1. THEORIES APPLIED IN
COMMUNITY HEALTH
NURSING
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING

2. Nursing Theories and Health
Teaching Models
 Select an appropriate theoretical
framework or health teaching model for
the intervention. Discuss the rationale
for the selection, application to
population, and create a visual of the
framework that exemplifies the
population problem.

3. Nursing Theory
 Nightingale's Theory of the Environment
 Orem's Self Care Model
 Neuman's Health Care Systems Model
 King's Theory of Goal Attainment
 Pender's Health Promotion Model
 Roy's Adaptation Model
 Salmon's Construct for Public Health Nursing

4. Continued

5. Health Teaching Model
 The Health Belief Model
 Pender's Health Promotion Model
(also a nursing theory)
 PRECEDE and PROCEED Models

6. Health belief model

7. Pender's Health Promotion
Model (also a nursing theory)

8. Precede proceed model

9. Precede and proceed model

10. 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

11. PUBLIC HEALTH OR COMMUNITY
NURSING
 Public Health Nursing, also called Community Nursing, is a
type of nursing that is concerned with the overall health of the
community. Community health nurses often hold jobs in the
government or at publicly-funded clinics, but also work for
private health agencies. They may work in a brick and mortar
facility or make home visits or work in a specific
neighborhood. Public health nurses who work within a
business are called occupational health nurses.
 Public health nurses work to identify health or safety
problems, as well as risk factors, in a home, work
environment, and community by working with community
leaders, physicians, parents, and teachers. They implement
and manage intervention programs to address and correct
problems, as well as help prevent future problems and risk
factors.
 Many community health nurses also offer counseling for their
patients to help them improve their general health. This
includes disease prevention, nutrition and exercise, and child
care.
 Increasing a patient’s knowledge about health care will help
him or her make better decisions for his or her health. The

12. Public Health or Community
Nursing Theories and Models
1. Neuman’s Systems Model
2. Nightingale’s Environment Theory
3. Orem’s Self-Care Deficit Nursing Theory
4. Pender’s Health Promotion Model
5. Rogers’ Theory of Unitary Human Beings
6. Roy’s Adaptation Model of Nursing
7. Erickson’s Modeling and Role Modeling Theory
8. King’s Theory of Goal Attainment
9. Orlando’s Nursing Process Discipline Theory
10. Peplau’s Theory of Interpersonal Relations
11. Parse’s Human Becoming Theory
12. Kolcaba’s Theory of Comfort
13. Watson’s Philosophy and Science of Caring
14. Roper-Logan-Tierney’s Model for Nursing Based on a
Model of Living
15. Helvie’s Energy Theory and Nursing

13. OREM SELF-CARE THEORY

14. ROY ADAPTION THEORY

15. BETENEUMAN THEORY

17. KING THEORY

18. NOLA PENDERSON MODEL

19. FAMILY NURSING
 Family nursing is a part of the primary care provided to
patients of all ages, ranging from infant to geriatric
health. Nurses assess the health of the entire family to
identify health problems and risk factors, help develop
interventions to address health concerns, and
implement the interventions to improve the health of the
individual and family.
 Family nurses often work with patients through their
whole life cycle. This helps foster a strong relationship
between health care provider and patient.
 Family nursing is not as much patient-centered care as
it is centered on the care of the family unit. It also takes
a team approach to health care.
 A family nurse performs many duties commonly
performed by a physician. They have the ability to write
prescriptions, and need a broader base of knowledge
and skills in order to care for their patients. Nurses may
work in clinics, private offices, hospitals, hospice
centers, schools and homes to care for their patients.

20. Family Nursing Theories and
Models
 Erickson’s Modeling and Role Modeling Theory
 King’s Theory of Goal Attainment
 Neuman’s Systems Model
 Orem’s Self-Care Deficit Nursing Theory
 Orlando’s Nursing Process Discipline Theory
 Peplau’s Theory of Interpersonal Relations
 Parse’s Human Becoming Theory
 Rogers’ Theory of Unitary Human Beings
 Roy’s Adaptation Model of Nursing
 Kolcaba’s Theory of Comfort
 Watson’s Philosophy and Science of Caring
 Nightingale’s Environment Theory
 Pender’s Health Promotion Model
 Roper-Logan-Tierney’s Model for Nursing Based on a Model of
Living
 Mercer’s Maternal Role Attainment Theory

21. Theories and Models
1. Theories in Health Promotion
and Education
2. Social Learning Theory
3. Social Cognitive Theory
4. Social Action Theory
5. Health Belief Model
6. Theory of Reasoned Action
7. Theory of Planned Behavior
8. Subjective Expected Utility
Theory
9.Trans theoretical
Model/Stages of Change
10.Social Support and Social
Networks
11.Community Organization
12.Social Marketing
13.Diffusion of Innovation

22. Continued
 Stress and Coping
 Patient-Provider Interaction
 Ecological Model/ Social
Ecology
 Protection Motivation Theory
 Community Popular Opinion
Leader Model
 Subjective Expected Utility
Theory
 Precaution Adoption Process
Model
Structural Model of Health
Behavior
Behavioral Ecological Model
Planned Approach to Community
Health Model (PATCH)
Precede-Proceed Model
Multilevel Approach to Community
Health Model (MATCH)
Model for Health Education
Planning
PEN-3 Model

23. 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.

24. 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

25. Community health workers

26. 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 specific area, but can be
practiced anywhere.

27. THEORIES AND MODELS FOR COMMUNITY
HEALTH NURSING
 The commonly used theories are:
 Nightingale’s theory of environment
 Orem’s Self care model
 Neuman’s health care system model
 Roger’s model of the science and unitary
man
 Pender’s health promotion model
 Roy’s adaptation model
 Milio’s Framework of prevention
 Salmon White’s Construct for Public health
nursing
 Block and Josten’s Ethical Theory of
population focused nursing
 Canadian Model

28. MILIO’S 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. 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.

29. SALMON WHITE’S 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.; prevention
of disease and poor health, protection against
disease and external agents and promotion
of health.
 For these 3 general categories of nursing
intervention have also been put forward, they
are:

30. Continued
 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.

31. Continued
 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

32. BLOCK AND JOSTEN’S 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 2 fields:

33. Continued
 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 relation-based
care is very important in population
focused care.

34. 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.

35. Lewins changes model

36. Continued
 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.
 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:

37. Continued
 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 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.

38. Continued
 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.
 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.

39. MODELING AND ROLE MODELING
THEORY
 The Modeling and Role Modeling Theory was
developed by Helen Erickson, Evelyn M.
Tomlin, and Mary Anne P. Swain. It was first
published in 1983 in their book Modeling and
Role Modeling: A Theory and Paradigm for
Nursing.
 The theory enables nurses to care for and
nurture each patient with an awareness of and
respect for the individual patient’s uniqueness.
 This exemplifies theory-based clinical practice
that focuses on the patient’s needs.

40. Concept of theories
 The theory draws concepts from a variety
of sources. Included in the sources are
Maslow’s Theory of Hierarchy of Needs,
Erikson’s Theory of Psychosocial Stages,
Piaget’s Theory of Cognitive
Development, and Seyle and Lazarus’s
General Adaptation Syndrome.
 The Modeling and Role Modeling Theory
explains some commonalities and
differences among people.

41. The commonalities among people
include:
 Holism, which is the belief that people are more than the sum of their
parts. Instead, mind, body, emotion, and spirit function as one unit,
affecting and controlling the parts in dynamic interaction with one
another. This means conscious and unconscious processes are
equally important.
 Basic needs, which drive behavior. Basic needs are only met when
the patient perceives they are met.
 According to Maslow, whose hierarchical ordering of basic and
growth needs is the basis for basic needs in the Modeling and Role
Modeling Theory, when a need is met, it no longer exists, and
growth can occur. When needs are left unmet, a situation may be
perceived as a threat, leading to distress and illness.
 Lack of growth-need satisfaction usually provides challenging
anxiety and stimulates growth. Need to know and fear of knowing
are associated with meeting safety and security needs.
 Affiliated Individuation is a concept unique to the Modeling and Role
Modeling Theory, based on the belief that all people have an
instinctual drive to be accepted and dependent on support systems
throughout life, while also maintaining a sense of independence and
freedom. This differs from the concept of interdependence.

42.  Attachment and Loss addresses the idea that people
have an innate drive to attach to objects that meet their
needs repeatedly. They also grieve the loss of any of
these objects.
 The loss can be real, as well as perceived or
threatened. Unresolved loss leads to a lack of
resources to cope with daily stressors, which results in
morbid grief and chronic need deficits.
 Psychosocial Stages, based on Erikson’s theory, say
that task resolution depends on the degree of need
satisfaction.
 Resolution of stage-critical tasks lead to growth-
promoting or growth-impeding residual attributes that
affect one’s ability to be fully functional and able to
respond in a healthy way to daily stressors. As each
age-specific task is negotiated, the person gains
enduring character-building strengths and virtues.
 Cognitive Stages are based on Piaget’s theory, and are
the thinking abilities that develop in a sequential order.
It is useful to understand the stages to determine what
developmental stage the patient may have had difficulty
with.

43. The differences among people include:
 Inherent Endowment, which is genetic as well as
prenatal and perinatal influences that affect health
status.
 Model of the World is the patient’s perspective of his or
her own environment
based on past experiences, knowledge, state in life, etc.
 Adaptation is the way a patient responds to stressors
that are health- and growth-directed.
 Adaptation Potential is the individual patient’s ability to
cope with a stressor. This can be predicted with an
assessment model that delineates three categories of
coping: arousal, equilibrium, and impoverishment.
 Stress is a general response to stressful stimuli in a
pattern of changes
involving the endocrine, GI, and lymphatic systems.
 Self-Care is the process of managing responses to
stressors. It includes
what the patient knows about him or herself, his or her
resources, and his or
her behaviors.

44. Continued
 Self-Care Knowledge is the information about the self
that a person has concerning what promotes or
interferes with his or her own health, growth, and
development. This includes mind-body data.
 Self-Care Resources are internal and external sources
of help for coping with stressors. They develop over
time as basic needs are met and developmental tasks
are achieved.
 Self-Care Action is the development and utilization of
self-care knowledge and resources to promote
optimum health. This includes all conscious and
unconscious
behaviors directed toward health, growth,
development, and adaptation.

45. Continued
 In the theory, modeling is the process by
which the nurse seeks to know and
understand the patient’s personal model of
his or her own world, as well as learns to
appreciate its value and significance.
 Modeling recognizes that each patient has
a unique perspective of his or her own
world. These perspectives are called
models.
 The nurse uses the process to develop an
image and understanding of the patient’s
world from that patient’s unique

46. Continued
 Role modeling is the process by which the nurse
facilitates and nurtures the individual in attaining,
maintaining, and promoting health. It accepts the
patient as he or she is unconditionally, and allows the
planning of unique interventions. According to this
concept, the patient is the expert in his or her own care,
and knows best how he or she needs to be helped.
 This model gives the nurse three main roles. They are
facilitation, nurturance, and unconditional acceptance.
As a facilitator, the nurse helps the patient take steps
toward health, including providing necessary resources
and information. As a nurturer, the nurse provides care
and comfort to the patient. In unconditional acceptance,
the nurse accepts each patient just as he or she is
without any conditions.

47. Continued
 The basic theoretical linkages used in nursing practice
for this model are: developmental task resolution
(residual) and need satisfaction are related; basic need
status, object attachment and loss, growth and
development are all interrelated; and adaptive potential
and need status are related.
 According to the theory, the five goals of nursing
intervention are to build trust, promote the patient’s
positive orientation, promote the patient’s control, affirm
and promote the patient’s strengths, and set mutual,
health-directed goals.
 Modeling refers to the development of an understanding
of the patient’s world, while role modeling is the nursing
intervention, or nurturance, that requires unconditional
acceptance. This model considers nursing as a self-
care model based on the patient’s perception of the
world, as well as his or her adaptation to stressors.

48. When it comes to research, the following are
some theoretical propositions presented by
the model:
 The individual’s ability to contend with new
stressors is directly related
to the ability to mobilize resources needed.
 The individual’s ability to mobilize resources is
directly related to their need deficits and assets.
 Distressors are unmet basic needs; stressors are
unmet growth.
 Objects that repeatedly facilitate the individual
patient in need take on
significance for that individual patient. When this
occurs, attachment to the significant object
occurs.
 Secure attachment produces feelings of
worthiness.

49. Continued
 Feelings of worthiness result in a sense of
futurity.
 Real, threatened, or perceived loss of the
attachment object results in morbid grief.
 Basic need deficits co-exist with the grief
process.
 An adequate alternative object must be
perceived as available in order for the patient to
resolve his or her grief process.
 Prolonged grief due to an unavailable or
inadequate object results in morbid grief.
 Unmet basic and growth needs interfere with
growth processes for the patient.
 Repeated satisfaction of basic needs is a
prerequisite to working through developmental
tasks and resolution of related developmental
crises.
 Morbid grief is always related to need deficits.

50. REFERENCES
 Allender J.N; Spradely B.W.
Community Health Nursing Concepts
and practice. (8th edn)
2001.Lippincott,342-45.
 Stanhope M; Lancaster J. Community
Health Nursing Promoting health of
Aggregates, Families and
individuals.(4th edn)
2001.Mosby,265-80.