Community Health Nursing

Theoretical basis of Community

Health Nursing
Chapter 14

WHEN THE CLIENT IS A COMMUNITY:

characteristics of community health

practice
Community health nursing is a specialty in which the
unit of care is a specific community or aggregate
and the nurse has responsibility to promote group
health
The goal of this specialty is health improvement of
the community.

WHEN THE CLIENT IS A COMMUNITY:

characteristics of community health

practice

The skills required for excellence in community

health nursing practice include
epidemiology, research, teaching, community
organizing, and interpersonal relational care,

WHEN THE CLIENT IS A COMMUNITY:

characteristics of community health

practice
community health nursing is characterized
by community-oriented, population-focused care and
is based on interpersonal relationships.

Community-Oriented, PopulationFocused Care

A community is a group of people who have some
characteristics in common,
are bounded by time, interact with one another, and
feel a connection to one another.
They share similar experiences and concerns, and
they often influence one anothers behavior.

Community-orientation,
population-focused care

Is a process that is actively shaped by the unique

experiences knowledge, concerns, values, beliefs,
and culture of a given community.

Community-orientation,
population-focused care

when the outbreak of a such disease, the nurse also

1- Uses disease-investigation skills to locate

possible sources of infection
2- Determines how the communitys knowledge,
values, beliefs, influence its interpretation of the
disease, response to and prior experiences with
infectious disease may outbreak, and treatment
preferences

Community-orientation,
population-focused care
3- Uses knowledge and suggestions gathered from
the community to develop, in collaboration with
other health professionals community-specific
program to prevent future outbreaks

Community-orientation,
population-focused care

A community-oriented nurse who provides

nutritional counseling to a community considers the
meaning of food in this culture, the types of food
most commonly consumed, and the cooking
methods most commonly used.

Community-orientation,
population-focused care
A population
is any group of people who share at least one
characteristic, such as age, gender, race, a particular
risk factor, or disease.
Smokers and breast cancer survivors are two
populations.

Relationship-based care
Incorporates, the value of establishing and
maintaining a reciprocal, caring relationship with
the community health nursing practice and is
foundational to caring effectively for the
communitys health.

Relationship-based care
A reciprocal, caring relationship with the
community involves listening, participatory
dialogue, and critical reflection, and it may also
involve sociopolitical elements of practice such
as advocacy, community empowerment, and
movement to action

Theories and Models for CHN Practice

Theory: set of systematically interrelated concepts or
hypotheses; explain or predict phenomena
Early theories: grand theories or conceptual models
Key to nursing theories: nursing metaparadigm concepts
Nursing
Client/patient
Health
Environment
Model: pictorial representation

Nightingales Theory of Environment

Focus on preventive care for populations
Use of observations to validate her
hypothesis
Poor environmental conditions are bad
for health.
Good environmental conditions reduce
disease.
Others have added social services and
health care in addition to environment as
conditions for health.

Orems Self-Care Model

Communities with collective set of self-care actions and
requirements affecting well-being of the group
Self-care deficit: demand exceeds client abilities related
to:
Universal requirements
Developmental requirements
Health deviation requirements
Nursing care supports client
Specific theories: self-care deficit theory; theory of selfcare; theory of nursing system

Neuman's Health Care Systems

Model
Open systems constantly and reciprocally interacting with
environment
System > sum of parts
Wellness = parts interacting in harmony with each other and
the systems environment
Variables: physiologic, psychological, sociocultural,
developmental
Each system with unique response to stressors and tensionproducing stimuli
System response (see Fig. 14.1) with boundaries: flexible line
of resistance; normal line of defense; dynamic flexible line of
defense

Rogers Model of the Science of

Unitary Man

Based on systems theory

Whole is greater than the sum of the parts
Three principles:
1. Life proceeds in one direction along a rhythmic
spiral.
2. Energy fields follow a certain wave pattern and
organization.
3. Human and environmental energy fields interact
simultaneously and mutually, leading to
completeness and unity.

Kings Theory of Goal

Attainment
Personal and interpersonal systems
In any nurse-client encounter, each comes
with own goals and expectations
Success at goal achievement is possible
only when nurse and client work together
to set goals

Penders Health Promotion

Model
Proactive set of behaviors to increase level of well-being
and self-actualization
Individuals acting on environment; not reacting to
stressors from environment
Modifying factors
Demographic factors
Biologic characteristics
Interpersonal influences
Situational factors
Behavioral factors

Roys Adaptation Model

Open adaptive systems, experiencing stimuli, developing
coping mechanisms, and producing responses
Adaptive or maladaptive responses; provide feedback
influencing amount & type of stimuli that can be handled
in future
Regulator process: stimuli from internal and external
environment processed for a response
Cognator process: perceptions, learning, judgment, and
emotion considered in formulating response

Salmon Construct for PHN

Categories of nursing interventions
Education directed toward voluntary change in the
attitudes and behavior of the subjects
Engineering directed at managing risk-related
variables
Enforcement directed at mandatory regulation to
achieve better health
Interventions target determinants in four categories:
Human/biologic, environmental,
medical/technologic/organizational, and social

Minnesota Wheel the Public

Health Interventions Model
17 different interventions
Three levels of public health practice:
Population-based community-focused practice
Systems-focused practice
Individual-focused practice (see Fig. 14.2)

Principles of Public Health Nursing

Principle 1: focus on community
the client or unit of care is the population
Principle 2: give priority to community needs
the primary obligation is to achieve the
greatest good for the greatest number of
people or the population as a whole

Principles of Public Health Nursing

Principle 3: Work in Partnership With the People
the processes used by public health nurses
include working with the client as equal
partner.
Principle 4: Focus on Primary Prevention
primary prevention is the priority in
selecting appropriate activities.

Principles of Public Health Nursing

Principle 5: Promote a Healthful Environment
public health nursing focuses on
strategies that create healthy
environmental, social, and economic
conditions in which population may thrive.

Principles of Public Health Nursing

Principle 6: Target All Who Might Benefit
a public heath nurse is obligated to
actively identify and reach out to all who
might benefit from a specific activity or
service

Principles of Public Health Nursing

Principle 7: Promote Optimum Allocation of resources
optimal use of available resources to assure
the best overall improvement in the health of
the population is a key element of the
practice

Principles of Public Health Nursing

Principle 8: Collaborate with Others in the Community
collaboration with a variety of other
professions, populations, organizations,
and other stakeholder groups is the most
effective way to promote and protect the
health of the people

SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING

Social changes influence a communitys health.

Community
communicable disease. affect the availability of
resources
Contemporary community health nurses must be
especially aware of the mutual interaction between
nursing and technology

SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING

Communication Technology
Genetic Engineering can be defined as gene
manipulation in a laboratory setting
Global Economy
Migration is the act of moving from one region
or country to another, either temporarily,
seasonally, or permanently.

SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING

Terrorism is one way in which a small number of
people who perceive that they have been unfairly
treated can exert influence on a larger group or
nation.
Bioterrorism is the use of living organisms, such as
bacteria, viruses, or other organic materials, to
harm or intimidate others, in order to achieve
political ends.

SOCIETAL INFLUENCES ON COMMUNITYORIENTED POPULATION-FOCUSED NURSING

Climate changes can be considered societal

changes because they may be influenced by
economics