Introduction to

Community Health
Nursing
Community Health Nursing-I

Imran Waheed/ Zafar Iqbal

Lecturers
(INS-
KMU)
7/28/2021
Education 1
al Platform
 Objectives
At the end of this session students will be able to:
• Define the terms:
• a) Community
• b) Community health, and
• c) Community health nursing
• d) Urban & rural communities
• Discuss the historical background of Community
Health Nursing from Public Health Nursing.
• Describe the philosophy of Community Health Nursing.
• Discuss the concepts of health, wellness, illness and
disease.
• Discuss the roles of the Community Health Nurse in
community settings.
Education
7/28/2021 2
al Platform
 Terminologies
Community:
• Traditionally, a community has been thought of as a
geographic area with specific boundaries— for example, a
neighborhood, city, country, or state.
• Derived from a latin word “comunicas” which means a
group of people.

 However, in the context of community health, a

community is:
• “A group of people who have common
characteristics; communities can be defined by
location, race, ethnicity, age, occupation, interest in
particular problems or outcomes, or common bonds.”

Education 3
al Platform
 Conti…
• 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.

Education 4
al Platform
 Conti…
• Communities are characterized by the following
elements:

 (1) Membership—a sense of identity and belonging

 (2) Common symbol systems—similar language, rituals, and
ceremonies
 (3) Shared values and norms
 (4) Mutual influence—community members have influence
and are influenced by each other
 (5) Shared needs and commitment to meeting them
 (6) Shared emotional connection—members share
common history,experiences,and mutual support

Education 5
al Platform
 Conti…
Community Health:
• Community health refers to the health status of a
defined group of people and the actions and
conditions, both private and public (governmental),
to promote, protect, and preserve their health.
 For example, the health status of the people of
Hazara, Kalash, Parsis, and the private and
public actions taken to promote, protect, and
preserve the health of these people, would
constitute community health.

Education 6
al Platform
 Conti…
• 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 )
Education 7
al Platform
 Conti…
• “The utilization of the nursing process in the
different levels of clientele-individuals,
families, population groups and
communities, concerned with the promotion
of health, prevention of disease and
disability and rehabilitation.” ( Maglaya, et
al)

Education 8
al Platform
 Types of Communities

Urban Suburban Rural

There are special characteristics for each type

Education 9
al Platform
 Conti…
• Urban Areas :
 Urban areas refers to areas of high population
that is both for living and working purposes.
• These communities do have political
autonomy and are typically a hub in their
area where all resources are available for the
outlying rural and suburban areas.

Education 10
al Platform
Urban Community Tall
( Cities) Buildings

Bus

taxi
• Many people living close
together
• Small amount of space Walk

• Not very much open Train

space or natural areas

7/28/2021
Education 11
al Platform
 Conti…
• Rural Areas:
Rural areas are referred to as open and
spread out country where there is a small
population.
This is countryside where farming and
natural resources are predominantly used
for family income. These people travel to
cities for medical care and any other basic
living needs.

Education
al Platform
Rural Community

• Fewer people
• A few buildings spread out over large distances
• Lots of open space and natural areas - Must drive
because it is
too far to walk

- Roads are not

paved, so people
need special
vehicles, like pick-
up trucks

special types
of vehicles
(tractors)
Farms have
Education
al Platform
 Conti…
• Suburban Areas :
• Suburban areas are references to areas where
there are residences. These areas have a larger
population than a rural area; however, they
are small and typically outlying from a larger
city.
• Suburban areas are also known as “burbs” for
short. And if they are their own city, they are
limited on resources and have little political
autonomy and representation.
Education
al Platform
Suburban Community
• Close to, but not in, cities Usually
• Fewer People drive
• Live in Houses or small apartment
buildings not skyscraper
• many people have yards
• many natural areas.

Sometime walk or take the bus

Use the train to get to

the city
7/28/2021
Education 1
al Platform 5
 Access Anywhere

Suburban

7/28/2021 Imran Waheed 16

 Historical Background of
Community Health
Nursing
Four stages of community health development:

• Early Home Care (before Mid-1800s)

• District Nursing (Mid-1800s to 1900)

• Public Health Nursing (1900 – 1970)

• Community Health Nursing (1970 – present)

Education
7/28/2021 Imran Waheed 17
al Platform
 Early Home Care
Stage (Before Mid
• 1800s)
For many centuries female family members and
friends attended the sick at home. The focus of
this care was to reduce suffering and promote
healing (Kalish and Kalish, 1986).
• The early roots of home care nursing began with
religious and charitable groups.
• This stage was in the midst of these deplorable
conditions and response to them that
Florence Nightingale (1820 - 1910) began her
work.
Education
al Platform
 Conti…
• Much of the foundation for modern
community health nursing practice was
laid through Florence Nightingale's
remarkable accomplishments.
• Nightingale’s concern for population at risk as
well as her vision and successful efforts at
health reform provided a model for
community health nursing today.

Education
al Platform
 District Nursing (Mid 1800s
to 1900)
• The next stage in the development of
community health nursing was the formal
organization of visiting nursing (Phoebe,
58AD) or district nursing.
• Although district nurses primarily care for
the sick, they also thought cleanliness and
wholesome living to their patients, even in
that early period.

Education
al Platform
 Conti…
• Nightingale referred to them as “health
nurse”.
• This early emphasis on prevention and
health nursing became one of the
distinguishing features of district nursing
and later of public health nursing as a
specialty.

Education
al Platform
Problems of District Nursing:
• Increased number of immigrants
• Increased crowded city slums
• Inadequate sanitation practices
• Unsafe and unhealthy working conditions
• Nevertheless, nursing educational programs
at that time did not truly prepare district
nurses to cope with their patients, multiple
health, and social problems.
Education
al Platform
 Public Health Nursing
Training (1900-1970)
• By the turn of the century, district nursing had
broadened its focus to include the health
and welfare of the general public, not just
the poor.
• Lillian D. Wald’s (1867-1940) contributions to
public health nursing were enormous.
• Her driving commitment was to serve
needy populations.

Education
al Platform
 Conti…
• Wald’s emphasis on illness prevention and
health promotion through health teaching and
nursing intervention as well as her use of
epidemiological methodology established
these actions as hallmarks of public health
nursing practice .

Education
al Platform
Community Health Nursing (1970
to present)

⚫The emergence of the term community health

nursing heralded a new era while public health
nurses continued their work in public health by
the late 1960s and early 1970s.
⚫Many other nurses, not necessarily practicing
public health, were based in the community.

Education
al Platform
 Conti…
• Their practice settings included community
based clinics, doctor’s office, work sites,
schools, etc, to provide a label that
encompassed all nurses in the community.
• The confusion was laid in distinguishing
between public health nursing and
community health nursing.

Education
al Platform
 Conti…
• The terms were being used interchangeably and
yet, had different meanings for many in the field
in 1984 the division of nursing convened a
consensus conference on the essentials of Public
Health Nursing practice and education in
Washington DC (1985).
• This group concluded that community health
nursing was the broader term referring to all
nurses practicing in the community regardless of
their educational preparation.

Education
al Platform
 Conti…
• Public health nursing, viewed as a part of
community health nursing, was described as
generalist practice for nurses prepared with basic
public health content at the baccalaureate level
and a specialized practice for nurses prepared in
the public health at the master's level or beyond.
• The debate over these areas of confusion
continued through the 1980’s with some issues
unresolved even today.

Education
al Platform
 Conti…
• Public health nursing continues to mean the
synthesis of nursing and public health
sciences applied to promoting and protecting
the health of populations.
• Community health nursing is used
synonymously with public health nursing and
refers to specialized population focused
nursing practice, which applies public health
sciences as well as nursing services.

Education
al Platform
 Conti…
• A possible distraction between the two terms
might be to view community health nursing as a
beginning level of specialization and public health
nursing as advanced level.
• Which ever, term is used to describe this
specialty, the fundamental issues and defining
criteria remain as:
 Are the populations and communities the target
of practice?
 Are the nurses prepared in public health
and engaging in public health practice?

Education
al Platform
Summary of Development of
Community Health Nursing

Early homecare stage District nursing (mid 1800s

(before mid to 1900)
1800s) • Focus: sick, poor
• Focus: sick, poor • Nursing orientation:
• Nursing orientation: individual
individual • Services: curative
• Services: curative preventive
• Agencies: lay, religious • Agencies: voluntary,
orders some government
Education
al Platform
 Conti…

Public Health Nursing • Community Health

(1900- 1970) Nursing(1970 to
• Focus: needy public present)
and general public • Focus: total population
• Nursing orientation: • Nursing orientation:
family population
• Services: less curative • Services: health promotion,
,preventive illness prevention
• Agencies: voluntary, • Agencies: many kinds,
some government some independent practice
Education
al Platform
 Philosophy
• 1) Philosophy of individual’s right of
being healthy.
• Health is believed to be one of the rights of
all human beings nationally and
internationally according to the WHO charter.
• Goal of health for all is based on the
philosophy of individual’s right of
being healthy.

Education
al Platform
 Conti…
• This philosophy encompasses all the
aspects of the society i.e. sociocultural,
economic aspects, so that there is no
hindrance of any kind to attain these rights.

Education
al Platform
 Conti…
• 2)Philosophy of working together under
a competent leader for the common
good.
• It is from the primitive ages of human ages,
man has learnt to live together to meet their
needs.
• The basis of modern community health
nursing is to share responsibility of
helping each other.
Education
al Platform
 Conti…
• When it comes to considering an
organization, equal participation of the
people working through the community
groups/people with the people, for the
people for their mutual benefit, change in
behavior and health practices.
• A democratic team functioning is essential
for effective delivery of health care services.

Education
al Platform
 Conti…
• 3. Philosophy that people in the community
have the potential for continual development
and are capable of dealing with their own
problems if educated and helped.
• An individual with average intelligence can
learn and deal with his/her own needs,
modify his/her lifestyles adjust to his or
her changing environment i.e. he can
learn to solve his or her problems.

Education
al Platform
 Conti…
• On the basis of this philosophy ,emphasis is
placed on health education projected towards
individuals in home, health center, place of
work, school, community places or hospital.
• This helps to modify their
behaviors respective to health.
• 4. Philosophy of Socialism

Education
al Platform
 Definition of Health
• The concept of 'Health' has been defined
differently by different individuals. For
example, Florence Nightingale, the celebrated
nurse, better known as the 'Lady with the Lamp',
defined 'Health' as
• “A state of being well and using every power
the individual possesses to the fullest extent.”
• Alternately, The World Health Organization
(WHO) defines health as “a state of complete
physical, mental and social wellbeing and
not merely the absence of disease or
infirmity .”
Education
al Platform
 Concept of Health
• The term 'Health' is derived from the old
English word 'Hoelth' which literally means
"A state or condition of being sound or
whole."
• Way back in 400 BC, Hippocrates affirmed that
human well-being was influenced by the
sum- total of all the environmental factors:
living habits, climate, quality of air, water, and
food.
Education
al Platform
 Conti…
• Accordingly, in ancient times, health was
thought to result from the harmony
among three vital components, namely,
body, environment and lifestyle.
• Historically speaking, health and disease have
been considered to be two extremes of the
same continuum, with 'Health' at one
extreme and 'Death' at the other - the
absence of one, indicates the presence of the
other.
Education
al Platform
 Health and Wellness
• The terms health and wellness are often
used interchangeably.
• However, there is a subtle degree of difference
between the two.
• Wellness can be considered to be the
precursor of health. It is an active process
involved in making choices for a healthy and
fulfilling life.

Education
al Platform
 Conti…
• Wellness is achieved through a dynamic lifestyle,
which encompasses various aspects, including
self-reliance, physical fitness, nutritional
awareness, stress management, and
environmental sensitivity.
• It is a feeling experienced by a person about their
health and quality of life.
• Hence, wellness can be considered to be a
subjective phenomenon and for this state to exist
both the body and mind have to be in an
optimum state.

Education
al Platform
 Conti…
• They are different concepts. Wellness means an
active process of becoming aware of and making
choices toward a healthy and fulfilling life.
• It is a process of change and growth. It is how a
person feels about their health and quality of life.
• This is a broader term than health. These
concepts are interchangeable. It is based on
subjective experience (personal opinion, etc.).

Education
al Platform
 Illness
• Illness is a feeling, an experience of unhealthy
which is entirely personal, interior to the
person of the patient.
• A state in which the person feels unhealthy
may or may not related to disease. Often it
accompanies disease, but the disease may
be undeclared, as in the early stages of
cancer or tuberculosis or diabetes.

Education
al Platform
 Conti…
• According to Kozier et al. (2004), illness
is a highly personal state in which the
person’s physical, emotional, intellectual,
social, developmental, or physical
functioning is thought to be diminished.
• Illness is different from disease. Illness is
merely a subjective feeling of being sick
and does not pertain to a pathologic
processes problem.

Education
al Platform
 Conti…
• It is only the individual who can say that he
or she is ill.
• There are individuals who have abnormalities
that can be counted as symptoms of a
disease but do not feel ill and there are
individuals whose body tissues do not
demonstrate changes but who feel ill and do
not function well (Santorious, 2006).
• Sickness refers to a state of social
dysfunction.
Education
al Platform
 Disease
• Dis-ease (from old French and ultimately Latin) is
literally the absence of ease.
• Disease is pathological change in the structure or
function of the mind and body.
• Disease is an objective phenomenon as it is based
on facts derived from diagnostic tests and is not
dependent on personal opinion.
• A disease will be classified as a specific medical
condition and will have signs and symptoms that
are associated with it.
Education
al Platform
 Conti…
• Often different diseases have similar
symptoms, so it is important for a physician to
do an in depth analysis in order to arrive at
the correct diagnosis.
• The study of diseases is known as pathology.
Pathologists seek to find the cause
(etiology) of the disease.
• It differs from disorder that means a slight,
partial or temporary irregularity in the system.

Education
al Platform
Community Health Nurse
Roles

• Client-oriented roles

• Delivery-oriented roles
• Population-oriented roles

Education
al Platform
 Client-oriented Roles

1. Caregiver 5. Role model

2. Educator 6. Advocate
3. Counselor 7. Primary care
4. Referral resourc provider
8. Case
manager

Education
al Platform
 Conti…
• Caregiver: Uses the nursing process to
provide direct nursing intervention to
individuals, families, or population groups.
• Educator: Facilitates learning for positive
health behavior change
• Counselor: Teaches and assists clients in
the use of the problem solving process

Education
al Platform
7/28/2021
Education Imran Waheed 53
al Platform
 Conti…

• Referral Resource: Links clients to services

to meet identified health needs.
• Role Model: Demonstrates desired
health-related behaviors
• Advocate: Speaks or acts on behalf of
clients who cannot do so for themselves

Education
al Platform
 Conti…
• Primary Care Provider: Provides essential health
services to promote health, prevent illness,
and deal with existing health problems.
• Case Manager: Coordinates and directs the
selection and use of health care services to
meet client needs, maximize resource
utilization, and minimize the expense of care

Education
al Platform
 Delivery-oriented Roles

1. Coordinator/Case manager
2. Collaborator
3. Liaison

Education
al Platform
 Conti…
• Coordinator/Care Manager: Organizes and
integrates services to best meet client needs
in the most efficient manner possible.
• Collaborator: Engages in shared decision
making regarding the nature of health
problems and potential solutions to
them.
• Liaison: Provides and maintains
connections and communication between
clients and health care providers or among
providers.
Education
al Platform
Population-oriented Roles
4.
1. Case finder
Community
2. Leader developer
3. Change agent 5. Coalition
builder
6. Researcher
Education
al Platform
 Conti…
• Case Finder: Identifies clients with specific
health problems or conditions. Geared
toward awareness of population - level
problems.
• Leader: Influences clients and others to take
action regarding identified health
problems.
• Change Agent: Initiates and facilitates change
in individual or client behaviors or
conditions or those affecting population
Education
al Platform
 Conti…
• Community Developer: Mobilizes residents and
other segments of the population to take action
regarding identified community health problems
or issues.
• Coalition Builder: Promotes the development
and maintenance of alliances of individuals
or groups of people to address a specific
health issue.
• Researcher: Conducts studies to explain health-
related phenomena and to evaluate the
effectiveness of interventions to control them.

Education
al Platform
 References
• 1. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004).
Fundamentals of nursing: Concepts, process and practice,
7th edition. Pearson Education, Inc., Upper Saddle River,
New Jersey 07458.
• 2. O’Donnell, M.P., (2011). My Dad: A balance of physical,
emotional, social, intellectual, and spiritual health.
American Journal of Health Promotion, 25(5), ffmiv-fmvi.
doi: http://dx.doi.org/10.4278/ajhp.25.5.iv
• 3. Marinker M. Why make people patients? Journal of
Medical Ethics 1975:I:81–4
• 4.Handbook of Food Additives. Compiled by Michael and
Irene Ash. 2nd ed. 2002.D. H. Hill Ref TX553 .A3 A84 2002

Education
al Platform
• “Rivers know this: there
is no hurry. We shall get
there some day.” ―A.A. Milne

Education 62
al Platform