Roles and Functions of the Community and Public Health Nurse

1. Roles and Functions of the Community and Public Health Nurse

2. Upon mastery of this chapter, you should be able to: • ● Identify the three core public health functions basic to communityhealth nursing. • ● Describe and differentiate among seven different roles of thecommunity health nurse. • ● Discuss the seven roles within the framework of public healthnursing functions. • ● Explain the importance of each role for influencing people’s health. • ● Identify and discuss factors that affect a nurse’s selection andpractice of each role. • ● Describe seven settings in which community health nursespractice. • ● Discuss the nature of community health nursing, and the commonthreads basic to its practice, woven throughout all roles andsettings. • ● Identify principles of sound nursing practice in the community.

3. Threeprimary functions of public health • The various roles and settings for practice hinge onthree primary functions of public health: • assessment, • policydevelopment, • and assurance. • They are foundational to allroles assumed by the community health nurse and are appliedat three levels of service: • to individuals, • to families, • and tocommunities

5. Assessment • An essential first function in public health • the community health nurse must gather and analyzeinformation that will affect the health of the people tobe serve: • health needs, • health risks, • environmental conditions, • political agendas, • and financial and other resources

6. Policy Development • is enhanced bythe synthesis and analysis of information obtained during assessment. • At the community level, the nurse provides leadershipin convening and facilitating community groups toevaluate health concerns and develop a plan to address theconcerns. • Typically, the nurse recommends specific trainingand programs to meet identified health needs of target populations.

7. Assurance • Assurance activities—activities that make certain that servicesare provided—often consume most of the communityhealth nurse’s time. • Communityhealth nurses perform the assurance function at the communitylevel when they • provide service to target populations, • improve quality assurance activities, • and maintain safe levelsof communicable disease surveillance and outbreak control.

8. Standards for Community Nursing • Individuals should receive nursing services based onstandards developed by the American Nurses Association(ANA), such as: • the Code for Nurses With Interpretive Statements(1985), • Nursing’s Social Policy Statement (1995), • Standards of Clinical Nursing Practice (2nd edition) (1998a), • The Scope and Standards of Public Health NursingPractice (1999).

9. Clinician Role • The most familiar role of the community health nurse is that ofclinician or care provider; • means that the nurseensures that health services are provided not just to individualsand families, but also to groups and populations. • Three clinician emphases, in particular, are useful toconsider here: • holism, • health promotion, • and skill expansion.

10. Holistic Practice • In communityhealth a holistic approach means consideringthe broad range of interacting needs that affect the collectivehealth of the “client” as a larger system • Holistic nursing care encompassesthe comprehensive and total care of the client in allareas, such as physical, emotional, social, spiritual, and economic.

11. Healthpromotion • The clinician role in community health also is characterizedby its focus on promoting wellness. • Examples include immunization ofpreschoolers, family planning programs, cholesterol screening,and prevention of behavioral problems in adolescents. • Protecting and promoting the health of vulnerable populationsis an important component of the clinician role

12. Expanded Skills • With time,skills in observation, listening, communication, and counselingbecame integral to the clinician role as it grew to encompassan increased emphasis on psychological and socioculturalfactors. • Recently, environmental and community-wide considerations, such as problems caused by: • pollution, • Violenceand crime, • drug abuse, • unemployment, poverty, homelessness, • and limited funding for health programs • have createda need for stronger skills in assessing the needs of groups andpopulations and intervening at the community level.

13. Role of the Public Health Nurse • To: Provide input to interdisciplinary programs that monitor, anticipate and respond to health problems in population groups for all diseases or public health threats including bioterrorism • To: Evaluate health trends and risk factors of population groups to help determine priorities forming targeted interventions

14. Role of the Public Health Nurse • To: • Work with the community or specific population groups to develop targeted health promotion and disease prevention activities • To: Evaluate health care services • To: Provide health education, care, management and primary care to individuals and families who are members of vulnerable populations and high risk groups

15. Public health nurses integrate community involvement and knowledge of the entire population with the personal clinical understandings of health and illness gleaned from the experiences of individuals and families within the population.

16. The nurse working in public health should be a voice for members of the community to voice problems and desires

17. The public health nurse can apply her knowledge of strategies to choose the intervention(s) that meets the needs of a particular community, family or individual

18. The nurse is the agent who translates and applies the knowledge of health and social sciences to individuals and population groups through specific interventions, programs and advocacy

19. He or she also articulates and translates health and illness experiences of diverse, often vulnerable, individuals and families to the health planners and policy makers

20. Standards of practice have been established by the American Nurses Association

21. The Quad Council, made up of four public health nursing organizations, has established core competencies

22. These competencies reflect an agreement by the Quad Council that the public health nurse requires preparation at the baccalaureate level.

23. However, in many states nurses doing public health work are not baccalaureate graduates.

24. Even early on, the shortage of nurses affected the hiring of BSN or MSN prepared nurses. Public health departments could not compete with hospital systems.

25. The specialist level competencies require preparation at the Master’s level in community and /or public health nursing.