Chapter 2

Foundation of community and public health nursing practice

Learning Objectives:

1. Define the key concepts of community and public health nursing

2. Enumerate the different levels of clientele in community and public health nursing

3. Explain the various principles underpinning the practice of community health nursing

4. Identify myriad roles and functions of the nurse in community and public health

nursing

5. Discuss the various public health interventions applied in practice

Key concepts of community and public health nursing

To better understand the complex nature of community and public health nursing, we

have three basic concepts: (l) the community as a client, (2) health as a goal, and (3)

nursing as the vehicle or means to achieve its aims.

Dealing with the community as a client entails a collective approach. Individuals,

families, and population groups are included. Women, children, elderly, adults form part

of our clientele. Community and Public Health work requires an understanding and

respect for culture in the hope of introducing meaningful health information and

influencing people to embrace a culture of health.

Nursing is traditionally defined as the art and science of caring. Its body of knowledge is

grounded on the works of nursing theorists or philosophers, foremost of whom is the

Mother of Modern Nursing herself, Florence Nightingale. She defined nursing as means
of ensuring that people are placed in an optimum condition where nature can contribute

to healing and wellness.

Definitions of community and public health nursing (CPHN)

Community Health Nursing is defined as a specialized field of nursing practice that

renders care to individuals, families, and communities; focusing on health promotion

and disease prevention through people empowerment. Health promotion and disease

prevention are the core of community health nursing practice. Efforts to help people

reduce their risks from developing disease and maintain their optimum functioning is a

priority in this field. Preventive measures like vaccination and screening activities for

certain diseases for early detection and prompt treatment are packaged into health

programs for communities.

Janet Heinrich and Ruth Freeman (1981) define Community Health Nursing as -an area

of human services directed toward developing and enhancing the health capabilities of

people - either singly, as individuals, or collectively, as groups and communities."

Enabling people in communities provide them the opportunity to do things on their own

to maximize wellness. This requires the utilization of health education to equip patients

with the information critical to self-care.

Characteristics and features of community and public health nursing (CPHN)

Nursing practice has changed in response, and today a growing proportion of nurses

are working outside of hospitals. Public and community health nursing practice includes

population-focused interventions that seek to improve the health and well-being of

groups, aggregates, and communities.

CPHN is developmental. People are imbued with human rights and this includes right to

health however, with rights it has responsibilities.

CPHN is multidisciplinary. Health needs of our clientele are varied. It ranges from

sanitation, food safety, control of non-communicable diseases, and infection. All of

these result from the interaction of the core determinants of health. Community and

Public Health nurses do not work in a silo and operates not on claiming that solutions

are in their hands alone. Rather the nurse fosters collaboration with different

professionals and sectors from society.

CPHN is ecology oriented. The largest portion of the healthcare delivery system is

community based and that care is provided in the natural environment of people.

CPHN promotes social justice. Health is a human right and all people should enjoy

access to healthcare. This puts the community/public health nurse in a pivotal position

to ensure that people regardless of age, sex, creed, or religion enjoy healthcare

services in their communities.

CPHN values consumer involvement. Patients in community/public health are not

merely consumers or end-users of healthcare service. They are considered as partners

in health.

CPHN uses prepayment mechanism. Services provided by public health system are not

given for free. It is funded by taxes of the people. Hence, healthcare is a basic social

service that should be provided by the state to all people.

CPHN focuses on preventive service. Nurses on the field provide healthcare to a wide

range of clientele afflicted by both acute and chronic conditions. Services required at the
point of contact does not limit his/her application of science but extends to reducing

risks of the current patient being attended to and groups who may similarly end up with

the same condition.

CPHN offers comprehensive care. The old adage that nursing is caring from womb to

tomb is a reality in community and public health.

Philosophical and ethical underpinnings

Respect for people's inherent value regardless of their background and beliefs are

edified in the universal bioethical principles. The role of nurses when engaging

communities is to foster awareness that will lead people to manage their own health.

Individual and to do this requires awareness that health truly lies in his/her own hands.

One hallmark of a profession is having its own code of ethics. This serves as a guide

among its members in dealing with clients and society. Community and Public Health

Nurses engage population groups imbued with human rights. This may open doors to

issues specifically in delivering healthcare enforced by the state.

Roles of the community and public health nurse

Professional nurses to be able to perform three roles; that of health care provider,

manager-leader, and researcher.

Healthcare Provider. Caring is the essence of nursing and has been widely accepted in

all settings. The use of the nursing process applied in the natural environment of the

client pertains to this role.

Health Educator. Communicating information to help patients make an informed choice

regarding their health is a key activity in public health work. It is hoped that awareness

will impact people's behavior to achieve health in their own hands.

Program Implementer. Nurses working under local government units deliver healthcare

to the grassroots. This also requires that programs initiated by the national government

thru the Philippine Department of Health (DOH) are executed at all levels.

Community Organizer. Working with people in communities and providing them

ownership of their healthcare needs and to act collectively on their issues is best

captured by this role of the nurse in public health.

Manager/Leader. Community and public health work deals with competing claims

specifically on utilization of limited resources.

Researcher/EpidemioIogist. The nurse is regarded as the health monitor of the

community. Together with the rural health midwife, they keep track of illnesses

encountered in their areas of jurisdiction and submits reports to health authorities as

required by law.

Client Advocate. The community/public health nurse takes a proactive stance in

ensuring that the right to health of the population

Analytic assessment skills- Identifies sources of public health data and Information,

collects, Interprets, and documents data in understandable terms

Policy development program planning- Describes the structure of the public health

system; identifies public health laws and regulations relevant to practice and

participates as a team member to implement programs and policies

Communication skills - Communicates effectively in writing, orally, and electronically;

communicates in a culturally responsive and relevant manner

Cultural competency- Adapts PHN care on the basis of cultural needs and differences

and demonstrates culturally appropriate public health nursing practice

Community dimensions of practice skills- Partners effectively with key stakeholders and

groups in care delivery, collaborates with community partners to promote health.

Participates effectively in activities that facilitate community involvement. Describes the

role of government and the private and nonprofit sectors in the delivery of health

services. Utilizes community assets and resources to promote health and deliver care.

Public health sciences - incorporates public health and nursing science in the delivery of

care

Financial planning and management skills - Describes the interrelationships among

local and national healthcare systems. Describes the structure, function, and

jurisdictional authority of organizational units within national and local public health

agencies.

Leadership and systems thinking - skills Incorporates ethical standards of practice as

the basis of all interactions Applies systems theory to PHN practice

Levels of clientele in community and public health nursing (CPHN)

Philippine Nursing Law of 2002 (RA 9173) states that a person shall be deemed to be

practicing nursing within the meaning of this Act when he/she singly or in collaboration

with another, initiates and performs nursing services to individuals, families and

communities in any health care setting. It includes, but not limited to, nursing care
during conception, labor, delivery, infancy, childhood, toddler, preschool, school age,

adolescence, adulthood and old age. As independent practitioners, nurses are primarily

responsible for the promotion of health and prevention of illness. As members of the

health team, nurses shall collaborate with other health care providers for the curative,

preventive, and rehabilitative aspects of care, restoration of health, alleviation of

suffering, and when recovery is not possible, towards a peaceful death. Community

health nurses deal with four levels of clientele in his/her practice. These include

individuals, families, groups, and communities. Community and Public Health nurses

can influence health practices and policies that will positively affect the future health of

individuals, families, groups, and communities.

Public health

Public Health is the science and the art of preventing disease. prolonging life, and

promoting physical health and efficiency through organized community efforts for the

sanitation of the environment the control of community infections, the education of the

individual in principles of personal hygiene the organization of medical and nursing

service for the early diagnosis and preventive treatment of disease, and the

development of the social machinery which will ensure to every individual in the

community a standard of living adequate for the maintenance of health; organizing

these benefits in such fashion as to enable every citizen to realize his birthright of health

and longevity. (Winslow, 1920 as cited in Kemper 2015). Public health as a science is

concerned with the knowledge and skills required of a nurse to be able to institute

interventions for the welfare of the public.

Local-level structures provide direct services to communities through two avenues:

• Community health services, which protect the public from hazards such as polluted

water and air, tainted food, and unsafe housing.

• Personal health care services, such as immunization and family planning services,

well-infant care, and sexually transmitted disease (SFD) treatment.

The purpose of public health is to improve the health of the public by promoting healthy

lifestyles, preventing disease and injury, and protecting the health of communities.

Core Public Health Functions

Assessment: Regular collection, analysis, and information sharing about health

conditions. risks, and resources in a community.

Policy development: Use of 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 and the

capacity to respond to critical situations and emergencies.

Essential Public Health Services

• Monitor health status to Identify and solve community health problems

Diagnose and Investigate health problems and health hazards in the community

Inform. educate, and empower people about health issues

• Mobilize community partnerships and actions to Identify and solve health problems

Develop policies and plans that support individual and

community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health

care when otherwise unavailable

• Assure a competent public health and personal health

care workforce

• Evaluate effectiveness, accessibility. and quality of personal and population-based

health services

• Research for new Insights and Innovative solutions to health problems

Public Health Interventions

Public health nurses focus on the care of individuals, groups, aggregates, and

populations in many settings, including homes, clinics, worksites, and schools.

The public health intervention wheel

The Public Health Intervention Model was initially proposed in the late 1990s by nurses

from the Minnesota Department of Health in the USA to describe the breadth and scope

of public health nursing practice (Keller et al., 1998).

Surveillance - Describes and monitors health events through ongoing and systematic

collection, analysts, and interpretation of health data for the purpose of planning,

implementing. and evaluating public health interventions

Disease and other health event investigation - Systematically gathers and analyzes data

regarding threats to the health of populations, source of the threat, identifies cases and

others at risk, and determines control ascertains the measures.

Outreach - Locates populations of interest or populations at risk and provides

information about the nature of the concern. what can be done about lt. and how

services can be obtained

Screening - Identifies individuals with unrecognized health risk factors or asymptomatic

disease

Conditions

Case finding - Locates individuals and families with identified risk factors and connects

them with resources

Referral and follow-up - Assists individuals, families, groups, organizations, and/or

communities to identify and access necessary resources to prevent or resolve problems

or concerns

Case management - Optimizes self-care capabilities of individuals and families and the

capacity of systems and communities to coordinate and provide services

Delegated functions - Carnes out direct care tasks under the authority of a health care

practitioner as allowed by law

Health teaching - Communicates facts, Ideas, and skills that change knowledge.

attitudes. values. beliefs, behaviors. and practices of individuals. families. systems,

and/or communities
Counseling - Establishes an interpersonal relationship with a community. a system. and

a family or individual. With the Intention of increasing or enhancing their capacity for

self-care and

Consultation - Seeks Information and generates optional solutions to perceived

problems or issues through interactive problem solving with a community system and

family or individual

Collaboration - Commits two or more persons or organizations to achieve a common

goal by enhancing the capacity of one or more of the members to promote and protect

health

Coalition building - Promotes and develops alliances among organizations or

constituents for a common purpose

Community organizing - Helps community groups to identify common problems or

goals. mobilize resources. and develop and implement strategies for realizing the goals

they collectively have set

Advocacy - Pleads someone cause or acts on someone behalf. With a focus on

developing the community, system. and individual or family capacity to plead their own

cause or act on their own behalf

Social marketing - Utilizes commercial marketing principles and technologies for

programs designed to influence the knowledge, attitudes. values. beliefs, behaviors,

and practices of the population of interest

Policy development - Places health issues on decision makers' agendas, acquires a

plan of resolution. and enforcement determines needed resources. resulting in laws,

rules. regulations. ordinances, and policies. Policy enforcement compels others to

comply with laws, rules, regulations, ordinances. and policies