Theories applied in Community Health Nursing

Introduction

The concept of community is defined as "a group of people who share some important feature of their lives and use some common agencies and institutions."  The concept of health is defined as "a balanced state of well-being resulting from harmonious interactions of body, mind, and spirit."  The term community health is defined by meeting the needs of a community by identifying problems and managing interactions within the community

Basic Elements

The six basic elements of nursing practice incorporated in community health programs and services are:

(1) promotion of healthful living
(2) prevention of health problems
(3) treatment of disorders
(4) rehabilitation
(5) evaluation and
(6) research.

Major Roles

The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles.  The seven major roles of a community health nurse are:

(1) care provider
(2) educator
(3) advocate
(4) manager
(5) collaborator
(6) leader, and
(7) researcher. 

Major Settings

Settings for community health nursing can be grouped into six categories: 

(1) homes
(2) ambulatory care settings
(3) schools
(4) occupational health settings
(5) residential institutions, and
(6) the community at large. 
Community health nursing practice is not limited to a specific area, but can be practiced anywhere.

Theories and Models for community health nursing

The commonly used theories are:

1. Nightingale’s theory of environment
2. Orem’s Self care model
3. Neuman’s health care system model
4. Roger’s model of the science and unitary man
5. Pender’s health promotion model
6. Roy’s adaptation model
7. Milio’s Framework of prevention
8. Salmon White’s Construct for Public health nursing
9. Block and Josten’s Ethical Theory of population focused nursing
10. Canadian Model

Milio’s Framework of prevention

• Nancy Milio a nurse and leader in public health policy and public health education developed a framework for prevention that includes concepts of community-oriented, population focused care.(1976,1981).
• The basic treatise is that behavioral patterns of populations and individuals who make up populations are a result of habitual selection from limited choices. She challenged the common notion that a main determinant for unhealthful behavioral choice is lack of knowledge. Governmental and institutional policies, she said set the range of options for personal choice making. It neglected the role of community health nursing, examining the determinants of community health and attempting to influence those determinants through public policy.

Salmon White’s construct for public health nursing

• Mark Salmon White (1982) describes a public health as an organized societal effort to protect, promote and restore the health of people and public health nursing as focused on achieving and maintaining public health.
• He gave 3 practice priorities i.e.; prevention of disease and poor health, protection against disease and external agents and promotion of health. For these 3 general categories of nursing intervention have also been put forward, they are:

1. education directed toward voluntary change in the attitude and behaviour of the subjects
2. engineering directed at managing risk-related variables
3. enforcement directed at mandatory regulation to achieve better health.

Scope of prevention spans individual, family, community and global care. Intervention target is in 4 categories:

 

1.Human/Biological
2. Environmental
 3. Medical/technological/organizational  
4. Social

Block and Josten’s Ethical Theory of population focused nursing

Derryl Block and Lavohn Josten, public health educators proposed this based on intersecting fields of public health and nursing. They have given 3 essential elements of population focused nursing that stem from these 2 fields:

1. an obligation to population
2. the primacy of prevention
3. centrality of relationship- based care 

the first two are from public health and the third element from nursing. Hence it implies to nursing that relation-based care is very important in population focused care.

Canadian Model for community

The community health nurse works with individuals, families, groups, communities, populations, systems and/or society, but at all times the health of the person or community is the focus and motivation from which nursing actions flow. The standards of practice are applied to practice in all settings where people live, work, learn, worship and play.

The philosophical base and foundational values and beliefs that characterize community health nursing - caring, the principles of primary health care, multiple ways of knowing, individual/community partnerships and empowerment - are embedded in the standards and are reflected in the development and application of the community health nursing process.

The community health nursing process involves the traditional nursing process components of assessment, planning, intervention and evaluation but is enhanced by community health nurses in three dimensions:

1. individual/community participation in each component,
2. multiple ways of knowing, each of which is necessary to understand the complexity and diversity of nursing in the community; knowledge and utilization of all these ways of knowing forms evidence-based practice consistent with these standards, and
3. the inherent influence of the broader environment on the individual/community that is the focus of care (e.g. the community will be affected by provincial/territorial policies, its own economic status and by the actions of its individual citizens). The standards of practice are founded on the values and beliefs of community health nurses, and utilization of the community health nursing process.

The model illustrates the dynamic nature of community health nursing practice, embracing the present and projecting into the future. The values and beliefs (green or shaded) ground practice in the present yet guide the evolution of community health nursing practice over time. The community health nursing process provides the vehicle through which community health nurses work with people, and supports practice that exemplifies the standards of community health nursing. The standards of practice revolve around both the values and beliefs and the nursing process with the energies of community health nursing always being focused on improving the health of people in the community and facilitating change in systems or society in support of health. Community health nursing practice does not occur in isolation but rather within an environmental context, such as policies within their workplace and the legislative framework applicable to their work.

 References

1. Allender J.N; Spradely B.W. Community Health Nursing Concepts and practice. (8th edn) 2001.Lippincott,342-45.
2. Stanhope M; Lancaster J. Community Health Nursing Promoting health of Aggregates, Families and individuals.(4th  edn) 2001.Mosby,265-80.