Introduction to Community Health Nursing PDF

**Introduction to Community Health Nursing** **Introduction** This study session welcomes the learners to the community health nursing course. Community health nursing expands beyond nursing's focus on individual care to family, group, and community care and encompasses the opportunity to affect t...

**Introduction to Community Health Nursing** **Introduction** This study session welcomes the learners to the community health nursing course. Community health nursing expands beyond nursing's focus on individual care to family, group, and community care and encompasses the opportunity to affect the health status of populations. You are familiar with the provision of nursing care in acute care settings in hospitals for the very ill with other professionals at your side. You have worked as part of a team to reestablish a client's health or comfort someone towards a peaceful death. Now, community health nursing care takes you outside the acute care setting to the community---into homes, schools, recreational facilities, work settings, parishes, and even street corners that are familiar to your clients and may be unfamiliar to you. Nurses must understand the concept of community health as a special field in nursing and have insight into its trend and it's future direction by tracing its history. **1.0 Learning Outcomes for Study Session 1** When you have studied this session, you should be able to: 1. Define community health (SAQ 1.1); 2. Distinguish community health from public health (SAQ 1.2); 3. Explain the characteristics of community health nursing (SAQ 1.3); 4. Describe the components of community health nursing (SAQ 1.4); 5. Explain the contribution of community health nursing from her global history (SAQ 1.5); and 6. Describe the history of community health Nursing in Nigeria (SAQ 1.6). 1. **Community Health** **Human beings are social creatures. We all with rare exception, live our lives in the company of other people. An** **Eskimo lives in a small, tightly-knit community of close relatives; a rural African may live in a small village with not more or less than 200 members. In contrast, an individual from Lagos or Abuja City might be a member of many overlapping communities, which include a political party, professional societies, a religious group, a cultural society, a neighborhood, and the city itself. People live in some group, and continue to depend on groups for material and emotional support. Communities are an essential and permanent feature of the human experience. The communities in which we live and work profound influence on our collective health and well-being (World Health Organization \[WHO\], 2006a).** +-----------------------------------------------------------------------+ | **Box 1.1: What is Community Health?** | | | | **Community health is a field of practice that seeks to provide | | organizational structure, a broad set of resources, and the | | collaborative activities needed to accomplish the goal of an | | optimally healthy community.** | +-----------------------------------------------------------------------+ Many different professionals form the community health complex team. For example, the city planner designing an urban renewal project is involved in community health. The social worker providing counseling about child abuse or working with adolescent substance abusers is involved in community health. A physician treating clients affected by a sudden outbreak of disease and investigating the source is engaged in community health practice. Prenatal clinics, meals for the elderly, genetic counseling centers, and educational programs for the early detection of cancer all are part of the community health effort. The professional nurse is an integral member of this community health team, she serves as a liaison between other members of the team and the community. Apart from working directly in a community, community health nurses work in all kinds of community agencies, from a state public health department to a community-based advocacy group. Their functions include examining infants in a well-baby clinic, teaching elderly stroke victims in their homes, carrying out epidemiologic research, or engaging in health policy analysis and decision-making. **1.2. Public Health and Community Health** Community and public health have similar features and are sometimes used interchangeably. Both are organized community efforts aimed at promoting, protecting, and preserving people's health. The public health field has been linked primarily with the efforts of official or government entities---for example, federal, state, or local tax-supported health agencies that target a wide range of health issues. Public health practice encompasses both approaches and works collaboratively with all health agencies and efforts, public or private, which are concerned with the public's health. In the IOM's landmark publication, The Future of the Public's Health (1998), the mission of public health is defined simply as "fulfilling society's interest in assuring conditions in which people can be healthy" (p. 7). Winslow (1920) defined public health thus: "Public health is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health" (Clinton County Health Department, 2006, p. 1) More recent and concise definitions of public health include "an effort organized by society to protect, promote, and restore the people's health" (Trust for America's Health, 2006, p. 27) and "the health of the population as a whole rather than medical health care, which focuses on the treatment of the individual ailment" (Public Health Data Standards Consortium, 2006, p. 120). The primary difference between community and public health is the scope. Public health has a much broader focus --- in terms of the number of factors it considers and the size of the target populations. Community health is a non-clinical, localized subspecialty within the wider field of public health. Community health practice refers to a focus on specific, designated communities. It is a part of the larger public health effort and recognizes the fundamental concepts and principles of public health as its birthright and foundation for practice. Community health is the identification of needs, along with the protection and improvement of collective health, within a geographically defined area. Community health practice is a part of public health. **1.3 The Concept of Community Health Nursing** Community health nursing is a specialized practice in nursing. It combines all of the basic elements of professional clinical nursing with public health and community practice. Community Health Nursing (CHN) is a field of nursing practice for which there exists a body of knowledge & related skills which is applied in meeting the health needs of the people of a community, individuals, groups & families in their normal environment such as the home, the school, the place of work, etc. In short, it is an area of practice that lies primarily outside the therapeutic institutions. The goal of care is the promotion of health & the prevention of disease. It is an area of professional Nursing focusing attention on serving people through organized community effect in their usual environments (home school & work), and part of a community effort of health promotion. Community health nursing is a branch of the nursing profession that deals with the aspect of rendering nursing services within a community as opposed to the hospital setting. In summary, there are three distinguishing characteristics of community health practice: It is a community-based care, the practice takes place in different settings outside the hospital, and the client is usually a group of people, which can be family unit, social group, or community. **1.3.1 Characteristics of Community Health Nursing** 1\. Community health nursing is population-focused. It is oriented towards the health of groups or aggregate of individuals rather than the care of individuals. 2\. It emphasizes promotional & preventive health care intervention rather than cure of illness 3\. It involves the collection of data regarding communities for planning intervention. 4\. It uses principles of organizational & management theory in health care delivery. 5\. It encourages commitment to client advocacy. 6\. It has concern for environmental factors (physical, biological & social) that impact on health status. 7\. It has an orientation to health rather than illness. 8\. Wide array of clients at different levels, from different ethnic backgrounds & in diverse settings. 9\. The term client in clinical care practice refers to a person whereas in community health care practice, the focus is on the health of populations or groups such as the family or community and these are referred to as the clients. **1.3.2 Settings for Community Health Nursing Practice** The settings for the practice of community health nursing are as follows 1\. Homes (e.g. old people's homes) 2\. Residential places 3\. Market 4\. Ambulatory services 5\. Workplace --Industry etc 6\. Schools 7\. Prisons 8\. Camps 9\. Families 10\. Community **1.4 Components of Community Health Nursing** **1.4.1 Promotion of health:** Promotion of health is recognized as one of the most important components of public health and community health practice (USDHHS, 2000). Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. Nursing has a social mandate to engage in health promotion (Pender, Murdaugh & Parsons, 2006). Health promotion programs and activities include health education and lifestyle modification **1.4.2 Prevention of illness & diseases** Prevention of health problems constitutes a major part of community health practice. Prevention means anticipating and averting illness and diseases or discovering them as early as possible to minimize potential disability and impairment. It is practiced on three levels in community health: primary prevention, secondary prevention, and tertiary prevention (Neuman, 2001). These will be explained fully in subsequent sessions. **1.4.3 Treatment of disorders:** It focuses on the illness end of the continuum and is the remedial aspect of community health practice. This is practiced by: direct service to people with health problems; such as home visits for elderly people, and individuals with chronic illness; Indirect service; e.g. assisting people with health problems to obtain treatment and thirdly, referral and development of intervention programs to correct unhealthy condition; e.g. alcoholism, drug abuse, etc. **1.4.4 Rehabilitation:** It involves efforts that seek to reduce disabilities, as much as possible, and restore functions; e.g. stroke rehabilitation. **1.4.5 Evaluation:** It is the process by which the practice is analyzed, judged, and improved according to set goals and standards. Evaluation helps to solve problems and provides direction for future healthcare planning. Programs, and interventions are evaluated for effectiveness and to ascertain that aims and objectives are met. **1.4.6 Research:** It is a systematic investigation that helps to discover facts affecting community health and community health practices, solve problems, and explore improved methods of health service **Roles and Functions of Community Health Nurse** 1\. The community health nurse provides and promotes nursing services to families through: a\) Assuming direct responsibility for providing care or supervising and directing others to provide care b\) Education of others on how to give nursing care e.g. other professionals, individuals, family, groups, etc. c\) Carries out a referral. 2\. Uses nursing as a channel for strengthening family life and for promoting personnel or family development and self-realization through: a\) Counseling b\) Communication process 3\. Participates in disease control activities -- through general prevention measures, early identification of disease, provision of care, and supervision to reduce effects of disease through a\) Health Education and campaign b\) Screening processes and massive prevention c\) epidemiological alerts and investigations 4\. Works with appropriate personnel in special settings, such as schools, working places to plan and implement nursing phases of their health programs by: a\) Reviewing and interpreting data b\) Monitoring and evaluation c\) Medical examinations d\) Serving as a member of committees for health planning and action. 5\. Plans and evaluates nursing services for the population group under her care by: a\) using demographic information b\) setting goals and objectives and plan outcomes for the community Health Nursing Services c\) planning with the members of the health team the care and services to be rendered 6\. Contributes to the decision and policy setting in the agency and community by: a\) writing and sending reports and recommendations to the appropriate agencies for action. 7\. Contributes to the extension of knowledge in nursing and health care by engaging in surveys studies or research through a\) proposing problems that need systematic study for their resolutions b\) planning and carrying out simple studies c\) participatory research. **1.5 Historical Development of Community Health Nursing** Community health nursing has a rich history that reflects the evolving needs of society and the development of public health systems. Here's an overview of its history: **1.5.1 Early Beginnings** - **Ancient and Medieval Times**: The roots of community health nursing can be traced back to ancient civilizations, where care for the sick was often provided by family members, religious groups, and informal caregivers within the community. During the medieval period, religious orders played a significant role in caring for the sick and poor, often within monasteries or through outreach to the community (Fee et al., 2010). - **1600s-1800s**: The formalization of community health practices began in the 17th century with the establishment of organized systems of poor relief and almshouses in Europe, particularly in England. These systems were designed to care for the poor and sick within the community. In the 19th century, the Industrial Revolution led to rapid urbanization, which in turn resulted in overcrowding, poor sanitation, and the spread of infectious diseases. This created a need for more organized public health efforts. **1.5.2 The Rise of Modern Public Health Nursing** - **Mid-1800s**: Florence Nightingale is often credited with laying the groundwork for modern nursing, including community health nursing. During the Crimean War (1853-1856), she introduced sanitation and hygiene practices that drastically reduced mortality rates. After the war, Nightingale's work in public health extended to her efforts to improve sanitary conditions in British hospitals and communities. She also established (Fee et al., 2010) - the first professional nursing school at St. Thomas\' Hospital in London in 1860, which emphasized the importance of community health. - **Late 1800s**: Lillian Wald, an American nurse and social reformer, is recognized as the founder of public health nursing in the United States. In 1893, she and Mary Brewster established the Henry Street Settlement in New York City, where they provided nursing care, education, and social services to impoverished immigrants in the community. Wald's work led to the formalization of visiting nursing services, where nurses would visit patients in their homes to provide care, health education, and disease prevention. **1.5.3 Early 20th Century Developments** - **1900s-1920s**: The early 20th century saw the expansion of public health nursing as an essential part of the broader public health movement. Public health nurses worked in schools, factories, and homes, focusing on disease prevention, maternal and child health, and the control of communicable diseases. In 1912, the National Organization for Public Health Nursing (NOPHN) was established in the United States, promoting the role of nurses in public health (Stanhope & Lancaster, 2020). - **1930s-1940s**: The Great Depression and World War II brought new challenges and opportunities for community health nursing. Nurses played crucial roles in addressing the health needs of impoverished communities during the Depression. During the war, they were involved in both military and civilian health services, including efforts to control the spread of infectious diseases and improve sanitation. **1.5.4 Post-War Expansion and Modern Era** - 1**950s-1960s**: After World War II, there was a significant expansion in public health services, driven by advances in medical technology and a growing focus on chronic disease management. Community health nursing began to incorporate more specialized roles, such as mental health nursing, occupational health nursing, and school nursing. - **1970s-1980s**: The focus of community health nursing expanded to include health promotion, disease prevention, and community education (Stanhope & Lancaster, 2020). The development of primary healthcare as a global priority, highlighted by the 1978 Alma-Ata Declaration, emphasized the role of community health nurses in delivering accessible and equitable healthcare. - **1990s-Present**: Community health nursing continues to evolve in response to changes in healthcare needs and systems. The rise of chronic diseases, aging populations, and health disparities has placed a greater emphasis on community-based care. Community health nurses now work in a variety of settings, including homes, schools, workplaces, and community clinics. They also play key roles in disaster response, global health initiatives, and the management of emerging public health threats like pandemics (Stanhope & Lancaster, 2020). ### Key Contributions and Future Directions - **Public Health Interventions**: Community health nurses have been instrumental in implementing public health interventions such as vaccination campaigns, maternal and child health programs, and initiatives to reduce health disparities. - **Education and Advocacy**: Community health nurses advocate for public health policies that promote equity and access to healthcare. They also educate individuals and communities about healthy behaviors and preventive care. - **Global Reach**: The principles of community health nursing have been applied worldwide, with nurses contributing to global health efforts in low- and middle-income countries, often in collaboration with international organizations. The future of community health nursing is likely to see further integration of technology, an increased focus on mental health, and continued advocacy for health equity and access. As healthcare systems worldwide continue to shift toward community-based care, the role of community health nurses will remain vital in addressing the complex health needs of populations (Stanhope & Lancaster, 2020). **1.6 History of Community Health Nursing in Nigeria** The history of community health nursing in Nigeria is deeply intertwined with the country\'s colonial past, post-independence health reforms, and the evolving public health challenges faced by its population. Here's an overview: **1.6.1 Colonial Era and Early Developments (Pre-1960)** - **Colonial Public Health Efforts**: The foundation of community health nursing in Nigeria can be traced back to the colonial period. During British colonial rule in the early 20th century, healthcare services were primarily established to cater to the health needs of colonial administrators and expatriates. However, as public health issues such as infectious diseases became more prevalent, efforts were made to extend health services to the indigenous population (Adeleye & Ofili, 2010). - **Introduction of Public Health Nursing**: In the 1920s and 1930s, the colonial government began to focus on public health measures, particularly in response to outbreaks of diseases such as smallpox, malaria, and tuberculosis. Public health nurses, often trained in mission hospitals or abroad, were deployed to educate communities on hygiene, sanitation, and disease prevention. These nurses worked in rural areas, promoting vaccination campaigns and health education, laying the groundwork for community health nursing in Nigeria (Adeleye & Ofili, 2010). - **Missionary Influence**: Missionaries played a crucial role in the early development of nursing in Nigeria. They established hospitals and training schools, where many of the first Nigerian nurses received their education. These mission-trained nurses were instrumental in extending healthcare services into rural communities, where they provided basic medical care and health education. **1.6.2 Post-Independence Expansion (1960s-1980s)** - **Health Sector Reforms**: After Nigeria gained independence in 1960, the newly formed government recognized the need to improve healthcare services for its citizens. The focus shifted toward expanding healthcare infrastructure and training more healthcare professionals, including nurses, to meet the growing demands of the population (Omololu, 2007). This period saw the establishment of more nursing schools, and the role of nurses expanded to include community health services. - **Primary Healthcare (PHC) Strategy**: In the 1970s and 1980s, Nigeria adopted the primary healthcare (PHC) approach, influenced by the global health movement led by the World Health Organization (WHO) and the 1978 Alma-Ata Declaration (Omololu, 2007). This approach emphasized the provision of essential health services at the community level, focusing on prevention, health promotion, and the involvement of communities in their healthcare. - **Establishment of Community Health Extension Workers (CHEWs)**: The Nigerian government introduced the concept of Community Health Extension Workers (CHEWs) during this period. These workers, who included nurses and midwives, were trained to deliver basic healthcare services in rural and underserved areas. They provided maternal and child health services, immunizations, health education, and disease surveillance, effectively bringing healthcare closer to the people. **1.6.3 Institutionalization and Professional Development (1990s-Present)** - **Community Health Nursing Programs**: In the 1990s, formal community health nursing programs were established in Nigerian universities and nursing schools. These programs were designed to equip nurses with the skills needed to address the specific health challenges faced by communities, such as infectious diseases, maternal and child health issues, and chronic conditions (Adeleye & Ofili, 2010). The curriculum included training in public health principles, health promotion, disease prevention, and community engagement. - **Integration into National Health Policy**: Community health nursing became a key component of Nigeria's National Health Policy. The government's focus on improving maternal and child health, combating HIV/AIDS, tuberculosis, and malaria, and reducing health disparities highlighted the importance of community-based healthcare. Community health nurses played a central role in implementing these policies, particularly in rural and hard-to-reach areas. - **Expansion of Community Health Nursing Roles**: Over time, the role of community health nurses in Nigeria has expanded beyond traditional duties. They are now involved in health education, advocacy, policy implementation, and research. Nurses work in various settings, including primary health centers, schools, industries, and non-governmental organizations (NGOs), addressing a wide range of public health issues. - **Challenges and Innovations**: Despite the progress, community health nursing in Nigeria faces challenges such as inadequate infrastructure, limited resources, and workforce shortages. However, innovations like task-shifting (where nurses take on roles traditionally reserved for doctors), mobile health clinics, and the use of digital health technologies are helping to overcome some of these challenges. 4. **Contemporary Developments of Community health Nursing** a. **Response to Emerging Health Threats**: Community health nurses have been at the forefront of responding to emerging health threats in Nigeria, such as the Ebola outbreak in 2014 and the ongoing COVID-19 pandemic. They play a critical role in disease surveillance, contact tracing, health education, and vaccination campaigns. b. **Focus on Health Equity**: The Nigerian government and health organizations continue to emphasize the importance of community health nursing in achieving health equity. Efforts are being made to strengthen the capacity of community health nurses,6particularly in underserved and marginalized communities, to ensure that all Nigerians have access to essential health services. c. **Global Health Influence**: Nigeria's approach to community health nursing has also been influenced by global health initiatives and partnerships. Nigerian nurses participate in international programs and collaborations, contributing to global health knowledge and practice. Community health nursing in Nigeria has evolved from its colonial roots to become a cornerstone of the country's healthcare system. As Nigeria continues to face new health challenges, the role of community health nurses will remain crucial in promoting public health, preventing disease, and ensuring that healthcare services reach all corners of the country.