Roles and Functions of the

Community and Public

Health Nurse
 Upon mastery of this chapter, you should be
•
able to:
● Identify the three core public health functions basic to
communityhealth nursing.
• ● Describe and differentiate among seven different roles of the
community health nurse.
• ● Discuss the seven roles within the framework of public health
nursing functions.
• ● Explain the importance of each role for influencing people’s
health.
• ● Identify and discuss factors that affect a nurse’s selection and
practice of each role.
• ● Describe seven settings in which community health nurses
practice.
• ● Discuss the nature of community health nursing, and the common
threads basic to its practice, woven throughout all roles and settings.
• ● Identify principles of sound nursing practice in the community.
 Three primary functions of public
health
• The various roles and settings for practice hinge on
three primary functions of public health:
– assessment,
– policy development,
– and assurance.
• They are foundational to all roles assumed by the
community health nurse and are applied at three levels
of service:
– to individuals,
– to families,
– and to communities
 Assessment
• An essential first function in public health
• the community health nurse must gather and
analyze information that will affect the health of
the people to be serve:
– health needs,
– health risks,
– environmental conditions,
– political agendas,
– and financial and other resources
 Policy Development
• is enhanced by the synthesis and analysis of
information obtained during assessment.
• At the community level, the nurse provides
leadership in convening and facilitating
community groups to evaluate health concerns
and develop a plan to address the concerns.
• Typically, the nurse recommends specific
training and programs to meet identified health
needs of target populations.
 Assurance
• Assurance activities—activities that make
certain that services are provided—often
consume most of the community health nurse’s
time.
• Community health nurses perform the assurance
function at the community level when they
– provide service to target populations,
– improve quality assurance activities,
– and maintain safe levels of communicable disease
surveillance and outbreak control.
 Standards for Community Nursing
• Individuals should receive nursing services based
on standards developed by the American Nurses
Association (ANA), such as:
• the Code for Nurses With Interpretive Statements
(1985),
• Nursing’s Social Policy Statement (1995),
• Standards of Clinical Nursing Practice (2nd edition)
(1998a),
• The Scope and Standards of Public Health Nursing
Practice (1999).
 Clinician Role
• The most familiar role of the community health nurse
is that of clinician or care provider;
• means that the nurse ensures that health services are
provided not just to individuals and families, but also to
groups and populations.
• Three clinician emphases, in particular, are useful to
consider here:
– holism,
– health promotion,
– and skill expansion.
 Holistic Practice
• In community health a holistic approach means
considering the broad range of interacting needs
that affect the collective health of the “client” as
a larger system
• Holistic nursing care encompasses the
comprehensive and total care of the client in all
areas, such as physical, emotional, social,
spiritual, and economic.
 Health promotion
• The clinician role in community health also is
characterized by its focus on promoting
wellness.
• Examples include immunization of
preschoolers, family planning programs,
cholesterol screening, and prevention of
behavioral problems in adolescents.
• Protecting and promoting the health of
vulnerable populations is an important
component of the clinician role
 Expanded Skills
• With time, skills in observation, listening, communication,
and counseling became integral to the clinician role as it
grew to encompass an increased emphasis on
psychological and sociocultural factors.
• Recently, environmental and community-wide
considerations, such as problems caused by:
– pollution,
– Violence and crime,
– drug abuse,
– unemployment, poverty, homelessness,
– and limited funding for health programs
• have created a need for stronger skills in assessing the
needs of groups and populations and intervening at the
community level.
 Role of the Public Health Nurse
• To: Provide input to interdisciplinary programs
that monitor, anticipate and respond to health
problems in population groups for all diseases
or public health threats including bioterrorism
• To: Evaluate health trends and risk factors of
population groups to help determine priorities
forming targeted interventions
 Role of the Public Health Nurse
• To:
• Work with the community or specific population
groups to develop targeted health promotion
and disease prevention activities
• To: Evaluate health care services
• To: Provide health education, care, management
and primary care to individuals and families who
are members of vulnerable populations and high
risk groups
 Public health nurses integrate
community involvement and
knowledge of the entire population
with the personal clinical
understandings of health and illness
gleaned from the experiences of
individuals and families within the
population.
 The nurse working in public health
should be a voice for members of the
community to voice problems and
desires
 The public health nurse can apply
her knowledge of strategies to
choose the intervention(s) that meets
the needs of a particular community,
family or individual
The nurse is the agent who translates
and applies the knowledge of health
and social sciences to individuals
and population groups through
specific interventions, programs and
advocacy
 He or she also articulates and
translates health and illness
experiences of diverse, often
vulnerable, individuals and families
to the health planners and policy
makers
 Standards of practice have been
established by the American Nurses
Association
The Quad Council, made up of four
public health nursing organizations,
has established core competencies
 These competencies reflect an
agreement by the Quad Council that
the public health nurse requires
preparation at the baccalaureate
level.
However, in many states nurses
doing public health work are not
baccalaureate graduates.
 Even early on, the shortage of
nurses affected the hiring of BSN or
MSN prepared nurses. Public health
departments could not compete with
hospital systems.
 The specialist level competencies
require preparation at the Master’s
level in community and /or public
health nursing.