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Community Health Nursing (47 1 Nur.

Complied by
Dr. / Essmat Mohamed Gemeay Dr./ Mona El -Nady Assistant Professors Faculty of Nursing King Saud University

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After completion of this session the students should be able to : 1. Define community health, and public health, 2. Identify Community health nursing practice and practice settings for the community health nurse 3. Identify the scope of community health nursing 4. Compare the community health nursing process and the individual/family/nursing process 5. Discuss roles of the community health nurse

Community health nurses actually action usually not apparent to the general population. The impact of their work becomes evident only over the longer term through population data such as a reduction in the number of low-birth-weight infants, more buildings and municipalities with smoke-free bylaws, and more elderly persons with less debilitating chronic illness remaining in their own homes because they are provided appropriate home health nursing services. The larger health -promoting changes that occur over time are an accumulation of smaller ini tiatives by community health nurses working in partnership with other professionals, sectors, and communities.

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Definition of Health according to WHO is a state of complete

physical, mental and social well -being and not merely the absence of disease or infirmity.

Definition of Community Health Nursing

Community Health Nursing according to ANA is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations.

Definition of Public Health

Public Health is the science and art of preventing disease, prolonging

life, and promoting health and efficiency through organized community effort Such as, a) The sanitation of the environment b) Control of communicable infections c) Education of the individual in personal hygiene

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d) Organization of medical and nursing services for the early diagnosis and preventive treatment of disease e) Development of the social machinery to insure everyone a standard of living adequate for the maintenance of health

Characteristic of Community health nursing practice

y y y y y
The practice is general and comprehensive. Encompasses nursing practice areas emphasizing health promotion, illness prevention, Building social and community support for health. The promotion of health &Prevention and health protection

It promote clients responsibility and self care y synthesizes knowledge from public health sciences and professional nursing theory; y promotes linkages between individuals, communities, the broader health system and other health determining sectors; and works with communities to develop specific services .

Five community nursing standards

1. Promoting health: incorporates practice strategies in health promotion, prevention, protection and maintenance, restoration and palliation 2. Building individual/community capacity: reflects the integral role of work with individuals, groups, organizations and communities in developing skills, knowledge and readiness to take action in support of health 3. Building relationships: emphasizes development of caring relationships, networks and supportive environments 4. Facilitating access and equity: integrates application of the principles of primary health care in working with others to facilitate universal and equitable access to services and addressing determinants of health 5. Demonstrating professional responsibility and accountability : acknowledges the autonomy of community health nursing practice and the practitioner's responsibility in providing competent care within a complex environment

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Core functions of the PHN(component of community health nursing practice

Health Promotion PHNs provide the leadership in health promotion. Health promotion is the process of enabling people to increase control over, and to improve their health. Health promotion: y involves the population as a whole in the context of everyday life, rather than y focusing only on at-risk people; y is directed toward action on the determinants or causes of health (e.g., food security, parenting skills, self-care skills, social support); y combines diverse, but complementary, methods or approaches including communication, education, legislation, fiscal measures, organizational y change, community development and spontaneous local activities against health hazards; aims particularly at effective and concrete public participation; Is basically an activity in the health and social services fields, and not a medical service. Health professionals, particularly in primary health care, have an important role in nurturing, enabling and practicing in health promotion. (Adapted from Ottawa Charter for Health Promotion, World Health Organization, 1986)

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Roles of the Community Health Nurse

The CHN implements same roles as other nurse specialists, because she works with individuals, families, the community, and selected subgroups of the community, her roles are: Advocate Provider Counselor Planner Consultant Educator Evaluator Researcher Coordinator

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Care provider

It is the most familial role of CHN


The definition of advocate is the act of informing and supporting a person so that he can make the best decisions possible for himself.  The CHN can work directed to providing care which promotes and preserves the health and well-being of communities.  The CHN can provide the client with information about options available, allows the client to make a decision & support the final decision.  The CHN can write letters, talk to the agency involved to care & provide appropriate information, and plead the case for the family.  Community advocacy involves workings with the community members to determine solutions for identified problems and supporting ultimate decisions.

The community health nurse may serve as consultant to a number of different groups. This includes consultation to other health care p roviders, health care agencies, agencies who relate to health care agencies, politicians and special interest community groups. The most commonly role applied with individuals and families is counselor. The counselor can provide crisis intervention, supportive counseling & other types of counseling that are appropriate with education and skills.

The CHN is often responsible for coordinating activities of other health care agencies.
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The role of educator includes education of individuals clients, family & specific community groups. Skills of teaching are incorporated with knowledge of the learning process in order to provide the best possible educational experience.

The evaluator role of the CHN is implemented in many ways. A nurse may be involved in evaluating health care programs through inspection duties. The role of evaluator requires careful preparation of the evaluation process to be used in selected situations. Preparation for the role of evaluator will include becoming familiar with the purpose of the evaluation, the person or content to be evaluated and the communication skills needed to communicate effectively the findings of the evaluation.

The role of the CHN in planning ranges from planning nursing care for individuals and families to participating in large community programs planning for specific health related needs and also participate in implementation of the planning phase of the nurse process. This role could involve gathering data. The role of provider, the type of nursing care provided may vary depending on the employing agency e.g. the administration of specific nursing treatments prescribed by a physician & performs various assessment activities.

Depending on educational preparation, the CHN may participate in research, the preparation for undergraduates includes learning the nature of inquiry, introduction to research grand, process and methodology and
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the use of research findings. Some CHN specialize in a particular aspect of nursing care. A clinical specialist may be employed in a community health agency as well as in a hospital. Clinical specialists are prepared on the masters level with a specialty in a specific field, e.g. family health, pediatrics, midwifery, mental health counseling and family therapy.

Community health nursing settings

A CHN may practice in an acute care setting, ambulatory care, and community settings.

Acute care settings

three roles that the CHN may practice in an acute c are setting include discharge planner, emergency department nurse, and epidemiologist (infection control nurse). the nurse interviews the family, determines their resources and needs, and facility a smooth transfer from hospital to home or another health or another health care facility.

The nurse conducts an investigation of the source and course of the disease, completes required forms, and makes referrals to appropriate health departments.
Ambulatory Care Settings

The CHN can practice in a variety of ambulatory care settings including doctors offices, clinics (both community based and those connected with hospitals), community mental health centers, and health maintenance organizations. In these settings, the nurses commonly provide instruction for self-care, and make appropriate referrals in addition to providing physical or emotional care. Nurses are usually available for consultation

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and maintaining independence of home visits, responsible for nursing assessment and for making recommendations to th e physician.
Community Settings

CHN practice in community settings includes schools, industry, prisons, home health agencies, health departments, private practice, or voluntary organizations. Health departments including sanitarians & vital record statisticians, communicable disease investigation, home visiting (focus on health promotion, assessment, education & referral), inspection (nursing homes, day care), school nursing: participation in clinics. Home health agencies provide home nursing care primarily for individuals. Services is initiated via physicians orders, and nurses provide tertiary care, including monitoring of health status & the performance of nursing treatments. School nursing services are including health evaluation, counseling, education & first aid. The school nurses practice focuses on primary and secondary prevention and serves not only students but also parents and teachers. Occupational health nurses are providing nursing services to employees (first aid, complete insurance forms, participate in health assessment, counseling, education and research).

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