Week 2: Community Health Nursing | Core Functions, Roles, Models, and Practice Settings

Functions of Public Health

• Assessment: Regular collection, analysis, and sharing of community health data, risks, and resources.

• Policy Development: Strategic use of assessment data to establish health policies and allocate resources.

• Assurance: Ensuring essential health services are available and accessible across communities.

Essential Public Health Services

• Assessment Services: Monitor community health status; diagnose and investigate health hazards.

• Policy Development Services: Educate and empower populations; mobilize community partnerships; develop supportive health policies.

• Assurance Services: Enforce safety laws; link individuals to personal care; assure a competent workforce; evaluate service effectiveness.

• System Steering Core: Conduct research for innovative public health solutions.

Clinician Role of Community Health Nurses

Delivers holistic care across individual, family, and aggregate levels, directly targeting Determinants of Health.

Educator Role of Community Health Nurses

Focuses on community health planning (3× more education hours than acute care nurses), adhering to CLAS standards and catering to visual, auditory, and kinesthetic learning styles.

Advocate Role of Community Health Nurses

Promotes patient self-determination, mediates healthcare system inadequacies, and lobbies for public health policy.

Manager Role of Community Health Nurses

Coordinates multidisciplinary care using a participative, collaborative community approach.

Leader Role of Community Health Nurses

Functions as an active change agent to drive health improvements.

Researcher Role of Community Health Nurses

Investigates community issues and translates evidence-based findings into practice.

Nightingale’s Theory of Environment

• Core Focus: Examines environmental impacts on health, emphasizing preventative measures (proper ventilation, pure water, warmth, light, cleanliness).

• Service Evaluation: Analyzes service creation purpose, beneficiaries, funding, direct user cost, and public perception.

Pender’s Health Promotion Model

• Core Focus: Proactive, Social Learning Theory-based behaviors where individuals actively transform their environment to promote well-being.

• Modifying Factors: Perceptions and actions are shaped by demographic, biologic, interpersonal, situational, and behavioral factors.

Ambulatory Service Nursing

Delivers outpatient diagnostics, screenings, procedures, and wellness counseling without overnight stays.

School Nursing

Advances student well-being and academic achievement (recommended ratio 1:750), aligning initiatives with Healthy People 2030 priorities.

• Primary Prevention: Health education and mandated immunization tracking.

• Secondary Prevention: Emergency/acute care, triage, and mandated screenings (vision, hearing, scoliosis, mental health, abuse reporting).

• Tertiary Prevention: IEP development and chronic disease management.

Camp Nursing

Ranges from specialized care for chronic conditions to traditional well-child maintenance and acute first aid.

Faith-Based Community Nursing (Parish Nursing)

Integrates faith and health practices to provide health promotion and pastoral care without duplicating existing community nursing services.

Occupational Health Nursing

Promotes worker safety and productivity guided by AAOHN standards (requires BSN).

• Total Worker Health Domains: Encompasses hazard control, work organization, built environment, leadership, compensation/benefits, community supports, workforce demographics, policy issues, and new employment patterns.

Forensic and Correctional Nursing

Delivers primary care to incarcerated individuals from intake through release, focusing on health education, safety, and preventing communicable disease transmission (specifically HIV and TB).

Hospice and Palliative Care

• Philosophy: Non-curative palliative end-of-life care focused on quality of life and family bereavement support.

• Eligibility: Clinical prognosis of ≤6 months with formal physician recertification required every 6 months.

• Interdisciplinary Team: Medically directed by physicians and RN-coordinated with 24 hours/day coverage.

Framework/Signs of Death

• Seven Primary Fears: Pain, loss of control, loss of loved ones, others' reactions, isolation, unknown, meaningless life.

• Kübler-Ross Stages: Denial & Isolation, Anger, Bargaining, Depression, Acceptance.

• Signs of Impending Death: Decreased LOC, anuria, skin mottling, apnea/gurgling, fluctuating pulse/BP, and terminal restlessness.

Interventions for Palliative Care

Aggressive pain management, dyspnea relief (O2​, opioids), secretion control (positioning, anticholinergics), and restlessness management (lorazepam, haloperidol).

Home Health Nursing

• Goal: Maximizes patient functional independence, comfort, and safety in their home.

• Skilled Nursing: Assessments, wound care, lab draws, medication administration, TPN/IV therapy, central line care, and catheter maintenance.

• Case Management: Coordinates multidisciplinary care, supervises LPNs/HHAs, documents for resource allocation, conducts home safety assessments, and supports family caregivers.