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Chamberlain University
NR-442 Community Health Nursing
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Community health nursing takes a population-focused approach, encompassing planning, implementation, and evaluation of care across various settings for individuals throughout their lifespans, regardless of diverse backgrounds. The primary goal is to protect community health by emphasizing health promotion and maintenance for individuals, families, and groups. Unlike traditional healthcare models that focus on episodic illness care, community health nursing emphasizes proactive identification of at-risk populations and the promotion of general well-being. The health status of communities across the United States varies significantly due to unequal access to preventive services and socio-economic disparities. As defined by the World Health Organization, health is a state of complete physical, mental, and social well-being, rather than merely the absence of illness (Nies & McEwen, 2019).
The scope of public health is broad, encompassing factors such as living conditions, environmental sanitation, personal hygiene education, preventive care, policy development, and control of communicable diseases. Heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries are the leading causes of premature death in the United States. Health, according to WHO, depends on the collective goals of individuals, families, and societies working together to prevent illness and promote well-being (Nies & McEwen, 2019). Public health protects and enhances community health through education, research, and disease prevention, ensuring an organized, community-driven effort to promote healthy lifestyles and prevent the spread of diseases (Centers for Disease Control and Prevention, 2020).
Community and public health nursing can trace its roots back to Florence Nightingale, who used statistical methods and community assessments to address health issues. Nightingale’s pioneering work laid the foundation for the development of district nursing in England and later influenced public health models in the United States (Nies & McEwen, 2019). Social determinants of health, including access to healthcare, socioeconomic status, environmental factors, and cultural practices, continue to play a crucial role in community health nursing. Nurses must understand these determinants to deliver effective, equitable care.
Table
| Components of Public Health | Determinants of Health | Healthy People 2030 Goals |
|---|---|---|
| – Living conditions | – Individual Determinants: age, gender, diet, physical activity | – Attain high-quality, longer lives free of preventable diseases, disability, injury & premature death |
| – Environmental sanitation | – Social Determinants: socioeconomic conditions, public safety | – Achieve health equity, eliminate disparities, and improve the health of all groups |
| – Personal hygiene education | – Economic and Cultural Conditions: education, work environment | – Create social and physical environments that promote good health for all |
| – Preventative care | – Health Services: lack of available healthcare, high costs | – Promote quality of life, healthy development, and healthy behaviors across all life stages |
| – Policy development | – Policy: local, state, and federal levels | |
| – Control of communicable infections |
Community health nursing is a population-focused approach aimed at planning, implementing, and evaluating care for individuals across various settings and from diverse backgrounds. The primary goal of community health nursing is to preserve the health of the community by emphasizing health promotion and maintenance for individuals, families, and groups within the community. This approach shifts the focus from illness and episodic care to identifying at-risk populations and fostering overall health. The health status of populations in the United States significantly varies, revealing a disparity in preventive services and social opportunities. Health is defined as a state of complete physical, mental, and social well-being, while a community is seen as a group of individuals sharing a geographic location, common interests, and values. In contrast, a population refers to a group of people with common personal or environmental characteristics.
Public health plays a crucial role in community health nursing, encompassing factors like living conditions, environmental sanitation, personal hygiene, and preventive care. Public health also includes policy development and the control of communicable infections. The leading causes of premature death in adults in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. As defined by the World Health Organization (WHO), health is more than the absence of disease—it is a state of complete physical, mental, and social well-being. Social health, a critical component of this definition, highlights the strength of communities in collaborating to promote health and prevent illness. Public health focuses on protecting and improving the health of communities through organized efforts, such as health promotion, disease prevention, and responding to infectious diseases (Nies & McEwen, 2019).
Public health involves a broad scope of activities aimed at improving the health of communities, such as promoting healthy lifestyles through education, researching disease and injury prevention, and responding to illnesses. A community consists of individuals sharing geographic locations or common values, while a population refers to a group of people with shared personal or environmental characteristics. Aggregates are subpopulations within a community that share similar characteristics or concerns. The Centers for Disease Control and Prevention (CDC) defines public health as an organized effort to improve community health through prevention, education, and policy recommendations (CDC, 2020).
The origins of community and public health nursing can be traced to Florence Nightingale, who used a community assessment to implement statistical methods to meet the needs of the population. Nightingale’s approach was innovative, considering the formal establishment of public health nursing did not occur until the late 19th and early 20th centuries (Nies & McEwen, 2019). Early public health nursing was based on district nursing in England, where care was delivered to disadvantaged families. In the United States, public health nursing developed from this model, addressing the social determinants of health such as access to care, socioeconomic status, and cultural practices.
The health status of a community is influenced by individual, social, economic, and cultural determinants, as well as healthcare services and policy. Nurses must understand these determinants to recognize how they affect disease, death, and disability. According to the CDC, approximately one million Americans die prematurely each year from the five leading causes of death, yet 40% of these deaths could be prevented. Many of these deaths are attributable to modifiable risk factors, and reducing health disparities would help lower mortality rates (CDC, 2014). Social determinants like income, education, and environment play a significant role in shaping health outcomes.
Public health is a holistic practice that focuses on preventing disease, promoting health, and ensuring efficient healthcare systems. Community health nurses are involved in assessing population health, diagnosing health issues, and addressing health hazards. They contribute to policy development and ensure equitable access to care by building a skilled workforce and supporting public health infrastructure. The overall goals of Healthy People 2030 are aligned with these objectives, focusing on improving health equity, promoting quality of life, and preventing premature death (Office of Disease Prevention and Health Promotion, n.d.).
Prevention plays a crucial role in community health nursing and is categorized into three levels: primary, secondary, and tertiary prevention. Primary prevention focuses on preventing problems before they occur, such as administering immunizations and promoting general health. Secondary prevention involves early detection and intervention, such as screening for sexually transmitted infections. Tertiary prevention aims at correcting or preventing the deterioration of diseases, such as teaching diabetic patients to administer insulin. Community health nurses work with individuals, families, and groups to ensure equitable healthcare delivery across these prevention levels.
| Component | Description | Examples |
|---|---|---|
| Public Health Components | Addresses factors like living conditions, environmental sanitation, personal hygiene, and policy development. | Health promotion, communicable disease control, policy initiatives |
| Determinants of Health | Involves individual, social, and environmental factors that impact the health of populations. | Age, income, education, healthcare access, community infrastructure |
| Prevention Levels | Primary, secondary, and tertiary prevention strategies are used to prevent, detect, and manage diseases across populations. | Immunizations, disease screenings, chronic disease management |
Community health is a specialty that emphasizes health promotion and disease prevention, particularly for subpopulations. When comparing population health with community health, the main distinction lies in their scope. Community health focuses on smaller populations within a defined geographic area, whereas population health addresses specific populations regardless of their geographic location. Despite these differences, both fields employ a scientific approach to health delivery, assessing the epidemiology of a health issue and considering broad determinants of health, including all levels of prevention.
Collaboration, defined as two or more individuals or organizations working toward a common goal, is essential for enhancing the capacity to promote and protect health. Coalition-building creates alliances among organizations with shared objectives, while delegated functions involve the execution of direct care tasks authorized by health practitioners. Outreach locates at-risk populations, providing information on the issue at hand, available interventions, and how services can be accessed.
Primary prevention entails health promotion and specific protective measures designed to prevent diseases or disabilities before they occur. It emphasizes keeping healthy individuals in good health through actions like vaccination, wearing seatbelts, and using helmets. Secondary prevention focuses on early disease detection, such as screenings for elevated cholesterol or vision and hearing checks, while tertiary prevention aims to minimize complications from an existing disease. Examples of tertiary prevention include cardiac rehabilitation and palliative care.
Population health integrates public health efforts with healthcare systems and organizations, promoting a collaborative approach that seeks to improve health outcomes on a larger scale. This interdisciplinary effort shifts the focus from episodic care to the management of specific populations, prioritizing preventive and primary care to maintain health, improve quality, and lower healthcare costs (Ariosto et al., 2018). Unlike acute care, which addresses immediate symptoms and diagnoses, population health examines the broader determinants of health, including individual, social, and environmental factors, along with available health services and policies.
Nurses specializing in population health prioritize aggregate outcomes, emphasizing prevention at the primary, secondary, and tertiary levels. Population health initiatives can occur in public health or clinical settings, with interventions targeting individuals, families, systems, and communities based on the population’s health status. Key determinants of health in population health include individual characteristics (e.g., age, gender, diet), social determinants (e.g., socioeconomic status, education), general socioeconomic conditions, healthcare services, and policies at various governmental levels.
Population health is underpinned by three primary pillars: clinical healthcare, public health, and public policy. Clinical healthcare delivers direct patient care, while public health addresses community-wide health concerns, such as disease prevention and environmental hazards. Public policy influences both health-related and non-health-related issues that ultimately affect health outcomes. For instance, policies promoting education, affordable housing, and transportation can contribute to better health at both individual and community levels. These pillars require a systems-oriented approach, with leadership and intersectoral collaboration being vital for effective population health initiatives.
In 2013, the Institute of Medicine (IOM) highlighted disparities in health outcomes in the United States compared to other developed nations, despite higher healthcare spending. Factors contributing to these disparities include chronic diseases, socio-economic conditions, and environments that encourage sedentary lifestyles. Health indicators where the U.S. ranks poorly include infant mortality, obesity, and heart disease, among others.
Globally, health organizations such as the World Health Organization (WHO) have established Sustainable Development Goals (SDGs) to address key health determinants. These goals, introduced in 2000 as the Millennium Development Goals and updated in 2015 as the SDGs, aim to eradicate poverty and hunger, promote education and equality, reduce mortality, and improve access to healthcare resources. The efforts outlined by the WHO align with U.S. initiatives to address health disparities and promote population health through collaborative, global approaches.
The Robert Wood Johnson Foundation’s support of population-focused practice emphasizes the role of community health nurses in improving health outcomes. Four key areas of knowledge and skills are critical for sustaining population health nursing: practice, research, education, and policy development. The levels of prevention model, which includes primary, secondary, and tertiary prevention, remains a fundamental framework for these practices.
The Public Health Intervention Wheel, developed by the Minnesota Department of Health in 1998, offers a structured approach to population health interventions. The model spans individual, community, and societal levels, with strategies such as surveillance, disease investigation, outreach, screening, and policy development, among others.
Epidemiology serves as the backbone of population health by studying the distribution and determinants of health-related states in populations. Through scientific data collection, analysis, and evaluation, epidemiology informs public health policy and directs interventions. The six core functions of epidemiology—surveillance, field investigation, analytic studies, evaluation, linkages, and policy development—guide population-specific care.
Primary prevention, which includes health education, is a central element of the Public Health Intervention Wheel. Epidemiological data supports surveillance and screening activities for disease prevention, while counseling enhances individuals’ ability to cope with health issues.
| Aspect | Community Health | Population Health |
|---|---|---|
| Focus | Small populations in specific geographic areas | Specific populations, regardless of geographic location |
| Scope of Interventions | Localized and community-specific interventions | Broader, systemic interventions aimed at larger populations |
| Determinants of Health | Local social, environmental, and healthcare factors | Wide-ranging determinants including socioeconomic, policy, and healthcare factors |
| Prevention Levels | Emphasis on primary and secondary prevention | Emphasis on all three levels of prevention |
One of the core functions of epidemiology is its contribution to public policy, especially in relation to the prevention and control of diseases and regulations concerning disease surveillance. The epidemiology function that encompasses the ongoing collection, interpretation, and dissemination of health data is surveillance. Surveillance plays a critical role in identifying health needs and guiding action steps to address those needs. Field investigations, often conducted by the public health system, involve an active, hands-on approach within communities to gather detailed information about individuals exposed to disease, clinical progression, risk factors, and other relevant factors. The aim is to determine the etiology of the disease and implement measures to prevent its spread. Epidemiologists also play a key role in evaluating public health interventions and services, contributing to better health outcomes.
In addition, interdisciplinary approaches, such as linkages between different health sectors, are essential for effective disease management. For example, a population health nurse might notice an increase in childhood obesity in a local community. From a population health perspective, the nurse would investigate individual factors such as genetics, dietary choices, physical activity levels, and parental work schedules. While age and gender are not directly linked to obesity, other modifiable factors can be addressed through interventions such as educating families on healthy food choices, parental involvement, and screening for genetic predispositions. Community-level environmental factors also play a role in childhood obesity, including the availability of healthy food options and access to physical education in schools. Legal and policy measures, such as food labeling laws or taxes on unhealthy foods, can also influence community health outcomes. Schools can further reduce obesity rates by implementing strategies such as limiting access to vending machines, providing recess breaks, and establishing food programs to support children from low-income households.
Tertiary prevention strategies for school-aged children diagnosed with obesity involve managing the disease and preventing its progression. This may include continuous dietary education and regular screening for related conditions such as hyperlipidemia. It is important to measure and monitor children’s body mass index (BMI) more frequently than every two years. Evaluating the effectiveness of obesity prevention programs requires examining data points such as average BMI, physical education class participation, and the availability of healthy food options in school cafeterias. Parental education levels, while important, are not easily modifiable factors in addressing childhood obesity rates.
In cases of foodborne illness outbreaks, such as salmonella, the pillars of community health play a crucial role in managing and preventing future outbreaks. Clinical healthcare providers diagnose and treat individual cases, while public health systems offer disease investigation, ongoing surveillance, and contact tracing. Epidemiologists identify the source of the outbreak and work to control it, with the goal of preventing recurrence. Public policy can also influence food safety regulations, further reducing the risk of future outbreaks.
Community health nurses conduct comprehensive assessments to identify health risks and promote wellness. These assessments can focus on various groups that constitute a community, such as those who live in the same geographic area, attend the same church, or share a common health trait. Community assessments often begin with windshield surveys, where nurses drive or walk through neighborhoods to gather data about the environment. Additional data collection methods include interviews with key informants, community forums, and the analysis of secondary data like census reports. After collecting and analyzing the data, nurses diagnose the health needs of the community, plan and implement interventions, and evaluate the outcomes.
Windshield surveys help nurses identify key social, economic, and environmental conditions affecting the community’s health. For example, observations may reveal evidence of substance use or homelessness, indicators of economic hardship, or the presence of health resources such as hospitals and clinics. Additionally, census data and vital statistics provide valuable demographic and socioeconomic information. Secondary data is particularly useful for assessing public health issues such as low birth weight or the prevalence of diabetes.
The nursing process in community health involves defining the community, collecting and analyzing data, formulating diagnoses, and planning and implementing interventions. It is also essential to prioritize identified health problems before proceeding with the development of community health programs. Nurses must collaborate with community members and leaders to create sustainable health solutions. By using comprehensive assessments, nurses ensure that interventions are appropriately targeted and that health disparities are addressed in a meaningful way.
| Core Function | Explanation | Example/Interventions |
|---|---|---|
| Surveillance | Ongoing collection, interpretation, and dissemination of health data to identify needs and direct actions. | Regular monitoring of disease trends to inform public health interventions. |
| Field Investigation | Conducted by public health systems to gather detailed information on disease exposures and characteristics. | “Feet on the ground” approach to investigate outbreaks, track exposures, and determine the etiology of diseases. |
| Evaluation | Assessing public health interventions and services to determine their effectiveness. | Evaluating the outcomes of vaccination programs or disease prevention initiatives. |
| Individual Causes of Obesity | Interventions |
|---|---|
| Genetic influences, food choices, physical activity levels, parental work schedules. | Educating families on healthy food choices, promoting physical activity, and screening for genetic predispositions. |
| Community Factors Influencing Obesity | Interventions |
|---|---|
| Availability of healthy food, physical education in schools, legal regulations on food. | Limiting access to vending machines, providing recess breaks, and implementing food programs for low-income children. |
| Primary Prevention | Secondary Prevention | Tertiary Prevention |
|---|---|---|
| Routine water maintenance and treatment | Mammogram screening for clients with family history of cancer | Ongoing dietary education for children diagnosed with obesity and regular BMI monitoring. |
Authoritative sources for this text should include:
Centers for Disease Control and Prevention (CDC). (n.d.). Epidemiology and Public Health. Available at: https://www.cdc.gov.
American Public Health Association (APHA). (2020). Obesity Prevention Strategies. Retrieved from https://www.apha.org.
World Health Organization (WHO). (2021). Foodborne Disease Surveillance and Control. Available at: https://www.who.int.
Ariosto, D., Billioux, A., & Conway, P. (2018). Population health: A guide for healthcare organizations and providers. New England Journal of Medicine, 379(11), 1055-1062.
Centers for Disease Control and Prevention (CDC). (2020). Population health: Improving health outcomes and reducing healthcare costs. CDC Report.
Institute of Medicine (IOM). (2013). U.S. health in international perspective: Shorter lives, poorer health. The National Academies Press.
Minnesota Department of Health Division of Community Health Services Public Health Nursing Section. (2001). Public Health Intervention Wheel.
Centers for Disease Control and Prevention. (2014). The leading causes of death in the United States. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Centers for Disease Control and Prevention. (2020). Public health and community nursing. Retrieved from https://www.cdc.gov/publichealth/nursing.htm
Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). Elsevier.
Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030 framework. Retrieved from https://www.healthypeople.gov/2030
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