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Course: Fundamentals of Nursing�Topic: Domains of Community Health Care

The Nurses International Community

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COPYRIGHT

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Module Goals

Learners will be able to:

Define the following terms: Community based care nursing,Community health nursing, Public health nursing, Community oriented nursing areas.
Include the primary health goal for each area.
Define the role of the nurse in each of the above areas.
Elaborate on the nurse’s role as advocate, educator, collaborator, counselor, case manager, policy change agent, research, disease prevention, and health promotion in the above areas.
Describe the barriers nurses may encounter in providing care in the above areas (include local, cultural and global factors).

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Community Health Nursing

WHO (2017) defines community health nursing as-

“A 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 programme for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”

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Community Health Nurse: Roles and Responsibilities

World Health Organization [WHO] (2017) states that the practice of community health nurses involve the following:

Assessment of entire population needs.

Systematic approaches are applied.
Identifying sub-population, families or individual who benefit from health promotion activities, or are at risks of illness, injury, disability or premature death.

Identification and articulation of the multiple determinants of health in communities.

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Community Health Nurse: Roles and Responsibilities

Works to provide solutions to the community needs, through.

Program planning.
Promotion of policy changes.
Developing interventions in collaboration with the community.

Effective and equitable implementation of public health plans and policies.
Conduct of evaluations to determine effectiveness of the health programs.
Use of evaluation results to inform further research, and influence and direct care service delivery, deployment of health resources, and policies to promote health and prevent disease.

WHO, 2017

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Community Health Nursing Practice Settings

Home care
Community health centers
Schools
Street clinics
Youth centers
Homeless shelters
Nursing outposts
Correctional facilities
Aid organizations like Doctors without borders, Red cross
Non-profit organizations with public health programs
Government public health agencies

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Community Health Nursing Roles and Activities

Roles of CHN depend on the practice setting
CHN activities include:

Case management
Referral and follow-up
Care/Counselling
Advocacy
Health education
Building capacity
Building coalitions & networks
Consultation
Facilitation
Health threat response

Canadian Public Health Association, 2010

Leadership
Outreach
Policy development & implementation
Research management, planning, coordination, evaluation
Screening
Surveillance
Team building & collaboration

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Summary of community health nursing interventions in public health care systems by WHO (2017)

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Critical Thinking Question:

Which is the primary goal of community health nursing?

Support and supplement the efforts of the medical profession in the promotion of health and prevention of illness.
Enhance the capacity of individuals, families and communities to cope with their health needs.
Increase the productivity of the people by providing them with services that will increase their level of health.
Contribute to national development through promotion of family welfare, focusing particularly on mothers and children.

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CHN’s Role: Advocacy

Canadian Public Health Association, 2010

Work to develop clients’ capacity to speak for themselves.
Use advertising and media in skilful ways for advocacy.
Promote resource development that will lead to equal access to health and health-related services.
Show a strong commitment to equity and social justice.

Speak out for equity in health through legislation/policy-making.

Act as spokesperson, when asked, to represent the views of individuals and groups seeking to promote their health.

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CHN’s Role: Case Management

Actively engage with individuals, groups, and communities who

May be at risk
Who meet the agency’s criteria for case management

Aim to empower the client (individual/family) to attain and/or maintain desired health status for improved quality of life.
Assess client’s strengths, skills, risks/barriers to care.
Identify resources and services available to help with care.
Develop, implement, and evaluate agreed-upon plan with the client.
Use interdisciplinary approach and cooperate with other organizations as needed.

Canadian Public Health Association, 2010

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CHN’s Role: Care/Counselling

Establish therapeutic relationship based on trust, respect, caring, listening, and boundaries.
Use clinical skills to assess the client’s ability to participate in joint planning, implementation, and evaluation of nursing interventions.
Use health promotion/illness/injury prevention techniques that are:

Client-centered
Client-driven
Strengths-based

Enhance the client’s strengths
Promote client self-care and/or avoidance of harm to self and others

Help client accept their share of responsibility for health.

Canadian Public Health Association, 2010

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CHN’s Role: Health Education

Provide education on health promotion, disease and injury prevention specific to the client.
Assess and identify client’s learning ability and needs.
Use teaching methods appropriate to the client’s needs.
Use content expertise on a topic.
Evaluate effectiveness of health education interventions.

Canadian Public Health Association, 2010

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CHN’s Role: Research

Identifies and supports investigation into key issues and approaches relevant to community health and wellness.
Participates in research projects.
Shares research and program evaluation information with colleagues, educators, nursing students, other professionals, and the public.
Uses research findings to assign human and financial resources and to evaluate interventions.
Identifies program areas which need to change; works with other colleagues to alter programs.

Canadian Public Health Association, 2010

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CHN’s Role: Policy Development and Implementation

Identify areas in need of policy and program development related to health promotion and prevention of disease/injuries/disability.
Help set clear philosophies, policies, standards of practice, and program objectives with measurable outcomes for nurses and other health care providers.
Participate in implementing and evaluating policy.
Use the political process to promote health.
As a delegated act, may enforce policy by requiring others to comply with laws, rules, regulations, and policies.
Uses effective communication skills to foster relationship-building, collaboration, negotiation, and conflict resolution.

Canadian Public Health Association, 2010

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CHN’s Role: Collaboration and Facilitation

Use mediation skills to facilitate inter-agency and inter-governmental cooperation for the shared purpose.
Commit to a capacity-building approach that uses collaboration (with two or more people or organizations) to promote and protect health.
Use effective processes to:

Bring people together and share point of views openly.
Clarify issues or processes.
Ensure that meetings are run well and achieve a high degree of agreement on the meeting’s stated goals and objectives.
Support building of community, group, and individual capacity.

Canadian Public Health Association, 2010

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Critical Thinking Question:

How might a community nurse accomplish the following interventions?

Client self-care and/or avoidance of harm to self and others.

Help clients accept their share of responsibility for health.

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CHN Skills

NHS, n.d.
WHO, 2010

Critical thinking and problem-solving skills^1,2
Excellent communication skills^1,2
Non-judgmental
Cultural sensitivity²
Leadership skills²
Project management skills^1,2
Research and Analytical skills^1,2
Influencing and negotiating skills^1,2
Ability to work across multi-agency or multi-disciplinary networks^1,2
People skills that develop and sustain relationships ^1,2
Agility to respond to sudden unexpected demands¹
Enthusiasm and genuine interest in health protection and promotion¹

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Community-Based Nursing

Primary focus is on caring for individuals and their families rather than the larger subgroup to which they belong¹.
Understanding of the influence of the interplay between client, family and their community on health and care of the client.
Philosophy of care characterized by: ²

Collaboration
Continuity of care
Client and family responsibility for self-care
Health promotion, disease prevention and restorative care

Eastern Michigan University, 2021
Hunt, 2005 as cited in WHO, 2010

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Community-Based Nursing: Nurse’s Role

Develop partnerships with clients.
Look at short-term and long term health care needs of the individual within the context of one's family and significant others, culture, community and society as a whole¹.
Major activities include²:

Direct care provision
Case management
Patient education
Individual and family advocacy
Application of Interdisciplinary approach
Referral

Easterm Michigan University, 2021
Zotti, Brown, Stotts, 1996, as cited in WHO, 2010

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Community-Based Nursing Practice Settings

Examples of community-based nursing practice settings:

Home care
Community clinic
School
Rehabilitation centers

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Public Health Nursing

American Public Health Association (2013) defines public health nursing as:

"the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences"

Missouri Department of Health & Senior Services (n.d.), states that public health nursing focuses on prevention of illness, injury or disability, promotion of health, and maintenance of the health of the public rather than on specific individual health.
Primary goal of the public health nursing is to build healthy communities.

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Public Health Nursing

Ohio University (2021) states that public health nurses (PHN) are less involved in daily patient care and more involved in community based care.
Focus is on health promotion and prevention of disease/injury/disability of target population rather than an individual or family.
‘Public health nursing’ is often used interchangeably with ‘community health nursing’.
Roles, responsibilities, and activities of the PHN are similar to those of community health nurses mentioned earlier in this slide deck.

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Critical Thinking Question:

Which of the following is related to the school nurse role? (Select all that apply)

Provides for a safe environment.
Detects, diagnose, and treats children with health problems.
Identifies and refers children with eye problems.
Conducts health education classes.

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Barriers to Community Health Nursing

In a study conducted by Winters and friends (2007) in North of West England, community nurses perceived following as barriers:

Need for facilitation to deal with organisational change.
Lack of clarity around the public health role.
Inadequate administrative support.
General practitioner attachment problems.
Poor interprofessional partnerships.
Competing priorities.
Resistance to change.

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Barriers to Community Nursing in Myanmar

Study by May and friends (2021) showed following as barriers to CHN:

Inadequate human resources, financial support, medical supplies, accommodations, and transportation facilities.
Lack of specialized training in community health nursing practices.
Role conflicts among various cadres of public health workers.
Culture and Language barriers.
Poor interest of local stakeholders and community for health.
Lack of access to advanced CHN education and research resulting in:

Inability to participate in policy development.
Inability to conduct health research to develop evidence-based practices.

May et al., 2021

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References:

American Public Health Association.(2013). The definition and practice of public health nursing: a statement of the public health nursing section[PDF]. https://www.apha.org/~/media/files/pdf/membergroups/phn/nursingdefinition.ashx

Canadian Public Health Association (2010). Public health/community health nursing practice in Canada[PDF]. https://www.cpha.ca/sites/default/files/assets/pubs/3-1bk04214.pdf

Easterm Michigan University (2021, January 1). What RNs need to know about community-based nursing?. https://online.emich.edu/articles/rnbsn/community-based-nursing.aspx

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References:

May, S. Y., Clara, N., Khin, O.K, Mar, W.W., Han, A.N., & Maw, S.S. (2021). Challenges faced by community health nurses to achieve universal health coverage in Myanmar: A mixed methods study. International Journal of Nursing Sciences, 8 (3), 271-278. https://doi.org/10.1016/j.ijnss.2021.05.003

Missouri Department of Health & Senior Services (n.d.). Role of public health nurses. Retrieved on September 21, 2021 from https://health.mo.gov/living/lpha/phnursing/phnroles.php

NHS (n.d.). Skills and interests (public health nurse). Retrieved on September 21, 2021 from https://www.healthcareers.nhs.uk/explore-roles/public-health/roles-public-health/public-health-nurse/skills-and-interests-public-health-nurse

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References:

Ohio University (2021, March 8). What is the role of public health nurse?. https://onlinemasters.ohio.edu/blog/role-of-a-public-health-nurse/

Winters, L., Gordon, U., Atherton, J., & Scott-Samuel, A. ( 2007). Developing public health nursing: barriers perceived by community nurses. Public Health, 121(8):623-33. DOI: 10.1016/j.puhe.2006.12.012

World Health Organization. (2010). A framework for community health nursing education. https://apps.who.int/iris/bitstream/handle/10665/204726/B4816.pdf?sequence=1&isAllowed=y

World Health Organization (2017). Enhancing the role of community health nursing for universal health coverage. Licence: CC BY-NC-SA 3.0 IGO. https://apps.who.int/iris/bitstream/handle/10665/255047/9789241511896-eng.pdf?sequence=1&isAllowed=y

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