THEORIES IN COMMUNITY HEALTH NURSING PRACTICE

Prepared By: SUJATHA.J

INTRODUCTION

The concept of community is defined as "a group of people who share some important feature of their lives and use some common agencies and institutions.

The concept of health is defined as "a balanced state of well-being resulting from harmonious interactions of body, mind, and spirit.
The term community health is defined by meeting the needs of a community by identifying problems and managing interactions within the community

BASIC ELEMENTS

The six basic elements of nursing practice incorporated in community health programs and services are: (1) promotion of healthful living (2) prevention of health problems (3) treatment of disorders (4) rehabilitation (5) evaluation and (6) research.

MAJOR ROLES
The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles. The seven major roles of a community health nurse are: (1) care provider

(2) educator (3) advocate (4) manager (5) collaborator (6) leader, and

(7) researcher.

MAJOR SETTINGS

Settings for community health nursing can be grouped into six categories:
(1) homes (2) ambulatory care settings (3) schools (4) occupational health settings (5) residential institutions, and

(6) the community at large.

Community health nursing practice is not limited to a

THEORIES AND MODELS FOR COMMUNITY HEALTH NURSING

The commonly used theories are:

Nightingales theory of environment Orems Self care model Neumans health care system model Rogers model of the science and unitary man Penders health promotion model Roys adaptation model Milios Framework of prevention Salmon Whites Construct for Public health nursing Block and Jostens Ethical Theory of population focused nursing Canadian Model

NIGHTINGALES ENVIRONMENTAL THEORY

Concepts and Definitions: Environment concepts of ventilation, warmth, light, diet, cleanliness and noise. She focus on the physical aspect of environment. She believed that Healthy surroundings were necessary for proper nursing.

5 Essential components of Healthy environment

Pure air Pure water Efficient drainage Cleanliness Light

Concerns of Environmental Theory

Proper ventilation focus on the architectural aspect of the hospital. Light has quite as real and tangible effects to the body. Her nursing intervention includes direct exposure to sunlight. Cleanliness and sanitation. She assumes that dirty environment was the source of infection and rejected the germ theory. Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and hand washing.

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Warmth, quiet and adequate environment. She introduce the manipulation of the environment for patients adaptation such as fir, opening the windows and repositioning the room seasonally, etc. Unnecessary noise is not healthy for recuperating patients. Dietary intake. Petty management proposed the avoidance of psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital.

Importance of Environmental Theory

Practice: Disease control Sanitation and water treatment Utilized by modern architecture in the prevention of sick building syndrome applying the principles of ventilation and good lighting. Waste disposal Control of room temperature Noise management.

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Education: Principles of nursing training. Better practice result from better education. Skills measurement through licensing by the use of testing methods, the case studies. Research: Use of graphical representations like the polar diagrams. Notes on nursing.

Betty Neumans Theory

Betty neumans system model has 2 major components: stress and reaction to stress. The client in the neumans system model is viewed as an open system continuously become more differentiated and elaborate or complex. The system may adjust to the environment to itself. Exchange with the environment are reciprocal, both the client and the environment may be affected either positively or negatively by the other.

Concepts of Betty Neumans system model

Person variable Central core Flexible lines of defense Normal line of defense Lines of resistance Reconstitution Stressors Prevention

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Betty neuman defines total person model incorporating the holistic concept and an open system approach. Person is a dynamic composite of physiological, socio cultural and developmental variables that function as an open system. As an open system the person interacts with, adjust to and is adjusted by the environment, which is viewed as a stressor disrupt the system.

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Neumans model include intrapersonal, interpersonal and extra personal stressors. Intrapersonal stressors are forces occurring within the person; interpersonal stressors such as role expectations which occur between people & extra personal stressors such as financial circumstances, occur outside the person.

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Neuman believes in that nursing is concerned with the whole person. She used the term client for patient. The goal of nursing is to assist individuals, families, and groups. The nurse assesses, manages & evaluate client system. Nursing focus on the variables affecting the clients response to the stressor. Nursing actions are in primary, secondary & tertiary level of prevention.

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Primary prevention focuses on strengthening a line of defence through the identification of actual or potential risk factors associated with stressors. Secondary prevention strengthens internal defences and resources by establishing priorities and treatment plans for identified symptoms and tertiary prevention focus on readaptation. Tertiary prevention is to strengthen resistance to stressors through client education and to assist in preventing a recurrence of the stress response.

MILIOS FRAMEWORK OF PREVENTION

Nancy Milio a nurse and leader in public health policy and public health education developed a framework for prevention that includes concepts of community-oriented, population focused care(1976,1981). The basic treatise is that behavioral patterns of populations and individuals who make up populations are a result of habitual selection from limited choices. She challenged the common notion that a main determinant for unhealthful behavioral choice is lack of knowledge.

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Governmental and institutional policies, she said set the range of options for personal choice making. It neglected the role of community health nursing, examining the determinants of community health and attempting to influence those determinants through public policy.

SALMON WHITES CONSTRUCT FOR PUBLIC HEALTH NURSING

Mark Salmon White (1982) describes a public health as an organized societal effort to protect, promote and restore the health of people and public health nursing as focused on achieving and maintaining public health. He gave 3 practice priorities i.e:. 1. prevention of disease and poor health, 2. protection against disease and 3. external agents and promotion of health. For these 3 general categories of nursing intervention have also been put forward, they are:

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Education directed toward voluntary change in the attitude and behaviour of the subjects Engineering directed at managing risk-related variables

Enforcement directed at mandatory regulation to achieve better health

CONTINUE Scope of prevention spans individual, family, community and global care. Intervention target is in 4 categories: 1.Human/Biological 2. Environmental 3. Medical/technological/organizational

4. Social

BLOCK AND JOSTENS ETHICAL THEORY OF POPULATION FOCUSED NURSING

Derryl Block and Lavohn Josten, public health educators proposed this based on intersecting fields of public health and nursing. They have given 3 essential elements of population focused nursing that stem from these 3 fields: an obligation to population the primacy of prevention centrality of relationship- based care The first two are from public health and the third element from nursing. Hence it implies to nursing that relationbased care is very important in population focused care.

CANADIAN MODEL FOR COMMUNITY:

The community health nurse works with individuals, families, groups, communities, populations, systems and/or society, but at all times the health of the person or community is the focus and motivation from which nursing actions flow. The standards of practice are applied to practice in all settings where people live, work, learn, worship and play.

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The philosophical base and foundational values and beliefs that characterize community health nursing - caring, the principles of primary health care, multiple ways of knowing, individual/community partnerships and empowerment - are embedded in the standards and are reflected in the development and application of the community health nursing process.

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The community health nursing process involves the traditional nursing process components of assessment, planning, intervention and evaluation but is enhanced by community health nurses in three dimensions:

individual/community participation in each component

multiple ways of knowing, each of which is necessary to understand the complexity and diversity of nursing in the community; knowledge and utilization of all these ways of knowing forms evidence-based practice consistent with these standards, and

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The inherent influence of the broader environment on the individual/community that is the focus of care (e.g. the community will be affected by provincial/territorial policies, its own economic status and by the actions of its individual citizens). The standards of practice are founded on the values and beliefs of community health nurses, and utilization of the community health nursing process.

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The model illustrates the dynamic nature of community health nursing practice, embracing the present and projecting into the future. The values and beliefs (green or shaded) ground practice in the present yet guide the evolution of community health nursing practice over time. The community health nursing process provides the vehicle through which community health nurses work with people, and supports practice that exemplifies the standards of community health nursing.

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The standards of practice revolve around both the values and beliefs and the nursing process with the energies of community health nursing always being focused on improving the health of people in the community and facilitating change in systems or society in support of health. Community health nursing practice does not occur in isolation but rather within an environmental context, such as policies within their workplace and the legislative framework applicable to their work.

Martha Rogers model

Rogers considers the unitary human being as an energy field coexisting within the universe. The human being is in continuous interaction with the environment. In addition, human being is a unified whole, possessing personal integrity and manifesting characteristics that are more than and different from the sum of parts. There are 4 dimensions used in the theory which are 1. energy field; 2. openness; 3. pattern and organization and 4. multi dimensionality.

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The utilization of Rogers model is used as a guide for theory development, research nursing education, and in the direct patient care practice.

Rogerian theories Grand theories: The theory of accelerating evolution The theory of paranormal phenomena The theory of rhythmicities

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1. Theory of paranormal phenomena: This theory focus on the explanations for precognition, telepathy, and therapeutic touch etc.

Rogers Model
Rogers concepts of nursing: Nursing is a learned profession - it is a science and art. The art of nursing involves the imaginative and creative use of nursing knowledge. The purpose of nurses is to promote health and well-being for all person and groups wherever they are using the art and science of nursing. The health services should be Community based.

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The art of nursing involves the imaginative and creative use of nursing knowledge. Rogers challenges nurses to consider nursing needs of all people, including future generation of space kind; as life continuous to evolve from earth to space and beyond. Her view provides a different world view that encompasses a practice of nursing for the present time and for the imagined and for the yet to be imagined future. Rogers proposes a nursing practice of noninvasive modalities, such as therapeutic touch, humor, guided imagery, use of color, light, music, meditation focusing on health potential of the person.

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Nursing intervention seeks to coordinate environmental field and human field rhythmicities, participates in the process of change, to help people move toward better health. Nursing aims to assist people in achieving their maximum potential. Nursing practice should be emphasized on pain management, supportive psychotherapy motivation for rehabilitation. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompasses the scope of nursing.

CONCLUSION

Till now we discussed about the importance of nursing theories. The theorist are having different concepts for nursing, environment and health paradigms.

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