Caring of community

health nursing
Learning Objectives:
 At the end of this lecture, the student will be able to:
1. Identify the definitions related to community health.
2. List characteristics of community health.
3. Explain mission of community health nursing.
4. Identify settings of community health nursing.
5. Mention component of community health nursing.
6. Identify community practice.
7. Discuss role of the community health nursing.
8. Discuss National Standards of Community Health Nursing
Practice.
Definitions:
 Community is a group of people sharing common
interest ,needs, resources, and environment.
 Public health is the science and art of preventing
disease, prolonging life and promoting health and
efficiency through organized community efforts.
 Population: is a statistical aggregate or subgroup of
people with similar or identical characteristics.
Cont…..,
 Community health it is the identification of needs, protection
and improvement of collective health within geographically
defined area.
 Community health Nursing is the synthesis of nursing and
public health practice applied to promote and protect the health
of population. It combines all the basic elements of
professional, clinical nursing with public health and community
practice.
CHARACTERICTICS OF CHN:
1. Caring relationships and partnerships with families and
communities. People in the community are seen as essential
participants in the process of promoting health and preventing
illness.
2. The community health nurse as a participants and facilitator
rather than just a dispenser of medications or information.
3. Focus on empowerment of families and communities
Empowerment means finding ways for people in a community
or population to acquire skills and knowledge so that they can
participate in decision making about their health .
4. Focus on populations or subpopulations rather than individual
based practice.
Missions of community health
nursing
 Health promotion: the World Health Organization(WHO)
defines health promotion as actions related to life styles and
choices that maintain or enhance a populations health.
 Health protection: this includes activities designed to detect
or prevent illness, or alter disease process.
Cont…,
 Health balance: this is a state of well being that results from a
healthy interaction between a persons body, mind, spirit, and
environment.
 Disease prevention: this includes activities designed to protect
people from disease and its consequences. In community
health nursing there are three levels of disease prevention:
 A. primary ( prevent a problem before it occurs).
Cont..,
B. Secondary :( diagnose and treat a condition in its earliest
stage before it has a chance to become full blown this
includes disease screening.
C. Tertiary :(prevent further progression of a disease that
has already occurred).
 Social justice: this concept states that all people have a
right to certain basics of life such as adequate income and
health protection.
 Community health nurses contribute in the
following ways to the missions of community health:

A. Help develop a system of comprehensive health care.

B. Help coordinate health care services.
C. Provide health education services.
D. Work in a variety of settings, at a variety of levels:
 Settings can include schools, health care planning agencies in

the community, neighborhood or community clinics, or senior

centers. Some community health nurses also provide home
based care to at risk populations such as pregnant teens.
Cont…,
 Levels of involvement can be person to person, person to
group, as members of health care planning boards or councils,
or in educational institutions.
 Community health nurses can also serve as elected officials or
at commissioner or other levels or other levels in order to
implement and impact community health policy.
Settings of community health nursing practice

 Settings of community health nursing practice The types of

places in which community health nurses practice are
increasingly varied including a growing number of non-
traditional settings and partnership with non-health groups.
Cont….,
 These settings can be grouped into five categories:
1-Homes.
2-Out patient department (ambulatory service settings) in
The health institutions.
3-Occupational health setting (factories, cottage industries).
4-Social institutions (schools, Prisons, Orphanages).
5-The community at large.
Component of community:
1-People.
2-Environment.
3-Systems including:
-Health -Welfare.
-Education -Economic.
-Government and leadership recreation.
-Religion.
4-Community dynamics.
5-Major sources of community data.
Community health Practice
 It is part of the larger public health effort that is
concerned with preserving and promoting the health of
specific populations and communities. Community
health practice incorporates six basic elements:
1-Promotion of health

 It includes all efforts that seek to move people closer

to optimal well-being or higher level of wellness.
 It is the combination of educational and environmental
supports for action and condition of living conducive to
health.
2-Prevention of health problems:

 Means anticipating or discovering problems as early as

possible to minimize possible disability and impairment,
through the three levels of prevention
 Cont…,

3-Treatment of disorders:
 It focuses on the illness end of continuum and is the

remedial aspects of community health practice. This is

practiced by:
a. Direct service to people with health problems;
E.g. home visit for elderly peoples, chronic illness, etc
b. Indirect service; e.g. assisting people with
health problem to obtain treatment and referral.
c. Development of program to correct unhealthy condition;
e.g. a lcoholism, drug abuse, etc.
 Cont…,

4-Rehabilitation:
 It involves efforts which seek to reduce disabilities, as
much as possible, and restore functions; e.g. stroke and rehabilitation.

5-Evaluation:
 It is the process by which the practice is analyzed,
judged, and improved according to established goals and standards.
 It helps to solve problems and provides direction for future health
care planning.
 Cont…,

6-Research:
 It is a systematic investigation which helps to
discover facts affecting community health and
community health practices, solve problems, and
explore improved methods of health services.
The role of the community health
nurse
 1. Care provider (functional role):
 In CH practice providing nursing care is different than
in hospitals. This is because the target of service
expands beyond the individual to include families,
groups, and communities.
 2. Educator:
 Health teaching is part of good nursing care and one of
the major functions of the community. Nurse being
mainly concerned with health promotion. As educators
community health nurses facilitate clients
understanding and learning facts about health and
health promotion.
 3. Manager (administrative role):
 In community health, the nurses role as a manager
includes managing family care handling a caseload,
administering a clinic, or planning a project. The
manager role also involves leading, planning,
organizing, coordinating, staffing, supervising,
motivating and controlling service activities.
 4. Leader:
 Through her role as a leader, the CH nurse stimulates

interest in health promotion, initiates therapy, and

guide in decision making.

 5. Collaborator:
 The CH nurse being a member of the health team,

assumes the role of collaborator between the different

personnel of the team. The public health includes
physicians, nurses, social workers, nutritionist, dentist ,
health educators, lab technicians.
 6. Coordinator:
 The CH nurse plays an important role in coordinating

between the different services in the community.

 7. Advocate:
 The role of the CH nurse in client advocacy is to help

the client to gain greater independence and direct the

health care system to the needs of the client by
influencing change.
 8. Researcher:
 The researcher role is an integral part of CHN practice.
It helps to identify needs, evaluate effectiveness of care
and develop theoretical basis for CHN practice.
 9. Role in evaluation:
 Evaluation is a continuous process and part of the daily

activities of the CH nurse. The CH nurse evaluate the

effectiveness of care provided to individuals, families
or groups. She also evaluates the effectiveness of the
services in health programs in special settings. She uses
available help to study and evaluate her own job
performance and plan for continuing professional
growth.
The National Standards of Community Health Nursing Practice

 All community health nurses are expected to know and use

the following standards of practice:
1. Promoting health.
a) Health promotion.
b) Prevention and health protection.
c) Health maintenance, restoration and palliation.
2. Building individual and community capacity.
3. Building relationships.
4. Facilitating access and equity.
5. Demonstrating professional responsibility and accountability.
Standard 1: Promoting health
 Community health nurses view health as a dynamic process of
physical, mental, spiritual and social well-being. Health
includes self-determination and a sense of connection to the
community. Community health nurses believe that individuals
and communities realize hopes and satisfy needs within their
cultural, social, economic and physical environments. They
consider health as a resource for everyday life that is
influenced by circumstances, beliefs and the determinants of
health. Social, economic and environmental health
determinants include:
Cont…,
1. Income and social status.
2. Social support networks.
3. Education.
4. Employment and working conditions.
5. Social environments.
6. Physical environments.
7. Biology and genetic endowment.
8. Personal health practices and coping skills.
9. Healthy child development.
10. Health services.
11. Gender.
12. Culture.
Cont…,
 Community health nurses promote health using the following
strategies:
a) Health promotion:
 Community health nurses focus on health promotion and the
health of populations. Health promotion is a mediating
strategy between people and their environments. It is a
positive, dynamic, empowering and unifying concept based in
the socio-environmental approach to health.
Cont…,
 The community health nurse:
1. Collaborates with individual, community and other stakeholders
to do a holistic assessment of assets and needs of the individual
or community.
2. Uses a variety of information sources to access data and research
findings related to health at the national, provincial, territorial,
regional and local levels.
3. Identifies and seeks to address root causes of illness and disease.
b) Prevention and health protection:
 The community health nurse applies a range of activities to minimize the occurrence
of diseases or injuries and their consequences for individuals and communities.
 The community health nurse:

1. Recognizes the differences between the levels of prevention

(primary, secondary, tertiary).
2. Selects the appropriate level of preventive intervention.
3. Helps individuals and communities make informed choices
about protective and preventive health measures such as immunization, birth control,
breastfeeding and palliative care.
4. Helps individuals, groups, families and communities to
identify potential risks to health.
5. Uses harm reduction principles to identify, reduce or remove
risk factors in a variety of contexts including the home,
neighborhood, workplace, school and street.
c) Health maintenance, restoration and palliation

 Community health nurses provide clinical nursing care, health

education and counseling to individuals, families, groups and
populations whether they are seeking to maintain their health
or dealing with acute, chronic or terminal illness. Community
health nurses practice in health centers, homes, schools and
other community-based settings.
 The community health nurse
1. Assesses the health status and functional competence of the
individual, family or population within the context of their
environmental and social supports.
2. Develops a mutually agreed upon plan and priorities for care
with the individual and family.
3. Identifies a range of interventions including health promotion,
disease prevention and direct clinical care strategies (including
palliation), along with short- and long-term goals and outcomes.
4. Maximizes the ability of an individual, family or community
to take responsibility for and manage their health needs
according to resources and personal skills available.
Standard 2: Building individual and
community capacity

1. Works collaboratively with the individual, community, other

professionals, agencies and sectors to identify needs, strengths
and available resources.
2. Facilitates action in support of the five priorities of:
 Promote social responsibility for health.

 Increase investments for health development.

 Expand partnerships for health promotion.

 Increase individual and community capacity.

 Secure an infrastructure for health promotion.

Cont..,
3.Uses community development principles.
• Engages the individual and community in a consultative
process.
• Recognizes and builds on the readiness of the group or
community to participate.
• Uses empowering strategies such as mutual goal setting,
visioning and facilitation.
• Understands group dynamics and effectively uses facilitation
skills to support group development.
Standard 3: Building relationships
1. Recognizes her or his personal beliefs, attitudes, assumptions,
feelings and values about health and their potential effect on
interventions with individuals and communities.
2. Identifies the individual and community beliefs, attitudes,
feelings and values about health and their potential effect on
the relationship and intervention.
3.Promotes and supports linkages with appropriate community
resources when the individual or community is ready to
receive them (e.g., hospice or palliative care, parenting
groups).
4. Maintains professional boundaries in often long-term
relationships in the home or other community settings
where professional and social relationships may become blurred.
 Standard 4: Facilitating access and
equity
1. Assesses and understands individual and community
capacities including norms, values, beliefs, knowledge, resources and
power structures.
2. Provides culturally sensitive care in diverse communities and
settings.
3. Supports individuals and communities in their choice to access
alternate health care options.
4. Advocates for appropriate resource allocation for individuals,
groups and populations to support access to conditions for health
and health services.
5. Refers, coordinates or facilitates access to services in
the health sector and other sectors.
Standard 5: Demonstrating professional
responsibility and accountability
1. Takes preventive or corrective action individually or in
partnership to protect individuals and communities from unsafe or
unethical circumstances.
2. Advocates for societal change in support of health for all.
3. Uses nursing informatics (including information and
communication technology) to generate, manage and process
relevant data to support nursing practice.
4. Identifies and takes action on factors which affect autonomy of
practice and quality of care.
5. Participates in the advancement of community health nursing by
mentoring students and new practitioners.
6. Participates in research and professional activities.
Reference:
 Stanhope M & Lancaster J:(2004) community health nursing, 6th
ed, U S, pp: 6- 12.
 American Nurses Association.(2010). Standards of community

health nursing practice. Washington, DC:American Nurses

Association.
 World Health Organization (WHO)

http://www.who.int
Thank You