roles and settings for community health nursing practice prepared by suhail alhumoud 1 1

Roles and Settings for Community Health Nursing Practice

Roles and Settings for Community Health Nursing Practice

Prepared by Suhail ALHumoud 1

objective

After completion the lecture the students enable to:

● Identify the three core public health functions basic to community health nursing.● Describe and differentiate among seven different roles of the community health nurse.● Discuss the seven roles within the framework of public health nursing functions.● Explain the importance of each role for influencing people’s health.● Identify and discuss factors that affect a nurse’s selection and practice of each role.● Describe seven settings in which community health nurses practice.● Discuss the nature of community health nursing, and the common threads basic to its practice, woven throughout all roles and settings.● Identify principles of sound nursing practice in the community.

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Core public health functions basic to community health nursing.

Community health nurses work as partners within a team of professionals (in public health and other disciplines), nonprofessionals, and consumers to improve the health of populations. The various roles and settings for practice hinge on three primary functions of public health: assessment, policy development, and assurance. They are foundational to all roles assumed by the community health nurse and are applied at three levels of service: to individuals, to families, and to communitiesRegardless of role or setting of choice, these foundational responsibilities direct the work of all community health nurses.

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The model includes assessment, policy development, and assurance surrounding the individual, family, and community. Assessment is the regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community. Policy development uses the information gathered during assessment to develop local and state health policies and to direct resources toward those policies. Assurance focuses on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies 4


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Assessment

means that the community health nurse must gather and analyze information that will affect the health of the people to be served. The nurse and others on the health team need to determine health needs, health risks, environmental conditions, political agendas, and financial and other resources, depending on the persons, community, or population targeted for intervention. Data may be gathered in many ways; typical methods include interviewing people in the community, conducting surveys, gathering information from public records, and using research findings. At the community level, assessment is done both formally and informally as nurses identify and interact with key community leaders.

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Assessment

With families, the nurse can evaluate family strengths and areas of concern in the immediate living environment and in the neighborhood. At the individual level, people are identified within the family who are in need

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Policy development At the community level, the nurse provides leadership in convening and facilitating community groups to evaluate health concerns and develop a plan to address the concerns. Typically, the nurse recommends specific training and programs to meet identified health needs of target populations.

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Assurance

. activities that make certain that services are provided Community health nurses perform the assurance function at the communitylevel when they provide service to target populations, improve quality assurance activities, and maintain safe levels of communicable disease surveillance and outbreak control.In addition, they participate in research, provide expert consultation, and provide services within the community based on standards of care. 9

Role of the community health nursing .

.Historically, community health nurse have engaged in many roles. From the beginning, nurse in this professional specialty have provided care to the sick, taught positive health habits and self-care, advocated on behalf of needy populations, developed and managed, health programs, provided leadership, and collaborated with other professionals and consumer to implement changes in health services.

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.The settings in which theses nurses practiced varied, too. The home certainly has been one site for practice, but so too have clinics, schools, factories, and other community-based locations.

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Community health nurses wear many hats while conducting day-to-day practice. The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles.

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Role of the community health nursing (1)clinician, (2) educator,(3) advocate,(4) manager,(5) collaborator, (6) leader, and (7) researcher.It also describes the factors that influence the selection and performance of those roles.

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Role of the community health nursing: Clinician

(1)ClinicianThe most familiar role of the

community health nurse is that of clinician or care provider

It means that the nurse ensures that health services are provided not just to individuals and families, but also to groups and populations.

The goals for the nurse as clinician are to reduce disease, discomfort, disability, and premature death for the total community. 14


(1)Clinician

Clinician role involves certain emphases that are different from those of basic nursing. Three clinician emphases, in particular, are useful to consider here: holism, health promotion, and skill expansion.

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Holistic PracticeA holistic approach means

considering the broad range of interacting needs that affect the collective health of the “client” as a larger system

Holistic nursing care encompasses the comprehensive and total care of the client in all areas, such as physical, emotional, social, spiritual, and economic. 16

Role of the community health nursing: Clinician.

Focus on Wellness

The role characterized by its focus on promoting wellness. the community health nurse provides service along the entire range of the health continuum but especially emphasizes promotion of health and prevention of illness.

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Focus on Wellness

Groups and populations are identified that may be vulnerable to certain health threats, and preventive and health promoting programs can be designed. Examples includes:

-Immunization of preschoolers. -Family planning programs.

-Cholesterol screening. -Prevention of behavioral problems in

adolescents .Protecting and promoting the health of vulnerable population is an important component of the clinician role . 18


Expanded SkillsMany different skills are used in the role of the community health clinician. In the early years of community health nursing, emphasis was placed on physical care skills. With time, skills in observation, listening, communication, and counseling became integral to the clinician role as it grew to encompass an increased emphasis on psychological and sociocultural factors.

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Expanded SkillsRecently, environmental and community-wide considerations— such as problems caused by pollution, violence and crime, drug abuse, unemployment, poverty, homelessness, and limited funding for health programs—have created a need for stronger skills in assessing the needs of groups and populations and intervening at the community level.

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Expanded SkillsThe clinician role in population-based nursing also

requires skills in-: -Collaboration with consumers and other

professionals. -Use of epidemiology and biostatistics.

-Community organization and development. -Research.

-Program evaluation.- Administration and leadership.

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Role of the community health nursing: Educator .

(2) Educator,Health teaching is one of the major function of the community health nurse .

The educator role is especially usefulness in promoting the public's health for at least two reasons:

1.Community clients usually are not actually ill and can absorb and act on health information.

2.The educator role in community health nursing is significant because a wider audience can be reached.

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Health educationProviding information and teaching people how to behave safely and in a manner that promotes and maintains their health.A continuing process of informing people how to achieve and maintain good health; of motivating them to do so; and of promoting environmental and lifestyle changes to facilitate their objective.


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Goals of Health education: The rational for health education is

1 .To equip people with the knowledge, attitude, and behaviors to live the fullest life possible for the greatest length of time.

2 .Clients anticipate achieving their maximum life span.

3 .The nurse develops partnerships with a client to achieve a behavior change that

promotes, maintains, or restore health .4 .Teaching is a specialized communication

process in which desired behavior changes are achieved.


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Teaching at Three Levels of Prevention •Nurses should develop teaching programs that coincide with the level of prevention needed by the client. The three levels primary, secondary and tertiary.

• Ideally , the nurse focuses teaching at the primary level. If nurses were able to reach more people at this level, it would help to diminish the years of morbidity and limit subsequent infirmity.


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Teaching – Learning Principles Teaching in community health nursing means to influence, motivate, and act as catalyst in the learning process. Nurses bring information and learns together and stimulate a reaction that leads to a change.

Nurses facilitate learning when they make it as easy as possible for clients to change. To do this, the nurse needs to understand the basic principles underlying the art and science of teaching-learning process and use of appropriate materials to influence learning.


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Seven Principles for Maximizing the Teaching –Learning Process

1 .Client readiness Clients' readiness to learn influences teaching effectiveness. The community health nurse

must assess the clients for :1 .Emotional readiness.

2 .Educational background .


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2 .Client PerceptionClients' perception also affect their learning, individual perceptions help people interpret and attach meaning to things. A wide range of variables affects human perception. Theses variables includes:- Values. - Past experience.- Culture. - Religion.- Personality. - Developmental stage.-Educational level. - Economic level. - Surrounding social forces.- Physical environment.


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3 .Educational Environment The setting in which the educational endeavor takes place has a significant impact on learning.•noise, heat, or uncomfortable seating.•Physical conditions such as ventilation, lighting, decor, room temperature, view of the speaker


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4 .Client Participation The degree of participation in the educational process directly influences the amount of learning.

5 .Subject Relevance .Subject matter that is relevant to the client is learned more readily and retained longer than information that is not meaningful.


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6 .Client Satisfaction Clients must derive satisfaction from learning to maintain motivation and increase self-direction

7 .Client Application Learning is reinforced through application. Learners need as many opportunities as possible to apply the learning in daily life

Health Education .

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Teaching Process The process of teaching in community health nursing follows steps similar to those of the nursing process:

1 .Interaction .Reciprocal communication must take place between nurse and client. It is essential in helping relationship and requisite to effective use of the nursing process .

Community health nurses need to develop good questioning techniques and listening skills to determine client's learning needs and level of readiness.

Health Education .

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2 .Assessment and diagnosis.Determine client's present status and identify clients' needs for teaching.Assessing educational needs may be accomplished in several ways :

-The nurse can use surveys. -Interviews .

-Open forums .The principles to remember is that clients should be involved in identifying what they want to learn.

Health Education .

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3 .Setting goals and objectives.Once a need has been clearly identified, the nurse and clients can establish mutually agreed-on goals and objectives.Goals : are broad statement of desired end outcomes .

Objectives: are more specific descriptions of intended outcomes .

Health Education .

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4 .Planning.Design a plan for the learning experience that meets

the mutually developed objectives :The plan should include the following:

1 .Subject: Content to be covered, sequence of the topics.

2 .Intended audience .3 .Dates, times, and places.

4 .Short- and long term goal statements.5 .Teaching –learning methods.

6 .Activities and assignments.7 .Course outline of topics.

8 .Evaluation methods and criteria.A written plan is best; it may part of the written nursing care plan .

Health Education .

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5 .Teaching.The class, seminar, workshop, or small-group teaching should be conducted according to the plan. Even one-on-one teaching, each eight steps should be planned in advance, because each client has:

-A different cultural background. -Education.

-Intellectual level.- Learning needs.

Health Education .

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6 .Evaluation. Determine whether learning objectives were met and if not, why not.Evaluation measures progress toward goals. Effectiveness of chosen teaching methods, or future learning needs.

Health Education .

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Teaching Methods and Materials Teaching occurs on many levels and incorporates various types of activities. It can be formal or informal, planned or unplanned.- Formal presentations, such as lecture with groups, usually are planned and fairly structured. Some teaching is less formal but still planned and relatively structured, as in group discussions in which questions stimulate exploration of ideas and guide thinking.- Informal levels of teaching, such as counseling or anticipatory guidance:-in which the client is assisted in preparing for a future role or development stage, require the teacher to be prepared, but there is no defined plan of presentation.

Health Education .

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There are four teaching methods:1. Lectures.2. Discussion.3. Demonstration.4. Role ply.

Health Education .

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Teaching Materials Many different kinds of teaching materials are available to the nurse. They often are used in combination and are useful during the teaching process .

-Visual images: -Such as Power point presentations, pictures, slides, posters,

chalkboards, flannel boards, videotapes, CDs, bulletin boards, flash cards, pamphlets, flyers, charts, and gestures.

-Television and Radio:It appeals to sight and sound and grasp attention. Learning of both positive and negative health behaviors through television can be more effective and efficient than traditional teaching methods .

-Other tools:- Such as, anatomic models, and improvised or purchased equipment, provide clients with both visual and tactile learning experience

Health Education .

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Selection of teaching materials depends on: -How well they suit learners and help to meet the

desired objectives. -Sources of teaching materials that are free or

inexpensive can enhance the nurse's teaching but need to evaluated foe effectiveness.The nurse needs to know how to help learners with special needs, those with physical or mental disabilities.

Role of the community health nursing: Advocate

(3) AdvocateThe community health nurse often acts as an

advocate for clients, pleading their cause or acting on their behalf:

Clients may need some one :- -To explain which services to expect, which

services they ought to receive.-To make referrals as needed.

-To write letters to agencies or health care providers for them .

- To assure the satisfaction of their needs.

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Role of the community health nursing: Advocate .

(3) AdvocateAdvocacy Goals:There are two underlying goals in client advocacy.1. To help clients gain greater independence or self-

administration. by:- Showing them what services are available.- The ones to which they are entitled, and how to

obtain them.

2. To make the system more responsive and relevant to the needs of clients, by calling attention to inadequate, inaccessible, or unjust care, community health nurses can influence change.

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Role of the community health nursing: Advocate .

Advocacy ActionsThe advocate role incorporate four characteristics actions:

1 .Being assertive.2 .Taking risks.

3 .Communicating and negating well.4. Identifying recourses and obtaining results.

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Role of the community health nursing: Manager .

(4) Manager,The nurse exercises administrative direction toward the accomplishment of specified goals by• assessing clients’ needs, •planning and organizing to meet those needs, directing and leading to achieve results, and •controlling and evaluating the progress to ensure that goals are met

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Role of the community health nursing: Manager

The nurse serves as a manager •when overseeing client care as a case manager• supervising ancillary staff,• running clinics• conducting community health needs assessment projects

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Role of the community health nursing: Manager

In each instance, the nurse engages in four basic functions that make up the management process. The management process, like the nursing process, incorporates a series of problem solving activities or functions: 1.planning, 2.organizing, 3.leading, and 4.controlling and evaluating. These activities are sequential and yet also occur simultaneously for managing service objectives

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Role of the community health nursing: Manager.

Nurse as PlannerThe first function in the management process is planning. A planner sets the goals and direction for the organization or project and determines the means to achieve them. Specifically, planning includes 1.defining goals and objectives, 2.Determining the strategy for reaching them, and 3.designing a coordinated set of activities for implementing and evaluating them.

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Nurse as OrganizerThe second function of the manager role is that of organizer. This involves designing a structure within which people and tasks function to reach the desired objectives.

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Nurse as LeaderAs a leader, the nurse directs, influences, or persuades others to effect change so as to positively affect people’s health and move them toward a goal. The leading function includes 1.persuading and motivating people, 2.directing activities, 3.ensuring effective two-way communication, 4.resolving conflicts, and coordinating the plan. 5.Coordination means bringing people and activities together so that they function in harmony while pursuing desired objectives. 50


Nurse as Controller and EvaluatorA controller monitors the plan and ensures that it stays on course. Monitoring, comparing, and adjusting make up the controlling part of this function. At the same time, the nurse must compare and judge performance and outcomes against previously set goals and standards—a process that forms the evaluator aspect of this management function.

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Role of the community health nursing: Collaborator .

(5) collaborator, Community health nurses seldom practice in isolation. They must work with many people, including •Clients•other nurses, •physicians, •teachers, •health educators• social workers•physical therapists•nutritionists, •occupational therapists, •psychologists, epidemiologists, biostaticians and other

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Role of the community health nursing: Collaborator

The community health nurse's collaborator role requires-:

-Skill in communicating. -Interpreting the nurse's unique contribution to

the team.- Acting assertively as an equal partner.

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Role of the community health nursing: Leadership Role .

(6) Leadership RoleCommunity health nurses are becoming increasingly active in the leadership role, separate from leading within the manager role mentioned earlier. The leadership role focuses on effecting change thus, the nurse becomes an agent of change. As leaders, community health nurses seek to initiate changes that positively affect people’s health. They also seek to influence people to think and behave differently about their health and the factors contributing to it.

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(6) Leadership Role At the community level, the leadership role may involve working with a team of professionals to direct and coordinate such projects as a campaign to eliminate smoking in public areas or to lobby legislators for improved child day care facilities.

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(7) researcher.In the researcher role, community health nurses

engage in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice. But how can research be combined with practice? Although research technically involves a complex set of activities conducted by persons with highly developed and specialized skills, research also means applying that technical study to real-practice situations. Community health nurses base their practice on the evidence found in the literature to enhance and change practice as needed. For example, the work of several researchers over 15 years supports the value of intensive home visiting to high-risk families. The outcomes of this research are changing practice protocol to high-risk families in many health departments today.

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SETTINGS FOR COMMUNITY HEALTH NURSING PRACTICE.

SETTINGS FOR COMMUNITYHEALTH NURSING PRACTICE

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The setting in which the community health nurses are practiced their different roles are grouped into six categories:

1 .Homes.2 .Ambulatory service settings.

3 .Schools.4 .Occupational health settings.

5 .Residential institutions.6. The community at large.

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(1)HomesFor a long time, the most frequently used

setting for community health nursing practice was the home. In the home, all of the community health nursing roles, to varying degrees, are performed. Clients who are discharged from acute care institutions, such as hospitals or mental health facilities, are regularly referred to community health nurses for continued care and follow-up. Here, the community health nurse can see clients in a family and environmental context, and service can be tailored to the clients’ unique needs. 59


The home also is a setting for health promotion. Many community health nursing visits focus on assisting families to understand and practice healthier living behaviors. Nurses may, for example, instruct clients on parenting, infant care, child discipline, diet, exercise, coping with stress, or managing grief and loss.

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(2) Ambulatory service settings, Ambulatory service settings include a variety of venues for community health nursing practice in which clients come for day or evening services that do not include overnight stays. Community health centers are an example of an ambulatory setting. Sometimes, multiple clinics offering comprehensiveservices are community based or are located in outpatient departments of hospitals or medical centers.

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(3) SchoolsSchools of all levels make up a major group of settings for community health nursing practice.Community health nurses’ roles in school settings are changing. School nurses, whose primary role initially was that of clinician, are widening their practice to include more health education, interprofessional collaboration, and client advocacy.

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(4) occupational health settings, Business and industry provide another group of settings for community health nursing practice. Employee health has long been recognized as making a vital contribution to individual lives, productivity of business, and the well-being of the entire nation.Community health nurses in occupational health settings practice a variety of roles.

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(5) Residential institutions,Any facility where clients reside can be a setting in which community health nursing is practiced. Residential institutions can include a halfway house in which clients live temporarily while recovering from drug addiction or an inpatient hospice program in which terminally ill clients live. A continuing care center is another example of a residential site providing health care that may use community health nursing services.Community health nurses also practice in settings where residents are gathered for purposes other than receiving care. 64


(6) ParishesParish nursing finds its beginnings in an ancient tradition. The beginnings of community health nursing can be traced to religious orders and for centuries churches, temples, mosques, and other spiritual communities were important sources of health care. In parish nursing today, the practice focal point remains the faith community and the religious belief system provided by the philosophical framework

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(6) ParishesParish nursing may take different names. Whatever the service is called, it involves a large-scale effort by the church community to improve the health of its members through education, screening, referral, treatment, and group support.

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(7) The community at large.Unlike the six settings already discussed, the seventh setting for community health nursing practice is not confined to a specific philosophy, location, or building. When working with groups, populations, or the total community, the nurse may practice in many different places.

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roles and settings for community health nursing practice prepared by suhail alhumoud 1 1

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