Roles and Settings for Community Health Nursing Practice

Roles and Settings for Community Health Nursing Practice

● Explain the importance of each role for influencing people’s health.
objective After completion the lecture the students enable to: ● Identify the three core public health functions basic to community health nursing. ● Describe and differentiate among seven different roles of the community health nurse. ● Discuss the seven roles within the framework of public health nursing functions. ● Explain the importance of each role for influencing people’s health. ● Identify and discuss factors that affect a nurse’s selection and practice of each role. ● Describe seven settings in which community health nurses practice. ● Discuss the nature of community health nursing, and the common threads basic to its practice, woven throughout all roles and settings. ● Identify principles of sound nursing practice in the community.

Core public health functions basic to community health nursing.
Community health nurses work as partners within a team of professionals (in public health and other disciplines), nonprofessionals, and consumers to improve the health of populations. The various roles and settings for practice hinge on three primary functions of public health: assessment, policy development, and assurance. They are foundational to all roles assumed by the community health nurse and are applied at three levels of service: to individuals, to families, and to communities (Display 3–1). Regardless of role or setting of choice, these foundational responsibilities direct the work of all community health nurses.

The model includes assessment, policy development, and assurance surrounding the individual, family, and community. Assessment is the regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community. Policy development uses the information gathered during assessment to develop local and state health policies and to direct resources toward those policies. Assurance focuses on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies (Conley & Dahl, 1993).

Assessment means that the community health nurse must gather and analyze information that will affect the health of the people to be served. The nurse and others on the health team need to determine health needs, health risks, environmental conditions, political agendas, and financial and other resources, depending on the persons, community, or population targeted for intervention. Data may be gathered in many ways; typical methods include interviewing people in the community, conducting surveys, gathering information from public records, and using research findings. At the community level, assessment is done both formally and informally as nurses identify and interact with key community leaders. With families, the nurse can evaluate family strengths and areas of concern in the immediate living environment and in the neighborhood. At the individual level, people are identified within the family who are in need

Policy development At the community level, the nurse provides leadership in convening and facilitating community groups to evaluate health concerns and develop a plan to address the concerns. Typically, the nurse recommends specific training and programs to meet identified health needs of target populations.

Assurance . activities that make certain that services are provided Community health nurses perform the assurance function at the community level when they provide service to target populations, improve quality assurance activities, and maintain safe levels of communicable disease surveillance and outbreak control. In addition, they participate in research, provide expert consultation, and provide services within the community based on standards of care.

Role of the community health nursing .
Just as the health care system is continually evolving, community health nursing practice evolves to remain effective with the clients it serves. Over time, the role of the community health nurse has broadened. This breadth is reflected in the definition of public health nursing from the American Public Health Association, Public Health Nursing Section (1996): .

Public health nurses integrate community involvement and knowledge about the entire population with personal, clinical understandings of the health and illness experiences of individuals and families within the population. They translate and articulate the health and illness experiences of diverse, often vulnerable individuals and families in the population to health planners and policy makers, and assist members of the community to voice their problems and aspirations. Public health nurses are knowledgeable about multiple strategies for intervention, from those applicable to the entire population, to those for the family, and the individual. Public health nurses translate knowledge from the health and social sciences to individuals and population groups through targeted interventions, programs, and advocacy.

Public health nursing may be practiced by one public health nurse or by a group of public health nurses working collaboratively. In both instances, public health nurses are directly engaged in the interdisciplinary activities of the core public health functions of assessment, assurance and policy development. Interventions or strategies may be targeted to multiple levels depending on where the most effective outcomes are possible. They include strategies aimed at entire population groups, families, or individuals. In any setting, the role of public health nurses focuses on the prevention of illness, injury, or disability, the promotion of health, and maintenance of the health of population

Role of the community health nursing clinician, (2) educator,
(3) advocate, (4) manager, (5) collaborator, (6) leader, and (7) researcher. It also describes the factors that influence the selection and performance of those roles.

Role of the community health nursing: Clinician
The clinician role in community health means that the nurse ensures that health services are provided not just to individuals and families, but also to groups and populations. The goal for the nurse as clinician are to reduce disease, discomfort, disability, and premature death for the total community.

For community health nurses, the clinician role involves certain emphases that are different from those of basic nursing. Three clinician emphases, in particular, are useful to consider here: holism, health promotion, and skill expansion.

Holistic Practice Most clinical nursing seeks to be broad and holistic. In community health, however, a holistic approach means considering the broad range of interacting needs that affect the collective health of the “client” as a larger system

. Focus on Wellness The clinician role in community health also is characterized by its focus on promoting wellness. the community health nurse provides service along the entire range of the health continuum but especially emphasizes promotion of health and prevention of illness.

. Expanded Skills Many different skills are used in the role of the community health clinician. In the early years of community health nursing, emphasis was placed on physical care skills. With time, skills in observation, listening, communication, and counseling became integral to the clinician role as it grew to encompass an increased emphasis on psychological and sociocultural factors. Recently, environmental and community-wide considerations— such as problems caused by pollution, violence and crime, drug abuse, unemployment, poverty, homelessness, and limited funding for health programs—have created a need for stronger skills in assessing the needs of groups and populations and intervening at the community level.

Role of the community health nursing: Educator .
Health teaching, a widely recognized part of nursing practice, is legislated through nurse practice acts in several states and is one of the major functions of the community health nurse Provide people with information, knowledge, or skills that they need to make appropriate choices or decisions. e.g. provide a reliable information about the birth control methods, reliability, and side effects to teens and young adults..

Role of the community health nursing: Advocate
The issue of clients’ rights is important in health care. Every patient or client has the right to receive just, equal, and humane treatment. The role of nurse includes client advocacy, which is highlighted in the ANA’s Code for Nurses (1985) and Nursing’s Social Policy Statement (1995). Our current health care system often is characterized by fragmented and depersonalized services, and many clients—especially the poor, the disadvantaged, those without health insurance, and people with language barriers—frequently are denied their rights. They become frustrated, confused, degraded, and unable to cope with the system on their own. The community health nurse often acts as an advocate for clients, pleading their cause or acting on their behalf

. (3) Advocate The community health nurse acts a s advocate for a community or group. The nurse speaks or acts for those who may not be able to speak or act for themselves, due to (lack of knowledge, inability to articulate needs, fear, perceived lack of power, physical or mental disability). Community health nurse advocates to promote self care- peoples ability to be active participants in their own health. Support self esteem and self actualization of people.

. (3) Advocate Clients may need someone to explain which services to expect and which services they ought to receive, to make referrals as needed, and to write letters to agencies or health care providers for them. They need someone to guide them through the complexities of the system, to assure the satisfaction of their needs

(3) Advocate Advocacy Goals
Role of the community health nursing: Advocate . (3) Advocate Advocacy Goals is to help clients gain greater independence or self-determination. Until they can research the needed information and access health and social services for themselves, the community health nurse acts as an advocate for the clients by showing them what services are available, the ones to which they are entitled, and how to obtain them. is to make the system more responsive and relevant to the needs of clients. By calling attention to inadequate, inaccessible, or unjust care, community health nurses can influence change.

The advocate role incorporates four characteristic actions:
Role of the community health nursing: Advocate . (3) Advocate Advocacy Actions The advocate role incorporates four characteristic actions: being assertive, taking risks, (3) communicating and negotiating well, and (4) identifying resources and obtaining results

Role of the community health nursing: Manager .
Community health nurses, like all nurses, engage in the role of managing health services. As a manager, the nurse exercises administrative direction toward the accomplishment of specified goals by assessing clients’ needs, planning and organizing to meet those needs, directing and leading to achieve results, and controlling and evaluating the progress to ensure that goals are met

Role of the community health nursing: Manager
The nurse serves as a manager when overseeing client care as a case manager, supervising ancillary staff, managing caseloads, running clinics, or conducting community health needs assessment projects In each instance, the nurse engages in four basic functions that make up the management process. The management process, like the nursing process, incorporates a series of problem solving activities or functions: planning, organizing, leading, and controlling and evaluating. These activities are sequential and yet also occur simultaneously for managing service objectives

Role of the community health nursing: Manager.
Nurse as Planner The first function in the management process is planning. A planner sets the goals and direction for the organization or project and determines the means to achieve them. Specifically, planning includes defining goals and objectives, determining the strategy for reaching them, and designing a coordinated set of activities for implementing and evaluating them. The community health nurse engages in planning as a part of the manager role when supervising a group of home health aides working with home care clients.

Nurse as Organizer The second function of the manager role is that of organizer. This involves designing a structure within which people and tasks function to reach the desired objectives. A manager must arrange matters so that the job can be done. People, activities, and relationships have to be assembled to put the plan into effect. Organizing includes deciding the tasks to be done, who will do them, how to group the tasks, who reports to whom, and where decisions will be made

Nurse as Leader In the manager role, the community health nurse also must act as a leader. As a leader, the nurse directs, influences, or persuades others to effect change so as to positively affect people’s health and move them toward a goal. The leading function includes persuading and motivating people, directing activities, ensuring effective two-way communication, resolving conflicts, and coordinating the plan. Coordination means bringing people and activities together so that they function in harmony while pursuing desired objectives.

Nurse as Controller and Evaluator
Role of the community health nursing: Manager. Nurse as Controller and Evaluator The fourth management function is to control and evaluate projects or programs. A controller monitors the plan and ensures that it stays on course. In this function, the community health nurse must realize that plans may not proceed as intended and may need adjustments or corrections to reach the desired results or goals. Monitoring, comparing, and adjusting make up the controlling part of this function. At the same time, the nurse must compare and judge performance and outcomes against previously set goals and standards—a process that forms the evaluator aspect of this management function.

transferring of information, and
Role of the community health nursing: Manager. Management Behaviors As managers, community health nurses engage in many different types of behaviors. These behaviors or parts of the manager role were first described by Mintzberg (1973). He grouped them into three sets of behaviors: decisionmaking, transferring of information, and engaging in interpersonal relationships.

Decision-Making Behaviors
Role of the community health nursing: Manager. Decision-Making Behaviors Mintzberg identified four types of decisional roles or behaviors: entrepreneur, disturbance handler, resource allocator, and negotiator. A manager serves in the entrepreneur role when initiating new projects. Starting a nursing center to serve a homeless population is an example. Community health nurses play the disturbance-handler role when they manage disturbances and crises—particularly interpersonal conflicts among staff, between staff and clients, or among clients (especially when being served in an agency). The resource-allocator role is demonstrated by determining the distribution and use of human, physical, and financial resources. Nurses play the negotiator role when negotiating, perhaps with higher levels of administration or a funding agency, for new health policy or budget increases to support expanded services for clients..

Transfer of Information Behaviors
Role of the community health nursing: Manager Transfer of Information Behaviors Mintzberg described three informational roles or behaviors: monitor, information disseminator, and spokesperson. The monitor role requires collecting and processing information, such as gathering ongoing evaluation data to determine whether a program is meeting its goals. In the disseminator role, nurses transmit the collected information to people involved in the project or organization. In the spokesperson role, nurses share information on behalf of the project or agency with outsiders.

Interpersonal Behaviors
Role of the community health nursing: Manager Interpersonal Behaviors While engaging in various interpersonal roles, the community health nurse may function as figurehead, a leader, and a liaison. In the figurehead role, the nurse acts in a ceremonial or symbolic capacity, such as participating in a ribbon cutting ceremony to mark the opening of a new clinic or representing the project or agency for news media coverage. In the leader role, the nurse motivates and directs people involved in the project. In the liaison role, a network is maintained with people outside the organization or project for information exchange and project enhancement...

human, conceptual, and technical
Role of the community health nursing: Manager Management Skills What types of skills and competencies does the community health nurse need in the manager role? Three basic management skills are needed for successful achievement of goals: human, conceptual, and technical

Human skills refer to the ability to understand, communicate, motivate, delegate, and work well with people Example: An example is a nursing supervisor’s or team leader’s ability to gain the trust and respect of staff and promote a productive and satisfying work environment. A manager can accomplish goals only with the cooperation of others. Therefore, human skills are essential to successfully perform the manager role.

Conceptual skills refer to the mental ability to analyze and interpret abstract ideas for the purpose of understanding and diagnosing situations and formulating solutions. Examples are analyzing demographic data for program planning and developing a conceptual model to describe and improve organizational function. Finally,

technical skills refer to the ability to apply special management-related knowledge and expertise to a particular situation or problem. Such skills performed by a community health nurse might include implementing a staff development program or developing a computerized management information system.

environmentalists, city planners, and legislators. As
Role of the community health nursing: Collaborator . (5) collaborator, Community health nurses seldom practice in isolation. They must work with many people, including clients, other nurses, physicians, teachers, health educators, social workers, physical therapists, nutritionists, occupational therapists, psychologists, epidemiologists, biostaticians, attorneys, secretaries, environmentalists, city planners, and legislators. As members of the health team

Role of the community health nursing: Collaborator
Community health nurses assume the role of collaborator, which means to work jointly with others in a common endeavor, to cooperate as partners. Successful community health practice depends on this multidisciplinary collegiality and leadership. Everyone on the team has an important and unique contribution to make to the health care effort. As on a championship ball team, the better all members play their individual positions and cooperate with other members, the more likely the health team is to win.

Role of the community health nursing: Leadership Role .
Community health nurses are becoming increasingly active in the leadership role, separate from leading within the manager role mentioned earlier. The leadership role focuses on effecting change thus, the nurse becomes an agent of change. As leaders, community health nurses seek to initiate changes that positively affect people’s health. They also seek to influence people to think and behave differently about their health and the factors contributing to it.

(6) Leadership Role At the community level, the leadership role may involve working with a team of professionals to direct and coordinate such projects as a campaign to eliminate smoking in public areas or to lobby legislators for improved child day care facilities.

(7) researcher. In the researcher role, community health nurses engage in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice. But how can research be combined with practice? Although research technically involves a complex set of activities conducted by persons with highly developed and specialized skills, research also means applying that technical study to real-practice situations. Community health nurses base their practice on the evidence found in the literature to enhance and change practice as needed. For example, the work of several researchers over 15 years supports the value of intensive home visiting to high-risk families. The outcomes of this research are changing practice protocol to high-risk families in many health departments today.

Role of the community health nursing
. Consultant: Provide information, helping clients understand, and assisting in decision making and choosing actions that are most appropriate or beneficial. Help people to make their decision by providing to them information and may share them in putting alternatives.

. 5.Counselor: Help people choose the most appropriate solutions, not by deciding for them, but by strengthening and guiding peoples own decision-making skills or processes. Key tasks fro the counseling role include listening, and providing feedback and information.

Case manager: Case management involves the complex task of coordinating care in a system that is made up of many different programs, which have different policies, services, and missions. Case management can also be used to control costs associated with inefficient use, or lack of coordination, of available resources.

HEALTH NURSING PRACTICE
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE

SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE.
The previous section examined community health nursing from the perspective of its major roles. The roles now can be placed in context by viewing the settings in which they are practiced. The types of places in which community health nurses practice are increasingly varied and include a growing number of nontraditional settings and partnerships with nonhealth groups. Employers of community health nurses range from state and local health departments and home health agencies to managed care organizations, businesses and industries, and nonprofit organizations.

Homes For a long time, the most frequently used setting for community health nursing practice was the home. In the home, all of the community health nursing roles, to varying degrees, are performed. Clients who are discharged from acute care institutions, such as hospitals or mental health facilities, are regularly referred to community health nurses for continued care and follow-up. Here, the community health nurse can see clients in a family and environmental context, and service can be tailored to the clients’ unique needs.

The home also is a setting for health promotion. Many
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. The home also is a setting for health promotion. Many community health nursing visits focus on assisting families to understand and practice healthier living behaviors. Nurses may, for example, instruct clients on parenting, infant care, child discipline, diet, exercise, coping with stress, or managing grief and loss.

(2) Ambulatory service settings,
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (2) Ambulatory service settings, Ambulatory service settings include a variety of venues for community health nursing practice in which clients come for day or evening services that do not include overnight stays. Community health centers are an example of an ambulatory setting. Sometimes, multiple clinics offering comprehensive services are community based or are located in outpatient departments of hospitals or medical centers.

Community health nurses’ roles in school settings are
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (3) Schools Schools of all levels make up a major group of settings for community health nursing practice. Community health nurses’ roles in school settings are changing. School nurses, whose primary role initially was that of clinician, are widening their practice to include more health education, interprofessional collaboration, and client advocacy.

(4) occupational health settings,
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (4) occupational health settings, Business and industry provide another group of settings for community health nursing practice. Employee health has long been recognized as making a vital contribution to individual lives, productivity of business, and the well-being of the entire nation. Community health nurses in occupational health settings practice a variety of roles.

(5) residential institutions,
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (5) residential institutions, Any facility where clients reside can be a setting in which community health nursing is practiced. Residential institutions can include a halfway house in which clients live temporarily while recovering from drug addiction or an inpatient hospice program in which terminally ill clients live. A continuing care center is another example of a residential site providing health care that may use community health nursing services. Community health nurses also practice in settings where residents are gathered for purposes other than receiving care.

(6) Parishes Parish nursing finds its beginnings in an ancient tradition. The beginnings of community health nursing can be traced to religious orders (see Chapter 2), and for centuries churches, temples, mosques, and other spiritual communities were important sources of health care. In parish nursing today, the practice focal point remains the faith community and the religious belief system provided by the philosophical framework

by the church community to improve the health of its
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (6) Parishes Parish nursing may take different names. Whatever the service is called, it involves a large-scale effort by the church community to improve the health of its members through education, screening, referral, treatment, and group support.

(7) the community at large.
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE. (7) the community at large. Unlike the six settings already discussed, the seventh setting for community health nursing practice is not confined to a specific philosophy, location, or building. When working with groups, populations, or the total community, the nurse may practice in many different places.

Roles and Settings for Community Health Nursing Practice

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