untitled

expert knower of the process. The facilitator’s role
is to encourage expressions of knowing so calls for
nursing and guidance for nursing responses can
be heard. In this way, the essential care for persons
and families can be known, and care designed,
offered, and evaluated (Barry, 1998; Parker, Barry,
& King, 2000).

COMMUNITY

Community, as understood within the model, was
formed from the classical definition offered by
Smith and Maurer (1995) and from the Peck’s exis-
tential, relational view (1987). According to Smith
and Maurer, a community is defined by its mem-
bers and is characterized by shared values. This ex-
panded notion of community moves away from a
locale as a defining characteristic and includes self-
defined groups who share common interests and
concerns and who interact with one another.
Community, offered by Peck (1987), is a safe
place for members and ensures the security of
being included and honored. His work focuses on
building community through a web of relation-
ships grounded in acceptance of individual and
cultural differences among faculty and staff and ac-
ceptance of others in the widening circles, includ-
ing: colleagues within the practice and discipline,
other health-care colleagues from varied disci-
plines, grant funders, and other collaborators. The
notion of a transdisciplinary care is an exemplar of
this approach to community. Another defining
characteristic of community, according to Peck, is
willingness to risk and to tolerate a certain lack
of structure. The practice guided by the model re-
flects this in fostering a creative approach to pro-
gram development, implementation, evaluation,
and research.
Practice in the model, whether unfolding in a
clinic or under a tree where persons have gathered,
provides a welcoming and safe place for sharing
stories of caring. The intention to know others as
experts in their self-care while listening to their
hopes and dreams for well-being creates a com-
munion between the client and provider that
guides the development of a nurturing relation-
ship. Knowing the other in relationship to their
communities, such as family, school, work, wor-
ship, or play, honors the complexity of the context
of persons’ lives and offers the opportunity to
understand and participate with them.

ENVIRONMENT

The notion of environment within this model pro-

vides the context for understanding the wholeness

of interconnected lives. The environment, one of

the oldest concepts in nursing described by

Nightingale (1859/1992), is not only immediate

effects of air, odors, noise, and warmth on the

reparative powers of the patient, but also indicates

the social settings that contribute to health and

illness. Another nursing visionary, Lillian Wald,

witnessed the hardships of poverty and disenfran-

chisement on the residents of the lower Manhattan

immigrant communities; she developed the Henry

Street Settlement House to provide a broad range

of care that included direct physical care up to and

including finding jobs, housing, and influencing

the creation of child labor laws (Barry, 2003).

Chooporian (1986) reinspired nurses to expand

the notion of environment to include not only the

immediate context of patients’ lives, but also to

think of the relationship between health and social

issues that “influence human beings and hence cre-

ate conditions for heath and illness” (p. 53).

Reflecting on earth caring, Schuster (1990) urged

another look at the environment, inviting nurses to

consider a broader view that included nonhuman

species and the nonhuman world. Acknowledging

the interrelatedness of all living things energizes

caring from this broader perspective into a wider

circle. Kleffel (1996) described this as “an ecocentric

approach grounded in the cosmos. The whole envi-

ronment, including inanimate elements such as

rocks and minerals, along with animate animals and

plants, is assigned an intrinsic value” (p. 4). This di-

rects thinking about the interconnectedness of all

elements, both animate and inanimate. Teaching,

practice, and scholarship require a caring context

that respects, explores, nurtures, and celebrates the

interconnectedness of all living things and inani-

mate objects throughout the global environment.

Structure of Services

and Activities

The model is envisioned as three concentric circles

around a core. Envisioning the model as a water

color representation, one can appreciate the vi-

brancy of practice within the model, the amor-

phous interconnectedness of the core and the

CHAPTER 25 Developing a Community Nursing Practice Model 393