Nursing models and community as client

Each of the four nursing frameworks discussed here represents worldviews that result in different meanings of the concepts of health, community, and, therefore, of community health. Orem's framework reflects a casual model of the community as an aggregate of individuals and a concept of health that is most akin to Smith's clinical and functional levels of health. Roy's model broadens to allow for consideration of the community as a system. The community as a system is perceived from the perspective of behaviors in response to stimuli. Causality is time ordered and linear, although one must consider the context of continuing time through the mechanism of feedback loops. Smith's adaptive level of health is most congruent with this perspective. King's conceptual framework views the community as a system interacting with the personal and interpersonal systems it includes. Causality is necessarily symmetrical within a systems approach. Health includes both role performance and adaptive levels of health. Finally, Rogers' model considers the community as a field in itself. That field is one of awareness, is integral with the environmental field, and is acausal in nature. Health as expanding awareness is most similar to Smith's eudaimonistic concept of health. It is proposed that these four frameworks reflect increasingly integrated conceptions of community health by which to guide public health/community health nursing practice.