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College of nursing
Nazar Ahmed Mahmud
At the end of this chapter, the student should be able to:
Define community health nursing.
Distinguish between community health nursing and community-based nursing.
Differentiate between district and program-focused community health nursing.
Identify at least five attributes of community health nursing.
Distinguish among client-oriented, delivery-oriented, and population-oriented
community health nursing roles.
Describe at least five client-oriented roles performed by community health
Describe at least three delivery-oriented roles performed by community health
Describe at least four population-oriented roles performed by community health
Health: Is state of complete physical, mental, and social well-
being and it is not merely the absence of disease or infirmity
Community: A group of people who share common interests,
who interact with each other, and who function collectively
within a defined social structure to address common
Examples of some communities:
– Citizens of a town
– Group of farmers
– Prison community
– Tiny village in Appalachia
– Members of Mothers against Drug Driving
– Professional nurses
Three Types of Communities
1. Geographic = city, town, neighborhood
2. Common-interest = church, professional organization,
people with mastectomies
3. Community of solution = group of people who come
together to solve a problem that affects all of them.
Nursing: encompasses autonomous and collaborative care of individuals of all ages,
families, groups and communities, sick or well and in all setting. Nursing includes the
promotion of health, prevention of illness, and the care of ill, disabled, and dying
people. Advocacy, promotion of a safe environment, research, participation in shaping
health policy and in patient and health systems management, and education are also
key nursing roles (ICN, 2002).
Neighborhood: A smaller, more homogeneous group than a community that involves
interaction and a level of identification with others living near-by.
Population: The general public or society or a collection of communities.
Aggregates: Populations with some common characteristic that frequently have
common concerns, but may not interact with each other to address those concerns.
"Science and art of preventing disease, prolonging life, promoting
health and efficiency through organized community effort.
1. The sanitation of the environment.
2. Control of communicable diseases.
3. The education of individuals in personal hygiene.
4. The organization of medical and nursing services for the early diagnosis
and preventive treatment of diseases.
5. The development of social machinery to ensure everyone a standard of
living adequate for the maintenance of health.
so organizing these benefits as to enable every citizen to realize his
birthright off birth and longevity” (Charles Edward A. Winslow, 1920)
The identification of needs and the protection and improvement of
collective health within a geographically defined area.
Community Health Nursing:
Special field of nursing that combines the skills of nursing, public
health and some phases of social assistance and functions as part of the
total public health program for the promotion of health, the improvement
of the conditions in the social and physical environment, rehabilitation of
illness and disability ( WHO Expert Committee of Nursing )
Community Health (CH) vs Public Health (PH)
• CH : “identification of needs and the protection and
improvement of collective health within a geographically
• PH : “activities that society undertake to assure the
conditions in which people can be healthy”
Application of the nurses process in caring for individuals, families and
group were they live, work or go to school or as they move through the
health care system.
Zotti and Stotts (1996) compared Community-Based Nursing and community
health nursing and explained that the goals of the two are different:
Community health nursing emphasizes preservation and protection of
health, while community-based nursing emphasizes managing acute or
In community health nursing, the primary client is the community while in
community-based nursing, the primary clients are the individual and the
Services in the community-based nursing are largely direct while in
community health nursing, services are both direct and indirect.
“Community” or “public” health nursing is population based.
Care may be given to individuals and families, but its purpose is
the improvement of the health of the population as whole.
Focus on the entire population.
Is based on assessment of the populations' health status.
Considers the broad determinants of health.
Emphasizes all levels of prevention.
Intervenes with communities, systems, individuals, and families.
The mission of community health nursing:
The primary mission of community health nursing is improving
the overall health of the population through health promotion,
illness prevention, and protection of the public from a wide
variety of biological, behavioral, social and environmental
"promote the good life" in all of Its physical, social,
psychological, cultural, and economic aspects
HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH NURSING
Concept of Health
Health: holistic state of well-being, including soundness of
mind, body, and spirit
Wellness: health plus the capacity to develop one’s
potential, leading to a fulfilling and productive life
Illness: state of being relatively unhealthy
Characteristics of CHN:
1. The client or “unit of care” is the population.
2. The primary obligation is to achieve the greatest good for the greatest number of
people or the population as a whole.
3. The processes used by public health nurses include working with the client(s) as
an equal partner.
4. Primary prevention is the priority in selecting appropriate activities.
5. Selecting strategies that create healthy environmental, social, and economic
conditions in which populations may thrive is the focus.
6. There is an obligation to actively reach out to all who might benefit from a
specific activity or service.
7. Optimal use of available resources to assure the best overall improvement in the
health of the population is a key element of the practice.
8. Collaboration with a variety of other professions, organizations, and entities is
the most effective way to promote and protect the health of people.
COMPONENT OF COMMUINTY HEALTH PRACTICE
› Community health practice can be best understood by examining six
basic components, which, when combined, encompass its services
and programs. These components are:
1. Promotion of health.
Includes all efforts that seek to move people closer to optimal well-
being or higher levels of wellness .
The goal of health promotion:
Is to enable people to exercise control over their well-being and
ultimately improve their health.
Is to raise levels of wellness for individuals, families, populations, and
2. Prevention of health problems.
Prevention of health problems constitutes a major part of community health
Prevention means: Anticipating and averting problems or discovering them as
early as possible to minimize potential disability and impairment.
Three Levels of prevention:
1- Primary prevention: Action taken prior to the occurrence of health
problems and directed toward avoiding their occurrence. Primary
prevention includes health promotion, health protection, and illness
2- Secondary prevention: The early identification and treatment of
existing health problems.
3- Tertiary prevention: Activity aimed at returning the client to the
highest level of function and preventing further deterioration in health.
3. Treatment of disorders.
It focuses on the illness end of the continuum and is the remedial
aspect of community health practice.
This occurs by three methods :
1. Direct service to people with health problem.
2. Indirect service that helps people to obtain treatment.
3. Development programs to correct unhealthy conditions.
The fourth component of community health practice, involves efforts to
reduce disability and , as much as possible, restore function.
People whose handicaps are congenital or acquired through illness or
accident e.g:.Stroke, .Heart condition,.Amputation, Mental illness.
The process by which that practices is analyzed,
judged, and improved according to established goals
Is systematic investigation to discover facts affecting
community health and community health practice,
solve problems, and explore improved methods of
Community Health Nursing Roles:
A. Client-oriented roles
B. Delivery-oriented roles
C. Population-oriented roles
A. Client-oriented Roles
Uses the nursing process to provide direct nursing intervention to individuals, families, or
Facilitates learning for positive health behavior change
Teaches and assists clients in the use of the problem solving process
4. Referral Resource
Links clients to services to meet identified health needs
5. Role Model
Demonstrates desired health-related behaviors
Speaks or acts on behalf of clients who cannot do so for themselves
7. Primary Care Provider
Provides essential health services to promote health, prevent illness, and deal with existing
8. Case Manager
Coordinates and directs the selection and use of health care services to meet client needs,
maximize resource utilization, and minimize the expense of care
B. Delivery-oriented Roles
1. Coordinator/Care Manager
Organizes and integrates services to best meet client needs in
the most efficient manner possible
Engages in shared decision making regarding the nature of
health problems and potential solutions to them
Provides and maintains connections and communication
between clients and health care providers or among providers
C. Population-oriented Roles
1. Case Finder
Identifies clients with specific health problems or conditions
Geared toward awareness of population-level problems
Influences clients and others to take action regarding identified health problems
3. Change Agent
Initiates and facilitates change in individual or client behaviors or conditions or
those affecting population groups
4. Community Developer
Mobilizes residents and other segments of the population to take action regarding
identified community health problems or issues
5. Coalition Builder
Promotes the development and maintenance of alliances of individuals or groups of
people to address a specific health issue
Conducts studies to explain health-related phenomena and to evaluate the
effectiveness of interventions to control them