INTRODUCTION TO COMMUNITY HEALTH NURSING

(COMMUNITY HEALTH NURSING 1 (NSC321))

By

JOSEPH, JONATHAN GIMBA

DEPARTMENT OF NURSING SCIENCES

PRINCE ABUBAKAR AUDU UNIVERSITY
ANYIGBA, KOGI STATE

DECEMBER, 2024
Learning Outcomes
At the end of the session, student should be able to:
. Understand and define the basic community health concepts of:
 community
 Health
 Community Health Nursing
 Public Health Nursing
 List the types of community and basic characteristics of a healthy community
 List community health principles: primary health care, health promotion,
disease prevention and community participation
 Compare and contrast the public/community definitions of health
 Define and discuss the focus of Public/Community Health Nursing
 List the three levels of prevention and give one example of each
Introduction
 Most of your nursing education journey has focused on caring for
clients/patients in hospitals
 However, nurses also serve important roles in promoting the health and
wellness of families, communities and populations
 Florence Nigtingale, founder of modern nursing, advocated for two
foundational components of community health nursing: health
promotion and disease prevention
 Of recent, community health nursing has become increasingly important
for several reasons:
Introduction, cont’d
 There are currently shorter hospital stays and decreasing readmission rates
 As the ability to successfully manage chronic conditions improves, the need for
outpatient health services also increases
 As the usage of telehealth and virtual healthcare expands, so does the need for
community member support and patient education
 Curative healthcare account for the majority of escalating healthcare
expenditures in developing nations like Nigeria yet health indicators rate
considerably below the health indicators of nations that have prioritized
preventative health care
 This session provides you the foundational introduction to community health
nursing
The concept community
 Definitions of community are numerous and variable
 Before now, definitions of community focused on geographical boundaries,
combined with social attributes of people
 However, at present, geographical location is observed to be secondary
characteristic in the discussion of what defines community
 In recent nursing literature, community has been defined as:
 “a collection of people who interact with one another and whose common
interests or characteristics form the basis for a sense of unity or belonging.”
 “a group of people sharing common interests, needs, resources and
environment.”
The concept community, cont’d
 “a locality-based entity, composed of systems of formal organizations
reflecting society’s institutions, informal groups and aggregate
 A synthesis of definitions from sociology suggests that a community:
 “is a social unit (or group of living things) that share something in
common, such as customs, identifying characteristics, values, beliefs, or
norms.”
 “are groups of individuals linked by social bonds that give rise to a
collective consciousness.’
The concept community, cont’d
 The shared sense of belonging –shared area, common life and social
relationships – is the pillar of a community, distinguishing it from a mere
gathering of people
 And thefour defining attributes of a community include:
 People,
 Place,
 Interaction, and
 common characteristics, values, and/or goals
Types of community
 Many different types of community exist
 Each type has different characteristics, purpose, membership requirements, and
traditions of interactions
 There are two main types of communities
 Geopolitical communities, and
 Phenomenological communities
 Geopolitical communities are those most traditionally recognized or imagined
 Geopolitical communities are defined or formed by both natural and manmade
boundaries and include cities, counties, states, and nations; school districts,
neighborhood
Types of community, cont’d
 Phenomenological communities refer to the relational, interactive groups
 In phenomenological communities, the place or setting is more abstract
 and individuals share a group perspective or identity based on culture,
values, history, interests and goals
 Examples: schools, colleges, and universities; churches, mosques
 A community of solution/interest is a typical type of phenomenological
community
 It is a collection of people who form a group specifically to address a
common need or concern
Types of community, cont’d
From the community main types are 8 community sub-types:
 Community of Place: Defined by a shared physical location, such as a
community of people living in a specific apartment building or
neighborhood
 Geographic Community: Bound together by a specific geographic
location, such as a city, town, or village
 Psychological Community: Connected by shared interests, values, or
beliefs, such as a community of people with a specific hobby or a support
group
 Cultural Community: Bound together by shared cultural values,
traditions, and practices
Types of community, cont’d
 Community of Interest: United by a shared interest or goal, such as a
community of people advocating for a specific health issue
 Community of Practice: Connected by a shared profession or occupation,
such as a community of nurses or healthcare professionals
 Virtual Community: Connected through digital technologies, such as
online forums, social media groups, or online support groups.
 Sociological Community: Defined by social relationships, such as a
community of people with a shared culture, ethnicity, or socioeconomic
status
Characteristics of a healthy community
 The quality of a community is often dictated by the degree of engagement
and happiness individuals can draw from community interactions
 Yet, sadly, some communities promote feelings of self-doubt and isolation
 Positive communities inspire members in ways that promote a sense of
self-discovery and group connection,
 encourage members to express their beliefs and values and build
relationships with others
Characteristics of a healthy community, cont’d
 Communities may differ in what they encourage, but overall, ten characteristics
tend to make for a successful community
1. Common goals
 Effective communities often share similar values and belief systems
 These can motivate its individuals to accomplish mutually held goals, the nature
of which may vary depending on the group in question
2. Freedom of expression
 A positive community ensures comfort among its members when it comes to
speaking their minds and expressing what is important to them
 In contrast, dysfunctional communities tend to silence voices that diverge from
those espoused by the majority or group leaders
Characteristics of a healthy community, cont’d
3. Address member concerns with sensitivity
 Just as it is important to create a community that encourages the voicing
of concerns,
 it is also important to ensure that members feel their concerns are
adequately addressed
4. Set clear policies and obligations
 Strong and enduring communities typically set clear rules and
expectations to guide the conduct of its members
 Doing so ensures that there is as little ambiguity as possible regarding
what is and is not okay and will help minimize misunderstandings
Characteristics of a healthy community, cont’d
5. Fairness
 With policies and expectations clearly in place, enforcement of these rules
should be applied fairly
 Feeling a sense of fairness is critical to the experience of good
relationships, and good relationships are often a key driver of people’s
involvement in communities
6. Celebrate heritage and traditions
 Every long-standing community has heritage and traditions
 Positive communities embrace their culture by reminding members of the
long way the community has come
Characteristics of a healthy community, cont’d
7. Promote interaction among members
 Positive communities ensure a feeling of genuine connection among members
by providing plenty of interaction opportunities
 Doing this can motivate members to meet their obligations and work toward the
established goals of the community
8. Elect leaders that stand by community values
 Positive communities have elected leaders who lead them
 Individuals elected to leadership positions within positive communities should
be fair and just in their focus
 Their shared values should inform the decisions they make on behalf of the
community
Characteristics of a healthy community, cont’d
9. Prioritize effective communication
 Communication is essential for any effective community
 Not only does this mean clearly communicating policies, rules, and
expectations,
 but it also means keeping members up to date about ongoing projects, changes
to policies, and upcoming events
10. Make smart decisions
 Positive communities’ decisions focus primarily on the promotion of its vision
and aims
 Decisions are ensured to aligned with the community’s vision and aims
 It is the members’ identification with a vision and aims that likely led them to
join the community in the first place
Concept Population
 Population and aggregate are related terms that are often used in
community/public health nursing
 Population is typically used to denote a group of people having common
personal or environmental characteristics
 It can also refer to all of the people in a defined community
 Aggregates are subgroup or subpopulations that have some common
characteristics or concerns
 Community health nursing interventions are always:
 directed toward a community, a population, or an aggregate (e.g pregnant teens
within a school),
 depending on situations, need or practice parameters
The Concept Health
 The concept of health is central to the nursing metaparadigm
 And the definition of health is evolving
 The WHO definition of health set a trend toward describing health in
social terms, rather than in medical terms
 WHO defined health as “a state of complete physical, mental, and social
wellbeing and not merely the absence of disease or infirmity.”
 Social means “of or relating to living together in organized groups or
similar close aggregates”
 And refers to units of people in communities who interact with each other
The Concept Health, cont’d
 “Social health” connotes community wellness and is a function of positive
interaction among groups within the community

 The emphasis is on the health promotion and disease prevention

 For example, community groups in your local community may sponsor

enlightenment campaign against teenage pregnancy
The Concept Health, cont’d
 WHO later expansion of the definition of health include the socialized
conceptualization of health as under:
The extent to which an individual or group is able, on the one hand, to realize
aspirations and satisfy needs; and on the other hand, to change or cope with the
environment. Health is, therefore, seen as a resource for everyday life, not the objective
of living; it is a positive concept emphasizing social and personal resources, and
physical capacities.

(WHO, 1986, p. 73)

The Concept Health, cont’d
 It should be noted that the concept of health can vary between different
cultures
 What is considered to be a disease in one culture/community, can be
considered to be normal in another
 Thus, Health is a slippery concept to grasp, define and measure
 Importantly, the concept of health is multifaceted
 It encompasses physical, psychological, intellectual, emotional, spiritual,
and social dimensions
Determinants of Health and Illness in
community
 A number of factors affect the health status of a community
 Factors include health care access, economic conditions, social and environmental issues, and
cultural practices
 These factors can be broadly grouped into the following determinants of health and illness:
1. Individual determinants:
a. Behavior:
 Lifestyle choices (diet, exercise, smoking)
 Health behavior(hand and personal hygiene, vaccination)
b. Biology:
Sex
Age
Genetics
Pre-existing medical conditions
Determinants of Health and Illness in
community, cont’d
c. Economic:
 Housing affordability and quality
 Income and poverty levels
2. Healthcare system determinants:
 Access to Healthcare services
 Healthcare workforce and infrastructure
 Quality of healthcare services
 Healthcare financing and insurance
3. Environmental determinants:
 Natural environment (geography, climate)
 Built environment (urban planning, transportation)
 Physical environment (air and water quality, housing)
Determinants of Health and Illness in
community, cont’d
4. Social determinants:
 Culture and cultural beliefs
 Social support networks
 Employment
 Education
 These determinants interact with each other and with the individual
characteristics to influence health and illness in a community
 Community Health Nurses should understand these interactions and how they
influence health and illness
 and that some of these determinants can be modified or changed (individual
factors –tobacco use, activity, diet),
 while some cannot be modified (biology, age, sex/gender, in Nigeria of course)
Determinants of Health and Illness in
community, cont’d
 Other factors such ass physical and social environment, healthcare access
will require policy formulations and directions from government
 Community Health Nurses must work with policy makers and community
leaders,
 to advocate for activities and policies that promote health at the
individual, family, and community levels
Community Health Indicators
 Several health indicators are used by the Community Health Nurse to measure
the health of a community
 Local, state, national and international health agencies provide morbidity,
mortality, and other health-related data
 Some of the more commonly reported indicators are infant mortality, age-
adjusted death rates, life expectancy etc
 Other indicators could include, depending on the country, individual behaviors
(physical activity, overweight and obesity)
 Physical and social environmental factors(environmental quality, injury, and
violence), and
 Health systems access (Access to healthcare services)
Community Health Indicators, cont’d
 Each of these indicators can affect the health of individuals and
communities
 The indicators can be correlated with leading causes of morbidity and
mortality
 Important questions such as what are the leading causes of death and
disease among various groups served?
 What are the most common environmental risks?
 How do teenage pregnancy rates in this community compare with
regional, state, and national rates?
 Answers to these questions will guide community health interventions
Concepts of Public Health and Community
Health
 Public health is the science and art of Preventing disease, Prolonging life,
and Promoting health and efficiency through organized community effort
 The key phrase here is “through organized community effort.”
 Thus, public health connotes organized, legislated, and tax-supported
efforts that serve all people through health departments or related
governmental agencies
 The term community health extends the scope of public health to include
organized health efforts at the community level through both government
and private efforts such as Nigerian Red Cross, Malaria Consortium
Concepts of Public Health and Community
Health, cont’d
 Public health efforts focus on prevention and promotion of public health
at the federal, state and local levels
 The efforts at the federal levels concentrate on providing support and
advisory services to public health structures at the local level
 Then the local structures provide direct services to communities through:
1. General services that ensure public protection from polluted water and
air; tainted food, unsafe housing
2. Personal healthcare services such as immunization and family planning
services, ASRHs
History of Public Health: Summary
The public health nursing tradition begun in the late 1800s by Lilian Wald
and her associates
These nurses, on providing care to immigrant community, realized that
neither administering bedside clinical nursing nor teaching family
members to deliver care in the home adequately addressed the true
determinants of health and disease
They resolved that collective political activity should focus on advancing the
health of aggregates and improving social and environmental determinants
of health
History, cont’d
 They impacted the health of the community by organizing the
community and establishing school nursing
 They asserted that public health has threefold functions: assessment,
assurance, and policy development
 Assurance focuses on the availability of necessary health services on the
community
 Policy development use information gathered during assessment to
develop local and state health policies
Public Health Nursing, Community Health
Nursing and Community-based Nursing
 Public health nursing and community health nursing are often used
interchangeably
 However, there is a subtle difference between the two terms
 Definitions of public health nursing and community health nursing indicate
similar yet distinctive ideologies, visions or philosophies of nursing
 Public health nursing is the synthesis of public health and nursing practice
 It is a field that combines nursing and public health skills to address community
health issues
 It involves collaboration with other health professionals to provide
comprehensive nursing care of families and other groups, public health
education, and public mobilization to promote health and prevent disease
The American Public Health Association committee on Public Health Nursing
defined Public Health Nursing as:
 “the practice of promoting and protecting the health of populations using
knowledge from nursing, social and public health sciences.”
 A systematic process by which the health care needs of a population are
assessed,
 A plan for intervention is developed with the community to meet identified
needs,
 The plan is implemented effectively, efficiently and equitably
 Evaluations are conducted to determine the extent of which the
interventions have impacted individuals and populations health,
 Results of the process are used to inform policy formulations and direction
Community Health Nursing
ANA defined community health nursing as synthesis of nursing practice
and public health practice applied to promoting and preserving the
health of populations
The practice is general, not limited to particular age group and is
continuing, not episodic
The dominant responsibility is to the population as a whole as nursing
directed to individuals, families, or groups contributes to the health of
the total population
And the nursing care focus on health promotion, health maintenance,
health education and management, coordination, and continuity of care
 Some authors use community health nursing as a global or umbrella term
and public health nursing as a component or subset
 Yet others, as mentioned earlier, use the terms interchangeably
Community-based Nursing
 This refers to application of the nursing process in caring for individuals,
families and groups where they live, work or go to school
 The practice is setting specific, and the emphasis is on acute and chronic
care
 Includes such practices as home health nursing and nursing in out patient or
ambulatory settings
 While community health nursing primary client is the community,
community-based nursing clients are the individual and the family
 In the later, services are direct while in former services are both direct and
indirect
Health Promotion and Levels of Prevention
 While medical care focus on disease management and cure, public health efforts
focus on health promotion and disease prevention
 Disease prevention activities protect people from disease and the effects thereof
whereas health promotion activities enhance resources directed at improving
wellbeing
 Concepts of health promotion, self-care and community participation emerged
during 1970s because of limitation of professional health
 According to the WHO Ottawa Charter for health promotion (1986), Health
Promotion is the process of enabling people to increase control over, and to
improve their health
 For harmony in health, an individual or group must be able to identify and to
realize aspirations, to satisfy needs, and to change or cope with the environment
Concept of Health Promotion, cont’d
 Thus, health is resource for daily living and a personal responsibility
 As such, health promotion is not just the responsibility of the health sector, but
goes beyond healthy lifestyles to well-being
 Consequently, the Ottawa charter noted that five key strategies for Health
Promotion action are:
 building healthy public policy,

 creating supportive environments,

 strengthening community action,

 developing personal skills, and

 reorienting health services

Concept of Illness Prevention
 Illness prevention and health promotion are related concepts, and in practice,
can be used interchangeably
 Activities for health promotion help the patients/clients maintain or enhance
their present levels of health
 while activities for illness prevention protect patients/clients from actual or
potential threats to health
 Both types of activities are future orientated
 The difference between them involves motivations and goals
 Health promotion activities motivate people to act positively to reach the goals
of more stable levels of health
 Illness prevention activities motivate people to avoid declines in health and
functional states (Cox, 2010)
Concept Illness Prevention, cont’d
 Health promotion activities can be passive or active
 With passive strategies of health promotion, individuals gain from the activities
of others without doing anything themselves
 Examples include fluoridation of municipal drinking water, the fortification of
salt with iodine and milk with vitamin D
 The active health promotion strategies on the other hand, involves active
participation of individuals - individuals are motivated to adopt specific health
programs
 Example, The weight reduction and smoking cessation programs require the
patient/client to be actively involved in measures to improve their present and
future levels of wellness while decreasing the risk of disease.
 Some health promotion and illness prevention programs are operated by health
care agencies
Concept Illness Prevention, cont’d
 Hence, health is effectively promoted when the organizational, social,
individual, and environmental aspects are combined in an integrated
approach
Goals of Health Promotion
According to Delaune and Ladner (1998), goals of health promotion include the
following:
1. Respect and support clients right to make decisions
2. Identify and use clients’ strengths and assets
3. Empower clients to promote own health or healing
Levels of Prevention
 There are three levels of prevention:
 Primary prevention:
 Activities at this level are directed at preventing a problem before it occurs
by altering susceptibility or reducing it
 Primary prevention consists of two elements: general health promotion
and specific protection
 Health promotion efforts promote resiliency and protective factors
 The targets are essentially well populations
 Examples are promotion of good nutrition, encouraging regular exercise and
fostering good housing
 Specific protection efforts reduce or eliminate risk factors through measures
as immunization and water purification
 Secondary prevention:
 Focus on early detection of diseases or health challenges and prompt
intervention
 Health efforts here are implemented after implemented after a problem has
started but before signs and symptoms appear
 Target populations who have risk factors
 Examples are medical screenings – pap smear screening for cervical cancer,
breast self examination, testicular self examination BP screening etc
 Tertiary prevention:
 The focus is on populations who have experienced disease or injury
 Efforts are then directed towards limitation of disability and
rehabilitation
 The aim here is to keep health problems/challenges from getting
worse; to reduce effects of disease and injury; and to restore individual
to their optimal level of functioning
 Examples include teaching how to perform insulin injections and
disease management to a diabetic, referral of a spinal cord injury
victim for occupational and physical therapy