The term “community” refers to a geographic location or a population of individuals who have common characteristics and culture. Community health nursing (CHN) is the field of nursing that provides primary health care to a wide variety of populations. Community development societies (CDS) are organizations that identify communities as the building blocks for society. The elements of a community include the people, their physical locality, their shared culture, and their relationships among each other. Due to global migration, more and more people are crossing into other regions and countries, resulting in entirely new community boundaries. Examples of communities are rural villages, homeless shelters, religious groups, and refugee groups. Smaller communities can exist within each community.

Three frameworks are used to understand communities: critical social theory, the Citizen Ladder of Participation framework, and ecological theory. Critical social theory addresses the need for social change to alter health-damaging conditions. The nurse can use several questions to assess and plan in response to a health issue: (1) What is the issue and who is defining the issue? (2) What is the history of the issue? (3) Whose health is damaged? Who benefits? (4) What are the inequities, and who has the political power? (5) How effective are programs, strategies, and policies used to address the issue? (6) What are the barriers to help and relief? and (7) What strategies have been tried, and what is their effect?

Applying the Citizen Ladder of Participation framework, the nurse assesses whether a community is at the informing, consultation, partnership, or delegated power level of participation. Informing is the lowest degree of participation, in which the emphasis is on a top-down flow of information, from officials to citizens. In consultation, officials consult citizens but do not necessarily follow citizen input. When there is a partnership between officials and the community, decisions are based on negotiation between officials (including community health nurses) and citizens. Communities using delegated power have the highest degree of citizen participation because they have the power and responsibility to assure accountability of a program or plan to the community.

According the ecological theory, health care decisions are made within a social context. Ecological theory helps the nurse to perceive and understand structural barriers to health promotion and illness prevention, to advocate for healthy public policy, and to help individuals make healthy lifestyle choices.

Community health nurses perform several roles, such as educator, advocate, researcher, consultant, direct care provider, social marketer, and facilitator. Advocacy is taking action to achieve a goal on behalf of another, based on the other person’s world view. The role of researcher includes collecting and analyzing community data for program planning as well as applying research to community problems. Consultation is the act of two or more health care professionals deliberating together to make a decision. Community health care nurses consult with other professionals and community clients themselves. As direct care providers, nurses apply the nursing process. A specialty in this area is the nurse epidemiologist, in which the nurse studies illnesses, their causes, and their distributions. The nurse in the social marketer role applies marketing techniques and skills to promote healthy living and health promotion programs. The facilitator role includes working with the community to address a community need.

Schools, the home (in home visits or through telecare), migrant clinics, rural areas, correction facilities, occupational health, and public health clinics are examples of settings for community based health care. The school nurse provides illness prevention, health promotion, and injury and illness interventions in the school setting. Nurses also provide community telehealth, the use of telecommunication equipment and communication networks for transferring healthcare information between participants at different locations. Telecare involves monitoring the daily living of individuals at risk and providing health information. Nurses work with migrants (laborers who move from one location to another in pursuit of work) at immigrant clinics, identifying the health needs of the migrant community and developing programs to address those needs. Nurses, including community nurses, nurse midwives, and nurse practitioners, provide much of the health care in rural areas. Nursing services in the correctional setting range from ambulatory care to comprehensive health programs. Nurses working in occupational health settings provide primary care, health promotion and education programs; strategies to reduce worker injury and safety; and rehabilitation. Finally, public health clinics employ nurses as educators, case managers, and direct care providers.

Community partnerships are combinations of community-based agencies, health care clinicians, educational institutions, and public organizations formed to address the health needs of a specific community. Examples are homeless advocacy, parish nursing, and international partnerships.

Community health nurses apply the nursing process by addressing the health needs of populations. They assess the needs of a group to ascertain common concerns or appropriate interventions through surveys, observations, record reviews, and literature review. Nursing diagnoses in community health include needs for health promotion, illness prevention, and illness management. One system available for formulating nursing diagnoses is the OMAHA system, developed by the Visiting Nurses Association of Omaha, Nebraska. The nursing diagnoses in this system are stated as problems and are classified as environmental, psychosocial, physiological, or health-related problems. Before planning for community intervention, nurses must establish rapport with community groups. Community interventions are carried out through the various community health nursing roles. Evaluation of community health care interventions is based on expected outcomes. The United States Healthy People 2010 outcomes are community goals established by the federal government.