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The Role Of Community Health Nursing And Public Health Nursing

The Role of Community Health Nursing and Public Health Nursing

The American Nurses Association (ANA), the Association of Community Health Nurse Educators (ACHNE), the American Public Health Association (APHA), and the Association of State and Territorial District Nurses (ASTDN) constitute the “Quad Council.” This information is important because the Quad Council defines the scope and standards of practice— and thus the definitions—for both CH and PH nursing.

Community health (CH) nursing practice synthesizes information from both public health theory and nursing theory. Its goal is to promote, preserve, and maintain the health of populations through the delivery of personal health services to individuals, families, and groups. The focus is to improve the health of the community as a whole by improving the health status of the individuals, families, and groups who reside in the community. CH nurses work in home health, hospice, and community-based clinics.

Public health (PH) nursing is a subset of CH nursing. In developing the PH nursing competencies, the Quad Council members concurred that the generalist level of public health nursing would reflect preparation at the baccalaureate level; the specialist would require a master’s-prepared nurse. Although PH nursing also synthesizes nursing and PH theories, its focus is on health promotion and health preservation at the population level. Population is defined as a collection of individuals who share one or more environmental or personal characteristics. Many times in PH, the term population is used interchangeably with the term aggregate. This specialty area looks at the community and the effects of the community’s health status, including access to healthcare resources, on the health of individuals, families, and groups. The goal is the prevention of disease and disability and the promotion and protection of the community as a whole. Examples of where PH nurses work include the U.S. Indian Health Service (IHS), the Bureau of Prisons (BoP), the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH).

The Commission Corp

The Commissioned Corp is a unique organization of healthcare professionals and is one of the seven uniformed services of the United States. It is headed by the Surgeon General of the United States. The mission of the Commissioned Corp is stated as follows: “The Mission of the Commissioned Corps of the U.S. Public Health Service is protecting, promoting, and advancing the health and safety of the Nation” (U.S. Department of Health and Human Services, 2007, para. 1).

Its role is defined as thus: “As America’s uniformed service of public health professionals, the Commissioned corps achieves this mission through rapid and effective response to public health needs, leadership and excellence in public health practices, and the advancement of public health science”(U.S. Department of Health and Human Services, 2007, para. 2).

The U.S. Public Health Service’s commissioned officers serve in some of the most medically underserved communities in the country. In addition to providing essential primary care to people in need, they work as members of a mobile team of health professionals who are trained to respond quickly and effectively in the event of a large-scale regional or national medical emergency.

Community-Based versus Community-Oriented Practice

Community-based nursing practice is setting specific: that is, care is provided where clients live, work, and attend school. The clinical emphasis is both acute and chronic care, with the goal of providing comprehensive, coordinated, and continuous health services. Nurses who work in community-based settings can either be generalists or specialists in such areas as maternal/infant, pediatric, adult, or psychiatric health nursing.

Community-oriented nursing practice is a philosophy of nursing practice. It applies to both generalists and specialists in CH and PH. Care is provided through an investigation of major health and environmental problems, health surveillance, and the monitoring and evaluation of community and populations. The goal is the prevention of disease and disability and the promotion, protection, and maintenance of health.

Levels of prevention are central to CH and apply to both of the above concepts. Table 1 defines the 3 levels of prevention.

Table 1: Levels of Prevention

     

    Level

Definition

Example

Primary

Actions taken to prevent the development of disease in a person who is healthy and does not have the disease. These interventions occur at the pre-pathological level.

Teaching kindergarten children who have no respiratory problems the reasons they should not smoke.

Secondary

Screening, diagnosing, and treating a disease that is at the pathological level.

Community-based blood pressure screening program.

Tertiary

Actions taken to limit the disability or restore function caused by the pathological state.

Rehabilitation care after a stroke.


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