Chapter 1

Chapter 1
The Journey Begins: Introduction to

Community Health Nursing
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
-Challenges in nursing are boundless and ever
changing , also these challenges confront nurses

personally and professionally
Challenge of expanding nursing practice from

individual and family to encompass communities
and opportunity to affect health of population
Challenge of terminating the needs of population
at risk and opportunity to design intervention to
address their needs
Community health
CH nursing is community based and most important, its
population based, operating with environment of rapid
changing and increasing in complexity
Community is an essential and permanent features of
human experiences
Community health is concerned with the interchange
between population groups and their environment, and
with the impact of that interchange on collective health
Community health nursing is a specialized practice
combines all basic elements of professional clinical
nursing with public health and community
Community nursing and public nursing share many

features: both are organized community efforts aimed
at promotion, protection and preservation of public
health
Public health had been primarily associated with
governmental efforts supported with health agencies
that target the whole range of health issue, and
currently public health practice encompass both
approaches and works collaboratively with health
agencies and efforts
Community health practice focus on specific,
designated communities, its part of larger public
health
4
Community Health (CH) and Public Health

(PH)
CH = identification of needs and the protection and
improvement of collective health within a
geographically defined area
PH = an effort organized by society to protect,
promote, and restore the peoples health
Concept of Community
Collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging
Examples of some communities:
Citizens of a town
Group of farmers
Prison community
Tiny village in Appalachia
Members of Mothers Against Drug Driving (MADD)
Professional nurses
Concept of Community
Sharing of people holding common rights and privileges
Living under the same laws and regulation
The function of any community includes its members
collective sense of belonging and shared identity, values
norms, communication and common interest and
concern
Three Types of Communities

Geographic
Common-interest
Community of solution
Three Types of Communities

Geographic = city, town, neighborhood
-clear target for analysis of health needs
-available data (morbidity, mortality, basis for planning
health program)
-borders of country change with political revolution
-the world is one large community
-Global health: has become dominant phrase in
international public health circles.
Common-interest = church, professional organization,

people with mastectomies , disabled individuals, and
communities to protect the rights of children.
- A collection of people, they are widely scattered
geographically, can have an interest or goal binds the
members together.
10
Community of solution = group of people who come

together to solve a problem that affects all of them
- the shape of this community varies with the nature of the

problem that affect all of them, number of resources e.g.
substance abuse, HIV infection, water control, air
pollution.
11
Example of Communities
of Solution
Populations and Aggregates

Population
All people occupying an area or all of those who
share one or more characteristics
People do not necessarily interact with one
another and do not necessarily share a sense of
belonging to that group
May be defined geographically e.g. USA POP
Also can be defined by common qualities or
characteristic e.g. elderly population, homeless
population, ethnic group.
Aggregate
Mass or grouping of individuals considered as a
whole
Loosely associated with one another
Aggregate: Its broader term that encompasses
many different size groups
Both communities and population are types of
aggregate
Concept of Health
Health: holistic state of well-being, including
soundness of mind, body, and spirit
Health refers to persons physical, mental and
spiritual state it can be positive (being in a good
health) or negative as (being in poor health)
WHO state of complete physical, mental and social
well being and not merely the absence of disease or
infirmity
Wellness: health plus the capacity to develop

ones potential, leading to a fulfilling and
productive life
Illness: state of being relatively unhealthy
16
Subjective and objective dimension of

health
Subjective :how people feel (feeling well or ill)
Objective :how well they function in their environment
(functioning).
A healthy person is one who feels well who experience a
sensation of vital, positive state
Healthy people are full of life and vigor ( strength),
capable of physical and mental productivity
17
People experience varying degree of vitality (life) and

well being
Health involves the objective dimension of ability of
function
A healthy individual or community carries out necessary
activity and achieves goals, while unhealthy people not
only feel ill but they are limited to some degree in their
ability to carry out their daily activities.
18
Indeed levels of illness or wellness are measured largely

in terms of ability to function and this can be observed
The action of an individual family or community are
motivated by their values
Together subjective and objective dimensions provide a
clearer picture of people health
When they demonstrate functional ability, they are close
of wellness end of the health
19
Continuous needs: include all age groups with birth to

death (developmental health care needs) e.g. toilet
training techniques
Episodic needs: when population may have one time
specific, negative part of life such as illness or injury that
not an expected part of life e.g. infants with down
syndrome, head injuries (crush)
20
Health Continuum
Leading Health Indicators

(Healthy People 2010)
Physical activity
Mental health
Overweight and obesity
Injury and violence
Tobacco use
Environmental quality
Substance use
Immunization
Responsible sexual
behavior
Access to health care
Six Components of Community Health

Practice
Promotion of health
Prevention of health problems
Treatment of disorders
Rehabilitation
Evaluation
Research
Health Promotion
All efforts that seek to move people closer to optimal
well-being or higher levels of wellness
( Enabling people)
Goal: raise level of wellness for individuals, families,
populations, and communities
heath education
environmental sanitation
healthy life style
Health Promotion
Initiatives for health promotion as a U.S nation
Healthy People, Promoting Health, Preventing
Disease: 1990 Health Objectives for the Nation,
Healthy People 2000, and Healthy People 2010
Community health efforts achieve its goal by:
1. Increase the span of healthy life for all citizen
2. Reduce health disparities among population groups
3. Achieve access to preventive services for everyone.
Prevention of Health Problems

Anticipating and averting problems or discovering
them as early as possible to minimize potential
disability and impairment
Three levels
Primary: Keep illness or injury from occurring
(e.g. educational programs).
Secondary: Detect and treat existing disease

(e.g. screening programs).
Tertiary: Reduce the extent and severity of a

health problem to its lowest possible level to
minimize disability and restore or preserve
function (e.g. rehabilitation).
Characteristics of Community Health Nursing

Knowledge of elements of public health is essential to
community health nursing (ANA, 2005):
-Priority of preventive, protective, and health promoting
strategies over curative strategies.
-Means for measurement and analysis of community health
problems including epidemiology concepts and biostatistics
-Influence of environmental factors on aggregate health
-Principles underlying management and organization for
community health
-Public policy analysis and development a long with health
advocacy and understanding of the political process.
Community health nursing: a field of nursing,

combines nursing science with public health science to
formulate a community-based and population focused
practice.
Public health nursing: the practice of promoting and
protecting the health of population using knowledge from
nursing, social, and public health sciences
Characteristics of Community Health Nursing

(cont.)
Eight characteristics:
1. Population is client or unit of care: concerned for the
health status of the population groups and their
environment.
2. Primary obligation is to achieve greatest good for
greatest number of people or population as a whole.
3. Processes used include working with the client as an
equal partner
4. Primary prevention is the priority: the emphasis is on
positive health or wellness.
Characteristics of Community Health

Nursing (contd)
Eight characteristics:
5. Strategies are selected to create health environmental,
social, and economic conditions in which populations may
thrive.
6. There is an obligation to actively reach out to all who
might benefit from a specific activity.
7. Optimal use of resources to ensure best overall
improvement in health of population is a key element.
8. Collaboration with a variety of other professions,
organizations, and entities is the most effective way to
promote and protect health of people.
health literacy: is the ability to obtain, process, and

understand basic health information and services needed to
make appropriate health decisions.
Self care: is the process of taking responsibility for

developing ones own health potential.
Self care deficit: when peoples ability to continue selfcare activities drops below their need.
Healthy People 2010 Internet Resources

Increase the quality and years of healthy life
http://www.healthypeople.gov/Publications/
Healthy People 2010 fact sheet
http://www.healthypeople.gov/About/hpfact.htm
Leading Health Indicators
http://www.healthypeople.gov/lhi/priorities
Healthy People in Healthy Communities
http://www.healthypeople.gov/Publications/HealthyCommunities2001
/default.htm

Chapter 1

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Chapter 1

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Chapter 1

The Journey Begins: Introduction to

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

-Challenges in nursing are boundless and ever

changing , also these challenges confront nurses

Challenge of expanding nursing practice from

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Community nursing and public nursing share many

Community Health (CH) and Public Health

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Three Types of Communities

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Three Types of Communities

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common-interest = church, professional organization,

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Community of solution = group of people who come

- the shape of this community varies with the nature of the

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Populations and Aggregates

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Wellness: health plus the capacity to develop

Illness: state of being relatively unhealthy

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Subjective and objective dimension of

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

People experience varying degree of vitality (life) and

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Indeed levels of illness or wellness are measured largely

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Continuous needs: include all age groups with birth to

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Leading Health Indicators

Overweight and obesity

Injury and violence

Access to health care

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Six Components of Community Health

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Prevention of Health Problems

Secondary: Detect and treat existing disease

Tertiary: Reduce the extent and severity of a

Characteristics of Community Health Nursing

Community health nursing: a field of nursing,

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Characteristics of Community Health Nursing

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Characteristics of Community Health

health literacy: is the ability to obtain, process, and

Self care: is the process of taking responsibility for

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Healthy People 2010 Internet Resources

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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