Roles and Functions of the Community and Public Health Nurse

Upon mastery of this chapter, you should be able to: ● Identify the three core public health functions basic to communityhealth nursing. ● Describe and differentiate among seven different roles of the community health nurse. ● Discuss the seven roles within the framework of public health nursing functions. ● Explain the importance of each role for influencing people’s health. ● Identify and discuss factors that affect a nurse’s selection and practice of each role. ● Describe seven settings in which community health nurses practice. ● Discuss the nature of community health nursing, and the common threads basic to its practice, woven throughout all roles and settings. ● Identify principles of sound nursing practice in the community.

Three primary functions of public health The various roles and settings for practice hinge on three primary functions of public health: assessment, policy development, and assurance. They are foundational to all roles assumed by the community health nurse and are applied at three levels of service: to individuals, to families, and to communities

Assessment An essential first function in public health the community health nurse must gather and analyze information that will affect the health of the people to be serve: health needs, health risks, environmental conditions, political agendas, and financial and other resources

Policy Development is enhanced by the synthesis and analysis of information obtained during assessment. At the community level, the nurse provides leadership in convening and facilitating community groups to evaluate health concerns and develop a plan to address the concerns. Typically, the nurse recommends specific training and programs to meet identified health needs of target populations.

Assurance Assurance activities—activities that make certain that services are provided—often consume most of the community health nurse’s time. Community health nurses perform the assurance function at the community level when they provide service to target populations, improve quality assurance activities, and maintain safe levels of communicable disease surveillance and outbreak control.

Standards for Community Nursing Individuals should receive nursing services based on standards developed by the American Nurses Association (ANA), such as: the Code for Nurses With Interpretive Statements (1985), Nursing’s Social Policy Statement (1995), Standards of Clinical Nursing Practice (2nd edition) (1998a), The Scope and Standards of Public Health Nursing Practice (1999).

Clinician Role The most familiar role of the community health nurse is that of clinician or care provider; means that the nurse ensures that health services are provided not just to individuals and families, but also to groups and populations. Three clinician emphases, in particular, are useful to consider here: holism, health promotion, and skill expansion.

Holistic Practice In community health a holistic approach means considering the broad range of interacting needs that affect the collective health of the “client” as a larger system Holistic nursing care encompasses the comprehensive and total care of the client in all areas, such as physical, emotional, social, spiritual, and economic.

Health promotion The clinician role in community health also is characterized by its focus on promoting wellness. Examples include immunization of preschoolers, family planning programs, cholesterol screening, and prevention of behavioral problems in adolescents. Protecting and promoting the health of vulnerable populations is an important component of the clinician role

Expanded Skills With time, skills in observation, listening, communication, and counseling became integral to the clinician role as it grew to encompass an increased emphasis on psychological and sociocultural factors. Recently, environmental and community-wide considerations, such as problems caused by: pollution, Violence and crime, drug abuse, unemployment, poverty, homelessness, and limited funding for health programs have created a need for stronger skills in assessing the needs of groups and populations and intervening at the community level.

Role of the Public Health Nurse To: Provide input to interdisciplinary programs that monitor, anticipate and respond to health problems in population groups for all diseases or public health threats including bioterrorism To: Evaluate health trends and risk factors of population groups to help determine priorities forming targeted interventions

Role of the Public Health Nurse To: Work with the community or specific population groups to develop targeted health promotion and disease prevention activities To: Evaluate health care services To: Provide health education, care, management and primary care to individuals and families who are members of vulnerable populations and high risk groups

Public health nurses integrate community involvement and knowledge of the entire population with the personal clinical understandings of health and illness gleaned from the experiences of individuals and families within the population.

The nurse working in public health should be a voice for members of the community to voice problems and desires

The public health nurse can apply her knowledge of strategies to choose the intervention(s) that meets the needs of a particular community, family or individual

The nurse is the agent who translates and applies the knowledge of health and social sciences to individuals and population groups through specific interventions, programs and advocacy

He or she also articulates and translates health and illness experiences of diverse, often vulnerable, individuals and families to the health planners and policy makers

Standards of practice have been established by the American Nurses Association

The Quad Council, made up of four public health nursing organizations, has established core competencies

These competencies reflect an agreement by the Quad Council that the public health nurse requires preparation at the baccalaureate level.

However, in many states nurses doing public health work are not baccalaureate graduates.

Even early on, the shortage of nurses affected the hiring of BSN or MSN prepared nurses. Public health departments could not compete with hospital systems.

The specialist level competencies require preparation at the Master’s level in community and /or public health nursing.