1

CHAPTER

Community Health Nursing

as Advocacy

Copyright ©2008 by Pearson Education, Inc.

Community Health Nursing, 5/e Upper Saddle River, New Jersey 07458
Mary Jo Clark All rights reserved.
Definition of Community Health Nursing

• There are many definitions of Community

Health Nursing, the most comprehensive
one was the ANA definition:

“ Synthesis of nursing practice and public

health practice applied to promoting and
preserving the health of populations”
Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark
Definition of Community Health Nursing

• Science and practice of public health

• Systematic use of nursing process

• Promotes health and prevent illness

• Focuses on population groups

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Public Health

• Public Health was described by Winslow (1952) as follows:

• Is the science and art of:
– Preventing disease.
– Prolonging life.
– Promoting health; by:
• Organized community effort for the sanitation of the environment
• Control of communicable and non-communicable diseases.
• Education of individuals in personal hygiene
• Early diagnosis and prevention .
• Maintenance of health

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Past and Present

• Public health
– Environmental sanitation
– Control of communicable diseases
• Community health
– Health education
– Individual behavior change
– Actions to change factors that influence health

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 KEEP IN MIND THAT

• The nature of this practice is general and

comprehensive.
• It is not limited to a particular age or
diagnostic group.
• It is continuous not episodic.
• The dominant responsibility is to the
population as a whole.

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Definition of Community

• Defining the community is based on

different aspects:
– Some definition focus on functions performed
by communities; for example;
• A system of formal and informal groups
characterized by independence and whose
function is to meet the collective needs of group
members.

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Definition of Community Conti

• some definitions use locale as basis for

community. For example;
– A social system, a place, and people.
• Some definitions based on existence of
commonalities among members of the
community; for example
– Collection of people who share some
important features of their lives.

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Definition of Community Conti

• Other authors take more elective view that

community can be defined either in terms
of geography or special interest.

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Critical Attributes of Communities

• Despite the diversity in definitions of

community, certain common elements are
revealed; which are:
1. Group orientation
2. Bond between individuals
3. Human interaction

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Community Health Nursing

• Mission, goals, and expectations

– Promote and improve health
– Prevent illness and injury
– Protect from threats
• Biological
• Behavioral
• Social
• Environmental

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Health
(Community View)
• World Health Organization(WHO) defines
health as
a state of complete physical, mental,
and social well-being and not merely the
absence of disease.

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Professional Standards of
Community Health Nurses
• Expected levels of professional
performance
• Quality of practice
• Education
• Practice evaluation
• Collegiality

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
Professional Standards (continued)

• Ethics
• Collaboration
• Research
• Resource utilization
• Leadership
• Advocacy

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Mary Jo Clark
 Eight Domains of Competency

• Analytic assessment
• Policy development and program planning
• Communication
• Cultural competence

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Mary Jo Clark
 Eight Domains of Competency
(continued)
• Community dimensions of practice
• Basic public health practice
• Financial planning and measurement
• Leadership and systems thinking

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
Community Health Nursing Roles

• Vary based on specific practice setting

• Focus of activity
– Client-oriented roles
– Delivery-oriented roles
– Population-oriented roles

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Focus of Services
• Types and emphasis placed on specific roles
vary by practice setting
• Client-oriented roles
– Emphasize direct care of specific individuals or
families
• Delivery-oriented roles
– Focus on mechanisms of care delivery
– Primarily address care delivery to individuals and
families
• Population-oriented roles
– Care of communities or populations

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Client-Oriented Objectives

• Apply the nursing process

• Assess client needs
• Develop nursing diagnoses
• Plan nursing interventions
• Evaluate nursing care and outcomes

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Client-Oriented Roles

• Caregiver
• Educator
• Counselor
• Referral resource
• Role model
• Primary care provider
• Case manager

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Mary Jo Clark
 Caregiver Functions

• Assess client health status

• Derive nursing diagnosis
• Plan nursing intervention
• Implement plan of care
• Perform delegated medical treatments or
provide primary care as needed

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
Caregiver Functions (continued)

• Introduce other supportive services as

needed
• Teach and supervise others
• Teach clients self-care
• Coordinate health care services
• Serve as liaison between client and
system
• Evaluate the outcome of nursing
intervention and modify plan
Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark
 Educator Role

• Assess client’s need for education

• Develop health education plan
• Present health education
• Evaluate outcome of health education

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Mary Jo Clark
 Counseling Role: Choose Viable
Solutions to Health Problems
• Assist client to identify and clarify problem
• Help identify alternative solutions to problem
• Assist client to develop criteria for acceptable
solution
• Assist client to evaluate alternative solutions
• Evaluate problem-solving process
• Point out use of problem-solving process for
future use

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Referral Resource: Direct Client to
Resources Required to Meet Their Needs

• Obtain information on community

resources
• Determine need for and appropriateness
of referral
• Make and follow up on the referral

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Role Model

• Demonstrate behaviors
– Influence health related behaviors
– Display competence

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 Case Manager

• Identify need for case management

• Assess and identify client health needs
• Design plan of care
• Oversee implementation of care by others
• Evaluate outcome of care

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Delivery-Oriented Roles

• Enhance operation of health care delivery

system
– Coordinator/care manager
– Collaborator
– Liaison

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Mary Jo Clark
 Coordinator/Care Manager

• Determine who is providing care to client

• Communicate with other providers
regarding client situation and needs
• Arrange case conferences as needed
• Assist in development of care networks

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Collaborator

• Communicate with other health team

members
• Participate in joint decision making
• Participate in joint action to resolve client
problems
• Participate in joint activities to evaluate the
outcome of care

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Liaison

• Serve as initial point of contact between

client and agency
• Facilitate communication between client
and agency personnel
• Interpret and reinforce provider
recommendations
• Serve as client advocate as needed

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Population-Oriented Roles

• Promote, maintain, and restore the health

of population
– Case finder
– Leader
– Change agent
– Policy developer

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
Population-Oriented Roles (continued)

• Community organizer/mobilizer
• Coalition builder
• Researcher

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Mary Jo Clark
 Case Finder Role

• Develop knowledge of signs and

symptoms of health-related conditions and
contributing factors

• Carry out investigation of specific cases of

disease as needed

• Provide follow-up care to identified cases

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark
 Leadership Role

• Identify need for action

• Assess situation and followers to
determine appropriate leadership style
• Motivate followers to take action
• Coordinate group member activities in
planning and implementing action
• Assist followers to evaluate the
effectiveness of action taken
Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark
 Change Agent

• Plans, controls, and enhances health

processes
– Recognizes need for change
– Makes others aware of need
– Motivates others to change
– Initiates and directs desired change

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Community Mobilizer
• Assists community members to identify health issues of
concern
• Participates in data collection relevant to issues of
concern
• Mobilizes community members to take action
• Assists with coalition development to foster community
action
• Assists community members to identify achievable goals
• Participates in the development of strategies to
accomplish identified goals
• Participates in the implementation of community
strategies to achieve goals

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Coalition Builder Creating
Temporary/Permanent Alliances
• Functions include
– Identify potential coalition members based on
common interest, assets available, etc.
– Present potential coalition members with the
benefits to be achieved through alliance
– Participate in the delineation of coalition goals
– Assist in the development of operating
guidelines for the coalition
– Participate in the selection and
implementation of strategies to accomplish
coalition goals

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Policy Advocate

• Determine need for policy development

• Analyze factors influencing the policy
situation
• Identify key decision makers
• Assist in policy formation
• Communicate the proposed policy
• Monitor the progress of policy
development
Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark
 Researcher

• Critically review relevant research

• Apply research findings to practice
• Identify researchable problems
• Design and conduct research
• Collect and analyze data
• Disseminate research findings

Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.

Mary Jo Clark
 Resources
• The Center for Nursing Advocacy
The Center for Nursing Advocacy seeks to increase
public understanding of the central, front-line role
nurses play in modern health care. The focus of the
Center is to promote more accurate, balanced and
frequent media portrayals of nurses and increase
the media's use of nurses as expert sources. The
Center's ultimate goal is to foster growth in the size
and diversity of the nursing profession at a time of
critical shortage, strengthen nursing practice,
teaching and research, and improve the health care
system.
Community Health Nursing, 5/e Copyright ©2008 by Pearson Education, Inc.
Mary Jo Clark