Running Head: COMMUNITY THEORY UTILIZATION AND APPLICATION
Community Theory Utilization and Application
Lisa C. Bayhi
Southeastern Louisiana University
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COMMUNITY THEORY UTILIZATION AND APPLICATION
Community Theory Utilization and Application
The purpose of this study is to explore and evaluate the Community Nursing Practice
Model (CNPM) authored by Dr. Marilyn Parker and Dr. Charlotte Barry. The corpus of the
study will include nursing conceptualizations, theory development, authoritative sources and
overall significance of the model as applied in nursing practice. The theory itself is described as
an amalgamation of the ideal, with commitment to development and the practical, as applied to
nursing practice (Barry, Gordon, & Lange, 2007).
Nursing Conceptualization
Conceptualization of nursing portrayed in the CNPM includes a discussion of the focus,
purpose, boundaries and description of nursing practice. The focus of nursing in this model
according to the college mission, is a reflection of the Florida Atlantic University (FAU)
Christine E. Lynn College of Nursing as nurturing the wholeness of persons and environments
through caring as cited in Parker & Barry (1999). Nursing is directed by a caring approach,
ensuring the nurse is authentically present for the patient in order to deliver exemplary care
(Parker & Barry, 1999). Nursing practice is guided by three essential attributes that form the
foundation of the model; respect for person, caring as the essence of nursing and the belief that
persons are whole and allied with one another in families and communities (Parker & Barry
2010). Instrumental values for this model are espoused and adopted from the principles of
primary health according to the World Health Organization Alma-Ata Conference in 1978 as
cited in Parker & Barry (1999). These values include access, essentiality, community
participation, empowerment and intersectoral collaboration. Using this substructure, the focus of
the CNPM becomes four interrelated themes; nursing, person, community and environment
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COMMUNITY THEORY UTILIZATION AND APPLICATION
(Parker & Barry, 1999). The nurse uses these four subjects to guide observations, reflections,
decisions and actions in the practice setting.
The theorists describe the purpose of nursing practice as the encouragement of wholeness
and well-being (Parker & Barry, 1999). Nursing actions and reflections require “creative
integration of multiple ways of knowing and involve understanding through the synthesis of
information within a context of value and meaning” (Parker & Barry, 1999, p. 126). The nurse
practicing within the CNPM designs care, plans activities and services based on the theory
structure. The structural theory design presented by Parker & Barry (1999) is the fashioning of
three concentric circles of empathetic concern centering on the activities and services provided at
the site of care, called the nursing situation. These services and activities intertwine throughout
the surrounding loops connecting and ensuring continuity as a fluid movement to provide
interconnectedness. The first inner band is composed of the school and community, individuals
and groups. The second band is comprised of structured and organized individuals and groups.
The outer ring constitutes any organizations with wider jurisdiction (Barry et al., 2007). The
nurse practicing within the CNPM uses assessment and evaluation of the patient to incorporate
other resources and programs from any of these circles to ensure planning that centers on the
patient. The core services are supported by the surrounding spheres providing a rich complex
interplay where “expert, caring-based, comprehensive nursing is realized” (Parker & Barry,
1999, p.127).
The CMNP has boundaries and limitations for nursing, but also creates an outstanding
interdisciplinary approach to care provision. The CNPM operates with and enhances other
health related services while remaining distinguished as a model of nursing practice. It is the
expectation of the CNPM that the nurse employ interconnectivity from a wide range of services
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COMMUNITY THEORY UTILIZATION AND APPLICATION
within the two focal themes of community and environment to assist through collaboration in the
provision of nursing care. Functioning closely with nursing through the concentric circles is the
health-related service of social workers (Parker & Barry 2010). Although these two disciplines
work closely with each other, nursing stands out as the provider of intimate care, while the social
service role is focused on discovery and matching of community resources. The nurse provides
the design and coordination of care, health education, screening, protection of well-being and the
nurturing of wholeness according to Parker & Barry (1999). The original CNPM was utilized in
a university setting as a faculty practice center to provide financial support, a nursing practice
situation and to enhance research (Parker & Barry, 1999). Limiting the practice of nursing in the
original model is the omission of the advanced practice role; however, Florida’s prescriptive
authority statutes must be considered. Nurse practitioners in the state of Florida can prescribe
legend drugs only; no scheduled drug prescribing is permitted (Lugo, Grady, Hodnicki, &
Hanson, 2007). This seriously impedes their ability to practice within the CNPM. Although
lacking the advanced nursing role as part of the original structure, the theory has been adapted
for this purpose in a current master’s program at Naresuan University in Thailand (Parker,
Locsin, & Longo, 2006). The addition of advanced nursing roles enhances and solidifies the
core empathetic concerns of the theory that include primary, secondary and tertiary care services
(Barry et al., 2007).
Nursing situations can collectively be described through the incorporation of the nurse,
the patient and the environment. The relationship between the nurse and one nursed is an
integral part of the CNPM in the delivery of nursing care. In the community model by Parker &
Barry (2010) the qualities of the nurse are exemplified by caring and accepting the person,
culture or group as unique and worthy of respect. The nurse approaches with humility and
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perceives the person, not the problem or illness in order to integrate multiple ways of knowing to
practice the discipline of nursing (Parker & Barry, 1999). The attributes of the person are seen
as unique and affected by the community and culture in which they reside. In addition, only the
person can “define what is necessary to well-being” (Parker & Barry, 1999, p. 126). It is the
nurse who must be authentically present and accept the person in the now to allow choice which
is the forerunner to empowerment (Parker & Barry, 1999). Nurse and patient interactions can be
styled as one of caring with an appreciation of wholeness of the person (Gordon & Barry, 2009).
This theory emphasizes the portability of nursing practice to wherever the person is present;
there are no environmental requirements or barriers for nursing care. In fact, Parker & Barry
(1999) suggest reaching into the community to nurse in homes, workplaces, schools, camps,
even under trees; meeting and caring for the patient where they reside. The caring approach this
model advocates demands the complete contribution of the nurse to assess, design and evaluate
services as she coordinates the interfaces between patient, family, and community (Parker &
Barry, 1999).
A descriptive examination of this theory in a nursing situation is proficiently illustrated
by a student nurse group planning care at a homeless shelter according to Parker & Barry (2010).
The theory channeled the students to approach the residents with openness and respect to assess
their needs. The residents expressed a desire for proper clothing for job interviews. The students
began obtaining clothing in several ways, starting with their own closets and extending into the
community as the CNPM exemplifies. A business owner consented to establishing a collection
box where clothes could be contributed and the shelter residents could acquire the gathered
clothing to prepare for job interviews. The students used the CNPM to coordinate community
resources, create a sustainable civic project and met the health needs of the homeless shelter by
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respecting the residents’ definition of wellness (Parker & Barry 2010).
Context of Theory Development
There are many influences on the development of CNPN, including philosophies, values,
beliefs and relationships of the two central theorists. Dr. Marilyn E. Parker is a professor at the
Christine E. Lynn College of Nursing at Florida Atlantic University. She is the founding director
of the Quantum Foundation Center for Innovation in School and Community Well-Being (Parker
& Smith, 2010). In her career, she found meager prospects for care in several populations,
especially multicultural communities (Barry et al., 2007). This lack of desired access facilitated
the formation of the model. She also comments that nursing theories developed here in the
United States are not always perceived as applicable to other cultures (Fawcett, 2003). The
central value or belief of Dr. Parker is multiculturalism and healthcare availability. With these
values as principal, she continues her collaboration with colleagues in other countries and
received the 2001 Fulbright Scholar Award for her endeavors with Thailand (Parker & Smith,
2010).
The co-theorist, Dr. Charlotte D. Barry is an associate professor and associate director at
the Quantum Foundation Center for Innovation in School and Community Well-Being at the
Florida Atlantic University Christine E. Lynn College of Nursing (Parker & Barry 2010). She
holds a PhD from the University of Miami, Florida, is nationally certified in school nursing and
contributes her leadership skills nationally. Dr. Charlotte Barry is active in several organizations
including the International Association of Human Caring, the National Association of School
Nursing and Florida Association of School Nurses. She also has promoted the use of the
community nursing theory in the United States and at the Mbarara University of Science in
Uganda (Parker & Barry 2010).
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COMMUNITY THEORY UTILIZATION AND APPLICATION
Several nursing philosophies and core beliefs enhanced the development of the CNPM.
The two premises of caring and environment are principles found throughout nursing theory and
are fundamental to CNPM. The earliest sphere of influence is the well-known perception of
environment as first written by Florence Nightingale. The authoring theorists found Nightingale
essential for describing the interconnectedness of the patient and environment. The well-being
of the patient is affected by surroundings and influences the reparative powers of the patient
(Parker & Barry 2010). Numerous nursing theories and models have been influenced by the
philosophy of caring. Parker & Barry (1999) embraced the mission statement of the Florida
Atlantic University College of Nursing focusing on nursing as “nurturing wholeness of person
through caring” (p. 126). The conception of caring is also evident in Lydia Hall’s model, the
Care, Core and Cure Model according to Gordon, Touhy, Gesse, Dombro, and Birnbach (2010).
Other nursing theorist who focused on caring suppositions are Madeleine Leininger in the
Theory of Culture Care Diversity and Universality, Jean Watson in the Theory of Human Caring,
Rosemary Parse, in her theory of Humanbecoming School of Thought and Kristen Swanson, in
the Theory of Caring (Matsuoka, 2007). There are further nursing related theories concerning
“poverty, multiculturalism, feminism, and ethics, as well as biomedical theories that will
continue to be important to nursing” (Fawcett, 2003, p. 135).
In the state of Florida various social, economic and political influences contributed to the
creation of CNPM. The status of nursing as a discipline and profession was well established in
1999 when the theory was conceived. As previously mentioned, however, the role of the nurse
practitioner was limited. At the time of model development, the underserved population,
especially agricultural workers and their families lacked healthcare access or the financial means
to procure healthcare (Parker, Barry, & King, 2000). A free clinic was started in the
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multicultural community of Palm Beach County and blossomed to include an elementary school
to enhance admittance to children in the area. The Florida Atlantic University (FAU) began the
FAU Community Nursing Project in 1994 (Parker et al., 2000). As the project flourished,
additional school based wellness centers opened. The cooperating influences are correspondingly
expressed as the second and third circle in the CNPM (Parker & Barry, 1999).
Authoritative Sources
Information about development, evaluation and the use of the CNPM are the emphasis of
the authoritative sources. Dr. Marilyn Parker and Dr. Charlotte Barry are the central authorities
on the CNPM (Parker & Barry 2010). These two authoring theorists are prevalent scholars in the
nursing community and are well documented as leaders in theory research and development.
The authors foster CNPM in other countries and communities and have contributed other literary
works to the nursing body of knowledge. Other nurses who should be considered as authorities
are those who actually participated in the implementation of the CNPM in practice settings
within the published research. These contributors functioned closely with the authors and should
have a strong sense of the essence of CNPM. Any nurse who is interested in the theory could
become an authority by utilizing the model in nursing practice.
The major resources available to elucidate the theory are published works in periodicals,
nursing theory textbooks and several references in other nursing research. Nursing societies who
support the theory are the Florida Nurses Association, the International Association of Human
Caring and the school based community nursing centers in Uganda and Thailand (Parker &
Barry, 1999). The academic authorities on this particular theory are the Florida Atlantic
University, Mbarara University and Naresuan University in Thailand (Parker & Barry 2010).
The universities have developed programs to construct the theory as part of their curriculum.
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Overall Significance
The overall significance of the CNPM is characterized by an enduring philosophy that
can be applied currently and in the future. Individual nurse professionals have structured their
practice with the integration of education, practice, research and community improvement as
conceptualized by the three circles of influence to guide the distribution of care (Parker et al.,
2000). In one instance provided by Parker & Barry (1999) a nurse caring for a child with
multiple birth defects applied the bands of connection within the theory to search resources and
obtain a replacement for a lost hearing aide. The ability of nurses to embrace this model has
been expressed as a rewarding experience and has enriched nursing professional practice (Parker
& Barry, 1999). Nursing administration and education has similarly been enhanced as
exemplified best by the successful application of the theory in Thailand (Parker & Barry 2010;
Parker et al., 2006)) and Uganda (Barry et al., 2007) by faculty of nursing programs in both of
these countries. This demonstrates the endurance of the CNPM and its applicability to multiple
cultures. The theory has provided a nursing foundation for healthcare as well as nursing
education and research. In regards to nursing organizations, this theory has been embraced by
the Florida Nurses Association who has lobbied for state funding to support the venture (Parker
& Barry, 1999). Healthcare policy in Florida has been directly impacted as illustrated by state
funding for the school based project. The theory has been employed as the theoretical
framework for research on the nursing delegation to unlicensed assistive personnel in school
based clinics in Florida (Gordon & Barry, 2009). The research found keys measures within the
theory for safe and effective delegation to this group of unlicensed assistants in the Florida
school system (Gordon & Barry, 2009).
The CNPM will continue to be applicable for the future since it encompasses all phases
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the person encounters during a lifetime. It is highly adaptable for nurse practitioners since they
can provide the core services of primary, secondary and tertiary care and future use of the CNPM
in other communities seems highly probable. Literature review reveals scarce published nursing
scholarship on application of this model on a broad scale in the United States. The tenants of the
theory have evolved over time as connections between the three spheres strengthen amid their
areas of application. Although the inclusion of the suppositions of community in other nursing
theories is prevalent, utilization of the CNPM itself is infrequent.
The influence of the CNPM on the future of nursing is multifactorial. The nursing
profession has been strengthened by the model as proven in the growth of the theory in nursing
education and community based clinics; however, usage is currently limited to a small number of
communities according to literature review. Other theoretical formulations, nursing design
methods and the development of new nursing practice are scarce at best. The theory has
provided a fundamental framework within nursing scholarship as demonstrated by a doctoral
study by Bernadette Lange, DNS on the community interconnectivity in women with substance
abuse disorders (Barry et al., 2007). The social value of CNPM is its ability to coordinate and
nurture wholeness to communities (Parker & Barry, 1999). Because of this adaptability, future
community clinics in other regions may be a reality and could significantly impact healthcare
and well-being.
The rationale for the selection of this theory involves value and beliefs most treasured.
As a nurse practitioner in daily advanced practice, the necessities of the community are
constantly brought forth in the quest to deliver healthcare (Center to Champion Nursing in
America, 2010). Difficulty is encountered throughout the process in the areas of community,
the region and the state. Ensuring the model chosen encompasses the person, the environment as
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well as the community was crucial. The expansive nature of this model allows for health policy
implementation, evaluation, reform and is intricately connected to the changes within a
community that can enhance the conveyance of healthcare. The fluidity of movement in the
CNPM, especially through the three circles and inner core provide an illustration of the dialogue
and connections that are necessary to enact change within the healthcare arena.
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References
Barry, C. D., Gordon, S. C., & Lange, B. (2007). The usefulness of the community nursing
practice model in grounding practice and research: narratives from the United States and
Africa. Research and theory for nursing practice, 21(3), 174–84. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17849650
Center to Champion Nursing in America. (2010). Access to Care and Advanced Practice Nurses
A Review of Southern U . S . Practice Laws (pp. 1–8). Washington, DC. Retrieved from
http://www.rwjf.org/content/dam/web-assets/2010/01/access-to-care-and-advancedpractice-nurses
Fawcett, J. (2003). Theory and Practice: A Conversation With Marilyn E. Parker. Nursing
Science Quarterly, 16(2), 131–136. doi:10.1177/0894318403251788
Gordon, S. C., & Barry, C. D. (2009). Delegation guided by school nursing values:
comprehensive knowledge, trust, and empowerment. The Journal of school nursing : the
official publication of the National Association of School Nurses, 25(5), 352–60.
doi:10.1177/1059840509337724
Lugo, N. R., Grady, E. T. O., Hodnicki, D. R., & Hanson, C. M. (2007). Ranking State NP
Regulation : Practice Environment and Consumer Healthcare Choice, 11(4).
Matsuoka, R. (2007). Examining Caring Theories in Nursing from Non-nursing Viewpoints.
Nurs Studies N C N J, 6(1), 43–51.
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Parker, M., & Barry, C. (1999). Community Practice Guided by a Nursing Model. Nursing
Science Quarterly, 12(2), 125–131. doi:10.1177/089431849901200211
Parker, Marilyn, Barry, C., & King, B. (2000). Use of Inquiry Method for Assessment and
Evaluation in a School-Based Community. Family & Community Health, 23(2), 54–61.
Parker, Marilyn, Locsin, R., & Longo, J. (2006). A Community Nursing Practice Model for
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