1. Roles and Settings for Community Health Nursing Practice
Chapter 3
Roles and Settings for Community Health Nursing Practice

2. Historically, community health nurses have engaged in many roles
Historically, community health nurses have engaged in many roles. From the beginning, nurses in this professional specialty have provided care to the sick, taught positive health habits and self-care, advocated on behalf of needy populations, developed and managed health programs, provided leadership, and collaborated with other professionals and consumers to implement changes in health services.

3. The settings in which these nurses practiced varied, too
The settings in which these nurses practiced varied, too. The home certainly has been one site for practice, but so too have clinics, schools , factories, and other community-based locations. Today, the roles and settings of professional community health nursing practice have expanded even further.

4. Core Public Health Functions
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).

5. Assessment:
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 form public records, and using research findings.

6. Policy Development
Policy development, defined in Display 3-1, is enhanced by the synthesis and analysis of information obtained during assessment. Assessment is used to develop local and national policies.
Typically, the nurse recommends specific training and programs to meet identified health needs of target populations. This is accompanied by raising the awareness of key policy makers about factors such as health regulations and budget decisions that negatively affect the health of the community.

7. Assurance مراقبة
Assurance activates—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.

9. Roles of Community Health Nurses
Over time, the role of the community health nurse has broadened. Community health nurses wear many hats while conducting day-to-day practice. This is especially true for specialized roles such as that of full-time manager. This chapter examines seven major roles: (1) clinician, (2) educator, (3) advocate, (4) manager, (5) collaborator, (6) leader, and (7) researcher

10. Clinician Role
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.

11. Educator Role
A second important role of the community health nurse is that of educator or health teacher. Health teaching, a widely recognized part of nursing practice.
The educator role is especially useful in promoting the public’s health for at least two reasons. First, community clients usually are not acutely ill and can absorb and act on health information.
Second, the educator role in community health nursing is significant because a wider audience can be reached.

12. Advocate Role
The issue of client’s rights is important in health care. Every patient or client has the right to receive just, equal, and humane treatment. Our current health care system often is characterized by fragmented and 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. Clients may need someone to explain which services to expect and which services write letters to agencies or health care providers for them.

13. Manager Role
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.
The management process, like the nursing process, incorporates a series of problem solving activates or functions: planning, organizing, leading, and controlling and evaluating.

14. Collaborator Role
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, 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.

15. 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 and agent of change.

16. Researcher Role
In the researcher role, community health nurses engage in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.

17. Settings For Community Health Nursing Practice
The pervious section examined community health nursing form the perspective of its major roles, the roles now can be placed in context by viewing the settings in which they are practiced.

18. 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.
The home also is setting for health promotion. Many community health nursing visits focus on assisting families to understand and practice healthier living behaviors: child discipline, diet, exercise, coping with stress, or managing grief and loss.

19. 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.
Sometimes, multiple clinics offering comprehensive services are community based or are located in outpatient departments of hospitals or medical centers. Such as a family planning clinic or a well-child clinic.

20. Schools
Schools of all levels make up a major group of settings for community health nursing practice.

21. 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. Organizations are expected to provide a safe and healthy work environment in addition to offering insurance for health care.

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