unit 1community

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UNIT 1 INTRODUCTION TO CO TU

Structure1.0 Objectives1.1 Introduction /1.2 Development of Comm uility and Com munity I-Iealth Nursing , ,

1.2.1 The World/Global1.2.2 India

1.3 Concepts of C om nun ity Health Nursing1.3.1 Related to Community1.3.2 Related to Community Health1.3.3 Related to Community Health Nursing

1.4 Com munity Identification and Cormxlunity Diagnosis1.4.1 Identification1.4.2 Diagnosis

1.5 Comm unity Health Nursing Process1.6 Principles of Co m~ nun ityHealth Nursing1.7 Preparation and unctions of Com munity Health Nurse. 1.7.1 Educational Requirement

1.7.2 Competence Required1.7.3 Scope1.7.4 Role and Functions

1.8 Let Us Sum Up1.9 Key Words1.10 Answers t i Check Your P~o gre ss

After going through this unit, you should be able to :a summarize the events involved in the clianges arxd deve lopment in communityhealth in India;o define various terms, such as health, public health, com munity health andcommunity health nursing;a explain the concept of identification and diagnosis of com~ nunity ealth;a discuss community health n ursing process; and

describe the knowled ge, skill and attitude required to practice coinmunity healthnursing.

1 INTRODUCTIONIn this unit, you will go through the development of carnrnunity health in India andworld wide. We shall trace the historical development during various periods bcforeIndependence of India and in post indepenclence period, You will also he review ing


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Principles and Practice various terms commonly uszd in the course of community health nursing. AS youof CommunityHealth understand an individual's signs and symptoms for identification and diagnosis of her/Nursing his health status, sirnilarIy you will learn about the process of identification anddiagnosis of a family's health status and community health status. You will also befamiliar with the preparation needed for the community health nurse.

1.2 DEVELOPMENTOF CO TYANDCOMMUNITYNEALTW:NURSING

: We shall trace out the development of community health and community healthnursing in the following sub-sections.1.2.1 The world/GlobalThehistorical development from Pre-Christian era influenced the medical and nursingpractices. Rudiments of community health can be traced from the earliest civilizations.Pre-Christian Era : People have always been concerned with the events surroundingbirth, death and illness.A new c~nce~tualization'ofan influenced the healthpractices. The early church believed that the Roman and Grecian ways pampered thebody at the expense of the soul. Disease was viiwed as a punishment for sin. .The Renaissance ushered in a new period of history during which community healthas currently known began.The history of the early Christian Church is replete with examples of home healthcare. Of considerable importance was the work of St. Vincent de Paul andMademoiselle Le Gras who established what was probably the first actual cormnunityhealth niuding programme.The industrial revolution witnessed tremendous advances in transportation,communication and other forms of technology. Modern public health efforts begap inEngland, the first modern industrial nation. .The Poor Law Amendment Act of 1834 ushered in a new era of social welfare andcommunity Health in England.Lilian Wald organized visiting nursing in New York in the 19thcentury, established theunique programme at the Henry Street Settlement and was responsible for manyimprovements in living conditions in New York City. ,The first visiting nurse society in America began in Philadelphia in 1886 to providehome health care for the sick.The early 2 ~ hentury witnessed multiple improvements that both directly andindirectly affected health status.1.2.2 India

I Let us discuss the development of community health under various periods in thehistory of India.The changes and developments in man's environment and society and the scientificadvancement in technology and medicine have affected cormnbity medicine andcommunity nursing practice for co~nmunity ealth in India. I~idustrializatian ndurbanization have compounded the problems in the management of co~mnuiiity ealth.Let us briefly present the historical events in the development of community heal& in

6 India.a L


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c Period (300 0 BC to 1400 BC) The I ndus V alley civilization showed relics ofd cities and practice of env ironmental sanitation. The Ayurveda and Siddh aive concept of health by the ancient sages o l India.

an ancient saying ofof life, whic h conc eived the onene ss and unity of all people, wherever they

ic period (600 B C to 600 AD ) Medical education was introduced in thet uiliversities of N alanda and Taxila. Icing Asholca expanded the hospital systemoduced during the B uddhist period.

hal Period (about 1000 AD ) The Ambic systein of' medicine known in India as

systenl in India.- Th e Britishers established their rule in India- Quarantine act promulgated- A royal com~nissio nwas appointed to investigate'into the cause ofunhe althy cond itions p ~.evailing n the British army stationecl in India- Sa ni ta ~y ommissioners appointed in Bombrty, Madri~s ml Beiigul- Public Health commissioner ancl a statistical officer were appointed byGovernrnent of India- Birth and Dealh Registlation act promulgated- Vaccination act passed- First Indian Factories Act passed

First all India censu s taken- Epidemic act passed- Plague com tnission recornmendation.- Central Research Laboratory at Kausali established- Indian Council of Medical Research (ICMR) established- Lady Reading Health Scl~ooln Delhi estublist.led

Nutrition Research Laboratory at Cownoor (Tamil Nadu) established- Decentralization a1health adm inistration in India- Legislation introduced l'or advmcemerrt o f public healtll- All India Institute of Hygiene an d Public I-Iealth established at Calcuttawith aid from Rockfeller hu nd at io n- Maternal and Child Wealth B ureau eststblished by Ix~dianRed CrossSociety

Introduction to Community ,Health Norsir~g


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Principles and Practice 1939 - Madras Public Health Act passedof Community HealthNursing Rural health training at Singur near Calcutta started with assistance from

Rockfeller foundationIndian Tuberculosis association established

1940 - Drug Act passedPre-Independence Period:1943 - Bhore Committee appointed1946 - Bhore Committee report submittedPos t-Independence Period:1947 - Ministries of Health established in Centre & State Government

Director General of health services and Director of I-Iealth Servicesappointed by Central and State Health Ministers.Indian Nursing Council Act passed

1948 - India joined as a member state of WHO1949 - ESI act passed1950 - Constitution of India came into force

Planning Commission set up in India1951 - Beginning of first five year plan

Central Drug Research Institute at Lucknow establishedCentral Food Research Institute at Mysore establishedDiploma in Community Health Nursing started at College of Nursing,Delhi

1952 - Community Development programme launched on 2nd OctoberConstitution of Central Council of HealthPrimary HeaIth centres set upViral Research Centre at Pune established .

1953 , - National Malaria Control Programme started- National Small Pox Eradication Progrm ne started

National Family Planning Programme started1954 - Contributory health s6rvices scheme initiated

Central Social Welfare Board set up@ National Water Supply and Sanitation Scheme started

National Leprosy Control pogrd rne startedVDRL antigen production set up in Calcutta

b Food Adultration Act passed


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National Filaria Control programme started Introduction to CommunityHealth N~rrsingCentral Leprosy Training and Research Centre at ChinglepetCentral Health Education Bureau establishedSecond Five Year PlanNational Mal'xia Eradication Programme initiatedMud liar Comm ittee appointedNational Tuberculosis Institute at BangaloreNational Research L aboratoty at Coonoor shifted to Hyderabad (AP )Constitution of School Health CommitteeMuldaliar comm ittee report publishedThird F ive Year PlanCentral Fam ily Planning Institute establishedNational Small Pox Eradication Progra~runeNational Goiter Con trol Programme startedApplied Nu trition P rogramme launchedNational Institute of C omnunica ble Disease inauguratedNational Trachoma Control Progr,unine startedChadda Co~nm issioneport submittedNational Institute of Health Administration & Education set up at DelhiMukerjee Com mittee constitutedJungwalla Com mittee submited reportModhak Comm ittee set upSmall Family Norm Committee set upFourth Five Year Plan

1970 - Drug Control orderAll India Hospital Post Parturn Programme

li Population Council of India1971 - Family Pension Scheme for industrial workers came into force1972 - 'Medical Termination of Pregnancy Act came into force on 1st ~ ~ r i l

N ational h s t i t~ ~ tef Nutrition set up in Nyderabad1973 - Kartar Singh C omm ittee submits report

National Programme of Min imum needs incorporated with healthservices1974 - Fifth Five Year Plan1975 - India declared Sm all Pox free in July +

ICDS set up in OctoberESI Act amendedNational C hildren Welfare Board set upSrivastavza / ' :amittee submits report , I !

l__.._-"- -


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Principles and Practice 1976 - Preveiition of Food Adulteration Act amended + passedof Community HealthNursing Indian Factories Act amended

National Programme for Preventions of Blindness form ulated1977 - Small Pox declared Eradicated in Asia by WHO

National Institute of Health And Family Planning formedTraining of Community Health Workers & Rural Wealth Scheine s tarte

1978 - Alma Ata declaration of Health for All adopted by India1979 - World Health assembly endorsed declaration of Alma Ata on Primaryhealth care1980 - Sixth Five Year Plan1981 - Census Wen

%Emergence of AIDSIndia comm itted to the goal of providing safe drinkingwater andadequate sanitation for all by 1990Prevention and control ofAir Pollution Act introduced

1982 - National Health policy announcedGuinea-worm Eradication Programme launched

1984 - Bhopal Gas tragedy December1985 - Seventh Five Year Plan

Universal Immunization programme launchedLeper's Act 1898 repealed

1987 - National AIDS Control programme startedNew 20-point programme launchedSafe Motherhood programme launched

I National Diabetes Control programme started' . . 1991 - Census taken

1992 - Eighth Five Year Plan1994 - IGNOU launched Post Basic B.Sc Nursing programme

I 1995 - Pulse P olio Immunization conducted '1997 - Reproductive and Child HealthProgramme i~nple me ted.

',iI 1998 i - Ninth Five Year Plan1

2000 - Nutional Population Policy\I 201 - Census taken

2002 - National Health Policy 20022003 - Tenth Five Year Plan

b \ 1' 2005 - National Rural Health Mission Launched ' ,,


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1.3 CONCEPTSOFCOlMMUNITY WEALTH NURSPNG I~~troductlono CommunityHealth NursingWe shall focus on the concep t of community, community health and community healthnursing as follows.1.3.1 Related to CommunityCommunity is a social gro up determined by geographical boundaries and or colnmonvalues and interests. Its mem bers know and interact with each other. It functionswithin a particular social struc ture and exhibits and creates certain nornls, valucs andsocial institutions. The individual belongs to the broader society through his family andcommunity.1.3.2 Related tdCommunity HealthCommunity healt l~efers to the health status of the members of the coinmunity, to theproblems affecting the health and to the totality of health care provided for thecommunity. The major determinants of community health are the health status, diseasepatterns and health expecta tions of the people. In addition, the social, econolnic andcultural environmellts influence the health, health behavior and health perceplions ofthe group both positively an d negatively. Rap id population growth and urbanizationcontribute to the health problems.A new concept of public health arose in this century according to which communityhas a direct responsibility for the health of the individual in h e community. A sickperson is a comm unity 's liability, This led to the concep t that healthy people are anation's greatest human resource for econon lic developrncnt of the country. For thisreason the comm unity should provide facilities to provide cornprehensivc medical andhealth care both prolnotive and curative to a11 its citizens. Comm unity health postulatesa unified and balanced in tegration of prom otive, preventive, curative and rehabilitatiarlservices. Thus the -term public health i s replaccd by comm unity hed th. Since ncommunity has a direct responsibility for the health of eveiy ind ividual, action wasdirected towards all aspects of health. Healll-1of an indiviciual includes physical,mental, social and spintual well being in his natural environment such as family, schoolor place of work.The assessment of health requires an understanding of the general population to beserved. Major categories of information on health are:1) Demographic data- present and projected populatjon according to age, sex, location- population density

- migration- life expectancy- probable birth rate- literacy rates

2) Environmental charactexistics- housing conditions- working conditions- educational opportunities- . sources of water supply, water duality


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of community HealthNursing - solid waste management, including sanitary handling and disposal- vector control and the control of alternative hosts of diseases- environmental pollution- climate '- structural organization and administration of environmental health services

8 .

3) Economic information- occupational characteristics- patterns and tendencies regarding personal or family income- health sector income and expenditure- national income and expenditure- cost of providing health services and of maintaining the different categories

of health manpower- cosdeffect information for selected health problems4) Health needs

- mortality and morbidity data according to major causes, age, sex, geographicdistribution- the extent to which &e principal diagnostic categories result in a deinand forhealth care and in disability

5) Utilization of health care services by the population- Health services actually utilized: number, types, quality, effects- Characteristics of those who use services, including their attitudes andknowledge regarding the use of heal* services and the health system that

provide them .- 'unmet' demands or needs for health services- Approximate volulne of services desired that are not obtained, according to

type of service- Characteristics of those who desire services- . Reasons for not obtaining the desircd services.

1.3.3 ~elatedo CommunityHealth Nursing

Cormn~~nityealth nursing as practiced today is a product of growth and adaptation. Ithas been amended to acconmodate the needs of a changing society. Many factorshave influenced the growth of co~nmunity ealth nursing. Five significant forces'thatcontinue to shape the development of community health ilursing we advancedtechnology, progress in casual thinking, changes in education, the changing role of the

12 Ilurse and the consumer movement.

Community Health Nursing combines nursing and public health. It synthesizes thebody of knowledge from the public health sciences and professional nursing theories.The purpose of this synthesis is to improve the health of the entire community. Thuscommunity health nursing can be defined as a field of practice that synthesizesknowledge and skills in nursing, public health and applies them toward the promotionof optimal health for the total community.


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Trends in Comm unity Health Nursing are: Introduction to CommunityHealth Nursinge Chronic diseases and prolonged hospitalizatione Problems of the agede Population explosion and family planninge Pollution-noise and radiatione Industrialization and Urbanizatione Addiction to drugs and alcoh ole Health education

Concep ts of sociology, psychology, a~lthropology nd mental healthe Introduction and use of gobar gas plant, 'anganwadi, vocational courses and use ofmedia

Vital statistics - assessment and recordinge Adulteration of drugs and food.Characteristics of Community Health NursingSix characteristics of com lnunity health nursing are:1) It is a field of nursing

Comm unity health nursing is a field of nursing ,its basic knowledge and skills arethose of professiona l nursing practice. It seeks to give hum anistic, accessible andholistic care. co*mu nity health nursing is a nursing specialty, nursing heb@forms its foundation and the nursing process is one of its basic tool& ndcopununity hea lth nursing adds concepts, knowledge nncl skills from otherdisciplines to beco me a distinctive practice.

2 ) It combines public health with nursingCom munity health nursing inco rporates public health content. Knowledge of theelements essential to com munity health are history & philosophy of public health,concepts of aggregates; priority of preventive and health promotive strategies;concepts of epidemiology and its m ethods; influence of environmental factors onhealth; principles underlying xnailagement and organization of co rn ~ n ~ ~ n it yealth;and public health po licy analyses and development.

3 ) It is population orientedThe centra l missio n of community health practice is to improve the health of thepopulation group s. Comm unity health nursing shares the essential features: it ispopulation oriented, concerned wilh the persanal and environmental health of thepopulation groups: The population oriented focus requires the observation ofrelationships.

4 ) It emphasizes healthComm unity health nursing emphasizes on positive health or wellness. Communityhealth nursing has the primay charg e to prevent health problems from occurringand to.prom ote a highe r level o f health. Comm unity health, nurses concentrate onthe wellness end of the wellness-illness continuum in a variety of ways.Co mn unity health nurses seek ou t potential health problems. They identify highrisk groups and institute preventive p ro gr am ~~ ~e s.wellness em phasis requirestaking initiative and making sound judgements.


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Principles and Practice 5 ) I t involves interd isciplinary collaboration.of CommunityHealthNursing Community health nurses work as full members of the health care team.Coordination and cooperation are required in practice that deals with thepopulation groups. Effective collaboration requires team members who are strongindividuals. Community health nurses who think and act independently make a

' great contribution to the team effort.6 ) It pro~notesclient participation

Consumer participation in health care in an important characteristic of communityhealth nursing. Community health nurses encourage consumer participation bypromoting client's sense of responsibility for their own health. This process isknown as self-care. Consumer participation is promoted when clients are treatedas partners on the health care team. The goal is collaborating with clients ratherthan working for clients.Conceptual Framework for Community health Nursing PracticeConceptual framework for community health nursing include five sets of variables:e Practice priorities are prevention, protection and promotione . Interventions are education, engineering and enforcemento Scope of practice encompasses the range froin individual to aggregatese Four health determinants are factors to be considered in designing practiceinterventions. They are human biological determinants, environmental'determinants, medical-technological-organizational determinants and social-behavioural determinants

Communityhealth nursing dynamics with'two essential dynanics - he nursingprocess and the valuing process.


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CO TYDIAGNOSISIn this section we shall discuss about community diagnosis and identification as givenbelow.1.4.1 Community IdentificationCoinmunity identification is a systematic process of knowing and exploring a definedcommunity for assessing its health status and determining the possible factorsaffecting the health of people. It is more than making a medical or nursing diagnosjsrelevant to the community. It implies getting to know he area where the community isliving, the other families in the area, the conlmunity leaders in particular, their life styleand their resources.All these information can be obtained by:i) holding fo d a l and informal meeting with community people, leaders andorganized group which may include panchayat members, school teachers, lnahilamandals, youth clubs/groups, young innovators etc.ii) observation visit to community for observation of physical environment, biologicalenvironment and psychosocial environment,iii) informal conversation with people.iv) going through records.v) formal community/sample surveys.vi) discussions with health and allied health personnel working in the community.Community assessment tools which are present with the agency or the communityhealth centre can be used to collect valid information about the conlmunity. Thecormnunity identification will also help in making Comnluility diagnosis. Communityidentification is to :0 Systematically gather health related data about a selected community- Develop community profile- Explore boundaries of communi y- Identify health and health related resources in the communily- Identify community assets and liabilities- Examine relationship between data gathered to the health and well being ofthe colnmunity and- Record the health conditions that are threats lo a specific populatiox~ roups

in the community- dentify biological, physical and social forces that have beslring on the healthof the cornmunity,- ndications for community identification are:

To become acquainted with a given community for the purpose ofassessment.Community identification providcs datil for nursing action.

e Needs assessment of a specific community.

Introduction to CommunityHealth Nursing '


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Principles and Practiceof Community Health 1.4.2 Community DiagnosisNursing This will highlight the health problems and the healih needs of the community whichyou will be able to assess from the information. Assessment of the health status wi l lbe with reference to the people, their environment, their life style, available resources.Family diagnosis, may include problems and needs of different age group of people,illiteracy and poverty, high infant and maternal mortality, high fertility, high morbidity,prevalence of risk factors, poor environmental sanitation, poor personal hygiene a n dhealth habits or traditional cultural practices , ack of health knowledge and attitude;

inadequate and inefficient resources available.Subsequent to making the community diagnosis, the health problems or needs areprioritized for planning and implementing comprehensive health action.Community health action is the sum total of various health and health related activitieswhich arcdecided to deal with the health problems and health needs, keeping in m i n dthe resources, whishes of the family, nature of the problem, their impact on the heallhof the people at large and the agencies policies and objectives. These services includesafe motherhood services, child survival services, nutrition and family welfareservices, prevention and control of local communicable diseases, environmentalsanitation, health education etc.Coinmunity diagnosis is the cornerstone of community health practice. Variousassessments and procedures are undertaken before a diagnosis is made. Similarlybefore implementation of the health activities i l i a given community, it is important toassess the situation in the community; its problems; its needs; resources as well as itstraditions history etc. Only with this knowledge appropriate measures would beundertaken in the delivery of health care.~onimuni ty iagnosis is the f rst step in the establishment of a health programme.Steps in planning programme are:

Community Diagnosis(Identification of problems, needs and resources)nvEstablishment of prioritiesCIDefinition of objectives for action

' nU~stablishmentf a plan of actionChoice of activi!iesnobilization and coordination of resources

Different stages in community diagnosis:To come to the conclusion of thecommunity diagnosis, a community health nurse needs to have general knowledge ofthe community which is necessary for a l l community activities. Andalong with t h egeneral knowledge we need to have specific knowledge.Stage I : Involves the identification of the factors which may influence

16 community health, includes knowledge related to concerned program.


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Stage I1 : Identification and classification of data which includes quantitative Introduction to Communityand qualitative data. Health NursingStage I11 : Invo lves d ata collecting i.e., source of data and methodology of

a collection.

1.5 COMMUNITY HEALTH NURSING PROCESSNursing process is a problem solvin g process and helps in providing systematic needbased care to the client in hospital and co ~n mu nity etting. Community health nursing isconcerned with helping peop le to solve their health problems which may be simple likedealing with minor ailments o r complex like control of comm unicable diseases. Theproblems may b e dealt w ith at individual level, family level, village level, block ordistrict level. This can be do ne by deliberated systematic series of steps which helps tosolve the problems and achieve desired goals of health promotion, p revention andcontrol of health problems.Com munity health nursing proce ss is a systenlatic approach to nursing practice in aninteracting, interrelated and interdependent psychic phenomenon of assessment,planning, intervention and evalualion termed as com ponents of nursing process whichis interchanged to assist the client in a collaborative manner.Th e aim is to restore a continuu m of balance and powerful direction within the internalenvironment.Three characteristics emphasize the ilnportance of this tool for cotninunity healthnursing.First, the nursing process is a problem solving process that addresses the communityhealth problems at all ag grega te levels and aims to preven t illness ant1 to promotecommunity health.&econd, it is a management process that requires analysis of a siluation. decisionmaking , planning, orga nizing , directing and controlling servicc efforts and evaliiatingoutComes. As a man agem ent too l the nursing process addresses a11 aggregate levels.Third, it is a ~ h a n g e ' ~ r o c e s shat worlcs to improve various levels of health relatedsystems and the way peop le behave within those systems.The process has five major steps:i) establishing and m aintaining nworking relationshipii) assessing the health and nursing situationiii) establishing the goals for health and nursing careiv) constructing and implemen ting a programm e of actionv) evaluating the action .These steps may also be categorized into three different phases:i) The assessment phase

' i) The intervention ph aseiii) The evaluation phase.These plzases are sequential, progress Born one phase to another i.e,, the assessmentof problems help in formu lation of goals and ob jectives, actions to be implemen tedbfollowedby evaluation to m easure the outcom es of the intervention.


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Principles and Practice i) Establishing and Maintaining Working Relationshipof Community HealthNursing Com munity health nursing process is working with the people, helping them to solve

their problems, develop their competencies to meet their own health needs. T his ispossible only by establishing working relationship with the f d l y nd community. 'Basic to this kind of relationship is an attitude of trust an d confidence in the integrityand capab ilities of each partner in health to improve the client's h ea lth status.A working relationship0 permits the nurse and the c lient to know ea ch other and worktogether, have two-way communication, discuss the problem and f ind solution toimp rove health conditions or situation i.e., productivity. It promotes acceptance by theclient (Mutual Trust). Working relationship is developed by kno win g the client and bycommunicating the intentions to help and the nature of assistance that can beextended; be a good listner (comm unication) show desire to help, answ er their queries,consider their views, meet their immediate needs, appreciates what is worthwhile,confidence, motivate to bring change in health behaviour, be emp athetic (empathy).ii) Assessing the Health and Nursing SituationAssessment of health and nursing situation is essential as it will help to determ ine theextent and nature of problems and the underlying causes and the resources availableto deal with the health and nursing problem s. It involves collection and analysis ofinitial data (factual information) about the following aspects as a ls o described withcommunity idegtification:a) Human ~ i o l ~ ~ y :emographic characteristics like age, sex, so cia l econom icconditions, deaths, births, mental status, hereditary characteristics.b) Life style and culp ral customs.

;\ 1..P c ) Environment: phy$qal,.+ :, biological, social,and spiritual.

d) Resources: health'and health allied resources.The methods used for data collec tion are the same a s for cormnunity identificationand they axe: questioning, observation and record analysis.The tools to collect data are interview, questionnaire, observation cl~ec klist.A nu& may walk through the area to get to ob skv e the over all status of thecommunity and their living standards. She meets the vi~ la~ e ' le ad erso know their lifestyle, health problems, vai ou s assets, and liabilities. Th e coping ability of the familycan be assessed from family folders and individual records and b y actually workingwith the family. This information will help to identify health de ficits eg 'any disease;health threats i.e.,any situation which may cause any disease e.g., poor environmentalsituation; foreseeable crisis situation e.g., ildolescence, old age, menopause etc., andcoping abilities to deal with prob lems e.g., Knowledge, attitude, life style etc.Once the problems are identified, it is better to prioritize these proble tns because allproblems canno t be dealt with at once. Four major criteria have been selected toconsider the priority of problems:- ~ a k r ef problem, its gravity, prognosis and impact on the health of others.- Whether the problem can be minimized, controlled or erad icated i.e., whethersomething useful can be done for the problem.- Whether the problem can be prevented or not.- Family's/community's perception of the problem and its need i.e., whether thefamily/community considers it a serious problem requiring imm edia te care,

18 whether it is considered as a felt prob ledfe lt need by the fam ily community.\


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After identification of the problem use the above criteria to prioritise the problems.Ensure the understanding and acceptance of these problems and health needs by thecomm unity and families. Th is can be done by establishing contacts and discussing andexplaining the actual findings to them, answering their queries and doubts, and relatinghealth need to overall fam ily developmental goals, etc. Thus, you can help them solveone problem at a time.iii) Establishing Goals for Health and Nursing CareEstablishing goals is the third step of the nursing process. A goal is a broad statementof directions to resolve the situation identified w hile assessing the health and nursingsituation. ?t is very important lo set the goa ls because goals not only give directions toselection of ac tions but also h elp in sustaining and evaluating the actions planned andimplemented. They also help the client to judge whether the individual, family andcomm unity know what to do. The go als should be clearly, stated, specific, measurableand time-related, e.g., to en sure comprehensive m aternal care to all mothers in aparticular village by trained health personnel in order to bring down IMR from 162 per1000live birth to 8011000 live births during period of fiv e years.This is a very general go al. This goal includes three sub-area.i.e., antenatal, natal andpost natal goals. The s pecific goals which are explicit statements relevant to thesethree sub-areas of the goal need to be identified.For antenatal care the goal Iilay include f or that village:- To register all antenatal rnolhers of 12 to 16 weeks of pregnancy.- To get medical exam ination of all mothers done on ce in each trimester.

To mange for periodical check-up.- To prevent anaem ia by propl~y laxis reatment.- To immun ize against letanus.

Introduction to CommunityHealth Nursing

- To educate the mothers on various aspects of antenatal care.- To identify high risk mothers and arrange for services etc.- To prepare for bonfinements at home.- To train Traditional Birth Attendants (TBA/Dai)These specific goalslobjectives determine the actual actions to'be planned andimplemented which will help resolve the situation and achieve the targets. Like thatthere can be a nu mb er of g eneral goals/objectives and the specific objectives.The general goal with its specific objectives is at the level of comm unity. Similar goalwith its specific ob jectives can be stated a t the individuals 'and family level, e.g.:- Ensure safe and e ffective maternal ca re to the pregnant mother by the trainedhealth personnel so as to have a live healthy baby and to promote and maintainthe health of mother and baby.- To develop a fam ily's aw weness and competence to deal with the specia l need of

the mother during an tenatal period, natal period and post-natal period so as topromote and maintain the health of both mother and the baby.Specific objectives will b e the sam e as listed earlier.After the general and specific goals are estab lisl~ed,hey should be reviewed todetermine which a re to be achieved immediately or within a limited period of time i.e.,the short term goals, e.g., preparation fo r compo nent which are to be achieved in thefuture i.e., long tern goals determining ways for decreasiilg expenditure and 19


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Principles and Practice increasing income. This will permit the health worker and the client to concentrate onof Community Health those goals which help in meeting the immediate needs and movement towardsNursing achieving of the final goal.

All these goals and objectives are meant for clients and therefore should bedetermined by a joint effort of the nurse and the client. This will promote client'scompliance with the actions to be planned and implemented.Above all, the goals and specific objectives should be realistic and achievableotherwise it would lead to disappointments an conflicts.iv) Constructing and Implementing Programme of ActionsThis phase refers to identification of appropriate nursing interventions, developing anintervention. For any single objective to be achieved, there will be several suitablealternative actions and we have to choose those which are appropriate and feasible inachieving the objectives. We can take the example of specific objectives listed in theprevious step i.e.:- To register all antenatal mothers by 12-16weeks of pregnancy.- To get medical examinations of all mothers who are at risk.Alternative actions for objectives (i) could be: (a) registration in home, registration inthe clinic or both, (b) registration by indigenous trained Dai, midwife, ANM or byanyone of them who is responsible for registration, (c) what care to be included at thetime of registration. Similarly there can be several alternative actions for objectives(ii) in terms of day, time, location and what care to be included.Similarly, we can take another example of providing care to the disabled arthritispatient or tuberculosis patienl. The care can be given at home, in the nursing home/hospital, in day care centre etc. All these actions have pros and cons which need to bethoroughly considered along with the family and the one which is most suitable to thefamily situations should be implemented. The criteria which can help choosealternative actions are (i) agency policy, (ii) family resources, (iii) comi~~unilyresources, (iv) nursing personal available elc.For each of the above mentioned actions to be implemented, there are three types ofnursing interventions i.e.:a) Supplementalb) Facilitativec) Development.In supplemental nursing intervention, the nurse gives the care which the familycannot do but at the same time the nurse helps family to develop the abilities to givethe care through education which is developmental intervention. She also helpsfamilies in mobilizing and developing resources which are required to give care. Thistype of intervention is facilitative. Most of the times al l the three types ofinterventions are implemented.Of course any one of these may predominatedepending upon the situation themselves and the nurses provide direct care wither bythemselves or through the auxiliary nurses, e,g., care of the sick individual, anlenatalmothers post-natal lnothers etc. But, at the sanie time, she educates the mothers andother meinbers of the family to learn to take care of the sick, new born babies,post-natal mothers, etc., and give care in her absence.She also helps families develop their own resources and mobilize resources availableto the communitywhich will h.elp in implementing the actions planned. The nurse needto know he functional relation of these resources which include health and healthallied agencies. You are expected to identify these resources, make a list of these and

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visit these agencies to know their functions and procedu re of Sunctioning;governmental or non-governmental.During your field experience you are expected to identify these resources, make a listof these and visit these agencies to know their functions and procedure of functioning.In com nlunity health, varied health problem and health need s are identified. For eachof the health problem and ne ed, th ere will be alternative actions e.g., health threats likepoor environm ental sanitation , defectiv e health behaviors, health deficits like variouscommunicable and chronic diseases and various interventions. She also helps familiesin mobilizing and dev elopin g resources w hich are required to give care. This type ofintervention is facilitative. M ost of the times all the three types oS interventions a- eimplemented. Of course any one of these may predominate depending upon thesituation thenlselves and the nurse provides direct care whether by themselves orthrough the auxiliary n urses, e.g ., care of [he sick individual, antenatal niothers, post-natal mothers etc. But, at the sa me time, shc educates the ~n olh crs nd othermembers of [be family to leru-n to take care of the sick, 13cw born babies, postnatalmothers, etc. and give case in her absence.She also helps fam ilies dev elop their own resources and rnobilizc resources availableto the cormnun ity which will help in implemen ting the actions planned. The nurse needto know the functional relation of these resources w hich include heallh and healthallied agencies but you are expected to identify these resources, make a list of thesean d visit these agencies to kno w their functions and procedure of fuactioning,governmental o r n o~i.goves~~ rnental..During your field experience you are expected to identify these resources, make a list01 hese and visit these agencies to know their fcinctions and procedure of S~111lnctionin.g.In comm unity health, varied health problems an d hcillth ~ ic cd s re identified. For encliof th e health problem and need , thcre will h e alternative actions e.g ., lienlth threats likepoor env ironmenlal sanitation, del'ectivc h ealth behaviours, h ealth deficits like variousco~llm unica ble nd ch ronic diseases and various crisis situation, etc., which requirenursing intervention. It is very important to develop an orgrlnizetl sched ule i.e., when todo what and who w ill deal with the problems. This ilnplies prioritizing and phasing outproblems and the actions to deal with these problems as all problems that cannot bedealt with simultaneously. Prioritizing iinplics that there m-c some problems and healthsituation which require i~ nn ied ii~ tentervention c.g., com municable discases, malaria,etc., which can be prevented by s imple me;lsures. high risk groups like mothers andchildren and the elderly gm ups. Phasing im plies dealing of problem into manageableunits or stages.v) Evaluating the Action PlanEvaluation of community heallh nursing services determines the effectiveness ofservices provided i.e., whether the intended re s ~ ~ l t sre achieved or no1 specified. Italso helps to identify the ca uses of failure wh ich can be rectil'ied.Evidence of effectiveness are change in knowledge, attitudes and practice, degree of:independen ce, reduc tion in morL>idity and ~ no rta lit y ates, decrease in birth rates,increase in life expec tancy , population cove rage, clinic ritrendance. It shows evaluationis qualitative and quantitative. It is very important to havea) well defined measurtible objectives,b) baseline data to start with,C ) maintain accurate record of scrvices rendered,d) observe changes in health beh~tviour,e ) analyze, and


f) interpret the data, to determine the effectiveness o r services.


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Principles and Practiceof Community I-IealthNursingCheck Your Progress 2i) List the steps of Nursing Proc ess in cornnlunity health,

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...................................................................................................................................ii) Mention any five areas of action for cohm un ity he alth.

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................................................................................................................................iii) Enumerate the specific conipetencies required to be successl'ul c o k u n i t y health

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iv) Differentiate be tye en the functions of a com nunity health nurse and hospital. ,nurse.

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CIPLES OF60 PTY HEALTH NURSINGThe co~ nmu nity ealth nurse occupies a ltey place in the health team. The process todeal with health problems in the comm unity remains constant. Principle is an ac ceptedtruth, the evidence for which might be scientific. The com mun ity health nu rses'role inher community work makes her a teacher, counselor, friend, a mid wife, a socialworlter, a nutritionist, a nurse practitioner, a health edu cator, leading he r to performseveral tasks.


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The comm unity health nurse working in the communily should follow the followingprincip les in he r daily w ork regardless of her special training or position.Principles of comm unity health nursing practice are:a) A com munity health nurse should know the comm unity thoroughly i.e., comm unitylead ers, school teachers, women leaders. This wiil help to establish good working

relationship.The work of the community health nurse is family centered , with the home beingt h e usual setling. The nu rse is the guest and the farnily/patient is the host. Theilltles s of one m ember of the family affects the whole family. The communityhealth nurse is able to observe the anxiety, fear and behaviour of each familyme mb er in the h ~ u s e ore closely and she can decide the health actionappropriately and utilize the co m nunity resources. The nu rse's ultimate goal is tomake the entire fam ily independent and know ledgeable regarding health principlesand practices. Nurse has to plan with the family and not for the family. Emphasisis on health promotion for all fa ni ly m embers through health counseling emotionalsupper- and understanding , teaching, demonstrating and providing nursing care toth e patient.

b) T h e conlniunity health nu rse shou ld work effectively with other members of thehealth tcam by nstablish ing good interpersonal relationship. She should be awareof .the role of various health team mem bers to avoid duplication of services.Health tea111 ~llemnbers n com nunity health are doctors, co rnm ~~ nit yealth nurse,multipurpose health w orker male and female, lady health visitor, traditional birthattendant, village guidc etc. T he team plans and executes health programmes.Th e co ~lln lun ity ealth nu rse should assist in planning, implementation andevaluation of the programm es. The cornlnunity health nurse works w ith the familyas n unit of setvice and bring into each home special services required forsanitation , nutritional, lnaternal and child health problems and family welfare, orcontrol of c otnm ur~ icab le iseases or i~tlmun ization. he needs medical support forher work. Sh e solves the problem of environm ental sanitation, by coordinatingwill1 sanitarian, and he can also refer problems to her which fall within herjurisdiction. She supervises the work of ~n ultipurp ose ealth assistant and healthworker. She guides them and avoids dup lication and repetition of services. Teammembers have to support each other's work to get the results.

c ) The com munity health nurse is responsible to the authorized agency throughwhich she is emp loyed.Nurse em ployed by the agency which may be a state, municipality, local bodies,voluntary or private, sh e has to work in close consultation with the employingauthority 'and work w ithin tbeir laid down policies, If she is working as DistrictPublic Health Nursing Officer then Chief M edical Officer of the District isautho rity for reporting, who is responsible for coordinatioll of local programme ofthe district.

d) Comm unity health nurse needs to m aintain professional relationship and etiquettewith everyone in the comm unity. She needs to bk conversant with the localc ~ ~ s t o m snd should live m ore or less with the people whom she serves. Itbecomes manclatory for a nurse to develop professional relationsl~ipwith otherorganization concerned with health in her area. She needs to visit offices of BlockDevelopment Officer ,Child Developinent.Project Officer, Panchayat, M ahilaMandals ,Voluntary C o ~ m u n i t y rganizations and local Dais. The nurse shouldwork with HsLkims, Vaids, hom eopathic and allopathic medical practitioners. Sheneeds to explain her programm e of work to get cooperation from all especiallydevelop friendly relationship with the dai in w hom the village people have faith.Local health p ractitioners can becom e hindrance for starting a new p r o g r m l e ,



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Principles and Practice so to get their s~ ~ pp or turse needs to orient them for getting com munity'sof Commu~lityHealth cooperation.Nursing

' e) Comm unity health nursing services should be available to all people irrespectiveof their age, sex, creed nationality, religion, political affiliation, socio-econom icstatus.Every human being has a right to good personal'health and environmentconducive to healthy living. So community health nursing services must beavailable to all persons according to their health needs.

f) The com munity health nurse should be non -sectarian, non-political in herrelationship. She should not interfere with the religious and political beliefs ofpeople. This will help tlik community in accepting the com mun ity health nurse.e

A community health nurse would not interfere in the affairs of person's political orreligious beliefs. Understanding of various religious beliefs, cultu re and customs ofcomm unity can help her to render better services. People should feel that sheaccepts them, as they are, then they will listen attentively and accept herteaching. A comnlunity health nurse should also be careful not to thrust herreligious beliefs on the family.g) She needs to be vigilant in not accepting any bribes or gifts. According to thepolicy of the employing authority the nurse has to ch arge fees in certain cases butshe m ust g ive official receipts and deposit the fees in the conce rned o ffice assoon as possible. She'should not take anything for her personal u se such as giftsor money.h) Health services should be based on felt needs. Health progranlmes should beplanned 'on the felt need of the people. Needs can be assessed by health surveyto enable the nurse to be familiar with the prevailing health problem s and healthresources. Nurses should concentrate on the urgent health p roblem s using themore efficient methods available.i) The services offered need to be realistic in terms of available manpow er andfacilities and be of continuous nature.

Th e services planned should be according to the needs of the clients and thecommunity. Before planning the health services the m oney, material andmanpower needs to be assessed.j) Health education needs to be interwoven throughout the practice. Sh e should plancommunity health education programmes. .

Health teaching is an integral part of every health program me. T eaching is atherapeutic tool for the nurse, which is cheap, permanent and all nurses can useit. Many liealth problems can be solved by effective health teaching. ~ e a c ' h i n ~sto be imparted to individual as well as to group. Teaching mu st be well plannedaccording to the need and scientifically correct and of practical value to changehabits for healthy living.k) Continuous service is effective service. Health services should be providedcontinuously to the individual family and the nurse must have repeated contactwith them. With repeated contact people can get to know and trust the health

worker. Careful follow-up is necessary to see the effectiveness of therapy an dwhether teaching has been put into practice to improve health habits.1) The services offered by the com munity health nurse needs to b e periodicallyassessed t o determine the progress.


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The criteria for evaluation should be built in the plan to meet the objectives which h t r ~ ~ u ~ ~o C*mmu11it3'should be clearly stated. Evaluation helps to critically review programme and Health Nursingguide future planning.

rn) Adequate reports and records need to be maintained on the work and servicescarried out by the community health nurse.The maintenance of accurate records and reports help in their use to both, fanlilyand agency. The family record is indispensable to the nurse in her daily work. It isalso an important element in providing continuity of nursing care. Good recordingcover all nurse-family, and the nurse patient contacts and interaction. Thecomnunity health nurse uses patient and family records in planning for homevisits and care of the patient. Before first visit to the family, the comn~unity ealthnurse goes through the records to get acquainted with the family.Periodical critical study of records and reports help the agency top leadership toevaluate its programme and deternzine current and long tenn objectives. Therecords are a source of statistical information. These are valuable in ascertainingneeds for additional staff and planning budget. Records provide guidance inmaking staff assignments.The comnunity health nurse is responsible for nlaintaining records which arecurrent, accurate, complete and legible.The community health nurse needs to be well qualified and should maintainpofessional interest.The comnunity health nurse is herself responsible for her professional growthand education. Continuing education is considered a life long activity in all fields tobe the greatest single challenge to health professional personnel. Each nurseneeds to establish her own immediate and long tern1 goals in order to continuebuilding and developing her education, both professional and general.Acommunity health nurse can do it by reading journals ancl periodicals on nursingand allied subjects, by attending and participating in the meetii~g f herprofessional organization, by attending lechrres in th e humanilies and arts. Thecommunity health nurse should plan to join courses in the colleges and universities .for higher education whenever possible.Facilities musl be provided in any agency for professional growlh. Tl~communityhealth nurse should attend on-going staff education programmes.An in-service education programme is essential for the attainment of efficiencyand for the professional growth. Provision should be made for in-service trainingand refreslzer course. Promising nurses should be encouraged to joill advancedstudies. Periodic planned staff meetings for sharing experiences and informationwith other members of the health team also provide an opport~lniry or wideningprofessional knowledge and skills. Attending conferences, professional meetingsin the states and national level also help to broaden knowledge. ;The community health nurse needs to have job satisfaction. There should beprovision for supervision and directing co~llmunity ealth nursing services.

,

The aim of supervision is to develop the abilities and skills of the commuilityhealth nurse. Supervision in the community health agencies by qualified~zursesessential for continuous improvement of nursing services to patient and ECunily.thelps in the planning of nursing work and for coordination of their activities withthe agency.The methods used in supervision are planned and continuous staff orientation,review of family case records by supervisorand nurse, supervised home visits,individual and group conferences related to nurse's work, An adequate and 25


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Principles and Practice satisfactory propgram me of su pervision by fully prepared co inrnun ity health nurseof Community Health assists in the growth and development of each staff member and continuesNursing improvement of the nursing service to the community.q) The community health nurse needs to practice herself what she teaches.

1.7 PWIEPAMFIONA m UNCTIONS OF COMMWITUmALTIP NURSEWe shall discuss about preparation roles, and functions of comnlu nity health-n urse infollo\;ling sub-sections.1.7.1 Educational RequirementA community health nurse prepared in general nursing diploina/degree programmewith integrated community health nursing course or who has done certificate course inpub lic health nursing can work in th e hospital as well as the conunu nity.The community health nurse should hold a registration certificate a s a nu rse l n d as amidwife from the State Registration Nursing Council.In the hospital, the nurse works wit h sick patients but the co~ nm un ity ealth nu rse hasto deal with healthy fam ilies and sick persons in the honles and their fam ilies. Sh e alsohas to work w ith teachers and school children or industrial workers, elderIy grandparents within the social and cultural situations. She is expected to solve t he problem sof the conununity such as clean healthy environment, safe water supply andpr ev en tio n and control of commu nicable diseases. She'has to give health education topeop le to dev elop healthy habits. S o she needs to be well versed in social sciences and.huma nities. The methods and techniques of epidemiology. Mo st of the time commun ityhealth nu rse is placed in such a situation that she has to take independent decisions. Soin addition to the knowledge of theory and practice of nursing other co n~ pe ten cie s fmanagement and leadership are also required in com n~un ity ealth nur sing to meet theneeds of patients, family and commu nity. Mo st of the time she wou ld be wgrkin gwher e there is no doctor.1.7.2 Competence RequiredA commun ity health nurse needs to have:- Abilities an d skills in communication: interviewing, listening, teaching an d sharingof pertinent information with professional colleagues.- Observational skill: ability to no te signs and sylnptorns of physical, men tal and26 emotio nal state in health and disease conditions of patients and their fam ilies.

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- Knowledge of community resources.- Expertise for understanding of human behaviour in a particular situation.


- Ability totake decision independently.

The community health nurse has a varied scope and can function in various positionsand situations as given below.e She can work as a Primary care providere Perform Expanded rolee Work as a Practitioner - Family nurse

School health nurseOccupational health nursePaediatric nurse.* Home health services 1

0 Teacher, educator.o Counselor0 Researcher* Work - health settingslagencies1.7.4 Role and FunctionsA community health nurse is a qualified person who Elas undergone basic nursingcourse with the integration of community health nursing and registered with statenursing council.The personal characteristics of a cormnunity health nurse are:

Ability to work with people. . soundphysical health (Emotional stability

I Resourcefulness I 1 Good listeningability 1I - I '

Ability to establish good IPR

Aspects of a community health nurse :C - , Consultant0 - OrganizerM - Main member of the health teamM - Manager


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Principles and Practice U - Utilizer of manpowerof Commun ity HealthNursing N .- Nurse Practitioner

I - Independent roleT - Teacher

H - Helping client to achieve positive healthE - Encouraging to practice healthy habitsA - Adequate provision of preventive and curative careL - Leading to progression of health careT - Teaching I.E.C.H - Helping in crisis intervention. .N - NobilityU - UnselfishnessR - ResponsibilityS - SympathyE - EfficiencyRole of a Community Health Nurse~ o r m n u n i t ~ealth nursing incorporates a variety of roles. Several factors influencethe roles playedby the community health nurses. The or&ization with which thenurse is affiliated usually has policies that govern nursing activity. Consumers usecommunity health nursing services differently depending on their perception ofnursing. Seven'major roles have been identified:a) Care provider

As a care provider she has to ensure:Is the basic services provided

e Target of serviCe if for I.E.C. .* Assessing collective needs and give servicese See holistic care is provided ,

Ensure that the focus is on wellnesse Necessary skills as a care provider required are observation, listening,communicationand counseling.

b) Educatora

\ .Health teaching is a part of gabd rhrsing care and one of three major functions oftheCommunityHealth Nurse. Health education provides health information andhealth consciousness.Community health nurse educates people beyond the scope of routine educational

28 activity. - .-


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As an Educator comm unity health nurse has to;e Facilitate clients learning

Share information0 Act as a consultante Hold f o y a l c lassese Utilize groups for teachingUse expertise/referrals,.* . Facilitate client's self education

Em phas ise illness, prevention and health promotion.c) Advocate

- Patien ts right to receive just equal and human treatment.


- The goal is to help clien t gain grea ter independence and make the systemmore responsive and relevant to the ne6ds of the client.- As an advocate the community health nurse pleads the cause of another byspeaking and acting on others behalf.- Clients need som eone to guide them through the complexities of the systemand to assume the satisfaction of their need.- Advocate roles require four important characteristics:

a Assertiveness* Willingness to take risk'@ Ability to com municate well, to bargain thoroughly & convincingly@ Ability to identify sources of power and tap them for client's benefit.

d) ManagerCommunity health nu rses a re managers of health ca re. It involves activities likesupervising care, m anaging case load, administering cliiric, conducting acomlnunity health planning project etc.The main functions as a mangager include: '- Planning: .It is the basic function which enables to decide objectives aid achieve objectivesand time required fo r planning.She has to:

detenziine client concern and needsestablish objectivesdecide appropriate course of actidn

- Organising : t includes c *Identify and structure the activities of an organisationPlacing people to achieve objectives

- - Arrange m atters to accomplish goalsNurse provides framework in various aspects of service. Framework is part -of service preparation. - 29-


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Principles and Practice - Coordinating : It involves bringing people and activities together so that theyof Community Health function harmoniously and achieve desired objectives.Nursing

- It is-a complex activity at community level.- Leading- Supervising- Motivating- Controlling service activities.

e) Collaborator- This involves working involves other memberse Community health nurse should work jointly in common endeavor andcooperate with partners of health care .e Successful community health nursing practice depends on collegiability

' a Every mem ber of the health team has unique contributione It requires skill in communication, nterpreting nurses contribu tion, acting

assertivelye Community health nurse may also involve functioning as a consultant.

$ f) Leader- Community health nurse remains an active leader- Community health nurse assumes leadership role by:a guiding decisionmaking,stimu late interest in'health promotiona initiate therapya direct preventive programm e,

influence health policy- It is a role of influence and persuasion- It effects changes and community health nurse is a change agent- Leader role assum is different form in different situation

% - Community health nurse exerts influence through health p lannin g- Need for coordinated, accessible, cost effective health c are serv ices createsa challenge.g ) Researcher- Research is an integralpart of community health nurs ing practice


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e Analytic skille Tenacity- research can be done at different levels.

Functions of The Community Health NurseCdmmunity health nurse functions according to the designation under which she isemployed which would be in accordance with her education and experience. Sheplays the role of an administrator, supervisor, teacher, counselor and practitioner.Function I : Provide and promote comprehensive nursing care.

Activity : Assume direct responsibility for providing care1supervise and direct others to do so.Teaching otherslorganize volunteers/regular staff.Referring to other source for care.

FunctionI1 : The Community Health Nurse uses nursing as a channel forstrengthening family life and promoting personnel development andself realization.Activity: e Using opportunities to be with the families in theirfamily functioneto learn the customs and traditionsof the community.

o Involving herself in the functions of the society1social gathering to assess how coimunity as awhole functions which will help her promoting thesocial life of the people.e Using opportunities by participating in thepanchayat meetings and conveying the healthmessages of the time.

Function I11 : The Co~nrnunity ealth nurse participates in disease control activitiesthrough general preventive measures, early identification of disease,provision of care and supervision of care to reduce effects ofdisease.Activity: o Using channels to alert parents, teachers, patients,

vulnerable group etc., to symptoms that meritfurther investigation1preventing intervention.Use of family and patient history as a tool foreliciting symptoms, impairment and health risk.

a Participating in epidemiological alert andinvestigation.Participating in screening.

FunctionN : The community health nurse \:arks with appropriate person inspecial setting to plan, implerr,i.nt-healthprogrammes.d

Activity: * Reviewing ;,I ,d interpreting data relevant to healthneeds of SPE a1 population groups.* hanging J ih appropriate administrative personnelfor schedult and prozedures for reporting andevaluating tgoing and special health activities:



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Principles and Practice e Serving as a member of committees for healthof Community Health planning and actions.Nursing

Function V : The Community Health Nurse plans and evaluates nursing servicesfor the population groups under her care to maximize benefits ofnursing care and to bring the nursing effort into proper relationship. with that of other health workers serving the same population.Activity: Identify service development and demographic andvital statistics trends that might have relevance for

nursing.e Setting goals and clearly defined outcomes fornursing service and establishing a systematicmethod for checking progress.e Conferring and planning with other health workersfor the care of families and groups. ,

Working with nursing supervisor6administrator oevaluate nursing accomplishments and to plan forimprovement.Function V1 : The Community Health Nurse contributes to decision and policysetting in the agency and community.

Activity: Sending reports/suggestions based on fieldobservation or other personal experience,0 Accepting membership of agency or communityplanning agency.

Function VII : The Community Health Nurse contributes to the extension ofknowledge in nursing and health care by engaging in surveys, studiesand research.Activity: Planning and carrying out sample surveys orstudies as part of continuing seqice effort.

o Participating in research done by others when it isappropriate.However, community health nurses working at the primary health centre in staffposition have following main functions:a) Identification of community

- This include study of geographical aspects, demographic aspects,environmental aspects, socio-cultural aspects and health facilities andresource facilities etc.- Identify the health needs and resources and interpret these to the peopleand to the agency.- Estimates the required services in her area in relation to her load of work.

'b*b) Planning- Community health nurse plans for preparing comprehensive nursing care toindividual, family and the community of her areas.- Plans with the medical officer and with other members of the health team33. and other related sectors for appropriate care to the family.


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- Plans for services in the schools, clinics and health centres.- Plans for health educational programmes and conducts meetings.c) Implementation II- Community health nurse gives direct care to patients and families in thehomes and in the community with the active participation of the people sheserves.

%- Assists doctors with the early diagnosis and carries out theirrecommendations such as giving injections, doing dressings.Explains and utilizes the available resources in the homes and thus givesadequate care adapted to home situations. .

- Guides the family in giving care to the sick and supervises the care rendered.This will help the family and community to be self reliant and responsible formaintaining good health.- Gives health teaching and counsels the family appropriately.- Analysis and guides the families on matters of upkeep of environmentalsanitation, nutrition, personal hygiene.- Makes referrals to appropriate agencies when required.- Maintain adequate records of families and the care given.- Collects the vital statistics of her area.- Integrates health education in all her services.- Supervises and guides health assistants, health workers, dais and healthguides. '

*- Trains local traditional birth attendants (TBA).) Evaluation

- ' Nurse analyses her own performance periodically, making monthly reports ofher area.- Evaluates the clinic servicei by going through attendance registers, numberof new visits, revisits and the number of immunization completed andmotivation of eligible couples for family planning.

e) Participation in surveys and conducting research programme. Community healthnursing is a challenging work and is different from hospital set up. A communityhealth nurse works in the community in their natural environment.She needs tobe well oriented and knowledgeable to handle different situations.

1.8 LETUS S UM UPu:We have seen that communi?tYhealth nursing services are for the welfare of the total

community. The terms used in community health nursing are defined, starting fromhealth, which is a state of complete physical, mental and social well being .Publichealth is for prevention of disease and promotion of health. But in community healththe emphasis that the community health nurse is responsible to provide preventive,promotive, curati7e and rehabilitative services far each individual. Community health



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Principles and Practice nursing services are provided within the framew ork of tot& hea lth e fforts. Theseof Community Health practices are for preserving and promoting the health of the total population. SoNursing nursing is directed to individual, family and comm unity. Com munity health nursingprocess is a continuous processs of assessing, planning, implementing and evaluationof the programmes.The process helps on developing working relationship with the fam ily to assess theirhealth needs.Community identification helps to assess the needs of the co .mnunity related tohealthy living. You make a conlm unity diagnosis and plan for action, such asimprovement of water supply, universal immunization, control of comm unicablediseases and health education etc. The action taken may be called cqmm unitytreatment.Nurses employed in com munity health services has to be specially prepared along withnursing, medicine, in social and behavioral sciences and epidemiology. Her area ofwork is ou tside the hospital and is vast. She has to make independent decisions. Herrole is administrator, supervisor, teacher, counselor, and practitioner. Her functions areassessing, identifying the health needs and resou rces and plan the health services. Inimplementation of care, health education is given priority over cu rative treatm ent.Evaluation is done periodically to achieve the set goals.The principles of com munity health nursing are guidelines to be follow ed in anysituation with sound judgem ent and comm on sense. Most of these principles pertainsto nursing'in general, not to comm unity health nursing alone. The responsibilities ofcommunity health nurse is to help individual, family and co m nu nit y to de velop andutilize their potential for healthful living, and to provide nursing care fo r sick anddisabled in their homes. The nurse carries ou t responsibilities of hom e v isit to patients,families and community groups such as school children, teachers, parents, antenataland post natal mothers, industrial workers and elderly, following th e laid downprinciples. Community health nursing must be based o n an understanding andappreciation of needs, social relationship, culture norms, custom s and traditions of

I patient, family and community.

1.9 KEYWORDSAppraisaI : To evaluate the worth, significance or status.Assessment : To determine the importance, size or value.'

I ClientICustomer : A person who engages the professional services ofanother.

I Competency : Required ability or quality.Demographic : Statistics of human population.Goal : The end toward which effort is directed.~ a n d a t o r ~ / ~ b l i ~ a t o r ~ Compulsory binding of constitution - command.Postulate : To assume, hypothesis advanced as an essential

presupposition of a train of reasoning.PreceptIPrinciple : Intended as a general rule of action or conduct.Strategies : A carefulplan.34


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1.10 ANSWERS TO CHECKYOUR PROGRESSCheck Your Progress 11) Go through the definitions given in the text and write on the paper.

Y2) Services provided in community heath are:- me$ical care- mother and child health- family planning services- disease control measures- healtheducation.

Check Your Progress 21 ) a) Establishing and maintaining a working relationship.

b) Assessing the health and nursing situation.c) Establishing the goals for health and nursing care.d) Constructing and implementing a programme of action.. ,e) Evaluating the action.

2) improvement of water supply, immunization, health education, control of specificdiseases, health legislation.1

3) Skills in co&nication, observation, knowledge of community resources,expertise for understanding human behavior.

4) Community Health NurseAssessing about community, identifying the health nee& a ~ dhen interpreting tothe community agency, estimating the required services:'- Area of planning is broad i.e., health team, school personnel 'and with agency,- Runs clinic independently, and- Works with sick as well as healthy families and emphasis is on prevention ofdisease andpromotion of health.Hospital Nursepatients, ward, units are assigned and she has to give car6 to thosegatients only:- area is of specific diseases,' he patient is sufferiqg from,- has to work under the supervision of physicianlsurgeon and sknior nurse, and.

, - work'with sick people, emphasis is on treatment and care.LCheck Your Progress 3L Responsible to the,5mploying agency,m Health services should be available to people irrespective of age, sex, creed,

nationality, political affiliation, social or iconomic: status. ,*".



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Principles andFractice e Th e nurse as a health worker must be non-political an d non-sectarian in herof Community HealthNursing relationship with people.

@ In commu nity health Nursing the family is recognized as a unit of service.a Facilities for further training should be provided by the organization lag en^^.a Th e nurse assumes responsi5ility for her own co ntihuing professionaldevelopment.

unit 1community

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