THEORIES IN COMMUNITY HEALTH NURSING PRACTICE

THEORIES IN COMMUNITY
HEALTH NURSING
• BY ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III
1

• 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
2

BASIC ELEMENTS
The 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.
3

MAJOR ROLES OF A CHNURSE
(1) care provider
(2) educator
(3) advocate
(4) manager
(5) collaborator
(6) leader, and
(7) researcher.
4

MAJOR SETTINGS
Six categories:
1. homes
2. ambulatory care settings
3. Schools
4. occupational health settings
5. residential institutions, and
6. the community at large.
Community health nursing practice is not limited to a
specific area, but can be practiced anywhere.
5

THEORIES AND MODELS FOR
COMMUNITY HEALTH NURSING
• Nightingale’s theory of environment
• Orem’s Self care model
• Neuman’s health care system model
• Roger’s model of the science and unitary man
• Pender’s health promotion model
• Roy’s adaptation model
• Milio’s Framework of prevention
• Salmon White’s Construct for Public health nursing
• Block and Josten’s Ethical Theory of population focused nursing
• Canadian Model
6

NIGHTINGALE’S ENVIRONMENTAL
THEORY
• Environment – concepts of ventilation,
warmth, light, diet, cleanliness and noise.
She focus on the physical aspect of
environment.
• She believed that “Healthy surroundings
were necessary for proper nursing.
7

5 ESSENTIAL COMPONENTS OF
HEALTHY ENVIRONMENT
•Pure air
•Pure water
•Efficient drainage
•Cleanliness
•Light
8

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.
9

• 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.
10

IMPORTANCE OF ENVIRONMENTAL
THEORY
• Practice:
• Disease control
• Sanitation and water treatment
• Utilized by modern architecture in the prevention of “sick
building syndrome” applying the principles of ventilation and
good lighting.
• Waste disposal
• Control of room temperature
• Noise management.
11

• Education:
• Principles of nursing training. Better practice
result from better education.
• Skills measurement through licensing by the
use of testing methods, the case studies.
• Research:
• Use of graphical representations like the polar
diagrams.
• Notes on nursing.
12

BETTY NEUMAN’S THEORY
• Betty Neuman’s system model has 2 major components:
stress and reaction to stress.
• The client in the neuman’s system model is viewed as an
open system continuously become more differentiated and
elaborate or complex.
• The system may adjust to the environment to itself.
• Exchange with the environment are reciprocal, both the
client and the environment may be affected either positively
or negatively by the other.
13

CONCEPTS OF BETTY NEUMAN’S
SYSTEM MODEL
• Person variable
• Central core
• Flexible lines of defense
• Normal line of defense
• Lines of resistance
• Reconstitution
• Stressors
• Prevention
14

• Betty neuman defines total person model
incorporating the holistic concept and an open
system approach.
• Person is a dynamic composite of physiological,
socio cultural and developmental variables that
function as an open system.
• As an open system the person interacts with,
adjust to and is adjusted by the environment,
which is viewed as a stressor disrupt the system.
15

• Neuman’s model include intrapersonal,
interpersonal and extra personal stressors.
• Intrapersonal stressors are forces occurring
within the person; interpersonal stressors
such as role expectations which occur
between people & extra personal stressors
such as financial circumstances, occur
outside the person.
16

• Neuman believes in that nursing is concerned
with the whole person. She used the term client
for patient.
• The goal of nursing is to assist individuals,
families, and groups. The nurse assesses, manages
& evaluate client system.
• Nursing focus on the variables affecting the
client’s response to the stressor.
• Nursing actions are in primary, secondary &
tertiary level of prevention.
17

• Primary prevention focuses on strengthening a line of
defence through the identification of actual or
potential risk factors associated with stressors.
• Secondary prevention strengthens internal defences
and resources by establishing priorities and treatment
plans for identified symptoms and tertiary prevention
focus on readaptation.
• Tertiary prevention is to strengthen resistance to
stressors through client education and to assist in
preventing a recurrence of the stress response.
18

MILIO’S FRAMEWORK OF PREVENTION
Nancy Milio a nurse and leader in public health policy
and public health education developed a framework for
prevention that includes concepts of community-oriented,
population focused care(1976,1981).
The basic treaty is that behavioral patterns of populations and
individuals who make up populations are a result of habitual
selection from limited choices. She challenged the common
notion that a main determinant for unhealthful behavioral
choice is lack of knowledge.
19

•Governmental and institutional
policies, she said set the range of
options for personal choice making.
It neglected the role of community
health nursing, examining the
determinants of community health
and attempting to influence those
determinants through public policy.
20

SALMON WHITE’S
CONSTRUCT FOR PUBLIC HEALTH NURSING
• describes a public health as an organized societal effort to protect,
promote and restore the health of people and public health
nursing as focused on achieving and maintaining public health.
• He gave priorities
i.e:. 1. prevention of disease and poor health,
2. protection against disease and
3. external agents and promotion of health.
For these 3 general categories of nursing intervention have also
been put forward, they are:
21

• Education directed toward voluntary change in
the attitude and behaviour of the subjects
• Engineering directed at managing risk-related
variables
• Enforcement directed at mandatory regulation
to achieve better health
22

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
23

BLOCK AND JOSTEN’S ETHICAL THEORY OF
POPULATION FOCUSED NURSING
• Derryl Block and Lavohn Josten, public health educators
proposed this based on intersecting fields of public health and nursing.
• They have given 3 essential elements of population focused nursing that stem
from these 3 fields:
• an obligation to population
• the primacy of prevention
• centrality of relationship- based care
The first two are from public health and the third element from nursing.
Hence it implies to nursing that relation-based care is very important in
population focused care.
24

CANADIAN MODEL FOR COMMUNITY:
• The community health nurse works with
individuals, families, groups, communities,
populations, systems and/or society, but at all
times the health of the person or community is
the focus and motivation from which nursing
actions flow. The standards of practice are applied
to practice in all settings where people live, work,
learn, worship and play.
25

• The philosophical base and foundational values
and beliefs that characterize community health
nursing - caring, the principles of primary health
care, multiple ways of knowing,
individual/community partnerships and
empowerment - are embedded in the standards
and are reflected in the development and
application of the community health nursing
process.
26

The community health nursing process involves the
traditional nursing process components of assessment,
planning, intervention and evaluation but is enhanced
by community health nurses in three dimensions:
• individual/community participation in each component
• multiple ways of knowing, each of which is necessary to
understand the complexity and diversity of nursing in
the community; knowledge and utilization of all these
ways of knowing forms evidence-based practice
consistent with these standards, and
27

• 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.
28

• 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.
29

• 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.
30

MARTHA ROGERS MODEL
• Rogers considers the unitary human being as an
energy field coexisting within the universe.
• The human being is in continuous interaction with
the environment. In addition, human being is a
unified whole, possessing personal integrity and
manifesting characteristics that are more than and
different from the sum of parts.
• There are 4 dimensions used in the theory which are
1. energy field; 2. openness; 3. pattern and
organization and 4. multi dimensionality.
31

The utilization of Rogers model is used as a guide
for theory development, research nursing
education, and in the direct patient care practice.
Rogerian theories – Grand theories:
• The theory of accelerating evolution
• The theory of paranormal phenomena
• The theory of rhythmicities
32

1. Theory of paranormal
phenomena:
•This theory focus on the
explanations for precognition,
telepathy, and therapeutic touch
etc.
33

Rogers concepts of nursing:
• Nursing is a learned profession - it is a science and
art.
• The art of nursing involves the imaginative and
creative use of nursing knowledge.
• The purpose of nurses is to promote health and well-
being for all person and groups wherever they are
using the art and science of nursing.
• The health services should be Community based.
34

• The art of nursing involves the imaginative and creative use
of nursing knowledge.
• Rogers challenges nurses to consider nursing needs of all
people, including future generation of space kind; as life
continuous to evolve from earth to space and beyond.
• Her view provides a different world view that encompasses a
practice of nursing for the present time and for the imagined
and for the yet to be imagined future.
• Rogers proposes a nursing practice of noninvasive modalities,
such as therapeutic touch, humor, guided imagery, use of
color, light, music, meditation focusing on health potential of
the person.
35

• Nursing intervention seeks to coordinate environmental field
and human field rhythmicities, participates in the process of
change, to help people move toward better health.
• Nursing aims to assist people in achieving their maximum
potential.
• Nursing practice should be emphasized on pain management,
supportive psychotherapy motivation for rehabilitation.
• Maintenance and promotion of health, prevention of disease,
nursing diagnosis, intervention, and rehabilitation
encompasses the scope of nursing.
36

•Till now we discussed about the
importance of nursing theories. The
theorist are having different
concepts for nursing, environment
and health paradigms.
37

THEORIES IN COMMUNITY HEALTH NURSING PRACTICE

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