University of San Carlos

School of Health Care Professions

Department of Nursing-Graduate School Program

Cebu City

REFLECTION PAPER

ROLE OF NURSES IN COMMUNITY HEALTH NURSING

Submitted by:

MA. GRACE JOYLYN L. BAJAN, RN

M.A.N STUDENT

Submitted to:

MRS. LAARNE PONTILLAS,RN, MSN, MAN

PROFESSOR

INTODUCTION

Trying to keep an entire community is a big job, but somebody has to do it. And I am one

of those persons who chose this kind of responsibility, to become a community health nurse.

Unlike traditional nurses that care only individual person during the shift, but community health

nurse take the responsibility of the entire community at a time. This could include areas from

small towns to entire countries and everything in between. Although I have a stressful job at

times with massive amount of responsibility, but mostly I find it personally rewarding as well.

Especially when I help indigent person to get better and heard complements from them.

In my setting, the role of public health nurses focuses on the prevention of illness, injury

or disability, the promotion of health, and maintenance of the health population, (The Role of

Public Health Nurses, 2012). In the community, I chose to be assigned in the far-flung area

which health care services is not available and accessible. I believe that because of the lower to

middle income level of this community, focus should also be on better health care accessibility to

all residents.

At times, I have encounter certain disease and other health related issues that spread

throughout an entire community. Some examples of this health issues that affect the community

include the increasing number of teenage pregnancy, substance abuse, viruses like measles and

mumps, influenza, schistosomiasis, filariasis, and tuberculosis, just to name a few. If these

community health problem are ignored, they could grow out of control and cause problem for all

member of the community.

Communities need these types of nurses for a number of reasons. Most importantly,

community health nurses working in conjunction with other healthcare professionals that can

help improve the health of a community as a whole. Community health nurses can also help

provide necessary care in communities that lack easily accessible healthcare.

AIM AND REFLECTION PLAN

The aim of this reflection paper is to express my experience as a community nurse at the

community health nursing clinical rotation and how I achieved my objective during my

community health nursing clinical activities. The experiences I gained in my participation in

community health nursing at Rural Health Unit at the Municipality of Tubod, Surigao del Norte

are particularly satisfying, especially those gained learnings while I was working with various

patients of different backgrounds. This reflection paper will include the paramount that proper

behaviour conduct and professionalism should exhibited by a community health nurse.

Providing treatment for community members is often one of the primary duties of

community health nurse. In my reflection I will emphasize how community health nurses

provide affordable care to the community member that are ill or suffering from another health

related matter.

Working as a community health nurses is an excellent way to combine a love of nursing

and a love of to your community. In this reflection I will share my job as a community health

nurse that help keep these community health problems under control and the different strategies

trying to empower the people by educating the community on and work towards preventing

common health problems.

FINDINGS

The role of the community health nurse in the participating family’s community is to

focus on the health needs of the aggregate or group. Community health nursing refers to a

systematic, comprehensive focus on wellness, health protection, and disease, and injury

prevention for the population residing in a specific area. The nurse as advocate, case manager,

consultant, health care provider, educator, and collaborator with other agencies for health

outcomes of the entire community. Nurse involved in the health of specific community such as

the family participating will assess the members living in the demographic area and monitor the

environment for potential predisposing factors that may lead to illness. The conclusion of the

community assessment by the nurse directs, which types of services required to maintain the

health of the population. The nurse may determine that preventive health care will benefit the

community, (Stanhope & Lancaster, 2012). Community health nurse focus on preventing health

issues from sweeping through a community. In order to do this, these nurses will often need to

circulate through the community in question and interact directly with community members.

Prevention methods may include handling out informational fliers on certain health issues in the

community or spreading the word about common practices to avoid and prevent certain health

issues. In some cases, a community health nurse may even distribute health nurses might

distribute health related items or medications to help prevent certain health problems. For

example is the dispensing of free condo to aid in the prevention of pregnancy and sexually

transmitted disease, or administer vaccination and immunizations to help protect people against

contagious disease.

Public health nursing practice at the generalist and advanced or specialist level is

competency based. PHN core competencies include knowledge and skills derived from the core

public health workforce competencies, which were developed by the Council on Linkages (COL)

(Council on Linkages, 2010). These PHN core competencies include the three tiers of practice

used in the COL competencies, i.e., Tier 1 -- the PHN generalist; Tier 2 -- the PHN specialist or

manager; and, Tier 3 -- the PHN organization leader or executive level administrator (Quad

Council, 2011). These core competencies are necessary to implement community participatory

health promoting roles. In addition, it is essential to emphasize collaboration and partnerships

with communities and populations as contemporary PHN roles evolve in the context of Healthy

People 2020 (DHHS, 2010), the Patient Protection Affordable Care Act (ACA) (U.S. House of

Representatives, 2010), and the National Prevention, Health Promotion, and Public Health

Council (Executive Order 13544, 2010). These national initiatives provide new opportunities for

emerging roles in PHN focused on community health promotion and prevention practices.

Coordination is an important element of effective nursing management. Relationships

between professionals are known to be important for coordinating work based on the argument

that coordination is the management of task interdependence and therefore fundamentally a

relational process (Gittell et al. 2010). One of these relational perspectives – relational

coordination – identifies specific dimensions of relationships that are integral to effective nursing

management through coordination of care delivery. Relational coordination is a type of

relationship that is particularly relevant for coordinating work that is highly interdependent,

uncertain and time-constrained, such as providing comprehensive care to community-dwelling

frail people. This study supports this notion and clearly shows that comprehensive care delivery

to community-dwelling frail people requires strong relational connections between all health and

social care professionals. Rather than focusing primarily on knowledge and skills or on

commitment to their own organisation, effective nursing management requires strengthening of

relationships between primary care professionals from various disciplines by focusing on

frequent, high-quality communication supported by relationships of shared goals, shared

knowledge and mutual respect between them.

Moreover, it is proper the self-image that convey is pleasant to the eyes of everybody that

will affect the trust and respect of the people in the community. One should also guarantee

confidentiality of client information in order to promote mutual trust and respect between one

and the client. Appearance of the health nurse is also important and I ensured that I was always

appropriate and formally dressed in accordance with the dress code. Punctuality ad completion of

assignment within schedule was also important for me and I always made sure that I achieved

both at all times.

As this study showed that community health nurses may be an important factor in

strengthening these connections, community health nurses should not only be selected for their

functional competence but also for their relational competence (Gittell et al. 2008). They could

act as cross-functional boundary spanners to foster relational coordination (Gittell et al. 2010).

Relational competence refers to the ability to see the larger process and the manner in which

each individual’s work connects to the work of others (Cramm & Nieboer 2011). The ability to

perceive others’ perspectives, empathize with their situations and respect their work is

imperative. Relational competent community health nurses may therefore also act as cross

functional conflict mediators to enhance relational coordination among professionals involved in

delivery to frail people in the community (Gittell et al. 2010). In addition, stimulating cross-

functional interactions, facilitating cross-functional meetings, use of cross functional

performance measurement and conferring cross-functional rewards to health and social care

professionals who do not normally interact much may further enhance relational coordination

(Gittell et al. 2010, Jordan et al. 2009) and improve care delivery to frail people in the

community.

Public health nurses are able to gain these skills by creating collaborative partnerships

with community leaders and stakeholders and identifying resources and solutions to problems

through the CBPR method (Fletcher et al., 2011; Hassouneh et al., 2011; Marcus et al., 2004).

These skills are enhanced by empowering community members to address their community’s

health issues and increasing individual and community self-efficacy for health promotion

throughout the CBPR process (Andrews et al., 2007; Marcus et al., 2004). Ultimately, PHNs can

develop these skills by building community capacity and engaging community members and

partners to design more effective, sustainable health-promoting programs.

Again, there are examples of research that used a community participatory approach to

foster these community practice skills. Andrews et al. (2007) illustrated community dimensions

of practice skills when partnering with community stakeholders to develop multiple levels of

interventions using an ecological framework that enhanced sustainability. In another study,

PHNs built partnerships with community stakeholders (Hassouneh et al., 2011) to increase trust

and to better utilize community resources in applying interventions such as training. As shown in

these examples, public health nurses can use CBPR to enhance partnerships and empower

community members as participants by including them in the decision-making processes of

assessment and program planning (Andrews et al., 2007; Hassouneh et al., 2011; Perry &

Hoffaman, 2010).

PHNs in Ireland indicate that more resources are needed for them to carry out health

promotion initiatives and fulfil the vision of primary care. The findings of this study also

suggest a more efficient electronic database may improve communication among PCT

members and between primary and secondary services. However, full attendance at PCT

meetings is needed along with teambuilding exercises and socialising to build relationships and

team functioning. The next step is to test whether changes to policy would improve patient

outcomes using prospective interventional methods, such as a cluster randomised control trial.

This type of methodology would be ideal as it would allow comparisons to be made between

patient outcomes of those attached to PCTs and an intervention group in which PHNs have a

capped caseload number, thus allowing more time to carry-out health promotion activities.

Finally, if the PHN role is to change to a specialised one, PHNs may need appropriate up-skilling

and education.

As the roles of public health nurses as advocates, collaborators, educators, partners,

policy-makers, and researchers evolve in the area of community health promotion and

prevention, greater emphasis on community participatory and ethnographic approaches in PHN

education will provide benefits to students at the generalist and advanced practice levels (Zandee

et al., 2010). Moreover, basic and advanced public health nursing practice roles, which

emphasize inter-professional collaboration, community participatory strategies, and the

importance of local knowledge to address community health problems, will continue to

contribute to improved community and population health outcomes.

CONCLUSION AND RECOMMENDATION

The purpose of Community Health Nurse is to provide community health promotion

services in a designated region in accordance with the philosophy and objectives of the Authority

and to promote the prevention of disease, maintenance of health and the overall health and well-

being of the community.

The important skills that a community health nurse must poses is they can demonstrate

analytical assessment, cultural competence, program planning, and community dimensions of

practice are critical for pursuing community health promotion goals as public health nurses

become more widely involved in community participatory approaches. Other important

competencies for the health promotion role are required for public health nurses, including

communication; financial planning and management leadership and systems thinking; policy

development and public health science. Public health nurses can further develop these skills by

continuing to engage in community participatory practices. For example, PHN practice utilizes

public health science knowledge, competencies, and skills by partnering with public health

educators and researchers to develop evidence-based prevention interventions programs and thus

contribute to nursing science. Community initiatives by PHNs can contribute to the development

of policies based on in-depth evidence, assist community health advocates, and lead to improved

long term outcomes.

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