1 CHAPTER

Definition of Community Health Nursing Science and practice of public health Systematic use of nursing process Promotes health and prevent illness Focuses on population groups

Past and Present Public health Community health Environmental sanitation Control of communicable diseases Community health Health education Individual behavior change Actions to change factors that influence health

Community-Based Nursing Provides care to individuals (often to those who are ill) Delivers care in a community setting

Community-Focused Nursing Brings nursing knowledge and expertise to community

Community-Driven Nursing Focuses on whole community needs as identified by community members Emphasizes community participation to determine needs

Community Health Nursing Mission, goals, and expectations Promote and improve health Prevent illness and injury Protect from threats Biological Behavioral Social Environmental

Program-focused Service delivery system Specific health problems Specific target populations Specialist practice Focus on a specific set of services More focus on services to groups

Problem Solving in Community Health Nursing FIGURE 1-1 Problem Solving in Community Health Nursing.

District Nursing Originated in England Addresses health needs of given geographic segment of the population Broad spectrum of services Generalist practice More services to individuals

Eight Unique Attributes of Community Health Nurses Population consciousness Orientation to health Autonomy Creativity

Eight Unique Attributes of Community Health Nurses (continued) Continuity Collaboration Intimacy Variability

Advocacy Definition Nursing advocacy

Community Health Nursing Advocacy Definition

Advocacy Models Guardian of legal rights Preservation of patient values Champion of social justice and access to care Client empowerment

Advocacy Process A recipient of the advocacy An advocate An adversary A consequence for all the participants in the process

Advocacy Process (continued) Factors that influence participants in an advocacy situation Knowledge Conviction Emotion

Approaches to Effective Advocacy Advocate takes action that is situation- and client-specific Use a collaborative and cooperative approach with the adversary Educate the advocacy recipient or adversary Confront the adversary Request a change Explain Enlist the aid of others

Community Health Nurse Functions in the Advocacy Role Determine the need for advocacy Determine the point at which advocacy is most effective Collect facts surrounding the problem Present the client’s case to the appropriate decision makers Prepare clients to speak for themselves

Standards of Practice Essential to a profession

Developed by Quad Council of Public Health Nursing Organizations Apply nursing process to community/public health nursing practice Incorporate core functions of pubic health

Professional Standards Expected levels of professional performance Quality of practice Education Practice evaluation Collegiality

Professional Standards (continued) Ethics Collaboration Research Resource utilization Leadership Advocacy

Eight Domains of Competency Analytic assessment Policy development and program planning Communication Cultural competence

Eight Domains of Competency (continued) Community dimensions of practice Basic public health practice Financial planning and measurement Leadership and systems thinking

Community Health Nursing Roles Vary based on specific practice setting Focus of activity Client-oriented roles Delivery-oriented roles Population-oriented roles

Focus of Services Types and emphasis placed on specific roles vary by practice setting Client-oriented roles Emphasize direct care of specific individuals or families Delivery-oriented roles Focus on mechanisms of care delivery Primarily address care delivery to individuals and families Population-oriented roles Care of communities or populations

Client-Oriented Objectives Apply the nursing process Assess client needs Develop nursing diagnoses Plan nursing interventions Evaluate nursing care and outcomes

Client-Oriented Roles Caregiver Educator Counselor Referral resource Role model Primary care provider Case manager

Caregiver Functions Assess client health status Derive nursing diagnosis Plan nursing intervention Implement plan of care Perform delegated medical treatments or provide primary care as needed

Caregiver Functions (continued) Introduce other supportive services as needed Teach and supervise others Teach clients self-care Coordinate health care services Serve as liaison between client and system Evaluate the outcome of nursing intervention and modify plan

Educator Role Assess client’s need for education Develop health education plan Present health education Evaluate outcome of health education

Counseling Role: Choose Viable Solutions to Health Problems Assist client to identify and clarify problem Help identify alternative solutions to problem Assist client to develop criteria for acceptable solution Assist client to evaluate alternative solutions Evaluate problem-solving process Point out use of problem-solving process for future use

Referral Resource: Direct Client to Resources Required to Meet Their Needs Obtain information on community resources Determine need for and appropriateness of referral Make and follow up on the referral

Role Model Demonstrate behaviors Influence health related behaviors Response to crisis Treatment of clients Types of client-focused activities Display competence

Case Manager Identify need for case management Assess and identify client health needs Design plan of care Oversee implementation of care by others Evaluate outcome of care

Delivery-Oriented Roles Enhance operation of health care delivery system Coordinator/care manager Collaborator Liaison

Coordinator/Care Manager Determine who is providing care to client Communicate with other providers regarding client situation and needs Arrange case conferences as needed Assist in development of care networks

Collaborator Communicate with other health team members Participate in joint decision making Participate in joint action to resolve client problems Participate in joint activities to evaluate the outcome of care

Liaison Serve as initial point of contact between client and agency Facilitate communication between client and agency personnel Interpret and reinforce provider recommendations Serve as client advocate as needed

Population-Oriented Roles Promote, maintain, and restore the health of population Case finder Leader Change agent Policy developer

Population-Oriented Roles (continued) Community organizer/mobilizer Coalition builder Social marketer Researcher

Case Finder Role Develop knowledge of signs and symptoms of health-related conditions and contributing factors Use diagnostic reasoning process to identify potential cases of disease or other health-related conditions Carry out investigation of specific cases of disease as needed Provide follow-up care to identified cases

Leadership Role Identify need for action Assess situation and followers to determine appropriate leadership style Motivate followers to take action Coordinate group member activities in planning and implementing action Assist followers to evaluate the effectiveness of action taken

Change Agent Plans, controls, and enhances health processes Recognizes need for change Makes others aware of need Motivates others to change Initiates and directs desired change

Community Mobilizer Assists community members to identify health issues of concern Participates in data collection relevant to issues of concern Mobilizes community members to take action Assists with coalition development to foster community action Assists community members to identify achievable goals Participates in the development of strategies to accomplish identified goals Participates in the implementation of community strategies to achieve goals

Coalition Builder Creating Temporary/Permanent Alliances Functions include Identify potential coalition members based on common interest, assets available, etc. Present potential coalition members with the benefits to be achieved through alliance Participate in the delineation of coalition goals Assist in the development of operating guidelines for the coalition Participate in the selection and implementation of strategies to accomplish coalition goals

Policy Advocate Determine need for policy development Analyze factors influencing the policy situation Identify key decision makers Assist in policy formation Communicate the proposed policy Monitor the progress of policy development

Social Marketer Identify the need for societal behavior change Analyze motivation and perceived benefits and barriers to the desired change Identify target markets and their unique features Develop and test social marketing strategies appropriate to target markets Assist with implementation strategies Evaluate the effectiveness of social marketing strategies in achieving the desired change

Researcher Critically review relevant research Apply research findings to practice Identify researchable problems Design and conduct research Collect and analyze data Disseminate research findings

Resources The Center for Nursing Advocacy The Center for Nursing Advocacy seeks to increase public understanding of the central, front-line role nurses play in modern health care. The focus of the Center is to promote more accurate, balanced and frequent media portrayals of nurses and increase the media's use of nurses as expert sources. The Center's ultimate goal is to foster growth in the size and diversity of the nursing profession at a time of critical shortage, strengthen nursing practice, teaching and research, and improve the health care system.