COMMUNITY HEALTH NURSING

Miss Mehwish Nazir

Bsc Nursing( Generic)
Msc. Population Sciences
(Gold Medalist)
OBJECTIVES
At the end of this session you will be able:---
 To Illustrate the historical evolution in the term of

community health nursing

 To define terms related to CHN
 To be able to describe what is CHN.
 To analyze the characteristics of community health

nursing.
 To verify the factors influence the CHN.
CONT…
 To discuss the CHN practice
 To describe the setting for community
health nursing
 To identify the factors affecting
community health
 To describe the scope of CHN.
 Role of CHN in reproductive health
 HISTORY OF COMMUNITY
HEALTH NURSING

Before mid 1800s-

Home Care which focus on Sick and Poor individual.
Orientation: curative
Agencies: religious orders

 Mid 1800s to 1900-

District Nursing with focus on Sick and poor individual.
Orientation: curative/less in prevention
Agencies: voluntary & some government
HISTORY OF COMMUNITY HEALTH NURSING

Public health nursing(1900-1970)

focus: public needs
nursing orientation: families
service: curative; preventive
agencies: government & some voluntary

Community health nursing(1970 to present)

focus: total community
nursing orientation: population
service: health promotion; illness prevention
agencies: many kinds; some independent practice

Definitions of terms
related
DEFINITIONS
Community:
“A group of people sharing common
interest, needs, resources and environment.”
Population
- “A statistical aggregate or subgroup of people with
similar or identical characteristics; may or may not
interact with one another.”
Health:
“ Is defined as a state of well -being resulting
from harmonious interaction of body, mind,
spirit and the environment”
CONT….
Community health:
Is achieved by meeting the collective needs of
the community and society by identifying
problems and supporting community
participation in the process
Community health nursing:
Is a field of nursing practice that applies
knowledge and skills from nursing and public
health toward the promotion of optimal
health for the total community.
CONT…
 A "disease" has a pathological cause
such as bacteria or a virus.
 A "disorder" has a mental, chemical, or
physical cause.
 An illness is more generally any
condition that causes one to not feel well.
 It includes diseases and disorders and
it can be applied to more transient
maladies such as a cold.
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10
COMMUNITY HEALTH NURSING
(ANA, 1986)

“The synthesis of
nursing practice and
public health
practice applied to
promoting and
preserving the health
of populations”

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 PUBLIC HEALTH DEFINITION

Public health is the Science and Art of :

 preventing disease,

 prolonging life,

 promoting health and efficiency

through organized community effort.
 CHARACTERISTICS OF
COMMUNITY HEALTH NURSING
 It is a field of nursing
 It combines public health and nursing
 It focus in services, population,
environment, nutritional and diseases
factors (SPEND) that may impact to
people’s health
 It emphasize in health promotion,
illness prevention, and wellness
CHARACTERISTICS OF COMMUNITY
HEALTH NURSING:
Community health nursing has 6 important
characteristics:
 It is field of nursing i.e. especially within the
large discipline.

 It combines the specialized knowledge of

public health with nursing practice
(i.e. .epidemiology, vital statistics…etc)

 It is population oriented and does not deal

only with individual clients.
CONT……
 It emphasized health rather than disease or
illness.

 It involves interdisciplinary collaboration i.e.

team work with other professionals.

 It promotes client participation by fostering a

sense of responsibility among people for
their own health.
FUNCTIONS OF COMMUNITY HEALTH
NURSING:
1. Control of communicable disease.
2. Environmental sanitation.
3. Mental and child health.
4. Health education.
5. Laboratory services.
6. Vital statistics
Any community heath program is built on
these 6 basic functions in addition to
school, industrial and rural heath programs.
FACTORS INFLUENCING THE DEVELOPMENT OF
COMMUNITY HEALTH NURSING:

1. Advanced technology which solved some health

care problems thus nurse's attention was
shifted to problems of aging, chronic illness and
prevention.

2. Progress in causal thinking has broadened our

perspective to multiple causes including stress,
environmental hazards and the community
structure.

3. Changes in education, which led the community

health nurse to emphasize collaborating with
clients rather than planning for them.
CONT……
4. The changing role of women helped to open
new avenues of leadership for community
health nurses.
5. The consumer movement has increases the
public's concern for quality health services
(as consumers have assumed responsibility
for their own health, the community health
nurse became a catalyst to assist client
toward autonomy in health).
SETTINGS FOR COMMUNITY HEALTH NURSING
PRACTICE:-

 The types of places in which

community health nurses practice are
increasingly varied and include a
growing number of nontraditional
settings and partnerships with non
health groups
CONT…..
These settings are grouped into six
categories:
(1) Homes
(2) Ambulatory service settings
(3) Schools
(4) Occupational health settings
(5) Residential institutions
(6) The community at large.
CONT….
 Community at large:
It becomes the setting for practice of a
nurse who serves on health care
planning committees, lobbies for health
legislation, or runs for a school board
position.
COMMUNITY HEALTH NURSE
PRACTICE
 Is focussed on wellness not sickness.
 Is focussed on prevention not just treatment
of problems.
 Is focussed on assisting people and
communities make their own decisions
regarding health care.
 Is focussed on assisting those with existing
health conditions to maximise their potential
and prevent deterioration if possible.
CONT..
 Is based in the community in a range of
settings, wherever there is a need for
support, information and education.
 Responds to public health needs in
relation to communicable diseases.
CONT…
 Has the whole community as their
client, as well as groups, families and
individuals.
 Recognises the impact of life course
and social determinants of health and
works in partnership with the
community to address these.
CONT….

 Community health nurses recognise

health as “ a state of complete physical,
mental and social well-being and not
merely the absence of disease and
infirmity” W.H.O.
 Community health nurses deal with
clients in a holistic manner, working
with them wherever they are on the
health – illness continuum.
 ROLE OF THE COMMUNITY
HEALTH NURSE.
The community heath nurse must be capable to performing
multiple role functions of the setting of employment. These
role functions include:
1. Care provider (function role)
2. Educator role
3. Counselor role
4. Manger (Administrative role)
5. Leader role
6. Collaborator role
7. Coordinator role
8. Advocate role
9. Researcher role
10. Evaluation role
GOAL OF COMMUNITY HEALTH
PROGRAMS

 “To improve the levels of

health of the community”
 First, identify potential and
existing community health
problems
 Unique to each city

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COMMUNITY HEALTH PROGRAMS

 World Health Organization (WHO)

 Healthy People 2010
 Department of Health and Human
Services (DHS)
 Public Health Department

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WORLD HEALTH ORGANIZATION

 Founded in 1948 to give

worldwide guidance in
health, set standards of
health, cooperate with
governments in
strengthening national
health programs, and
develop and transfer
health technology,
information, and
standards.

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PUBLIC HEALTH
 Focuses on assessing and identifying sub
populations at high risk or threat of disease
or, at high risk of poor recovery
 Makes sure resources and services are
available and accessible to this population
 Includes the study and practice of techniques
that protect communities from epidemics,
toxic exposure
 Determines the risk for environmental
disasters
 Sets policy
 Enforces laws that provide a safe supply of
water and food 30
PUBLIC HEALTH
 Includes various governmental
agencies:
 Center for Disease Control and
Prevention (CDC)
 Food and Drug Administration
(FDA)
 National Institutes of Health (NIH)
 All are active in maintaining public
health
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COMMUNITY HEALTH ASSESSMENT

 A systematic way to determine

the health status, resources or
needs of a population.
 Community health requires a
population-based approach with
attention given to the economic,
social and political environments
of the community as they impact
a community’s health. 32
CHN MISSION
Health Promotion
Physical health, mental health, and
social and environmental health.
Includes individuals’ and communities’
abilities to cope with changes
(environmental, social) and to maintain
overall health and well-being.
Health Protection
Workplace safety and health, food and
drug safety, and other health/safety
areas, as well as the regulations that
provide for them.
Avoiding illness and its consequences. 33
 CHN MISSION
(CONTINUED)
Health Balance
A state of well-being that results from a
healthy interaction among a person’s
body, mind, spirit and environment
Disease Prevention
Includes activities designed to protect
people from disease and its consequences
Includes the three levels of disease
prevention: Primary, Secondary and
Tertiary Prevention
Social Justice
Ensuring basic needs are met (adequate
income and health protection)
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 CHN PRACTICE
 Builds caring relationships with families and
communities.
 Acts as a participant and facilitator rather than
just a dispenser of medications or information.
 Fosters mutual respect from both the giver and
the receiver of care (effective care requires
cooperation).
 Understands and works with diversity and
differences.
 Focuses on populations or subpopulations
rather than individual-based practice.
35
 CHN PRACTICE
(CONTINUED)

 Focuses on wellness, not sickness.

 Focuses on prevention, not just treatment
of problems.
 Assists people and communities make
their own decisions regarding health care
(empowerment).
 Assists those with existing health
conditions to maximize their potential
and prevent deterioration, if possible.

36
CHN PRACTICE
(CONTINUED)

 Works in partnership with the

community to address and
support public health needs with
education and referrals.
 Responds to communicable
disease needs.

37
CHN PRACTICE
(CONTINUED)

 CHN recognizes health as “a state

of complete physical, mental and
social well-being and not merely
the absence of disease and
infirmity.” (W.H.O.)
 Holistic focus; works with clients
along the Wellness/Illness
continuum.
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PREVENTATIVE NURSING

 A branch of nursing aimed at preventing

the occurrence of both mental and
physical illnesses and diseases.
 The nurse, as a member of a team of
professionals, has the opportunity to
emphasize and implement health care
services to promote health and prevent
disease.

39
PREVENTATIVE NURSING
(CONTINUED)

Nursing expertise and general

professional competence can also
be used in supporting community
action at all levels for the
promotion of public health. There
are three levels of preventative
nursing:
 Primary Prevention
 Secondary Prevention
 Tertiary Prevention
40
NURSE’S ROLE IN PREVENTION

 Primary - prevent homelessness by

identifying and eliminating risks for this.
Refer those with psychiatric disorders to
specialists.
 Secondary - refer to financial assistance,
food supplements, assist finding shelter.
 Tertiary - prevent recurrence of poverty,
health problems, homelessness. Make
referrals, educate.

41
 PRIMARY PREVENTION
 Is applied to a generally healthy population.
 Aim is general health promotion.
 Involves measures taken to keep illness or injuries
from occurring.
 Includes whatever intervention is required to
provide a health-promoting environment:
 In the home
 In schools
 In public places
 In the workplace
 Includes good nutrition, adequate clothing, shelter,
rest and recreation.
 Health education.
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PRIMARY PREVENTION
 Health education includes sex education
and realistic plans for retirement for the
aging population.
 Areas of emphasis include protective
measures such as immunizations,
environmental sanitation, accident
prevention and protection from
environmental hazards (Occupational
Safety and Health Administration - OSHA).

43
PRIMARY PREVENTION
(CONTINUED)

 Promotes changes in lifestyle through

behavioral therapies to those areas
that represent major health risks:
 Smoking
 Obesity
 Sedentary life-styles
 Improper diet
 Alcohol and drug abuse
 Sexual promiscuity
 Not practicing safe sex
 Falls
 Preventing automobile accidents 44
 PRIMARY PREVENTION -
INTERVENTIONS

 Primary prevention: prevent the

initial occurrence of the disease
or injury
 Immunization clinics
 Smoking cessation
 Tobacco chewing cessation
 Sex education
 Use of infant car seats, seat belts
 Family planning
 Dietary teaching and exercise
 Water fluoridation
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SECONDARY PREVENTION

 Aimed at early recognition and

treatment of disease
 Includes general nursing
interventions and teaching of
early signs of disease.
 These include but are not limited
to glaucoma, obesity and cancer.

46
SECONDARY PREVENTION -
INTERVENTIONS

Secondary-early detection:
 Testicular self-exam
 Blood pressure and cholesterol
screening
 Diabetes screening
 HIV screening
 Mammograms, pap smears
 TB screening for those at risk
 Hearing and vision screening

47
TERTIARY PREVENTION
 The goal is to prevent further deterioration
of physical and mental functioning.
 Individuals involved have an existing
illness or disability whose impact on their
lives is lessened through tertiary
prevention.
 To help maintain whatever residual
function is available for maximum
enjoyment of and participation in life’s
activities.
 Includes nursing care for patients with
incurable diseases.
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TERTIARY PREVENTION
(CONTINUED)

 Patient education concerning how

to manage and optimize new level
of wellness associated with already
diagnosed diseases and conditions.
Examples include Parkinson’s
disease, multiple sclerosis and
cancer.
 Rehabilitation services are an
essential part of tertiary
prevention.
49
TERTIARY PREVENTION -
INTERVENTIONS
 Tertiary Prevention-maximize recovery
after an injury or illness including
rehabilitative care.
 Dietary education on low-fat, low-
sodium diet or other prescribed diets.
 Post-stroke exercise, speech or
occupational therapy.
 Nutritional counseling to support
clients with HIV or AIDS
 Foot care, eye exams and renal
function studies in diabetic clients.
 Swim therapy for clients with
disabilities, rheumatologic or
musculoskeletal health issues.
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ROLE OF A CHN IN REPRODUCTIVE HEALTH CARE

 Prenatal care
 Intranatal care
 Post natal care
 Care of newborn
 Care of pt with sexually transmitted
diseses

51
BARRIERS TO REFERRAL PROCESS

 Attitudes of health  Priorities

care professionals  Motivation
 Physical  Previous
accessibility of experiences
resources  Lack of knowledge
 Cost of resource of available
services services
 Time  Cultural factors
 Other  Finances
 Other 52
COMMUNITY HEALTH NURSING
CASE STUDY

The emergency room physician has referred a

60-year-old man to a clinic for follow-up care
of his hypertension. While taking his health
history, the clinic nurse learns that the client
has recently been released from prison after
a twenty-year sentence. He has just started
working as a dishwasher in a local restaurant.

53
COMMUNITY HEALTH NURSING
CASE STUDY (CONTINUED)

• He is living in a low-rent housing facility and does

not have a car, a telephone or health insurance.
During his years of incarceration, the client lost all
contact with family members and friends. Since
he has only recently moved to this city, he has no
local contacts. In reviewing clinic admission forms,
the nurse assesses that the client’s reading skills
are very low level.

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Community Health Nursing
Case Study (continued)

Questions for this hypertensive client

scenario:
A. What risk factors should the nurse consider
when providing comprehensive care for this
client?
B. What other health care providers may
collaborate in this case?
C. What community agencies may be an
appropriate referral for this client?

55
 NCLEX-RN Practice
Question #1
THE NURSE IS TEACHING A CLIENT RECENTLY
DIAGNOSED WITH A SEIZURE DISORDER. WHAT
INFORMATION PROVIDED BY THE NURSE IS THE
ISSUE OF GREATEST CONCERN TO AN INDIVIDUAL
WHO HAS SEIZURES IN THE COMMUNITY?

1. Having a seizure in public.

2. Operating a motor vehicle.
3. Operating machinery on the
job.
4. Choking on food during a
seizure.
56
 NCLEX-RN Practice
Question #2
WHAT LEVEL OF PREVENTION IS THE GOAL OF
A COMMUNITY HEALTH NURSE IN AN AREA
THAT HAS JUST EXPERIENCED A MAJOR
EARTHQUAKE?
1. Primary
2.
Secondary
3. Tertiary
4.
Essential
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THANK YOU