Unit one:

Introduction to concepts of
Community Health Nursing

1
Learning Objectivities:

At the end of this unit, you will be able to:

• Discuss the basic concepts in community health nursing using various

definitions
• Describe the health – illness continuum
• Explain the relation ship between community health perception of the
community and related health problems
• Analyze components of community health practices
• Describe characteristics of community health practice

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Community

 Broadly defined, a community is a collection of people who interact

with one another and whose common interest or characteristics
gives them a sense of unity and belonging.
 A community is a group of people in defined geographical area
with common goal and objective and the potential for interacting
with one another.

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 The Three Features of a Community

A community has three features, location, population and social system.

• Location: every physical community carries out its daily existence in a specific
geographical location. The health of the community is affected by this
location, including the placement of the service, the geographical features…
• Population: consists of specialized aggregates, but all of the diverse people
who live with in the boundary of the community.
• Social system: the various parts of communities’ social system that interact
and include the heath system, family system, economic system and
educational system.

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 Health
Health is defined as a state of physical, mental and social well being not
merely the absence of disease or infirmity (WHO,1948).
• Physical health implies a mechanistic functioning of the body.
• Mental health means the ability to think clearly and coherently and has to
do with your thinking and feeling and how you deal with your problem.
• Social health refers to the ability to Make and maintain relationship with
others and Interact well with people and the environment.

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 Health and Wellness
 Health
 Each person has a personal perception of health.
 Some people describe their state of health as good even though they may
actually have one or more diagnosed illness (es). That is because each
person perceives health in relation to personal expectations and values
 Health is a dynamic state in which the person is constantly adapting to
changes in the internal and external environments.
• For example, a person may see himself/herself as healthy while
experiencing a respiratory infection.

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Wellness
 Wellness is a life – style aimed at achieving physical, emotional,
intellectual, spiritual and environmental well being.
 The use of wellness measures can increase stamina, energy and self –
esteem, then enhance quality of life.
 Wellness can be thought of a balance of the physical, emotional,
psychological, social and spiritual aspects of a person’s life. This is a
dynamic state. Each person would define wellness in relation to personal
expectations.
 Wellness behaviors are those that promote healthy functioning and help
prevent illness. These include, for example, stress management, nutritional
awareness, and physical fitness.
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 Models of Health
• There are various models of the concept of health. Some models are based
narrowly on the presence or absence of definable illness. Others are based
more conceptually on health beliefs, wellness and holism.
A. Clinical Model (Dunn, 1961)
• In this model, health is interpreted as the absence of signs and symptoms
of disease or injury;
• the opposite of health is disease. Dunn defined, in this model, “health as a
relatively passive state of freedom from illness, and a condition of relative
homeostasis.” Illness is therefore, something that happens to a person. This
model may not take into consideration person’s health beliefs or person
life- styles.

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Cont…
B. Host –Agent Environment Model (Leavell, 1965)
This model helps to identify the cause of an illness. In this model:
• Host: Refers to the person (or group) who may be at risk for or
susceptible to an illness.
• Agent: is any factor (internal or external) that can lead to illness by its
presence.
• Environment: refers to those factors (physical, social, economic,
emotional, spiritual) that may create the likelihood or the
predisposition for the person to develop disease.

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Cont..

HO
ST
AGENT ENVIRONMENT

Fig. Host – agent – environment model.

• In this model health and illness depends on the interaction of these
three factors.

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 Cont..
C. Health Belief Model (HBM) (Rosenstock, 1974, as Modified by Stone
1991).
There is a relationship between a person’s belief and actions.
 Factors that influence persons belief’s:
• Personal expectation in relation to health and illness
• Earlier experience with illness or health
• Age and development state.

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 Cont..
• Health beliefs are person’s ideas, convictions and attitudes about health
and illness. They may be based on factual information, misinformation,
commonsense or myths, or reality or false expectations.
• Health beliefs usually influence health behavior this influence can be
positive or negative.

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 .
Health Belief Model (HBM)
• Addresses relationship between persons belief and behavior
• Provides a way of understanding and predicting how clients will behave in relation
to their health and how they will comply with health care therapies.
Components in HBM
First component (Individual Perception)
• Individual’s perception of susceptibility to illness: e.g. family like with coronary
health disease (CHD), after link is recognized particularly if one parent or both
siblings have died in the 4th decade from myocardial infections (MI).
Second component (Modifying Factors)
• Individual’s perception of the seriousness of the illness. This perception is
influenced and modified by demographic and socio-psychological variables,
perceived
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threat of the illness and cuesGAto action. 13
 .

Third component (Likelihood of Action)

• The likelihood that the person will take preventive action results from the person’s
perception of the benefits of and barriers to taking action.
• The preventive action may include: Lifestyle modification/change, increased
adherence to medical therapies or search for medical advice or treatment.
Implication of HBM to Nursing
• Helps nurses to understand factors influencing client’s
• Perception
• Beliefs and
• Behaviors
• Plan care that will most effectively assist client in maintaining or restoring health
and preventing illness.
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 .
D. High – Level Wellness Model (Dunn, 1961)

• According to Dunn (1961), health recognized as an ongoing process toward

the person’s highest potential functioning. This process involves the
person, family, and Community. Dunn described high level wellness as the
experience of the person alive with the glow of good health, alive to the tips
of their fingers with energy to burn, tingling with vitality – at times like this
the world is a glorious place.

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 E. Holistic Health Model

• Holism is a different approach to health is that acknowledges and respects

the interaction of a person’s mind, body and spirit within the environment.

• Holism is derived from the Greek holos (whole), was first used by South
African philosopher Jan Christian Smuts (1926) in Holism and Evolution

• Holism is based on the belief that people (or even their parts) cannot be fully
understood if examined solely in pieces apart from their environment.
People are seen as every changing systems of energy.
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.

Fig: Schematic representation of holism.

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 Health and illness

• Rather than focusing on curing illnesses, community based nursing care

focuses on promoting health and preventing illness. This holistic
philosophy therefore differs greatly from that of the acute care setting.

• Care provided in acute care setting is usually directed at resolving

immediate health problems. In the community, care focuses on maximizing
individual potential for self-care regardless of any injury or illness.

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 .
• Educational and community based programs can be designed to address
life- style.

• Health protection strategies relate to environmental or regulatory measures

that confer protection on large population groups. Health protection
involves a community wide focus.

• Preventive services include counseling, screening, immunization, or

chemo prophylactic interventions for individuals in clinical settings.

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 .
The prevention focus is a key concept of community based nursing.
Prevention is conceptualized on three levels:
• Primary prevention level
• Secondary prevention level
• Tertiary prevention level

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 Health – illness continuum

• The wellness- illness continuum (Travis and Ryan 1988) is a visual comparison of high –
level wellness and traditional medicine’s view of wellness. At the neutral point, there are no
signs or symptoms of disease.

• A person moving toward the left experiences a worsening state of health.

• Someone with wellness – oriented goals wants to more beyond the neutral point (more
absence of disease) to the right (toward high – level wellness).

• This person evaluates the current conduct of his/her life, learns about the available options,
and grows toward self – actualization by tying out of these options in the search of high level
wellness.
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.

Fig. Illness – wellness continuum model (Travis and Ryan, 1988)

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 Community health Practice

• It is part of the larger public health effort that is concerned with preserving
and promoting the health of specific populations and communities.
• Community health practice incorporates six basic elements:
Promotion of health
• It includes all efforts that seek to move people closer to optimal well-being
or higher level of wellness.
• It is the combination of educational and environmental supports for action
and condition of living conducive to health.
Prevention of health problems

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 Treatment
It focuses on the illness end of continuum and is the remedial aspects
of community health practice. This is practiced by:
A. Direct service to people with health problems; E.g. home visit for
elderly peoples, chronic illness, etc
B. Indirect service; e.g. assisting people with health problem to obtain
treatment and referral.
C. Development of program to correct unhealthy condition; e.g.
alcoholism, drug abuse, etc.

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 .
Rehabilitation
• It involves efforts which seek to reduce disabilities, as much as possible, and
restore functions; e.g. stroke rehabilitation.
Evaluation
• It is the process by which the practice is analyzed, judged, and improved
according to established goals and standards.
• It helps to solve problems and provides direction for future health care
planning.
Research
• It is a systematic investigation which helps to discover facts affecting
community health and community health practices, solve problems, and
explore improved methods of health services.
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 Community health Nursing

• It is defined as the synthesis of nursing and public health practice applied

to promoting and protecting the health of population.
• It is a specialized field of nursing that focuses on the health needs of
communities, aggregates, and in particular vulnerable populations.
• It is a practice that is continuous and comprehensive directed towards all
groups of community members.
• It combines all the basic elements of professional, clinical nursing with
public health and community practice.

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 .
• It synthesizes the body of knowledge from public health science and
professional nursing theories to improve the health of communities.
Characteristics of Community health Nursing
• Six important characteristics of community health nursing are
• particularly salient(relevant) to the practice of this specialty.
• It is a specialty field of nursing
• Its practice combines public health with nursing
• it is population focused.
• it emphasizes on wellness and other than disease or illness
• it involves inter-disciplinary collaboration
• it promotes client’s responsibility and self-care

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 .
Community settings nursing care
• Community health nursing takes place in a wide variety of settings
which includes promoting health, preventing illness, maintaining
health, restoration, coordination, management and evaluation of care of
individuals, families, and aggregates, including communities (Lancaster,
S.).
• In the community settings, care focuses on maximizing individual
potential for self-care regardless of any injury or illness.
• The client assumes responsibility for health care divisions and care
provision.

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 .

• The intent of care is not to fix with treatment but to enhance the quality of life
and support actions that make the client’s life as comfortable as possible.
Acute Care Setting
• This term is used for people who are receiving intensive hospital care.
• Care provided in acute care setting is usually directed at resolving immediate
health problems.
• An acute care setting is part of the hospital setting which also can be used as an
ambulatory clinic or day surgical clients or they require highly technical care.
• Many of these clients have life-threatening conditions and require close
monitoring and constant care. Therefore, acute nursing care is different from
community based nursing care.
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 Public Health Nursing

• It is the art and science of prolonging life, promoting health and preventing
disease through organization of community efforts.
• Public health nursing refers to composition of nursing services and health
promotion of the population.
• It is aimed to:
o improve sanitation
o control of community epidemics
o prevent the transmission of infection
o provide education about the basic principles of personal hygiene
o organize medical and nursing services for early diagnosis, prevention and treatment
of diseases.

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 Thank you

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