An Introduction to Community and Primary Health Care

Introduction

While community nursing has a long tradition in Australia and New Zealand, the specific specialty of community health nursing evolved in the 1970s with the rise of primary health care (PHC) and a change of focus towards the health promotion, illness prevention and early intervention (von Loon, 2011). This shifted the understanding of health away from a biophysical understanding, which emphasised disease management and reactive health care delivery, towards prevention, promotion of social and environmental health and well-being, and care focused on the prevention of further complications from exiting conditions (von Loon, 2011). Community health nurses (CHNs) are leaders in improving the health of whole communities and providing health care to those most in need (Congdon & Magilvy, 2006). They work in community health programs which aim to provide intergrated, comprehensive and people-centred PHC (International Federation of Community Health Centres, 2013). As part of an interprofessional team, CHNs work with communities to identify health needs and develop localised tailored programs to meet these needs (Brooks et al., 2004; von Loon, 2011). This chapter focuses on the practice and role of CHNs. Other chapters will focus on other areas of community nursing practice and specialised CHN roles.

Community health nursing practice

Community health nursing practice is underpinned by the social model of health and principles of PHC, incorporating accessible health care, appropriate technology, health promotion, intersectorial collaboration, community participation and cultural safety (McMurray & Clendon, 2015). Recognition of the social determinants of health, diversity, empowerment, social justice, advocacy and interdependence underpin community practice. From this perspective, identifying the specific needs of high-risk populations is an essential component when exploring the needs of the population as a whole.

Community health nursing practice is evidence-based and focused on addressing social, political, economic and environmental determinants that can contribute to poorer health outcomes (von Loon, 2011). Community health nursing embodies principles of nursing practice, blended with concepts of community and population health, and health promotion. CHNs primarily focus on prevention, protection and promotion of health and early intervention, incorporating principles of inclusiveness, equity and social justice. They use principles of community development to support capacity building focused on community strengths and community participation (Community Health Nurses of Canada, 2011).