1. Community Health Nursing
Theoretical basis of Community Health Nursing
Chapter 14

2. WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice
Community health nursing is a specialty in which the unit of care is a specific community or aggregate and the nurse has responsibility to promote group health
The goal of this specialty is health improvement of the community.

3. WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice
The skills required for excellence in community health nursing practice include
epidemiology, research, teaching, community organizing, and interpersonal relational care,

4. WHEN THE CLIENT IS A COMMUNITY: characteristics of community health practice
community health nursing is characterized
by community-oriented, population-focused care and is based on interpersonal relationships.

5. Community-Oriented, Population- Focused Care
A community is a group of people who have some characteristics in common,
are bounded by time, interact with one another, and feel a connection to one another.
They share similar experiences and concerns, and they often influence one another’s behavior.

6. Community-orientation, population-focused care
Is a process that is actively shaped by the unique experiences knowledge, concerns, values, beliefs, and culture of a given community.

7. Community-orientation, population-focused care
when the outbreak of a such disease, the nurse also
1- Uses disease-investigation skills to locate possible sources of infection
2- Determines how the community’s knowledge, values, beliefs, influence its interpretation of the disease, response to and prior experiences with infectious disease may outbreak, and treatment preferences

8. Community-orientation, population-focused care
3- Uses knowledge and suggestions gathered from the community to develop, in collaboration with other health professionals community-specific program to prevent future outbreaks

9. Community-orientation, population-focused care
A community-oriented nurse who provides nutritional counseling to a community considers the meaning of food in this culture, the types of food most commonly consumed, and the cooking methods most commonly used.

10. Community-orientation, population-focused care
A population
is any group of people who share at least one characteristic, such as age, gender, race, a particular risk factor, or disease.
Smokers and breast cancer survivors are two populations.

11. Relationship-based care
Incorporates, the value of establishing and maintaining a reciprocal, caring relationship with the community health nursing practice and is foundational to caring effectively for the community’s health.

12. Relationship-based care
A reciprocal, caring relationship with the community involves listening, participatory dialogue, and critical reflection, and it may also involve sociopolitical elements of practice such as advocacy, community empowerment, and movement to action

13. Theories and Models for CHN Practice
Theory: set of systematically interrelated concepts or hypotheses; explain or predict phenomena
Early theories: grand theories or conceptual models
Key to nursing theories: nursing metaparadigm concepts
Nursing
Client/patient
Health
Environment
Model: pictorial representation

14. Nightingale’s Theory of Environment
Focus on preventive care for populations
Use of observations to validate her hypothesis
Poor environmental conditions are bad for health.
Good environmental conditions reduce disease.
Others have added social services and health care in addition to environment as conditions for health.

15. Orem’s Self-Care Model
Communities with collective set of self-care actions and requirements affecting well-being of the group
Self-care deficit: demand exceeds client abilities related to:
Universal requirements
Developmental requirements
Health deviation requirements
Nursing care supports client
Specific theories: self-care deficit theory; theory of self-care; theory of nursing system

16. Neuman's Health Care Systems Model
Open systems constantly and reciprocally interacting with environment
System > sum of parts
Wellness = parts interacting in harmony with each other and the system’s environment
Variables: physiologic, psychological, sociocultural, developmental
Each system with unique response to stressors and tension-producing stimuli
System response (see Fig. 14.1) with boundaries: flexible line of resistance; normal line of defense; dynamic flexible line of defense

17. Rogers’ Model of the Science of Unitary Man
Based on systems theory
Whole is greater than the sum of the parts
Three principles:
Life proceeds in one direction along a rhythmic spiral.
Energy fields follow a certain wave pattern and organization.
Human and environmental energy fields interact simultaneously and mutually, leading to completeness and unity.

18. King’s Theory of Goal Attainment
Personal and interpersonal systems
In any nurse-client encounter, each comes with own goals and expectations
Success at goal achievement is possible only when nurse and client work together to set goals

19. Pender’s Health Promotion Model
Proactive set of behaviors to increase level of well-being and self-actualization
Individuals acting on environment; not reacting to stressors from environment
Modifying factors
Demographic factors
Biologic characteristics
Interpersonal influences
Situational factors
Behavioral factors

20. Roy’s Adaptation Model
Open adaptive systems, experiencing stimuli, developing coping mechanisms, and producing responses
Adaptive or maladaptive responses; provide feedback influencing amount & type of stimuli that can be handled in future
Regulator process: stimuli from internal and external environment processed for a response
Cognator process: perceptions, learning, judgment, and emotion considered in formulating response

21. Salmon Construct for PHN
Categories of nursing interventions
Education directed toward voluntary change in the attitudes and behavior of the subjects
Engineering directed at managing risk-related variables
Enforcement directed at mandatory regulation to achieve better health
Interventions target determinants in four categories:
Human/biologic, environmental, medical/technologic/organizational, and social

22. Minnesota Wheel – the Public Health Interventions Model
17 different interventions
Three levels of public health practice:
Population-based community-focused practice
Systems-focused practice
Individual-focused practice (see Fig. 14.2)

23. Principles of Public Health Nursing
Principle 1: focus on community
the client or unit of care is the population
Principle 2: give priority to community needs
the primary obligation is to achieve the
greatest good for the greatest number of
people or the population as a whole

24. Principles of Public Health Nursing
Principle 3: Work in Partnership With the People
the processes used by public health nurses
include working with the client as equal
partner.
Principle 4: Focus on Primary Prevention
primary prevention is the priority in
selecting appropriate activities.

25. Principles of Public Health Nursing
Principle 5: Promote a Healthful Environment
public health nursing focuses on
strategies that create healthy
environmental, social, and economic
conditions in which population may thrive.

26. Principles of Public Health Nursing
Principle 6: Target All Who Might Benefit
a public heath nurse is obligated to
actively identify and reach out to all who
might benefit from a specific activity or
service

27. Principles of Public Health Nursing
Principle 7: Promote Optimum Allocation of resources
optimal use of available resources to assure
the best overall improvement in the health of
the population is a key element of the
practice

28. Principles of Public Health Nursing
Principle 8: Collaborate with Others in the Community
collaboration with a variety of other
professions, populations, organizations,
and other stakeholder groups is the most
effective way to promote and protect the
health of the people

29. SOCIETAL INFLUENCES ON COMMUNITY-ORIENTED POPULATION-FOCUSED NURSING
Social changes influence a community’s health. Community
communicable disease. affect the availability of resources
Contemporary community health nurses must be especially aware of the mutual interaction between nursing and technology

30. SOCIETAL INFLUENCES ON COMMUNITY-ORIENTED POPULATION-FOCUSED NURSING
Communication Technology
Genetic Engineering can be defined as gene manipulation in a laboratory setting
Global Economy
Migration is the act of moving from one region or country to another, either temporarily, seasonally, or permanently.

31. SOCIETAL INFLUENCES ON COMMUNITY-ORIENTED POPULATION-FOCUSED NURSING
Terrorism is one way in which a small number of people who perceive that they have been unfairly treated can exert influence on a larger group or nation.
Bioterrorism is the use of living organisms, such as bacteria, viruses, or other organic materials, to harm or intimidate others, in order to achieve political ends.

32. SOCIETAL INFLUENCES ON COMMUNITY-ORIENTED POPULATION-FOCUSED NURSING
Climate changes can be considered societal changes because they may be influenced by economics