Introduction to

community nursing

Prepared by lecturer /
basmat Hassan alshiek
 Nursing
Perspectives

‫الهدوء‬

‫التركيز‬
Learning Objectives
 Define the nature, philosophy and
scope of community health nursing
 Identify challenges and opportunities
in community health nursing
 Identify the common definitions used
in community health nursing
Learning Objectives

 List and explain the essential rules in

community health nursing practice
 Explain the basic functions and roles
in community health nursing
 Outline
 Definition of
 Community
 health
 community health
 public health
 community health nursing
 Goals of community health nursing
 Setting of community health nursing practice
 Components of community
 Role of community health nurse
Definition of community
A community is a social group determined
geographical boundaries and/or common
values and interests.
Its member knows and interacts with each
other. It functions within a particular
social structure and exhibits and creates
certain norms; values, and social
institutions.
 Definition of health
It is a state of complete physical, social
and mental well being and not merely
absence of disease or infirmity.
Definition of public health
It is the science and art of
 preventing disease,
 prolonging life,
 promoting better health
 through the organized efforts of society.
Definition of community health

It refers to
the health of the members of the
community, to the problem affecting
their health and to the totality of
health care provided for the
community.
Definition of community health
.nursing (C.H.N)

A.N.A (1980) defined C.H.N as a

combination of nursing practice and
public health practice applied to
promoting and preserving the health
of the population.
 Definition of community health
nursing
 Community health nursing is a synthesis of
nursing and public health practice applied
to promoting and preserving the health of
populations.
 Focus on in dividual,family,groups,and
community
 Utilizing Healthpromotion,health
maintenance, health education, and
management, coordination, and continuity
of care for meeting population needs.
”Treat “ Population as a Whole
Focus on individual, family,
groups, community
Definition of community health
.nursing (C.H.N)

The new definition of C.H.N is nurse

practice includes nursing care directed
to individuals, families, and groups, the
dominant responsibility are to the
population as a whole (Clark, 1999).
Community health nursing

Is a field of nursing practice that applies

knowledge &skills from nursing &
public health toward the promotion
of optimal health for the total
community.
History of Community Health
Nursing
Before mid 1800s-Early Home Care with
focus in Sick and Poor individual.
Orientation: curative
 Mid 1800s to 1900-district Nursing with
focus in Sick and poor individual
Orientation: curative/less in prevention
History of Community Health Nursing

 1900-1970 public health nursing- Pubic

Health Needs, focus in family and
orientation in Curative and Prevention
1970 to present-Community Health
Nursing, focus in total community and
oriented to population health,
servicesaddress health promotion; illness
prevention
History of Community Health Nursing

 Public health nursing traces its roots to England

where, in 1859, Florence Nightingale assisted in
organizing district public health nursing.
 Each nurse was assigned a specific geographic
area of London and was responsible for the health
of the people living in that neighborhood.
Community and public health
nursing practice
 The practice of Community and Public Health Nurses
advocates diseasesprevention and health
promotion.
 It is important to note that Community Nursing
Practice is collaborative and is based in research
and theory.
 It applies the nursing process to the care of
individuals,families, aggregates, and the community.
 ….Cont

 Community health practice is unique therefore nursing

intervention in community setting are different from
nursing interventions in institutional settings.
 Nursing intervention in community setting focus on
assessment of aggregate and populations, recognition of
health threats, education of those at risk, and advocacy
for the underserved and vulnerabel populations
….Cont
 All community health nursing roles
adhere to a philosophy of wellness.
Philosophy Of CHN

 Philosophy of individual’s right of being

healthy
 Philosophy of working together under a
competent leader for the common good.
 Philosophy that people in the community
have the potential for continual development
 and are capable of dealing with their own
problems if educated and helped.
 Philosophy of Socialism
 Difference between hospital nurse and
The community health nurse
Community Nurse Hospital Nurse
Works in community Setting
Works in hospital
settings, homes, schools,

industries, hospitals... etc

Generalized i.e. works with
all groups and different
diseases
Interdependent within the
health sector and other
.sectors
Provide comprehensive care
to individual, families and
.community
Applies professional
practice with basic CHN
.practice
Specialized i.e. works with Nursing role
Specific age or disease
Interdependent within the
health sector
Provide comprehensive care
.to individual patients only
Applies professional Nursing
practice
Prevailing health Conditions requiring Nursing concern
problems and community hospitalization i.e. sick
.needs .individuals and disabled
Total population
especially high-risk
.groups
main principle in her Main principle in her Nursing practice
practice is prevention, practice is curative,
early case finding, prevention of
health teaching, follow complication and health
up and family self- teaching i.e. focus
direction i.e. focus mainly on secondary and
mainly on primary tertiary prevention
.prevention
Improved patient, family patient well to be
and community health discharged
.and self-care
What are the factors affecting
?community health
 Political, Behavior( human
determinants).
 Socioeconomic, and social
determinants.
 Environment.
 health care delivery systems,
organizational determinants.
 Local community health services
These are usually divided into two
-:branches, which work closely together
Environmental health services
Personal health services
and there may be a community health
officer who supervises both the
environmental and personal local
.government health services
A) Environmental health
services
These are under supervision of the public
health superintendent . They are concerned
:with
adequate supplies of safe drinking water to 
.families
.Refuse collection and disposal •
Supervision of housing conditions (factories, •
.schools, and private dwellings)
Prevention and control of communicable •
.disease
.Collection of health statistics •
 .….Cont

.Health education •

.Pollution, public and health hazards •

Provision and supervision of sanitation •
Enforcement of regulations concerning •
.health (e.g. food hygiene, houses, etc)
B) Personal health services
These are under supervision of the doctor,
senior health sister (health visitor),
midwives, community health nurses . They
:are concerned with
.General curative out-patient services
.Maternity care
Care of the “under-fives” and
.immunization
.Care of school children
.Consultative clinics
Clinics for special diseases, e.g.
tuberculosis, leprosy
Care of the elderly and handicapped
 Public Health Nursing
Development in Sudan
 Hospital-Public Health
 Attention to city and rural areas
community center development and
practice model
 Government emphasize the
importance of Community health,
improve community health centers,
functions, farmer health
insurances 。
Major Cause of Death in Sudan
 respiratory infections
 watery diarrhea
 Malaria
 poor sanitation
 malnutrition
 Measles
 violence.
Issues in Chronic Diseases

 DM
 Hypertension
 Stroke
 Cardiovascular diseases

 Obese
 Smoking

 TB
 Characteristics of Community
Health Nursing
 It is a field of nursing
 It combines public health and nursing
 It focus in population and environment
factors that may impact to people’s health
 It emphasize in health promotion, illness
prevention, and wellness
Characteristics of Community
Health Nursing
 It promotes client responsibility and
self-care
 It uses aggregate measurement and
analysis
 It use principle of organizational
theory
 It involves inter-professional
collaboration.
:Pubic 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
 :Pubic Health is for
 The early diagnosis and preventive
treatment of disease

 Thedevelopment to the social

machinery to insure every one a
standard of living adequate for the
maintenance of health
 Goals of community health
nursing
 To describe the characteristics of the
community and the factors that influences its
health.
 To identify the most common health problems
and diseases in the community.
 To discover the health needs of the community.
Goals of community health nursing

 Todetermine the priority of the needs for

health problems.
 Toidentify the community health
resources in order to implement the plans
for the resolution of health problem.
Levels of Community Health Nursing
.Practice
 Components of
a community

People Needs Boundaries Service

Environment
 Setting of community health nursing practice

Homes
Homes Schools
Schools Residential
Residential
insinuations
insinuations

Occupational
Occupational community
community
Ambulatory
Ambulatory health
health at
at large
large
clinic
clinic
BREAK
 Opportunity for Future
Community Health Nursing
 Chronic Disease management
 Home Care
 Extended care from Acute care
setting
 Elderly care
 Opportunity for Future
Community Health Nursing

 Rehabilitation care in different

population
 Health promotion in every level
 Health system referral, emphasize
individual role and function of
community health sector
Roles of Community Health Nurses

Clinician

Researcher Educator

Nurses
Leadership Advocate

Collaborator Manager
The role of the community
health nurse
Care provider (functional role):
In community health practice,
providing nursing care is different
than in hospitals.
This is because the target of service
expands beyond the individual to
include families, groups,&
communities.
Role of community nurse
 Care giver :
 Assess the client health status.
 Drive nursing diagnosis.
 Plan un being intervention.
 Implement the plan of care.
 Evaluate the outcome of nursing
intervention.
 Role of community nurse
Educator:-
Health teaching is part of good nursing care
& one of the major functions of the
community health nurse being mainly
concerned with health promotion.
As educator, community health nurse
facilitate client’s understanding & learning
facts about health promotion.
 Role of community nurse
 Educator
 Assess the client need for education.
 Develop health education plane
 Present health education.
 Evaluate outcome of health
education.
 This could be achieved by sharing
information with the client either
formally e.g. through health
classes in different clinics or
informally at home.
Role of community nurse
Counselor (provide counseling) and
referral :
 Identify and clarify problem to be solved.
 Help the client identify alternative solution.
 Assist client to develop criteria for
solution.
 Assist the client to evaluate alternative
solution.
 Make client aware of problem solving
process.
Manager (Administrative role):-
In community health, the nurse’s role as
manager includes managing family care
handling a caseload, administering a
clinic, or planning a project.
The manager role also involves leading,
planning, organizing, coordinating,
staffing, supervising, motivating &
controlling service activities.
 Leader:-

Through her role as a leader, the

community health nurse stimulates
interest in health promotion, initiates
therapy, guides in decision making,
direct a preventive program,
influences a health policy &effects
change.
 Collaborator:-

The community health nurse, being a

member of the health team, assumes the
role of collaborator between the different
personnel of the team.
the public health includes physicians,
nurses, social worker, nutritionist, dentist,
educator, lab technicians… etc.
 Coordinator:-

the community health nurse plays

an important role in coordinating
between the different services in
community.
 Advocator:-
The role of the community health nurse
in client advocacy is to help him to gain
greater independence & direct the health
care system to the needs of the client by
influencing change.
She also help to direct attention to
inadequate or improper care &/or service
provided to the client.
 Researcher:-

The researcher role is an integral

part of community health nursing
practice.
I t helps to identify needs, evaluate
effectiveness of care & develop
theoretical basis for community
health nursing practice.
 Role in evaluation:-

Evaluation is continuous process

& part of the community nurse. The
community health nurse evaluates
the effectiveness of care provided
to individuals, families, or groups.
She also evaluates the
effectiveness of services in health
programs in special setting.
She uses available help to study
&evaluate her own job performance &
plan for continuing professional growth.
She also contributes to the evaluation of
workers for whom she shares
supervising responsibility.
Role of community nurse
Referral resources :
 Obtain information on community
resources.
 Determine the need for and
appropriateness of referral.
 Follow up on the referral.
Role community nurse
primary care provider :
 Assess the client health status and
identify problem.
 Plan and provide treatment.
 Introduce other supportive series as
need.
 Teach and supervise other.
 Modify care plan as required.
 Teach client self care.
Role community nurse
change agent :
 Identify driving and restraining
forces operating in change
situation.
 Assist in unfreezing and creating
motivation for change.
 Assist implantation of change.
 Assist group to internalize change