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PubMed1999

Community health nursing practice and the Roy Adaptation Model.

In the current health care environment in the United States, the work performed by community health nurses is increasingly being recognized and valued by society at large. An increased societal emphasis on health promotion and disease prevention has generated many opportunities for community health nurses (CHNs) to stretch their practices from individually-oriented type practice models to more encompassing population-focused type practices. Addressing this trend, the Roy Adaptation Model of nursing has been reconceptualized and expanded to offer a framework for the systematic delivery of nursing care to aggregates in community settings. The purpose of this paper is to describe the current health promotion movement in the United States and discuss the impact of this movement on the practice of community health nursing. In recognition of the importance of theory-based nursing practice and the opportunities that CHNs will have in the health promotion movement, the use of the a specific conceptual model, the reconceptualized Roy Adaptation Model, will be presented as a theoretical framework for community health nursing practice. The nursing process according to Roy is applied to community health nursing and specific attention is paid to the performance of community assessments within the newly defined adaptive modes that relate to collectives: the physical, group identity, role function, and interdependence modes. To date, few references appear in the literature which link the Roy Adaptation Model to community health nursing.

Adaptation, Psychological↗
PubMed1994

The role of the community health nurse in environmental health.

Chemical contamination in the environment is affecting public health in increasing numbers of communities across the country. Although historically and theoretically well within the realm of nursing, methods for assessing and diagnosing threats to community environmental health are not being included in community health nurses' training. A community's environmental health is assessed by retrieving information from federal, state, and local sources. Developing the diagnosis involves four steps: identifying a community aggregate at highest risk of exposure, determining the potential or actual health response, citing related host and environmental factors, and correlating any existing epidemiologic data that may substantiate the nursing diagnosis. To illustrate these concepts, a systematic environmental health assessment was conducted for Douglas, Arizona. The results indicated elevated lead levels in residential soils and led to the community diagnosis, potential for injury: children in Douglas are at risk of developing adverse neurobehavioral health effects, and pregnant women in Douglas are at risk of developing adverse reproductive health effects related to several environmental and host factors, as evidenced by average blood lead level, in children exceeding the Centers for Disease Control recommended level of 10 micrograms/dl.

Arizona↗
PubMed1999

Building community health nursing in the People's Republic of China: a partnership between schools of nursing in Ottawa, Canada, and Tianjin, China.

Community health nursing in China is an emerging specialty. A multi-component collaborative endeavor between the Schools of Nursing of Tianjin Medical University, China, and the University of Ottawa, Canada is described. This project, funded by the Canadian International Development Agency, commenced in 1989. It has laid the groundwork for an expanded role for community health nurses in Tianjin, a municipality of 11 million people located in Northeast China. The historical context for the evolution of community health nursing in China and the emergence of community health nursing as a priority area within the project are described. Major project activities are highlighted, illustrating several underlying principles for strengthening the educational preparation of baccalaureate nurses who can apply community health skills. These include creating a critical mass of faculty who can teach community health nursing, modelling classroom and clinical teaching of community health nursing, bridging the gap between nursing in the community and nursing, in the hospital, and developing a prototype for baccalaureate community health nursing experience. Lessons learned from this initiative are summarized.

China↗
PubMed1998

Genetics and community health nursing.

Genetic discoveries affect the practice of community health nurses. These nurses identify groups at risk for genetic diseases and participate in newborn screening, carrier detection testing, and presymptomatic genetic testing programs. Community health nurses also provide direct nursing care to individuals with genetic disorders. Protecting clients from harmful use of genetic information, planning and implementing genetic screening programs, and identifying genetic resources are essential components of the community health nurse's role.

Adult↗
PubMed1999

Beyond the sick role: situating community health nursing practice.

This grounded theory research into the role of the community health nurse in Australia identified that moving from the comfort and structure of an institutional setting to the client's turf results in profound changes to the purpose of nursing practice. Data were collected from 17 'excellent' community health nurses practising in a range of community health settings in three states of Australia. Data included transcripts from in-depth interviews, questionnaires, group discussions with participants, job descriptions, agency documentation, professional organisation documentation and focus groups. Data were analysed using constant comparative techniques. In community health nursing practice, the client's role changes from a sick role to a well role and there is a shift in responsibility for outcomes from the nurse to the client. The central purpose of the community health nursing role is to facilitate Situated Health Competence, which the client achieves within the context of going about their everyday life, including work, recreation, relationships and role responsibilities. Situated Health Competence requires families, groups and communities to address their own illnesses, health problems, health issues and health behaviours; have enough knowledge and power to make their own decisions; question matters that impact on their health; and seek out and access appropriate health resources on an ongoing basis. The findings of this study make the intangible motivations of the community health nurse more explicit. The aim of facilitating Situated Health Competence results in an expanded view of the boundaries of nursing practice. The traditional foci of nursing practice are still present, but are incorporated within a broader 'situated' role.

Attitude of Health Personnel↗
PubMed1996

Students practice essential components of community health nursing in home health care.

Because home health differs from community health nursing, using home health agencies as clinical sites to teach community health nursing may be inappropriate. This retrospective descriptive study compared the perceptions of students who took community health before it included a home health placement with those whose course included home health. Mailed surveys were returned from 28(63.6%) of the 44 students enrolled prior to the home health placements and from 30(60%) of the 50 students enrolled afterwards. Students whose experience included home health rated the home visit experience significantly better in terms of providing them an opportunity to perform health promotion and to care for family as client. They found the course more relevant, felt safer in making home visits, and were more likely to consider working in community health nursing. This study supports using home health agencies as clinical placements for community health nursing if they are supplemented with aggregate-level experiences.

Community Health Nursing↗
PubMed2006

Experiences of Swedish community health nurses working with health promotion and a patient-held health record.

Community health nurses have a tradition of preventive care, and might therefore be a key group in the introduction of new health-promotion methods. The aim of this study was to describe Swedish community health nurses' experiences in working with health promotion and a patient-held record as an integrated tool in their health-promotion work. Interviews were performed with 12 nurses at primary healthcare centres in the county of Dalarna, Sweden. A qualitative content analysis applying aspects of the grounded theory approach was performed. Central to the analysis was the nurses' struggle for balance, in being both a doer of practical disease-oriented tasks and a health-promotion communicator. Descriptions of the nurses' struggles to balance their work were grouped into three themes: (i) working alone and as a part of a team; (ii) nurse-related and patient-related interests; and (iii) patient's responsibility and shared responsibility between patient and nurse. The findings indicated that the structural organization in the primary healthcare centres was important for the community health nurses' means to work with health promotion and the patient-held record. In addition, the community health nurses' cognitive and emotional needs also affected this balance. In conclusion, the struggle of community health nurses to find a balance between being doers and health-promotion communicators is valuable in understanding health promotion in primary health care. The study indicates that it is not enough to develop health-promotion methods acceptable to community health nurses. A comprehensive examination of working conditions and the content of daily work is needed to ensure an emphasis on health promotion, including long-term usage of patient-held records.

Adult↗
PubMed1998

Reconceptualization of community health nursing clinicals for undergraduate students.

The multilevel community intervention model is a way of maximizing community resources and services and providing a community focus for undergraduate community health nursing students. The rationale for a change from traditional community health nursing clinical experiences to more community focused ones and current nursing standards supporting this change are identified. The model and its utilization with undergraduate nursing students is discussed. Three groups of undergraduate community health nursing students will each implement one piece of the model and through group discussions learn about the total model.

Community Health Nursing↗
PubMed1989

Educational needs of community health nursing supervisors.

Recent legislative trends toward early hospital dismissal and cost containment have shifted the setting for health care from the hospital to the home. Consequently, community health nursing supervisors are becoming increasingly responsible both for coordinating care for sicker clients with fewer available resources, and for guiding staff nurses who provide high-tech nursing skills in the home. This has resulted in new educational needs for these supervisors. To determine their educational needs and the barriers to implementing their roles, 160 community health nursing supervisors employed by community health nursing agencies in Michigan were surveyed. They reported educational needs related to labor relations, reimbursement procedures, fiscal management, marketing, and computer systems. Several types of educational experiences were found to influence their abilities to handle supervisory responsibilities, including enrollment in an educational program, highest level of education, and selected content areas taught in their formal educational programs. Nursing implications include using the research results to develop educational programs to meet the needs of community health nursing supervisors. Those who are adequately prepared educationally will be better able to provide effective supervision of staff nurses and ultimately, coordinate high-level client home care.

Community Health Nursing↗
PubMed1996

Community development: theoretical and practical issues for community health nursing in Canada.

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature. This paper provides background information on the historical origins of community development work through an extensive review of the literature. As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science. These include economic development models, education models both formal and informal, confrontational models, and empowerment models. Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health. However, much additional work will be needed to test out models for community development in actual practice. Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population.

Canada↗
PubMed1991

Pairing students for community health nursing home visits.

Faculty paired community health nursing (CHN) students for home visits to reduce students' anxiety and enhance their learning of the nursing process. The pairing method involved 60 students over a three-semester period. The process is described and advantages and disadvantages are analyzed. The net results are favorable. Faculty found that students' fear of entering an unfamiliar home was supplanted by a sense of challenge at working collaboratively with a peer. Furthermore, the pairing experience increased students' confidence in making decisions about client care and offered them more physical safety when visiting high-crime urban settings. Students felt positive about the increased safety and expressed greater confidence in their CHN role and their application of the nursing process.

Community Health Nursing↗
PubMed1992

The relationship of ideology to developing community health nursing theory.

Ideology plays a major role in developing theory, guiding education, and directing practice in nursing. This study investigated the opinions of community health nurse educators regarding specific elements of community health nursing ideology and its relationship to the educators' opinions about the appropriateness of existing theory for professional use. The majority of participants agreed that a specific set of beliefs can be called a community health nursing ideology. Covariant factor analysis indicated that it is not a undimensional, internally consistent single set of beliefs or values, but rather is a set of two types of values, one focusing on the individual and the other on society. Individually oriented beliefs were positively related to satisfaction with existing theory. Socially oriented beliefs were negatively related to satisfaction with existing theory, but the relationship was not statistically significant. Anyone engaged in developing community health nursing theory would do well to consider which ideologic model is undergirding the process.

Attitude↗