Chapter 3
Roles and Settings for Community
Health Nursing Practice
Historically, community health nurses
have engaged in many roles. From the
beginning, nurses in this professional
specialty have provided care to the sick,
taught positive health habits and self-care,
advocated on behalf of needy populations,
developed and managed health programs,
provided leadership, and collaborated with
other professionals and consumers to
implement changes in health services.
The settings in which these nurses
practiced varied, too. The home certainly
has been one site for practice, but so too
have clinics, schools , factories, and other
community-based locations. Today, the
roles and settings of professional
community health nursing practice have
expanded even further.
Core Public Health Functions
The various roles and settings for practice hinge on
three primary functions of public health: assessment,
policy development, and assurance. They are
foundational to all roles assumed by the community
health nurse and are applied at three levels of service:
to individuals, to families, and to communities
(Display 3-1).
Assessment:
Assessment, means that the community health nurse
must gather and analyze information that will affect
the health of the people to be served. The nurse and
others on the health team need to determine health
needs, health risks, environmental conditions,
political agendas, and financial and other resources,
depending on the persons, community, or population
targeted for intervention.
Data may be gathered in many ways; typical methods
include interviewing people in the community,
conducting surveys, gathering information form
public records, and using research findings.
Policy Development
Policy development, defined in Display 3-1, is
enhanced by the synthesis and analysis of information
obtained during assessment. Assessment is used to
develop local and national policies.
Typically, the nurse recommends specific training
and programs to meet identified health needs of target
populations. This is accompanied by raising the
awareness of key policy makers about factors such as
health regulations and budget decisions that
negatively affect the health of the community.
Assurance ‫مراقبة‬
Assurance activates—activities that make certain that services
are provided, community health nurses perform the assurance
function at the community level when they provide service to
target populations, improve quality assurance activities, and
maintain safe levels of communicable disease surveillance and
outbreak control. In addition, they participate in research,
provide expert consultation, and provide services within the
community based on standards of care.
Roles of Community Health
Nurses
Over time, the role of the community health nurse has
broadened. Community health nurses wear many hats
while conducting day-to-day practice. This is
especially true for specialized roles such as that of
full-time manager. This chapter examines seven
major roles: (1) clinician, (2) educator, (3) advocate,
(4) manager, (5) collaborator, (6) leader, and (7)
researcher
Clinician Role
The clinician role in community health means
that the nurse ensures that health services are
provided not just to individuals and families,
but also to groups and populations.
Educator Role
A second important role of the community health
nurse is that of educator or health teacher. Health
teaching, a widely recognized part of nursing
practice.
The educator role is especially useful in promoting
the public’s health for at least two reasons. First,
community clients usually are not acutely ill and can
absorb and act on health information.
Second, the educator role in community health
nursing is significant because a wider audience can be
reached.
Advocate Role
The issue of client’s rights is important in health care. Every
patient or client has the right to receive just, equal, and
humane treatment. Our current health care system often is
characterized by fragmented and poor, the disadvantaged,
those without health insurance, and people with language
barriers – frequently are denied their rights. They become
frustrated, confused, degraded, and unable to cope with the
system on their own. The community health nurse often acts as
an advocate for clients, pleading their cause or acting on their
behalf. Clients may need someone to explain which services
to expect and which services write letters to agencies or health
care providers for them.
Manager Role
Community health nurses, like all nurses, engage in the role of
managing health services. As a manager, the nurse exercises
administrative direction toward the accomplishment of
specified goals by assessing clients’ needs, planning and
organizing to meet those needs, directing and leading to
achieve results, and controlling and evaluating the progress to
ensure that goals are met.
The management process, like the nursing process,
incorporates a series of problem solving activates or functions:
planning, organizing, leading, and controlling and evaluating.
Collaborator Role
Community health nurses seldom practice in isolation. They
must work with many people, including clients, other nurses,
physicians, teachers, health educators, social workers, physical
therapists, nutritionists, occupational therapists, psychologists,
epidemiologists,
biostaticians,
attorneys,
secretaries,
environmentalists, city planners, and legislators.
As members of the health team, community health nurses
assume the role of collaborator, which means to work jointly
with others in a common endeavor, to cooperate as partners.
Successful community health practice depends on this
multidisciplinary collegiality and leadership.
Leadership Role
Community health nurses are becoming increasingly
active in the leadership role, separate from leading
within the manager role mentioned earlier. The
leadership role focuses on effecting change; thus, the
nurse becomes and agent of change.
Researcher Role
In the researcher role, community health
nurses engage in systematic investigation,
collection, and analysis of data for solving
problems and enhancing community health
practice.
Settings For Community Health
Nursing Practice
The pervious section examined community
health nursing form the perspective of its
major roles, the roles now can be placed in
context by viewing the settings in which they
are practiced.
Homes
For a long time, the most frequently used setting for
community health nursing practice was the home. In the home,
all of the community health nursing roles, to varying degrees,
are performed.
The home also is setting for health promotion. Many
community health nursing visits focus on assisting families to
understand and practice healthier living behaviors: child
discipline, diet, exercise, coping with stress, or managing grief
and loss.
Ambulatory Service Settings
Ambulatory service settings include a variety of
venues for community health nursing practice in
which clients come for day or evening services that
do not include overnight stays.
Sometimes, multiple clinics offering comprehensive
services are community based or are located in
outpatient departments of hospitals or medical
centers. Such as a family planning clinic or a wellchild clinic.
Schools
Schools of all levels make up a major group of
settings for community health nursing
practice.
Occupational Health Settings
Business and industry provide another group of
settings for community health nursing practice.
Employee health has long been recognized as making
a vital contribution to individual lives, productivity of
business, and the well-being of the entire nation.
Organizations are expected to provide a safe and
healthy work environment in addition to offering
insurance for health care.
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