Theoretical Basis of community

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TH EO RETICAL BASIS O FCO M M U N ITY H EALTHN U RSIN G

Ns. Setyoadi, M.Kep., Sp.Kom



Community health nursing is a specialty inwhich the unit of care is a speciccommunity or aggregate, and the nurse

has responsibility to promote group health. The goal of this specialty is health

improvement of the community. The sillsre!uired for e"cellence in community

health nursing practice includeepidemiology, research, teaching,community organi#ing, and interpersonalrelational care, as well as many others.



Com m unity-O riented, Pou!"tion-Fo#u$ed C"re

a community is a group of people whohave some characteristics in common,are bounded by time, interact with oneanother, and feel a connection to oneanother.

Community orientation is a process

that is actively shaped by the uni!uee"periences, nowledge, concerns,values, beliefs, and culture of a givencommunity.



$ population is any group of peoplewho share at least one characteristic,such as age, gender, race, a particularris factor, or disease.

$ population focus implies that a nurseuses population based sills such as

epidemiology, research in communityassessment, and communityorgani#ing as the basis forinterventions.



TH EO RIES AN % M O % ELS FO R CO M M UN ITYH EALTH N URSIN G PRACTICE

$ theory is a set of systematicallyinterrelated concepts or hypotheses thatsee to e"plain or predict phenomena.

These early theories, also termed grandtheories or conceptual models, provideda basis for building nursing nowledge.

%ne feature separating nursing theory

from other professional theories is theuse of the nursing metaparadigmconcepts& nursing, client'patient, health, andenvironment.



To more fully understand the elementsinherent in a nursing theory, a pictorialrepresentation, or model, is oftenused.

These models provide a visual meansto understand the relationships

between, for instance, the nurse andthe environment, the nurse and theclient, or the stress factorse"perienced by the client.



(oth theories and models have beendeveloped to describe, clarify, andguide nursing practice. Theories andmodels that have particularrelevance to the practice ofcommunity health nursing are

described here.



N i&'tin&"!e($ T'eory o) En*ironm ent

)lorence Nightingale*s environmental theory hasgreat signicance to nursing in general and tocommunity health nursing specically, because itfocuses on preventive care for populations.

Crime +arer observations suggested thatdisease was more prevalent in poor environments,and that health could be promoted by providingade!uate ventilation, pure water, !uiet, warmth,

light, and cleanliness. The cru" of her theory was that poor environmental

conditions are bad for health and that goodenvironmental conditions reduce disease.



O rem ($ Se!)-C"re M ode!

-orothy %rem, a nurse administratorand educator, focused on theconcept of self-care—learned, goal-oriented actions to preserve andpromote life, health, and wellbeing.She described people who need

nursing care as those who lac abilityin selfcare



The goal of nursing action is to helppeople recogni#e their selfcaredemands and limitations andincrease their selfcare ability.Nursing care also functions to meetclients* selfcare needs until they are

able to care for themselves.



%rem further described three types ofre!uirements that in/uence people*s selfcare abilities&

0niversal re!uirements, common to all humanbeings, are selfcare activities essential to meetphysiologic and psychosocial needs.

-evelopmental re!uirements are activities

necessary to help people progressdevelopmentally.

ealthdeviation re!uirements are activitiesneeded to help people deal with a diminishedlevel of wellness.



$lthough %rem*s model focused primarily onindividuals, it can be applied to community healthnursing.

1opulations and communities can be considered to

have a collective set of actions and re!uirements thata2ect the wellbeing of the total group.

3f an aggregate*s demands for selfcare e"ceed itsability, the aggregate e"periences a selfcare decit,and community health nursing intervention isindicated.

$ccording to this interpretation, the goal of communityhealth nursing is to promote a community*s collectiveindependence and selfcare ability.



N eum "n($ H e"!t' C"re Sy$tem $ M ode!

3n this model, people are seen as open systems thatconstantly and reciprocally interact with theirenvironments.

4ach system is greater than the sum of its parts, and

wellness e"ists when the parts of the system interact inharmony with each other and with the system*senvironment.

)our sets of variables, or in/uences, mae up eachsystem*s 5whole.6 These are physiologic, psychological,

sociocultural, and developmental variables.

7iven these variables, each system has a uni!ueresponse to stressors and to those tensionproducingstimuli that may cause dise!uilibrium or illness.



$ system*s response to stressors may be envisioned as aseries of concentric circles. 3n the center is a core of basicsurvival abilities, such as a community*s ability to maethe best use of its natural resources.

Surrounding this core are three boundaries. The innermostboundary is a /e"ible line of resistance that encompassesinternal defenses, such as a community*s collective senseof responsibility for raising healthy children.

The second boundary is the system*s normal line of

defense, such as a community*s police force or voluntaryre brigade.

The third boundary is a dynamic, /e"ible line of defense, abu2er that prevents stressors from invading the system*snormal line of defense.





Ro&er$( M ode! o) t'e S#ien#eo) Unit"ry Bein&$

8ogers is responsible for modernnursing*s emphasis on the wholeperson

she developed a nursing conceptualmodel based on systems theory. ermodel emphasi#ed that the whole is

greater than the sum of its parts



8ogers also incorporated developmental theory into hermodel by describing the development of 5unitary6 personsor systems according to three principles& 9:; life proceedsin one direction along a rhythmic spiral, 9<; energy elds

follow a certain wave pattern and organi#ation, and 9=;human and environmental energy elds interactsimultaneously and mutually, leading to completenessand unity.

0sing this model, the community health nurse can focus

on community>environment interaction? the communityfunctions interdependently with others and with theenvironment.

The goal of community health nursing is to promoteholistic and healthful community>environment interaction.



INTERACTION BETWEEN

HUMAN AND ENVIRONMENT

18

Environment

Energy Field

Human Being

Energy Field



Pender($ H e"!t' Prom otion

M ode! 1ender dened health promotion as actionsthat are directed toward increasing the level ofwellbeing and selfactuali#ation in individuals

or groups 1ender*s health promotion model seeks to

explain this proactive behavior.

The model, based on social learning theory,

stresses cognitive processes that help regulatebehavior such as perceptions people have thatdirectly in/uence their motivation to begin orcontinue healthpromoting behaviors.



)ive types of modifying factors in/uencepeople*s perceptions about pursuing healthpromoting behaviors&

-emographic factors, such as age and race (iologic characteristics, such as height and

weight

3nterpersonal in/uences, such as thee"pectations of others

Situational factors, such as availability ofhealthfulfoods

(ehavioral factors, such as stresscopingpatterns



Com m unity-"$-P"rtner

M ode! (ased on Neuman*s model of a totalperson approach to viewing patientproblems, the community-as-client model

was developed by the authors to illustratethe denition of public health nursing asthe synthesis of public health and nursing.

The model has been renamed the

community-as-partner model toemphasize the underlying philosophy ofprimary health care.



Systems have a common purpose,interrelated parts, and boundaries.

The whole system is considered greaterthan the sum of its parts, and there isemphasis on the interaction of thoseparts to mae up the whole.

$n individual, group, or community canbe considered an open system in thatthere is constant interaction with theenvironment through boundaries.



There are two central factors in thismodel& a focus on the community as partner (represented by the community

assessment wheel at the top, whichincorporates the community*s people asthe core; and the use of the nursing process.

he model is described in some detail toassist you in understanding its parts? thiswill guide your practice in the community.



The core of the assessment wheel represents the people who make up the community.

3ncluded in the core are the demographics of the

population as well as their values, beliefs, andhistory.

$s residents of the community, the people area2ected by and, in turn, in/uence the eightsubsystems of the community.

These subsystems are physical environment,education, safety and transportation, politics andgovernment, health and social services,communication, economics, and recreation.



The solid line surrounding the communityrepresents its normal line of defense, or thelevel of health the community has reached over

time. The normal line of defense may include

characteristics such as a high rate of immunity,low infant mortality,or middleincome level.

The normal line of defense also includes usualpatterns of coping, along with problemsolving

capabilities? it represents the health of thecommunity.



The !exible line of defense, depictedas a broken line around thecommunity and its normal line ofdefense, is a bu2er #onerepresenting a dynamic level ofhealth resulting from a temporary

response to stressors.



+ithin the community are lines ofresistance, internal mechanisms thatact to defend against stressors.

@ines of resistance e"ist throughouteach of the subsystems andrepresent the community*s

strengths.



"tressors are tension-producing stimuli thathave the potential of causing dise#uilibrium inthe system.

They may originate outside the community9e.g., air pollution from a nearby industry; orinside the community 9e.g., the closing of aclinic;.

Stressors penetrate the /e"ible and normallines of defense, resulting in disruption of thecommunity. 3nade!uate, inaccessible, oruna2ordable services are stressors on thehealth of the community.



Stressors and lines of resistance 9strengths;together become part of the communitynursing diagnosis by giving rise to the

degree of reaction. he degree of reactionis the amount of dise!uilibrium or disruptionthat results from stressors impinging on thecommunity*s lines of defense.

The degree of reaction may be re/ected inmortality and morbidity rates,unemployment, or crime statistics, to namea few.



PRIN CIPLES O F PU BLIC H EALTH N URSIN G

1rinciple :& )ocus on the Community

1rinciple <& 7ive 1riority to Community Needs

1rinciple =& +or in 1artnership +ith the 1eople

1rinciple A& )ocus on 1rimary 1revention 1rinciple B& 1romote a ealthful 4nvironment

1rinciple & Target $ll +ho Might (enet

1rinciple D& 1romote %ptimum $llocation of

8esources

1rinciple E& Collaborate with %thers in theCommunity



SO CIETAL IN FLUEN CES O N CO M M UN ITYO RIEN TE% ,

PO PU LATIO N -FO CU SE% N URSIN G Communication Technology

3n addition, 3nternet technology has made it possible toaccess local, state, national, and international data forcommunity assessment, planning, and evaluation.

Nurses who re!uire data for a new interventionstrategy, for e"ample, can search the 3nternet forinformation from consumer groups, researchers, andother e"perts worldwide.

To eep apprised of emerging issues and trends in

public health, the nurse can Foin numerous 3nternetbased electronic discussion groups or listservs9electronic discussions distributed by way of email;.

The challenge to the nurse is to manage the volume ofinformation and to weigh its worth.



Genetics, Genomics, and GeneticEngineering

7enetics, the science of heredity andgenomics, the study of the entiregenome, are terms that have gainedincreased attention from nurses over

the past decade. $n outgrowth of thisnowledge is genetic engineering,which can be dened as genemanipulation in a laboratory setting.



3n addition to increasing understanding of the contributionof genetic material to health and disease, genetic researchhas created new opportunities for early identication,prevention, and treatment of people at ris for disease.

)or e"ample, techni!ues for -N$ screening of newbornsallows early detection of ris for certain diseases anddisabilities, thereby permitting early intervention. 7eneticcounseling, previously only available to a limitedpopulation, is being used increasingly by women in thepreconception and prenatal periods.

3n dealing with these concerns, it is the community healthnurse*s responsibility to be aware of the latest scienticinformation when educating communities, so that thedecisions made best t the community*s value system.



Global Economy $ global economy also permits rich countries in

need of silled worers to recruit them fromdeveloping countries, causing a shortage ofsilled labor in those countries that need it most.

3n countries able to recruit labor, the presence ofnew immigrant groups may be seen as a threatto the local culture or economy, causing an

increase in ethnic, racial, and religious tensions. 4ven people with Fobs that pay well may react

negatively because they see their worldchanging and their own future as more uncertain.



The economic trends of the late <Gthcenturyhave contributed to greater worldwidedisparities in wealth, health, and relative poverty, a measurement of an individual$sincome against the average for the society inwhich that individual lives.

Community health nurses have an obligation toread the latest research, so that they can better

understand the relationship of poverty to health. $t the same time, they need to advocate

forpolicies that will reduce adverse e2ects ofpoverty and income disparities.



Migration Migration is the act of moving from one region or country to

another, either temporarily, seasonally, or permanently.

The health care needs of migrants and migrant refugees are

enormous. 4nvironmental factors are a primary reason for compromised

health, and include inade!uate waste disposal, crowded andoften unsanitary living conditions, lac of access to healthfulfoods, and air pollution from an increased concentration ofvehicles used for moving refugees.

The potential detriments to health associated with migrationre!uire that community health nurses ensure thatsurveillance systems able to detect emerging healthproblems are in place? programs to prevent health problemsand treat e"isting conditions also need to be developed.



Terrorism and Bioterrorism Terrorism is one way in which a small number

of people who perceive that they have been

unfairly treated can e"ert in/uence on a largergroup or nation.

Bioterrorism is the use of livingorganisms, such as bacteria, viruses, or otherorganic materials, to harm or intimidate others,

in order to achieve political ends. Some of the possible biologic agents used

include %acillus anthracis, smallpox virus,%rucella, and botulinum toxin



1erhaps more importantly, communityhealth nurses need to be involved inprimary prevention of bioterrorism

through advocating for theelimination of biologic weapons andaddressing the root causes of

terrorism, such as poverty, hunger,poor housing, limited educationalopportunities, lac of clean water, andinade!uate or no health care.



Climate Changes Climate changes can be considered societal changes because

they may be in/uenced by economics. Since the 3ndustrial

8evolution, increased amounts of carbon dio"ide, methane,

and nitrous o"ide created by manufacturing industries,automobile emissions, and consumer products have beenintroduced into the earth*s atmosphere.

These increases have contributed to climate changes that aree"pected to a2ect sea level? the production of food, ber, andmedicines? and the spread of infectious diseases. Conversely,

signicant 1opulation focused nurses need to educate the public about

the potential dangers of continuing to contaminate theenvironment and to advocate for changes in public policy thatreduce air and water contaminants.

DaftarPustaka



Daftar Pustaka

$nderson, 4.T., and Mc)arlane, H.9<G::;.

Community as partner&Theory and practicein nursing, =rd.ed, 1hiladelpia& @ippincott

$llender, H.$., and Spradley, (.+.9<G:G;.

Community health nursing & Concepts andpractice, Ath.ed, 1hiladelpia& @ippincott

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Theoretical Basis of community

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