Community Health Nursing Concepts

A. Definition
Community: A group of people who share common interests, who interact with
each other, and who function collectively within a defined social structure to
address common concerns.

Health: Is state of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity (WHO).

Nursing: encompasses autonomous and collaborative care of individuals of all ages,

families, groups and communities, sick or well and in all setting. Nursing
includes the promotion of health, prevention of illness, and the care of ill, disabled, and
dyingpeople. Advocacy, promotion of a safe environment, research, participation in
shaping health policy and in patient and health systems management, and
education are also key nursing roles (ICN, 2002).

Community Health Nursing

Special field of nursing that combines the skills of nursing,
public health and some phases of social assistance and functions as part of the
total public health program for the promotion of health, the improvement of the
conditions in the social and physical environment, rehabilitation of illness and
disability (WHO Expert Committee of Nursing)
Community health nursing is a synthesis of nursing practice and public health
practice applied in promoting and preserving the health of populations. the nature of
this practice is general and comprehensive. it is not limited to a particular age or
diagnostic group. It is continuous and not episodic. The dominant responsibility
is to the population as a whole (American Nurses Association)

B. Philosophy and Principles

1. Recognized needs and functioning within the total health programme.
2. Clearly defined objectives and purposes
3. An active organized citizens group of the community group is an integral part of
the community health programme.
4. Community health nursing services are available to the entire community
5. Community health nursing recognized the family and community as units of
service.
6. Health education and counseling for the individual, family and community are
the integral part of community health nursing.
7. Participation in planning relating to goals for the attainment of health.
8. The community health nurse should qualify as a full-fledged nurse.
 9. Based on the needs of the patient and there should be proper continuity of
services to patients
10. Periodic and continuous appraisal and evaluation of health situation
11. The community health nurse should function/serve as an important member of
the health team.
12. There should be provision for qualified nurse to make supervision for
community health services.
13. The community health nurse directs the patient to appropriate community
resources for necessary financial and social assistance.
14. The community health nurse should not belong to one
15. particular section or political group.
16. Community health agency should provide a continuing education programme
for nurse
17. The nurses assume responsibilities of their own continuing professional
development through acquiring higher and higher education and forming and
strengthening the professional associations
18. The community health nursing services should develop proper guidelines, in
maintaining records and reports.
19. There should be proper facilities and job conditions.
20. The community health nurse should maintain professional relationship with all
leaders in the community and maintain ethics at all times.
21. Should not accept gifts or bribes from the patients

C. Features of CHN
a) Home visiting.
b) Running child welfare clinic.
c) Running family planning clinic or assisting.
d) Assist in running ANC and PNC. (Antenatal clinic, Postnatal clinics)
e) Conducts school health services.
f) Carries out or assist the PHN (Public health nurse) in inspection of day care
centers.
g) Collection of information or data from community.
h) Health education.
i) Record keeping.

The primary mission of community health nursing is improving the overall health of
the population through health promotion, illness prevention, and protection of the
public from a wide variety of biological, behavioural, social and environmental threats.
"promote the good life” in all of its physical, social, psychological, cultural, and
economic aspects’
 Concept of Health
Health: holistic state of well-being, including soundness of mind, body, and spirit
Wellness: health plus the capacity to develop potential, leading to a fulfilling
and productive life
Illness: state of being relatively unhealthy

COMPONENT OF COMMUINTY HEALTH PRACTICE

› Community health practice can be best understood by examining six basic
components, which, when combined, encompass its services and programs. These
components are:
1. Promotion of health
Includes all efforts that seek to move people closer to optimal well-being or
higher levels of wellness. The goal of health promotion is to enable people to
exercise control over their well-being and ultimately improve their health. Is to
raise levels of wellness for individuals, families, populations, and communities.
2. Prevention of health problems
Prevention of health problems constitutes a major part of community health practice.
Prevention means: Anticipating and averting problems or discovering them as early as
possible to minimize potential disability and impairment.
Three Levels of prevention:
1. Primary prevention: Action taken prior to the occurrence of health problems and
directed toward avoiding their occurrence. Primary prevention includes health
promotion, health protection, and illness prevention.
2. Secondary prevention: The early identification and treatment of existing health
problems.
3. Tertiary prevention: Activity aimed at returning the client to the highest level of
function and preventing further deterioration in health.
3. Treatment of disorders: It focuses on the illness end of the continuum and is the
remedial aspect of community health practice.
This occurs by three methods:
a) Direct service to people with health problem.
b) Indirect service that helps people to obtain treatment.
c) Development programs to correct unhealthy conditions.
4. Rehabilitation: The fourth component of community health practice, involves efforts to
reduce disability and as much as possible, restore function. People whose handicaps
are congenital or acquired through illness or accident e.g: Stroke, Heart condition,
Amputation, Mental illness
5. Evaluation: The process by which that practices were analyzed, judged, and
improved according to established goals and standards.
6. Research: Is systematic investigation to discover facts affecting community health
and community health practice, solve problems an explore improved methods of
health services
Scope of Community Health Nursing
includes health promotion, illness prevention and restoration of health of individuals,
families and communities. The scope of nursing is wide; there is still a much wider
scope for a nurse. Nurse can work in different place, such as home care, nursing home,
school health center, old age home, industries.
Home Care: Nursing care services are received by number of patient at their home
when hospital was overcrowded for admitting the patients who require indoor care or
when a patient is in need of isolated treatment.
School Health Nursing:
The nurse can work as SHN in school.
The SHN renders/provide services.
1. To prevent diseases.
2. To promote and maintain good health of the school children’s
The school health programmers are carried out by PHC.
The nurse provides her services in the areas likes – health, education,
- early diagnosis of disease
- immunization
- dental health
- Health records of students

Occupational Health Nursing

Occupational health services, provided at the workplace to address the health care
needs of working populations have been identified as an important component of the
public health strategy. These services can also make a significant contribution to other
government initiatives, such as; reducing health inequalities, reducing social exclusion
and sickness absence, and by protecting and promoting the health of the working
population occupational health services can help to reduce the overall burden of ill
health.

Rehabilitation
means restoration of all treated cases to the highest level of functional ability. Nursing is
an important component in the rehabilitation of the disabled.
Community Health Nursing Roles:
 Client-oriented roles-
A. Client-oriented Roles
a) Caregiver - Uses the nursing process to provide direct nursing intervention to
individuals, families, or population groups
b) Educator - facilitates learning for positive health behavior change
c) Counselor - teaches and assists clients in the use of the problem solving
process
d) Referral Resource - links clients to services to meet identified health needs
e) Role Model - demonstrates desired health-related behaviors
f) Advocate - speaks or acts on behalf of clients who cannot do so for
themselves
g) Primary Care Provider - provides essential health services to promote health,
prevent illness, and deal with existing health problems
h) Case Manager - coordinates and directs the selection and use of healthcare
services to meet client needs, maximize resource utilization, and minimize the
expense of care

 Delivery-oriented roles
a) Coordinator/Care Manager - organizes and integrates services to best
meet client needs in the most efficient manner possible
b) Collaborator- engages in shared decision making
regarding the nature of health problems and potential solutions to
them
c) Liaison - provides and maintains connections and communication
between clients and health care providers or among providers

 Population-oriented roles
 a) Case Finder - identifies clients with specific health problems or conditions
geared toward awareness of population-level problems
b) Leader - influences clients and others to take action regarding identified
health problems
c) Change Agent - initiates and facilitates change in individual or client
behaviors or conditions or those affecting population groups
d) Community Developer - mobilizes residents and other segments of the
population to take action regarding identified community health problems
or issues
e) Coalition Builder - promotes the development and maintenance of
alliances of individuals or groups of people to address a specific health
issue
f) Researcher – conducts studies to explain health- related phenomena and
to evaluate the effectiveness of interventions to control them.

COMMUNITY HEALTH NURSING THEORIES

● Systems thinking studies how an individual, or unit, interacts with other organizations
or systems. Systems thinking is useful in examining cause and effect relationships.
● Upstream thinking is used to focus on interventions that promote health or prevent
illness, as opposed to medical treatment models that focus on care after an individual
becomes ill.

Nursing theory provides the basis for care of the community and family. Theorists have
developed sound principles to guide nurses in providing high-quality care. Examples of
nursing theories appropriate for community health include the following.
Nightingale’s Environmental Theory
● Highlights the relationship between an individual’s environment and health.
● Depicts health as a continuum.
● Emphasizes preventive care.
Health Belief Model
● Purpose is to predict or explain health behaviors.
● Assumes that preventive health behaviors are taken primarily for the purpose of
avoiding disease.
● Emphasizes change at the individual level.
● Describes the likelihood of taking an action to avoid disease based on the following.
  Perceived susceptibility, seriousness, and threat of a disease
 Modifying factors (e.g., demographics, knowledge level)
 Cues to action (e.g., media campaigns, disease effect on family/friends,
recommendations from health care professionals)
 Perceived benefits minus perceived barriers to taking action
Milio’s framework for prevention
● Complements the health belief model.
● Emphasizes change at the community level.
● Identifies relationship between health deficits and availability of health-promoting
resources.
● Theorizes that behavior changes within a large number of people can ultimately lead
to social change.
Pender’s Health Promotion Model
● Similar to Health Belief Model.
● Does not consider health risk as a factor that provokes change.
● Examines factors that affect individual actions to promote and protect health.
 Personal factors (biological, psychological, sociocultural), behaviors, abilities,
self-efficacy
 Feelings, benefits, barriers, and characteristics associated with the action
 Attitudes of others, and competing demands and preferences
Lawrence Green’s PRECEDE-PROCEED MODEL
The Precede-Proceed framework for planning is created on the disciplines of
epidemiology; the social, behavioral, and educational sciences; and health
administration.
Two fundamental propositions are emphasized:
(1) health and health risks are caused by multiple factors and
(2) because health and health risks are determined by multiple factors, efforts to effect
behavioral, environmental, and social change must be multidimensional or multisectoral,
and participatory. http://www.lgreen.net/precede.htm