History of Community Health Nursing

 Before mid-1800s Early Home Care with focus in Sick and Poor individual.
Orientation: Curative
Agencies: lay and religious orders St. Phoebe)

 Mid 1800s to 1900 distinct Nursing with focus in Sick and poor individual
Orientation: Curative/less in prevention
Agencies: voluntary and some government (William Rathbone)

 1900- 1970 public health nursing- Public Health Needs, focus in family and orientation in
Curative and Prevention.
Agencies: government and some voluntary (Lilliam Wald)

 1970 to present- Community Health Nursing, focus on total community and oriented to
population health, services address health promotion, illness prevention.
Agencies: many kinds; some independent practice (Ruth Freedman)

Public Health Definition

Public health is the Science and Art of:

 Preventing Disease
 Prolonging life
 Promoting health and efficiency through organized community effort.
“An effort organized by society to protect, promote, and restore the people’s health”

Community Health Definition (ANA, 2000)

 Community health nursing is a synthesis of nursing and public health practice applied to
promoting and preserving the health of populations.
 Treat “Population as a Whole”
 Focus on individual, family, group, community
 Utilizing Health promotion, health coordination and continuity of care for meeting
population needs.
 “Identification of needs and the protection and improvement of collective health within a
geographically defines area”

Characteristics of Community Health Nursing

 It is a field of nursing
 It combines public health and nursing
 It focuses on population and environment factors that may impact to people’s health
 It emphasizes in health promotion and illness prevention, and wellness
 It promotes client responsibility and self-care
 It uses aggregate measurement and analysis
 It uses principle of organizational theory
 It involves inter-professional collaboration

Public Health is for:

 The sanitation of environment
 The control of communicable infections
 The education of the individual in personal hygiene
 The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease and
 The development of the social machinery to ensure everyone a standard of living
adequate for the maintenance of health (Healthy lifestyle and longevity).

Challenges and Opportunities in Community Health Nursing

Challenge Opportunity
Understanding early PHN efforts Enriching the heritage of early PHN efforts
Expanding nursing focus from the individual Including communities
and the family
Determining the needs of populations as risk Designing interventions
Learning the complexities of the health care Shape its service delivery
system
Community Health and Public Health
Similarities:

 Both are organized community efforts aimed at promotion, protection, and preservation
of the public’s health
 Historically, public health has been associated with official or government efforts
 Currently, it includes both public and private health efforts
Difference:
Community health focuses on specific designated communities. It’s part of the larger public
health effort.

Community Health Practice

Components of Community Health Practice

Community health practice can be best understood by examining six basic components, which
when combines encompass its services and programs.
1. Promotion of health
Includes all efforts that seek to move people close to optimal well-being or hinger levels of
wellness.
Goal of health promotion:
 Is to enable people to exercise control over their well-being and ultimately improve
their health.
 Is to raise levels of wellness for individuals, families, populations, and communities.
2. Prevention of health problems
 Prevention of health problems constitutes a major part of community health practice.
 Prevention means anticipating and averting problems or discovering them as early as
possible to minimize potential disability and impairment.
Three Levels of prevention:
A. Primary prevention: Action taken prior to the occurrence of health problems and
directed toward avoiding their occurrence. Primary prevention includes health
promotion, protection, and illness prevention.
B. Secondary prevention: The early identification and treatment of existing health
problems.
C. Tertiary prevention: Activity aimed at returning the client to the highest level of function
and preventing further deterioration in health
3. Treatments of disorders
It focuses on the illness end of the continuum and is the remedial aspect of community health
practice.
This occurs the three methods:
1. Direct service to people with health problem
2. Indirect service that helps people to obtain treatment
3. Development programs to correct unhealthy conditions
4. Rehabilitation
The fourth component of community health practice involves efforts to reduce disability and, as
much as possible, restore functions.
People whose handicaps are congenital or acquired through illness or accident e.g., Stroke,
Heart condition, amputation, mental illness.
5. Evaluation
The process by which that practice is analyzed, judged, and improved according to established
goals and standards.
6. Research
Is systematic investigation to discover facts affecting community health and community health
practice, solve problems, and explore improved methods of health services

Health Prevention for Health Promotion

Primary Prevention

 Health education
 Adequate nutrition
 Individual development
 Adequate working environment and recreation, resting
 Pre-marriage counseling and education
 Genetic counseling
 Regular physical examination
 Comply with immunization
 Individual hygiene
 Improve environment sanitary
 Occupational safety
 Prevent accident in all ages
 Avoid cancer cause agents
 Avoid allergic agents
Secondary Prevention

 Identify cases in the community

 Scree and test
 Conduct special physical examination
 Treat and prevent the progress of illness
 Avoid the spreading of disease
 Reduce the disability time
Tertiary Prevention

 Treat and stop the disease progress and avoid complication and side effects
 Limit the chance for disability
 Provide rehabilitation for physical and psychological well-being, occupational therapy,
availability of long-term care
Community Health Nursing
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 program for the promotion of
health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.

Mission of Community Health Nursing

 The primary mission of community health nursing is improving the overall health of the
population through health promotion, illness prevention, and protection of the public
from a wide variety of biological, behavioral, social and environmental threats
 “Promote the good life” in all of its physical, social, psychological, cultural, and
economic aspects.
Focus

 Health promotion
 Prevention of illness
 Health maintenance
 Health education
 Continuity of care
 Management
 Coordination

Roles of Community Health Nurses

Client-oriented roles

 Caregiver
Uses the nursing process to provide direct nursing intervention to individuals, families,
or population groups
 Educator
Facilitates learning for positive health behavior change
 Counselor
Teaches and assists clients in the use of the problem-solving process
 Referral Resource
Links clients to services to meet identified health needs
 Role model
Demonstrates desired health-related behaviors
 Advocate
 Speaks or acts on behalf of clients who cannot do so, for themselves
 Primary Care Provider
Provides essential health services to promote health, prevent illness, and deal with
existing health problems
 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

Delivery-oriented roles

 Coordinator/Care manager
Organizes and integrates services to best meet client needs in the most efficient manner
possible.
 Collaborator
Engages in shared decision making regarding the nature of health problems and
potential solutions to them.
 Liaison
Provides and maintains connections and communication between clients and health
care providers or among providers.

Population-oriented roles

 Case finder
 Identifies clients with specific health problems or conditions.
 Geared toward awareness of population-level problems.
 Leader
Influences clients and others to take action regarding identified health problems
 Change agent
Initiates and facilitates change in individual or client behaviors or conditions or those
affecting population groups
 Community developer
Mobilizes residents and other segments of the population to take action regarding
identified community health problems or issues
 Coalition builder
Promotes the development and maintenance of alliances of individuals or groups of
people to address a specific health issue
 Researcher
Conducts studies to explain health-related phenomena and to evaluate the effectiveness
of interventions to control them
Setting for community health nursing practice
 Home
 Ambulatory service setting
 Schools
 Occupational health setting
 Residential institutions
 The community at large
 Health centers
 Special clinics
 Rural and slums areas of cities

Opportunity for future Community Health Nursing

 Chronic disease management
 Home care
 Extended care from acute care setting
 Elderly care
 Rehabilitation care in different population
 Health promotion in every level
 Health system referral, emphasize individual role and function of community health
sector

Health
Is state of complete physical, mental, and social well-being and it is not merely the absence of
disease or infirmity.
Concept of Health

 Health: holistic state of well-being, including soundness of mind, body and spirit.
 Wellness: health plus the capacity to develop one’s potential, leading to a fulfilling and
productive life.
 Illness: state of being relatively unhealthy
Health literacy: is the ability to obtain, process, and understand basic health information and
services needed to make appropriate health decisions”.
Self-care: is the process of taking responsibility for developing one’s own health potential.
Self-care deficit: when people’s ability to continue self- care activities drops below their need.

Community
A group of people who share common interests, who interact with each other, and who
function collectively within a defines social structure to address common concerns.

Concept of Community

 Collection of people who interact with one another and whose common interests or
characteristics form the basis for a sense of unity or belonging.
 Sharing of people holding common rights and privileges
 Living under the same laws and regulation
 The function of any community includes its members collective sense of belonging and
shared identity, values norms, communication and common interest and concern

Examples of some communities:

Citizens of a town
Group of farmers
Prison community
Tiny village in Appalachia
Members of Mothers Against Drug Driving (MADD)
Professional nurses

Elements of Community

 A sense of membership
 Common symbol system
 Common values
 Reciprocal influence
  Shared History
Healthy Community

 Collaborate effectively in identifying need of the community

 Working consensus on goal
 Implement intervention
Feature of Communities

 Location
 Population
 Social System

Three Types of Communities

1. Geographic = city, town, neighborhood
 clear target for analysis of health needs
 available data (morbidity, mortality, basis for planning health program)
 borders of country change with political revolution
 the world is one large community
 Global health: has become dominant phrase in international public health circles.

2. Common interest = church, professional organization, people with mastectomies

disabled individuals, and communities to protect the rights of children.
 A collection of people, they are widely scattered geographically, can have an interest or
goal binds the members together.

3. Community of solution = group of people who come together to solve a problem that
affects all of them
 the shape of this community varies with the nature of the problem that affect all of
them, number of resources e.g., substance abuse, HIV infection, water control, air
pollution.
Factors Affecting Community Health
Physical

 Geography
 Environment
 Community size
Industrialization

 Positive and negative effect

 Work for people
 Pollution
Social and Cultural

 Culture
 Belief
 Economy
 Politics
 Social norms
 Socio-economic status
Community Organization

 Resources
 Cost effectiveness
 Increase productivity
Individual behavior
Active participation of each individual of community towards the contribute to the health
status.

Nursing
Encompasses autonomous and collaborative care of individual of all ages, families, group and
communities, sick or well and in all setting. Nursing includes the promotion of health,
prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a
safe environment, research, participation in shaping health policy and in patient and health
systems management, and education are also key nursing roles.

Neighborhood
A smaller, more homogenous group that a community that involves interactions and a level of
identification with other living near-by.

Population
The general public or society or a collection of communities.

Aggregates
Population with some common characteristics that frequently have common concerns, but may
not interact with each other to address those concerns

Community-Based Nursing
Application of the nurse process in caring for individuals, families, and group where they live,
work, or go to school or as they move through the health care system.
Population-focused Nursing

 “Community” or “public” health nursing is population based

 Care may be given to individuals and families, but its purpose is the improvement of the
health of the population as whole.

Population-focused practice

 Focus on the entire population

 Is based on assessment of the population’s health status
 Considers the broad determinants of health
 Emphasizes all levels of prevention
 Intervenes with communities, systems, individuals, and families