1. © Ma'en Aljezawi

2. Setting the stages for community health nursing
Standards of practice: provide guidance as to what constitutes public health nursing and how it is different from other professions.
These standards must be consistent with the nursing process and include assessment, diagnosing, planning, implementation, and evaluation.
Standards for a profession must be included in the nursing education curriculum
© Ma'en Aljezawi

3. Standards of practice (cont)
In addition to standards there are competencies list: a tool to evaluate practice. This tool can be applied in practice and management.
Competencies list is beneficial in practice, education and research.
This list ensures that the community nurse is equipped with all the needed knowledge and skills to practice as a community nurses
© Ma'en Aljezawi

4. Standards of practice (cont)
Competencies include:
Analytic assessment skills
Policy development & programme planning
Communication skills
Cultural skills
Community practice skills
Financial and management skills
Leadership & thinking skills
© Ma'en Aljezawi

5. Standards of practice (cont)
Standards of care is also based on other standards: code of ethics
Code of ethics provide essential information for a sound ethical nursing practice.
These standards are applied to all levels of practice and nurses should be aware of them.
© Ma'en Aljezawi

6. Healthy people
Public health infrastructure: ensure that health agencies on the various levels have an infrastructure to provide essential health Accordingly there is a need for a competent public health agencies to assess their health care workers according to this competency list and codes of ethics.
© Ma'en Aljezawi

7. Who provides these standards in Jordan
Jordan nurses and midwives council
Ministry of health
Ministry of higher education
Jordanian nursing council
© Ma'en Aljezawi

8. Roles of community health nurses
The roles of community health nurses must be adaptive and changing because the health care system is changing along with the Community needs.
Usually one role is primary for a certain speciality e.g. manager role.
The roles of community nurses may be practiced as individual nurses or as group of nurses.
© Ma'en Aljezawi

9. Roles of community health nurses (cont)
Clinician
Educator
Advocate
Manager
Collaborator
Leader
Researcher
© Ma'en Aljezawi

10. Clinician role (care provider)
Ensures that the health services are not only provided to individuals and families but also to groups and populations.
S/he must have the abilities to apply individual services to aggregates and be adaptive to different situations.
© Ma'en Aljezawi

11. As clinician nurses must have skills that emphasis:
holistic practice
focus on wellness
expanded skills
© Ma'en Aljezawi

12. Clinician role (cont) Holistic practice
Considering the broad range of needs of the community
Comprehensive care in all areas
Interactions and relations between individuals in the community must be considered in totality
These consideration of holistic practice must be taken into consideration when planning a health programme.
© Ma'en Aljezawi

13. Clinician role (cont) Focus on wellness
Provides services along the health continuum but focuses on the wellness side.
Clients at risk must be located within the community not to wait them to come for help.
Looks for agencies or groups that seeks to learn about healthy behaviour
Search for vulnerable groups
E.g. immunization
© Ma'en Aljezawi

14. Clinician role (cont) Expanded skills Physical care skills
Assessment skills (observation, listening, communicating)
Counselling skills
Assessing groups skills
Assessing environment (pollution, crime, drugs abuse, unemployment)
Collaboration with health consumers
Use of epidemiology and biostatistics
Community organization and development skills
© Ma'en Aljezawi

15. Educator role
Health education is more useful in the community than acute settings for two reasons
Presence of more healthy people who can absorb and act on health promotional information.
A wider range of audience can be reached
e.g. family planning campaign in Jordan
© Ma'en Aljezawi

16. Reaching a wide range of audience
© Ma'en Aljezawi

17. Advocate role
Nurses in this role act on behalf of the clients to ensure getting their rights and being treated equally
Every client has the right to receive equal and human treatment.
Minorities, poor, uneducated people can feel depressed and frustrated when their needs are neglected
The role of nurse as an advocate is to insure that these and every clients is treated equally.
© Ma'en Aljezawi

18. Advocacy goals Two main goals:
1- help client to gain more independence or be self determinant: the community nurse can show available services to clients
2- Make system more responsive for the clients’ needs,. This can be achieved by calling attention to inadequacies, inaccessible or unjust care.
© Ma'en Aljezawi

19. Advocacy action The advocate role take four characteristic actions:
1- being assertive: taking any and every chance to fulfil the client needs: act on the run.
Chances must be taken quickly to benefit the client to the max.
© Ma'en Aljezawi

20. Advocacy action (cont)
2- Risk taker: take actions that can remove risky situations. This should be planned fast and accurately 3- Communicator and negotiator: get good care bargains without compromising the needs of their clients. 4- Identify resources: contacting the most influential people to fulfil clients needs
© Ma'en Aljezawi

21. Advocacy action (cont)
Advocacy at the population level incorporates the same goals and actions as in individuals.
Advocacy actions takes place at various places in the community, homes, schools, nursing homes.
Advocacy for very large groups at the national level requires changing policies or even laws.
Conducting needs assessment that might be necessary to fulfil the advocacy role).
© Ma'en Aljezawi

22. Manager role The community nurse act as a manager when:
Trying to accomplish specific goals: this needs assessment and organizing.
Directing and leading to assure that the goals are accomplished.
Controlling and evaluating the progress of the health goals
When supervising other nurses, caseloads, clinics or conducting a community health project.
© Ma'en Aljezawi

23. Manager role (cont)
Management process in nursing incorporates steps as in any problem solving process:
Planning
Organizing
Leading
Controlling
evaluating
© Ma'en Aljezawi

24. Manager role (cont) Nurse as a planner
- The first step in the management process.
planer: set goals and direction in addition to means to achieve goals.
Planning may be strategic : for long term e.g. ten years plan to eradicate a communicable disease.
Or operational (less than six months) e.g. Six months plan to train nurses on a new computer programme.
© Ma'en Aljezawi

25. Manager role (cont) Nurse as organizer
This involves designing a structure that facilitates reaching goal and objectives.
It also involves assigning tasks to persons, when, where and how these tasks are going to take place.
E.g. when planning for a new clinic: organizer make certain that all equipment, staff are present for the clinic to work properly
© Ma'en Aljezawi

26. Manager role (cont) Nurse as a leader:
Involves direction, influencing, persuading, motivating, resolving conflict and coordinating with other staff to act in order to achieve goals.
Leader must ensure a two way communication in order to resolve conflicts and swap ideas
© Ma'en Aljezawi

27. Manager role (cont) Nurse as controller and evaluator
Monitor plan to stay of planned course
If go out of course plans must be revised (adjusted)
Compare outcome to predefined goals.
© Ma'en Aljezawi

28. Manager role (cont) Management behaviour Decision making behaviour
Transfer of information behaviour
Interpersonal behaviour
© Ma'en Aljezawi

29. Manager role (cont) Management behaviour
Decision making behaviour : has four sub- behaviours
Entrepreneur: when initiating a new project
Disturbance handler: when staff engage in a conflict
Resources allocator: determine where resources should go
Negotiator: with higher administrative level personnel
© Ma'en Aljezawi

30. Manager role (cont) Management skills:
Human skills: ability to understand, communicate, motivate, delegate and work with people.
Conceptual skills: have the mental ability to understand abstract ideas
Technical skills: ability to apply managerial skills into practice.
© Ma'en Aljezawi

31. Manager role (cont) Case management:
Is a systematic process by which the nurse assess, plans, coordinates clients services then refer to other specialized providers.
After the service is provided the nurse (or case manager) evaluate progress to ensure that needs are met.
© Ma'en Aljezawi

32. Manager role (cont)
Case management: the environment that the case manager work in is called case managed care.
Case managed care is a systematic way to ensure that client needs are met in a cost effective manner.
Discharge planning is put in place to ensure continuity of care
Example: working with domestic violence victims
© Ma'en Aljezawi

33. Collaborator role
Working jointly with others (health care workers and non-health care workers) as partners.
Nurse is only one member in the multidisciplinary team and cannot work is isolation.
This role requires skills in communication
© Ma'en Aljezawi

34. Leadership role Different from the leader role in case management
Here it involves being a change agent to promote health behaviour.
A leader in nursing must have a vision to see what can affect clients to reach goals.
© Ma'en Aljezawi

35. Researcher role
Community health nurse have this role in order to systematically find solutions for the health problem.
Research also means to apply scientific evidence into practice
Outcomes of research can change care protocols applied by community nurses
Community nurse usually work within a team or agency when conducting health research
© Ma'en Aljezawi

36. A resemblance of the nursing process 
The research process
Identify an area of interest
Specify the research question or aims
Review the literature
Identify a conceptual framework
Select a research design
Collect and analyze data
Interpret results
Communicate findings
A resemblance of the nursing process 
© Ma'en Aljezawi

37. Attributes of researcher role
Spirit of inquiry : nurse is always asking why then try to find solution e.g. Nurse saw many children at traffic lights cleaning windshields : nurse asks is there an increase in the child labour
Careful observations: nurse needs to be a sharp observer
Any life examples
© Ma'en Aljezawi

38. Settings for the community health practice
Homes
Ambulatory service settings
Schools
Occupational health settings
Residential institution
Faith communities
Community at large
© Ma'en Aljezawi

39. Homes Interventions can be tailored according to client specific needs
Can help families to understand healthy behaviour (health behaviour)
The character of the home setting is as varied as the client served (rich, middle class, poor).
Nurse can feel fear from the unknown when visiting a client home for the first time (basic safety measures should be sought).
© Ma'en Aljezawi

40. Ambulatory service settings
Various types of venues that can provide community nursing service (day only), no facility to keep patients sleeping.
Examples: community health centres , offices, migrant camps.
© Ma'en Aljezawi

41. schools Specialized community nurse in school nursing
Has a role of clinician in addition to health promoter.
Can collaborate with others to promote health (educators)
Also can fulfil a managerial in addition to researcher role.
© Ma'en Aljezawi

42. Occupational health settings
Basic clinician role to treat injured workers
Advocate employees
Health education
Safety officer
Leader and manager
This role is not restricted to factories: companies, large retail shops can also have a nurse.
© Ma'en Aljezawi

43. Residential institutions
Rehabilitation centres, nursing homes (continuing care centre), camps
Keeps on with discharge planning from hospitals
Provide community based services (collaborating with hospitals
Good environment to practice health promotion (captive audience)
© Ma'en Aljezawi

44. Faith communities In worship places (e.g. Hajj)
It involves large scale effort to provide health care
Services include: education, screening, referral, treatment, group support
Faith communities nurse can keep promoting health of individuals while they are engage worship
© Ma'en Aljezawi

45. Community at large
Role is not defined to a group or geographical area or place
The role here is defined by the nature of practice.
© Ma'en Aljezawi