PrefacePreface

We enter the new millennium, the opportunities We enter the new millennium, the opportunities and challenges in nursing are boundless and and challenges in nursing are boundless and ever-changing. New biotechnologies offer ever-changing. New biotechnologies offer opportunities not experienced before: women opportunities not experienced before: women can give birth to eight living babies in one can give birth to eight living babies in one delivery; multiple defective organs can be delivery; multiple defective organs can be replaced; and through genomic typing we soon replaced; and through genomic typing we soon will be able to anticipate the anomalies that lead will be able to anticipate the anomalies that lead to illness.to illness.

However, challenges abound: millions of people die each year from conflicts resulting in wars and terrorism, drought, and starvation; from preventable ancient, new, and reemerging infectious diseases; and from unhealthy lifestyle choices.

Community health The communities in which we live and work have a profound influence on our collective health and well-being. Here are three examples: Research has established that both smoking and passive exposure to tobacco smoke are directly associated with serious negative health effects and premature mortality among more than 1 billion smokers worldwide

State laws that require the use of a seat belt, child restraints, and placing young children in the back seat and that severely penalize the combination of drinking and driving protects motorists and reduce the risk of vehicular crashes, injures, and death.

On a larger scale, " theory and research suggest that behavioral interventions to prevent HIV/ AIDS may be most effective when they are personalized and effectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives"

Just as a whole is greater than the sum of its parts, the health of a community is more than of sum of the health of its individual citizens. A community that achieves a high level of wellness is composed of healthy citizens, functioning in an environment that protects and promotes health.

Community health, as a field of practice, seeks to provide organization structure, a broad set of resources, and the collaborative activities needed to accomplish the goal of an optimally healthy community.

Although many believe that health and illness are individual issues, evidence indicates that they also are community issues. The spread of HIV pandemic, nationally and internationally, is a dramatic and tragic case in point ( Berkman, 2001 ).

Other community and national concerns include the rising incidence and prevalence of sexually transmitted diseases, substance abuse, tuberculosis, teen pregnancy, family and teen violence, terrorism, and pollution-driven environmental hazards.

Communities can influence the spread of diseases, provides barrier to protect members from health hazards, organize ways to combat outbreaks of infectious diseases, and promote practices that contribute to individual and collective health

Many different professionals work in community health to form complex team ?!!

The city planners designing an urban renewal project necessarily becomes involved in community health. The social workers providing counseling about child abuse or the use of chemical substance among adolescents is involved in community health. A physician treating clients a effected by a sudden outbreak of hepatitis and seeking to find the source is engaged in community health practice.

The professional nurse is an integrated member of this team. Their duties range from examining infant in a well-baby clinic, or teaching elderly stroke victims in their homes, to carrying out epidemiologic research or engaging in health policy analysis and decision-making.

Despite its breadth, however, community health nursing is a specialized practice. It combines all of the basic elements of professional clinical nursing with public health and community practice.

Community health and public health share many features. Both are organized community efforts aimed at the promotion, protection, and reservation of the public's health.

Winslow's classic 1920 definition of public health still holds true and forms the basis for our understanding of community health in this text:

Public health is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for:• the sanitation of the environment, the control of communicable infections,• the education of the individual in personal hygiene,

•the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, •and the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity .

Turncock (1997, p. 375) offered a more concise definition of public health and stated that it includes "activities that society undertakes to assure the conditions in which people can be healthy. This includes organized community efforts to prevent, identify, and counter threats to the health of the public."

Given this understanding of public health, the concept of community health can be defined. Community health is the identification of needs and the protection and improvement of collective health within a geographically defined area.

The concept of community

A community is a collection of people who share some important feature of their life. In this text, the term community refers to a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging.

It can be a society of people holding

common rights and privileges (e.g., citizens

of a town); sharing common interests (e.g., a

community of farmers), or living under the

same laws and regulations (e.g., a prison

community).

The function of any community includes its members' collective sense of belonging and their shared identity, values, norms, communication, and common interests and concerns.

Populations and aggregates

The three types of communities just discussed underscore the meaning of the concept of community: in each instance, a collection of people choose to interact with one another because of common interests, characteristics, or goals.

The concept of population has a different meaning. In this text, the term population refers to all of the people occupying an area, or to all of those who share one or more characteristics. In contrast to a community, a population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

A population also may be defined by common qualities or characteristics, such as the elderly population or the homeless population. In this text, the term aggregate refers to a mass or grouping of distinct individuals who are considered as a whole and who are loosely associated with one another. It is a broader term that encompasses many different-sized groups. Both communities and populations are types of aggregates.

The health continuum:Wellness-illness Continuum: Yet wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. There are many levels and degrees of wellness and illness. Because health involves a range of degrees from optimal health at one end to total disability or death at the other (Fig.1-2), it often is described as a continuum. This health continuum applies not only to individuals but also to families and communities.

Health as a state of being

Health refers to a state of being, including many different qualities and characteristics. Health involves the total person or community. All of the dimensions of life affecting everyday functioning determine an individual's or a community's health, including physical, psychological, spiritual, economic, and sociocultural experiences. All of these factors must be considered when dealing with the health of an individual or community. The approach should be holistic.

Subjective and objective dimensions of health Health involves both subjective and objective dimensions; that is, it involves both how people feel (subjective) and how well they can function in their environment (objective).

Continuous and episodic health care needs

Community health practice encompasses populations in all age groups with birth-to death developmental health care needs. These continuous needs may include, for example, assistance with providing a toddler-proof home or establishing positive toilet-training techniques, help in effectively dealing with the progressive emancipation of preteens and teenagers, anticipatory guidance for reducing and managing the stress associated with retirement, or help coping with the death of an aged parent.

In addition, populations may have one-time, specific, negative health events, such as an illness or injury, that are not an expectd part of life. These episodic needs might derive from the birth of n infant with down syndrome, a head injury incurred from an automobile crash, or a diagnosis of HIV/AIDS.

Components of community Health practicePromotion of health Health promotion includes all ef-forts that seek to

move people closer to optimal well-being or higher levels of wellness.

The goal of health promotion is to raise levels of well-ness for individuals, families, populations, and communities, community health efforts accomplish this goal through a three-pronged effort to:

1. increase the span of healthy life for all citizens 2. reduce health disparities among population groups 3. achieve access to preventive services for everyone

Prevention of health problems prevention of health problems constitutes a major part of community health practice. Prevention means anticipating and averting problems or discovering them a early as possible to minimize potential disability and impairment. It is practiced on three levels in community health: (1) primary prevention, (2) secondary prevention, and (3) tertiary prevention.

a. Primary prevention obviates the occurrence of a health problem; it includes measures taken to keep illness or in-juries from occurring. It is applied to a generally health population and precedes disease or dysfunction. Examples of primary prevention activities by a community health nurse include encouraging elderly people to install and use safety devices (e.g.. Grab bars by bathtubs, hand rails on steps), to prevent injuries from falls; teaching young adults healthy lifestyle behaviors

b. Secondary prevention involves efforts to detect and treat existing health problems at the earliest possible stage when disease or impairment already exist. Hypertension and cholesterol screening programs in many communities help to identify high-risk individuals and encourage early treatment to prevent heart attacks or stroke.

c. Tertiary prevention attempts to reduce the extent and severity of a health problem to its lowest possible level, so as to minimize disability and restore or preserve function. Examples include treatment and rehabilitation of persons after a stroke to reduce impairment,

Treatment of Disorders The third component of community health practice is treatment of disorders. It focuses on the illness end of the continuum and is the remedial aspect of community health practice. This occurs by three methods: (1) direct service to people with health problems, (2) indirect service that helps people to obtain treatment, and (3) development of programs to correct unhealthy conditions.

Rehabilitation Rehabilitation, the fourth component of community health practice, involves efforts to reduce disability and, as much as possible, restore function. People whose handicaps are congenital or are acquired through illness or accident (e.g., stroke, heart condition, amputation, mental illness) can be helped to regain some measure of lost function or to develop new compensating skills.

Evaluation Evaluation, the fifth component of community health practice, is the process by with that practice is analyzed, judged, and improved according to established goals and standards. Research Research, the sixth component of community health practice, is systematic investigation to discover facts affecting community health and community health practice, solve problems, and explore improved methods of health service.

Characteristics of community nursing Eight characteristics of community heath nursing are particularly salient to the practice of this specialty : (1) it is a field of nursing; (2) it combines public health with nursing; (3) it is population focused; (4) it emphasizes prevention, health promotion, and wellness; (5) it promotes client responsibility and self-care; (6) it uses aggregate measurement and analysis; (7) it uses principles of organizational theory; and (8) it involves interprofessional collaboration.