Community and public health nursing: roles, levels of prevention and settings
- Fundamental
Community nurses care for whole groups where people live, study and work: they promote health, prevent disease and link people to services.
What it is
Community and public health nursing moves care out of the hospital and into homes, schools, workplaces and neighbourhoods. Its subject is the person, the family and the community together. It rests on promoting healthy living, preventing illness, supporting rehabilitation, evaluating community resources and advocating for better health, always looking at the social determinants of health: the conditions in which people are born, grow, live, work and age. In Colombia this work is organised by the health promotion and maintenance route (Res. 3280 de 2018), which combines population, collective and individual interventions, and by the basic health teams (equipos básicos de salud) that visit families in small territories.
Key points
- Health equity means everyone has a fair and just chance to be as healthy as possible.
- Health disparities are differences in health linked to social, economic or environmental disadvantage.
- Health inequities are avoidable differences in health between and within communities; health follows a social gradient.
- A community health needs assessment identifies needs and assets, ranks them and acts on unmet needs.
- Interventions can be clinical (vaccination clinics, screening), behavioural (exercise or smoking-cessation programmes) or environmental (clean water, smoke-free rules).
Components
- Population interventions (Res. 3280): public policies on social and environmental determinants, health information and social participation.
- Collective interventions: delivered in five settings (home, school, community, workplace and institutions) and for vulnerable groups, funded through the plan de intervenciones colectivas (PIC).
- Individual interventions: integral assessment by life-course moment, early detection, specific protection (such as vaccination) and health education.
- Basic health team (MinSalud guidance on Res. 2788 de 2022): one doctor, one professional nurse, four nursing assistants, one community leader or health promoter, and a social or health professional as needed, for up to 5,000 families.
- Micro-territory: from 60 families or fewer in highly dispersed areas up to 500 in dense cities; it is the smallest unit of team work.
What it is for
- Brings promotion and prevention to people who do not come to the health centre.
- Finds risks early in families and settings and refers people to the right route or service.
- Strengthens community participation and support networks.
- Gives the territory data for planning and for public health surveillance.
The five levels of prevention, with community examples
| Level | Aim | Example |
|---|---|---|
| Primordial | Change the social and environmental conditions that create risk | Taxes on tobacco, safe parks and walking paths |
| Primary | Prevent the disease before it starts in susceptible people | Vaccination, birth classes, tobacco-cessation education |
| Secondary | Detect disease early, before symptoms | Blood-pressure screening days, depression screening |
| Tertiary | Reduce severity and complications in people already ill | Cardiac rehabilitation, therapy after a stroke, support groups |
| Quaternary | Protect people from interventions likely to do more harm than good | Education on advance directives and hospice care |
In nursing practice
- Public health nurses work in government agencies, community centres, shelters and vaccination sites, and help prepare for disasters and epidemics.
- School nurses care for children with chronic conditions, support mental health and help with emergency plans.
- Nurses may be neighbours or relatives of the people they serve: they keep these roles separate and protect confidentiality.
- Every contact is a chance to check vaccination, screening and route attendance for the whole family.
Common mistakes
- Looking only at the sick person and not at the family, the home and the setting.
- Arriving as an outsider without building trust with leaders and residents.
- Planning for the community instead of with the community.
- Treating a mass information campaign as if it were health education.
- Forgetting to record and follow up referrals made in the field.
Test yourself
Think of the answer, then tap the question to see it.
What are the five levels of prevention used in community health nursing?
Primordial, primary, secondary, tertiary and quaternary prevention.
Which level of prevention is a blood-pressure screening day in a neighbourhood?
Secondary prevention: it looks for disease early, before symptoms appear.
What three types of intervention does Colombia's Res. 3280 de 2018 combine?
Population interventions (policies, information, participation), collective interventions (in settings such as home and school) and individual interventions (consultations, screening, vaccination, education).
Who is assigned to the families of each micro-territory in a Colombian basic health team?
A nursing assistant, who characterises the families and coordinates activities with the rest of the team.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing: Mental Health and Community Concepts, 16.2 Community Health Concepts (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 16.3 Applying the Nursing Process to Community Health (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022); Lineamientos para la organización y operación de los Equipos Básicos de Salud (Resolución 2788 de 2022) (Ministerio de Salud y Protección Social, Colombia, 2023); Resolución 3280 de 2018: lineamientos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social, Colombia, 2018).
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Representative model, for educational purposes only.