Roles and Settings for Community Roles and Settings for Community Health Nursing PracticeHealth Nursing Practice

Chapter 3Chapter 3

Historically, community health nurses Historically, community health nurses have engaged in many roles. From the have engaged in many roles. From the beginning, nurses in this professional beginning, nurses in this professional specialty have provided care to the sick, specialty have provided care to the sick, taught positive health habits and self-care, taught positive health habits and self-care, advocated on behalf of needy populations, advocated on behalf of needy populations, developed and managed health programs, developed and managed health programs, provided leadership, and collaborated with provided leadership, and collaborated with other professionals and consumers to other professionals and consumers to implement changes in health services. implement changes in health services.

The settings in which these nurses The settings in which these nurses practiced varied, too. The home certainly practiced varied, too. The home certainly has been one site for practice, but so too has been one site for practice, but so too have clinics, schools , factories, and other have clinics, schools , factories, and other community-based locations. Today, the community-based locations. Today, the roles and settings of professional roles and settings of professional community health nursing practice have community health nursing practice have expanded even further.expanded even further.

Core Public Health FunctionsCore Public Health Functions

The various roles and settings for practice hinge on The various roles and settings for practice hinge on three primary functions of public health: assessment, three primary functions of public health: assessment, policy development, and assurance. They are policy development, and assurance. They are foundational to all roles assumed by the community foundational to all roles assumed by the community health nurse and are applied at three levels of service: health nurse and are applied at three levels of service: to individuals, to families, and to communities to individuals, to families, and to communities (Display 3-1). (Display 3-1).

Assessment:Assessment:

Assessment, means that the community health nurse Assessment, means that the community health nurse must gather and analyze information that will affect must gather and analyze information that will affect the health of the people to be served. The nurse and the health of the people to be served. The nurse and others on the health team need to determine health others on the health team need to determine health needs, health risks, environmental conditions, needs, health risks, environmental conditions, political agendas, and financial and other resources, political agendas, and financial and other resources, depending on the persons, community, or population depending on the persons, community, or population targeted for intervention. targeted for intervention.

Data may be gathered in many ways; typical methods Data may be gathered in many ways; typical methods include interviewing people in the community, include interviewing people in the community, conducting surveys, gathering information form conducting surveys, gathering information form public records, and using research findings. public records, and using research findings.

Policy DevelopmentPolicy Development

Policy development, defined in Display 3-1, is Policy development, defined in Display 3-1, is enhanced by the synthesis and analysis of information enhanced by the synthesis and analysis of information obtained during assessment. Assessment is used to obtained during assessment. Assessment is used to develop local and national policies.develop local and national policies.

Typically, the nurse recommends specific training Typically, the nurse recommends specific training and programs to meet identified health needs of target and programs to meet identified health needs of target populations. This is accompanied by raising the populations. This is accompanied by raising the awareness of key policy makers about factors such as awareness of key policy makers about factors such as health regulations and budget decisions that health regulations and budget decisions that negatively affect the health of the community.negatively affect the health of the community.

Assurance Assurance مراقبةمراقبة

AssuranceAssurance activates—activities that make certain that services activates—activities that make certain that services are provided, community health nurses perform the assurance are provided, community health nurses perform the assurance function at the community level when they provide service to function at the community level when they provide service to target populations, improve quality assurance activities, and target populations, improve quality assurance activities, and maintain safe levels of communicable disease surveillance and maintain safe levels of communicable disease surveillance and outbreak control. In addition, they participate in research, outbreak control. In addition, they participate in research, provide expert consultation, and provide services within the provide expert consultation, and provide services within the community based on standards of care. community based on standards of care.

Roles of Community Health Roles of Community Health NursesNurses

Over time, the role of the community health nurse has Over time, the role of the community health nurse has broadened. Community health nurses wear many hats broadened. Community health nurses wear many hats while conducting day-to-day practice. This is while conducting day-to-day practice. This is especially true for specialized roles such as that of especially true for specialized roles such as that of full-time manager. This chapter examines seven full-time manager. This chapter examines seven major roles: (1) clinician, (2) educator, (3) advocate, major roles: (1) clinician, (2) educator, (3) advocate, (4) manager, (5) collaborator, (6) leader, and (7) (4) manager, (5) collaborator, (6) leader, and (7) researcherresearcher

Clinician RoleClinician Role

The clinician role in community health means The clinician role in community health means that the nurse ensures that health services are that the nurse ensures that health services are provided not just to individuals and families, provided not just to individuals and families, but also to groups and populations. but also to groups and populations.

Educator RoleEducator Role

A second important role of the community health A second important role of the community health nurse is that of educator or health teacher. Health nurse is that of educator or health teacher. Health teaching, a widely recognized part of nursing teaching, a widely recognized part of nursing practice.practice.The educator role is especially useful in promoting The educator role is especially useful in promoting the public’s health for at least two reasons. the public’s health for at least two reasons. FirstFirst, , community clients usually are not acutely ill and can community clients usually are not acutely ill and can absorb and act on health information. absorb and act on health information. SecondSecond, the educator role in community health , the educator role in community health nursing is significant because a wider audience can be nursing is significant because a wider audience can be reached. reached.

Advocate RoleAdvocate Role

The issue of client’s rights is important in health care. Every The issue of client’s rights is important in health care. Every patient or client has the right to receive just, equal, and patient or client has the right to receive just, equal, and humane treatment. Our current health care system often is humane treatment. Our current health care system often is characterized by fragmented and poor, the disadvantaged, characterized by fragmented and poor, the disadvantaged, those without health insurance, and people with language those without health insurance, and people with language barriers – frequently are denied their rights. They become barriers – frequently are denied their rights. They become frustrated, confused, degraded, and unable to cope with the frustrated, confused, degraded, and unable to cope with the system on their own. The community health nurse often acts system on their own. The community health nurse often acts as an advocate for clients, pleading their cause or acting on as an advocate for clients, pleading their cause or acting on their behalf. Clients may need someone to explain which their behalf. Clients may need someone to explain which services to expect and which services write letters to agencies services to expect and which services write letters to agencies or health care providers for them. or health care providers for them.

Manager RoleManager Role

Community health nurses, like all nurses, engage in the role of Community health nurses, like all nurses, engage in the role of managing health services. As a manager, the nurse exercises managing health services. As a manager, the nurse exercises administrative direction toward the accomplishment of administrative direction toward the accomplishment of specified goals by assessing clients’ needs, planning and specified goals by assessing clients’ needs, planning and organizing to meet those needs, directing and leading to organizing to meet those needs, directing and leading to achieve results, and controlling and evaluating the progress to achieve results, and controlling and evaluating the progress to ensure that goals are met. ensure that goals are met. The management process, like the nursing process, The management process, like the nursing process, incorporates a series of problem solving activates or functions: incorporates a series of problem solving activates or functions: planning, organizing, leading, and controlling and evaluating. planning, organizing, leading, and controlling and evaluating.

Collaborator RoleCollaborator Role

Community health nurses seldom practice in isolation. They Community health nurses seldom practice in isolation. They must work with many people, including clients, other nurses, must work with many people, including clients, other nurses, physicians, teachers, health educators, social workers, physical physicians, teachers, health educators, social workers, physical therapists, nutritionists, occupational therapists, psychologists, therapists, nutritionists, occupational therapists, psychologists, epidemiologists, biostaticians, attorneys, secretaries, epidemiologists, biostaticians, attorneys, secretaries, environmentalists, city planners, and legislators. environmentalists, city planners, and legislators.

As members of the health team, community health nurses As members of the health team, community health nurses assume the role of collaborator, which means to work jointly assume the role of collaborator, which means to work jointly with others in a common endeavor, to cooperate as partners. with others in a common endeavor, to cooperate as partners. Successful community health practice depends on this Successful community health practice depends on this multidisciplinary collegiality and leadership. multidisciplinary collegiality and leadership.

Leadership RoleLeadership Role

Community health nurses are becoming increasingly Community health nurses are becoming increasingly active in the leadership role, separate from leading active in the leadership role, separate from leading within the manager role mentioned earlier. The within the manager role mentioned earlier. The leadership role focuses on effecting change; thus, the leadership role focuses on effecting change; thus, the nurse becomes and agent of change. nurse becomes and agent of change.

Researcher RoleResearcher Role

In the researcher role, community health In the researcher role, community health nurses engage in systematic investigation, nurses engage in systematic investigation, collection, and analysis of data for solving collection, and analysis of data for solving problems and enhancing community health problems and enhancing community health practice. practice.

Settings For Community Health Settings For Community Health Nursing PracticeNursing Practice

The pervious section examined community The pervious section examined community health nursing form the perspective of its health nursing form the perspective of its major roles, the roles now can be placed in major roles, the roles now can be placed in context by viewing the settings in which they context by viewing the settings in which they are practiced. are practiced.

HomesHomes

For a long time, the most frequently used setting for For a long time, the most frequently used setting for community health nursing practice was the home. In the home, community health nursing practice was the home. In the home, all of the community health nursing roles, to varying degrees, all of the community health nursing roles, to varying degrees, are performed. are performed.

The home also is setting for health promotion. Many The home also is setting for health promotion. Many community health nursing visits focus on assisting families to community health nursing visits focus on assisting families to understand and practice healthier living behaviors: child understand and practice healthier living behaviors: child discipline, diet, exercise, coping with stress, or managing grief discipline, diet, exercise, coping with stress, or managing grief and loss. and loss.

Ambulatory Service SettingsAmbulatory Service Settings

Ambulatory service settings include a variety of Ambulatory service settings include a variety of venues for community health nursing practice in venues for community health nursing practice in which clients come for day or evening services that which clients come for day or evening services that do not include overnight stays. do not include overnight stays.

Sometimes, multiple clinics offering comprehensive Sometimes, multiple clinics offering comprehensive services are community based or are located in services are community based or are located in outpatient departments of hospitals or medical outpatient departments of hospitals or medical centers. Such as a family planning clinic or a well-centers. Such as a family planning clinic or a well-child clinic. child clinic.

SchoolsSchools

Schools of all levels make up a major group of Schools of all levels make up a major group of settings for community health nursing settings for community health nursing practice. practice.

Occupational Health SettingsOccupational Health Settings

Business and industry provide another group of Business and industry provide another group of settings for community health nursing practice. settings for community health nursing practice. Employee health has long been recognized as making Employee health has long been recognized as making a vital contribution to individual lives, productivity of a vital contribution to individual lives, productivity of business, and the well-being of the entire nation. business, and the well-being of the entire nation. Organizations are expected to provide a safe and Organizations are expected to provide a safe and healthy work environment in addition to offering healthy work environment in addition to offering insurance for health care. insurance for health care.

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