THEORIES USED 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:
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Nightingale’s theory of environment
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Orem’s Self care model
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Neumann’s health care system model
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Roger’s model of the science and unitary man
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Pender’s health promotion model
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Roy’s adaptation model
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Milio’s Framework of prevention
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Salmon White’s Construct for Public health
nursing
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Block and Josten’s Ethical Theory of
population focused nursing
-
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:
-
education directed toward voluntary change in
the attitude and behaviour of the subjects
-
engineering directed at managing risk-related
variables
-
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:
-
an obligation to population
-
the primacy of prevention
-
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
-
Allender J.N; Spradely B.W. Community Health
Nursing Concepts and practice. (8th
edn) 2001.Lippincott,342-45.
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Stanhope M; Lancaster J. Community Health
Nursing Promoting health of Aggregates,
Families and individuals.(4th edn)
2001.Mosby,265-80.
