The demands of community health nursing practice are sig- nificant, as described in Chapter 1, and are elaborated else- where in this textbook. The daily routine of the community health nurse may include organizing a flu clinic for seniors in the community, making home visits, giving a presentation on playground safety at a parent–teacher meeting, partici- pating in a team meeting in the health department office, answering telephone calls, and charting. All of the skills learned in a basic baccalaureate nursing program are needed to effectively manage this type of day. Furthermore, this day may not represent the bigger picture of the community health nurse’s role in community advisory panels, grant writing for new programs, or participation in or presentation of in-service programs. Academic preparation for this role is necessary, as is continuous professional development, and this training must meet the requirements of both employers and, in many instances, state regulations.
Academic Preparation
The minimum preparation for community health nurses in many states has been graduation from a baccalaureate-level nursing program, a nursing major built on 2 years of liberal arts and sciences courses (Ellis & Hartley, 2000). This can be
achieved in a variety of ways. Some students enter a bac- calaureate program as their initial higher educational experi- ence after high school or later. Others complete an associate degree program in nursing and continue on to a university to receive the baccalaureate degree. This requires additional courses in liberal arts and sciences, along with selected nurs- ing courses, usually one or more courses in public health nurs- ing, nursing research, and leadership-management courses. In some programs designed to extend an RN to a Bachelor of Science in Nursing (BSN), nurses with years of experience in acute care nursing can “challenge” the previously mentioned courses by taking a test to demonstrate clinical expertise or by presenting a portfolio of experience, or a combination of these. Nevertheless, whatever the initial entry into practice, a comprehensive nursing education that is rich in leadership, management, research, health maintenance and promotion, disease prevention, and community health nursing experience is needed to meet the demands of this specialty.
In some states, meeting criteria for entry into practice as a public health nurse is required by some employers. In California, the State Board of Registered Nursing (BRN) has established specific criteria, including completion of specific coursework (e.g., child abuse and prevention infor- mation), which must be documented in undergraduate classes. On graduation, a school transcript, application, and fee are sent to the BRN to receive the public health nursing certificate. After they pass the RN license examination (NCLEX), these nurses can sign “RN, PHN” after their names. Only those who have completed a baccalaureate nursing program can apply for this certificate, and only peo- ple with the certificate can take jobs as public health nurses.
In California, this means that employment as an RN in settings such as health departments, schools, and Native American health services requires a PHN certificate.
Professional Development
Completion of a baccalaureate education may not be suffi- cient educational preparation for the more demanding com- munity health nursing settings. Furthermore, to maintain licensure in most states, it is mandated that nurses partici- pate in continuing education programs and receive continu- ing education units (Ellis & Hartley, 2000). In the United States, courses on specific topics are offered by employers, nursing associations, nursing journals, and private programs that travel to various cities. These help nurses to remain cur- rent on topics covered by the courses; however, a community health nurse may consider more lengthy and formal profes- sional development opportunities such as advanced nursing practice (NP) programs or certification opportunities.
To someone who is just finishing an undergraduate nursing program, the thought of continuing in school may be overwhelming. However, within a few months or years after graduation, continuing in higher education may seem right. It can take time and experience to find a particular focus in nursing and to decide on specializing at an advanced level.
When that time comes, a variety of course work and degree options are available. For example, short-term certificate pro- grams specialize in a narrow focus of health care, such as early recognition and prevention of child abuse, research, grant writing, or team management. These may or may not be offered for university credit, but the content enhances a nurse’s role in an agency.
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Matriculation in an NP program or a master’s degree program in nursing is a longer commitment and gives the nurse greater marketability. In some health departments, NPs run well-child clinics, and a school nurse with an NP license can direct a school-based clinic. Advanced practice in community health nursing can open doors into leadership positions in community health agencies. A master’s degree in business, public health, education, or epidemiology can lead to management positions, private community health agency ownership, agency teaching, or research positions. A doctoral program may be the next educational step for those wanting tenure-track university teaching, research, or upper- level administrative positions.
The American Nurses Credentialing Center (ANCC) provides other opportunities by offering nurses certification in more than 36 specialty areas (2008). Currently, only one specialty is available in community health nursing:
Advanced Public Health Nurse (APHN–BC). A generalist certificate in public/community health nursing had been available but was suspended in 2006, pending an ongoing review. Related certifications as an NP or in nursing admin- istration also exist. Each certificate is awarded after comple- tion of a certain number of years of practice in the specialty, payment of a fee, and passage of an ANCC Certification Examination. Many employers reward the initiative required for certification with promotion or a higher salary, accom- panied by additional responsibilities and opportunities.
Summary
The specialty of community health nursing developed his- torically through four stages. The early home-care stage (before the mid-1800s) emphasized care to the sick poor in their homes by various lay and religious orders. The district nursing stage (mid-1800s) included voluntary home nurs- ing care for the poor by specialists or “health nurses” who treated the sick and taught wholesome living to patients.
The public health nursing stage (1900 to 1970) was charac- terized by an increased concern for the health of the general public. The community health nursing stage (1970 to the present) includes increased recognition of community health nursing as a specialty field, with focus on communi- ties and populations.
Six major societal influences have shaped the develop- ment of community health nursing. They are advanced tech- nology, progress in causal thinking, changes in education, the changing demographics and role of women, the con- sumer movement, and economic factors such as health care costs, access, limited funds for public health, and increased competition among health service providers.
Academic preparation for community health nursing begins at the baccalaureate level. However, students begin- ning at the diploma or associate degree level can advance to a BSN completion program and then are prepared to enter this challenging specialty in nursing. The demands of com- munity health nursing require additional courses in liberal arts and science, along with courses in community health nursing practice at the student level. Once students achieve an undergraduate degree, completion of additional educational programs is required to keep current and, in most states, to maintain licensure, advance in practice opportunities, or branch out into administration, teaching, or research. ■
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UNIT 1 Foundations of Community Health Nursing❂ ACTIVITIES TO PROMOTE CRITICAL THINKING
1. Select one societal influence on the development of community health nursing and explore its continuing impact. What other events are occurring today that shape community health nursing practice? Support your arguments with documentation. Use the Internet to find your documentation.
2. Using the Internet, seek out information about a historical public health nursing leader. Using this information, determine how this practitioner might deal with current population-based issues such as AIDS, sexually transmitted diseases, or child neglect and abuse.
3. Assume that you have been asked to make a home visit to a 75-year-old man, living alone, whose wife recently died. Besides assessing his individual needs, what additional factors should you consider for assessment and intervention that would indicate an aggregate or population-focused approach? What self-care practices might you encourage or teach?
4. Interview a community health nursing director to determine what population-based programs are offered in your locality. Explore nursing’s role in the assessment, development, implementation, and evaluation of these programs. Discuss with the director how community health nurses might expand their population-focused interventions.
5. Go to your university, nursing college, or school and locate brochures for advanced degrees in nurs- ing and related areas. Peruse them and see whether any of the programs appeal to you. Request more information from at least one of these programs through the mail or the Internet.
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Selected Readings
100 years in pictures. (2000). American Journal of Nursing, 100(10), 40–45.
Baer, E.D., D’Antonio, P., Rinker, S., & Lynaugh, J.E. (2001).
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(2007). Nurses’ work: Issues across time and place. New York:
Springer Publishing Company.
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Hawkins, J.W., & Bellig, L.L. (2000). The evolution of advanced practice nursing in the United States: Caring for women and newborns. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 29(1), 83–89.
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Lynaugh, J.E. (2002). Nursing History Review: Official journal of the American Association for the History of Nursing. New York: Springer.
Macrae, J.A. (2001). Nursing as a spiritual practice: A contempo- rary application of Florence Nightingale’s views. New York:
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Nichols, F.H. (2000). History of the women’s health movement in the 20th century. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 29(1), 56–64.
Sandelowski, M. (2000). Thermometers and telephones: A century of nursing and technology. American Journal of Nurs- ing, 100(10), 82–86.
Sarnecky, M.T. (2001). Army nurses in “The Forgotten War.”
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Author.
Internet Resources
American Academy of Nursing: http://www.aannet.org/
American Assembly for Men in Nursing: http://www.aamn.org American Nurses Association: http://www.ana.org
American Nurses Credentialing Center:
http://www.nursingworld.org/ancc/index.html
American Nursing Informatics Association: http://www.ania.org American Public Health Association: http://www.apha.org Association of Community Health Nursing Educators:
http://www.achne.org/
Frontier Nursing Service, Inc.: http://www.frontiernursing.org/
National Association of Hispanic Nurses:
http://thehispanicnurses.org/index.php
National Black Nurses Association, Inc.: http://nbna.org National Center for Health Statistics: http://www.cdc.gov/nchs/
National League for Nursing: http://www.nln.org Sigma Theta Tau International Honor Society of Nursing:
http://www.nursingsociety.org
U.S. Department of Labor. Bureau of Labor Statistics:
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“
One good community nurse will save a dozen policemen.”
—Herbert HooverLEARNING OBJECTIVES
Upon mastery of this chapter, you should be able to:
◆ Identify the three core public health functions basic to community health 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.
KEY TERMS
Advocate Assessment Assurance
Case management Clinician
Collaborator Educator Leader Manager
Policy development Researcher
3
Setting the Stage for Community Health Nursing
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Historically, community health nurses have engaged in many professional roles. Nurses in this professional specialty have provided care to the sick, taught positive health habits and self-care, advocated on behalf of needy populations, developed and managed health programs, provided leader- ship, and collaborated with other professionals and con- sumers to implement changes in health services. Although the practice settings may have differed, the essential goal of the community health nurse has always been a healthier community. The home certainly has been one site for practice, but so too have public health clinics, schools, factories, and other community-based locations. Today, the roles and settings of community health nursing practice have expanded even further, offering a wide range of professional opportunities.This chapter examines how the conceptual foundations and core functions of community health practice are inte- grated into the various roles and settings of community health nursing. It provides an opportunity to gain greater understanding about how and where community health nurs- ing is practiced. Moreover, it will expand awareness of the many existing and future possibilities for community health nurses to improve the public’s health. As you read through this chapter, think about client populations that you may have encountered in the acute care setting and consider your role with these same populations in a community setting.
Perhaps you may discover a community health nursing spe- cialty area that you never even considered.