Advanced practice community health nursing in community nursing centers: a holistic approach to the community as client

Community nursing centers are unique arenas for advanced practice community health nursing. These innovative nurse-managed delivery models are grounded in a holistic approach to the community-as-client. They provide the public with direct access to a range of advanced practice professional nursing services that are not otherwise available. Community Nursing Centers are collaborative with other health professions and organizations. They aim to meet the assessed needs of underserved populations using extant resources to achieve optimal health for all members of the community. This article discusses the underlying conceptual basis for development of community nursing centers and provides a case study example.     

Revisiting the concepts of community care and community health nursing

As care moves away from hospital settings, continual re-evaluation of community nursing and health care is essential for the wellbeing of patients. With the approach of the year 2000, Jean Clarke examines World Health Organization objectives, particularly in light of the Health for All (1998) policy.     

Ethical challenge in community health nursing

Community health nurses frequently face situations involving ethical conflicts, but little research has been carried out in this area. This paper, based on a study of dilemmas defined by 30 practising community health nurses in urban and rural British Columbia, Canada, presents an analysis of the situations that contain the most serious ethical conflicts for nurses working in the community. Although issues related to client's rights, nurses' interactions with colleagues and the system, and nurses' rights were explored, nurses in the study reported that situations involving high-risk parenting provided the most serious ethical challenges. Strategies to help nurses caring for such vulnerable clients are described. As well, this paper offers some discussion on implications for community health nursing practice and education in light of current changes and challenges.     

Expertise in community health nursing.

This article reports on a study of expertise in community health nursing. The objective of the study was to develop a model of expertise derived from identification of the characteristics and factors influencing clinical expertise in community health nurses (CHNs) practicing in district nursing, school health, and child health. Participant observations, individual interviews, and written retrospective accounts of clinical episodes were analyzed from 37 nurses (10 novices within the first year of community practice and 27 experts identified by peers and colleagues). The data identified the expert as someone in whom the following characteristics operate synchronously: knowledge; empathy; appropriate communication; holistic understanding; an ability to get right to the problem at hand; and self-confidence in her or his perceptions, judgments, and intervention strategies. The findings suggest that there is a combination of factors which influences the development of expertise. These include educational factors, personal factors, and experience. These factors are incorporated into the model of expertise. The data also suggest that, in order to educate for expert levels of practice, the educational process must be designed to stimulate the learner's perceptual as well as analytic abilities. This can best be achieved through clinical practice opportunities and through demonstrations and case studies which stimulate inferential and intuitive thinking in students.     

多元化健康教育模式在社区老年护理中应用的优势

以防治高血压为例,对社区老年人开展多元化健康教育,探讨多元化健康教育模式在社区老年护理中应用的优势。符合老年人特点的多元化健康教育受到了高度欢迎,并调动了老年入的参与积极性,提高了社区健康教育的效果。