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University of San Carlos

School of Health Care Professions


Department of Nursing-Graduate School Program
Cebu City

REFLECTION PAPER
ROLE OF NURSES IN COMMUNITY HEALTH
NURSING

Submitted by:
MA. GRACE JOYLYN L. BAJAN, RN
M.A.N STUDENT

Submitted to:
MRS. LAARNE PONTILLAS,RN, MSN, MAN
PROFESSOR

INTODUCTION

Trying to keep an entire community is a big job, but somebody has to do it. And I am one
of those persons who chose this kind of responsibility, to become a community health nurse.
Unlike traditional nurses that care only individual person during the shift, but community health
nurse take the responsibility of the entire community at a time. This could include areas from
small towns to entire countries and everything in between. Although I have a stressful job at
times with massive amount of responsibility, but mostly I find it personally rewarding as well.
Especially when I help indigent person to get better and heard complements from them.

In my 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 population, (The Role of
Public Health Nurses, 2012). In the community, I chose to be assigned in the far-flung area
which health care services is not available and accessible. I believe that because of the lower to
middle income level of this community, focus should also be on better health care accessibility to
all residents.

At times, I have encounter certain disease and other health related issues that spread
throughout an entire community. Some examples of this health issues that affect the community
include the increasing number of teenage pregnancy, substance abuse, viruses like measles and
mumps, influenza, schistosomiasis, filariasis, and tuberculosis, just to name a few. If these
community health problem are ignored, they could grow out of control and cause problem for all
member of the community.

Communities need these types of nurses for a number of reasons. Most importantly,
community health nurses working in conjunction with other healthcare professionals that can
help improve the health of a community as a whole. Community health nurses can also help
provide necessary care in communities that lack easily accessible healthcare.

AIM AND REFLECTION PLAN

The aim of this reflection paper is to express my experience as a community nurse at the
community health nursing clinical rotation and how I achieved my objective during my
community health nursing clinical activities. The experiences I gained in my participation in
community health nursing at Rural Health Unit at the Municipality of Tubod, Surigao del Norte
are particularly satisfying, especially those gained learnings while I was working with various
patients of different backgrounds. This reflection paper will include the paramount that proper
behaviour conduct and professionalism should exhibited by a community health nurse.

Providing treatment for community members is often one of the primary duties of
community health nurse. In my reflection I will emphasize how community health nurses
provide affordable care to the community member that are ill or suffering from another health
related matter.

Working as a community health nurses is an excellent way to combine a love of nursing


and a love of to your community. In this reflection I will share my job as a community health
nurse that help keep these community health problems under control and the different strategies

trying to empower the people by educating the community on and work towards preventing
common health problems.

FINDINGS

The role of the community health nurse in the participating familys community is to
focus on the health needs of the aggregate or group. Community health nursing refers to a
systematic, comprehensive focus on wellness, health protection, and disease, and injury
prevention for the population residing in a specific area. The nurse as advocate, case manager,
consultant, health care provider, educator, and collaborator with other agencies for health
outcomes of the entire community. Nurse involved in the health of specific community such as
the family participating will assess the members living in the demographic area and monitor the
environment for potential predisposing factors that may lead to illness. The conclusion of the
community assessment by the nurse directs, which types of services required to maintain the
health of the population. The nurse may determine that preventive health care will benefit the
community, (Stanhope & Lancaster, 2012). Community health nurse focus on preventing health
issues from sweeping through a community. In order to do this, these nurses will often need to
circulate through the community in question and interact directly with community members.
Prevention methods may include handling out informational fliers on certain health issues in the
community or spreading the word about common practices to avoid and prevent certain health
issues. In some cases, a community health nurse may even distribute health nurses might
distribute health related items or medications to help prevent certain health problems. For
example is the dispensing of free condo to aid in the prevention of pregnancy and sexually

transmitted disease, or administer vaccination and immunizations to help protect people against
contagious disease.
Public health nursing practice at the generalist and advanced or specialist level is
competency based. PHN core competencies include knowledge and skills derived from the core
public health workforce competencies, which were developed by the Council on Linkages (COL)
(Council on Linkages, 2010). These PHN core competencies include the three tiers of practice
used in the COL competencies, i.e., Tier 1 -- the PHN generalist; Tier 2 -- the PHN specialist or
manager; and, Tier 3 -- the PHN organization leader or executive level administrator (Quad
Council, 2011). These core competencies are necessary to implement community participatory
health promoting roles. In addition, it is essential to emphasize collaboration and partnerships
with communities and populations as contemporary PHN roles evolve in the context of Healthy
People 2020 (DHHS, 2010), the Patient Protection Affordable Care Act (ACA) (U.S. House of
Representatives, 2010), and the National Prevention, Health Promotion, and Public Health
Council (Executive Order 13544, 2010). These national initiatives provide new opportunities for
emerging roles in PHN focused on community health promotion and prevention practices.
Coordination is an important element of effective nursing management. Relationships
between professionals are known to be important for coordinating work based on the argument
that coordination is the management of task interdependence and therefore fundamentally a
relational process (Gittell et al. 2010). One of these relational perspectives relational
coordination identifies specific dimensions of relationships that are integral to effective nursing
management through coordination of care delivery. Relational coordination is a type of
relationship that is particularly relevant for coordinating work that is highly interdependent,
uncertain and time-constrained, such as providing comprehensive care to community-dwelling

frail people. This study supports this notion and clearly shows that comprehensive care delivery
to community-dwelling frail people requires strong relational connections between all health and
social care professionals. Rather than focusing primarily on knowledge and skills or on
commitment to their own organisation, effective nursing management requires strengthening of
relationships between primary care professionals from various disciplines by focusing on
frequent, high-quality communication supported by relationships of shared goals, shared
knowledge and mutual respect between them.
Moreover, it is proper the self-image that convey is pleasant to the eyes of everybody that
will affect the trust and respect of the people in the community. One should also guarantee
confidentiality of client information in order to promote mutual trust and respect between one
and the client. Appearance of the health nurse is also important and I ensured that I was always
appropriate and formally dressed in accordance with the dress code. Punctuality ad completion of
assignment within schedule was also important for me and I always made sure that I achieved
both at all times.
As this study showed that community health nurses may be an important factor in
strengthening these connections, community health nurses should not only be selected for their
functional competence but also for their relational competence (Gittell et al. 2008). They could
act as cross-functional boundary spanners to foster relational coordination (Gittell et al. 2010).
Relational competence refers to the ability to see the larger process and the manner in which
each individuals work connects to the work of others (Cramm & Nieboer 2011). The ability to
perceive others perspectives, empathize with their situations and respect their work is
imperative. Relational competent community health nurses may therefore also act as cross
functional conflict mediators to enhance relational coordination among professionals involved in

delivery to frail people in the community (Gittell et al. 2010). In addition, stimulating crossfunctional interactions, facilitating cross-functional meetings, use of cross functional
performance measurement and conferring cross-functional rewards to health and social care
professionals who do not normally interact much may further enhance relational coordination
(Gittell et al. 2010, Jordan et al. 2009) and improve care delivery to frail people in the
community.
Public health nurses are able to gain these skills by creating collaborative partnerships
with community leaders and stakeholders and identifying resources and solutions to problems
through the CBPR method (Fletcher et al., 2011; Hassouneh et al., 2011; Marcus et al., 2004).
These skills are enhanced by empowering community members to address their communitys
health issues and increasing individual and community self-efficacy for health promotion
throughout the CBPR process (Andrews et al., 2007; Marcus et al., 2004). Ultimately, PHNs can
develop these skills by building community capacity and engaging community members and
partners to design more effective, sustainable health-promoting programs.
Again, there are examples of research that used a community participatory approach to
foster these community practice skills. Andrews et al. (2007) illustrated community dimensions
of practice skills when partnering with community stakeholders to develop multiple levels of
interventions using an ecological framework that enhanced sustainability. In another study, PHNs
built partnerships with community stakeholders (Hassouneh et al., 2011) to increase trust and to
better utilize community resources in applying interventions such as training. As shown in these
examples, public health nurses can use CBPR to enhance partnerships and empower community
members as participants by including them in the decision-making processes of assessment and
program planning (Andrews et al., 2007; Hassouneh et al., 2011; Perry & Hoffaman, 2010).

PHNs in Ireland indicate that more resources are needed for them to carry out health
promotion initiatives and
suggest a

fulfil the vision of primary care. The findings of this study also

more efficient electronic database may improve communication among PCT

members and between primary and secondary services. However, full attendance at PCT
meetings is needed along with teambuilding exercises and socialising to build relationships and
team functioning. The next step is to test whether changes to policy would improve patient
outcomes using prospective interventional methods, such as a cluster randomised control trial.
This type of methodology would be ideal as it would allow comparisons to be made between
patient outcomes of those attached to PCTs and an intervention group in which PHNs have a
capped caseload number, thus allowing more time to carry-out health promotion activities.
Finally, if the PHN role is to change to a specialised one, PHNs may need appropriate
up-skilling and education.
As the roles of public health nurses as advocates, collaborators, educators, partners,
policy-makers, and researchers evolve in the area of community health promotion and
prevention, greater emphasis on community participatory and ethnographic approaches in PHN
education will provide benefits to students at the generalist and advanced practice levels (Zandee
et al., 2010). Moreover, basic and advanced public health nursing practice roles, which
emphasize inter-professional collaboration, community participatory strategies, and the
importance of local knowledge to address community health problems, will continue to
contribute to improved community and population health outcomes.
CONCLUSION AND RECOMMENDATION

The purpose of Community Health Nurse is to provide community health promotion


services in a designated region in accordance with the philosophy and objectives of the Authority
and to promote the prevention of disease, maintenance of health and the overall health and wellbeing of the community.
The important skills that a community health nurse must poses is they can demonstrate
analytical assessment, cultural competence, program planning, and community dimensions of
practice are critical for pursuing community health promotion goals as public health nurses
become more widely involved in community participatory approaches. Other important
competencies for the health promotion role are required for public health nurses, including
communication; financial planning and management leadership and systems thinking; policy
development and public health science. Public health nurses can further develop these skills by
continuing to engage in community participatory practices. For example, PHN practice utilizes
public health science knowledge, competencies, and skills by partnering with public health
educators and researchers to develop evidence-based prevention interventions programs and thus
contribute to nursing science. Community initiatives by PHNs can contribute to the development
of policies based on in-depth evidence, assist community health advocates, and lead to improved
long term outcomes.
REFERENCES
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Henry, L. (2015). Physician Assistants, Nurse Practitioners, and Community Health Centers
under the Affordable Care Act. Human Organization, 74(1), 42-51.
Mabhala, M. A. (2015). Public health nurse educators' conceptualisation of public health as a
strategy to reduce health inequalities: a qualitative study. International Journal For Equity
In Health, 14(1), 1-11. doi:10.1186/s12939-015-0146-2