COMMUNI

TYHEALTHNURSI
NG 7.Pr
omot
ionofheal
thandef
fi
ciency

TOPI
C1
Communi tyHeal thNur sing:
Whati sacommuni ty? -Af i
el dofnur singpr act i
cewher eserv i
cesare
-agr oupofpeopl ewi t
hcommonchar act eri
stics deli
veredout sidet hehospi talincommuni t
yset ti
ngs.
orinterestl ivingt oget herwi t
hinat erri
toryor -ut il
izat i
onoft heNur singpr ocessi nthe
geogr aphi cal boundar i
esand/ orcommonv aluesand di
fferentl evel sofcl ientele
i
nterest -pr omot i
onofheal t
hpr ev enti
onofdi sease,
di
sabi l
ityandr ehabi lit
at i
on
-peopl eshar et hesamecul turalherit
age,
maki ngeachcommuni tyuni quef r
om ot hers. Theut i
lizat i
onofNURSI NGPROCESSi ntheDI FFERENT
LEVELSOFCLI ENTELE, concer nedwi ththe
Charact eri
st icsofaCommuni ty
: PROMOTI ONOFHEALTH, PREVENTI ONOFDI SEASE,
DISABI LITY&REHABI LITATI ON.( Dr
.Ar aceli
Mal aya,et
1.I tisdef inedbyusgeogr aphicboundar i
eswi t
hi n al
.)
cer taini dent i
fiablechar acter
istics.
2.I tismadeupofi nst i
tutionsor ganizedint oasoci al Cl i
entor“ Pat ient ”( I
NDI VIDUAL)
sy stem, wi ththei nstitutionsandor ganizations -ent rypoi ntt of ami l
yandcar etosickorwel l
li
nkedi nacompl exnet wor k,hav i
ngf or
mal and Family
infor mal powerst ructur esandacommuni cation -t otal funct ioninguni trefersto2ormor e
sy stem. i
ndivi
dual sjoi nedorr elatedbyt iesofbl ood.mar ri
ageor
3.I thascommonorshar edinterestt hatbindst he adoptionl ivingt oget heri nahousehol d.
membert ogether . -basi cuni tofsoci etyandcar e
4.I thasanar eaoff luidboundar i
eswi t
hinwhi ch Populat iongr oups
pr obl em canbei dent i
fiedorsol ve -uni queheal t
hneedsoratr i
skofdev elopingor
5.I thasapopul at i
onaggr egateconcept . haveal readydev elopedacer tainhealthpr oblems.

TheThr
eeFeat
uresofaCommuni
ty: CHNdeli
ver
snursi
ngserv
icesaddr
essedt
ocommuni
ty
-
wideheal
thpr
oblems.
Location
-Theheal thofthecommuni t
yisaffect edbythis Hist
or yofCommuni t
yHeal t
hNur sing
l
ocation,includi ngt heplacementoft heservice, t
he Theear lyhomecar est age
geographi calfeat ure. •Thedi stri
ctnursingst age
•Thepubl i
chealthnur singst age
Population •Thecommuni t
yheal thnur singstageHist
oryof
-special izedaggr egates,
butallofthev ar
ious Communi tyHeal thNur sing
peoplewhol ivewi thi
ntheboundar yofthecommuni t
y.
PublicHeal thNur sing( 1900–1970
Socialsyst em Focus: PublicNeeds
-thev ariouspar tsofcommuni t
ies’soci al NursingOr ientat
ion:Fami li
es
syst
em t hatint er actandincludethehealthsy stem, Servi
ces: Preventi
v eandCur ativemeasures
familysyst em, economi csystem andeducational Agencies: Gov er
nmentandot herPri
vate
syst
em. Sector/Voluntary

WhatisNursing Communi tyHealthNursi

ng( 1970)
I
tisassi
sti
nghealt
hindi
vidual
stobecome Focus:Totalcommunity
heal
thyandhealt
hyindi
vi
dualsachiev
eopti
mum Nursi
ngor i
entati
on:Populat
ion
well
ness. Servi
ces:Healthpromoti
onandI l
lnesspr
event
ion
Agencies:
Independentpracti
ce
Publ i
cHealth
-t
hescienceandartofprevent
ingdi
sease, TOPI
C2
prolongli
feandpr omot
inghealt
handef f
ici
ency
throughorganizedcommunityeff
ort. Whati sHeal th?
-WHO1948def inedheal thasast ateof
Publi
cHeal t
hNur si
ng physical ,
ment alandsoci alwell-
beingnotmer elythe
-I
st heter
m usedbeforeforCommuni tyHealt
h absenceofdi seaseorinf i
rmitya.
Nursi
ng. -TheOt t
awaChar terforhealth(1986)best
-t
hepr act
iceofnursi
nginnationalandlocal describedheal thasa“ resourcef orever ydayli
fe,nott
he
governmenthealt
hdepartments objectiveofdai l
yli
v i
ng.
”
-acommuni tyheal
thnursingpract
icedina -i
tisanenabl i
ngf actorthatwi l
l all
owaper son
publi
csector. toachi evehisorherownl i
fe’
saspi r
ation, whetherfor
himselforher self,hi
sorherf ami ly,
orf orthe
Accor
dingtoDr.C.E.Winsl
ow,
Publ
icHeal
thi
sa communi t
yasawhol e
sci
enceandartof3P’ s:
1.Preventi
onofdisease Whati
sWel
lness?
6.Prolongi
ngli
fe
 -Wel l
nessisal if
e-styl
eaimedatachi ev
ing -I
tist
hepr
ocessbywhi
cht
hepr
act
icei
sanal
yzed,
physical,emot i
onal,int
ell
ectual,
spir
it
ualand j
udged,andimprov
edaccor
dingt
oest
abl
i
shedgoal
s
envi
ronment alwell-
being.Itcanincr
easestamina, andst
andards.
energyandsel f
-esteem, t
henenhancequal i
tyofli
fe.
-I
thel
pst
osol
vepr
obl
emsandpr
ovi
desdi
rect
ionf
or
-Wel l
nessbehav iorarethosethatpromote
healt
hyf unctioningandhel ppreventi
ll
ness. f
utur
eheal
thcar
epl
anni
ng.
FactorsAf fecti
ngCommuni tyHealt
h
6.Resear
ch
Pov
ert
yandHeal
th -I
tisasy
stemat
ici
nvest
igat
ionwhi
chhel
pst
o
-poorheal
thbecauset
heydon’
thav
ether
esour
cest
o discoverf
actsaff
ect
ingcommunityhealt
hand
af
for
dthebasi
crequi
sit
esofheal
th(
noheal
th communi t
yhealt
hpracti
ces,
solv
epr obl
ems,and
i
nsur
ance) explor
eimprovedmethodsofhealt
hservi
ces.
-Theydon’
thav
ethecapaci
tyt
otr
ansactornegot
iat
e
wi
thheal
thcar
esy
stem.
TOPI
C3
Cul
tur
eandHeal
th
Basi
cPr
inci
plesofCommuni
tyHeal
thNur
sing?
-wayofl
if
e
-i
ncl
udesmanyt
hingssuchasbel
i
efs,
val
uesand 1. Thecommuni tyist hepat ientinCHN, thef amilyis
cust omsorpracticesEnvi
ronmentandHeal th the u ni
t ofcare andt here are fourle v
e l
s ofc l
i
e nt
e l
e:
Individual,Family,communi t
yandpopul ati
ongr oup
Polit
icsandheal t
h (thosewhoshar ecommonchar acterist
ics,
dev elopment alchangesandcommonexposur et o
heal thproblemse. g.chi l
drenandel derl
y )
-heal thbudgetist hemostconcret
eexpr essionoft
he 2.InCHN, t
hecl i
entisconsi der edanACTI VEpar tner
gov ernment’
spol i
ti
calwil
l notPASSI VEr ecipientofcar e.
3.CHNpr acti
ceisaf fectedbydev elopment sinheal th
Communi tyHealthPracti
ce technol ogy,inparticul
ar ,
changesi nsoci et
y, i
n
-I ti
spar tofthelargerpubl
icheal
theffortt hatis gener al.
concer nedwit
hpr eserv
ingandpromot ingt heheal
th 4. Thegoal ofCommuni tyHeal thNur si
ngi sachiev ed
ofspeci fi
cpopulati
onsandcommuni ties. throughmul ti-
sector i
alef f
ort s.
5. Communi tyHeal thNur singispar tofHeal thCar e
6basi celementsofCommuni t
yhealt
h Sy stem andt helargerhumanser vicessy stem

1.Pr
omot
ionofheal
th TOPI
C4
-I
tincl
udesal
lef
for
tst
hatseekt
omov
epeopl
ecl
oser
t
oopt
imalwel
l-
bei
ngorhi
gherl
evel
ofwel
l
ness. RolesofCommunit
yHealt
hNursi
ng
-Thecombi 1.Cli
nici
anr
ole/
dir
ectcar
epr
ov i
der
nat
ionofeducat
ionalandenv
ironment
al
supportsforacti
onandcondi
ti
onoflivi
ngconduciv e -Theclini
cianroleint hecommuni tyhealthmeanst hat
tohealt
h. thenurseensur esthathealthservi
cesar eprovi
ded,
notjusttoindivi
dualsandf amili
esbutal sotogroups
2.Preventi
onofheal t
hprobl
ems andp opulati
on.
-t heacti
onofst oppi
ngsomethi
ngfrom happeningor -I nvol
vescer t
ainemphasi sdiff
erentfrom basic
ari
sing nursi
ng, i
.e.–Holism, heal
thpromot i
on, andski
ll
expansion.
3.Treatmentofdisorders
-I Hol i
sm: Theclientisacomposi teofpeople
tf
ocusesont heill
nessendofconti
nuum andi sthe
whoser elati
onshipsandi nt
eractionswitheach
remedialaspectsofcommunit
yhealthpract
ice.This
othermustbeconsi deredintotali
ty.
i
spr act
icedby:
Healt
hPr omotionfocusonwel lness:The
A.Directservicet opeopl ewi t
hheal t
hproblems;
communi tyheal
thnurseprovidesservicealong
e.g.homev isitforelderlypeoples,chronic
theenti
rerangeofthewellness–i ll
ness
i
llness.
conti
nuum butespecial
lyemphasi son
B.Indirectservice;e.g.assisti
ngpeopl ewi t
hhealth
promoti
onofheal t
handpr eventi
onofi ll
ness.
probl em t
oobt ai
nt r
eat mentandr eferral
.
C.Dev elopmentofpr ogram t ocorrectunhealthy
Expandedski l
ls:thenur seusesmanydi ffer
ent
condi ti
on;e.g.alcoholism, drugabuse, et
c.
skil
lsinthecommuni tyhealt
hcl i
nicianr oleskil
l
.
Inadditi
ontophy sicalcareskill
,recentlyskillsi
n
4.Rehabi
li
tat
ion
observati
on,li
stening,communi cat i
onand
-seekt
oreducedi
sabi
li
ti
es,
asmuchaspossi
ble,
and counsell
ingbecamei ntegralt
ot hecl i
nicianrole
r
est
oref
unct
ions;
e.g.st
roker
ehabi
l
itat
ion. withanincreasedemphasi sonenv i
ronment al
andcommuni tywideconsi derati
onssuchas
5.Ev
aluat
ion problemswi t
hpol lut
ion,viol
enceandcr ime,
 drugabuse,
unemploy
mentandl
i
mit
edf
undi
ng -I
nther
esear
cherr
olecommuni
tyheal
thnur
ses
forheal
thpr
ograms. engagei
nsystemati
cinv
esti
gati
on,col
lect
ionand
anal
ysi
sofdatafort
hepurposeofsolv
ingprobl
ems
2.Educat
orr
ole andenhanci
ngcommunityheal
thpract
ice.
-Al
lresear
chesi
ncommuni
tyheal
thf
rom t
hesi
mpl
est
-I
tiswi
del
yrecogni
zedt
hatheal
tht
eachi
ngi
sapar
t inqui
rytot hemostepi demi ologi
calst
udyusest he
ofgoodnursi
ngpract
iceandoneofthemajor samef undament al process.Ther esearchprocess
funct
ionsofacommunityheal
thnur
se(Br
own, 1988)
. invol
vest hef ollowingst eps:
-Hast
hepot
ent
ial
forf
indi
nggr
eat
err
ecept
ivi
tyand •Ident if
y i
nganar eaofi nter
est
pr
ovi
dinghi
ghery
iel
dresul
ts. •Speci f
yt her esear chquest i
onorstatement•
-Wi
deraudi
encecanber
eachedandheal
tht
eachi
ng Reviewofl it
eratur e
processcont
inuet
obepl
acedoni
l
lnesspr
event
ion •Ident if
y i
ngt heconcept ual
framewor k
andhealthpr
omoti
on. •Selectr esear chdesi gn
•Col lectandanal yzedat a
3.Adv
ocat
erol
e •Inter pretther esul t
-Thecommuni •Communi catet hef i
ndi ngs
tyheal
thnur
seof
tenmustactas
advocateforcli
entspleadi
ngthecauseoracti
ngon
Thecommuni tyheal t
hnur seidenti
fi
esapr obl em or
behalfoft
hecl i
entgroup.Ther
earetimeswhen
question,
inv esti
gatesbycol l
ecti
ngandanal y zingdata,
healt
hcareclient
sneedsomeonet oexplai
nwhat
suggestsandev aluatespossi bl
esol ut
ionsandsel ects
servi
cestoexpectandwhi chserv
icestheyoughtt
o
andorr ej
ectsal lsolutionsandst art
sthei nv estigati
ve
recei
ve.
processov eragai n.Inonesense, t
henur sei ngat heri
ng
dataforheal thplanning, i
nvesti
gatesheal t
hpr oblemsi n
4.Manager
ialr
ole
ordertodesi gnwel lness–pr omot i
nganddi sease
-Asamanagert
henur
seexer
cisesadmi
nist
rat
ive preventi
onf orthecommuni ty.
dir
ect i
ont owar dstheaccompl ishmentofspeci fi
ed
goalsbyassessi ngcl i
ent s’needs, planningand
organi zingt omeett hoseneeds, di
rect i
ngand Responsi bil
it
iesoft heCommuni t
yHeal thNurse:
control l
ingandev aluati
ngt hepr ogresst oassur ethat 1.Par ti
cipatesinthedev el
opmentofanov eral
lhealt
h
goalsar emet . plan.
-Nur sesser veasmanager swhent heyov erseeclient 2.Pr ovidesqual i
tynur si
ngser vi
ces.
care,super viseancill
aryst aff,docasemanagement , 3. Ma i
n t
ains coordi
n a t
ion/
li
nk agesw/ot herhealth
managecasel oads,runcl inicsorconductcommuni ty tea m me mb ers.4.I
n iti
ates&c on duct
s researches
healthneedsassessmentpr ojects. relevanttoCHNser v ices.
5.Initi
ate&pr ovi
desoppor t
uniti
esf orprofessi
onal
Casemanagement growt h
Casemanagementr eferst oasy st
emat i
c
pr ocessbywhi cht henur seassessescl i
ents’ PhasesofHomeVi sit:
needs, plansforandco- ordinatesserv i
ces, *Pr e-
visit
ref erstoot herappr opriatepr oviders,
and *In-home
moni torsandev aluat espr ogresst oensur ethat *P ostv i
sit
clientsmul t
ipl
eser v i
ceneedsar emet
Tel ephonecont act-i fresourcesareav ail
ableuseof
5.Collabor atorrole communi cati
onserv ices.
-Nur
sewor
kwi
thmanypeopl
eincl
udi
ngcl
i
ent
s,ot
her
nurses, physici
ans,socialwor kersandcommuni t
y Writ
tencommuni cati
on–uset ogiv
especi f
ic
l
eader s,therapist
s,nutri
ti
onists,occupational i
nformat i
onsuchasi nstruct
ionsgiventoparents
therapists,psychologi
sts,epidemi ologi
sts, howev erthenur
secannotbecer t
ainthatthe
biostati
stici
ans, l
egisl
ator
s,et c.asamemberoft he i
nformat i
onwill
reacht heint
endedr eci
pientifgi
ven
healthteam ( Fair
ly1993,Will
iams, 1986). thr
ought heschoolchil
drenrequir
inglit
eracyand
i
nterest.
-Thecommuni
tyheal
thnur
seassumest
her
oleof
col
labor
ator
,whi
chmeanstoworkj
oint
lyi
na Homev i
sit
commonendeavor,
toco-
oper
ateaspart
ners. Professi
onali
nter
act
ionthatt
akespl
acei
nthefamil
y’
s
resi
dencewhereinst
eadthefamil
ygoi
ngtothenur
se
6.Leaderr
ole thenursegoestothefamil
y
-Thel
eader
shi
prol
e’
spr
imar
yfunct
ioni
stoef
fect
change;
thus,t
hecommuni
tyheal
thnur
sebecomes Cli
nicVisit
anagentofchange. Pati
entvisit
stheHealthcentert
oav ai
loftheser
vices
-Theyal
soseekt
oinf
luencepeopl
etot
hinkand off
eredbyt hefaci
l
itypri
mar i
l
yfortheconsult
ati
onon
behavediff
erent
lyaboutt
hei
rheal
thandt
hef
act
ors matter
st hatai
ledthem physi
cal
ly
contr
ibut
ingtoit
.
HomeVi si
t
8.Resear
cherr
ole Familynur
secont
actwhi
chall
owst heheal
thworkert
o
assessthehomeandfami
lysi
tuat
ionsinordert
o
provi
dethenecessar
ynur
singcar
eandheal
thr
elat
ed -f
ocusedoni
l
lnesscar
efori
ndi
vi
dual
sandf
ami
l
ies
acti
vi
ti
es. bot
hacut
eandchr
oni
cdi
seases.
PURPOSE: Examples:Homeheal
thnur
seperfor
mingwoundcar e
-Togi
venursi
ngcaretothecl
i
ent. tooneofthememberofthefamil
y.Anotheroneisa
-Toassessl
iv
ingcondi
ti
onsofthepat
ientandhi
s school
nursetaki
ngcar
eofallst
udent’
smedi cal
needs.
f
ami
l
yandt
hei
rheal
thpr
act
ices.
Communi
tyheal
thnur
singt
akespl
acei
nawi
dev
ari
ety
-Togi
veheal
tht
eachi
ngsr
egar
dingpr
event
ionand ofset ti
ngswhi chincludespr omot ingheal t
h, preventing
cont
rol
ofdi
seases. i
llness, mai ntai
ningheal th,rest oration,coordinat i
on,
-Toest
abl
i
shcl
oser
elat
ionshi
psbet
weent
he managementandev aluat i
onofcar eofi ndivi
dual s,
heal
thagenci
esandt
hepubl
i
c. fami l
ies,andcommuni tiesint hecommuni tyset tings,
car efocusesonmaxi mi zingi ndividual potential f
orself-
PRI
NCI
PLES: car eregardl essofanyi njuryori l
lness.Thecl ient
-Musthaveapur
poseorobj
ecti
ve. assumesr esponsibil
ityforheal thcar edi vi
sionsand
-Shoul car eprovision.Thechangei nheal thcar eser vices
dmakeuseofal
lavai
labl
einf
ormat
ionabout
resultedinchangesi nnur si
ngcar easwel l
.Set ti
ngsar e
thepat
ient
.Shoul
dconsi
derandgi
vepr
ior
it
ytot
he
changedt ot hecommuni tyandespeci allytohome.The
needsofcl
ient
s.
i
nt entofcar eisnottof i
xwi tht reatmentbutt oenhance
-Shoul
dinv
olvethecli
ent
s. thequal it
yofl i
feandsuppor tact i
onst hatmaket he
-Shoul
dbeflexi
ble. client
’slif
eascomf ortableaspossi bl
e.

GUIDELINESr egardingtheFREQUENCYofHomeVi si
t: 2.Communi ty–orientednursing
-Needsoft hecl i
ent. -f ocusedonpopul ati
onandcommuni t
yasawhol e.
-Accept anceoft hefamily. H eal
thp r
o mo t
iona ndd i
sease prevent
iona ct
ivi
ti
es
aredonet ohel pi mprovethehealthofthecommuni t
y
-Pol i
cyoft hespecifi
cagency. andpopul ati
on.Thi sisessential
lyknownPubl ic
-Ot herhealthagenciesandpersonnel
involv
edincar
e HealthNur si
ng.
offamily
.Pastser vi
cesgiventothef
ami l
i
es.
-Abi l
it
yofcl i
entstorecognizeownneeds. Iti
sthear tandsci enceofpr ol
onginglif
e,promot i
ng
healt
handpr eventingdiseasethroughorganizati
onof
-Gr eettheclientandintr
oducesel
f. communi tyef f
orts.Publichealt
hnur si
ngr ef
ersto
composi t
ionofnur singservicesandheal t
hpr omotion
ofthepopul ati
on.Itisaimedt o:

-i
mpr ov esani tation
Statet hepurposeoft hev isi
t. -controlofcommuni t
yepidemics
-Assessheal thneeds. -preventt hetransmi ssionofinfecti
on
-Performt hebagt echnique. -provideeducat ionaboutthebasi cpri
nci
plesof
-Perform nursingcareandgi veheal
tht
eachi
ngs.- personal hygiene
Recor dalldata,observati
onandcarerender
ed.-
Make -organizemedi cal andnursingservi
cesforearly
appoi ntmentforar et
urnv i
sit
. diagnosi s,prev enti
onandt reat
mentofdi seases.
-Newbor n
-PostPar t
um AcuteCar eSet ti
ng
-PregnantMot hers Thistermi susedf orpeopl ewhoar erecei v
ingi ntensiv
e
-Morbi dCases hospitalcar e.Carepr ovidedi nacut ecar eset ti
ngi s
usuall
ydi rectedatr esolvingi mmedi ateheal thproblems.
Module2 Anacut ecar esetti
ngi spar toft hehospi talset ti
ng
Topi
c1 whichalsocanbeusedasanambul atoryclinicorday
surgi
calcl i
ent sort heyrequi r
ehi ghlytechni cal care.
COMMUNI TYMENTALHEALTHNURSI NG( CMHN) Manyoft hesecl ientshav el i
fe-threateningcondi ti
ons
Thepri
mar yfuncti
oni stocoll
aborat
ew/a andrequi recl osemoni toringandconst antcar e.
community-basedsuppor tser
vicestopeopl
ew/ Therefore, acutenur si
ngcar ei sdi
fferentf r
om
mentali
ll
nessand/ oraddicti
on. communi ty-basednur singcar e.
OCCUPATI ONALHEALTHNURSI NG
Speci
alt
ynur si
ngpract i
cethatprovi
desheal
th
car
eservicestowor kers&wor kerpopul
ati
ons.

SCHOOLHEALTHNURSI NG
Aspeciali
zedpracticeofprof
essional
nur
sing
thatadvancesthewel l
-bei
ng,
academicsuccess,
andlif
elongachievementofstudents.
CommunitySetti
ngNur si
ngCar e:

6.Communi
ty-
basednur
sing