Chapter 1

Community-Oriented Nursing and

Community-Based Nursing

Dr. Sahbanathul Missiriya

Dr.Joanne Austria
Learning Objectives
• To learn about basic terminology in CHN
• To describe about the key nursing modes
in the community
• To enumerate Public Health Core
Functions
 Key Terms

• Community
• Community – based
• Community – based nursing
 Key Terms
Community
• a group of people living in the same place or having a particular
characteristic in common.

• People and the relationships that emerge among them as they

develop and use in common some agencies and institutions and
share a physical environment.
 Key Terms
Community – based

• focused on or relating to a community.

• occurs outside an institution; services are

provided to individuals and families in a
community.
 Key Terms
Community – based nursing

• the provision of acute care and care for chronic health problems
to individuals and families in the community.
Four key nursing modes in the community

• Community-Oriented Nursing Practice

• Community Based Nursing Practice
• Public Health Nursing Practice
• Community Health Nursing Practice
Community-Oriented Nursing Practice

• Philosophy- Primary focus is on health

care of individuals, families, groups &
community or populations.

• That involves generalist or specialist public

health and community health nurses
providing "health care" through community
diagnosis in order to create conditions in
which people can be healthy.
Community-Oriented Nursing Practice
• Goal- Preserve, protect, promote, or
maintain health and prevent disease.

• Service Context- Community health care

and population health

• Interaction Pattern-
– One to one
– Group
– May be Organized
Characteristic features of CON
Client characteristics.
·       Individuals at risk
·       Families at risk
·       Communities Usually healthy
·       Culturally diverse
·       Autonomous
·   Able to define own problem
·   Involved in decision making
Community-Oriented Nursing Practice
• Practice Setting-
• Community agencies
• Home
• Work
• School
• Organization.
• Level of Prevention-
• Primary
• Secondary
• Tertiary
Characteristic features of CON

Priority of nurse activities.

·  Care management (direct care)
·   Client education
·   Community Education
• Individual, family & population advocacy
·   Interdisciplinary practice
·Programme planning and
implementation
Community-Based Nursing
Community-Based Nursing Practice

• Philosophy- Focus on illness care of

individuals and families across the
life span.

• Goal- Manage acute or chronic

conditions.
Community-Based Nursing Practice

• A setting-specific practice whereby

care is provided for "sick"
individuals and families where they
live, work, and attend school.
• Provide acute and chronic illness care and
the provision of comprehensive,
coordinated, and continuous care
 Growing costs of hospital care

More services are being provided in

community – based settings

Increasingly, nurses will engage in what is

called community – based nursing
(CBN)
Characteristic features of CBN
• Service Context- Family centered
illness care

• Community type- Human ecological.

Characteristic features of CBN
Client characteristics.
·       Individuals
·       Families
·       Usually ill
·       Culturally diverse
·       Autonomous
·       Able to define own problem
·       Involved in decision making
Characteristic features of CBN
Practice settings.
·        Community agencies
·        Home
·        Work
·        School
Interaction patterns. One – to- one
Type of service. Direct illness care
Level of Prevention- Secondary &
Tertiary
Characteristic features of CBN

Priority of nurse activities.

·  Care management (direct care)
·   Client education
·   Individual and family advocacy
·   Interdisciplinary practice
·   Continuity of care provider
Public Health Nursing Practice
• The synthesis of nursing and public
health theory applied to promoting
and preserving the health of
populations. The goal is to prevent
disease and disability and promote
and protect the health of the
community as a whole.
 What is Public Health ?
Surveillance

Health Promotion Monitoring

Research
Public Analysis
Risk
Health

Communication Out Breaks

Diseases
Public Health Core Functions
 Public Health Core Functions
• Assessment-

• Monitor health status to identify community

health problems
• Diagnose and investigate health problems and
hazards in the community.
 Public Health Core Functions
• Policy Development-

• Inform, educate and empower people about

health issues
• Mobilize community partnership to identify &
solve health problems
• Develop policies & plan that supports individual
community health efforts.
 Public Health Core Functions
• Assurance-
• Enforce laws & regulations that protect health &
ensure safety.
• Link people to needed personal health services
and assure the provision of health care
• Assure a competent public health and personal
health care workforce
• Evaluate effectiveness accessibility & quality of
personal and population based health services.
 Health Services
Te
rti
Pyramid
rti
ar
y
he
alt
h
Secondary
ca
health
re care

Primary health care

Clinical Preventive Services

Population based health care services

 Levels of Prevention
• Primary Prevention

• Secondary Prevention

• Tertiary Prevention
 Levels of Prevention
• Primary Prevention
Aimed at individuals in the Susceptibility
stage.
It refers to activities or measures, that are
directed at reducing the risk of
exposure to a risk factor or health
determinant in an individual or the
population.
Measles immunization is an example of a
primary prevention measure.
 Levels of Prevention
• Secondary Prevention
Focus on the Sub-clinical stage and the
early clinical stage.
These measures enable early detection
and prompt effective intervention to
correct departures from a state of
health.
Screening programme is an example of a
Secondary prevention measure.
 Levels of Prevention
• Tertiary Prevention
Measures are directed primarily at the
recovery, disability or death stage -
although they are used to some extent
at the Clinical stage.
Their purpose is to reduce or eliminate
long-term impairments and disabilities,
minimize suffering, optimize function,
assist in adjusting to limitations in
health and function resulting from the
event, and sometimes extend survival.
Community Health Nursing Practice

• The synthesis of nursing and public health

theory to promote, preserve, and maintain
the health of the population through the
delivery of personal health services to
individuals, families, and groups.

• Focus is on the health of individuals,

families, and groups and how their health
status affects the community as a whole.
Difference in PHN & CHN
• Boundaries between these two concepts
exist in relation to the level of assessment.
• Public health nurses are trained and
educated to assess the population overall.
• Whereas the community health nurse's
knowledge lies within assessing the needs
of individuals and families within the
population that they work.