Community Nursing Explained: Unit One

people wearing shoes in community join together

Community Nursing applies to all nurses who work in, as well as with the community in a variety of areas such as public health, home health, and occupational health.

First adopted in 2003, The Canadian Community Health Nursing Standards of Practice has reinforced community nursing as a specialty field of practice within nursing. This form of nursing focuses on the community, family, individuals, groups, and populations. Community is people and relationships that emerge among them as they develop and commonly share agencies, institutions, and a physical environment.

Community Health Nursing includes public health, home health, occupational health, forensic, outpost, and parish.

There are many roles and specialties of a community health nurse.

Specialties include military nurse, school nurse, public health nurse, forensic nurse, home health nurse, occupational health nurse, nurse entrepreneur, and street/outreach nurse.

Roles include advocator, collaborator, researcher, educator, coordinator, leader, manager, consultant, and facilitator. Community-based nursing focuses on health promotion and disease prevention. It involves acute, chronic, and palliative care. It also enhances self-care and promotes autonomy in decision making.

Population Health

Population Health refers to the health outcomes of a population measured by the determinants of health and health status indicators. Health status indicators are wellbeing, life expectancy, incidence and prevalence rate, mortality rate, and burden of illness. Population health involves eight key elements. First, to focus on the health of populations. Second, to address the determinants of health and their interactions. Third, to base decisions on evidence. Fourth, to increase upstream investments. Fifth, to apply multiple interventions and strategies. Sixth, for collaboration across sectors and levels. Seventh to employ mechanisms for public involvement. Lastly, to demonstrate accountability for health outcomes.

Disease Prevention

nurse takes a patients blood with gloves on

A focus of community nurses is disease prevention. There are three levels of disease prevention. Primary prevention is to prevent the occurrence of a disease or injury such as immunizations and hand washing. Secondary prevention is to detect disease early on in its progression before clinical signs and symptoms become apparent such as hypertension and breast cancer. Tertiary prevention occurs once a disease has become obvious, the goals are to interrupt the course of the disease, reduce the amount of disability that might occur, and begin rehabilitation.

Downstream thinking considers individual health concerns and treatments but does not consider the sociopolitical, economic, and environmental variables. It is a microscopic individual curative focus. Upstream thinking is a macroscopic “big picture” approach. It considers the determinants of health and other economic, political, and health factors.

Social Determinants of Health

Social determinants for health are the social conditions and broader forces that interact to influence risks to health and wellbeing and affect how vulnerable or resilient people are to disease and injury. These determinants of health include income, education, employment, working conditions, food insecurity, housing, health services, race, disability, and gender. Social determinants of health have profound impacts on all of society’s efforts to improve health and reduce health inequalities.

Primary Health Care

Primary Health Care is comprehensive care that includes disease prevention, community development, a widespread spectrum of services and programs, working in interprofessional teams, and intersectoral collaboration for healthy public policy. There are five principles of primary health. First, for equal distribution of essential health services to all populations. Second, to increase emphasis on services that are preventive and promotive, rather than curative only. Third, for maximum individual and community involvement in the planning and operation of health care services. Fourth, for the integration of health development with social and economic development. Lastly the use of appropriate technology.

Primary care is the first contact with the health care system which focuses on treating disease, rehabilitation, and preventive measures. Primary health care includes disease prevention, community development, services and programs, and working in teams.

Public Health

people in community join hands and hold arms

Public health is an organized activity of society to promote, protect, improve, and restore the health of individuals. it is a combination of science, skills, and values, that function through collective societal activities and involves programs, services, and institutions aimed at protecting and improving the health of all people. It is a set of scientific, professional, and technological forms of practice. Public health focuses to have “the greatest good for the greatest number”.

Collaboration is the commitment between two or more parties who set goals to address identified client health concerns. There are six principles of collaboration: client focus, population health approach, quality care and services, access, trust/respect, and communication.

Population Focused Practice

Population-focused practice directs community health nursing practice: in contrast to individual-focused health care, it emphasizes reducing health inequalities of a defined population or aggregate. The group is the focus.

Health Promotion is when community nurses work alongside low incomes to support health promotion and disease prevention to support health promotion and disease prevention by supporting education and demonstration programs for healthy eating on a restricted budget (e.g. grocery store tours, community gardens, and cooking classes).

Nursing Metaparadigm

In community-nursing, health is looked at as a whole. It involves working in groups to reach long term goals as opposed to the short term. Determinants of health play a big factor in health. The environment can include physical and social. The environment is important because this is both where client interaction takes place and may be a focus for nursing intervention. Nursing is at a more collaborative level. You look at the needs of larger groups rather than individual needs.

History

Throughout history, people have worked to understand, prevent, and control disease, illness, and injury. Ancient Babylonians understood the importance of hygiene, had some medical skills and knew how to use medicine to treat the sick. The Egyptians developed a variety of Pharmaceutical preparations and public drainage systems. Roman civilization viewed medicine from the perspective of community health and social medicine. They established sewage systems and drainage of swamps, as well as street cleaning. During the middle ages, European cities suffered high-density populations, lacked clean water, and had insufficient systems to dispose of body waste.  Poor sanitary conditions and crowding increases in communicable diseases such as cholera, smallpox, and plague.  There are established hospitals to care for the sick, poor, and neglected including the aged, disabled, and orphaned.

Later on in the Middle Ages, there was an increase in health education, promotion of personal hygiene, and moderate eating was encouraged. In the eleventh century Muslim nurses in what is now Saudi Arabia, a school of nursing for women and developed a code for nursing conduct and ethics. During the Renaissance, there were public health efforts and community health nursing in western Europe and North America.

The Industrial Revolution in the nineteenth century in Europe led to advances in transportation, communication, and other forms of technology. Many early hospitals in Great Britain were poorly ran and had untrained nurses.

In the early 1900’s public health nursing made visits to people with TB. Around 1910 Canada Public Health Association was founded to deliver and support national health programs. After world war 2 focus shifted to treatment focus/ medical focus (use of antibiotics). in the 1970s the Lalonde Report initiated the health promotion movement. This looked at wellness through lifestyle changes. In 1978 the Alma Ata Declaration defined primary health care. The Epp Report of 1986 stated that all public policy sectors (income, employment, education, and housing) all impact health. Home health care became popular in 1980-1990. There was a shift in public health strategy from illness prevention to health promotion. Before 1980 “public health nurse” and “community health nurse” were used interchangeably.

In 2001 researchers determined that home care for older adults cost less than institutional care. In 2002 the Romanow Report identified home care as the most rapidly growing area of community health, part of this was due to early discharge.

Inspiring Nurses

Kate Brighty Colley developed two long term facilities in Alberta that didn’t have road access, traveling to communities via horse-drawn carriage or sled. She provided health information to community residence through radio broadcast.

Eunice Dyke had a vision for public health nursing and was the first director of public health nursing in Toronto.

Lillian Wald thought sickness should be considered in its social and economic context. Her visionary work is recognized in three critical areas: the intervention of public health nursing, the establishment of an American insurance system for home-based care, and the creation of an American public health nursing service. She created the Life Insurance Company for life insurance. Wald’s program included the following: to provide home nursing care on a fee-for-service basis, establishing an effective cost-accounting system for visiting nurses, using advertisements in newspapers and on the radio to recruit nurses, and reducing mortality rates from infectious diseases.

During the Crimean War, (1854-1856) the British military established hospitals for the sick and wounded. These hospitals were crowed and had poor sanitation, lice, and rats. They also had insufficient food and medical supplies. Florence Nightingale asked to be sent to go work. Her personal wealth, social, and political connections and knowledge of hospitals influenced the British government, along with 40 other women, 117 hired nurses, and 15 paid servants. She significantly improved soldiers’ health by better environmental conditions and excellent nursing. She documented a decrease in the mortality rate from 415/1000 to 11.5/1000.

After the war, Nightingale went on to organize hospital nursing practice and nursing education. She focused on sanitation, rest, nutrition, and hygiene. Her work marks the beginning of community health nursing as we know it today.

Florence Nightengale, Lillian Wald, Eunice Dyke, and Kate Colley continued to inspire practice in the present and the future. These nurses developed an exceptional ability to develop approaches and programs to solve health care and social problems of their time.

Government Agencies

There are many agencies in Canada such as the Public Health Agency of Canada, Canadian Institutes of Health Research, Health Products and food branch, First Nations and Inuit Health Branch and Healthy Environments, and Consumer Safety Branch. Health Canada safeguards the populations’ health through surveillance, prevention, legislation, and research in areas such as environmental health, disease outbreak, drug products, and food safety.

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