Week 1 - Introduction To Community Practice-Modified

BSN315 Community Health Nursing Hand Hygiene
Introduction to Community Health Nursing Practice

SEM 1 AY 2023 2024
Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 1
Hand Hygiene
By the end of this session, the students will be able to:

1.Define the following terms: Community, Health, Public
Health, Community Health, and Community Health Nursing.
2.Explain the roles of Community Health Nursing.
3.Describe the settings of Community Health Nursing.
4.Compare & contrast between acute care and
community–based settings.
5.Describe the process of advocacy as enacted by community
health nurses.
6.Summarize the Characteristics of Community Health Nursing.
Outline Hand Hygiene
I. The Concept of Community

1. Definition of Community
2. Types of Community
II. The Concept of Health

1. Definition of Health
2. Health and Illness
3. Public Health
4. Core activities of Public Health
III. The Concept of Community Health

1. Definition of Community Health
2. Fundamental components of Community Health
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org
Cont. Outline
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IV. Community Health Nursing

1. Definition of Community Health Nursing
2. Aim of Community Health Nursing
3. Roles of Community Health Nurses
4. Characteristics of Community Nursing
5. Settings For Community Health Nursing Practice
6. Comparison of values between in acute care and
community – based settings
7. Advocacy in CHN
8. Characteristics of Community Health Nursing
IV. Summary
V. References
The Concept of Community Hand Hygiene
• Community refer to:

• A collection of people who interact with one another and whose common interests
or characteristics form the basis for a sense of unity belonging.
• Collection of people who share some important features of their lives.
• It can be:
1.A society of people who holding common rights and privilege (citizen of town), or
2.Sharing common interest (community of farmers, nurses), or
3.Living under the same law and regulation ( prison community)..etc
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From the WHO point of view: community is a term that

refers to:
A group of people determined by geographical boundaries
and/or common values and interests. Its members know
and interact with each other; it functions within a particular
social structure and exhibits and creates certain norms,
values, and social institutions.
So, every community must have several dimensions

including:
1.Group of people.
2.Shared geographical boundaries and/or common values.
3.Has functions.
Types of community Hand Hygiene
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1. Geographic Community.
A community is defined by its geographic boundaries. A city, town,
or neighborhood is a geographic community.
 E.g Al Ain community(defined it by it’s geographical boundaries,
South of UAE)
 The population has certain identifiable characteristics such as age

and sex ratios and size.
 Frequently, a single part of a city can also be treated as a
community.
2. Community-Interest Community Hand Hygiene
A community can be identified by a common interest or goal that

binds the members together. A collection of people, although they
are widely scattered geographically, can have an interest or goal
that binds members together.
 E.g: members of a national professional organization (nursing

profession), the residents in an industrial community may develop
a common interest in air or water pollution issues; communities
protect the rights of children and stop violence against women …
etc.
3. Community of Solution
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A type of community encountered frequently in community health

practice.
 It is a group that comes together to solve a health problem that affects
all of them. The shape of this community varies with the nature of the
problem, the size of the geographic area affected, and the number of
resources needed to address the problem.
 Forexample, a water pollution problem may involve several counties

whose agencies and personnel must work together to control upstream
water supply, industrial waste disposal, and city water treatment.
Definition of Health by World Health Organization Hand Hygiene
(WHO)
• Originally defined in 1948 as a “state of complete physical,

mental, and social well-being, and not merely the absence of
disease or infirmity”
• WHO expanded the definition in 1986 to include a community

concept, “the extent to which an individual or group is able on
the one hand, to realize aspirations and satisfy needs; and on
the other hand, to change or cope with the environment”
Definition of Health by World Health Organization Hand Hygiene
(WHO) (continued.)
• Physical health implies a mechanistic functioning of
the body.
• Mental health means the ability to think clearly and
coherently and has to do with your thinking and
feeling and how you deal with your problem.
• Social health refers to the ability to:
oMake and maintain relationship with others:
oInteract well with people and the environment.
Health and illness
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• Rather than focusing on curing illnesses, community-based

nursing care focuses on promoting health and preventing illness.
• Care provided in acute care settings is usually directed at
resolving immediate health problems.
• In the community, care focuses on maximizing individual
potential for self-care regardless of any injury or illness
Health – illness continuum Hand Hygiene
Health and illness
Hand Hygiene
• The wellness-illness continuum (Travis and Ryan, 1988) provides a

visual comparison between high-level wellness and the
conventional perception of wellness in traditional medicine.
• Positioned at the midpoint, there are no indications or
manifestations of the disease.
• Progressing towards the left signifies a deteriorating health
condition. Individuals aspiring for wellness-driven objectives aim to
surpass the midpoint (reducing disease presence) and move
towards the right (achieving high-level wellness).
• Such individuals assess their current lifestyle choices, educate
themselves about available alternatives, and evolve towards self-
actualization by experimenting with these alternatives to pursue
optimal wellness.
Public Health
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• “The science and practice of protecting and improving the health of

the community, as by preventive medicine, health education, control
of communicable diseases, application of sanitary measures, and
monitoring of environmental hazards.” -The American Heritage
Dictionary of Public Health.
Watch the videos:

https://www.youtube.com/watch?v=t_eWESXTnic
https://www.youtube.com/watch?v=fOym9a6Nezc
Core Activities of Public Health Hand Hygiene
1. Prevents epidemics and the spread of disease

2. Protects against environmental hazards
3. Responds to disasters and assists communities in recovery
4. Prevents injuries
5. Promotes healthy behaviors
6. Assures the quality, accessibility and accountability of health services
7. Monitoring the health status of the population
8. Mobilizing community action
9. Reaching out to link high-risk and hard-to-reach people to needed services
10. Researching to develop new insights and innovative solutions
11. Leading the development of sound health policy and planning Core Activities
of Public Health
Community health Practice Hand Hygiene
• It is a component of public health efforts that are concerned with

maintaining and promoting the health of particular populations
and communities.
• Community health practice encompasses six fundamental
components:
1)Promotion of health
2)Prevention of health problems
3)Treatment of disorders
4)Rehabilitation
5)Evaluation
6)Research
Community health Practice (continued..) Hand Hygiene
1. Promotion of health
• Includes all efforts that are intended to move people closer to a
higher level of wellness.
• It is the combination of educational and environmental supports.
• E.g., physical activity, nutrition, tobacco and alcohol use, and
family planning.
2. Prevention of health problems (We will discuss later)
3. Treatment of disorders
a. Offering direct assistance to individuals with health issues; e.g.,
conducting home visits for the elderly, managing chronic illnesses,
etc.
b. Providing indirect support; e.g., aiding individuals with health
problems in accessing treatment and facilitating referrals.
c. Development of programs to rectify unhealthy situations; e.g.
addressing challenges related to alcoholism, substance abuse, …etc.
4. Rehabilitation
It encompasses efforts to lessen disabilities, as much as possible, and
restore functions; e.g., stroke rehabilitation.
5. Evaluation
• It involves analyzing, judging, and improving health practices according
to established goals and standards.
• It aids in problem-solving and offers guidance for next health care
planning.
6. Research
• It is a systematic investigation which aids to discern facts affecting
community health, solve problems, and discover improved methods of
health services.
Community Health Nursing
Hand Hygiene
• American Nurses Association (ANA) defined community health

nursing as “the synthesis of nursing practice and public health
practice applied to promoting and preserving the health of
populations”.
• This viewpoint noted that a community health nurse directs care

to individuals, families, or groups; this care, in turn, contributes to
the health of the total population.
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• It is a specialized field of nursing that focuses on the health

needs of communities, aggregates, and in particular
vulnerable populations.
• It is a practice that is continuous and comprehensive, directed

towards all groups of community members.
• It combines all the basic elements of professional clinical
nursing with public health and community practice.
• Watch video
https://www.youtube.com/watch?v=pdTvSHAcQ1s
Aim of Community Nursing
Hand Hygiene
• CHN aims to Improving the overall health of the population through health
promotion, illness prevention, and protection from wide variety of biological,
behavioral, and social, & environmental threats.
• The focus of CHN is the aggregate, a population with some common

characteristics (e.g., pregnant, elderly…)
• The goal of care is the promotion of health and the prevention of injury.
• Interventions could be directed at the total population or at the individuals,
families, and groups that constitute its members.
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Summary Roles of CH Nurses

1. Caregiver: Uses the nursing process to provide direct nursing
intervention to individuals, families, or population groups.
2. Educators: Facilitates learning for positive health behavior change.
3. Counselor: Teaches and assists clients in the use of the problem-
solving process.
4. Advocate: Speaks or acts on behalf of clients who cannot do so for
themselves.
5. Primary Care Provider: Provides essential health services to promote
health, prevent illness, and deal with existing health problems.
Cont. Summary Roles of CH Nurses
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6. 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.
7. Liaison: Provides and maintains connections and communication
between clients and health care providers or among providers.
8. Leader: Influences clients and others to take action regarding
identified health problems.
9. Change Agent: Initiates and facilitates change in individual or client
behaviors or conditions or those affecting population groups.
Cont. Summary Roles of CH Nurses
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10. Case Finder: Identifies clients with specific health problems or conditions
and Geared toward awareness of population-level problems.
11. Community Developer: Mobilizes residents and other segments of the
population to take action regarding identified community health problems
or issues.
12. Researcher: Conducts studies to explain health-related phenomena and to
evaluate the effectiveness of interventions to control them.
Characteristics of Community Nursing Hand Hygiene
Six important characteristics of community health

nursing:
1.It is a specialty field of nursing.
2.Its practice combines public health with nursing.
3.It is population-focused.
4.It emphasizes on wellness and other than disease or
illness.
5.It involves interdisciplinary collaboration.
6.It promotes the client’s responsibility and self-care.
Settings For Community Health Nursing Practice Hand Hygiene
• The nursing roles can be placed in context by viewing the settings in

which they are practiced.
1.Homes (Clients who are discharged from acute care institutions, such as
hospitals or mental health facilities, are regularly referred to community health
nurses for continued care and follow-up)
2.Ambulatory service settings(include a variety of venues for community
health nursing practice in which clients come for day or evening services that
do not include overnight stays e.g., community health centers, outpatient
departments of hospitals, or medical centers).
3.Schools (School nurses, whose primary role initially was that of clinician, are
widening their practice to include more health education, interprofessional
collaboration, and client advocacy.
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5. Occupational health settings (Care for sick or injured employees at work, recognition
of the need to protect employees’ safety, health education, employee advocacy,
assuring appropriate job assignments for workers, and adequate treatment for job-
related illness or injury. collaborate with other healthcare providers and company
management to offer better services to their clients. act as leaders and managers in
developing new health services in the work setting)
6. Residential institutions (Residential institutions can include a halfway house in which
clients live temporarily while recovering from drug addiction or an inpatient hospice
program in which terminally ill clients live).
7. Faith communities (e.g., in Haj season improve the health of its members through
education, screening, referral, treatment, and group support).
8. Community at large (not confined to a specific philosophy, location, or building. When
working with groups, populations, or the total community, the nurse may practice in
many different places e.g. AIDS organization or a support group for parents experiencing
the violent death of a child, assisting with flood relief in another state or another
country).
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Acute Care Setting

• This term is used for people who are receiving intensive hospital care.
• Care provided in acute care settings is usually directed at resolving
immediate health problems.
• An acute care setting is part of the hospital setting which also can be used
as an ambulatory clinic or day surgical clients or they require highly
technical care.
• Many of these clients have life-threatening conditions and require close
monitoring and constant care.
• In acute care, the health of an individual is the primary focus.
• Community health broadens that focus to concentrate on families,
populations, and the community at large.
Comparison of values between in acute care and Hand Hygiene
community – based settings

Nursing Acute care setting Community based setting
concepts
Client An individual who is isolated from their An individual observed within the context of both
family due to illness. the family and the community.
Environmen A standardized room, ward, or specialized The client is embedded in a natural environment
t unit where family access and client freedom that is shared with their family and community, and
are regulated by the facility. they cannot be isolated from this environment.
Health In contrast to illness, often seen as its Illness is a facet of life, and the goal of care is to
complete opposite, the primary aim of care optimize functionality and enhance quality of life.
is to eradicate illness.
Nursing Tasks predominantly assigned by physicians, Independent practice involving interventions
focusing on illness treatment, medications, collaboratively determined according to the client's
and technological interventions. These tasks values.
are of short duration and involve predictable
interventions.
Advocacy in CHN
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• Action taken on behalf of, or in concern with, individuals, families,

or populations to create or support an environment that
promotes health.
• Those actions could be at any level (family, individual, community)
and may include a variety of activities (education, promotion of
access to Health services..)
• An equitable distribution of benefits to all society members.
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Advocacy Process
Advocacy arises out of a precipitating situation that results in a
vulnerability that could be related to:
- Health status (mental retardation, HIV,…)

- Social status (unemployment, poverty,.)
- Environment
- Culture
or any social factors that lessen people’s ability to promote and
protect their health.
Vulnerability prevents people from acting on their behalf and requires
efforts from outside agencies.
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Advocacy Categories
1. A recipient of the advocacy: vulnerable individual, family, or group.
2. An advocate: a person who acts for or enables action by the recipient.
3. An adversary: person, institution, or social system.
For example, a Community Health Nurse may have to intervene with overly
protective parents who are not allowing a handicapped child to achieve his
or her potential.
Advocacy has consequences for all of the participants in an advocacy situation.

• Generally positive.
• Could carry an element of risk and negative consequences.
CH Nurse as Advocate Hand Hygiene
1. Determine the need for advocacy and the factors that prevent clients from acting on their
own behalf.
Ex, a lack of knowledge about how to make their needs known, fear of reprisal, feelings of
hopelessness, language barriers…
2. Determine the point at which the advocacy will be most effective.
Ex, should we raise the issue with the authorities, media, call for a meeting with interested
parties?. How cases should be presented require knowledge of what had been done before,
rules…
3. Collect facts related to the problem. Advocate is less effective when lack of facts. The nurse
should try to validate and verify the obtained information to support her claim.
4. Present the client’s case to the appropriate decision-makers. It requires tact and good
interpersonal skills. threatening behavior should be avoided unless other avenues fail.
5. Prepare clients to speak for themselves. Collaborate b/w nurse and client.
Characteristics of Community Hand Hygiene
Health Nursing
1. Population consciousness: CHN’s should see the big picture and be aware of
factors (political, social, economic, individual) that influence community
Health & well-being.
2. Orientation to health: emphasis on health promotion and maintenance

rather than cure of disease.
3. Autonomy: CHNs are more autonomous in practice than is the institution-

based nurses.
Cont. Characteristics of Hand Hygiene

4. Continuity: The relationship between nurse and clients tend to be for long
duration, this will help evaluate the long-term and short effects of interventions.
5. Collaboration: Populations are actively involved in the design and

implementation of community needs.
6. Intimacy: Nurses are more intimately aware of every detail of clients’ life and
environment.
7. Variability: Dealing with diverse groups necessitates a wide range of knowledge

for those willing to accept this challenge.
Summary
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• Community health nursing is a specialized field within nursing that

focuses on providing healthcare services, health education, and support
to individuals, families, and communities in their local environments.
• It emphasizes health promotion, disease prevention, and wellness

enhancement, aiming to improve the overall well-being of populations.
• Community health nurses work closely with diverse communities to

address health disparities, develop tailored interventions, and advocate
for better health outcomes.
• This field plays a crucial role in bridging the gap between healthcare
services and the unique needs of communities, fostering a proactive and
holistic approach to healthcare delivery.
References
Hand Hygiene
1. Centers for Disease Control and Prevention (2011). From:

http://www.cdc.gov/nchs/healthy_people/hp2020.htm
2. Clark, M. J. (2008). Community Health Nursing. Advocacy for Population Health. (5 th edition).Pearson
Education, Inc., Upper Saddle River, NJ.
3. Lundy & Janes (2016). Community Health Nursing: Caring for the Public’s Health (3 rd ed.). Boston:
Jones & Bartlet.
4. Allender J. A. Warner K. D. & Rector C. L. (2014). Community and public health nursing : promoting the
public's health (8th ed.). Wolters Kluwer/Lippincott Williams & Wilkins Health.
Video references
• https://www.youtube.com/watch?v=pdTvSHAcQ1s
• https://www.youtube.com/watch?v=t_eWESXTnic
• https://www.youtube.com/watch?v=fOym9a6Nezc

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BSN315 Community Health Nursing Hand Hygiene

Introduction to Community Health Nursing Practice

By the end of this session, the students will be able to:

I. The Concept of Community

II. The Concept of Health

III. The Concept of Community Health

IV. Community Health Nursing

• Community refer to:

• Collection of people who share some important features of their lives.

From the WHO point of view: community is a term that

So, every community must have several dimensions

 The population has certain identifiable characteristics such as age

A community can be identified by a common interest or goal that

 E.g: members of a national professional organization (nursing

A type of community encountered frequently in community health

 Forexample, a water pollution problem may involve several counties

• Originally defined in 1948 as a “state of complete physical,

• WHO expanded the definition in 1986 to include a community

• Rather than focusing on curing illnesses, community-based

• The wellness-illness continuum (Travis and Ryan, 1988) provides a

• “The science and practice of protecting and improving the health of

Watch the videos:

1. Prevents epidemics and the spread of disease

• It is a component of public health efforts that are concerned with

2. Prevention of health problems (We will discuss later)

• American Nurses Association (ANA) defined community health

• This viewpoint noted that a community health nurse directs care

• It is a specialized field of nursing that focuses on the health

• It is a practice that is continuous and comprehensive, directed

• The focus of CHN is the aggregate, a population with some common

Summary Roles of CH Nurses

6. Case Manager: Coordinates and directs the selection and use of

Six important characteristics of community health

• The nursing roles can be placed in context by viewing the settings in

Acute Care Setting

community – based settings

• Action taken on behalf of, or in concern with, individuals, families,

- Health status (mental retardation, HIV,…)

Advocacy has consequences for all of the participants in an advocacy situation.

2. Determine the point at which the advocacy will be most effective.

2. Orientation to health: emphasis on health promotion and maintenance

3. Autonomy: CHNs are more autonomous in practice than is the institution-

Community Health Nursing

5. Collaboration: Populations are actively involved in the design and

7. Variability: Dealing with diverse groups necessitates a wide range of knowledge

• Community health nursing is a specialized field within nursing that

• It emphasizes health promotion, disease prevention, and wellness

• Community health nurses work closely with diverse communities to

1. Centers for Disease Control and Prevention (2011). From:

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