NURS3142

Nursing in the Community

I. Principles of Community Nursing

II. Basic Concepts of Public Health and
Epidemiology
III. Application of framework/ model
in community assessment

Dr Sally Lo
Email: sallylows@cuhk.edu.hk
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Learning objectives
Part I
• Define what is community.
• To compare public health nursing and community health nursing.
• To describe the components of community-based care.
• Identify and discuss levels of disease prevention.
Part II
• To understand the concept of public health
• To recognize the concept of epidemiology, health determinants, and the
basic study designs.
• To know the applications of public health and epidemiology.
Part II
• State the purpose of community assessment and its uses.
• Describe the Community as partner Model.
• Discuss methods for collecting community data, the advantages and
disadvantages of different methods.
• Explain how community health nurses can affect change within a
• community based on conclusions drawn from assessment.

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 Part I
Community Nursing

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Definition of Community
• Community of Place: Defined by distinct boundaries and
bound by a common political, economic and social system.
e.g. ShaTin, CUHK

• Community of Interest: A group of individuals who share

common interests or needs about something.
e.g. older adults with knee osteoarthritis, post-stroke elders

Definition : A group of people sharing common interests, needs,

resources, and environment; an interrelating and interacting group
of people with shared needs and interests.

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Community Nursing
• Community Nursing?
• Nursing in the Community?
• Public Health Nursing?

1950 to 1975 : Practice in the Community.

1975 to 2000 : Practice as Synthesis of Nursing and Public Health.
2000 to 2xxx : Practice in Health Promotion, Disease Prevention, Population Health.

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 Community Nursing

Nursing
Practice

Tertiary Community
Setting Setting

Individuals Individuals Families Groups

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Components of Public Health Nursing

Population-based Care

Family-based Care

Individual-based Care

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Differences between hospital and home

Hospital Home
Resource
Environment
Locating client
Access to client
Focus
Family support
Client role
Safety practice
Supervision of practice
Leadership style

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Components of Community-based Care

Collaborative Self-Care
Care

Continuity Preventive
of Care Health Care

Care within
the context of
the community

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Levels of Disease Prevention

Primary Prevention of the initial

occurrence of diseases or
injury
Secondary Early identification of
disease or disability
with prompt intervention
to prevent or limit
disability
Tertiary Assistance to stop further
disease progress and to
meet one’s potential and
maximize QoL despite
illness or injury.
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 Part II
Public Health

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What is “Health”?
• “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity”

- World Health Organization (WHO), 1946

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What is “Public Health”?
• “The science and art of preventing disease, prolonging life
and promoting health through the organized efforts of
society”
- Sir Donald Acheson

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History of Public Health
• Early History
• Miasma Theory
• Noxious odours caused disease
• Bacteriological (1880s – 1910s)
• Specific organism, specific disease
• Health resources and Social engineering (1910s-1975s)
• Infectious disease early in this period; emergence of l
ifestyle disease at end of period

• Old public health (1975-mid 1980s)

• Lifestyle diseases, some infectious diseases

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History of Public Health
• New public health (early 1980s to late 1990s)
• Reduction in infectious disease generally but emergenc
e of diseases that have no cure – HIV/AIDS, lifestyle dis
eases continue, emergence of chronic disease as a maj
or challenge.

• After 2000 to nowadays

• Impact of global warming on health
• NEW emerging infections
• Global epidemic of chronic non-communicable diseases
related to affluence
• Health services as part of the system which delivers he
alth.
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Public Health in Hong Kong
- Population Pyramid

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 Infant mortality rate (IMR)

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What does this tells you?

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Global Disparities in Mortality

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Global Disparities in Mortality
• High child mortality is associated with
• Extreme poverty
• Populations living in rural areas
• Female illiteracy
• Lower per capita expenditure on healthcare, outpatient
visits, hospital beds and doctors
• Lower rates of access to improved water, sanitation and
immunizations

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 Epidemiology
The term of epidemiology is derived from the Greek word meaning
epidemic.

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“Epidemiology”
“Epidemiology is concerned with the frequency and pattern of
health events in a population (CDC, 2012)”

Disease Frequency
• Simple count of affected individuals or events
• Measures for morbidity
• Prevalence
• Incidence
• Measures of mortality

Disease pattern
• Who, Where and When?

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Disease Frequency- Prevalence and Incidence

• Prevalence
• Total cases in population at given time / total population
at risk.
• Incidence
• NEW cases in population over a given time period / Tot
al population at risk during that time.

Usually Expresses per 1,000

• Chronic diseases : Prevalence incidence

• Acute diseases : Prevalence incidence

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Disease pattern - Who, Where and When?

Person-Place-Time Model
• Person
• Age, sex, ethnic group/race, social class, activities, occupation,
habits, etc.

• Place
• Spot maps
• Urban/rural
• Geographic distribution
Person Place
• Time
• Epidemic curve
• Time of day
•
•
Day of week
Season of year
Time
• Secular trend

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Uses of Epidemiology
• Description of health status of populations
• Causation of ill health
• Natural history of diseases
• Risk assessment / public health policy
• Evaluation of intervention/ health services

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Challenges Ahead
• Challenges in the Pandemic crisis
• Challenges for Client-Centered Care
• Challenges for Technology
• Challenges for Personal Responsibility for Health
• Challenges for reclaiming Public Health Roles

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 Part III
Community Assessment

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Learning outcomes
Part III
• State the purpose of community assessment and its uses.
• Describe the Community-as-partner Model.
• Discuss methods for collecting community data and their
respective advantages and disadvantages.
• Explain how community health nurses can affect change
within a community based on conclusions drawn from
assessment.

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Definition of Community
• Community of Place: Defined by distinct boundaries and
bound by a common political, economic and social system.
e.g. ShaTin, CUHK

• Community of Interest: A group of individuals who share

common interests or needs about something.
e.g. older adults with knee osteoarthritis, post-stroke elders

Definition : A group of people sharing common interests, needs,

resources, and environment; an interrelating and interacting group
of people with shared needs and interests.

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Comprehensive Assessment

Population-based Care

Family-based Care

Individual-based Care

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Community Assessment
Purposes:
• To identify the community health problems/needs that are
the priorities for intervention
• To identify community resources available to address the
community’s health problems/needs
• To determine the community’s readiness and capacity,
strengthens and weaknesses to address the identified
problems/needs
• To imply and prioritize goals and interventions in health
care planning for the community

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Community Assessment - Common pathway

1. Epidemiologic approach
− Use health indicators to measure health trend.
− Identify the pattern, relationship that can predict health.
− E.g. mortality , morbidity rate

2. Theoretical approach
− Use theoretical framework to guide practice.
− E.g. Community-as-partner Framework
(Community Assessment Wheel), SOAPE Framework

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Community Assessment - Common pathway

1. Epidemiologic approach
− Use health indicators to measure health trend.
− Identify the pattern, relationship that can predict health.
− E.g. mortality , morbidity rate

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Community Assessment - Common pathway

2. Theoretical approach
− Use theoretical framework
to guide practice.

Community-as-partner Model
 Community
 Use of nursing process.

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Community Assessment Wheel
• Community Cores (People) & 8 Community subsystems
• The people are affected by 8 Sub-systems:

1. Physical Environment
2. Education
3. Safety & Transportation
4. Politics & Government
5. Health & Social Services
6. Communication
7. Economics
8. Recreation

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Community Assessment Wheel
• Solid line of wheel – The normal line of defense
• Broken lines of inner wheel – The flexible line of defense
• Broken line of outer wheel – Lines of resistance
• – Stressors

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Community Assessment Wheel
• Primary prevention
• Reduce possible encounters with
stressors
• Strengthen the lines of defense

• Secondary prevention
• After a stressor crosses the line
of defense & causes a reaction,
to reduce further damage

• Tertiary prevention
• To maintain & restore a
more-or-less healthy state

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Community Assessment Wheel
• A comprehensive guide for data
collection

• Community Core:
• History and culture
• Demographic information
• Values and beliefs of the people

• Eight subsystems

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Community Core
• History and culture
• Demographic information
− Age & gender
− Racial & ethnic groups
− Vital statistics e.g. birth rate,
life expectancy, leading cause
of death
− Household size, marital status,
mobility
• Values & beliefs

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8 subsystems - Physical Environment

• Geographic boundaries
• Land use
• Housing & the living environment
• Climate & Terrain

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8 subsystems - Education

• Educational status
− Years of school completed.
− School enrolment by type of school.
− Language spoken.

• Educational sources
− Services e.g. quality & variety of education
al programs
− Facilities e.g. number & type of educational
institutions, public libraries
− Budget
− Manpower e.g. number & qualifications of
teachers
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8 subsystems - Safety & Transportation

• Protection Services
 Transportation means e.g.
• Firemen
• Police − Private cars
− Crime rates − Public transportation
• Sanitation − Walking paths
− Water source & treatment − Ferries
− Solid waste
− Air service
− Air quality
 Roads, highways, subways
− Accessibility
− Condition
 Cost

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8 subsystems - Politics & Government

• The government
− Leading, responsible and accessible to the community
• Political parties

• Dynamics between government and political parties

• The community’s responses:
− Voting rate
− Representation groups

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8 subsystems - Health & Social Services

• Hospitals, clinics, emergency care, private practitioners

• Public health & home health services
• Health services / programs for various age / disease
groups
• Social service agencies
• Long-term care services

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8 subsystems - Communication

• Formal Communication e.g.

− Newspaper
− Radio & television
− Postal service
− Telephone & cell phone
− Internet accessibility

• Informal Communication e.g.

− Bulletin boards, posters, hand bill
s, and church & NGO
− Newsletter
− Channels – words of mouth, email,
whatsapp
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8 subsystems - Economics

• Financial characteristics of households

• Economic activities
• Employment/unemployment rates

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8 subsystems - Recreation

•Recreation facilities
−Sport centers
−Parks
−Cinemas

•Related programs & associations

−Exercise classes
−Foreign language programs
−Dancing classes
−Sports associations
−Interest group associations

•Negative signs
−Gang activities
−Alcohol / drug abuse
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Methods used in community assessment

Data
Collection

Subjective Objective

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Methods used in community assessment

• Collection of subjective data

−Informant interviews
−Surveys

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Methods used in community assessment

• Collection of objective data

−**Windshield surveys/ Walking surveys
−Participant observations
−Existing data

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Conducting Community assessment
• Who?
• How?
• When?
• What to prepared?
• Study a map beforehand
• Be familiar.
• Use a checklist.
• Try to be unobtrusive.
• Carry identification.
• Take notes.
• Assign roles.
• Discuss your findings as you go.
• Pay attention to social distancing and safety.

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 Reference
• Anderson, E., & McFarlane, J. (2015). Community as partner : Theory and
practice in nursing (7th ed.)
Philadelphia : Wolters Kluwer.
• Carpenito-Moyet, L. J. (2017). Nursing diagnosis: Application to clinical pr
actice (15th ed.). Philadelphia: Wolters Kluwer.
• DeMarco, Healey-Walsh, Harkness, Healey-Walsh, Judith, & Harkness, G
ail A. (2020). Community and public health nursing : Evidence for practice
(3rd ed.). Philadelphia: Wolters Kluwer.
• Hunt, R. (2013). Introduction to community-based nursing (5th ed.). Philad
elphia: Lippincott Williams & Wilkins.
• United Nations, Department of Economic and Social Affairs (2019). World
Population Prospects 2019. Retrieved from https://population.un.org/wpp/

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