Community health nursing is a population-focused, community-orientedapproach aimed at health promotion of an entire population, and prevention ofdisease, disability and

premature death in a population. Unique to communityhealth nursing is the opportunity for nurses to learn and develop partnershipskills with all stakeholders and key actors in their communities. The experienceof community health nurses heightens communication and leadership skills andallows for creativity in solving community health problems. In cooperation withother disciplines, community nurses are expected to have greater professionalautonomy to provide ethical and legal nursing care services in differentcommunity settings, such as schools, homes and health centres.

All community health services and care activities carried out respond to the needs, health problems and health risks, cultural way of living, resources, and preferences of the community. In a health-care system in transition, where currently the quality of service is emphasized, community health nursing represents a profession that responds to all categories of demands of the people. The roles and responsibilities of the community health nurse thus vary and differ according to the context of the health-care delivery system. The dynamic, complex and emerging environment of health care presents complex healthcare demands of the community that require different capabilities in todays community health nurses and health-care professionals.

. The primary goal of community health nursing is to help a community protect and preserve the health of its members, while the secondary goal is to promote self-care among individuals and families. I

The Community Health Nurse must be prepared to play amuch wider role than is offered by her work in hospitals. There ismuch greater element of decision, making. Management skills,administration of programmes, teaching and acting as a teamleader, as well as a member of the health team are all importantperhaps the most crucial requirement is that the nurse must beprepared to learn from the people, and share leadership with themwhen it is necessary and to plan with them. The functions of a community health nurse have been classified broadly under the following heads: 1. Administration. 2. Communication. 3.. Nursing. 4. Teaching. 5. Research. 1. Administration :The nurse is responsible for the dayto-day assignment of the nursing staff and supervision of thesepersonnal. She provides direction and leadership to those whomshe supervises. She is reasponsible for planning, implementationand evaluation of a practical plan of nursing administration with inthe primary health centre and its associated sub centres. 2. Communication :This involves ability to maintain goodworking relationship with members of the health team, related agencies and the community. She is a link between the patient, Thefamily and the doctor. She participates in the staff and communitymeetings. 3. Nursing :-

She provides comprehensive nursing careto individuals and families. This includes family care of the pregnant women, before, at the time of and after delivery, care of thenew born, the premature, the infant, toddler, the school child, nutrition and family planning. 4. Teaching :Knowledge and skills of methods of individuals and group teaching, preperation and use of simple teachingaids; training of dais and health workers ; participation in student training programmes 5. Research :- These is probably far more research relavant tonursing than nurses realise. A good deal of knowledge derived fromsociology and physchology is relevant to public health nursing, Viz.,infant feeding and weaning, mother and child relation ship nursingneeds and practices in the community, utilization of the existing nursingservices, job analysis of nursing personel in the team The four core functions of community health nursing practice are: (1) community social capital, including community culture, and identification of resources as key actors in the community healthcare system (2) assessment of community health conditions, health risks and problems to identify the health-care demands of the people (3) design and implementation of comprehensive community health interventions, care, services and programmes, and (4) health policies/agreements developed at the local community level to drive policies/agreements at the state and national levels for collaborative endeavours and actions.

The characteristics of community social capital are:

(1) focusing on human capacity in finding solutions for community health, which depends upon an individuals own missions, roles and functions (2) participation of stakeholders including the community to strengthen social ties and encourage appreciation of the value of human capacity building for community selfreliance (3) being sensitive to the existence and use of community networks, volunteers, groups engaged in community actions (4) being aware of people who are involved in finding community solutions (5) identifying social relationships among the community especially in health care, which creates mutual benefits (6) appearing trusting of, as opposed to fearing, others in the community (7) requiring timeless communication, on a day-to-day basis, with people in the social network.

Characteristics of the assessment process: (1) a participatory process among stakeholders to encourage information sharing and increase awareness on health risks and problems in the community (2) community health-care team building comprising representatives from the community or members of stakeholder organizations (3) conducting the assessment process concurrently with other functions through out the course of the community health-care interventions and programmes (4) identifying community peoples health- care demands (individuals, families, groups in the community), which lays a strong foundation for other functions

(5)

collecting

up-to-date

information,

representing

both

the

peoples

perspective/experiences and academic perspective.

(3) Comprehensive community health interventions, care, services, and programme design and implementation; This function targets the design and implementation of interventions, care, services and programmes that respond to the health-care demands of the people in the community in a culturally sensitive manner. This function ensures that necessary health care and services are available and accessible to all, especially underserved and vulnerable groups. It should be participatory in nature, especially with stakeholders who are involved in the provision of interventions, care, services and programmes; represent the interactive learning through action process of

stakeholders in designing and implementing the interventions, care, services and programmes; require two essential sets of knowledge: (1) the health-care demands evidently supported by four contributory factors; and 14 A framework for community health nursing education - solutions which may be practice guidelines, care models, practice modalities, services reform, effective programmes and interventions, etc. from the literature, best practice experiences, and research and development projects; critically select

interventions, care, services and programmes through consensus building of stakeholders to fit well with their roles and missions for community health care; be oriented towards the health outcomes of the entire community rather than service oriented. Examples of ways of designing and implementing community health interventions, care, services and programmes are care and service model

development, regular design and implementation of intervention, care, services and programmes, health-care initiatives, etc. (4) Development of health policies/agreements This function relies on critical analysis of the information and evidence gathered during the community health assessment. Development of local health policies or agreements requires at least three essentials. These are: (1) shared understanding of the nature of apparent health-care demands of the people, (2) identifying social capital and resources for possible solutions to meet the demands in health care, (3) knowledge about the roles and functions of each stakeholder to fulfill the missions and scope of work. Methods to carry out this function mostly use platforms to encourage conversation and communication among stakeholders. These include forums, conferences, seminars, and the like. Indicators of success are workable agreements or policies on community health care, especially at the local level. (1) belief in human capacity (2) participation of all stakeholders as team members, taking turns at being leaders (3) using area-based evidence and information to guide the process and actions (4) using actual activities and processes as the centre of functions (5) putting emphasis on outcome-oriented rather than serviceoriented programmes, and welcoming all possible means and solutions to achieve desirable outcomes.

Role and Functions of the Community Health Nurse

Community health nurses have always practiced in a wide variety of settings and assumed various roles. In this topic, the seven major roles and six of the most common settings for CHN practice are examined. The seven major roles are:

clinician educator advocate manager collaborator leader researcher

The role of the clinician or care provider is a familiar one for most people. In community health the clinician views clients in the context of larger systems. The family or group must be considered in totality. The community health nurse provides care along the entire range of the wellness-illness continuum; however, promotion of health and prevention of illness are emphasized. Skills in observation, listening, communication, counseling, and physical care are important for the community health nurse. Recent concerns for environment, sociocultural, psychological, and economic factors in community health have created a need for stronger skills in assessing the needs of populations at the community level.

One of the major functions of the community health nurse is that of health educator. As educators, nurses seek to facilitate client learning on a broad range of topics. They

may act as consultants to individuals or groups, hold formal classes, or share information informally with clients. Self-care concepts, techniques for preventing illness, and health promotion strategies are emphasized throughout the health teaching process.

Two underlying goals in client advocacy are described. One goal of the community health nurse as advocate is to help clients find out what services are available, which ones they are entitled to, and how to obtain these services. A second goal is to inf luence change and make the system more relevant and responsible to clients' needs. Four characteristics required for successful advocacy are:

assertiveness willingness to take risks good communication and negotiation skills ability to identify resources and obtain results

The manager's role is common to all nurses. Nurses serve as managers when they oversee client care, supervise ancillary staff, do case management, run clinics and conduct community health needs assessment projects. The nurse engages in four steps of the management process of planning, organizing, leading and controlling evaluation. Each of these functions is described in the text. Specific decision-making behaviors are part of the manager's role as well as human, conceptual and technical skills.

Collaboration with clients, other nurses, physicians, social workers, physical therapists, nutritionists, attorneys, secretaries, and other colleagues is part of the role of the community health nurse. Collaboration is defined as working jointly with ot hers in a common endeavor to cooperate as partners. Skills required for successful collaboration are 1) communication skills, 2) assertiveness, and 3) consultant skills.

The role of leader is distinguished from the role of manager. As a leader, the community health nurse directs, influences, or persuades others to effect change that will positively affect people's health. Acting as a change agent and influencing health planning at the local, state and national levels are elements of the role of the leader.

In the ro Planner/Programmer

1. Identifies needs, priorities, and problems of individuals, families, and communities 2. Formulates municipal health plan in the absence of a medical doctor 3. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 4. Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace 2. Develops the familys capability to take care of the sick, disabled, or dependent member

Community Organizer

1. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 2. Initiates and participates in community development activities

1. le of researcher, community health nurses engage in systematic investigation, collection, and analysis of date to enhance community health practice. (The research process is discussed in Chapters 12 and 24.) Research in community health may ran ge from simple inquiries to complex agency or organizational studies. Attributes of a nurse researcher include a questioning attitude, careful observation, open-mindedness, analytical skills, and tenacity. Participates in the conduct of survey studies and researches on nursing and health-related subjects 4Coordinates with government and non-government organization in the implementation of studies/research Coordinates with individuals, families, and groups for health related services provided by various members of the health teamCoordinates nursing program with other health programs like environmental sanitation, health education, dental health, and mental health Planner/Programmer

5. Identifies needs, priorities, and problems of individuals, families, and communities 6. Formulates municipal health plan in the absence of a medical doctor 7. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 8. Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

3. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace

4. Develops the familys capability to take care of the sick, disabled, or dependent member

Community Organizer

3. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 4. Initiates and participates in community development activities

Recorder/Reporter/Statistician

1. Prepares and submits required reports and records 2. Maintain adequate, accurate, and complete recording and reporting 3. Reviews, validates, consolidates, analyzes, and interprets all records and reports 4. Prepares statistical data/chart and other data presentation Change Agent

Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health

Trainer/Health Educator

1. Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots 2. Conducts training for RHMs and hilots on promotion and disease prevention 3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and health related services 4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes 5. Conducts pre-marital counseling Planner/Programmer

1.Identifies needs, priorities, and problems of individuals, families, and communities 2.Formulates municipal health plan in the absence of a medical doctor 3.Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 4.Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

1.Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace

2.Develops the familys capability to take care of the sick, disabled, or dependent member

Community Organizer

1.Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 2.Initiates and participates in community development activities