A key strategy used by such services is a strength-based approach. Strengths-based approaches focus on identifying and building on the existing strengths of individuals, families and communities. Deficit-based approaches of the past focused on single issues, people’s gaps and inadequacies, and community problems. Such approaches can reinforce perceptions of loss, low self-esteem and failure. This change of approach in public health signalled a shift in thinking from the ‘old’ public health to a ‘new’ public health. In the former, public health agencies usually decided what was best for communities. In the latter, communities are actively engaged to decide on priorities and preferences for health (Baum, 2008, Keleher and Murphy, 2004 and McMurray, 2007). The five action strategies from the Ottawa Charter (World Health Organization 1986:i–v) illustrate this change:

Marshall (2004:175) has taken the five action areas of the Ottawa Charter and developed a useful table (Table 18.1) to illustrate examples under each action. Table 18.1 provides an example from a local government’s maternal and child health service initiative that was begun by two maternal and child health nurses (Higgins & Jones 2004).

The public health movement began in the nineteenth century with the goal to keep nations well across the life span through providing direct public health services to populations (universal maternal and child health services), enacting government legislation (e.g. to provide safe water, milk and food; to set standards for housing) and nationwide programs (e.g. immunisation, chest X-ray screening for tuberculosis) (Baum, 2008 and Duckett, 2004). Early public health service providers included public health nurses, school health nurses, maternal and child health nurses, health visitors and occupational health nurses. Each of these nursing specialties focused on a section of the population and provided a universal service to that population. The generalist public health nurse provided a range of services to local communities and worked with the specialist nurses and other members of the public health team to provide school and maternal and child health services.

Public health nursing has been developing along with the public health movement for the last 100 years under the auspices of national, regional and/or local government public health departments. Although the range and scope of this development varies greatly between countries, the main reasons worldwide for the development of public health nursing have been crushing poverty, inequity, lack of basic health services, environmental pollution and infectious disease. The strong, informed leadership capacity of public health nurses has been vital in ensuring that innovative programs are developed, implemented and evaluated, and receive ongoing funding.

Terms such as ‘healthy settings’, ‘community health’ and ‘community wellness’ have evolved through public health initiatives over the last century. The Healthy Cities projects were developed in response to the Ottawa Charter, which called for the creation of ‘supportive environments’ (World Health Organization 1986:2). Most work by the World Health Organization (WHO) to date has related to WHO Healthy Cities projects initiated by the WHO Regional Office for Europe (Baum, 2008 and World Health Organization (WHO) 2003 Phase IV, 2003–2007). Many countries, including Australia, have initiated a range of healthy community projects (Baum 2008). The WHO Healthy Cities project has four overarching actions:

If you are just beginning to work as a community nurse in any setting, it is very useful to find out exactly what other healthcare providers and agencies are doing in your area to support healthy communities.

In order to develop an understanding of the community, a community nurse will need to investigate the issues and resources related to the health of the community (Jackson & Edgecombe 2008). A community assessment is one strategy used to provide current information on local services and programs that may be useful for clients (Stanhope & Lancaster 2008).

There are a number of methods you can use to assess your local community. These may include:

Evidence-based Healthcare (Muir Gray 2001) is a very useful background text for community assessment. It also contains lists of key websites. The Australian Institute of Health and Welfare offers current data on a wide range of health-related issues. The data cubes contained on this website allow easy access to up-to-date information. The following websites are useful for community assessment:

It is useful to use a conceptual model to guide your community assessment. Bronfenbrenner’s (1979) ecological model of human development is being revisited by leaders in child health (Australian Research Alliance for Children and Youth (ARACY), 2006, Australian Institute of Family Studies, 2002, Keating and Hertzman, 1999 and Scott, 1992) because of the growing interest in how families relate to their local communities and larger social systems (Scott 1992: 204). This model can be helpful for community-based nurses undertaking a community assessment when considering the complexity of the influences impacting on any family or community.

Another useful document to consider for guiding a community assessment is ‘Social determinants of health: the solid facts’ (Wilkinson & Marmot 2003). This document is based on evidence supporting the impact of the ten main social determinants on our health:

Any assessment of a community must include an understanding of cultural diversity. McMurray (2004:16–17) also points out the need for evidence-based nursing practice that is culturally sensitive. The Department of Human Services (2004b), Victoria, has published a useful ‘Cultural diversity guide’. The policy statement’s core principles are: valuing diversity; reducing inequity; encouraging participation; and promoting the social, cultural and economic benefits of cultural diversity.

Community health nursing takes place within the context of public health considerations. Public health is a population-based approach to healthcare. Community health nurses will integrate their knowledge of the community with knowledge about the entire population of the country (i.e. Australia) to formulate understandings of the health and illness experiences of individuals and families within the population they serve. Last (1988) states that public health is:

A feature of public health programs is the concept of universal service provision. Universal health services are usually free at the point of access and are intended to promote equal access to all individuals and families. Such services provide scope for more intensive services for those who need extra support (Elkan et al 2001). Examples in Australia include Homeless Outreach Psychiatric Services (HOPS), Victoria’s Maternal and Child Health Service, school nursing programs, the QUIT program, and drug and alcohol services (Duckett 2004:167, Keleher 2004:102). In the past, many more services were provided in this manner to people on the basis of their need, but a growing number now have a fee or co-payment requirement (Hopkins & Speed 2005).

‘Old’ and ‘new’ public health are terms used to describe the change in approach to public health. Table 18.2, adapted from Baum (2008:37), is very useful when trying to compare the changes that are still taking place. Many of the strategies of the ‘old’ public health are still very important in the ‘new’ public health. This can be very confusing for new community nurses to unravel and understand.