01.02 Community Health Nursing Theories

Hi guys! Welcome to Community Health nursing theories. So we know nursing is always changing. We have a tendency to forget what drives these changes until we start researching. I’ll save you some time and tell you it’s the theories! Everything we do in nursing is based on some theory. In this lesson, we’ll talk about some of the theories more central to community health. So let’s get started!

So, first up is Nightingale’s Environmental Theory. Remember in the introduction lesson we talked about environment being a big influence on our health? Well environmental theory expands on that and actually explains how a patient’s environment relates to their health. It says that we need to alter a patient’s environment to bring changes to their health by creating the best conditions. Translation? We can’t thrive in an unclean or unsafe environment. So in the community I see patients all the time that live in homes that are unkempt and cluttered, there’s an odor, appliances don’t work, maybe there’s some critters running around and so on. In a lot of situations the water, gas or electric can be out as well. You’re probably asking yourself now how can anyone be healthy and live in conditions like this? According to Environmental theory, they can’t. So with that in mind, when I see patients like this my job is to connect them with resources that help improve their environmental health so that they can focus on improving their physical health. Let’s open some windows and get these lights back on and clean up a little so we can move around and get some fresh air in here. This is what Environmental theory tells us. It says illness comes from an unsanitary, noisy environment and lack of light along with several other concepts including… These. So these are other concepts used by environmental theory. They are those things that Nightingale says we need to maintain health. We already talked about light, noise and cleanliness but these others round off the list.

So health belief model explains health behaviors. Why do we do what we do with regard to health? How do our attitudes and beliefs affect our behaviors? There are six concepts to help explain how this works. The first four describe what we ourselves see as the risks, the consequences, the benefits and the barriers to making healthier choices. These are weighed on our perception of the situation. For instance, I know someone who had several cardiac stents, hypertension and was a smoker. For years she was told to change her diet and stop smoking and she changed her diet after a heart attack but continued smoking. Why? Because she believed the diet change may be enough. If I stop eating fried foods and salt, that should do the trick and I only smoke when I’m stressed out so it’s not that serious. She failed to understand how years of these negative behaviors affected her body. People use these perceptions to determine their response to a healthy alternative. So how do we change those beliefs? We should be dispelling them by explaining the risks, specifying consequences, discussing the positives and reassuring our patients to ensure we are guiding health promotion and disease prevention. Now, cues to action and self-efficacy are newer concepts. They describe our readiness to make positive changes and our confidence in our ability to make them, but these two are not as reliable. I may be ready and confident enough to make a change, but not necessarily be in the right position to carry out the change. These both require some guidance to making changes and promoting positive outcomes.

So as we are talking about health promotion, we have to talk about Pender’s health promotion model. There’s a lesson about this in Fundamentals so be sure to check that out. So Pender talks about health promotion in terms of increasing a person’s level of well-being. Here’s another theory that describes a person’s interaction with the environment as they pursue good health. But this theory says that a person’s past experiences, behaviors and outcomes all determine the likelihood that they will engage in health-promoting behavior. Take bullying for example. We’ve all seen “look at me now” talk show topics where the formerly overweight or awkward child turned bodybuilder or model in adulthood comes to the show to show off all their fabulosity to their childhood bully. What are the chances this person became who they are now because of what they experienced as a child? It’s the same premise for health.  Am I going to go back to the same restaurant that gave me food poisoning last month, even though it’s my favorite and I eat there three times a week? No. Because now I associate that place with a bad experience. Something there made me physically sick. So now I’m changing a habit because the most recent outcome was undesirable. I’m not taking any chances when it comes to my health.

So here is a theory that’s a huge part of community health and I say this because I see it frequently. Orem’s self-care theory states first and foremost, people are individuals and are responsible for their own care. Here’s some others: nursing is an action, self-care is a learned behavior and knowledge is necessary to promote self-care. These last two are pretty self-explanatory, but let’s talk about this nursing is an action part. How is that? Perspective point: isn’t nursing caring for other individuals and promoting health? That’s definitely action and we never thought of it that way. So now let’s discuss the focus of this theory. It’s the person and that person is multi-dimensional to include self, you and I and we in terms of ability to perform self-care. 

So Orem’s theory consists of 3 separate theories that break down those dimensions: self-care (“I”), self-care deficit (“YOU&I”), and nursing system (“WE”). Self-care is the ability to maintain your own health. And this is overall health, not just physical. Now, as we grow, we learn to perform our own ADLs like bathing, dressing, eating. ADLs are Activities for Daily Living, and they are universal to our functioning. They are central to maintaining health. So naturally, if there’s an inability to perform these tasks, there’s a deficit.  Most self-care deficits are caused by an event or condition like the flu or a stroke. These are two separate extremes but both leave you unable to perform certain tasks even if for a short time. Now, let’s take a stroke patient. There’s usually some kind of functional loss but it may not always be severe or long-lasting. This is where the nursing system comes in. We use the nursing process to determine how to meet needs and which ones. Are we addressing needs of the whole person, part of the person, or are we just providing support? You’ve heard “it takes a village?” In community health, that’s the “WE” factor.

Okay, so, some key points. Our environment plays a huge part in health maintenance. Our health is a direct reflection of our environment, so take care of it. We rely on our own perceptions and beliefs when performing health behaviors. Sometimes support, guidance or just a bad experience is needed as change agent. Self-care is a person centered concept based solely on a person’s own abilities, so always assess the situation. Lastly, while we work hard to promote health, it’s really dependent on the patient, their beliefs, choices and their abilities.

So that’s all for Community Health Nursing Theories. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves and as always, Happy Nursing!