs of a neighborhood's elderly population by collecting data neighborhood's elderly population by collecting data throughout the area and meeting with resources people throughout the area and meeting with resources people in many places.in many places.