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Nurse Settings for Community Health Nursing.


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Title: Nurse Settings for Community Health Nursing.

Nurse Settings for Community Health Nursing.
Lecture objectives
  • Upon finishing this lecture, you should be able
  • 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.

Community Health Nurse Practice
  • Is focussed on wellness not sickness.
  • Is focussed on prevention not just treatment of
  • Is focussed on assisting people and communities
    make their own decisions regarding health care.
  • Is focussed on assisting those with existing
    health conditions to maximise their potential and
    prevent deterioration if possible.

Community Health Nurse Practice
  • Is based in the community in a range of settings,
    wherever there is a need for support, information
    and education.
  • Responds to public health needs in relation to
    communicable diseases.

Community Health Nurse Practice
  • Has the whole community as their client, as well
    as groups, families and individuals.
  • Recognises the impact of life course and social
    determinants of health and works in partnership
    with the community to address these.

Community Health Nurse Practice
  • Utilises the primary health care philosophy to
    guide practice.
  • Has a specialised body of knowledge which
    reflects current research and evidence based

Community Health Nurse Practice
  • Community health nurses recognise health as a
    state of complete physical, mental and social
    well-being and not merely the absence of disease
    and infirmity W.H.O.
  • Community health nurses deal with clients in a
    holistic manner, working with them wherever they
    are on the health illness continuum.

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What is different about practice of community
health nurse
  • Community health nurse practice, by the nature of
    the work setting, requires autonomy,
    self-direction and use of a high level of
    professional judgement.

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Work settings for community health nurses
  • The types of places in which community health
    nurses practice are increasingly varied and
    include a growing number of nontraditional
    settings and partnerships with nonhealth groups.
  • Employers of community health nurses range from
    state and local health departments and home
    health agencies to managed care organizations,
    industries, and nonprofit organizations.

Work settings for community health nurses
  • These settings are grouped into seven categories
  • (1) homes,
  • (2) ambulatory service settings,
  • (3) schools,
  • (4) occupational health settings,
  • (5) residential institutions,
  • (6) parishes,
  • (7) the community at large.

What is different about practice of community
health nurse
  • Community health nurses interact with a wide
    range of both professional and non professional
    people within the community and must have a
    variety of interpersonal skills.

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  • For 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 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.
  • Service can be tailored to the clients unique

Homes 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.

Homes The diversity
  • The character of the home setting is as varied as
    the clients served by the community health nurse.
  • In one day, the nurse may visit
  • a well-to-do widow in her luxurious home,
  • a middle-income family in their modest bungalow,
  • an elderly transient man in his one-room
    fifth-story walk-up apartment,
  • and a teen mother and her infant living in a
    group foster home.
  • In each situation, the nurse can view the clients
    in perspective and, therefore, better understand
    their limitations, capitalize on their resources,
    and tailor health services to meet their needs.

Home visits
  • anxiety for the nurse.
  • nurses first experience outside the acute care,
    long-term care, or clinic setting.
  • visiting families in unfamiliar neighborhoods.
  • fear of the unknown.
  • collaboration with various types of home care
    providers, including hospitals, other nurses,
    physicians, rehabilitation therapists, and
    durable medical equipment companies

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
  • Community health centers
  • Multiple clinics offering comprehensive services
  • Family planning clinics or a well-child clinics
  • Day care centers, such as those for physically
    disabled or emotionally disturbed adults
  • Offices (for example, a community health nurse
    associated with a health maintenance organization
    sees clients in the office and undertakes
    screening, referrals, counseling, health
    education, and group work.

Ambulatory service settings cont
  • Independent nursing agencies that practice by
    seeing clients in community nursing centers as
    well as making home visits.
  • Another type of ambulatory service setting
    includes places where services are offered to
    selected groups.
  • community health nurses practice in migrant
  • through churches as parish nurses,
  • in remote mountain and coal-mining communities.

  • Schools of all levels make up a major group of
    settings for community health nursing practice.
  • Nurses from community health nursing agencies
    frequently serve private schools at elementary
    and intermediate levels.
  • Public schools are served by the same agencies or
    by community health nurses hired through the
    public school system.
  • The community health nurse may work with groups
    of students in preschool settings as well as in
    vocational or technical schools, junior colleges,
    and college and university settings.
  • Specialized schools, such as those for the
    developmentally disabled, are another setting for
    community health nursing practice.

Occupational Health Settings
  • Business and industry provide another group of
    settings for community health nursing practice.
  • Community health nurses in occupational health
    settings practice a variety of roles
  • The clinician role was primary for many years, as
    nurses continued to care for sick or injured
    employees at work.
  • However, recognition of the need to protect
    employees safety and, later, to prevent their
    illness led to the inclusion of health education
    in the occupational health nurse role.
  • Occupational health nurses also act as employee
    advocates, assuring appropriate job assignments
    for workers and adequate treatment for
    job-related illness or injury.

Residential Institutions
  • Any facility where clients reside can be a
    setting in which community health nursing is
  • Residential institutions can include
  • a halfway house in which clients live temporarily
    while recovering from drug addiction,
  • an inpatient hospice program in which terminally
    ill clients live.
  • Some residential settings, such as hospitals,
    exist solely to provide health care
  • others provide other services and support.

Residential Institutions cont
  • A continuing care centers
  • In this setting, residents usually are elderly
    some live quite independently, whereas others
    become increasingly more dependent and have many
    chronic health problems.
  • The community health nurse functions as advocate
    and collaborator to improve services.

Residential Institutions cont
  • Residential institutions provide unique settings
    for the community health nurse to practice health
  • Clients are a captive audience whose needs can
    be readily assessed and whose interests can be
  • These settings offer the opportunity to generate
    an environment of caring and optimal-quality
    health care provided by community health nursing

  • Parish nursing finds its beginnings in an ancient
  • In parish nursing today, the practice focal point
    remains the faith community and the religious
    belief system provided by the philosophical
  • Parish nursing may take different names, such as
  • church-based health promotion (CBHP),
  • faith community nursing, or
  • primary care parish nursing practice (PCPNP).

Parish nursing
  • 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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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.

Community at Large
  • For example,
  • A community health nurse, as clinician and health
    educator, may work with a parenting group in a
    church or town hall.
  • Another nurse, as client advocate, leader, and
    researcher, may study the health needs of a
    neighborhoods elderly population by collecting
    data throughout the area and meeting with
    resource people in many places.
  • A nurse may work with community-based
    organizations such as an AIDS organization or a
    support group for parents experiencing the
    violent death of a child.

Tasks for practical
  • Search the Internet or go to the library and find
    two sources of health-related information for
    consumers. Was the information accurate?
  • Search the Internet or go to the library and find
    two research articles on community health
    nursing. In what settings did the research take
    place? Did the nursing authors collaborate with
    interdisciplinary team members on this research?
    If so, how do you think this collaboration
    helped the research? If you were to conduct
    research in the community, would you conduct it
    with only nurses on the team, or would your team
    be interdisciplinary? Why? What would be the
    benefits or limits of each approach?
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