1. Chapter 1 The Journey Begins: Introduction to Community Health Nursing

2. -Challenges in nursing are boundless and ever changing , also these challenges confront nurses personally and professionally
Challenge of expanding nursing practice from individual and family to encompass communities and opportunity to affect health of population
Challenge of terminating the needs of population at risk and opportunity to design intervention to address their needs

3. Community health
CH nursing is community based and most important, its population based, operating with environment of rapid changing and increasing in complexity
Community is an essential and permanent features of human experiences
Community health is concerned with the interchange between population groups and their environment, and with the impact of that interchange on collective health
Community health nursing is a specialized practice combines all basic elements of professional clinical nursing with public health and community

4. Community nursing and public nursing share many features: both are organized community efforts aimed at promotion, protection and preservation of public health
Public health had been primarily associated with governmental efforts supported with health agencies that target the whole range of health issue, and currently public health practice encompass both approaches and works collaboratively with health agencies and efforts
Community health practice focus on specific, designated communities, its part of larger public health

5. Community Health (CH) and Public Health (PH)
CH = “identification of needs and the protection and improvement of collective health within a geographically defined area”
PH = “an effort organized by society to protect, promote, and restore the people’s health”

6. Concept of Community
Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging
Examples of some communities:
Citizens of a town
Group of farmers
Prison community
Tiny village in Appalachia
Members of Mothers Against Drug Driving (MADD)
Professional nurses

7. Concept of Community
Sharing of people holding common rights and privileges
Living under the same laws and regulation
The function of any community includes its members collective sense of belonging and shared identity, values norms, communication and common interest and concern

8. Three Types of Communities
Geographic
Common-interest
Community of solution

9. Three Types of Communities
Geographic = city, town, neighborhood
-clear target for analysis of health needs
-available data (morbidity, mortality, basis for planning health program)
-borders of country change with political revolution
-the world is one large community
-Global health: has become dominant phrase in international public health circles.

10. Common-interest = church, professional organization, people with mastectomies , disabled individuals, and communities to protect the rights of children.
- A collection of people, they are widely scattered geographically, can have an interest or goal binds the members together.

11. Community of solution = group of people who come together to solve a problem that affects all of them
- the shape of this community varies with the nature of the problem that affect all of them, number of resources e.g. substance abuse, HIV infection, water control, air pollution.

12. Example of Communities of Solution

13. Populations and Aggregates
All people occupying an area or all of those who share one or more characteristics
People do not necessarily interact with one another and do not necessarily share a sense of belonging to that group
May be defined geographically e.g. USA POP
Also can be defined by common qualities or characteristic e.g. elderly population, homeless population, ethnic group.

14. Aggregate
Mass or grouping of individuals considered as a whole
Loosely associated with one another
Aggregate: Its broader term that encompasses many different size groups
Both communities and population are types of aggregate

15. Concept of Health
Health: holistic state of well-being, including soundness of mind, body, and spirit
Health refers to persons physical, mental and spiritual state it can be positive (being in a good health) or negative as (being in poor health)
WHO state of complete physical, mental and social well being and not merely the absence of disease or infirmity

16. Wellness: health plus the capacity to develop one’s potential, leading to a fulfilling and productive life
Illness: state of being relatively unhealthy

17. Subjective and objective dimension of health
Subjective :how people feel (feeling well or ill)
Objective :how well they function in their environment (functioning).
A healthy person is one who feels well who experience a sensation of vital, positive state
Healthy people are full of life and vigor ( strength), capable of physical and mental productivity

18. People experience varying degree of vitality (life) and well being
Health involves the objective dimension of ability of function
A healthy individual or community carries out necessary activity and achieves goals, while unhealthy people not only feel ill but they are limited to some degree in their ability to carry out their daily activities.

19. Indeed levels of illness or wellness are measured largely in terms of ability to function and this can be observed
The action of an individual family or community are motivated by their values
Together subjective and objective dimensions provide a clearer picture of people health
When they demonstrate functional ability, they are close of wellness end of the health

20. Continuous needs: include all age groups with birth to death (developmental health care needs) e.g. toilet training techniques
Episodic needs: when population may have one time specific, negative part of life such as illness or injury that not an expected part of life e.g. infants with down syndrome, head injuries (crush)

21. Health Continuum

22. Leading Health Indicators (Healthy People 2010)
Physical activity
Overweight and obesity
Tobacco use
Substance use
Responsible sexual behavior
Mental health
Injury and violence
Environmental quality
Immunization
Access to health care

23. Six Components of Community Health Practice
Promotion of health
Prevention of health problems
Treatment of disorders
Rehabilitation
Evaluation
Research

24. Health Promotion
All efforts that seek to move people closer to optimal well-being or higher levels of wellness
( Enabling people)
Goal: raise level of wellness for individuals, families, populations, and communities
heath education
environmental sanitation
healthy life style

25. Health Promotion Initiatives for health promotion as a U.S nation
Healthy People, Promoting Health, Preventing Disease: 1990 Health Objectives for the Nation, Healthy People 2000, and Healthy People 2010
Community health efforts achieve its goal by:
1. Increase the span of healthy life for all citizen
2. Reduce health disparities among population groups
3. Achieve access to preventive services for everyone.

26. Prevention of Health Problems
Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment
Three levels
Primary: Keep illness or injury from occurring (e.g. educational programs).
Secondary: Detect and treat existing disease (e.g. screening programs).
Tertiary: Reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function (e.g. rehabilitation).

27. Characteristics of Community Health Nursing
Knowledge of elements of public health is essential to community health nursing (ANA, 2005):
Priority of preventive, protective, and health promoting strategies over curative strategies.
Means for measurement and analysis of community health problems including epidemiology concepts and biostatistics
Influence of environmental factors on aggregate health
Principles underlying management and organization for community health
Public policy analysis and development a long with health advocacy and understanding of the political process.

28. Community health nursing: a field of nursing, combines nursing science with public health science to formulate a community-based and population focused practice.
Public health nursing: the practice of promoting and protecting the health of population using knowledge from nursing, social, and public health sciences”

29. Characteristics of Community Health Nursing (cont.)
Eight characteristics:
1. Population is client or unit of care: concerned for the health status of the population groups and their environment.
2. Primary obligation is to achieve greatest good for greatest number of people or population as a whole.
3. Processes used include working with the client as an equal partner
4. Primary prevention is the priority: the emphasis is on positive health or wellness.

30. Characteristics of Community Health Nursing (cont’d)
Eight characteristics:
5. Strategies are selected to create health environmental, social, and economic conditions in which populations may thrive.
6. There is an obligation to actively reach out to all who might benefit from a specific activity.
7. Optimal use of resources to ensure best overall improvement in health of population is a key element.
8. Collaboration with a variety of other professions, organizations, and entities is the most effective way to promote and protect health of people.

31. health literacy: is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions”.
Self care: is the process of taking responsibility for developing one’s own health potential.
Self care deficit: when people’s ability to continue self- care activities drops below their need.

32. Healthy People 2010 Internet Resources
Increase the quality and years of healthy life
Healthy People 2010 fact sheet m
Leading Health Indicators
Healthy People in Healthy Communities
thyCommunities2001/default.htm