Community Health Nursing

Community Health Nursing

Concept of Community

Community : refers to 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.

List some communities:

  • It can be a society of people holding common rights and privileges ( e.g., a citizens of a town). `
  • Sharing common interests ( e.g., a community of farmers).
  • Living under the same lows and regulations ( e.g., a prison community).

Types of Communities

Three types of communities that have relevance to community health practice:

1.Geographic Community :

  • City, town, neighborhood.
  • In community health, it is useful to identify a geographic area as a community:
    • A community demarcated by geographic boundaries, such as city or county, become clear target for analysis of health needs.
  • Available data, such as morbidity and mortality figures, can augment assessment studies to form the basis for planning health programs.
  • Media campaigns and other health education efforts can readily reach intended audiences.

2. Common-Interest Community

– A community also can be identified by a common interest or goal.

  • The members of a national professional organization.
  • Women who have mastectomies,
  • Are all common-interest communities.

Example of Common-Interest Community

Disabled individuals scattered throughout a large city may emerge as a community through a common interest in promoting adherence to guidelines for wheel-chairs access, parking spaces, toilet facilities, elevators, or other facilities for the disabled.


3. Community of Solution

  • Group of people who come together to solve a problem that affects all of them.
  • The shape of this community varies with:

1.The nature of the problem.

2.The size of the geographic area affected.

3.The number of resources needed to address the problem.

Examples: Community of Solution

  • A water pollution problem may involve several counties whose agencies and personal must work together to control upstream water supply, industrial waste disposal, and city water treatment.
  • Several schools may collaborate with law enforcement and health agencies, as well as legislators and policy makers, to study patterns of substance abuse among students and design possible preventive approaches.


Community Health

  • Humans beings are social creatures. All of us, with rare exception, live out our lives in the company of other people.
  • Communities are an essential and permanent feature of human experience.
  • The communities in which we live and work have a profound influence on our collective health and well-being.


– Research has established that both smoking and passive exposure to tobacco smoke are directly associated with serious negative health effects and premature mortality among more than 1 billion smokers worldwide (Institute of Medicine, 2001).

– Many communities and organization including ( hospitals, schools, restaurants and airlines) have developed regulatory approaches to smoking as:

1.They have removed cigarette vending machines.

2.Conducted antismoking advertising campaigns.

3.Prohibited televised commercials.

4.Increased cigarette taxes.

5.Restricted smoking in public places.

– Such community rules and educational efforts:-

  • Protect nonsmokers.
  • Promote quitting smoking.
  • Decrease the potential for heart and lung disease

– Community health, as field of practice, seeks to provide organizational structure, a broad set of resources, and collaborative activities needed to accomplish the goal of an optimally healthy community.

– Community health is concerned with the interchange between population groups and their total environment, and with the impact of that interchange on collective health.

– Other community and national concerns include the rising incidence and prevalence of:

  • Sexually transmitted disease.
  • Substance abuse.
  • Tuberculosis.
  • Teen pregnancy.
  • Family and teen violence.
  • Terrorism.
  • Pollution-driven environmental hazards.

– Many different professionals work in community health to form complex team as follows:

  • City planner designing an urban renewal project.
  • The social worker providing counseling about child abuse or the use of chemical substance among adolescents.
  • A physician treating clients affected by a sudden outbreak of hepatitis.

– Prenatal clinics.

– Meals for elderly.

– Genetic counseling centers.

– Educational programs for elderly detection of cancer all are part of the community health effort.


Definition of Public Health

– Winslow’s classic(1920) definition of Public Health Public health is the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the following purposes:

1. Sanitation of the environment.

2. Control of communicable infections.

3. Education of the individual in principles of personal hygiene.

4. Organization of medical and nursing services for the early diagnosis and preventive treatment of disease.

5. Development of the social machinery that will ensure a standard of living adequate for the maintenance of health for every individual in the community.

– The concept of Community Health can be defined as:

"The identification of needs and the protection and improvement of collective health within a geographically defined area" .


Populations and Aggregates


– All of the people occupying an area, or to all of those who share one or more characteristics.

– A population may be defined:

1. Geographically: Such as the population of USA or a city’s population.

This designation of population is useful in community health:

– Epidemiologic study.

– Collecting demographic data for purposes such as health planning.

2. Common Qualities or Characteristics

– Might be any thing thought to relate to health, such as:

– age, race, sex, social class, medical diagnosis, level of disability, exposure to toxins, or participation in a health seeking behavior, such as smoking cessation.

This meaning become useful in community health

– When a specific group of people (e.g., homeless individuals ) is targeted for intervention.



– A mass or grouping of distinct individuals who are considered as a whole and who are loosely associated with one another.

For Example:

  • Aggregate can be identified by :
  • Virtue of setting (those enrolled in a well-baby clinic).
  • Demographic characteristics (women).
  • Health statue (smokers, or those with hypertension).

– Community health nurses, needs to define the community targeted for study and intervention:

  • Who are the people who compose the community?
  • Where are located, and what are their characteristics?
  • A clear delineation of the community or population must be established .
  • The complex nature of communities.
  • The characteristics of the people in terms of: age, sex, race, socioeconomic level, and health status.
  • What are the resources?
  • Is the community under rapid change? What are the changes?

The American Nurses Association(ANA), defines Community Health Nursing as:

– "Community Health Nursing is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. The practice is general and comprehensive . it is not limited to a particular age group or diagnosis, and it is continuing, not episodic.

The dominant responsibility is to population as a whole; nursing directed to individuals, families, or groups contributes to the total population….the focus of community health nursing is on the prevention of illness and the promotion and maintenance of health".


The Concept of Health

– Health in the abstract refers to a person’s physical, mental, and spiritual state.

– It can be positive (as being in good health), or negative (as being in poor health).

– The World Health Organization(WHO) define health positively as:

– " a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".

– Wellness, includes the definition of health incorporates the capacity to develop one’s potential to lead fulfilling and productive life; can be measured in terms of quality of life.

– There is increase awareness of the strong relationship of health and environment.

– 150 years ago Florence Nightingale explored the health and illness connection with environment.

– She believed that a person health greatly influenced by ventilation, noise, light, cleanliness, diet. And restful bed.


The Health Continuum:


The Health Continuum


– People either are well or they are ill. Yet wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy.

– They are many levels and degree of wellness and illness.

– Because health involves a range of degrees from optimal health at one end to total disability or death at other, it often describes as a continuum.

– It range from:

  • High level wellness.(Optimal Health)
  • Good health.
  • Normal health.
  • Illness.
  • Critical illness.
  • Total disability or Death.

– A person’s state of health is dynamic, varying from day to day and even hour to hour.

– Health is a state of being :

  • That includes all of many characteristics of a person, family, or community, whether physical, psychological, social, or spiritual.
  • These characteristics often indicate the degree of wellness or illness of an individual or community and suggest the presence or absence of vitality and well-being.

– Subjective and Objective Dimensions of Health

  • Health involves both subjective and objectives dimensions.
  • Subjective involves how well people feel.
  • Objective refers to how well they can function in their environment.
  • Most often, functional performance diminishes dramatically toward illness end of health continuum.

– Continuous and Episodic Health Care Needs

  • Community health practice encompasses populations in all age groups with birth-to-death development health care needs.

– Continuous needs may include, for example:

  • Assistance with providing a toddler-proof home.
  • Establishing positive toilet-training techniques.
  • Help in effectively dealing with the progressive emancipation of preteens and teenagers.

– Population may have one-time, specific, negative health events, such as an illness or injury, that are not an expected part of life. These episodic needs might derive from:

  • The birth of an infant with Down syndrome.
  • A head injury incurred from an automobile crash.
  • Diagnosis of HIV/AIDS.

– Community health nurse may interact with clients having either continuous or episodic health acre needs, or both. For example:

  • When can parents expect a child with Down syndrome to begin toilet training.



– A Primary Health Care Initiative

– "Health for All" was formally expressed in the Declaration of Alma-Ata in 1978.

– Functions:

– The Declaration of Alma-Ata lists the eight basic functions of PHC:

1.Education concerning prevailing health problems and the methods of preventing and controlling them.

2.Promotion of food supply and proper nutrition.

3.An adequate supply of safe water and basic sanitation.

4.Maternal and child health, including family planning.

5.Immunization against major infectious diseases.

6.Prevention and control of locally endemic diseases.

7.Appropriate treatment of common diseases and injuries.

8.Provision of essential drugs.


Major Goals for Community Health Nursing

1.Care of ill, disabled, and suffering in non-hospital setting.

2.Support of development and well-being throughout the lifecycle.

3.Promotion of human relatedness and mutual caring.

4.Promotion of self-responsibility regarding health and well-being.

5.Promotion of relative safety in the environment while conversing recourses.

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