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Families and Community/

Public Health Nursing

COMMUNITY/PUBLIC HEALTH NURSING


Community/public health nurses care for families in a
variety of settings, such as in their homes, schools,
clinics, adult day care or retirement centers,
correctional facilities, under bridges, or in temporary
housing during transitional or recovery programs.
Acute care typically expects nurses to focus care
with a biomedical orientation, whereas in family
nursing, as in other areas of community nursing
practice, nurses shift the focus of their care back and
forth between holistic and biomedical depending on
context.

THEORY AND CONCEPTS


Public health nurses integrate community
involvement and knowledge about the entire
population with personal, clinical
understandings of the health and illness
experiences of individuals and families within
the population.
Community/public health nurses are engaged in
the core public health functions of assessment,
assurance, and policy development.

Assessment is facilitated by the trust that public


health nurses have earned from their clients,
agencies, and private providers, trust that
provides ready access to populations that are
otherwise difficult to access and engage in health
care.
Assurance activities are the direct individual
focused services that public health nurses have
provided over the past several years.
Policy development at the family level relies on
data collected from individuals, families, and
communities.

FAMILY CAREGIVING MODEL FOR PUBLIC


HEALTH NURSING
This model addresses both views of the family as the
client within the community and the family as a part
of the community client.
At any level or in any setting, the role of the
community/public health nurse is targeted toward
promotion and maintenance of health, and prevention
of illness, disability, or injury.
Community/public health nurses must remain current
on social and political policies as they assist members
of the community to voice their needs and concerns.

FAMILY
CAREGIVING
MODEL
FOR PUBLIC
The first
three competencies
establish
the foundation for
HEALTH
NURSING(1) locating the family, (2) building trust,
family caregiving:
and (3) building strength.
After laying this foundation, community nurses use eight
encouraging self-help competencies when working with
families:
Being available
Mobilizing resources
Collaborating with other professionals
Resolving problems
Working through emotions
Fostering family understanding
Teaching
Persuading

The way community and public health


nurses work with families
The complexity of nursing care based on family as client
in community/public health nursing. Two key issues that
contribute to this complexity are: (1) labeling family health
problems, and (2) identifying the level of need of the family
as a whole.
When working with families, nurses need to consider
environmental, psychological, and behavioral health issues,
as well as those of a more physiologic nature. In addition,
Kaiser and colleagues suggest that providing family-focused
nursing care in the community requires a very different set
of skills from those required in acute care nursing.

FAMILY NURSING ROLES IN THE


COMMUNITY
Research shows the effectiveness of familycentered care and the effectiveness of
community/public health nursing home
visitation.
Specifically, it helps nurses to understand the
critical nature of fostering care for families on
the marginthat is, those without human or
financial resources that allow for true
integration into communities.

Assessment is facilitated by the trust that public


health nurses have earned from their clients,
agencies, and private providers, trust that
provides ready access to populations that are
otherwise difficult to access and engage in
health care.
Assurance activities are the direct individual
focused services that public health nurses have
provided over the past several years. Provision of
these services was due, in large part, to
programmatic funding and Medicaid
reimbursement that focused on the individual
rather than population-focused services.

Cultural Competence

For providers without language competencies,


this creates challenges to developing good
communication, a prerequisite to trust.
It is the professional responsibility of nurses to
ensure that families understand what is going
on in the meeting, either through an interpreter
or other means.

Nurse-Client Relationship in the Community


In fact, the early phase of home visiting programs is
based on the development of trust through helping
clients identify problems, engaging in mutual
problem solving, making decisions about necessary
health services, and adopting health-promoting
behaviors.
Zerwekh (1992) claims that this trust-building phase
is crucial to the success of longer term intervention
programs because the efficacy of home visiting
programs seems to be greater in longer-term,
relationship based home visiting programs than in
shorter term interventions.

Health Appraisal and Education in


Community Settings Outside of the Home
Community nursing centers: Family-focused
services that might be provided at community
nursing centers include health-promotion and
disease prevention interventions, such as health
screening, education, and well-child care.
Public health departments: Center-based
services for families is that used by county and
state departments of health services.

Education in the Home and in


Community Settings Outside the Home
Education is essential to the promotion of health
and the prevention of disease in families.
The four determinants of health include: (1)
environment (including socioeconomic status),
(2) social/lifestyle, (3) biology, and (4) health
care.
Community health nurses use a variety of
strategies to modify risky lifestyles identified in
the health appraisal.

Access to Resources
A major health-promotion strategy is to ensure
access to health promotion and prevention
services, including immunizations, family
planning, prenatal care, well-child care,
nutrition, exercise classes, and dental hygiene.
These services may be provided directly by
community health nurses in the home or in
clinics, schools, or work settings.
In some cases, community health nurses
facilitate access to these services through
referrals, case management, discharge planning,
advocacy, coordination, and collaboration.

SUMMARY

Community/public health nursing of families is a


rewarding experience for nursing students and
experienced nurses alike. For the student, caring for
families in a variety of community settings offers an
opportunity to assess change over time, which is not
possible in many other clinical settings. Community
health nurses forge strong nurse-client partnerships as
they maneuver through the maze of interventions and
resources in providing family-centered nursing.

Community/public health nurses are concerned with the


health of families and the ways in which family health
influences the health of communities. The settings in which
community/public health nurses work with families vary and
include, but are not limited to, public and private health
agencies, schools, and occupational sites. Community/public
health nursing roles vary according to whether the nurse is
focusing on the family as the unit of care in the context of the
community, or focusing on the
health of the community with families being a subunit.
Students working with experienced family nurses in a variety
of communities develop the skills necessary to provide
family-level care and experience the satisfaction of making a
difference to families. that they may come to know very well.
The following case study demonstrates the highly developed
skills of community health nurses.