THEORIES IN COMMUNITY HEALTH NURSING PRACTICE

Prepared By:

SUJATHA.J

INTRODUCTION INTRODUCTION

The concept of community is defined as "a group of people who share some important feature of their lives and use some common agencies and institutions.“

The concept of health is defined as "a balanced state of well-being resulting from harmonious interactions of body, mind, and spirit.“ 

The term community health is defined by meeting the needs of a community by identifying problems and managing interactions within the community

BASIC ELEMENTS BASIC ELEMENTS

The six basic elements of nursing practice incorporated in community health programs and services are:

(1) promotion of healthful living

(2) prevention of health problems

(3) treatment of disorders

(4) rehabilitation

(5) evaluation and

(6) research.

MAJOR ROLESMAJOR ROLES The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles. 

The seven major roles of a community health nurse are:

(1) care provider

(2) educator

(3) advocate

(4) manager

(5) collaborator

(6) leader, and

(7) researcher. 

MAJOR SETTINGS MAJOR SETTINGS Settings for community health nursing can be grouped into Settings for community health nursing can be grouped into

six categories: six categories: 

(1) homes(1) homes

(2) ambulatory care settings(2) ambulatory care settings

(3) schools(3) schools

(4) occupational health settings(4) occupational health settings

(5) residential institutions, and (5) residential institutions, and

(6) the community at large. (6) the community at large. 

Community health nursing practice is not limited to a Community health nursing practice is not limited to a

specific area, but can be practiced anywhere. specific area, but can be practiced anywhere.

THEORIES AND MODELS FOR THEORIES AND MODELS FOR COMMUNITY HEALTH NURSING COMMUNITY HEALTH NURSING

The commonly used theories are:

Nightingale’s theory of environment Nightingale’s theory of environment Orem’s Self care model Orem’s Self care model Neuman’s health care system model Neuman’s health care system model Roger’s model of the science and unitary man Roger’s model of the science and unitary man Pender’s health promotion model Pender’s health promotion model Roy’s adaptation model Roy’s adaptation model Milio’s Framework of prevention Milio’s Framework of prevention Salmon White’s Construct for Public health nursing Salmon White’s Construct for Public health nursing Block and Josten’s Ethical Theory of population focused Block and Josten’s Ethical Theory of population focused

nursing nursing Canadian Model Canadian Model

NIGHTINGALE’S NIGHTINGALE’S ENVIRONMENTAL THEORYENVIRONMENTAL THEORY

Concepts and Definitions: Concepts and Definitions: Environment – concepts of ventilation, Environment – concepts of ventilation,

warmth, light, diet, cleanliness and noise. She warmth, light, diet, cleanliness and noise. She focus on the physical aspect of environment.focus on the physical aspect of environment.

She believed that “Healthy surroundings were She believed that “Healthy surroundings were necessary for proper nursing. necessary for proper nursing.

5 Essential components of5 Essential components ofHealthy environment Healthy environment

Pure airPure air Pure waterPure water Efficient drainageEfficient drainage CleanlinessCleanliness LightLight

Concerns of Environmental Theory

Proper ventilation focus on the architectural aspect of the hospital.

Light has quite as real and tangible effects to the body. Her nursing intervention includes direct exposure to sunlight.

Cleanliness and sanitation. She assumes that dirty environment was the source of infection and rejected the “germ theory”. Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and hand washing.

CONTINUE……CONTINUE…… Warmth, quiet and adequate environment. She

introduce the manipulation of the environment for patient’s adaptation such as fir, opening the windows and repositioning the room seasonally, etc.

Unnecessary noise is not healthy for recuperating patients.

Dietary intake. Petty management proposed the avoidance of

psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital.

Importance of Environmental Importance of Environmental TheoryTheory

Practice: Practice: Disease controlDisease control Sanitation and water treatmentSanitation and water treatment Utilized by modern architecture in the Utilized by modern architecture in the

prevention of “sick building syndrome” prevention of “sick building syndrome” applying the principles of ventilation and good applying the principles of ventilation and good lighting.lighting.

Waste disposalWaste disposal Control of room temperatureControl of room temperature Noise management.Noise management.

Continue……Continue……

Education: Education: Principles of nursing training. Better practice Principles of nursing training. Better practice

result from better education.result from better education. Skills measurement through licensing by the use Skills measurement through licensing by the use

of testing methods, the case studies.of testing methods, the case studies. Research: Research: Use of graphical representations like the polar Use of graphical representations like the polar

diagrams.diagrams. Notes on nursing.Notes on nursing.

Betty Neuman’s TheoryBetty Neuman’s Theory Betty neuman’s system model has 2 major Betty neuman’s system model has 2 major

components: stress and reaction to stress.components: stress and reaction to stress. The client in the neuman’s system model is The client in the neuman’s system model is

viewed as an open system continuously become viewed as an open system continuously become more differentiated and elaborate or complex.more differentiated and elaborate or complex.

The system may adjust to the environment to The system may adjust to the environment to itself.itself.

Exchange with the environment are reciprocal, Exchange with the environment are reciprocal, both the client and the environment may be both the client and the environment may be affected either positively or negatively by the affected either positively or negatively by the other. other.

Concepts of Betty Neuman’s Concepts of Betty Neuman’s system modelsystem model

Person variablePerson variable Central coreCentral core Flexible lines of defenseFlexible lines of defense Normal line of defenseNormal line of defense Lines of resistanceLines of resistance ReconstitutionReconstitution StressorsStressors PreventionPrevention

Continue…..Continue….. Betty neuman defines total person model Betty neuman defines total person model

incorporating the holistic concept and an open incorporating the holistic concept and an open system approach.system approach.

Person is a dynamic composite of Person is a dynamic composite of physiological, socio cultural and physiological, socio cultural and developmental variables that function as an developmental variables that function as an open system. open system.

As an open system the person interacts with, As an open system the person interacts with, adjust to and is adjusted by the environment, adjust to and is adjusted by the environment, which is viewed as a stressor disrupt the which is viewed as a stressor disrupt the system. system.

Continue…..Continue….. Neuman’s model include intrapersonal, Neuman’s model include intrapersonal,

interpersonal and extra personal stressors.interpersonal and extra personal stressors. Intrapersonal stressors are forces occurring Intrapersonal stressors are forces occurring

within the person; interpersonal stressors such within the person; interpersonal stressors such as role expectations which occur between as role expectations which occur between people & extra personal stressors such as people & extra personal stressors such as financial circumstances, occur outside the financial circumstances, occur outside the person.person.

Continue…..Continue….. Neuman believes in that nursing is concerned Neuman believes in that nursing is concerned

with the whole person. She used the term with the whole person. She used the term client for patient. client for patient.

The goal of nursing is to assist individuals, The goal of nursing is to assist individuals, families, and groups. The nurse assesses, families, and groups. The nurse assesses, manages & evaluate client system. manages & evaluate client system.

Nursing focus on the variables affecting the Nursing focus on the variables affecting the client’s response to the stressor. client’s response to the stressor.

Nursing actions are in primary, secondary & Nursing actions are in primary, secondary & tertiary level of prevention. tertiary level of prevention.

Continue……Continue……

Primary prevention focuses on strengthening a line Primary prevention focuses on strengthening a line of defence through the identification of actual or of defence through the identification of actual or potential risk factors associated with stressors.potential risk factors associated with stressors.

Secondary prevention strengthens internal defences Secondary prevention strengthens internal defences and resources by establishing priorities and and resources by establishing priorities and treatment plans for identified symptoms and tertiary treatment plans for identified symptoms and tertiary prevention focus on readaptation.prevention focus on readaptation.

Tertiary prevention is to strengthen resistance to Tertiary prevention is to strengthen resistance to stressors through client education and to assist in stressors through client education and to assist in preventing a recurrence of the stress response. preventing a recurrence of the stress response.

MILIO’S MILIO’S FRAMEWORK OF FRAMEWORK OF PREVENTIONPREVENTION

Nancy Milio Nancy Milio a nurse and leader in public health policy and a nurse and leader in public health policy and public health education developed a framework for public health education developed a framework for prevention that includes concepts of community-oriented, prevention that includes concepts of community-oriented, population focused care(1976,1981). population focused care(1976,1981).

The basic treatise is that behavioral patterns of populations The basic treatise is that behavioral patterns of populations and individuals who make up populations are a result of and individuals who make up populations are a result of habitual selection from limited choices. She challenged the habitual selection from limited choices. She challenged the common notion that a main determinant for unhealthful common notion that a main determinant for unhealthful behavioral choice is lack of knowledge.behavioral choice is lack of knowledge.

CONTINUE……CONTINUE……

Governmental and institutional policies, she said set Governmental and institutional policies, she said set the range of options for personal choice making. It the range of options for personal choice making. It neglected the role of community health nursing, neglected the role of community health nursing, examining the determinants of community health and examining the determinants of community health and attempting to influence those determinants through attempting to influence those determinants through public policy.public policy.

SALMON WHITE’S SALMON WHITE’S CONSTRUCT FOR CONSTRUCT FOR PUBLIC HEALTH NURSINGPUBLIC HEALTH NURSING

Mark Salmon White (1982) Mark Salmon White (1982) describes a public health describes a public health as an organized societal effort to protect, promote as an organized societal effort to protect, promote and restore the health of people and public health and restore the health of people and public health nursing as focused on achieving and maintaining nursing as focused on achieving and maintaining public health. public health.

He gave He gave 3 practice 3 practice prioritiespriorities i.e:. i.e:. 1.1. prevention of disease and poor health, prevention of disease and poor health, 2.2. protection against disease andprotection against disease and 3.3. external agents and promotion of health.external agents and promotion of health. For these 3 general categories of nursing For these 3 general categories of nursing

intervention have also been put forward, they are: intervention have also been put forward, they are:

CONTINUE…CONTINUE…

Education directed toward voluntary change in Education directed toward voluntary change in the attitude and behaviour of the subjects the attitude and behaviour of the subjects

Engineering directed at managing risk-related Engineering directed at managing risk-related variables variables

Enforcement directed at mandatory regulation Enforcement directed at mandatory regulation to achieve better healthto achieve better health

CONTINUE…

Scope of prevention spans individual, family, community and global care.

Intervention target is in 4 categories: 

1.Human/Biological

2. Environmental

 3. Medical/technological/organizational  

4. Social

BLOCK AND JOSTEN’SBLOCK AND JOSTEN’S ETHICAL THEORY OF ETHICAL THEORY OF POPULATION FOCUSED NURSING POPULATION FOCUSED NURSING

Derryl Block and Lavohn JostenDerryl Block and Lavohn Josten, public health educators , public health educators proposed this based on intersecting fields of public health proposed this based on intersecting fields of public health and nursing. and nursing.

They have given 3 essential elements of population focused They have given 3 essential elements of population focused nursing that stem from these 3 fields: nursing that stem from these 3 fields:

an obligation to population an obligation to population the primacy of prevention the primacy of prevention centrality of relationship- based care  centrality of relationship- based care 

The first two are from public health and the third element The first two are from public health and the third element from nursing. Hence it implies to nursing that relation-from nursing. Hence it implies to nursing that relation-based care is very important in population focused care. based care is very important in population focused care.

CANADIAN MODEL FOR COMMUNITY:CANADIAN MODEL FOR COMMUNITY:

The community health nurse works with individuals, The community health nurse works with individuals, families, groups, communities, populations, systems families, groups, communities, populations, systems and/or society, but at all times the health of the and/or society, but at all times the health of the person or community is the focus and motivation person or community is the focus and motivation from which nursing actions flow. The standards of from which nursing actions flow. The standards of practice are applied to practice in all settings where practice are applied to practice in all settings where people live, work, learn, worship and play. people live, work, learn, worship and play.

CONTINUE…CONTINUE…

The philosophical base and foundational The philosophical base and foundational values and beliefs that characterize community values and beliefs that characterize community health nursing - caring, the principles of health nursing - caring, the principles of primary health care, multiple ways of primary health care, multiple ways of knowing, individual/community partnerships knowing, individual/community partnerships and empowerment - are embedded in the and empowerment - are embedded in the standards and are reflected in the development standards and are reflected in the development and application of the community health and application of the community health nursing process. nursing process.

CONTINUE…CONTINUE…

The community health nursing process involves the The community health nursing process involves the traditional nursing process components of assessment, traditional nursing process components of assessment, planning, intervention and evaluation but is enhanced by planning, intervention and evaluation but is enhanced by community health nurses in community health nurses in three dimensions:

individual/community participation in each componentindividual/community participation in each component

multiple ways of knowing, each of which is necessary to multiple ways of knowing, each of which is necessary to understand the complexity and diversity of nursing in the understand the complexity and diversity of nursing in the community; knowledge and utilization of all these ways of community; knowledge and utilization of all these ways of knowing forms evidence-based practice consistent with knowing forms evidence-based practice consistent with these standards, and these standards, and

CONTINUE…CONTINUE… The inherent influence of the broader environment

on the individual/community that is the focus of care (e.g. the community will be affected by provincial/territorial policies, its own economic status and by the actions of its individual citizens).

The standards of practice are founded on the values and beliefs of community health nurses, and utilization of the community health nursing process.

CONTINUE…CONTINUE… The model illustrates the dynamic nature of community

health nursing practice, embracing the present and projecting into the future. The values and beliefs (green or shaded) ground practice in the present yet guide the evolution of community health nursing practice over time.

The community health nursing process provides the vehicle through which community health nurses work with people, and supports practice that exemplifies the standards of community health nursing.

CONTINUECONTINUE….….

The standards of practice revolve around both the values and beliefs and the nursing process with the energies of community health nursing always being focused on improving the health of people in the community and facilitating change in systems or society in support of health.

Community health nursing practice does not occur in isolation but rather within an environmental context, such as policies within their workplace and the legislative framework applicable to their work.

Martha Rogers model Martha Rogers model

Rogers considers the unitary human being as an Rogers considers the unitary human being as an energy field coexisting within the universe.energy field coexisting within the universe.

The human being is in continuous interaction with The human being is in continuous interaction with the environment. In addition, human being is a the environment. In addition, human being is a unified whole, possessing personal integrity and unified whole, possessing personal integrity and manifesting characteristics that are more than and manifesting characteristics that are more than and different from the sum of parts.different from the sum of parts.

There are 4 dimensions used in the theory which There are 4 dimensions used in the theory which are 1. energy field; 2. openness; 3. pattern and are 1. energy field; 2. openness; 3. pattern and organization and 4. multi dimensionality.organization and 4. multi dimensionality.

Continue……Continue…… The utilization of Rogers model is used as a The utilization of Rogers model is used as a

guide for theory development, research guide for theory development, research nursing education, and in the direct patient nursing education, and in the direct patient care practice. care practice.

Rogerian theories – Grand theories: The theory of accelerating evolutionThe theory of accelerating evolution The theory of paranormal phenomenaThe theory of paranormal phenomena The theory of rhythmicities The theory of rhythmicities

Continue…..Continue….. 1. Theory of paranormal phenomena:1. Theory of paranormal phenomena: This theory focus on the explanations for This theory focus on the explanations for

precognition, telepathy, and therapeutic touch precognition, telepathy, and therapeutic touch etc.etc.

Rogers Model Rogers Model

Rogers concepts of nursing: Nursing is a learned profession - it is a science and Nursing is a learned profession - it is a science and

art. art. The art of nursing involves the imaginative and The art of nursing involves the imaginative and

creative use of nursing knowledge.creative use of nursing knowledge. The purpose of nurses is to promote health and The purpose of nurses is to promote health and

well-being for all person and groups wherever well-being for all person and groups wherever they are using the art and science of nursing.they are using the art and science of nursing.

The health services should be Community based.The health services should be Community based.

Continue…..Continue….. The art of nursing involves the imaginative and creative use of The art of nursing involves the imaginative and creative use of

nursing knowledge.nursing knowledge. Rogers challenges nurses to consider nursing needs of all people, Rogers challenges nurses to consider nursing needs of all people,

including future generation of space kind; as life continuous to including future generation of space kind; as life continuous to evolve from earth to space and beyond.evolve from earth to space and beyond.

Her view provides a different world view that encompasses a Her view provides a different world view that encompasses a practice of nursing for the present time and for the imagined and for practice of nursing for the present time and for the imagined and for the yet to be imagined future.the yet to be imagined future.

Rogers proposes a nursing practice of noninvasive modalities, such Rogers proposes a nursing practice of noninvasive modalities, such as therapeutic touch, humor, guided imagery, use of color, light, as therapeutic touch, humor, guided imagery, use of color, light, music, meditation focusing on health potential of the person. music, meditation focusing on health potential of the person.

Continue…..Continue….. Nursing intervention seeks to coordinate Nursing intervention seeks to coordinate

environmental field and human field rhythmicities, environmental field and human field rhythmicities, participates in the process of change, to help participates in the process of change, to help people move toward better health.people move toward better health.

Nursing aims to assist people in achieving their Nursing aims to assist people in achieving their maximum potential.maximum potential.

Nursing practice should be emphasized on pain Nursing practice should be emphasized on pain management, supportive psychotherapy management, supportive psychotherapy motivation for rehabilitation. motivation for rehabilitation.

Maintenance and promotion of health, prevention Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and of disease, nursing diagnosis, intervention, and rehabilitation encompasses the scope of nursing.rehabilitation encompasses the scope of nursing.

CONCLUSIONCONCLUSION

Till now we discussed about the importance of nursing theories. The theorist are having different concepts for nursing, environment and health paradigms.