Community health nursing

Definition

According to American Nursing Association,

“Community health nursing is a synthesis of
nursing practice and public health practice
applied in promoting and preserving the
health of populations. the nature of this
practice is general and comprehensive. it is
not limited to a particular age or diagnostic
group. It is continuous and not episodic. The
dominant responsibility is to the population
as a whole”
 Philosophy of CHN

Philosophy of individual’s right of being

healthy
Philosophy of working together under a
competent leader for the common good.
 Philosophy of CHN

Philosophy that people in the community

have the potential for continual development
and are capable of dealing with their own
problems if educated and helped.
 Philosophy of Socialism
 Aims of CHN

Aims: The aim of community health nursing

practice is to promote health and efficiency
To prevent and control diseases and
disabilities.
To prolong life by providing need based, well
balanced comprehensive health care services
to community at large through organized
community efforts.
 Objectives

1) To increase the capability of community to

deal with their own health problems.
 2) To strengthen community resources
 3) To control and counteract environment
4) To prevent and control communicable and
noncommunicable diseases
5) To provide specialised services
6) To conduct research
7) To prepare health personnel
 Principles of CHN

1)Recognized needs and functioning within

the total health programme.
2)Clearly defined objectives and purposes for
it’s services
3)An active organized citizens group of the
community group is an integral part of the
community health programme.
4)Community health nursing services are
available to the entire community
Cont..

5)Community health nursing recognized the

family and community as units of service.
6)Health education and counseling for the
individual, family and community are the
integral part of community health nursing.
7)Participation in planning relating to goals
for the attainment of health.
8)The community health nurse should qualify
as a full-fledged nurse.
9)Based on the needs of the patient and there
should be proper continuity of services to
patients
 Cont..

10) Periodic and continuous appraisal and evaluation

of health situation
11) The community health nurse should
function/serve as an important member of the
health team.
12)There should be provision for qualified nurse to
make supervision for community health services.
13)The community health nurse directs the patient to
appropriate community resources for necessary
financial and social assistance.
14)Should not accept gifts or bribes from the patients
 Cont..

15)The community health nurse should not belong to

one particular section or political group.
16)Community health agency should provide a
continuing education programme for nurse
17)The nurses assume responsibilities of their own
continuing professional development through
acquiring higher and higher education and forming
and strengthening the professional associations
18)The community health nursing services should
develop proper guidelines, in maintaining records
and reports.
19)There should be proper facilities and job
conditions.
20)The community health nurse should maintain
professional relationship with all leaders in the
community and maintain ethics at all times.
FUNCTIONS & QUALITIES OF A
COMMUNITY HEALTH NURSE
 Community health nursing

A community health nurse performs various

functions while she works in any defined
community health setting.
 There are various factors which determine
the roles & functions of a community health
nurse. They are as follows.
The designated position.
The organization’s policies.
The number and type of other health
workers.
A community health nurse performs various
functions while she works in any defined
community health setting.
 There are various factors which determine
the roles & functions of a community health
nurse. They are as follows.
The designated position.
The organization’s policies.
The number and type of other health
workers.
 CARE PROVIDER

She provides a continuous and comprehensive are

to the familily, group of people and community at
large
She emphasizes more on promotive and preventive
health care.
The community health nurse appraoches the
family and persuades them to implement
promotive and preventive measures.
Care during illness is beneficial gaining
acceptance, trust and confidence.
She also provides care during illness for which
usually the family members come forward to seek
help.
As care is given the nurse educates and helps
the family members to develop their abilities
and overcome their barriers so that they can
take care of their health and nursing needs,
promote their health and pre
The care is provided at home, clinic, school,
work place etc.
 This function is referred to as “CARE
PROVIDER ROLE”.
 2. HEALTH EDUCATOR

The community health nurse educates the individual,

family, groups of people and the community at large.
Health education thus given focuses on promoting
health, preventing illness and aspects related to care
during illness and rehabilitation & disability
prevention.
The nurse conducts planned health education
sessions for organized community groups e.g., school
children, antenatal mothers, eligible couples, elderly
etc.,
Health education for the family is planned and
implemented as part of the family care plan.
The community health nurses is involved in
giving incidental/casual/spontaneous health
education according to the situation.
(washing of hands before a child eats)
These functions refer to as “HEALTH
EDUCATOR ROLE”
 3. COUNSELLOR

The community health nurse helps individual,

families and the community at large to
recognize and understand their problems to
be solved, find solutions with-in resources
and implement feasible and acceptable
solutions.
 4. RESOURCEPERSON

The community health nurse explores

community resources in terms of money,
manpower, material, agencies etc.
 She makes use of these resources in helping
individual, family groups and community to
meet their health and nursing needs.
 5. SENSITIVE OBSERVER

The community health nurse makes

observations of any untoward change in health
behaviour and health status of the community,
people, their surroundings, unusual occurrence
of disease & take action acco
E.g., Providing information, health education to
people to improve their behaviour and health
status, working with the family and providing
direct care during illness, notification to health
authority about communicable disease.rdingly
 6. ADVISOR

The community health gives some

suggestions on practical situation which
requires immediate actions and where there
is little scope of health education.
• E.g., In case of a client with diabetes
mellitus, the community health nurse advices
with concern on the foods to be included and
avoided. (according to the socio –economic
condition of the individual & family)
 7. PLANNER

The community health nurse while giving

comprehensive care to family and community
makes a plan on the basis of identified health
problems and health & nursing needs.
She plans with other team members to
provide appropriate care, which is referred to
as planner role.
 8. CARE MANAGER

The community health nurse implements the care

which is planned for the family and community.
 She directly provides the care with the active
participation of family and community members.
She makes use of family and community
resources.
 She guides the family and community and refers
when required. She maintains a record of the
care given to families and the community.
The community health nurse evaluates the
effectiveness of care given in terms of change
in health status, health behaviour, reduction
in illness, improvement in clinic attendance-
immunization & rate of utilization of the
community health services.
 9. MEDICAL ASSISTANT ROLE

Community health nurse assists the physician

and coordinates wit the other team members
in the community health care team in
rendering co
She obtains orders from the physician and
explains it clearly to the clients, families,
helps and guides them to carry on medical
treatment at home.mmunity health services.
Other roles includes
Reseacher
Collaborator
Leader
Manager
Advocate
QUALITIES OF A COMMUNITY HEALTH
NURSE

1.INTEREST IN COMMUNITY HEALTH NURSING.

2. GOOD IPR SKILLS.
3. INTERESTED IN PEOPLE.
4. EMOTIONAL STABILITY.
5. GOOD COMMUNICABILITY.
6. GUIDING & HELPING NATURE.
7. SENSITIVE OBSERVATION.
8. GOOD LISTNER.
9. A FRIENDLY DISPOSITION.
10. INITIATIVENESS.
11. RESOURCEFULNESS
12. ENDURANCE & PATIENCE.
 Scopes of community health nursing

Community health nursing is concerned with

the people who are sick as well as the
healthy,young and old,male and female.
 At the same time community health nurse is
responsible for family centred care rather than
an individual oriented one
The community health nurse job is not only
limited to the sick but has equal responsibility
to prevent the disease and to preserve and
promote the health of the people.
 Scope includes

1. Home care

2. Nursing homes
3. Mch and family planning
4. School health nursing
5. Health care services
6. Industrial nursing services
7. Domiciliary nursing services
8. Geriatric nursing services
9. Mental health nursing services
10.Rehabilitation centers
1. Home care :
 Nursing practices is applied in meeting the
health needs of communities, families and
individual in their normal environment such as at
home.
2. . NURSING HOMES
The community health team which provides
nursingcare, treatment to the sick and health
counseling given in nursing homes.
3. Mch and family planning
 The public health nurse plays a major role in the
mch and family planning services.
 It comprises antenatal,postnatal and child care
services.
4. School health nursing
 The school health nurse provides services to
promote and protect the health of the school
children.
 She provides services like early detection of
disease, immunization first aid, dental health,
school sanitation, maintenance of health
records, health education, follow up and
referral services.
5. Health care services
 The purpose of health care services to
improve the health status of the population. it
aims at mortality and morbidity reduction,
increase in expectation of life, decreased in
population growth rate, improvements in
nutritional status, provision of basic
sanitation, health. manpower requirements
and resources development and certain other
parameters such as food production, literacy
rate, levels of poverty etc…
6. Industrial nursing services
The nursing service at industrial area includes
periodic health check up, care of the sick, first aid,
health counseling, industrial sanitation and safety,
organization of services to women and children ,
rehabilitation of the ill and disabled workers and
administration.
7. Domiciliary nursing services
Community health nurse focused at domiciliary
nursing services include maternity services health
supervision, and disease prevention services and
services for illness and accidents.
8. Geriatric nursing services
Community health nurse should take care of old
people in the community.
The need of the geriatric nursing care is
different and they need more care than the
younger age groups.
9. Mental health nursing service
Mental health nursing services of a community
health nurse include early diagnosis and
treatment rehabilitation, psychotherapy,use of
modern psychotropic drugs and after care
services.
10. Rehabilitation centers
The community health nurese provide care in
rehabilitation units.
Nursing is an important component in the
rehabilitation of the disabled.
 Definition of health

The World Health Organization (WHO)

defines health as a “state of complete
physical, mental, and social well-being, not
merely the absence of disease or infirmity”
(WHO, 1947)
 Concept Of Health

 An understanding of health is the basis of all

the health care
Health is not perceived the same way by all
the members of a community including
various professional groups (like biomedical
scientists, social scientists, health
administrators, ecologists) giving rise to
confusion about the concept of health.
Health has evolved over the centuries from
the concept of individual concern to a
worldwide social goal.
 The various changing concepts of health as
follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
 4. Holistic concept
 CONCEPT OF HEALTH

. Biomedical . Psychosocial
concept concept

CONCEPT
OF
HEALTH

Ecological Holistic
Concept concept
 1. Biomedical concept

Traditionally health has been considered as

an absence of the diseases and if someone
was free from disease, then that person was
considered healthy.
 This concept is known as biomedical
concept, and it is based on the “germ
theory of the disease.
Health means “absence of disease.”
 The medical profession viewed the human
body as a machine and disease is an
outcome of the breakdown of the machine,
and one of the doctor’s tasks was to repair
the machine.
 This concept has minimized the role of the
environment, social and cultural
determinants of the health.
 CRITICISM OF BIOMEDICAL
CONCEPT :

According to biomedical concept, one

factor ,i.e. Germ is responsible for illness ,but
other factors which contribute to the illness
are not considered.
But it has been seen that some of the health
problems such as accidents ,nutritional
deficiency disorders, mental disorders, disease
due to environment pollution also occur. Even
germs also get an opportunity to multiply and
thereby cause disease, it get appropriate
environment inside the body to grow.
Developments in medical and social sciences
led to the conclusion that the biomedical
concept of health was inadequate
 2. Ecological Concept

Deficiencies in the biomedical concept gave

rise to other concepts.
The ecologists put forward the concept of
ecological concept.
Ecologists viewed health as a dynamic
equilibrium between man and his
environment, and the disease as a
maladjustment of the human organism to
environment
 CRITICISM OF ECOLOGICAL
CONCEPT :

Ecologists have considered the external

environment of human beings ,but internal
environment is also responsible for disease.
E.g. ; Genetic inheritance, Hemophilia Mental
retardation
 3. Psychosocial Concept

Advances in social sciences showed that

health is not only a biomedical phenomenon,
but one which is influenced by social,
psychological, cultural, economic and
political factors of the people concerned.
These factors must be taken into
consideration in defining and measuring
health.
Thus health is both a biological and social
phenomenon
 4. Holistic Concept

The holistic model is a synthesis of all the

above concepts.
Holistic concept recognizes the strength of
social, economic, political and environmental
influences on health.
It has been variously described as
multidimensional process involving the
wellbeing of the person as a whole.
The emphasis is on the promotion and
protection of health.
The holistic approach implies that all sectors
of the society have an effect on health, in
particular, agriculture, animal husbandry,
food, industry, education, housing, public
works and other sectors.
 DIMENSIONS OF HEALTH

Physical
Mental
Social
Spiritual
Emotional
Vocational
 1.Physical Dimensions :

Physical health means perfect functioning of

the body in which each organ is working in
harmony with the maximum capacity.
 Physical health is achieved by the exercise,
healthy diet, adequate rest and sleep and no
smoking or alcohol intake.
To maintain proper physical health there is
need for taking safety precautions, and
regular follow up with the health care
providers.
 Signs of physical health :

 A good complexion.
 A clean skin.
 Bright eyes.
 Not too fatty.
 A sweet breath.
A good appetite.
Sound sleep.
Regular activities of bowels and bladder.
Smooth, easy, and coordinated bodily
movements
 Evaluation of Physical Health :

1. Self assessment of overall health.

2. Inquiry about ill health and risk factors.
3. Inquiry in to medications.
4. Standardized questionnaire for
cardiovascular and respiratory diseases.
5. Clinical examinations.
6. Nutritional and dietary history.
7. Biochemical and laboratory investigations
 2.Mental Dimensions :

 Mental health is a state of balance between

body and mind . Earlier the body and mind
were considered two separate entities.
 But these are interrelated as physical illness
can result mental illness and vice versa.
 How mental illness influence physical health
has been shown in
 Poor nutrition
Poor Decresed
intake
nutrition immune system
Mental illness
DEPRESSION intake

Prone to
Poor hygiene
infection

Physical illness
 Characteristics of mentally healthy
person :

1. Mentally healthy person will be capable of making

personal and social adjustment.
2. Mentally healthy person is free from internal
conflicts.
3. He faces problems and tries to solve them
intelligently.
4. He has good self control balances rationally and
emotionally.
5. He knows him self his needs problems and goals.
6. He has strong sense of self esteem.
7. He serches for identity.
8. He lives a well balanced life means able to maintain
the balance between work rest and recreation.
 3.Social Dimensions:

An individual is socially healthy if he is able

to maintain harmonious relationship with
other members of society in which he lives.
 Social health rooted in “positive material
environment” and “positive human environment”
which is concerned with the social network of the
individual.
 The social dimensions of health
includes;

Communication
 Intimacy
 Respect
 Equality
 Social functioning
 4. Spiritual Dimensions :

Spirituality means in touch with deeper self

and exploration the purpose of life, as people
believe in some force that transcend
physiology and psychology of human beings.
 It includes love , charity, purpose , principles
, ethics, intigrity,hope of life.
 Meditations ,prayers, or spiritual gatherings
are organized to maintain spiritual health.
 5. Emotional Dimensions :

 Emotional health is closely related to the mental

health and is considered as an important
element of health.
 Mental and emotional aspects of health are now
viewed as two separate entities for human life.
 Cognition is related to the mental health
whereas emotional health is related to the
feelings of a person.
 Emotional health includes ;
An emotionally healthy person has a
positive thinking and is capable of coping and
adjusting self.
An emotionally healthy person
participates in all the activities which are
related to personal growth and his self esteem.
Emotionally well people have the ability
to express feelings freely and manage feelings
effectively.
They are also aware of and accept a wide
range of feelings in themselves and others.
 6. Vocational Dimension :

The choice of profession, job satisfaction,

career ambitions and personal performance are
all important components of this dimension.
 To be occupationally well, a person is
ultimately doing exactly with what they want to
do in life and are comfortable with their future
plans.
 Vocational dimension of health can be assesed
by ;
Assessing the satisfaction level at job ,
Facilities attached to the job ,
Behaviour of the management and
 7.Other dimensions :

 A few other dimensions also suggested such

as ;
 Cultural dimensions
 Socio-economic dimensions
 Environmental dimensions
 Educational dimensions
Nutritional dimensions
Preventive dimensions