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Families and Community/

Public Health Nursing

Ns. Setyoadi, M.Kep., Sp.Kep.Kom.


Families have a major impact on the health of

individuals; that impact can be positive or
For example, families are assumed to provide
social support, which is both health-promoting
and restoring for their members

The health of families is important to every

communitys well-being. In fact, the health of
communities is measured by the collective
health of its individuals and families
Violence, poverty, employment rates, and
home lessness are indicators of the
communitys and familys health.
The character of the community and its ability
to deal with health issues inuences the wellbeing of all who live there.

What is community/public
health nursing?

The community may be an aggregate of

people with similar characteristics, such as all
people infected with HIV, those diagnosed
with juvenile-onset diabetes, or homeless
The practice of community and public health
nursing encompasses both caring for the
community as a whole and caring for
individuals and families within the community.

Traditional Community
Health Nursing Roles

(1) client-oriented,
(2) delivery-oriented, and
(3) group-oriented.

Client-oriented roles are directed toward providing

services to clients and include the roles of caregiver,
educator, counselor, referral source, role model,
advocate, primary care provider, and case manager.
Delivery-oriented roles are directed toward
facilitating the operation of the health care delivery
system and indi-rectly enhance the care of clients.
These roles include those of coordinator,
collaborator, liaison, and dis-charge planner. Lastly,
Group-oriented roles are directed toward promoting
the health of the popula-tion of a community and
include the roles of case nder, leader, change
agent, community care agent, and researcher.

Client-oriented and delivery-oriented roles are

used most frequently when providing care to
individuals, families, and groups in community
settings, whereas group-oriented roles are
used when care is directed toward the

Common theoretical perspective

Family Caregiving Model for Public Health

Core Public Health Function Model

Family Caregiving Model for Public Health


This model was created on the basis of

descriptions by expert community health
nurses of home visiting activities that made a
difference in the outcomes for maternal-child
From these descriptions, 16 competencies
were identied and a model of their
relationships was developed
The focus of this model is the family and
developing the ability of members to take
charge of their lives and make their own

The rst three competencies establish the

founda-tion for family caregiving: (1) locating
the family, (2) building trust, and (3) building
After this foundation is laid, eight encouraging
self-help competencies are employed when
working with families:1. Being available 2.
Mobilizing resources 3. Collaborating with
other professionals 4. Resolving problems 5.
Resolving crises 6. Working through emotions
7. Fostering family understanding 8. Teaching
9. Persuading

Three of these competencies help to foster

community: being available, mobilizing
resources, and collaborating with other
professionals. Thus, the model acknowledges
that the community is the context for family

Core Public Health Function Model

The Core Public Health Function Model

addresses assessment, policy development,
and assurance as the three primary functions
of public health

Policy Development

Public health nurses are uniquely qualied to inuence and develop policy at the individual, family,
andcommunity level.
Public health nurses synthesize and analyze data
collected from individuals, families, and
communities in making policy decisions


Assurance activities are the direct individualfocused services that public health nurses have
provided over the past several years.
This was due, in large part, to programmatic
funding and Medicaid reimbursement that focused
on the individual rather than on populationfocused services.

Health Promotion And

Disease Prevention

Several concepts basic to community/public

health nursing have set the direction for care
provided to individuals, families, groups, and
Health promotion, disease prevention, primary
prevention, secondary prevention, tertiary
prevention, epidemiology, risk, and case
nding will be dened, and examples from the
Healthy People 2000 and Healthy People

Health Promotion and Disease

Prevention Dened

Health promotion includes activities that

improve or maintain the well-being of people
Teaching families conict resolution skills is an
example of a health promotion activity.
Disease prevention includes those activities
that protect families from actual or potential
diseases and disabilities and their

Primary Prevention

Primary prevention focuses on preventing the

occur-rence of health problems. The four
leading causes of death for adolescents and
young adults aged 15 to 24 are motor vehicle
accidents, other unintended injuries,
homicide, and suicide.

Secondary Prevention

Secondary prevention activities are designed

to identify and treat health problems early.
Secondary pre-vention activities are carried
out during the early stage of an acute or
chronic illness.
Exp family: violence against women or partner

Tertiary Prevention

Tertiary prevention is aimed at correcting

health problems and preventing further
deterioration. It is used with both acute and
chronic health problems.
Tertiary prevention focused on rebuilding the
community, dealing with the grief and fears of
individuals, families, and the entire
community, and developing community
prevention strategies to help prevent such a


Community health nurses use concepts from

epidemiology to promote health and prevent
Epidemiology is a science that is concerned with
health events in human populations
An important epidemiological concept is risk, which
refers to the probability that individuals in a
community will be affected by a health problem.
Community health nurses assist in identifying
individuals, families, and populations at risk for
health problems by using case nding methods,
such as review of health statistics, screening
programs, and contact tracing

Strategies for Health Promotion and Disease

Prevention for Families in the Community

Many health promotion and disease

prevention strate-gies are directed at both
families and communities.
Five categories of health promotion and
disease prevention strategies: (1) health
appraisal, (2) health education, (3) lifestyle
modication, (4) provision of a healthy
environment, and (5) development of effective
coping skills.

Health Appraisal

An initial health promoting and disease-preventing

strategy is to conduct a health appraisal of families
and their environments for the purpose of
identifying strengths and potential risks to health.
If possible, the community health nurses make
home visits to directly observe the environment
and develop appropriate interventions based on
the availability of resources in that home
The community health nurse who works in a school
or occupational setting also directly appraises the
effects of these environments.

An environmental appraisal includes assessment

of physical, psychological, social, and economic
Assessment of the physical environment of the
home includes examination of safety hazards,
such as condition of paint, age of housing, re
extinguishers, and dangerous playground
equipment; facilities for hygiene, such as running
water and indoor plumbing; items to meet basic
needs, such as food, heating, cooking facilities,
and refrigeration; and objects that promote social,
emotional, and physical development, such as
toys and books.

The community health nurse appraises the

familys psychological, social, and economic
In the home, family communication patterns,
role relationships, family dynamics, emotional
strengths, copingstrategies, and childrearing
and discipline practices can be assessed
In settings other than the home, factors that
promote the psychological and social growth of
individual family members should be


Education is essential to the promotion of

health and the prevention of disease in
After completing the health appraisal, the
community health nurse reinforces health
promotion and provides health information
and teaching in areas identied as at risk.

Teaching and health information can be used

to discuss immunizations, nutrition, rest,
exercise, use of seat belts, and abuse of
harmful substances such as alcohol and
The community health nurse may refer the
family to programs and resources that assist
in lifestyle modications (e.g., smoking
cessation classes, exercise programs).

Health teaching based on appraisal of the

physical environment might include
information on child safety and prevention of
Other teaching might focus on psychological
or social environmental problems, such as
family communications or dealing with peer

Access to Resources

A major health promotion strategy is ensuring

access to health promotion and prevention
services, including immunizations, family
planning, prenatal care, well-child care,
nutrition, exercise classes, and dental
In some cases, the community health nurse
facilitates access to these services through
referrals, case management, discharge
planning, advocacy, coordination, and

Community as Client and Nursing

Care of Families

One strategy for promoting the health of

families when the community is client is to
conduct a community assessment or health
appraisal of a community to identify potential
and actual health risks to all individuals and
families living in the community.
After potential health risks are identied, the
community health nurse intervenes to temper
these risk factors.

A community assessment involves collecting

health and social data about the population,
the social institutions (e.g., health and social
services, economics, education, safety and
transportation, recreation, politics and
government, and communication), and the
environment (physical, psychological, and

Methods of gathering data for a community

assess-ment include windshield surveys,
interviews with key informants, analysis of
secondary data gathered by health
departments such as morbidity and mortality
rates, and large population surveys.

A windshield survey is the motorized

equivalent of simple observation. Through an
automobile windshield, many dimensions of a
communitys life and environment are
carefully observed
Via this method, data can be collected about
families in the community for example, the
proportion of single parent families or the
number of da care facilities.

Once data has been collected, it is analyzed to

iden-tify the communitys health problems,
that is, to make community diagnoses.
After community diagnoses are made,
researchers develop goals to correct the
problems and develop program plans to

Program planning includes the following:

Identication of potential solutions to the
Analysis and comparison of alternative solutions
Selection of one program and/or solution
Development of program goals and objectives
Identication of resources
Development of the specic activities of the
Development of methods to evaluate the

Usually program planning involves

multidisciplinary teams of health and nonhealth professionals.
The community and its families also should be
involved in the planning and implementation
to ensure that the program meets their needs.
Awareness of the need to design community
health programs with a family-centered
approach has grown over the past 20 years.

Community health nurses can facilitate

development of health programs that are
supportive to families by using these elements
to guide program planning and

Another strategy for promoting health and

prevent-ing disease from a community-asclient perspective is policy development and
Community health nurses frequently interact
in local and state policy by alerting policy
makers about the health problems in their
Nurses give direct accounts of the effects
these health problems have on families in the

They write letters, make telephone calls,

testify before committees, and take part in
other political activities to create awareness of
the health problem.
Nurses sit on advisory boards and task forces
at all levels: community, city, county, state,
and national. In these positions, nurses
directly inuence policy to promote health and
prevent disease.

The community health nurses perspective on

a proposed policys effect on families is
important to the development of health
Community health nurses have a role in the
implementation of these policies to ensure
optimum results for family health.

Implications Of Community/
Public Health Nursing


family-centered care


Nursing education needs to emphasize the interplay

between the health of the community and the health
of families.
Undergraduate students who learn communityfocused interventions can promote the health of
Graduate students specializing in family and
community health nursing study the theoretical
perspectives of community-focused and familyfocused interventions.


Research is needed to identify common family

health problems in the community, resources to
meet family needs, and effective organization of
services to promote family health and coping.
Research is also needed to determine which intervention strategies are most effective in promoting
family health and preventing family illness.

Health Care Policy

Policy-level barriers to providing family-centered

care in the community include the current
organization of health services and reimbursement
for health care.
Health services in the community frequently are
not family-focused but are arranged according to
specic health problems
Reimbursement for health care is designed to
promote an individual focus.