Community Health Nursing

Roles, Responsibilities and

History.
By
Mr. Imran Yousafzai
Lecturer INS KMU
 Learning Objectives
1. Define Community Health Nursing.
2. Discuss public, community and community
based nursing.
3. Describe different roles of the community health
nurse
4. Discuss the functions of CHN.
 How Healthcare Needs of a
community are established?
The health-care demands of the community could be
defined through analysing four major contributing
factors:
1.Health problems and risks,
2.Lifestyle in terms of health behaviour and care,
3.Environment as a threat to health, and
4.available and accessible health services and care.
• Community health-care demands underpin
health services and care activities, which
could also be categorized into four
interrelated groups:
• (1) clinical care, (2) health care, (3) support
for healthy activities and (4) welfare and
other support.
 (1) Clinical care
• is confined to diseases and symptomatic therapeutics.
• earlier discharged in the course of recovery, increase the
need for continuing clinical/medical care .
• People who are homebound under a physician’s plan of
treatment.
• Clinical care demands in community health may include
delegated medical treatment and observation – symptom
management, wound care, tube feeding, etc.
 (2)Health care
• Health care represents diverse direct health services and care provided to
individuals, families and groups, by the community health centre or similar
facility.
• Examples of health-care demands include the following:
 Health assessment and outreach/case finding.
 Screening and surveillance for both communicable diseases such as
tuberculosis (TB), HIV, dengue haemorrhagic fever (DHF), influenza; and
non-communicable diseases such as hypertension, diabetes mellitus,
cardiovascular diseases, etc.
 immunization for vaccine, health education – health counselling/family
counselling
 interventions for family planning and birth spacing, etc.
 (3) Support for healthy activity
• Support for healthy activity is designed to promote healthy lifestyles
and reduce health threats and risks in the community.
• This category of services and care activities is focused on public
health and covers a wide range of programmes and interventions
provided collaboratively to the residents by community allies
including the health centre and other facilities.
• Support for healthy activity may range from: – health teaching and
health information dissemination, capacity building etc
 (4) Welfare and other support
• (Welfare and other support is usually provided to the needy such as the
disabled, those who are housebound and bedridden, and the aged.

• Welfare and other support may include:

 aids and tools for day-to-day activities of the disabled.
 compensation for caregivers of persons who are bedridden etc.
 Community health nursing and
practical implications
• All community health services and care
activities carried out respond to the needs,
health problems and health risks, cultural
way of living, resources, and preferences of
the community.
• In a health-care system in transition,
community health nursing represents a
profession that responds to all categories of
demands of the people.
 What is Community Health
Nursing (WHO)
• Community health nursing is a population-
focused, community-oriented approach
aimed at health promotion of an entire
population, and prevention of disease,
disability and premature death in a
population.
 Public Health Nursing Vs
Community Health Nursing
• The term community health nursing is often synonymous
with public health nursing.
• Community health nursing is a specialty in nursing.
• According to the American Nursing Association (ANA),
public health nursing is the practice of promoting and
protecting the health of populations using knowledge from
nursing, social and public health sciences (Waldorf, 1999).
History and Development
 Main Roles
• The primary goal of community health
nursing is to help a community protect and
preserve the health of its members, while
the secondary goal is to promote self-care
among individuals and families.
 Community-Based Nursing
• covers nursing care provided to individuals, families and groups
wherever they live, work, play or go to school.
• Community based nursing is a philosophy of care that applies to all
nurses who practise outside the hospital.
• Major activities include case management, patient education,
individual and family advocacy, and an interdisciplinary approach
(Zotti, Brown, Stotts, 1996).
• According to this definition, community-based nursing is not a
specialty in nursing but a philosophy that guides care, design and
delivery of all nursing specialties.
 Core functions of community health
nursing practice:
1. community social capital, including community culture,
and identification of resources as key actors in the
community healthcare system.
2. assessment of community health conditions, health risks
and problems to identify the health-care demands of the
people
3. design and implementation of
comprehensive community health
interventions and care.
4. health policies/agreements developed at the
local community level to drive
policies/agreements at the provincial and
national levels.
Roles of Community Health Nurses
1. Clinician
2. Educator
3. Advocate
4. Manager
5. Collaborator
6. Leader
7. Researcher
 Clinician Role
• Care provider: The nurse ensures that health
services are not only provided to individuals and
families but also provided to groups and
populations
• The clinician role has emphasis on holism, health
promotion and skill expansion
Holistic practice = considering the broad range of
interacting needs that affect the “collective
health” of the client as a larger system
(Patterson 1998)
 Examples at the clinics & Schools
• Immunisation of infants and pre-schoolers
• Family planning programs
• Assessment and screening
• Prevention of behavioural problems in adolescents
Expanded skills in observation, listening,
communication and counseling are integral to
your role as a CHN with emphasis on
psychological and socio-cultural factors
 Educator Role
Health teacher: one of the major functions of the
CHN (Breckon et.al. 1998)

Important role because

•Community clients are NOT usually acutely ill and
can absorb and act on health information
•A wider audience can be reached leading to a
community-wide impact
•When public has a higher level of health
consciousness.
 Advocate Role
• Based on clients’ rights: Every patient or client has the
right to receive just, equal, and humane treatment.
Why Advocacy?
• Current health care system offers de-personalised and
fragmented services. Many clients who are poor and
disadvantaged are frustrated and the nurse becomes an
advocate for clients pleading their cause and acting on
their behalf
Goals of advocacy:
1. Help clients gain more independence and self-
determination
2. Make the system more responsive and relevant to the
needs of clients
 Characteristic Actions of an
Advocate
1. Being assertive
2. Taking risks
3. Communicating and negotiating well
4. Identifying resources and obtaining results
 Manager Role
• Nurse directs and administers care to meet goals by:
1. Assessing client needs
2. Planning and organising to meet those needs
3. Directing and leading to achieve results
4. Controlling and evaluating the progress to make sure
that the results are met
 Manager Role
• Nurse oversees client care as:
1. A case manager
2. Supervising ancillary staff
3. Managing caseloads
4. Running clinics
5. Conducting community health needs assessment
projects
 Nurse as Planner
• Sets the goals for the organisation
• Sets the direction
• Determines the means (strategies) to
achieve them
• It includes defining goals and objectives
• It may be strategic ( long-term broader
goals)
 Nurse as Organiser
• Designing a structure for people + tasks to function to
reach the desired objectives
• It includes assignments and scheduling
It includes:
1. Deciding what tasks to be done
2. Who will do them
3. How to group the tasks
4. Who reports to whom
5. Where decisions will be made (Robbins 1997)
Questions to be addressed by the organiser
6. Is the clinic, program providing the needed services?
7. Are the clients satisfied?
8. Are the services cost-effective?
 Nurse as Leader
• The nurse directs, influences, or persuades others
to make change to positively influence people’s
health.
• Includes persuading and motivating people,
directing activities, effective two-way
communication, resolving conflicts and
coordinating the plan
• Coordination: Bringing people and activities
together to function in harmony to achieve desired
objectives
 Nurse as Controller and Evaluator
• Controller: Monitors the plan and ensures
that it stays on course.
– Sometimes plans do not proceed as intended
and need to be adjusted
– Monitoring, comparing and adjusting are
activities of controlling
– Comparing performance and outcomes against
set goals and standards = Evaluator role
Management Skills (Robbins, 1997)
1. Human: ability to understand, communicate,
motivate, delegate and work with people. They
are essential to be successful in your role as a
manager
2. Conceptual: The mental abilities to analyse and
interpret abstract ideas to understand and
diagnose situations
3. Technical: Apply special management-related
knowledge and expertise for e.g. computerised
management information system
 Collaborator Role
• Means working jointly with others on a common project
to cooperate as partners
Who?
– Clients
– Other nurses and physicians
– Teachers and health educators
– Social workers
– Physical therapists
– Nutritionists
– Psychologists
– Epidemiologists and Biostatisticians
– Attorneys
– Secretaries
– City Planners and legislators
 Researcher Role
• Systematic investigation, collection, and
analysis of data for solving problems and
improving community health practice
• This role is at several levels:
– Agency and organisational studies for job
satisfaction among public health nurses
– Some CHN participate in more collaborative
research with other health professionals
 The Research Process
1. Identify an area of interest
2. Specify the research question or statement
3. Review the literature
4. Identify a conceptual framework
5. Select a research design
6. Collect and analyse data
7. Interpret the results
8. Communicate the findings
 Settings for CHN Practice
1. Homes
2. Community health centres
3. Schools
4. Occupational health settings (business and
industry)
5. Residential institutions: Older age residences
6. Parishes or charitable mosques related
organisations
7. National and International organizational
programs and projects.
8. Community at large
 References:
• Basavanthappa BT: Health Belief Model.
Community Health Nursing. 2008, New
Delhi: Jaypee Brothers Medical Publishers,
224-225.