COMMUNITY HEALTH NURSING

Concepts/Principles:

Health:
WHO: “ state of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity”

It is not a working definition but rather as a broad, philosophical declaration. The

statement has helped to publicize an expanded concept that emphasizes the
social aspects of health and has implications for positive health promotion.

Workable Concept of Health – man is an integrated whole, a biopsychosocial

being, who attempts to maintain dynamic equilibrium in the midst of constant
change.

According to Dubos, health or disease is an expressions of the success or failure a

person experiences in this efforts to respond adaptively to environmental challenges.
Therefore, health as a concept, is best described in relative terms, and may be viewed
along a wellness –illness continuum.

Wellness-illness continuum demonstrates the various levels of prevention in the

maintenance of health and control of disease. They are referred as a primary,
secondary, and tertiary prevention.

 Primary prevention measures are those that actively promote optimum health
and prevent illness.
 Secondary and tertiary preventive measures are those, which are applied
after an illness, or disabling condition has occurred.
 Secondary prevention as consisting of case finding, early diagnosis, treatment,
and prevention of complications of illness. Limitation of disability could be
considered secondary or tertiary prevention.
 Tertiary prevention also includes rehabilitation. Levell and Clark identify five
levels of prevention as follows: health promotion, specific protection, early
recognition and treatment, disability limitation, and rehabilitation.
 The concept of prevention is not new; it has been a recognized as part of public
health practice for decades, up to now it has gained only limited acceptation in
the total health care system as therapeutic or curative medicine has been
dominated in the medical profession.
 Health is considered as the goal of public health in general, and community
health nursing, in particular.
 Dunn- emphasized high-level wellness, which he defined as: “an integrated
method of functioning which is oriented toward maximizing the potential which
the individual is capable. It requires that the individual maintain a continuum of
balance and purposeful direction within the environment where he is functioning:
 Orem, a nursing theorist defined health as a “state characterized by soundness
and wholeness of human structures and bodily and mental functions.”
  The modern concept of health refers to optimum level of individuals, families
and communities.

There are several factors in the eco-system, which affect the level of functioning:
1. Political – political jurisdictions have the power and authority to regulate the
environment. E.g. safety, oppression and people empowerment
2. Behavioral – level of functioning is affected by culture, habits,; mores, ethnic
customs
3. Hereditary – genetically influenced diseases and genetic risk factors; such as
defects, familiar, ethnic, racial
4. Health care delivery – promotive, preventive, curative, rehabilitative care
5. Environmental influences – air, food, pollution, radiation, noise, water waste, etc.
6. Socio-economic – employment, education, housing, etc

Public Health:

Winslow defines is the science a art of (1) preventing disease, (2) prolonging life,
and (3) promoting health and efficiency through organized community effort for (a) the
sanitation of the environment, (b) the control of communicable infections, (c) the
education of the individual in personal hygiene, (d) the organization of medical and
nursing services for the early diagnosis and preventive treatment of disease, and (e) the
development of the social machinery to insure everyone a standard of living adequate
for the maintenance of health so organizing these benefits as to enable every citizen to
realize his birthright of health and longevity.

Hanlon stresses “public health is dedicated to the common attainment of the highest
level of physical, mental and social well-being and longevity consistent with available
knowledge and resources at a given time and place. It holds this goal as its contribution
to the most effective total development and life of the individual and his society.”

Community Health Nursing:

The concept of community health was summed up in the title of a book “Public Health is
People” – it means working together to help people help themselves, not to merely
survive but to achieve their maximum potential. The whole community is designated as
the patient. The nurse who works in the community is a public health nurse, visiting
nurse or district nurse and the newly coined terms “nurse practitioner.”

WHO: “public health nursing” – a 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 programme for the promotion of health, the improvement of the
conditions in the social and physical environment, rehabilitation of illness and disability.’
Dr. Paul Purdom – public health is an improvement of the quality of life in all stages,
early years, young adults, middle period especially in later years.

Summary:

 Public health practice is general and comprehensive

 Not limited to a particular age or diagnostic group
 It is continuing, not episodic. A dynamic process.
 Primary focus is on health promotion
 Initial contact is the family as the unit of society however the CHN practice is
extended to benefit the whole family and community
 The community health nurse is a generalist in terms of her practice throughout
life’s continuum – its full range of health problems and needs
 Contact with patient and/or family may continue over a long period of time-
include all ages and all types of heath care
 The nature of community health nursing practice requires that current knowledge
derived from the biological and social sciences, ecology, clinical nursing and
community organization be utilized.
 The dynamic nursing process of assessing, planning, implementing and
intervening, periodic measurements of progress, evaluation, and a
continuum, of the cycle until termination of nursing is implicit in the practice f
community health nursing.

Philosophy:
According to Dr. Margaret Shetland, the philosophy of CHN is based on the
wroth and dignity of man

Goal:
The ultimate goal of community health services is to raise the level of health of
the citizenry.
 To help communities and families to cope with the discontinuities in health and
threats in such a way as to maximize their potential for high level wellness
 To promote reciprocally supportive relationship between people and their
physical and social environment

Objectives:
1. To participate in the development of an over-all health plan for the
community
2. To provide quality nursing services to IFC
3. To coordinate nursing services with various members of the health team,
NGOs/GOs
4. To participate in and/or conduct researches relevant to community health
5. To provide community health nursing personnel with opportunities for
continuing education and professional growth through staff development
Principles:
(by Mary Gardner and Leahy, Cobb & Jones)
1. Community health nursing is based on recognized needs of the IFC
2. Community health nurse must understand fully the objectives and policies
of the agency she represents
3. In CHNursing, the family is the unit of service
4. CHN must be available to all regardless of race, creed and socio-
economic status
5. Health teaching is a primary responsibility of the community health nurse
6. The community health nurse works as member of the health team
7. There must be provision for periodic evaluation of community heath nursing
services
8. Opportunities for continuing staff education programs for nurses must be
provided by the CHNursing agency
9. The CHN makes use of available community health resources
10. The CHN utilizes the already existing active organized groups in the
community
11. There must be provision for educative supervision in community health
nursing
12. There should be an accurate recording and reporting in CHN

Qualifications of a Public Health Nurse/SPHN/RTN/RTS:

Public Health Nurse (Nurse 11 and 111)

 Bachelor of Science in Nursing, Registered Nurse

Supervising Public Health Nurse/Nurse Supervisor at the Provincial/City Level

 Bachelor of Science in Nursing, Registered Nurse, Master’s Degree in Nursing or
Public Health with at least 5 years experiences as Public Health Nurse

Nurse Instructor 11
 Bachelor of Science in Nursing, Registered Nurse, with Master’s Degree in
Nursing. Three years experience as a community health nurse, special training
on the functions of the Nurse Instructor

Regional Training Nurse

 BSN, RN, Master’s Degree in Nursing/Public Health with six years nursing
experience, three years of which are in training or nursing education

Regional Nurse Supervisor (Nurse V)

 BSN, RN, with at least 5 years experience in community health nursing, 2 years
of which are supervisory position, with Master’s Degree in Public Health or
Master of Arts in Nursing, major in Community Health Nursing, Administration
and Supervision.
PHN Functions and Activities:

 Management
 Training
 Supervision
 Provision of health and nursing care
 Health education
 Coordination

Expanding/Extending Role of the Nurse Practitioner:

The nurse have moved in as primary care practitioners and have assumed
responsibility for family health care in a variety of settings, and in numerous health
programs have been created outside the established public health nursing system, e.g.
Health Maintenance Organizations (HMOs), home care services, etc.
Health Maintenance Organizations (HMOs)- provide a comprehensive health care
services on a prepaid, capitation basis with emphasis on primary care, preventive
services and efficiency of operations. HMOs offer ambulatory, inpatient, and home care.

Home Care Program:

It has become not merely a substitute for institutional care, but rather a vital
preventive and therapeutic service in a system that seeks to provide appropriate care as
needed, to the patient in his own home.

Ethico-legal Aspects of Nursing Practice in the Community:

The practice of a profession is guided by a number of legal and ethical principles
that are primarily centered on the welfare of clients and protection of their rights.

Ethical practice is characterized by three major principles: respect for autonomy,

beneficence and justice. These form the bases of the client’s rights with a
corresponding professional responsibility.

 Clients have the right to be informed about his/her condition and treatment or
any health intervention. The nurse therefore, should respect the client’s decision
and his/her refusal to access services.

 Clients have the right to safe and quality care: therefore the nurse has a
responsibility to update himself/herself n the latest developments in health care
and in the nursing profession

 Clients have the right to privacy. The nurse is expected to ensure that the
client’s medical records are treated confidentially.
 One of the ethical principles that guide the provision of health services is
distributive justice – means “fair, equitable and appropriate distribution of
services and resources such as medicines” (Beauchamp and Walters)