Overview of Community Health Nursing
Community Health Nursing Theories
à Systems thinking; studies how individual or unit interacts w/ other organizations or systems; useful
in examining cause& effect relationships
à Upstream thinking; used to focus on interventions that promote health or prevent illness
• Nightingales Environmental Theory; highlights relationship between environment and health;
depicts health as continuum; emphasizes preventative care
• Health Belief Model (HBM); predict or explain health behaviors; assumes preventive actions are
taken to avoid disease; emphasizes change at individual level; describes likelihood of taking an action to avoid disease based on
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– Perceived susceptibility, seriousness, and threat of a disease
– Modifying factors (demographics, knowledge level)
– Cues to action (media campaigns, disease effect on family/friends, recommendations from health
care professionals)
– Perceived benefits minus perceived barriers to acting
• Milios Framework for Preventions; complements HBM; emphasizes change at community level;
identifies relationship between health deficits and availability of health promoting resources;
theorizes that behavior changes w/in a large number of people can lead to social change
• Penders Health promotion Model (HPM); similar to HBM; does not consider health risk as factor
that provokes change; examines factors that affects individual actions to promote and protect health
– Personal factors (biological, psychological, sociocultural), behaviors, abilities, self-efficacy
– Feelings, benefits, barriers, and characteristics associated with the action
– Attitudes of others, and competing demands and preferences
• Transtheoretical (TTM) of Stages of Change (SOC) Model; theorizes that change occurs over
time and in 6 stages
1. Precontemplation, where the individual is unaware of the need to change
2. Contemplation, where the individual considers change, and weighs the benefits with costs
3. Preparation, where the individual plans to take action
4. Action
5. Maintenance, where the individual implements actions to continue the behavior
6. Termination, when conscious efforts to continue the health behavior are no longer needed
because the individual is consistent. Most clients never reach this point.
• The Precaution Adoption Process Model; similar to TTM & SOC; includes stage of being
unengaged regarding issue between stages of being unaware & contemplating; does not include
termination stage
Essentials of Community Nursing
– Determinants of Health; client of environmental factors that influence health (nutrition, social
support, stress, education, finances, transportation, housing, biology, genetics, personal health
practices)
– Health Indicators; describe health status of a community & serves as targets for improvement
(mortality rates, disease prevalence, levels of physical activity, obesity, tobacco, or other
substance use)
– Nurses; determine community heaths by examining the degree to which the communities
collective health needs are identified and met
– Community; group of people and institutions that share geographic, civic, &/or social
parameters
• Community health nursing involves synthesis of nursing & public health theory
– Goals; promote, preserve, & maintain health of populations
– Client is the community or a population (an aggregate that shares 1+ personal characteristics
w/in community)
• Public Health Nursing; population focused, involves combo of nursing knowledge w/ social &
public health sciences; GOAL à promote health & prevent disease
– ASSESSMENT; systematic methods used to monitor health of population; monitor health status
to identify problems; diagnose & investigate health problems & hazards w/in community
– POLICY DEVELOPMENT; developing laws & practices to promote health of a population
based on scientific evidence; inform, educate & empower about health issues; mobilize
community partnerships to identify & solve health problems; develop policies & plans that
support individual & community health efforts
– ASSURANCE; ensuring adequate health care personnel and services are accessible; enforce
laws & regulations; link people to needed health services & ensure the provision of health care;
ensure competent public & personal healthcare workforce; evaluate effectiveness, accessibility,
and quality of personal & population based health services
• Population- Focused Nursing; includes assessing to determine needs, intervening to protect &
promote health, and preventing disease w/in specific populations ( those at risk for HTN, w/o health
insurance, w/ specific knowledge deficits)
– Key Principles of Public Health Nursing; emphasize primary prevention; work to achieve
greatest good for the most people; recognize that the client is a partner in health, use resources
wisely to promote the best outcomes
Principles Guiding Community Health Nursing
• Ethics; Ethical considerations include
preventing harm, doing no harm,
promoting good, respecting both
individual and community rights,
respecting autonomy, and diversity, and
providing confidentiality, competency,
trustworthiness, and advocacy.
– Apply ethical principles through core
functions as they collect and manage
information (assessment), develop
policies that are in the best interest of the
people in an area (policy development),
and create interventions that promote
healthcare equality across population
groups (assurance).
• Advocacy; Client advocate is one role of the community health nurse. The nurse plays the role of
informer, supporter, and mediator for the client.
• Evidence-Based Practice; involves using best practice, expert opinion, and client preferences to
change the delivery of client care; GOAL à improve outcomes
– DATA; nurse should appraise data collected to measure if bias was minimal (quality); the
number of studies, participants, or strength of effect (quantity); and whether the results are
repeatable (consistency)
– IN THE COMMUNITY; use evidence to provide new solutions for groups of people
(assessment), provide information to communities (policy development) and evaluate the
effectiveness of the health care environment for groups (assurance).
• Quality; Quality assurance, quality improvement, and quality management are part of improvement
of health care.
– Quality care is promoted through licensure and credentialing of health care providers, adherence
to facility policies, professional development, and compliance with legal guidelines.
– Total quality management (TQM); seeks to improve quality & performance which meets or
exceeds expectations
– Continuous quality improvement (CQI); Public health nurses follow the continuous quality
improvement process in carrying out roles of assessment, assurance, and policy development on
an ongoing basis. Nurses evaluate quality by examining aspects of care;
– Effectiveness: providing services to those who will benefit
– Timeliness: reducing waits and harmful delays in providing and receiving care
– Client-centered: ensuring client values guide decision-making
– Equity: providing equal care without discriminating against gender, race, sexual
orientation, socioeconomic status
– Safety: avoiding injuries to clients from the care intended to help them
– Efficiency: avoiding waste in supplies, ideas, energy
• Professional Collab & Communication
– BENEFITS OF PROFESSIONAL COMMUNICATION; adherence to treatment plan,
admits to acute care, ¯ cost, shared decision making, ¯ medication errors
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Health Promotion & Disease Prevention
• Primary Prevention; prevention of initial occurrence
– Nutrition education, Family planning and sex education, Smoking cessation education,
Communicable disease prevention education, Education about health and hygiene issues to
specific groups (day care workers, restaurant workers), Safety education (seat belt use, helmet
use), Prenatal classes, Providing immunizations, Advocating for access to health care, healthy
environments
• Secondary Prevention; early detection & treatment w/ goal of limiting severity & adverse effects
– Community assessments, Disease surveillance (communicable diseases), Screenings, Cancer
(breast, cervical, testicular, prostate, colorectal), Diabetes mellitus, Hypertension,
Hypercholesterolemia, Sensory impairments, Tuberculosis, Lead exposure, Genetic
disorders/metabolic deficiencies in newborns, Control of outbreaks of communicable diseases
• Tertiary Prevention; reduce limitations of disability & promoting rehab following health
alterations
– Maximization of recovery after an injury or illness (rehabilitation, Nutrition counseling for
management of Crohn’s disease, Exercise rehabilitation, Case management (chronic illness,
mental illness), Physical and occupational therapy, Support groups, Exercise for a client who has
hypertension (individual) Overview of Community Health Nursing