Key Terms to know
Aggregate - Group of people who share a common aspect (age,
economic status, cultural background, gender, area of residence, or
Client – Individual, family, group or community.
Community – Interactions among groups of people with common bonds
Community-based nursing – Focus is on the individual - Care of the
acute or chronically ill person and their family Focus is to promote self-
care, decision making and autonomy.
Community health nursing – Focus is on health of the community –
Here professional nursing merges with knowledge of public health
The distinction between community based and public health nursing is
critical to a quality, coordinated health delivery system. Public Health
Nursing is population-focused and community oriented, whereas
Community based care focuses on individuals and families in their
natural settings within communities.
As defined earlier, takes place where the clients live, work and play. It
may be a school, work site, camp, American Indian reservation, home,
or migrant workers’ camp.
The individual & family have primary responsibility for their health care
The philosophy related to CBN is the human ecological model, which
describes human development throughout the course of life.
Example: The inner circle beings the individual/immediate family
extending out to the next circle, friends, neighbors, co-workers & extended
family then out to local church & community and the farthest circle
involving the state & national government, and church denomination.
Community-Based Nursing versus Community Health Nursing
Community-based nursing is for the purpose of safeguarding &
improving the health of populations.
It is based on the principals of social justice, that everyone is entitled to
basic necessities such as adequate income and health care.
Also known as public health nursing, and is the art & science of
preventing disease, prolonging life, promoting health & efficiency
through organized efforts (Efforts are supported by federal, state and
local government, with state & government mostly providing advice or
support). Local levels provide protection services related to sanitation,
air, water pollution control & personal health (i.e. immunizations).
The nurse is the major health care professional on this team!
Community Health nurses use a population-focused approach, and this
focus is concerned with aggregates (groups of people with common or
similar problems that can be very broad or specific). They care for the
community as a whole & consider the person or family to be only one
member of a group at risk.
o Examples: Identify groups at high risk for disease & conduct
screenings; report, monitor & track a community outbreak; provide
immunizations (with a group objective).
Nursing Roles Compared
Community-Based Nurse Community Health Nurse
Direct care provider
Direct care provider
Case finder (population)
Data collector & analyzer (research &
Disease risk manger
Communicable disease reporter, monitor,
Goals: Manage acute or chronic
Goals: Preserve & protect health
Clients: Individual & family Clients: Community
Philosophy: Human ecological
Philosophy: Primary health care
Autonomy: Individual & family Autonomy: Community autonomy
Individual rights may be sacrificed for
good of the community
Client character: Across the
Client character: Across the lifespan with
emphasis on high-risk aggregates
Cultural diversity: Culturally
appropriate care of individuals
Cultural diversity: Collaboration with &
mobilization of diverse groups &
Type of service: Direct Type of service: Direct & indirect
Home visiting: Home visitor Home visiting: Home visitor
Service focus: Local community Service focus: Local, state, federal &
Community Based Nursing Service/Home Health
The goal of home health nursing is individual and family self-care which leads
to cost-effective, illness-oriented, direct-care service. The majority of care
provided is to elderly and disabled individuals.
Levels of care:-
1-The first level of care provided is the Homemaking Service that provides
homemaker services with assistive personnel providing the care.
2-The second level is personal care which provides the patient a high level of
personal care with nursing visits approximately once per month to supervise
the care provided.
3- The third level is the Long Term Care Alternative Program (LTCAP) in
which the patient receives homemaking, personal care and skilled nursing
4- The fourth level is the title 19 Waiver Program in which the highest level of
nursing care is provided.
* The majority of care provided in home health is through the Community
1-Maternal and child health services:
a) Maternity care(antenatal ,natal, postnatal)
b) Premarital examination and counseling.
c) Infant and preschool childcare.
d) Family planning.
e) Social services.
f) Health education.
2-School health services:-
a) Provision of healthfully environment.
b) Preventive health services e.g. assessment, medical examination, follow up,
counseling, first aids and prevention and control of communicable disease.
c) Curative health services.
d) School health education.
3-Communicable diseases control.
b) Public health education
c) Water and food sanitation.
d) Control of carriers of diseases.
4-Endemic and Parasitic disease control.
The community health nurse role:-
The nursing care delivered to the community is delivered through the
Community Health Services:-
School Health Services:
Nurses provide health screening, individual or group education, referral and
Follow-up to both students and faculty.
WIC Program services: (a nutrition education and food supplement
program for infants, children to age five, pregnant, breastfeeding and
postpartum (6 weeks) women).
*Program is based on income, nutrition and medical risk factors.
A nurse completes a nursing assessment which involves biochemical data,
Health history, and nutrition assessment and then provides appropriate
education based on identified needs.
The nurse provides Immunizations according to the Advisory Committee on
Immunization Practice for preventable diseases, assists in elimination of
barriers to assure age appropriate immunizations.
The nurse conducts tuberculosis screenings per guidelines for individuals or
groups with referral and follow-up of abnormal findings.
Family Planning services:-
Nurses counsel, educate, and Provide provisions for contraception to those
individuals seeking family planning services.
Nurses complete on-site physical examinations under contractual agreements
Prenatal Risk assessment, prenatal education, and case management:-
Nurses complete a standard risk assessment on all pregnant women and
provide ongoing education, counseling, and assessment of the women during
pregnancy. Referrals to other health and medical resources are done as
Postpartum visits, counseling and education:-
Nurses conduct postpartum home visits, assess mother and newborn, provide
appropriate education and counseling, and make referrals to other appropriate
Developmental screening for infants and children:-
Nurses conduct developmental screenings using Revised Parental
Development Questionnaire, well-child assessments and provide anticipatory
guidance education and counseling.
Health screening, counseling, and education services:-
Nurses complete health screenings and education for blood pressure, glucose,
Hemoglobin, vision, hearing, and urine screenings and make referrals. Nurses
educate individuals or groups on a broad range of public health prevention
topics or health promotional topics.
Community Health assists with client-need coordination and community
Nurses serve as a local resource for individuals, families or communities and
assist them in finding appropriate resources to address needs or public health
Maternal and Child Health (MCH) services:-
Nurses assess, educate, and provide guidance to parents’ and children who
have high risk factors of the home, parent or child.
Communicable disease control:-
Nurses work closely with Department Disease
Intervention staff in identified communicable disease issues or in the area of
prevention of communicable disease.
Implications for Nursing Practice:-
Nurses will need to have skills in assessment, critical thinking, teaching,
negotiation, collaboration, delegation and leadership. Advanced practice
nurses will need additional skills of policy formation, research, consultation,
collaboration with managed care groups and case management.
Nurses will function in roles of case management, education, researcher,
collaborator and advocate.