community health nursing

1. COMMUNITY HEALTH NURSING I
UNIT I : INTRODUCTION TO COMMUNITY HEALTH
NURSING
MUHAMMAD SULIMAN
Post RN BSc.N
ROYAL COLLEGE OF NURSING
SWAT
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2. INTRODUCTION
Human beings are social creatures. All of us, with rare
exception, live out our lives in the company of other people.
An Eskimo lives in a small, tightly knit community of close
relatives; a rural Mexican may live in a small village with
hardly more than 200 members. In contrast, someone from
New York City might be a member of many overlapping
communities, such as professional societies, a political party,
a religious group, a cultural society, a neighbourhood, and
the city itself. Even those who try to escape community
membership always begin their lives in some type of group,
and usually they continue to depend on groups for material
and emotional support. Communities are an essential and
permanent feature of the human experience.
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3. OBJECTIVES:
In the end of this presentation the students will be
able to:
 Define community, community health, community
health nursing, urban & rural communities
 Discuss the concepts of health, wellness, illness
and disease.
 Discuss the historical background of Community
Health Nursing from Public Health Nursing.
 Enlist the essential functions of community health
nursing.
 Discuss the roles of the Community Health Nurse
in community settings.
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4. COMMUNITY
a group of people living in the same place or
having a particular characteristic in common.
community refers to a collection of people who
interact with one another and whose common
interests or characteristics form the basis for a sense
of unity or belonging.
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5. Cont…
It can be a society of people holding common rights and
privileges (e.g., citizens of a town), sharing common
interests (e.g., a community of farmers), or living under the
same laws and regulations (e.g., a prison community). The
function of any community includes its members’ collective
sense of belonging and their shared identity, values, norms,
communication, and common interests and concerns
(Anderson & McFarlane, 2004).
Although most communities of people share many aspects of
their experience, it is useful to identify three types of
communities that have relevance to community health
practice: geographic, common interest, and health problem
or solution.
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6. COMMIUNITY HEALTH
Community Health is a discipline concerned
with the study and improvement of the health
characteristics of different communities.
Community health tends to focus on
geographical areas, and includes primary,
secondary and tertiary healthcare.
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7. PUBLIC HEALTH
Public health refers to all organized measures
(whether public or private) to prevent disease,
promote health, and prolong life among the population
as a whole. Its activities aim to provide conditions in
which people can be healthy and focus on entire
populations, not on individual patients or diseases.
Public Health includes community health. Public health is
"the science and art of preventing disease, prolonging life
and promoting health through the organized efforts and
informed choices of society, organizations, public and
private, communities and individuals”.
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8. Cont…
It is concerned with threats to health based on
population health analysis. Public health
incorporates the interdisciplinary approaches of
epidemiology, biostatistics and health services,
environmental health, community health,
behavioural health, health economics, public
policy, insurance medicine and occupational
health (respectively occupational medicine) are
other important subfields.
A CH service might be responsible for delivery of a
range of interventions in a local community, while the
PH Service might be involved at a policy level
looking at quality of water, traffic calming, or budgets
for drugs.
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9. COMMUNITY HEALTH NURSING
Community health nursing is to “assist the
Individual, family and community in attaining
their highest level of holistic health. To
provide and promote healthy life style choices
through education, public awareness and
community activities.”
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10. URBAN & RURAL COMMUNITIES
Rural community is a society that is in a rural
area ( country side ). An urban community is a
society that is in an urban area ( town or city )
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11. URBAN COMMUNITY
An Urban Community is a big city or town. It is
considered an Urban Community if there are more
than 2,500 people living in the community. Urban
communities are often busy and crowded. Normally,
the city is the most central location in a region. It is
also referred to as downtown. In an Urban
Community there are many buildings, houses, and
people. People often live close together.
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12. RURAL COMMUNITY
an area outside of cities and towns;
According to the US Census Bureau, a rural community is
one that does not qualify as an urban community.
Specifically, if a territory has more than 2,500 people
per square mile, it is defined as urban. Areas with less
than 2,500 would then be considered rural.
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13. 13

14. HEALTH
“a state of complete physical, mental, and social
well-being and not merely the absence of
disease or infirmity”
“World Health Organization”
ILLNESS:
A highly personal state in which the person feels
unhealthy, may or may not related to disease.
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15. WELLNESS
An integrated method of functioning which is
oriented toward maximizing the potential of
which the individual is capable.
OR
an active process by which an individual
progresses towards maximum potential
possible, regardless of current state of health
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16. Historical Development of Community
Health Nursing
The modern concept of community health and
welfare is one which has taken many centuries
to evolve. All ancient civilization particularly
Egypt, India and China developed their own
specific team of medicine.
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17. Historical Development of Community
Health Nursing
• Egypt appeared to have been the first and the
best in the field that had a fully developed
medical system by 3000BC.
• China appeared around 450 BC.
• Indian system of medicine around 200BC
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18. In modern period changes in development of
medicine and public health under different stages.
• Empirical health era (1800-1850)
• Basic science era (1850-1900)
• Clinical science era (1900-1950)
• Public health science era (1950-1975)
• Political science era (1975-2000)
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19. Public Health Science Era (1950-1975)
In this period preventive oriented approach
started. Now it is being called an era of the
community centered approach.
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20. Political Health Science Era (1975-2000)
In this period the involvement of the
community leaders and the members of
the health program was practiced stage
by stage.
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21. Early Home Care Stage (before mid 1800s)
1. Focus: Sick poor
2. Nursing orientation: individuals
3. Service: curative
4. Agencies: Lay & religious orders
(St. Phoebe)
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22. District Nursing (mid 1800-1900s)
1. Focus: Sick poor
2. Nursing orientation: Individuals
3. Service: Curative/preventative
4. Agencies: Voluntary & some government
(Willium Rathbone)
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23. Public Health Nursing (1900-1970)
i. Focus: needy public
ii. Nursing orientation: families
iii. Service: Curative/preventative.
Iv. Agencies: Voluntary & some voluntary
(Lilliam Wald)
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24. Community Health Nursing (1970 to present)
i. Focus: total community
ii. Nursing orientation: population
iii. Service: health promotion, illness prevention
iv. Agencies: many kinds, some independent practice
(Ruth Freedman)
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25. Development of public health in indo-Pakistan
1802- Vaccination started
1827- Vaccinators appointed
1875- Superintendent- general of vaccination Punjab
1880- Small pox vaccination Vs small pox inoculation
(injection)
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26. Development of public health in indo-Pakistan
1859- Royal commission focus curative care
but formation of local bodies 1888 looks after senators
1896- Plague
1904- Plague commission-strengthen PH services
1919- Reforms (improvement) government of India health
transferred to provinces
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27. Development of public health in indo-Pakistan
1946- Bhore committee-health survey
→ Health as basic human right
→ Preventive importance
→ Health care accessible
→ Community participation
→ Development of primary and secondary unit
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28. Development of public health in Pakistan
Starting with Bhore report- poor condition
1947-1951 -start with five years plans, opening
of medical and nursing school,
laboratory of medications.
1958 -revolutionary (new) government of
Pakistan focused as preventive
health was linked with Socio-
economical care.
- Many vertical programs existed.
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29. Development of public health Pakistan
1978- HFA-2000 basic health science, PHC, RHC,
- Increase horizontal program
-School health, training, and other activities
took birth, health care workers
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30. 30
Communities:
Essential Functions
• Production, distribution or consumption of items
• Socialization
• Transmission of culture
• Provision of norms/social controls
• Provision of mutual respect

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Communities:
Four Critical Attributes
• Group orientation
• Bond among individuals
• Human interaction
• Collective action

32. Role of community Health nurses
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33. 33
General roles Cont…
• Clinician/Care provider (Functional role)
In community health practice, providing nursing care
is different than in hospitals. This is because the target
of service expands beyond the individual to include
families, groups, and communities.

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• Functional role:
• Case finding and referral of needed cases.
• Complete history taken about each individual.
• Assist in any examination done.
• Know the first aid measures to implement it in
emergency.
• Know the health services available in the
community and use the system of referral when
needed.

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Cont..
Community health nurse provides care in following
forms:
• Provide Geriatric care
• Provide antenatal and post natal care
• Provide Neonatal care
• Conduct the deliveries in the communities

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General role Cont…
• Provide formal exercises to the bed ridden
individuals having paralysis
• Provides the first aid
• Provide nursing procedures like cold sponging
if fever is observed in any member of family in
community
• Wound dressing
• Treats minor illnesses

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• Educator:
Health teaching is part of good nursing care and
one of the major functions of the community
health nurse, mainly concerned with health
promotion.

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Educator role Cont…
• As educator, community health nurse focus on
the following teaching:
• Educates individuals, family and community for
the principles and techniques of proper
prevention of communicable diseases

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Health educator Cont…
• She teaches about the proper diet in quantity and
quality
• Teaches the personal, family and community
hygiene
• Teaches the handling of first aid techniques for
emergencies like snake bite
• Trains the traditional birth Attendants for normal
delivery and delivery in communities.

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Manager role Cont…
• Organizes and manages various programs of
health and assume leadership of nursing team for
supervision of nursing and other staff.
To manage resources for health programs
and implement them effectively in the
community.
FINANCING
STAFFING

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Role conti….
• Leader
• Community health work in the community
Guide them towards better health as leader.
• Researcher
The researcher's role is an integral part of the
community health nursing practice.
The researcher's role at all levels helps to determine
needs, evaluate effectiveness of care and develop
theoretical basis for community health nursing.

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• Role in research and evaluation:
• Help in evaluating the health program.
• Must have knowledge about how to keep
records related to the people who utilize the
clinic.
• She must complete the questionnaire for
purpose of accurate study.
• Analysis and evaluation of nursing practices to
fulfill the statistical survey.

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THE ROLE OF THE COMMUNITY HEALTH NURSE
IN THE CLINIC:
• Administrative role:
• Participate in the organization of health
program in the institution.
• Delegation of work.
• Plan of work hours.
• Cooperation with other health members.
• Systematic gathering of information for
evaluation.

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• Supervisory role:
• Understanding the policy of her agent.
• Supervise the function of her staff.
• Give in-service education program to the other
health team.
• Guides group discussion with staff.
• Guides her staff to overcome their difficulties
in work.

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• Advocate:
To speak in the community. She participates the
district Govt meeting and talks to
administration for the favor of talks for solution
of health care, social and financial problems
available in her constituency.

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APPLYING THE ROLE OF COMMUNITY HEALTH
NURSE ACCORDING TO NURSING PROCESS
(role in home visit)
1. Assessment:
• Identifying the needs of the family before
making the visit. By analyzing data available
in the family records, know all family members;
whether there are any children, if so, what are
their ages; what the health problems of this
family are; the environment of the house. Then
actual visit.

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2. Planning:
• Planning can be short term or long term, and
interventions can be implemented immediately
over a long period of time.
• Short term plans are those which can be met in
a few weeks time whereas long term plans are
accomplished over many weeks or perhaps
months or years.

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• In planning, the following are done:
– Setting the goal / objectives for the visit.
– Identifying the needs and health problems of the family.
– Specifying the actions to be carried out by the nurse during
the home visit e.g. health teaching about nutrition,
– Select proper place and time for carrying the visit.
– Prepare necessary equipment, instruments and material
which the nurse will need during the home visit i.e. cotton,
eye drops, etc.

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3. Implementation:
During the home visit, the nurse should:
 Identify the traditions & customs and healthful practices of the
family.
 Use effective therapeutic communication.
 Use audiovisual materials in teaching, also available home
utensils and materials.
 Emphasize to the family that this visit was made for them.

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Cont….
 Tie the family with the center. Explain services
offered.
 Answer questions rose from family members
clearly.
 Do not record any word said by family
members in front of them.
4. Evaluation:
• Evaluate whether the objectives were fulfilled
or not. If not, should know the reasons and
correct it.

51. References
Sarah Coulter Danner.community helth.4th Ed.
Department of Nursing Oglala Lakota College
Japee tapa.Community health nursing.3rd Ed.1998
New Dehli,india.
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52. QUESTIONS??
THANK YOU
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