UNIT 1 INTRODUCTION TO CO

Structure
1.0 Objectives Introduction Development of Commuility and Community I-Iealth Nursing 1.2.1 The World/Global 1.2.2 India Concepts of Comnunity Health Nursing 1.3.1 Related to Community 1.3.2 Related to Community Health 1.3.3 Related to Community Health Nursing Community Identification and Cormxlunity Diagnosis 1.4.1 Identification 1.4.2 Diagnosis Community Health Nursing Process Principles of Com~nunity Health Nursing Preparation and unctions of Community Health Nurse 1.7.1 Educational Requirement 1.7.2 Competence Required 1.7.3 Scope 1.7.4 Role and Functions Let Us Sum Up Key Words
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1.1
1.2

1.3

1.4

1.5

1.6 1.7

1.8

1.9

1.10 Answers t i Check Your P~ogress

After going through this unit, you should be able to :

a

summarize the events involved in the clianges arxd development in community health in India; define various terms, such as health, public health, community health and community health nursing; explain the concept of identification and diagnosis of com~nunity health; discuss community health nursing process; and describe the knowledge, skill and attitude required to practice coinmunity health nursing.

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INTRODUCTION

In this unit, you will go through the development of carnrnunity health in India and world wide. We shall trace the historical development during various periods bcfore Independence of India and in post indepenclence period, You will also he reviewing

Principles and Practice of Community Health Nursing

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

1.2 DEVELOPMENT OF CO TY AND COMMUNITY NEALTW:NURSING

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We shall trace out the development of community health and community health nursing in the following sub-sections.

1.2.1 The world/Global

The historical development from Pre-Christian era influenced the medical and nursing practices. Rudiments of community health can be traced from the earliest civilizations. Pre-Christian Era : People have always been concerned with the events surrounding birth, death and illness. A new c~nce~tualization'of man influenced the health practices. The early church believed that the Roman and Grecian ways pampered the body 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 health as currently known began. The history of the early Christian Church is replete with examples of home health care. Of considerable importance was the work of St. Vincent de Paul and Mademoiselle Le Gras who established what was probably the first actual cormnunity health niuding programme. The industrial revolution witnessed tremendous advances in transportation, communication and other forms of technology. Modern public health efforts begap in England, the first modern industrial nation. . The Poor Law Amendment Act of 1834 ushered in a new era of social welfare and community Health in England. Lilian Wald organized visiting nursing in New York in the 19th century, established the unique programme at the Henry Street Settlement and was responsible for many improvements in living conditions in New York City. , The first visiting nurse society in America began in Philadelphia in 1886 to provide home health care for the sick.

h witnessed multiple improvements that both directly and The early 2 ~century indirectly affected health status.

1.2.2 India
I

Let us discuss the development of community health under various periods in the history of India. The changes and developments in man's environment and society and the scientific advancement in technology and medicine have affected cormnbity medicine and community nursing practice for co~nmunity health in India. I~idustrializatian and urbanization have compounded the problems in the management of co~mnuiiity health. Let us briefly present the historical events in the development of community heal& in India.
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Vedic Period (3000 BC to 1400 BC) The Indus Valley civilization showed relics of planned cities and practice of environmental sanitation. The Ayurveda and Siddha system of medicine practiced during the time suggests the development of comprehensive concept of health by the ancient sages o l India. "May all men be free from disease and lnay all be healthy" was an ancient saying of the Indian sages. The concept of happiness has its roots in the ancient Indian philosophy of life, which conceived the oneness and unity of all people, wherever they lived. Post-Vedic period (600 BC to 600 AD) Medical education was introduced in the ancient uiliversities of Nalanda and Taxila. Icing Asholca expanded the hospital system introduced during the Buddhist period. Moughal Period (about 1000 AD) The Ambic systein of' medicine known in India as Unani system was introduced and becalne part of the Indian rncclicine. British Period (19th century to Mid 20th Century). Many acts on health were passed. Significant events during this period gives a brief account of the changes and development in the public health systenl in India. 1757 1825 1859 1801. 1869 1873 1880 1881

Introduction to Community Health Norsir~g

The Britishers established their rule in India Quarantine act promulgated

A royal com~nission was appointed to investigate'into the cause of unhealthy conditions p~.evailingin the British army stationecl in India
Sanita~y commissioners appointed in Bombrty, Madri~s nml Beiigul Public Health commissioner ancl a statistical officer were appointed by Governrnent of India Birth and Dealh Registlation act promulgated Vaccination act passed First Indian Factories Act passed First all India census taken

1897 1904. 1907 1911 1918

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Epidemic act passed Plague comtnission recornmendation Central Research Laboratory at Kausali established Indian Council of Medical Research (ICMR) established Lady Reading Health Scl~ool in Delhi estublist.led Nutrition Research Laboratory at Cownoor (Tamil Nadu) established

1919 1921 1930 1931

Decentralization a1health administration in India Legislation introduced l'or advmcemerrt of public healtll All India Institute of Hygiene and Public I-Iealth established at Calcutta with aid from Rockfeller hundation Maternal and Child Wealth Bureau eststblished by Ix~dian Red Cross Society

Principles and Practice of Community Health Nursing

1939

Madras Public Health Act passed Rural health training at Singur near Calcutta started with assistance from Rockfeller foundation Indian Tuberculosis association established

1940

Drug Act passed

Pre-Independence Period:
1943 1946

Bhore Committee appointed Bhore Committee report submitted

Post-Independence Period:
1947

Ministries of Health established in Centre & State Government Director General of health services and Director of I-Iealth Services appointed by Central and State Health Ministers. Indian Nursing Council Act passed

1948 1949 1950

India joined as a member state of WHO ESI act passed Constitution of India came into force Planning Commission set up in India

1951

Beginning of first five year plan Central Drug Research Institute at Lucknow established Central Food Research Institute at Mysore established Diploma in Community Health Nursing started at College of Nursing, Delhi

1952

Community Development programme launched on 2nd October Constitution of Central Council of Health

P r i m a r y HeaIth centres set up

Viral Research Centre at Pune established 1953
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National Malaria Control Programme started National Small Pox Eradication Progrmne started National Family Planning Programme started

1954
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Contributory health s6rvices scheme initiated Central Social Welfare Board set up

National Water Supply and Sanitation Scheme started National Leprosy Control p o g r d r n e started VDRL antigen production set up in Calcutta

Food Adultration Act passed

National Filaria Control programme started Central Leprosy Training and Research Centre at Chinglepet Central Health Education Bureau established Second Five Year Plan National Mal'xia Eradication Programme initiated Mudliar Committee appointed National Tuberculosis Institute at Bangalore National Research Laboratoty at Coonoor shifted to Hyderabad (AP) Constitution of School Health Committee Muldaliar committee report published Third Five Year Plan Central Family Planning Institute established National Small Pox Eradication Progra~rune National Goiter Control Programme started Applied Nutrition Programme launched National Institute of Comnunicable Disease inaugurated National Trachoma Control Progr,unine started Chadda Co~nmission report submitted National Institute of Health Administration & Education set up at Delhi Mukerjee Committee constituted Jungwalla Committee submited report Modhak Committee set up Small Family Norm Committee set up Fourth Five Year Plan 1970

Introduction to Community Health N~rrsing

Drug Control order All India Hospital Post Parturn Programme

l i

1971
1972

Population Council of India Family Pension Scheme for industrial workers came into force National h s t i t ~ ~of t eNutrition set up in Nyderabad

- 'Medical Termination of Pregnancy Act came into force on 1st ~ ~ r i l - Kartar Singh Committee submits report
National Programme of Minimum needs incorporated with health services

1973

1974 1975

Fifth Five Year Plan India declared Small Pox free in July ICDS set up in October
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ESI Act amended

National Children Welfare Board set up Srivastavza ' .:amittee submits report
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Principles and Practice of Community Health Nursing

1976

Preveiition of Food Adulteration Act amended Indian Factories Act amended

+ passed

National Programme for Preventions of Blindness formulated 1977

Small Pox declared Eradicated in Asia by WHO National Institute of Health And Family Planning formed Training of Community Health Workers & Rural Wealth Scheine started

1978 1979 1980 1981

Alma Ata declaration of Health for All adopted by India World Health assembly endorsed declaration of Alma Ata on Primary health care Sixth Five Year Plan Census Wen
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Emergence of AIDS India committed to the goal of providing safe drinking water and adequate sanitation for all by 1990 Prevention and control of Air Pollution Act introduced 1982

National Health policy announced Guinea-worm Eradication Programme launched

1984
1985

Bhopal Gas tragedy December Seventh Five Year Plan Universal Immunization programme launched Leper's Act 1898 repealed

1987

National AIDS Control programme started

New 20-point programme launched

Safe Motherhood programme launched
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National Diabetes Control programme started

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. 1991
1992

Census taken
Eighth Five Year Plan

1994 1995
1997
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IGNOU launched Post Basic B.Sc Nursing programme Pulse Polio Immunization conducted
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1998
2000
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Reproductive and Child Health Programme i~nplemeted. Ninth Five Year Plan Nutional Population Policy Census taken National Health Policy 2002

201 2002

2003
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Tenth Five Y e a r Plan

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2005

National Rural Health Mission Launched '

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1.3 CONCEPTS OF COlMMUNITY WEALTH NURSPNG

We shall focus on the concept of community, community health and community health nursing as follows.

I~~troductlon to Community Health Nursing

1.3.1 Related to Community

Community is a social group determined by geographical boundaries and or colnmon values and interests. Its members know and interact with each other. It functions within a particular social structure and exhibits and creates certain nornls, valucs and social institutions. The individual belongs to the broader society through his family and community.

1.3.2 Related td Community Health

Community healtl~ refers to the health status of the members of the coinmunity, to the problems affecting the health and to the totality of health care provided for the community..The major determinants of community health are the health status, disease patterns and health expectations of the people. In addition, the social, econolnic and cultural environmellts influence the health, health behavior and health perceplions of the group both positively and negatively. Rapid population growth and urbanization contribute to the health problems.
A new concept of public health arose in this century according to which community has a direct responsibility for the health of the individual in h e community. A sick person is a community's liability, This led to the concept that healthy people are a nation's greatest human resource for econonlic developrncnt of the country. For this reason the community should provide facilities to provide cornprehensivc medical and health care both prolnotive and curative to a11 its citizens. Community health postulates a unified and balanced integration of promotive, preventive, curative and rehabilitatiarl services. Thus the -term public health is replaccd by community hedth. Since n community has a direct responsibility for the health of eveiy individual, action was directed towards all aspects of health. Healll-1of an indiviciual includes physical, mental, social and spintual well being in his natural environment such as family, school or place of work.

The assessment of health requires an understanding of the general population to be served. 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

of community Health Nursing

solid waste management, including sanitary handling and disposal vector control and the control of alternative hosts of diseases environmentalpollution climate
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structural organization and administrationof environmental health services

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 problems

4) Health needs

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mortality and morbidity data according to major causes, age, sex, geographic distribution the extent to which &e principal diagnostic categories result in a deinand for health 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 and knowledge 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 ~ e l a t e d to Community Health Nursing

Community Health Nursing combines nursing and public health. It synthesizes the body 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. Thus community health nursing can be defined as a field of practice that synthesizes knowledge and skills in nursing, public health and applies them toward the promotion of optimal health for the total community. Cormn~~nity health nursing as practiced today is a product of growth and adaptation. It has been amended to acconmodate the needs of a changing society. Many factors health nursing. Five significant forces'that have influenced the growth of co~nmunity continue to shape the development of community health ilursing we advanced technology, progress in casual thinking, changes in education, the changing role of the Ilurse and the consumer movement.

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Trends in Community Health Nursing are:

e e e e e e e

Introduction to Community Health Nursing

Chronic diseases and prolonged hospitalization Problems of the aged Population explosion and family planning Pollution - noise and radiation Industrialization and Urbanization Addiction to drugs and alcohol Health education Concepts of sociology, psychology, a~lthropology and mental health

Introduction and use of gobar gas plant, 'anganwadi, vocational courses and use of media Vital statistics - assessment and recording

Adulteration of drugs and food.

Characteristics of Community Health Nursing

Six characteristics of comlnunity health nursing are:
1) It is a field of nursing

Community health nursing is a field of nursing,its basic knowledge and skills are those of professional nursing practice. It seeks to give humanistic, accessible and holistic care. co*munity health nursing is a nursing specialty, nursing heb@ forms its foundation and the nursing process is one of its basic tool&and copununity health nursing adds concepts, knowledge nncl skills from other disciplines to become a distinctive practice.
2) It combines public health with nursing

Community health nursing incorporates public health content. Knowledge of the elements essential to community health are history & philosophy of public health, concepts of aggregates; priority of preventive and health promotive strategies; concepts of epidemiology and its methods; influence of environmental factors on health; principles underlying xnailagement and organization ofcorn~n~~nity health; and public health policy analyses and development.
3 ) It is population oriented

The central mission of community health practice is to improve the health of the population groups. Community health nursing shares the essential features: it is population oriented, concerned wilh the persanal and environmental health of the population groups: The population oriented focus requires the observation of relationships.
4) It emphasizes health

Community health nursing emphasizes on positive health or wellness. Community health nursing has the primay charge to prevent health problems from occurring and to.promote a higher level of health. Community health, nurses concentrate on the wellness end of the wellness-illness continuum in a variety of ways. Comnunity health nurses seek out potential health problems. They identify high risk groups and institute preventive program~~~es. A wellness emphasis requires taking initiative and making sound judgements.

. of Community Health
Nursing

Principles and Practice

5 ) It involves interdisciplinary collaboration

Community health nurses work as full members of the health care team. Coordination and cooperation are required in practice that deals with the population groups. Effective collaboration requires team members who are strong individuals. Community health nurses who think and act independently make a great contribution to the team effort.

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6 ) It pro~notesclient participation
Consumer participation in health care in an important characteristic of community health nursing. Community health nurses encourage consumer participation by promoting client's sense of responsibility for their own health. This process is known as self-care. Consumer participation is promoted when clients are treated as partners on the health care team. The goal is collaborating with clients rather than working for clients.

Conceptual Framework for Community health Nursing Practice

Conceptual framework for community health nursing include five sets of variables:
e

Practice priorities are prevention, protection and promotion

e . Interventions are education, engineering and enforcement

o e

Scope of practice encompasses the range froin individual to aggregates Four health determinants are factors to be considered in designing practice interventions. They are human biological determinants, environmental' determinants,medical-technological-organizational determinants and socialbehavioural determinants Community health nursing dynamics with'two essential dynanics - the nursing process and the valuing process.

Introduction to Community Health Nursing

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CO

TY DIAGNOSIS

In this section we shall discuss about community diagnosis and identification as given below.

1.4.1 Community Identification

Coinmunity identification is a systematic process of knowing and exploring a defined community for assessing its health status and determining the possible factors affecting the health of people. It is more than making a medical or nursing diagnosjs relevant to the community. It implies getting to know the area where the community is living, the other families in the area, the conlmunity leaders in particular, their life style and their resources. All these information can be obtained by: i) holding f o d a l and informal meeting with community people, leaders and organized group which may include panchayat members, school teachers, lnahila mandals, youth clubs/groups, young innovators etc. observation visit to community for observation of physical environment, biological environment and psychosocial environment,

ii)

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 community health centre can be used to collect valid information about the conlmunity. The cormnunity identification will also help in making Comnluility diagnosis. Community identification is to :
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Systematically gather health related data about a selected community

Develop community profile Explore boundaries of community 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 of the colnmunity and - Record the health conditions that are threats lo a specific populatiox~ groups in the community

Identify biological, physical and social forces that have beslring on the health of the cornmunity,

- Indications for community identification are:

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

Needs assessment of a specific community.

Principles and Practice of Community Health Nursing

1.4.2 Community Diagnosis

This will highlight the health problems and the healih needs of the community which you will be able to assess from the information. Assessment of the health status will be 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 d health habits or traditional cultural practices , lack of health knowledge and attitude; inadequate and inefficient resources available. Subsequent to making the community diagnosis, the health problems or needs are prioritized for planning and implementing comprehensivehealth action. Community health action is the sum total of various health and health related activities which arc decided to deal with the health problems and health needs, keeping in m i n d the resources, whishes of the family, nature of the problem, their impact on the heallh of the people at large and the agencies policies and objectives. These services include safe motherhood services, child survival services, nutrition and family welfare services, prevention and control of local communicable diseases, environmental sanitation, health education etc. Coinmunity diagnosis is the cornerstone of community health practice. Various assessments and procedures are undertaken before a diagnosis is made. Similarly before implementation of the health activities ili a given community, it is important to assess the situation in the community; its problems; its needs; resources as well as its traditions history etc. Only with this knowledge appropriate measures would be undertaken in the delivery of health care. ~onimunity diagnosis is the frst step in the establishment of a health programme. Steps in planning programme are: Community Diagnosis (Identification o f problems, needs and resources)

v f priorities Establishment o

n U f action ~stablishment of a plan o

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Definition o f objectives for action

CI

Choice of activi!ies

Mobilization and coordination o f resources

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

Stage I1 Stage I11

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Identification and classification of data which includes quantitative and qualitative data. Involves data collecting i.e., source of data and methodology of collection.

Introduction to Community Health Nursing

1 . 5 COMMUNITY HEALTH NURSING PROCESS

Nursing process is a problem solving process and helps in providing systematic need setting. Community health nursing is based care to the client in hospital and co~nmunity concerned with helping people to solve their health problems which may be simple like dealing with minor ailments or complex like control of communicable diseases. The problems may be dealt with at individual level, family level, village level, block or district level. This can be done by deliberated systematic series of steps which helps to solve the problems and achieve desired goals of health promotion, prevention and control of health problems. Community health nursing process is a systenlatic approach to nursing practice in an interacting, interrelated and interdependent psychic phenomenon of assessment, planning, intervention and evalualion termed as components of nursing process which is interchanged to assist the client in a collaborative manner. The aim is to restore a continuum of balance and powerful direction within the internal environment. Three characteristics emphasize the ilnportance of this tool for cotninunity health nursing.

First, the nursing process is a problem solving process that addresses the community health problems at all aggregate levels and aims to prevent illness ant1 to promote community health.
&econd, it is a management process that requires analysis of a siluation. decision making, planning, organizing, directing and controlling servicc efforts and evaliiating outComes. As a management tool the nursing process addresses a11 aggregate levels.

Third, it is a ~ h a n g e ' ~ r o c ethat s s worlcs to improve various levels of health related

systems and the way people behave within those systems. The process has five major steps: i) establishing and maintaining n working relationship assessing the health and nursing situation

ii)

iii) establishing the goals for health and nursing care

iv) constructing and implementing a programme of action v) evaluating the action. These steps may also be categorized into three different phases:

i)
' ii)

The assessment phase The intervention phase

iii) The evaluation phase.

These plzases are sequential, progress Born one phase to another i.e,, the assessment of problems help in formulation of goals and objectives, actions to be implemented bfollowedby evaluation to measure the outcomes of the intervention.

Principles and Practice of Community Health Nursing

i)

Establishing and Maintaining Working Relationship

Community health nursing process is working with the people, helping them to solve their problems, develop their competencies to meet their own health needs. This is possible only by establishing working relationship with the f d l y and community. Basic to this kind of relationship is an attitude of trust and confidence in the integrity and capabilities of each partner in health to improve the client's health status.
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A working relationship0 permits the nurse and the client to know each other and work together, have two-way communication, discuss the problem and find solution to improve health conditions or situation i.e., productivity. It promotes acceptance by the client (Mutual Trust). Working relationship is developed by knowing the client and by communicating the intentions to help and the nature of assistance that can be extended; be a good listner (communication)show desire to help, answer their queries, consider their views, meet their immediate needs, appreciates what is worthwhile, confidence, motivate to bring change in health behaviour, be empathetic (empathy).

ii) Assessing the Health and Nursing Situation

Assessment of health and nursing situation is essential as it will help to determine the extent and nature of problems and the underlying causes and the resources available to deal with the health and nursing problems. It involves collection and analysis of initial data (factual information) about the following aspects as also described with community idegtification:

a) Human ~ i o l ~demographic ~y: characteristics like age, sex, social economic conditions, deaths, births, mental status, hereditary characteristics.
b) Life style and culpral
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customs.

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c ) Environment: phy$qal, ' : , biological, social, and spiritual.

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d) Resources: health'and health allied resources.

The methods used for data collection are the same as for cormnunity identification and they axe: questioning, observation and record analysis. The tools to collect data are interview, questionnaire, observation cl~ecklist.

A nu& may walk through the area to get to obskve the over all status of the community and their living standards. She meets the vi~la~e'leaders to know their life style, health problems, vaious assets, and liabilities. The coping ability of the family can be assessed from family folders and individual records and by actually working with the family. This information will help to identify health deficits eg 'any disease; health threats i.e.,any situation which may cause any disease e.g., poor environmental situation; foreseeable crisis situation e.g., ildolescence, old age, menopause etc., and coping abilities to deal with problems e.g., Knowledge, attitude, life style etc.
Once the problems are identified, it is better to prioritize these probletns because all problems cannot be dealt with at once. Four major criteria have been selected to consider the priority of problems:

~ a k r of e problem, its gravity, prognosis and impact on the health of others. Whether the problem can be minimized, controlled or eradicated i.e., whether something 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 the family/community considers it a serious problem requiring immediate care, whether it is considered as a felt probledfelt need by the family 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 the community and families. This can be done by establishing contacts and discussing and explaining the actual findings to them, answering their queries and doubts, and relating health need to overall family developmental goals, etc. Thus, you can help them solve one problem at a time.
iii) Establishing Goals for Health and Nursing Care

Introduction to Community Health Nursing

Establishing goals is the third step of the nursing process. A goal is a broad statement of directions to resolve the situation identified while assessing the health and nursing situation. ?t is very important lo set the goals because goals not only give directions to selection of actions but also help in sustaining and evaluating the actions planned and implemented. They also help the client to judge whether the individual, family and community know what to do. The goals should be clearly, stated, specific, measurable and time-related, e.g., to ensure comprehensive maternal care to all mothers in a particular village by trained health personnel in order to bring down IMR from 162 per 1000 live birth to 8011000 live births during period of five years. This is a very general goal. This goal includes three sub-area.i.e., antenatal, natal and post natal goals. The specific goals which are explicit statements relevant to these three sub-areas of the goal need to be identified. For antenatal care the goal Iilay include for that village:

To register all antenatal rnolhers of 12 to 16 weeks of pregnancy. To get medical examination of all mothers done once in each trimester. To mange for periodical check-up. To prevent anaemia by propl~ylaxis treatment. To immunize against letanus. To educate the mothers on various aspects of antenatal care. To identify high risk mothers and arrange for To prepare for bonfinements at home. To train Traditional Birth Attendants (TBA/Dai) services etc.

These specific goalslobjectives determine the actual actions to'be planned and implemented which will help resolve the situation and achieve the targets. Like that there can be a number of general goals/objectives and the specific objectives. The general goal with its specific objectives is at the level of community. Similar goal with its specific objectives can be stated at the individuals 'and family level, e.g.:

Ensure safe and effective maternal care to the pregnant mother by the trained health personnel so as to have a live healthy baby and to promote and maintain the health of mother and baby. To develop a family's awweness and competence to deal with the special need of the mother during antenatal period, natal period and post-natal period so as to promote and maintain the health of both mother and the baby.

Specific objectives will be the same as listed earlier. After the general and specific goals are establisl~ed, they should be reviewed to determine which are to be achieved immediately or within a limited period of time i.e., the short term goals, e.g., preparation for component which are to be achieved in the future i.e., long tern goals determining ways for decreasiilg expenditure and

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Principles and Practice of Community Health Nursing

increasing income. This will permit the health worker and the client to concentrate on those goals which help in meeting the immediate needs and movement towards achieving of the final goal. All these goals and objectives are meant for clients and therefore should be determined by a joint effort of the nurse and the client. This will promote client's compliance with the actions to be planned and implemented. Above all, the goals and specific objectives should be realistic and achievable otherwise it would lead to disappointments an conflicts. iv) Constructing and Implementing Programme of Actions This phase refers to identification of appropriate nursing interventions, developing an intervention. For any single objective to be achieved, there will be several suitable alternative actions and we have to choose those which are appropriate and feasible in achieving the objectives. We can take the example of specific objectives listed in the previous step i.e.:

To register all antenatal mothers by 12-16 weeks 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 in the clinic or both, (b) registration by indigenous trained Dai, midwife, ANM or by anyone of them who is responsible for registration, (c) what care to be included at the time 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 arthritis patient 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 be thoroughly considered along with the family and the one which is most suitable to the family situations should be implemented. The criteria which can help choose alternative actions are (i) agency policy, (ii) family resources, (iii) comi~~unily resources, (iv) nursing personal available elc. For each of the above mentioned actions to be implemented, there are three types of nursing interventions i.e.: a) Supplemental
b) Facilitative

c) Development.

In supplemental nursing intervention, the nurse gives the care which the family cannot do but at the same time the nurse helps family to develop the abilities to give the care through education which is developmental intervention. She also helps families in mobilizing and developing resources which are required to give care. This type of intervention is facilitative. Most of the times all the three types of interventions are implemented. Of course any one of these may predominate depending upon the situation themselves and the nurses provide direct care wither by themselves or through the auxiliary nurses, e,g., care of the sick individual, anlenatal mothers post-natal lnothers etc. But, at the sanie time, she educates the mothers and other 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 available to the community which will h.elp in implementing the actions planned. The nurse need to know the functional relation of these resources which include health and health allied agencies. You are expected to identify these resources, make a list of these and
. .

visit these agencies to know their functions and procedure of Sunctioning; governmental or non-governmental. During your field experience you are expected to identify these resources, make a list of these and visit these agencies to know their functions and procedure of functioning. In comnlunity health, varied health problem and health needs are identified. For each of the health problem and need, there will be alternative actions e.g., health threats like poor environmental sanitation, defective health behaviors, health deficits like various communicable and chronic diseases and various interventions. She also helps families in mobilizing and developing resources which are required to give care. This type of intervention is facilitative. Most of the times all the three types oS interventions a-e implemented. Of course any one of these may predominate depending upon the situation thenlselves and the nurse provides direct care whether by themselves or through the auxiliary nurses, e.g., care of [he sick individual, antenatal niothers, postand other natal mothers etc. But, at the same time, shc educates the ~nolhcrs members of [be family to leru-n to take care of the sick, 13cw born babies, postnatal mothers, etc. and give case in her absence. She also helps families develop their own resources and rnobilizc resources available to the cormnunity which will help in implementing the actions planned. The nurse need to know the functional relation of these resources which include heallh and health allied agencies but you are expected to identify these resources, make a list of these and visit these agencies to know their functions and procedure of fuactioning, governmental or no~i.goves~~rnental.. During your field experience you are expected to identify these resources, make a list 01these and visit these agencies to know their fcinctions and procedure of S~111lnctionin.g.

Introduction to Community Health Nursing

In community health, varied health problems and hcillth ~iccds are identified. For encli of the health problem and need, thcre will he alternative actions e.g., lienlth threats like poor environmenlal sanitation, del'ectivc health behaviours, health deficits like various co~llmunicable and chronic diseases and various crisis situation, etc., which require nursing intervention. It is very important to develop an orgrlnizetl schedule i.e., when to do what and who will deal with the problems. This ilnplies prioritizing and phasing out problems and the actions to deal with these problems as all problems that cannot be dealt with simultaneously. Prioritizing iinplics that there m-c some problems and health situation which require i~nniedii~te intervention c.g., communicable discases, malaria, etc., which can be prevented by simple me;lsures. high risk groups like mothers and children and the elderly gmups. Phasing implies dealing of problem into manageable units or stages.
v) Evaluating the Action Plan Evaluation of community heallh nursing services determines the effectiveness of services provided i.e., whether the intended r e s ~ ~ lare t s achieved or no1 specified. It also helps to identify the causes of failure which can be rectil'ied. Evidence of effectiveness are change in knowledge, attitudes and practice, degree of: independence, reduction in morL>idityand ~nortality rates, decrease in birth rates, increase in life expectancy, population coverage, clinic ritrendance. It shows evaluation is qualitative and quantitative. It is very important to have a) 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 or services.

Principles and Practice of Community I-Iealth Nursing

Check Your Progress 2

i) List the steps of Nursing Process in cornnlunity health,

.....................................................................................................................................

.....................................................................................................................................

................................................................................................................................

.....................................................................+.............................................,........... ..
ii) Mention any five areas of action for cohmunity health.

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.................................................................................................................................

..................................................................................................................................

..................................................................................................................................

.....................................................................................................................................

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

...................................................................................................................................... . " . ..................?...........*......... ............................................................................................. . . .................................................................................................

, ,

,...........,.....,l..1.....t....,,

....................................................................................................................................

...................................................................................................................................
iv) Differentiate betyeen the functions of a comnunity health nurse and hospital . nurse.
,

..................................................................................................................................... ' ................. '......................................#.........*.............*........*.*..............*....................... .

,
,

'

. . .

.
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8

' 1 . . . . . . . . . . , . * . , . ~ , . . t . * . . . . . t . * t . t t * t t , . t . t t , t . t t . t . t t . t t . . . t . . t t . t . t t . t . t . . t . t . t . t . .

................................................. .....:...............+................................. .............................

.
,

. ................................................................................................................... .............'...*... . .
% I

,.

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.,

CIPLES OF 60

PTY HEALTH NURSING

The co~nmunity health nurse occupies a ltey place in the health team. The process to deal with health problems in the community remains constant. Principle is an accepted truth, the evidence for which might be scientific. The community health nurses'role in her community work makes her a teacher, counselor, friend, a midwife, a social worlter, a nutritionist, a nurse practitioner, a health educator, leading her to perform several tasks.

The community health nurse working in the communily should follow the following principles in her daily work regardless of her special training or position. Principles of community health nursing practice are: a) A community health nurse should know the community thoroughly i.e., community leaders, 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 being the usual setling. The nurse is the guest and the farnily/patient is the host. The illtless of one member of the family affects the whole family. The community health nurse is able to observe the anxiety, fear and behaviour of each family member in the h ~ u s e more closely and she can decide the health action appropriately and utilize the comnunity resources. The nurse's ultimate goal is to make the entire family independent and knowledgeable regarding health principles and practices. Nurse has to plan with the family and not for the family. Emphasis is on health promotion for all fanily members through health counseling emotional supper- and understanding, teaching, demonstrating and providing nursing care to the patient.
b)

Introduction to Community Health Nursing

The conlniunity health nurse should work effectively with other members of the health tcam by nstablishing good interpersonal relationship. She should be aware of .the role of various health team members to avoid duplication of services. Health tea111~llemnbers in comnunity health are doctors, cornm~~nity health nurse, multipurpose health worker male and female, lady health visitor, traditional birth attendant, village guidc etc. The team plans and executes health programmes. health nurse should assist in planning, implementation and The co~llnlunity evaluation of the programmes. The cornlnunity health nurse works with the family as n unit of setvice and bring into each home special services required for sanitation, nutritional, lnaternal and child health problems and family welfare, or diseases or i~tlmunization. She needs medical support for control of cotnmur~icable her work. She solves the problem of environmental sanitation, by coordinating will1 sanitarian, and he can also refer problems to her which fall within her health assistant and health jurisdiction. She supervises the work of ~nultipurpose worker. She guides them and avoids duplication and repetition of services. Team members have to support each other's work to get the results.

c)

The community health nurse is responsible to the authorized agency through which she is employed. Nurse employed by the agency which may be a state, municipality, local bodies, voluntary or private, she has to work in close consultation with the employing authority 'and work within tbeir laid down policies, If she is working as District Public Health Nursing Officer then Chief Medical Officer of the District is authority for reporting, who is responsible for coordinatioll of local programme of the district.

d) Community health nurse needs to maintain professional relationship and etiquette with everyone in the community. She needs to bk conversant with the local c~~stoms and should live more or less with the people whom she serves. It becomes manclatory for a nurse to develop professional relationsl~ipwith other organization concerned with health in her area. She needs to visit offices of Block Development Officer , Child Developinent.Project Officer, Panchayat, Mahila Mandals , Voluntary Co~munity Organizations and local Dais. The nurse should work with HsLkims, Vaids, homeopathic and allopathic medical practitioners. She needs to explain her programme of work to get cooperation from all especially develop friendly relationship with the dai in whom the village people have faith. Local health practitioners can become hindrance for starting a new progrmle,

Principles and Practice of Commu~lity Health Nursing

'

so to get their s~~pport nurse needs to orient them for getting community's cooperation. e) Community health nursing services should be available to all people irrespective of their age, sex, creed nationality, religion, political affiliation, socio-economic status. Every human being has a right to good personal'health and environment conducive to healthy living. So community health nursing services must be available to all persons according to their health needs.
f)
e

The community health nurse should be non-sectarian, non-political in her relationship. She should not interfere with the religious and political beliefs of people. This will help tlik community in accepting the community health nurse. A community health nurse would not interfere in the affairs of person's political or religious beliefs. Understanding of various religious beliefs, culture and customs of community can help her to render better services. People should feel that she accepts them, as they are, then they will listen attentively and accept her teaching. A comnlunity health nurse should also be careful not to thrust her religious beliefs on the family.

g) She needs to be vigilant in not accepting any bribes or gifts. According to the policy of the employing authority the nurse has to charge fees in certain cases but she must give official receipts and deposit the fees in the concerned office as soon as possible. She'should not take anything for her personal use such as gifts or money.
h) Health services should be based on felt needs. Health progranlmes should be planned 'on the felt need of the people. Needs can be assessed by health survey to enable the nurse to be familiar with the prevailing health problems and health resources. Nurses should concentrate on the urgent health problems using the more efficient methods available. i) The services offered need to be realistic in terms of available manpower and facilities and be of continuous nature. The services planned should be according to the needs of the clients and the community. Before planning the health services the money, material and manpower needs to be assessed.
j)

Health education needs to be interwoven throughout the practice. She should plan community health education programmes. . Health teaching is an integral part of every health programme. Teaching is a therapeutic tool for the nurse, which is cheap, permanent and all nurses can use it. Many liealth problems can be solved by effective health teaching. ~ e a c ' h i n is~ to be imparted to individual as well as to group. Teaching must be well planned according to the need and scientifically correct and of practical value to change habits for healthy living.

k) Continuous service is effective service. Health services should be provided

continuously to the individual family and the nurse must have repeated contact with 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 and whether teaching has been put into practice to improve health habits. 1) The services offered by the community health nurse needs to be periodically assessed to determine the progress.

The criteria for evaluation should be built in the plan to meet the objectives which should be clearly stated. Evaluation helps to critically review programme and guide future planning.

~ to~C*mmu11it3' u ~ ~ Health Nursing

rn) Adequate reports and records need to be maintained on the work and services carried out by the community health nurse.
The maintenance of accurate records and reports help in their use to both, fanlily and agency. The family record is indispensable to the nurse in her daily work. It is also an important element in providing continuity of nursing care. Good recording cover all nurse-family, and the nurse patient contacts and interaction. The comnunity health nurse uses patient and family records in planning for home health visits and care of the patient. Before first visit to the family, the comn~unity nurse goes through the records to get acquainted with the family. Periodical critical study of records and reports help the agency top leadership to evaluate its programme and deternzine current and long tenn objectives. The records are a source of statistical information. These are valuable in ascertaining needs for additional staff and planning budget. Records provide guidance in making staff assignments. The comnunity health nurse is responsible for nlaintaining records which are current, accurate, complete and legible. The community health nurse needs to be well qualified and should maintain pofessional interest. The comnunity health nurse is herself responsible for her professional growth and education. Continuing education is considered a life long activity in all fields to be the greatest single challenge to health professional personnel. Each nurse needs to establish her own immediate and long tern1 goals in order to continue building and developing her education, both professional and general. A community health nurse can do it by reading journals ancl periodicals on nursing of her and allied subjects, by attending and participating in the meetii~g professional organization, by attending lechrres in the humanilies and arts. The community health nurse should plan to join courses in the colleges and universities . for higher education whenever possible. community Facilities musl be provided in any agency for professional growlh. T l ~ c health nurse should attend on-going staff education programmes. An in-service education programme is essential for the attainment of efficiency and for the professional growth. Provision should be made for in-service training and refreslzer course. Promising nurses should be encouraged to joill advanced studies. Periodic planned staff meetings for sharing experiences and information for widening with other members of the health team also provide an opport~lniry professional knowledge and skills. Attending conferences, professional meetings ; in the states and national level also help to broaden knowledge. The community health nurse needs to have job satisfaction. There should be health nursing services. provision for supervision and directing co~llmunity The aim of supervision is to develop the abilities and skills of the commuility health nurse. Supervision in the community health agencies by qualified ~zurse is It essential for continuous improvement of nursing services to patient and ECunily. helps in the planning of nursing work and for coordination of their activities with the agency. The methods used in supervision are planned and continuous staff orientation, review of family case records by supervisor and nurse, supervised home visits, individual and group conferences related to nurse's work, An adequate and

25

Principles and Practice of Community Health Nursing

satisfactory propgramme of supervision by fully prepared coinrnunity health nurse assists in the growth and development of each staff member and continues improvement of the nursing service to the community.

q) The community health nurse needs to practice herself what she teaches.

1.7 PWIEPAMFIONA m FUNCTIONS OF COMMWITU mALTIP NURSE

We shall discuss about preparation roles, and functions of comnlunity health-nurse in follo\;ling sub-sections.

1.7.1 Educational Requirement

A community health nurse prepared in general nursing diploina/degree programme with integrated community health nursing course or who has done certificate course in public health nursing can work in the hospital as well as the conununity.
The community health nurse should hold a registration certificate as a nurse lnd as a midwife from the State Registration Nursing Council. health nurse has In the hospital, the nurse works with sick patients but the co~nmunity to deal with healthy families and sick persons in the honles and their families. She also has to work with teachers and school children or industrial workers, elderIy grand parents within the social and cultural situations. She is expected to solve the problems of the conununity such as clean healthy environment, safe water supply and prevention and control of communicable diseases. She'has to give health education to people to develop healthy habits. S o she needs to be well versed in social sciences and .humanities. The methods and techniques of epidemiology. Most of the time community health nurse is placed in such a situation that she has to take independent decisions. So of in addition to the knowledge of theory and practice of nursing other con~petencies management and leadership are also required in comn~unity health nursing to meet the needs of patients, family and community. Most of the time she would be wgrking where there is no doctor.

1.7.2 Competence Required

A community health nurse needs to have:

26

Abilities and skills in communication: interviewing, listening, teaching and sharing of pertinent information with professional colleagues. Observational skill: ability to note signs and sylnptorns of physical, mental and emotional state in health and disease conditions of patients and their families.
-

Knowledge of community resources. Expertise for understanding of human behaviour in a particular situation. Ability totake decision independently.

Introduction to Community Health Nursing

The community health nurse has a varied scope and can function in various positions and situations as given below.
e
e e

She can work as a Primary care provider Perform Expanded role Work as a Practitioner

Family nurse School health nurse Occupational health nurse

1 *
I

II

Paediatric nurse .. Home health services Teacher, educator Counselor Researcher Work - health settingslagencies
1

,I

/
l

.o
0

*
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1.7.4 Role and Functions

A community health nurse is a qualified person who Elas undergone basic nursing course with the integration of community health nursing and registered with state nursing council. The personal characteristics of a cormnunity health nurse are:

Ability to work with people.

.
1
I

sound physical health (

Emotional stability

I Resourcefulness I

Good listening - ability

1
I

'

Ability to establish good IPR

Aspects of a community health nurse :

C
0

- , Consultant
Organizer Main member of the health team Manager

M M -

Principles and Practice of Community Health Nursing

U N

.-

Utilizer of manpower Nurse Practitioner

I T

- Independent role
Teacher

Helping client to achieve positive health

- Encouraging to practice healthy habits

A - Adequate provision of preventive and curative care

L T

Leading to progression of health care Teaching I.E.C.

H. .- Helping in crisis intervention N - Nobility

U
-

Unselfishness Responsibility Sympathy

R
S

- Efficiency

Role of a Community Health Nurse

~ o r m n u n ihealth t ~ nursing incorporates a variety of roles. Several factors influence the roles played by the community health nurses. The or&ization with which the nurse is affiliated usually has policies that govern nursing activity. Consumers use community health nursing services differently depending on their perception of nursing. 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.

*
e

Assessing collective needs and give services See holistic care is provided
,

Ensure that the focus is on wellness

e

Necessary skills as a care provider required are observation, listening, communication and counseling.
a
\ .

b) Educator

Health teaching is a part of gabd rhrsing care and one of three major functions of the Community Health Nurse. Health education provides health information and health consciousness.

28

Community health nurse educates people beyond the scope of routine educational activity.

- .-

As an Educator community health nurse has to;

e

Facilitate clients learning Share information

Introduction to Community Health Nursing

Act as a consultant Hold f o y a l classes Utilize groups for teaching

e e

Use expertise/referrals, . * . Facilitate client's self education Emphasise illness, prevention and health promotion. c) Advocate

- Patients right to receive just equal and human treatment. - The goal is to help client gain greater independence and make the system
more responsive and relevant to the ne6ds of the client.

- As an advocate the community health nurse pleads the cause of another by

speaking and acting on others behalf.

- Clients need someone to guide them through the complexities of the system
and to assume the satisfaction of their need.

Advocate roles require four important characteristics:

a

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

*
@ ,'
@

d) Manager Community health nurses are managers of health care. It involves activities like supervising care, managing case load, administering cliiric, conducting a comlnunity health planning project etc. The main functions as a mangager include:
'

- Planning: .
It is the basic function which enables to decide objectives aid achieve objectives and time required for planning. She has to: detenziine client concern and needs

establish objectives decide appropriate course of actidn

I1

- Organising :It includes

Identify and structure the activities of an organisation Placing people to achieve objectives
-

Arrange matters to accomplish goals Nurse provides framework in various aspects of service. Framework is part of service preparation. -

29-

Principles and Practice of Community Health Nursing

Coordinating : It involves bringing people and activities together so that they function harmoniously and achieve desired objectives. It is-a complex activity at community level. Leading

Supervising Motivating Controlling service activities.

e) Collaborator This involves working involves other members

e e
'

Community health nurse should work jointly in common endeavor and cooperate with partners of health care . Successful community health nursing practice depends on collegiability Every member of the health team has unique contribution

e
e
$

It requires skill in communication,interpreting nurses contribution, acting assertively

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 decision making, stimulate interest in'health promotion

a
a

initiate therapy direct preventive programme, influence health policy

It is a role of influence and persuasion It effects changes and community health nurse is a change agent Leader role assumis different form in different situation Community health nurse exerts influence through health planning Need for coordinated, accessible, cost effective health care services creates a challenge.

g) Researcher

Research is an integral part of community health nursing practice

e
e

Analytic skill Tenacity

Introduction to Community Health Nursing

research can be done at different levels.

Functions of The Community Health Nurse

Cdmmunity health nurse functions according to the designation under which she is employed which would be in accordance with her education and experience. She plays the role of an administrator, supervisor, teacher, counselor and practitioner. Function I
:

Provide and promote comprehensive nursing care.

Activity :

Assume direct responsibility for providing care1 supervise and direct others to do so. Teaching otherslorganize volunteers/regular staff.

a
Function I1 :

Referring to other source for care. The Community Health Nurse uses nursing as a channel for strengthening family life and promoting personnel development and self realization.

Activity:

Using opportunities to be with the families in their family functioneto learn the customs and traditions of the community. Involving herself in the functions of the society1 social gathering to assess how coimunity as a whole functions which will help her promoting the social life of the people. Using opportunities by participating in the panchayat meetings and conveying the health messages of the time.

Function I11 :
I

I I

The Co~nrnunity health nurse participates in disease control activities through general preventive measures, early identification of disease, provision of care and supervision of care to reduce effects of disease.

1
I

Activity:

Using channels to alert parents, teachers, patients, vulnerable group etc., to symptoms that merit further investigation1preventing intervention.

i
j
a

Use of family and patient history as a tool for eliciting symptoms, impairment and health risk.
Participating in epidemiological alert and investigation. Participating in screening. FunctionN : The community health nurse \:arks with appropriate person in special setting to plan, implerr,i.nt-healthprogrammes.
. d

Activity:

*
*

Reviewing ;,I ,d interpreting data relevant to health needs of SPE a1 population groups. h a n g i n g i h appropriate administrativepersonnel for schedult and prozedures for reporting and evaluating tgoing and special health activities:
J

Principles and Practice of Community Health Nursing

Serving as a member of committees for health planning and actions.

Function V

The Community Health Nurse plans and evaluates nursing services for the population groups under her care to maximize benefits of nursing 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 and vital statistics trends that might have relevance for nursing.
e

Setting goals and clearly defined outcomes for nursing service and establishing a systematic method for checking progress. Conferring and planning with other health workers for the care of families and groups. , Working with nursing supervisor6administratorto evaluate nursing accomplishments and to plan for improvement.

Function V1 :

The Community Health Nurse contributes to decision and policy setting in the agency and community.

Activity:
0

Sending reports/suggestions based on field observation or other personal experience, Accepting membership of agency or community planning agency.

Function VII : The Community Health Nurse contributes to the extension of knowledge in nursing and health care by engaging in surveys, studies and research.

Activity:
o

Planning and carrying out sample surveys or studies as part of continuing seqice effort. Participating in research done by others when it is appropriate.

However, community health nurses working at the primary health centre in staff position have following main functions:
a) Identification of community

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

* .

b) Planning

33.

Community health nurse plans for preparing comprehensive nursing care to individual, family and the community of her areas. Plans with the medical officer and with other members of the health team and other related sectors for appropriate care to the family.

Plans for services in the schools, clinics and health centres. Plans for health educational programmes and conducts meetings.

Introduction to Community Health Nursing

c) Implementation

Community health nurse gives direct care to patients and families in the homes and in the community with the active participation of the people she serves.
%

Assists doctors with the early diagnosis and carries out their recommendations such as giving injections, doing dressings. Explains and utilizes the available resources in the homes and thus gives . adequate 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 for maintaining good health. Gives health teaching and counsels the family appropriately. Analysis and guides the families on matters of upkeep of environmental sanitation, 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 health guides. '
*

Trains local traditional birth attendants (TBA).

Evaluation

'

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

1 i 1

e) Participation in surveys and conducting research programme. Community health

I
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nursing is a challenging work and is different from hospital set up. A community health nurse works in the community in their natural environment. She needs to be well oriented and knowledgeable to handle different situations.

1.8 LETUSSUMUP
u:

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 from health, which is a state of complete physical, mental and social well being .Public .- health is for prevention of disease and promotion of health. But in community health the emphasis that the community health nurse is responsible to provide preventive, promotive, curati7e and rehabilitative services far each individual. Community health

Principles and Practice of Community Health Nursing

nursing services are provided within the framework of tot& health efforts. These practices are for preserving and promoting the health of the total population. So nursing is directed to individual, family and community. Community health nursing process is a continuous processs of assessing, planning, implementing and evaluation of the programmes. The process helps on developing working relationship with the family to assess their health needs. Community identification helps to assess the needs of the co.mnunity related to healthy living. You make a conlmunity diagnosis and plan for action, such as improvement of water supply, universal immunization, control of communicable diseases and health education etc. The action taken may be called cqmmunity treatment. Nurses employed in community health services has to be specially prepared along with nursing, medicine, in social and behavioral sciences and epidemiology. Her area of work is outside the hospital and is vast. She has to make independent decisions. Her role is administrator, supervisor, teacher, counselor, and practitioner. Her functions are assessing, identifying the health needs and resources and plan the health services. In implementation of care, health education is given priority over curative treatment. Evaluation is done periodically to achieve the set goals. The principles of community health nursing are guidelines to be followed in any situation with sound judgement and common sense. Most of these principles pertains to nursing'in general, not to community health nursing alone. The responsibilities of community health nurse is to help individual, family and comnunity to develop and utilize their potential for healthful living, and to provide nursing care for sick and disabled in their homes. The nurse carries out responsibilities of home visit to patients, families and community groups such as school children, teachers, parents, antenatal and post natal mothers, industrial workers and elderly, following the laid down principles. Community health nursing must be based on an understanding and appreciation of needs, social relationship, culture norms, customs and traditions of patient, family and community.

1.9 KEYWORDS
AppraisaI Assessment
I

: To evaluate the worth, significance or status. : To determine the importance, size or value.' : A person who engages the professional services of

ClientICustomer Competency Demographic Goal

another.
I

: Required ability or quality.

: Statistics of human population. : 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 - a command. Postulate PreceptIPrinciple Strategies

34
: To assume, hypothesis advanced as an essential presupposition of a train of reasoning.
: Intended as a general rule of action or conduct.

: A carefulplan.

&

1.10 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
1) Go through the definitions given in the text and write on the paper. 2) Services provided in community heath are:
Y

Introduction to Community Health Nursing

me$ical care mother and child health family planning services disease control measures healtheducation.

1)

Check Your Progress 2

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 specific

diseases, health legislation.
1

'

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

4) Community Health Nurse

d interpreting to Assessing about community, identifying the health nee& a ~ then the 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 of disease and promotion of health.

Hospital Nurse patients, ward, units are assigned and she has to give car6 to thosegatients only:

,
L

area is of specific diseases,'the 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.

Check Your Progress 3

L
m
Responsible to the,5mploying agency
,

Health services should be available to people irrespective of age, sex, creed, nationality, political affiliation, social or iconomic: status. ,
*".

Principles and Fractice of Community Health Nursing

The nurse as a health worker must be non-political and non-sectarian in her relationship with people.

In community health Nursing the family is recognized as a unit of service.

Facilities for further training should be provided by the organization lag en^^. The nurse assumes responsi5ility for her own contihuing professional development.