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CHN 2: MODULE 1- Concepts of CHN
Lesson 1: Community Health Nursing
Concepts
Community is a collection of people who
interact with one another and whose
common interest or characteristics gives
them a sense of unity and belonging.
A community is a group of people in
defined geographical area with common
goal and objective and the potential for
interacting with one another 2
Health is defined as a state of physical,
mental and social well-being not merely
the absence of disease or infirmity (WHO,
1948).
Wellness is a life – style aimed at
achieving physical, emotional, intellectual,
spiritual and environmental well- being.
According to American Nursing Association,
“Community health nursing is a
synthesis of nursing practice and public
health practice applied in promoting and
preserving the health of populations.”
Philosophy and Principles
1. Philosophy of individual’s right of being
healthy
2. Philosophy of working together under
competent leader for the common good.
3. Philosophy that people in the community
has the potential for continual development
and is capable of dealing with their own
problems if educated and helped.
4. Philosophy of Socialism
Principles of CHN
Factors to consider when providing
community health nursing practice include the
following.
1. Ethics
The Public Health Code of Ethics identifies
the ethical practice of public health.
Ethical considerations include preventing
harm, doing no harm, promoting good,
respecting both individual and community
rights, respecting autonomy and diversity,
and providing confidentiality, competency,
trustworthiness, and advocacy.
 Community health nurses are concerned
with protecting, promoting, reserving, and
maintaining health, as well as preventing
disease. These concerns reflect the ethical
principle of promoting good and preventing
harm.
 Community health nurses address the
challenges of autonomy and providing ethical
care. Client rights include the right to
information disclosure, privacy, informed
consent, information confidentiality, and
participation in treatment decisions.
 As nurses participate in research in the
community setting, it is important to use
ethical decision-making to promote client
rights
2. Advocacy
The nurse plays the role of informer,
supporter, and mediator for the client. The
following are basic to client advocacy.
 Clients are autonomous beings who have
the right to make decisions affecting their own
health and welfare.
 Clients have the right to expect a nurse-
client relationship that is based on trust,
collaboration, and shared respect; related to
health; and considerate of their thoughts and
feelings.
 Clients are responsible for their own
health.
 It is the nurse’s responsibility to advocate
for resources or services that meet the
client’s health care needs.
 Advocating for clients requires
assertiveness, placing priority on the client’s
values, and willingness to progress through
the chain of command for resolution.
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 Nurses act as advocates for communities
and populations through efforts to change
health care systems and improve quality of
life. An example of public health advocacy
includes nurses working to promote access to
clinics for individuals who live in rural
communities.
3. Evidence-based practice
Evidence-based practice involves using
best practices, expert opinion, and client
preferences to change the delivery of
client care. The goal is to improve client
outcomes.
 Data
 The nurse should appraise data collected
from research to measure whether bias was
minimal (quality), the number of in the
community
 An example of evidence-based practice in
community health includes the use of high
levels of evidence to support media
campaigns regarding immunization
guidelines.
 The Task Force on Community Preventive
Services produces a guide that reviews
health promotion and disease prevention
guidelines compared to the available
evidence. The task force then determines
whether there is sufficient or strong evidence
to implement an intervention and lists which
ones have insufficient evidence to show that
they are effective.
 The nurse must consider several factors
when applying evidence to practice: cost,
benefit to the client, client satisfaction, safety,
and client specific factors, such as culture
and demographics. An intervention that is
appropriate on the client or family level might
not work when the nurse is caring for
communities or populations of people.
 Nurses in the community setting can
contribute to the body of evidence by
implementing research studies in the practice
setting and in collaboration with educational
institutions, health care facilities, and through
community-based participatory research
(CBPR).
 CBPR includes partners,
professionals, and community
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residents in identifying health issues
and intervening.
 The CBPR approach fosters support
from community members, develops
leadership within the community, and
promotes a positive collaborative
relationship with health professionals.
4. Quality Assurance
 Quality assurance, quality improvement,
and quality management are part of
improvement of health care.
 Quality report cards for managed care and
public health organizations provide data
about the effectiveness of care.
Community health report cards can include
health profiles, needs assessments,
information about quality of life and health
status.
 Nurses can use information from quality
report cards in developing or revising
strategies for care of communities.
5. Professional collaboration and
communication
 Nurses in various community settings use
communication skills in caring for individuals,
collaborating in teams and groups, interacting
with other professionals, and informing the
public and stakeholders.
 The nurse facilitates communication with
the client through transfers from one level of
care to another, across the continuum of
care.
 Nurse leaders use professional
communication in roles such as mentoring,
coaching employees, managing conflict, and
supervising programs.
 Community health nurses should take care
to use clear language with a respectful tone
when using written, electronic, or print
correspondence.
 The nurse should incorporate knowledge
about variations in verbal and nonverbal
communication, literacy needs, and client
preferences when interacting with clients and
groups.
 As with all aspects of health care, the
nurse in the community setting is bound by
laws regulating privacy and confidentiality in
all forms of communication.
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- Perceived susceptibility, seriousness,

Features of CHN and threat of a disease
- Modifying factors (e.g., demographics,
A. It is a specialty field of nursing. knowledge level)
B. Its practice combines public health with - Cues to action (e.g., media
nursing. campaigns, disease effect on
C. It is population based. family/friends, recommendations from
D. It emphasizes on wellness and other than health care professionals)
disease or Illness. - Perceived benefits minus perceived
E. It includes inter-disciplinary collaboration. barriers to taking action
F. It amplifies client’s responsibility and self-
care.

A community has three features, location,

population and social system.

1. Location: every physical community

carries out its daily existence in a
specific geographical location. The health of
the community is affected by this
location, including the placement of the
service, the geographical features

2. Population: consists of specialized

aggregates, but all of the diverse
people who live within the boundary of the 2. Milio’s Framework for Prevention
community. - Complements the health belief model.
- Emphasizes change at the community
3. Social system: the various parts of level.
communities’ social system that - Identifies relationship between health
interact and include the health system, family deficits and availability of health-
system, economic system and promoting resources.
educational system. - Theorizes that behavior changes
within a large number of people can
ultimately lead to social change.
Lesson 2: Theoretical Models /
Approaches

1.Health Belief Model (HBM)

- Purpose is to predict or explain

health behaviours.
- Assumes that preventive health
behaviours 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.

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- Attitudes of others, and competing

demands and preferences
3. Nola Pender’s Health Promotion

- 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
4.Lawrence Green’s PRECEDE - PROCEED MODEL (PRECEDE= Predisposing, Reinforcing,
Enabling Constructs in Educational Diagnosis and Evaluation)
It provides a comprehensive structure for assessing health and quality of life needs,
and for designing, implementing, and evaluating health promotion and other public health
programs to meet those needs. It guides planners through a process that starts with desired
outcomes and then works backwards in the causal chain to identify a mix of strategies for
achieving those objectives. In this framework, health behavior is regarded as being
influenced by both individual and environmental factors, and hence has two distinct parts.

6. (PROCEED = Policy, Regulatory and Organizational Constructs in Educational and

Environmental Development).

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PROCEED was added to the framework in consideration of the growing

recognition of the expansion of health education to encompass policy, regulatory and
related ecological/environmental factors in determining health and health behaviours. As
health-related behaviourssuch as smoking and alcohol abuse increased or became more resistant
to change, so did the recognition that these behavioursare influenced by factors such as the
media, politics, and businesses, which are outside the direct control of the individuals.

Lesson 3: Different Fields of Nursing
School Health Nursing
A specialized practice of professional nursing that
advances the well-being, academic success, and
lifelong achievement of students. To that end,
school nurses facilitate positive student
responses to normal development; promote
health and safety; intervene with actual and
potential health problems; provide case
management services; and actively collaborate
with others to build student and family capacity for
adaptation, self-management, self-advocacy, and
learning.
Occupational Health Nursing
Occupational health nurses work with employers
and employees to identify health and safety
needs in the workplace. To meet those needs,
occupational health nurses:
- Coordinate and deliver services and programs.
- Promote an interdisciplinary approach to
health care and advocate for the employee’s right
to prevention-oriented, cost-effective health and
safety programs.
- Encourage workers to take responsibility for
their own health through health education and
disease management programs, such as smoking
cessation, exercise/fitness, nutrition and weight
control, stress management, control of chronic
illnesses and effective use of medical services.
- Monitor the health status of workers, worker
populations and community groups.
- Conduct research on the effects of workplace
exposures,gathering health and hazard data

Community Mental Health Nursing

Community Mental Health Nursing provides holistic nursing services for people with mental health issues,
in a community setting. We provide caring and confidential supports for our clients, using the recovery
model for care
The services provided by the Community Mental Health NursingProgram include:
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• Treatment Planning • Family Support

• Medication Management • Education
• Assessment • Group Support
• Counselling • Facilitate services with visiting Psychiatrist