Nurse Settings for Community
Health Nursing.
Lecture objectives:
Upon finishing this lecture, you should be able to:
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Describe seven settings in which community health
nurses practice.
Discuss the nature of community health nursing, and
the common threads basic to its practice, woven
throughout all roles and settings.
Identify principles of sound nursing practice in the
community.
Community Health Nurse Practice
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Is focussed on wellness not sickness.
Is focussed on prevention not just treatment of
problems.
Is focussed on assisting people and
communities make their own decisions
regarding health care.
Is focussed on assisting those with existing
health conditions to maximise their potential
and prevent deterioration if possible.
Community Health Nurse Practice
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Is based in the community in a range of
settings, wherever there is a need for support,
information and education.
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Responds to public health needs in relation to
communicable diseases.
Community Health Nurse Practice
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Has the whole community as their client, as
well as groups, families and individuals.
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Recognises the impact of life course and
social determinants of health and works in
partnership with the community to address
these.
Community Health Nurse Practice
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Utilises the primary health care philosophy to
guide practice.
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Has a specialised body of knowledge which
reflects current research and evidence based
practice.
Community Health Nurse Practice
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Community health nurses recognise health
as “ a state of complete physical, mental and
social well-being and not merely the absence
of disease and infirmity” W.H.O.
Community health nurses deal with clients in
a holistic manner, working with them
wherever they are on the health – illness
continuum.
What is different about practice of
community health nurse
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Community health nurse practice, by the
nature of the work setting, requires
autonomy, self-direction and use of a high
level of professional judgement.
Work settings for community health
nurses
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The types of places in which community health
nurses practice are increasingly varied and include a
growing number of nontraditional settings and
partnerships with nonhealth groups.
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Employers of community health nurses range from
state and local health departments and home health
agencies to managed care organizations, industries,
and nonprofit organizations.
Work settings for community health
nurses
These settings are grouped into seven
categories:
 (1) homes,
 (2) ambulatory service settings,
 (3) schools,
 (4) occupational health settings,
 (5) residential institutions,
 (6) parishes,
 (7) the community at large.
What is different about practice of
community health nurse
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Community health nurses interact with a
wide range of both professional and non
professional people within the community
and must have a variety of interpersonal
skills.
Homes
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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
are performed:
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Clients who are discharged from acute care institutions, such
as hospitals or mental health facilities, are regularly referred to
community health nurses for continued care and follow-up.
Here, the community health nurse can see clients in a family
and environmental context.
Service can be tailored to the clients’ unique needs.
Homes: Health promotion
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Many community health nursing visits focus on
assisting families to understand and practice
healthier living behaviors:
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Nurses may, for example, instruct clients on
parenting, infant care, child discipline,
diet, exercise,
coping with stress,
or managing grief and loss.
Homes: The diversity
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The character of the home setting is as varied as the
clients served by the community health nurse.
In one day, the nurse may visit
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a well-to-do widow in her luxurious home,
a middle-income family in their modest bungalow,
an elderly transient man in his one-room fifth-story walk-up
apartment,
and a teen mother and her infant living in a group foster
home.
In each situation, the nurse can view the clients in
perspective and, therefore, better understand their
limitations, capitalize on their resources, and tailor
health services to meet their needs.
Home visits
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anxiety for the nurse.
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nurse’s first experience outside the acute care, longterm care, or clinic setting.
visiting families in unfamiliar neighborhoods.
fear of the unknown.
collaboration with various types of home care
providers, including hospitals, other nurses,
physicians, rehabilitation therapists, and durable
medical equipment companies
Ambulatory service settings
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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.
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Community health centers
Multiple clinics offering comprehensive services
Family planning clinics or a well-child clinics
Day care centers, such as those for physically disabled or
emotionally disturbed adults
Offices (for example, a community health nurse associated with
a health maintenance organization sees clients in the office and
undertakes screening, referrals, counseling, health education,
and group work.
Ambulatory service settings cont
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Independent nursing agencies that practice by
seeing clients in community nursing centers as
well as making home visits.
Another type of ambulatory service setting
includes places where services are offered to
selected groups.
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community health nurses practice in migrant
camps,
through churches as parish nurses,
in remote mountain and coal-mining communities.
Schools
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Schools of all levels make up a major group of settings for
community health nursing practice.
Nurses from community health nursing agencies frequently
serve private schools at elementary and intermediate
levels.
Public schools are served by the same agencies or by
community health nurses hired through the public school
system.
The community health nurse may work with groups of
students in preschool settings as well as in vocational or
technical schools, junior colleges, and college and
university settings.
Specialized schools, such as those for the developmentally
disabled, are another setting for community health nursing
practice.
Occupational Health Settings
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Business and industry provide another group of settings
for community health nursing practice.
Community health nurses in occupational health settings
practice a variety of roles:
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The clinician role was primary for many years, as nurses
continued to care for sick or injured employees at work.
However, recognition of the need to protect employees’ safety
and, later, to prevent their illness led to the inclusion of health
education in the occupational health nurse role.
Occupational health nurses also act as employee advocates,
assuring appropriate job assignments for workers and adequate
treatment for job-related illness or injury.
Residential Institutions
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Any facility where clients reside can be a setting
in which community health nursing is practiced.
Residential institutions can include
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a halfway house in which clients live temporarily
while recovering from drug addiction,
an inpatient hospice program in which terminally ill
clients live.
Some residential settings, such as hospitals,
exist solely to provide health care;
others provide other services and support.
Residential Institutions cont
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A continuing care centers:
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In this setting, residents usually are elderly; some
live quite independently, whereas others become
increasingly more dependent and have many
chronic health problems.
The community health nurse functions as
advocate and collaborator to improve
services.
Residential Institutions cont
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Residential institutions provide unique
settings for the community health nurse to
practice health promotion.
Clients are a “captive” audience whose
needs can be readily assessed and whose
interests can be stimulated.
These settings offer the opportunity to
generate an environment of caring and
optimal-quality health care provided by
community health nursing services.
Parishes
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Parish nursing finds its beginnings in an ancient
tradition.
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In parish nursing today, the practice focal point remains
the faith community and the religious belief system
provided by the philosophical framework
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Parish nursing may take different names, such as:
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church-based health promotion (CBHP),
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faith community nursing, or
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primary care parish nursing practice (PCPNP).
Parish nursing
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Involves a large-scale effort by the church
community to improve the health of its
members through education, screening,
referral, treatment, and group support.
Community at Large
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Unlike the six settings already discussed, the
seventh setting for community health nursing
practice is not confined to a specific
philosophy, location, or building. When
working with groups, populations, or the total
community, the nurse may practice in many
different places.
Community at Large
For example,
 A community health nurse, as clinician and health
educator, may work with a parenting group in a church
or town hall.
 Another nurse, as client advocate, leader, and
researcher, may study the health needs of a
neighborhood’s elderly population by collecting data
throughout the area and meeting with resource people
in many places.
 A nurse may work with community-based organizations
such as an AIDS organization or a support group for
parents experiencing the violent death of a child.
Tasks for practical
1.
2.
Search the Internet or go to the library and find two
sources of health-related information for consumers.
Was the information accurate?
Search the Internet or go to the library and find two
research articles on community health nursing. In what
settings did the research take place? Did the nursing
authors collaborate with interdisciplinary team
members on this research? If so, how do you think this
collaboration helped the research? If you were to
conduct research in the community, would you conduct
it with only nurses on the team, or would your team be
interdisciplinary? Why? What would be the benefits or
limits of each approach?