1 CHAPTER

Definition of Community Health Nursing There are many definitions of Community Health Nursing, the most comprehensive one was the ANA definition: “ Synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations”

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

Public Health Public Health was described by Winslow (1952) as follows: Is the science and art of: Preventing disease. Prolonging life. Promoting health; by: Organized community effort for the sanitation of the environment Control of communicable and non-communicable diseases. Education of individuals in personal hygiene Early diagnosis and prevention . Maintenance of health

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

KEEP IN MIND THAT The nature of this practice is general and comprehensive. It is not limited to a particular age or diagnostic group. It is continuous not episodic. The dominant responsibility is to the population as a whole.

Definition of Community Defining the community is based on different aspects: Some definition focus on functions performed by communities; for example; A system of formal and informal groups characterized by independence and whose function is to meet the collective needs of group members.

Definition of Community Conti some definitions use locale as basis for community. For example; A social system, a place, and people. Some definitions based on existence of commonalities among members of the community; for example Collection of people who share some important features of their lives.

Definition of Community Conti Other authors take more elective view that community can be defined either in terms of geography or special interest.

Critical Attributes of Communities Despite the diversity in definitions of community, certain common elements are revealed; which are: Group orientation Bond between individuals Human interaction

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

Health (Community View) World Health Organization(WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease.

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

Professional Standards of Community Health Nurses 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 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 Researcher

Case Finder Role Develop knowledge of signs and symptoms of health-related conditions and contributing factors 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

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.