Roles Settings Practice: Community Health Nursing

Roles and Settings for Community Health Nursing Practice
Roles and Settings for

Community Health Nursing
Practice
Prepared by Suhail ALHumoud 1

objective
After completion the lecture the students enable to:

● Identify the three core public health functions basic to community
health nursing.
● Describe and differentiate among seven different roles of the
community health nurse.
● Discuss the seven roles within the framework of public health
nursing functions.
● Explain the importance of each role for influencing people’s health.
● Identify and discuss factors that affect a nurse’s selection and
practice of each role.
● Describe seven settings in which community health nurses practice.
● Discuss the nature of community health nursing, and the common
threads basic to its practice, woven throughout all roles and settings.
● Identify principles of sound nursing practice in the community.
2
Core public health functions basic to community health nursing.
Community health nurses work as partners within a team

of professionals (in public health and other disciplines),
nonprofessionals, and consumers to improve the health of
populations.
The various roles and settings for practice hinge on
three primary functions of public health: assessment,
policy development, and assurance.
They are foundational to all roles assumed by the
community health nurse and are applied at three levels of
service: to individuals, to families, and to communities
Regardless of role or setting of choice, these
foundational responsibilities direct the work of all
community health nurses.
3
The model includes assessment, policy development,

and assurance surrounding the individual, family, and
community.
Assessment is the regular collection, analysis, and
sharing of information about health conditions, risks, and
resources in a community.
Policy development uses the information gathered
during assessment to develop local and state health
policies and to direct resources toward those policies.
Assurance focuses on the availability of necessary
health services throughout the community. It includes
maintaining the ability of both public health agencies and
private providers to manage day-to-day operations as
well as the capacity to respond to critical situations and
emergencies
4
5
Assessment
means that the community health nurse must gather and
analyze information that will affect the health of the
people to be served.
The nurse and others on the health team need to
determine health needs, health risks, environmental
conditions, political agendas, and financial and other
resources, depending on the persons, community, or
population targeted for intervention.
Data may be gathered in many ways; typical methods
include interviewing people in the community, conducting
surveys, gathering information from public records, and
using research findings.
At the community level, assessment is done both
formally and informally as nurses identify and interact with6
Assessment
With families, the nurse can evaluate family strengths
and areas of concern in the immediate living environment
and in the neighborhood.
At the individual level, people are identified within the
family who are in need
7
Policy development
At the community level, the nurse provides
leadership in convening and facilitating community
groups to evaluate health concerns and develop a
plan to address the concerns. Typically, the nurse
recommends specific training and programs to
meet identified health needs of target populations.
8
Assurance
.
activities that make certain that services are
provided Community health nurses perform the
assurance function at the community
level when they provide service to target
populations, improve quality assurance activities,
and maintain safe levels of communicable disease
surveillance and outbreak control.
In addition, they participate in research, provide
expert consultation, and provide services within
the community based on standards of care.
9
Role of the community health nursing .
Historically, community health nurse have

engaged in many roles. From the beginning,
.
nurse in this professional specialty have

provided care to the sick, taught positive
health habits and self-care, advocated on
behalf of needy populations, developed and
managed, health programs, provided
leadership, and collaborated with other
professionals and consumer to implement
.changes in health services
10
The settings in which theses nurses

practiced varied, too. The home certainly
.
has been one site for practice, but so too

have clinics, schools, factories, and other
community-based locations.
11
Community health nurses wear many

hats while conducting day-to-day
practice. The focus of nursing
includes not only the individual, but
also the family and the community,
meeting these multiple needs
requires multiple roles.
12
Role of the community health nursing

(1)clinician,
(2) educator,
(3) advocate,
(4) manager,
(5) collaborator,
(6) leader, and
(7) researcher.
It also describes the factors that influence the
selection and performance of those roles.
13
Role of the community health nursing: Clinician
(1)Clinician
The most familiar role of the community
health nurse is that of clinician or care
provider
It means that the nurse ensures that
health services are provided not just to
individuals and families, but also to groups
and populations.
The goals for the nurse as clinician are to
reduce disease, discomfort, disability, and
premature death for the total community.
14
(1)Clinician
Clinician role involves certain emphases

that are different from those of basic
nursing. Three clinician emphases, in
particular, are useful to consider here:
holism, health promotion, and skill
expansion.
15
Holistic Practice
A holistic approach means considering
the broad range of interacting needs
that affect the collective health of
the “client” as a larger system
Holistic nursing care encompasses the
comprehensive and total care of the
client in all areas, such as physical,
emotional, social, spiritual, and
economic.
16
.
Focus on Wellness
The role characterized by its focus on promoting

wellness. the community health nurse provides
service along the entire range of the health
continuum but especially emphasizes promotion of
health and prevention of illness.
17
.
Focus on Wellness
Groups and populations are identified that may

be vulnerable to certain health threats, and
preventive and health promoting programs can be
designed. Examples includes:
.Immunization of preschoolers -
.Family planning programs -
.Cholesterol screening -
.Prevention of behavioral problems in adolescents -
Protecting and promoting the health of
vulnerable population is an important component of
the clinician role .
18
.
Expanded Skills
Many different skills are used in the role of the
community health clinician.
In the early years of community health nursing,
emphasis was placed on physical care skills.
With time, skills in observation, listening,
communication, and counseling became integral to the
clinician role as it grew to encompass an increased
emphasis on psychological and sociocultural factors.
19
.
Expanded Skills
Recently, environmental and community-wide
considerations— such as
problems caused by pollution,
violence and crime,
drug abuse,
unemployment,
poverty,
 homelessness, and
limited funding for health programs—
have created a need for stronger skills in assessing
the needs of groups and populations and intervening
at the community level.
20
.
Expanded Skills
The clinician role in population-based nursing also
-:requires skills in
Collaboration with consumers and other -
.professionals
.Use of epidemiology and biostatistics -
.Community organization and development -
.Research -
.Program evaluation -
- Administration and leadership.
21
Role of the community health nursing: Educator .
(2) Educator,
Health teaching is one of the major function of the
.community health nurse
The educator role is especially usefulness in
promoting the public's health for at least two
reasons:
1.Community clients usually are not actually ill
and can absorb and act on health information.
2.The educator role in community health nursing
is significant because a wider audience can be
reached.
22
Health education
Providing information and teaching people
how to behave safely and in a manner
that promotes and maintains their health.
A continuing process of informing people
how to achieve and maintain good health;
of motivating them to do so; and of
promoting environmental and lifestyle
changes to facilitate their objective.
23
:Goals of Health education

The rational for health education is
To equip people with the knowledge, attitude, .1
and behaviors to live the fullest life possible for
.the greatest length of time
Clients anticipate achieving their maximum life .2
.span
The nurse develops partnerships with a client .3
to achieve a behavior change that promotes,
.maintains, or restore health
Teaching is a specialized communication .4
process in which desired behavior changes are
.achieved
24
Teaching at Three Levels of Prevention

•Nurses should develop teaching programs
that coincide with the level of prevention
needed by the client. The three levels
primary, secondary and tertiary.
• Ideally , the nurse focuses teaching at the

primary level. If nurses were able to reach
more people at this level, it would help to
diminish the years of morbidity and limit
subsequent infirmity.
25
Teaching – Learning Principles

Teaching in community health nursing means to
influence, motivate, and act as catalyst in the
learning process. Nurses bring information and
learns together and stimulate a reaction that
leads to a change.
Nurses facilitate learning when they make it as

easy as possible for clients to change. To do this,
the nurse needs to understand the basic
principles underlying the art and science of
teaching-learning process and use of appropriate
materials to influence learning.
26
Seven Principles for Maximizing the Teaching –

Learning Process
Client readiness .1
Clients' readiness to learn influences teaching
effectiveness. The community health nurse must
:assess the clients for
.Emotional readiness .1
.Educational background .2
27
Client Perception .2
Clients' perception also affect their learning, individual
perceptions help people interpret and attach meaning to
things. A wide range of variables affects human
:perception. Theses variables includes
- Values. - Past experience.
- Culture. - Religion.
- Personality. - Developmental stage.
-Educational level. - Economic level.
- Surrounding social forces.
- Physical environment.
28
Educational Environment .3

The setting in which the educational endeavor
takes place has a significant impact on
learning.
•noise, heat, or uncomfortable seating.
•Physical conditions such as ventilation,
lighting, decor, room temperature, view of the
speaker
29
Client Participation .4
The degree of participation in the educational
process directly influences the amount of
.learning
.Subject Relevance .5
Subject matter that is relevant to the client is
learned more readily and retained longer than
.information that is not meaningful
30
Client Satisfaction .6
Clients must derive satisfaction from learning to
maintain motivation and increase self-direction
Client Application .7
Learning is reinforced through application.
Learners need as many opportunities as possible
to apply the learning in daily life
31
Health Education .
Teaching Process
The process of teaching in community health
nursing follows steps similar to those of the
nursing process:
.Interaction .1
Reciprocal communication must take place
between nurse and client. It is essential in
helping relationship and requisite to effective
.use of the nursing process
Community health nurses need to develop good
questioning techniques and listening skills to
determine client's learning needs and level of
.readiness
32
Health Education .
.Assessment and diagnosis .2

Determine client's present status and identify
.clients' needs for teaching
Assessing educational needs may be accomplished
:in several ways
.The nurse can use surveys -
.Interviews -
.Open forums -
The principles to remember is that clients should
be involved in identifying what they want to
learn.
33
Health Education .
.Setting goals and objectives .3

Once a need has been clearly identified, the
nurse and clients can establish mutually agreed-
.on goals and objectives
Goals : are broad statement of desired end
.outcomes
Objectives: are more specific descriptions of
.intended outcomes
34
Health Education .
.Planning .4
Design a plan for the learning experience that meets the
:mutually developed objectives
:The plan should include the following
.Subject: Content to be covered, sequence of the topics .1
.Intended audience .2
.Dates, times, and places .3
.Short- and long term goal statements .4
.Teaching –learning methods .5
.Activities and assignments .6
.Course outline of topics .7
.Evaluation methods and criteria .8
A written plan is best; it may part of the written nursing
.care plan
35
Health Education .
.Teaching .5
The class, seminar, workshop, or small-group
teaching should be conducted according to the
plan. Even one-on-one teaching, each eight steps
should be planned in advance, because each client
:has
.A different cultural background -
.Education -
.Intellectual level -
- Learning needs.
36
Health Education .
.Evaluation .6
Determine whether learning objectives were met
.and if not, why not
Evaluation measures progress toward goals.
Effectiveness of chosen teaching methods, or future
learning needs.
37
Health Education .
Teaching Methods and Materials

Teaching occurs on many levels and incorporates various
types of activities. It can be formal or informal, planned
or unplanned.
- Formal presentations, such as lecture with groups,
usually are planned and fairly structured. Some teaching
is less formal but still planned and relatively structured,
as in group discussions in which questions stimulate
exploration of ideas and guide thinking.
- Informal levels of teaching, such as counseling or
anticipatory guidance:-in which the client is assisted in
preparing for a future role or development stage, require
the teacher to be prepared, but there is no defined plan
of presentation.
38
Health Education .
There are four teaching methods:

1. Lectures.
2. Discussion.
3. Demonstration.
4. Role ply.
39
Health Education .
Teaching Materials
Many different kinds of teaching materials are available to the
nurse. They often are used in combination and are useful during the
.teaching process
:Visual images -
Such as Power point presentations, pictures, slides, posters, -
chalkboards, flannel boards, videotapes, CDs, bulletin boards, flash
.cards, pamphlets, flyers, charts, and gestures
:Television and Radio -
It appeals to sight and sound and grasp attention. Learning of both
positive and negative health behaviors through television can be more
.effective and efficient than traditional teaching methods
:Other tools -
- Such as, anatomic models, and improvised or purchased equipment,
provide clients with both visual and tactile learning experience
40
Health Education .
:Selection of teaching materials depends on

How well they suit learners and help to meet the -
.desired objectives
Sources of teaching materials that are free or -
inexpensive can enhance the nurse's teaching but need to
.evaluated foe effectiveness
The nurse needs to know how to help learners with
.special needs, those with physical or mental disabilities
41
Role of the community health nursing: Advocate
(3) Advocate
The community health nurse often acts as an advocate for
clients, pleading their cause or acting on their behalf:
Clients may need some one :-
To explain which services to expect, which services -
.they ought to receive
.To make referrals as needed-
To write letters to agencies or health care providers-
.for them
- To assure the satisfaction of their needs.
42
.
(3) Advocate
Advocacy Goals:
There are two underlying goals in client advocacy.
1. To help clients gain greater independence or self-
administration. by:
- Showing them what services are available.
- The ones to which they are entitled, and how to obtain
them.
2. To make the system more responsive and relevant to the

needs of clients, by calling attention to inadequate,
inaccessible, or unjust care, community health nurses can
influence change.
43
.
Advocacy Actions
The advocate role incorporate four characteristics
:actions
.Being assertive .1
.Taking risks .2
.Communicating and negating well .3
4. Identifying recourses and obtaining results.
44
Role of the community health nursing: Manager .
(4) Manager,
The nurse exercises administrative direction
toward the accomplishment of specified
goals by
• assessing clients’ needs,
•planning and organizing to meet those
needs, directing and leading to achieve
results, and
•controlling and evaluating the progress to
ensure that goals are met
45
Role of the community health nursing: Manager
The nurse serves as a manager

•when overseeing client care as a case manager
• supervising ancillary staff,
• running clinics
• conducting community health needs assessment
projects
46
In each instance, the nurse engages in four basic

functions that make up the management process.
The management process, like the nursing process,
incorporates a series of problem solving activities
or functions:
1.planning,
2.organizing,
3.leading, and
4.controlling and evaluating. These activities are
sequential and yet also occur simultaneously for
managing service objectives
47
Role of the community health nursing: Manager.
Nurse as Planner
The first function in the management process is
planning. A planner sets the goals and direction
for the organization or project and determines
the means to achieve them.
Specifically, planning includes
1.defining goals and objectives,
2.Determining the strategy for reaching them, and
3.designing a coordinated set of activities for
implementing and evaluating them.
48
Nurse as Organizer
The second function of the manager role is
that of organizer. This involves designing a
structure within which people and tasks
function to reach the desired objectives.
49
Nurse as Leader
As a leader, the nurse directs, influences,
or persuades others to effect change so as
to positively affect people’s health and move
them toward a goal.
The leading function includes
1.persuading and motivating people,
2.directing activities,
3.ensuring effective two-way communication,
4.resolving conflicts, and coordinating the plan.
5.Coordination means bringing people and activities
together so that they function in harmony while
pursuing desired objectives. 50
Nurse as Controller and Evaluator

A controller monitors the plan and ensures that it
stays on course.
Monitoring, comparing, and adjusting make up the
controlling part of this function. At the same time,
the nurse must compare and judge performance
and outcomes against previously set goals and
standards—a process that forms the evaluator
aspect of this management function.
51
Role of the community health nursing: Collaborator .
(5) collaborator,
Community health nurses seldom practice in isolation. They
must work with many people, including
•Clients
•other nurses,
•physicians,
•teachers,
•health educators
• social workers
•physical therapists
•nutritionists,
•occupational therapists,
•psychologists, epidemiologists, biostaticians and other
52
Role of the community health nursing: Collaborator
The community health nurse's collaborator role

-:requires
.Skill in communicating -
Interpreting the nurse's unique contribution to -
.the team
- Acting assertively as an equal partner.
53
Role of the community health nursing: Leadership Role .
(6) Leadership Role

Community health nurses are becoming
increasingly active in the leadership role, separate
from leading within the manager role mentioned
earlier.
The leadership role focuses on effecting change
thus, the nurse becomes an agent of change. As
leaders, community health nurses seek to initiate
changes that positively affect people’s health.
They also seek to influence people to think and
behave differently about their health and the
factors contributing to it.
54
(6) Leadership Role

At the community level, the leadership role may
involve working with a team of professionals to
direct and coordinate such projects as a campaign
to eliminate smoking in public areas or to lobby
legislators for improved child day care facilities.
55
(7) researcher.
In the researcher role, community health nurses engage
in systematic investigation, collection, and analysis of
data for solving problems and enhancing community
health practice. But how can research be combined with
practice? Although research technically involves a
complex set of activities conducted by persons with
highly developed and specialized skills, research also
means applying that technical study to real-practice
situations. Community health nurses base their practice
on the evidence found in the literature to enhance and
change practice as needed. For example, the work of
several researchers over 15 years supports the value of
intensive home visiting to high-risk families. The
outcomes of this research are changing practice protocol
to high-risk families in many health departments today. 56
SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE.
SETTINGS FOR
COMMUNITY
HEALTH NURSING
PRACTICE
57
The setting in which the community health nurses

are practiced their different roles are grouped
:into six categories
.Homes .1
.Ambulatory service settings .2
.Schools .3
.Occupational health settings .4
.Residential institutions .5
6. The community at large.
58
(1) Homes
For a long time, the most frequently used setting
for community health nursing practice was the
home. In the home, all of the community health
nursing roles, to varying degrees, are
performed. Clients who are discharged from
acute care institutions, such as hospitals or
mental health facilities, are regularly referred
to community health nurses for continued care
and follow-up. Here, the community health
nurse can see clients in a family and
environmental context, and service can be
tailored to the clients’ unique needs.
59
The home also is a setting for health promotion.

Many community health nursing visits focus on
assisting families to understand and practice
healthier living behaviors. Nurses may, for
example, instruct clients on parenting, infant care,
child discipline, diet, exercise, coping with stress,
or managing grief and loss.
60
(2) Ambulatory service settings,

Ambulatory service settings include a variety of
venues for community health nursing practice in
which clients come for day or evening services that
do not include overnight stays. Community health
centers are an example of an ambulatory setting.
Sometimes, multiple clinics offering comprehensive
services are community based or are located in
outpatient departments of hospitals or medical
centers.
61
(3) Schools
Schools of all levels make up a major group of
settings for community health nursing practice.
Community health nurses’ roles in school settings
are changing. School nurses, whose primary role
initially was that of clinician, are widening their
practice to include more health education,
interprofessional collaboration, and client
advocacy.
62
(4) occupational health settings,

Business and industry provide another group of
settings for community health nursing practice.
Employee health has long been recognized as
making a vital contribution to individual lives,
productivity of business, and the well-being of the
entire nation.
Community health nurses in occupational health
settings practice a variety of roles.
63
(5) Residential institutions,

Any facility where clients reside can be a setting in
which community health nursing is practiced.
Residential institutions can include a halfway house
in which clients live temporarily while recovering
from drug addiction or an inpatient hospice
program in which terminally ill clients live. A
continuing care center is another example of a
residential site providing health care that may use
community health nursing services.
Community health nurses also practice in settings
where residents are gathered for purposes other
than receiving care.
64
(6) Parishes
Parish nursing finds its beginnings in an ancient
tradition. The beginnings of community health
nursing can be traced to religious orders and for
centuries churches, temples, mosques, and other
spiritual communities were important sources of
health care. In parish nursing today, the practice
focal point remains the faith community and the
religious belief system provided by the
philosophical framework
65
(6) Parishes
Parish nursing may take different names.
Whatever the service is called, it involves a large-
scale effort by the church community to improve
the health of its members through education,
screening, referral, treatment, and group support.
66
(7) The community at large.

Unlike the six settings already discussed, the
seventh setting for community health nursing
practice is not confined to a specific philosophy,
location, or building. When working with groups,
populations, or the total community, the nurse may
practice in many different places.
67

Roles Settings Practice: Community Health Nursing

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Roles and Settings for Community Health Nursing Practice

Roles and Settings for

Prepared by Suhail ALHumoud 1

After completion the lecture the students enable to:

Community health nurses work as partners within a team

The model includes assessment, policy development,

Historically, community health nurse have

nurse in this professional specialty have

The settings in which theses nurses

has been one site for practice, but so too

Community health nurses wear many

Role of the community health nursing

Clinician role involves certain emphases

The role characterized by its focus on promoting

Groups and populations are identified that may

:Goals of Health education

Teaching at Three Levels of Prevention

• Ideally , the nurse focuses teaching at the

Teaching – Learning Principles

Nurses facilitate learning when they make it as

Seven Principles for Maximizing the Teaching –

Educational Environment .3

.Assessment and diagnosis .2

.Setting goals and objectives .3

Teaching Methods and Materials

There are four teaching methods:

:Selection of teaching materials depends on

2. To make the system more responsive and relevant to the

The nurse serves as a manager

In each instance, the nurse engages in four basic

Nurse as Controller and Evaluator

The community health nurse's collaborator role

(6) Leadership Role

(6) Leadership Role

The setting in which the community health nurses

The home also is a setting for health promotion.

(2) Ambulatory service settings,

(4) occupational health settings,

(5) Residential institutions,

(7) The community at large.

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