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Volume 1 Nomor 6, August 2024
e-ISSN : 3047-017X
Oshada; Jurnal Kesehatan DOI : https://doi.org/10.62872/gbna7b66

The Role of Community Nurses in Improving Public Health:

Strategies and Implementation of Educational Programs

Paulus Subiyanto1, Masruroh2, Catur Budi Susilo3, Destiana4

STIKes Panti Rapih Yogyakarta1, Fakultas Ilmu Kesehatan, Universitas Darul
Ulum2, Poltekkes Yogyakarta3,4
e-mail: paulus.subiyantoluc@gmail.com1, maserha@gmail.com 2, catursusilo44@gmail.com 3,
destianasuud99@gmail.com 4

ABSTRACT
Community nurses play an important role in improving community health
through the implementation of educational strategies and programmes tailored to local
needs. This study aims to explore the role of community nurses in designing,
implementing and evaluating health education programmes to improve the quality of
community health. The methodology used included an extensive literature review and
case study analysis of several communities that have adopted such programmes. The
results showed that community nurses contribute significantly to improving health
awareness, knowledge and behaviours, resulting in improved quality of life and reduced
incidence of preventable diseases. Effective education programmes are designed using
interactive learning methods, such as workshops, group discussions and individual
counselling, tailored to the characteristics of the local community. The success of the
programme relies heavily on a collaborative approach between nurses, communities and
local health stakeholders. Ongoing support through professional training and increased
community engagement are key factors for long-term success. This study concludes that
the role of community nurses extends beyond basic medical care to include functioning
as change agents in sustainable health promotion. Recommendations include
strengthening the capacity of community nurses through ongoing training and
developing policies that support the integration of this role in a holistic public health
system.
Keywords : Community Nurses, Educational Programs, Publich Health

INTRODUCTION
Improving public health is key to reducing social inequality and injustice
(Augustia, 2024). Public policies based on the social determinants of health and
adequate public health services are needed to improve these social determinants
(Adler, 2016). The development, implementation and evaluation of health
policies and services play an important role in promoting health, well-being and
equity in society. The Health for All concept aims to build capacity, systems and
resources that support communities. In many countries, public health nurses
(PHNs) have a great responsibility in promoting and improving community
health. In daily practice, PHNs are able to identify health issues related to
individuals, families, and communities that require intervention through the
development of public health policies and services (Deal, 2024). Reducing the

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gap between public health needs and enriching the health care system is a public
health management strategy that needs to be developed sustainably (Desalvo,
2017).
Improving public health is one of the main goals of the global health
system (Byskov, 2019). General health conditions and ensuring universal access
to health services are very important priorities worldwide (WHO, 2018). An
effective health system not only focuses on treating diseases after symptoms
appear, but also prioritises prevention and health promotion (Beaglehole, 2018).
Prevention aims to prevent the onset of disease through measures such as
vaccination and health screening, while health promotion seeks to raise public
awareness about the importance of healthy lifestyles and health-supportive
behaviours. These aspects are fundamental in maintaining people's well-being
in a sustainable manner, as they contribute to reducing the burden of disease and
improving quality of life. In this context, community nurses play a very strategic
role. They act as a link between health services and the community, serving as a
bridge that connects health facilities with local communities (Cadet, 2019).
Community nurses not only deliver health information and provide education
on disease prevention, but also assist people in accessing the health services they
need (Zhao, 2021). Community nurses play an important role in ensuring that
health programmes and medical services can effectively reach the community,
as well as facilitating effective communication between patients and health care
providers (Seymour, 2020).
The important role of community nurses in improving community health
is through the implementation of educational strategies that are tailored to local
needs (Gilmore, 2023). As the paradigm shift in health care now places more
emphasis on prevention and health promotion, community nurses not only
provide basic medical services but are also actively involved in designing and
implementing health education programmes. These programmes often involve
interactive learning methods such as workshops, seminars and individual
counselling to improve understanding and healthy behaviours in the community
(Davis, 2019). When programmes are implemented, their effectiveness shows
significant variation depending on the strategies applied and the local context
(Durlak, 2018). A key challenge lies in integrating these programmes with local
health policies and ensuring active community engagement (Lambert, 2020). An
in-depth evaluation of how educational strategies implemented by community
nurses influence people's health awareness, knowledge and behaviours, as well
as identification of factors that influence the success of the programme
(Saunders, 2020). This study aims to fill this knowledge gap and provide
recommendations to improve the contribution of community nurses in
sustainable community health promotion.
Community nurses have broad responsibilities in health prevention and
promotion efforts (Iriarte, 2020). Community nurses are involved in a variety of
activities that aim to increase public awareness of the importance of health,
provide relevant information, and implement programmes designed to prevent

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disease and promote healthy lifestyles. These activities include counselling on
good health practices, such as the adoption of a balanced diet, personal hygiene,
and preventive health care. Community nurses provide information on the
benefits of consuming nutritious food, proper handwashing techniques, and the
importance of regular health check-ups. Community nurses play an important
role in chronic disease management. Their job is not only to provide education
on how to control health conditions such as diabetes, hypertension or heart
disease, but also to assist the community in monitoring and managing these
conditions on an ongoing basis. This involves training on proper medication use,
stress management techniques, and strategies to achieve optimal disease control.
Community nurses often collaborate with patients to formulate individualised
care plans and ensure that patients understand and adhere to these plans.
In practice, community nurses work closely with local communities to
identify specific needs and tailor educational programmes according to local
culture and conditions. Interactive and participatory methods, such as
workshops, discussion groups, and health campaigns, are used to deliver health
messages in an effective and accessible manner. This approach not only
disseminates knowledge, but also motivates individuals to adopt healthy
behaviours that can contribute to overall health improvement in the community.
Community nurses play a strategic role in shaping healthy lifestyles in the
community and ensuring that prevention and health promotion efforts are
thorough and sustainable. Their responsibilities include not only education and
disease management, but also active involvement in the development and
implementation of health strategies that meet the needs of the communities they
serve.
The definition of empowerment in the community psychology literature
suggests that this concept can increase individuals' competence and self-esteem,
which in turn increases their perception of personal control. This increased
personal control directly affects individuals' health conditions, as they feel more
capable in managing aspects of their own health. This theory of empowerment
can be extended to include dimensions of social relationships and interactions
with the community. In this context, empowerment focuses not only on
strengthening individuals but also on forming social networks and engaging
with the community. By establishing closer relationships with others and the
community, individuals are expected to gain additional strength through
changes in the external environment and wider social support.
There is a lack of in-depth understanding of the role of community nurses
in the context of developing and implementing health education programmes.
While many studies have addressed the medical aspects of the role of
community nurses, their contribution in designing and implementing health
education programmes has received less attention. Existing research generally
focuses on the provision of basic medical services, without exploring in detail
the effectiveness of various educational strategies implemented, especially in
different local contexts. In addition, while various education programmes have

Oshada, Vol.1 No.4 August 2024 31

been implemented, there is a lack of systematic evaluation of the outcomes and
long-term impact of these programmes on community health. The lack of
consistent data and in-depth analysis of how local factors influence programme
success points to the need for further study. In addition, little research has
examined the collaboration between community nurses, communities and local
stakeholders in the planning and implementation of health programmes, and
how this collaboration affects programme effectiveness. Thoroughly evaluating
the role of community nurses in health education programmes and analysing the
factors that influence programme effectiveness in different local contexts may
provide new insights to improve their contribution to community health
promotion.
Empowerment also has a significant positive impact on productivity in
healthcare. When analysing nursing productivity, especially in challenging
situations such as during a disease pandemic, it is important to consider factors
such as nurses' critical thinking, psychological status, and support from the
workplace. Research shows that nurses who feel empowered tend to complete
their tasks more effectively. Higher levels of organisational productivity and
better performance in nursing practice. Empowerment creates supportive
working conditions, strengthens nurses' critical skills, and improves
psychological well-being. Empowered nurses are better able to face challenges,
adapt to changing situations, and provide high-quality care to patients.
Empowerment plays an important role in leadership development and
collaboration within the nursing team. Nurses who feel empowered are more
likely to engage in innovative decision-making and initiatives, which in turn
improves team dynamics and promotes continuous improvement in healthcare.
Empowerment creates a working atmosphere that facilitates open
communication, skill development, and knowledge exchange, all of which
contribute to operational efficiency and better care outcomes. Thus,
empowerment is not only a strategy to improve individual performance, but also
a key element in creating a positive and productive work culture in healthcare.
The role of community nurses in improving community health through
the implementation of educational programmes. While community nurses are
recognised as having an important role in health education, disease prevention
and primary care, there is variability in the effectiveness of their role which is
influenced by the different educational programmes implemented. These
programmes often differ in terms of materials, learning methods and support
provided, which can affect how community nurses apply their knowledge and
skills. The implementation of educational programmes often faces challenges
such as resource limitations, differences in local contexts, and resistance to
change, which can affect programme success and public health outcomes. This
research is important to evaluate in depth how the strategy and implementation
of education programmes can be optimised, as well as to identify factors that
influence the effectiveness of community nurses in the public health context. This
research aims to uncover the best ways to improve the impact of education
programmes on community nurse performance and public health outcomes.

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 Community nurses play a very important role as educators in the
community, with the primary responsibility to teach and promote healthy
lifestyles. Their duties are not only limited to the delivery of health information,
but also involve an active process of facilitating positive changes in people's
behaviour and knowledge. Through various health education programmes,
community nurses seek to change people's habits by providing relevant and
useful information on disease prevention, healthy lifestyles, and health
management. According to Rahmah et al. (2016), health workers, including
community nurses, have a key role in providing health education. The aim of
this education is to change people's knowledge and habits in a sustainable way,
so as to promote optimal health. Community nurses carry out this role through
various activities such as counselling on infectious disease prevention,
environmental health promotion, and education on healthy eating and physical
activity.
Implementing this educative role, community nurses also act as
facilitators who bridge communication between the formal health system and
the community. They must be able to identify the specific health needs of the
communities they serve and customise educational materials according to the
local context. This includes customising information to suit the community's
level of understanding as well as considering relevant cultural and social aspects.
Community nurses also play a role in developing and implementing strategies
that encourage active community participation in health programmes. This
includes involving the community in the planning and evaluation of health
programmes, as well as providing ongoing support to ensure that the desired
behavioural changes are achieved. These efforts are important to ensure that the
health education provided is not only received, but also effectively implemented
in the daily lives of the community. Overall, community nurses as educators
have broad and complex responsibilities. They not only act as conveyors of
information, but also as agents of change who play an active role in empowering
the community to adopt a healthy lifestyle. Their involvement in health
education is expected to result in a significant impact towards improving the
overall health of the community, as well as contributing to the achievement of
better health in the long run.

RESEARCH METHODS
This study used a qualitative approach with a case study design to explore
and understand the role of community nurses in health education programmes.
This method allowed the researcher to gain in-depth insights into the
experiences, perceptions and challenges faced by community nurses in
programme implementation. This research utilised literature review as the main
method for collecting data. The literature study was conducted by reviewing
various relevant academic sources, including journal articles, books and research
reports that address the role of community nurses in health education
programmes. The sources were selected based on their relevance and
contribution to the understanding of educational strategies, programme

Oshada, Vol.1 No.4 August 2024 33

implementation and challenges faced. Data from the literature study were
analysed using a thematic analysis approach. The analysis process involved
identifying and coding the main themes that emerged from the review of the
sources. These themes were then categorised and interpreted to understand
significant patterns and relationships related to the role, strategy and
implementation of health education programmes. The literature review aimed to
develop a comprehensive picture of the contributions of community nurses, as
well as identify best practices and challenges often encountered in the
implementation of health education programmes. The results of the literature
review are expected to provide a solid foundation for a deeper understanding of
programme effectiveness and the role of community nurses in improving the
overall health of the community.

RESULT AND DISCUSSION

Community nurses play a crucial role in improving public health through
various interventions at the local level (Akbar, 2020). Community nurses are
responsible for providing health services that include disease prevention, health
education, and primary care (Mhlongo, 2020). In this context, educational
programmes are designed to strengthen their ability to carry out these tasks
effectively. The significance of educational programmes lies in their ability to
develop the practical skills and theoretical knowledge of community nurses,
which can further improve health outcomes in the community. Strategies in the
development of educational programmes for community nurses should be
tailored to the specific needs of the communities served. Educational
programmes should be designed to address the local health challenges faced, for
example by adding training modules on endemic diseases common in the area
or providing skills in relevant case management (Beaglehole, 2018). The learning
methods used should be interactive and evidence-based, such as practical
simulations, case studies, and community-based training, to ensure that
community nurses not only understand the theory but can also apply it in real
situations. The implementation of educational programmes often faces various
challenges that need to be overcome to ensure success. Limited resources, both
in terms of budget and facilities, can hinder the optimal implementation of
training. Time constraints are also often an issue, as many community nurses
have busy work schedules. In addition, differences in local contexts, such as
cultural, social and economic aspects, can affect how education programmes are
received and implemented. To overcome these constraints, adjustments in
educational programmes are necessary, including flexibility in training time,
provision of locally relevant materials, and ongoing support and access to
additional resources (Frehywot, 2023).
Community nurses play a very important strategic role in the improvement
of public health through the implementation of educational programmes tailored
to local needs. Their functions are not only limited to the provision of basic
medical care, but also include responsibilities in designing, implementing and
evaluating health education programmes. The main objective of these

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programmes is to effectively improve people's health knowledge, attitudes and
behaviours. Community nurses apply a holistic and evidence-based approach in
the implementation of educational programmes. Interactive learning methods,
such as workshops, seminars and individual counselling, are often used to meet
the specific needs of the community. Workshops and seminars provide a forum
for communities to participate in health discussions, obtain up-to-date
information and share experiences. This method allows community nurses to
identify and address specific concerns faced by the community and tailor
educational materials to local realities.
Individual counseling is a key element in health education programs.
Community nurses can provide advice that is more personalized and specific to
individuals' needs, and help them develop action plans tailored to their personal
health goals. This approach also allows for more in-depth monitoring and
assessment of individual health behavior change. Community nurses also play a
role in building partnerships with various local stakeholders, such as community
organizations, educational institutions, and other health service providers. These
partnerships are important to ensure that health education programs receive
adequate support and can be integrated with broader public health efforts. This
collaboration also helps in resource mobilization, information dissemination, and
improved access to necessary health services.
Individual counseling is a fundamental element in health education
programs implemented by community nurses. The nurse's approach can provide
advice that is more personalized and suited to each individual's health needs.
Individual counseling allows nurses to evaluate each person's health condition
and specific needs in depth, and help them formulate an action plan that matches
personal health goals. This not only improves the individual's health knowledge
but also encourages more sustainable behavior change. Community nurses play
an important role in building partnerships with various local stakeholders, such
as community organizations, educational institutions, and healthcare providers
(Brownstein, 2021). These partnerships are crucial to ensure that health education
programs receive adequate support and can be integrated with broader public
health efforts. This collaboration enables resource mobilization, dissemination of
relevant information and improved community access to necessary health
services. Collaboration with various stakeholders also facilitates the exchange of
useful information and helps in identifying and addressing shortcomings in
health services.
Multi-stakeholder support allows health education programs to be
designed and implemented more effectively, meeting multiple needs and
adapting to changing community health conditions. Solid and effective
partnerships between community nurses and local stakeholders are key factors
in the success of health education programs, which ultimately contribute to
improving the overall quality of public health. A public health strategy is a
crucial framework for promoting, protecting and improving population health.
It encompasses a range of interventions, policies and programs designed to

Oshada, Vol.1 No.4 August 2024 35

address the various determinants and challenges of health, thereby contributing
to the overall well-being of the community.
A key strategy in public health is disease prevention and control, which
includes efforts to reduce the incidence of communicable and non-communicable
diseases through vaccination programs, early screening, and promotion of
healthy lifestyles. In addition, health promotion is also a major focus with the aim
of empowering individuals and communities to take control of their health
through behaviors that support physical, mental, and social well-being.
Addressing the social determinants of health, such as income, education, and
access to health services, is integral in reducing inequalities and ensuring every
individual has an equal opportunity to achieve optimal health. Emergency
preparedness and response is also an important component, where public health
systems must be ready to respond effectively to emergencies such as pandemics
and natural disasters.
Environmental health strategies are also prioritized, particularly in
reducing environmental risks that can negatively affect health, through the
enforcement of environmental standards and the promotion of sustainable
practices. At the global level, international cooperation is needed to address
health challenges that transcend national borders, such as infectious disease
outbreaks and climate change. The success of these strategies relies on close
cooperation between governments, healthcare providers and communities in
prioritizing health and well-being as a shared responsibility.
Systematic evaluation of health education programs is essential. This
includes assessing the achievement of program objectives, changes in people's
health knowledge and behavior, and identifying areas for improvement
(Nutbeam, 2018). Accurate data and in-depth analysis of evaluation results allow
community nurses to make evidence-based decisions that can improve program
effectiveness and strengthen their contribution to community health promotion.
Community nurses play an integral role in the health system through the
integration of innovative, community-based educational approaches and
collaboration with various stakeholders. This approach is expected to create a
sustainable positive impact on public health.
Evaluating the effectiveness of educational programs is an important step
to ensure that training provides significant benefits. Assessment should include
measuring concrete changes in the performance of community nurses, such as
improved clinical skills and managerial abilities. The program's impact on public
health outcomes should be evaluated through indicators such as reduced
incidence of disease, increased adherence to care, and improved quality of life
for patients (Hamine, 2015). These evaluations should be conducted
systematically and continuously to identify areas that require improvement and
to ensure that educational programs remain relevant and effective. The
increasing role of community nurses in improving public health requires
education programs that are carefully designed and effectively implemented
(Petersen, 2024). Such programs must be able to adapt to local needs, overcome
challenges in implementation, and be thoroughly evaluated to ensure that

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educational interventions have a real positive impact on community health. This
approach will not only strengthen the capacity of community nurses but also
contribute to improving the overall health and well-being of the community
(Karimi, 2024).
Research conducted by Nurhajati (2015) revealed that education has an
important role in organizing communities to improve health. Low education
levels often result in a lack of awareness of environmental health, which can
affect healthy behaviors within the family. Conversely, higher levels of education
can broaden understanding of environmental health and increase awareness of
the principles of Clean and Healthy Living (PHBS). With a better understanding
of diseases, their causes, and non-pharmacological treatments, people can
implement healthy lifestyles independently at home as a preventive measure
(Suprapto, 2019). In educational institutions, counseling on PHBS and training
on how to wash hands properly aims to enable students to recognize the risk of
disease caused by poor hand washing habits. The importance of emphasizing
handwashing behavior from an early age is based on research that shows a
relationship between handwashing habits and a decrease in the incidence of
worms (Umar, 2008). Worm infections can cause stunting and reduce students'
learning abilities. In addition, Suprapto's (2021) research also shows that the
education provided can increase knowledge and awareness of clean living
behavior.
The development of character education programs has yielded positive
results in a number of schools. The program involves various factors that
influence its implementation. Among the factors that support the success of the
character education program is the existence of a school curriculum and learning
activities that are integrated with character education. The barriers are the lack
of professional and character educators, limited access to information, and the
mental attitude of the students themselves. Nevertheless, the implementation of
character education programs in some schools has had a good impact on students
and their social environment.
The development of education in realizing a culture of character in schools
that is horizontal in nature can be done through habituation, exemplary, and
persuasive approaches or inviting school members in a subtle way, by giving
good reasons and prospects that can convince them. Active actions create ideal
situations and conditions in order to achieve ideal goals (Boyatzis, 2016).
Educational institutions only focus on indicators of educational quality that are
superficial and not deep. In fact, if examined further, there are many indicators
of educational quality that can be developed to create competent and quality
graduates (Chalmers, 2017). Research conducted by Khori shows a change in
consumer behavior, namely students and parents, who are now increasingly
demanding aspects such as the quality of graduates, educational facilities, and
education costs (Khori, 2016). Without the intention to make changes, these
indicators can cause educational institutions to become stagnant and not
develop.

Oshada, Vol.1 No.4 August 2024 37

 Health education programs developed by community nurses often use
various interactive learning methods, such as workshops, seminars and
individual counseling, to increase their effectiveness (Fordis, 2020). Workshops
and seminars provide a platform for communities to engage in open discussions
on relevant health issues. Through these sessions, participants obtain updated
information from experts, share personal experiences, and discuss health
management strategies. Workshops, with their interactive approach, encourage
active participation through group activities and simulations, while seminars
usually involve speakers from different backgrounds to provide a broader,
evidence-based perspective (Malik, 2016).
Individual counseling is an important element of educational programs,
allowing community nurses to provide advice that is more personalized and
tailored to the specific needs of the individual (Saunders, 2020). Nurses conduct
in-depth evaluations of each individual's health condition, provide appropriate
recommendations, and build closer relationships and increase individuals'
motivation to manage their health. Based on feedback from workshops,
seminars, and individual counseling, community nurses can customize
educational materials to make them more relevant and appropriate to the social,
cultural, and economic realities of the community (Surr, 2017). These adjustments
ensure that the information provided is more easily accepted and applied in
people's daily lives. This interactive method-based approach is expected to
increase community understanding and engagement, and result in positive
changes in health knowledge and behavior (Vergara, 2020).
Implementing educational programs is a complex process that requires
careful planning, implementation and evaluation of structured learning
initiatives to achieve specific educational goals. These programs, which can range
from early childhood education to professional development courses, play an
important role in developing knowledge, skills and attitudes that contribute to
individual and societal progress. Successful implementation of education
programs requires a comprehensive approach, including curriculum design,
resource allocation, teacher training and learner engagement. Good curriculum
design should be relevant and adaptive, integrating up-to-date information and
pedagogical approaches that suit learners' needs. Effective resource allocation is
also an important factor, ensuring the availability of materials, facilities and
technological tools that support the learning process.
Training and professional development for educators is essential to ensure
that they are able to teach effectively, using methodologies that suit the various
learning styles of learners. Learner engagement is also an important component,
as learners who are actively involved in the learning process tend to be more
motivated and achieve more optimal results. Evaluation and assessment play an
important role in providing feedback on program effectiveness, enabling
necessary adjustments to ensure the program remains relevant and effective.
Educational institutions can implement programs that improve the quality of
learning and contribute to the development of individuals and society as a whole.

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 Evaluating the success of a community service program involves systematic
monitoring during the implementation of activities, followed by a thorough
analysis after the program is completed (Saunders, 2020). The success of
extension is measured by seeing the extent to which knowledge about Clean and
Healthy Living Behavior (PHBS) increases according to predetermined
parameters (Kosasih, 2021). The monitoring results of the three main programs-
household PHBS counseling, PHBS counseling and practice in primary schools,
and community empowerment for environmental health improvement-show
excellent community participation (Rizal, 2018). In household counseling, the
community was actively involved in discussions and asked questions about
various health issues related to PHBS, indicating that they were very enthusiastic
about the information provided and committed to applying the principles in their
daily lives. In primary schools, the counseling program and training on proper
handwashing received a positive response from students.
Their ability to practice proper handwashing techniques shows that they
have understood and are able to apply the knowledge gained (Kumar, 2017). The
active participation of the community in environmental cleaning activities also
shows that they are committed to improving the quality of their surrounding
environment. This involvement indicates that the community empowerment
program is successful in increasing awareness and concern for environmental
health. Effective counseling can improve public health knowledge (Alamsyah,
2021). The results of monitoring and evaluation, which show an increase in
community knowledge and participation in maintaining environmental health
and cleanliness, can be concluded that this community service program has
succeeded in achieving the set objectives and having a positive impact on the
community.

CONCLUSION
Community nurses play a very important role in improving community
health through the implementation of educational programs tailored to local
needs. They not only provide basic medical services but also serve as prime
movers in health promotion. Educational programs designed and implemented
by community nurses using various interactive methods, such as workshops,
seminars and individual counseling, have proven to be effective in improving
people's health knowledge and behavior. Workshops and seminars provide a
space for communities to engage in open discussions, get up-to-date information
on health issues, and share health management experiences and strategies.
Individual counseling, on the other hand, provides advice that is more
personalized and tailored to each individual's specific needs. The success of these
programs largely depends on the ability of community nurses to adapt
educational materials to the local context and collaborate effectively with local
health stakeholders.
There is an urgent need to conduct systematic evaluations of health
education programs to assess their long-term impact. These evidence-based
evaluations will enable community nurses to make necessary adjustments and

Oshada, Vol.1 No.4 August 2024 39

 improve program effectiveness. In addition, strengthening the capacity of
community nurses through continuous training and developing policies that
support the integration of their role in the public health system are important
steps to achieve optimal results. Overall, community nurses have an integral role
in public health promotion through effective educational programs. With an
evidence-based approach that is responsive to local needs, they can maximize the
impact of health programs and contribute to improved quality of life. The
findings emphasize the need for continued support for community nurses as well
as the development of better evaluation strategies to ensure the long-term success
of health education programs.

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