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By: Muhammad Ibrahim Ansari,



+92 301 3461167

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I dedicate these CHN III notes towards my worthy

(Jamal-Ul-Din Lund, Syed Hameedullah Shah, Qamar_Ul_Din Bahalkani, Aijaz Ali Noonari, )

who always encouraged me a lot in walk of my harden life,

Ansari Muhammad Ibrahim


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COMMUNITY HEALTH NURSING III __________________________From the desk of writer & Composer;

The enthusiastic welcome of the Community Health Nursing III The major view of writing these notes is to provide an update , reasonably brief and comprehensive notes of the Community Health Nursing. In addition, all the other notes have been reviewed to accommodate new information, illustration and figures resulting into extensive modification. As during the past several decades, considerable progress has been made in ascertaining the correlation. An attempt has been made to write these notes, these notes are complete enough to study but also lead you towards the more interest towards the study. Community Health Nursing is developed to provide nursing students with the knowledge and skill they need to become competent, think critically and possess the sensitivity they need to become caring nurses. Professional nursing practice continues to evolve and adapt to society’s changing health priorities. The rapidly changing health care delivery system offers new opportunities for nurses to alter the practice of Community Health Nursing and to improve the way to care the community and the fulfillment the Performa regarding the community assessment. I believe that the changes in health care present exciting challenges to nurses and it is felt that there is a need for good nursing notes of Pakistan origin to assist nurses to meet their challenges in the walk of study. These notes are referenced from many different books for to give new shape to notes included:   Encarta Encyclopedia   Britannica Encyclopedia   CHN BT Basavanthappa   Oxford Dictionary   Previous Question papers (NEB’s)   Public Health & Community Medicine   Basis of Community Health Nursing   Different Dictionaries & different authorized Books I am aware of manifold reasons, errors might have crept in. I shall feel obliged, if such errors are brought to my notice. I sincerely, welcome constrictive criticism from both teachers and students that would help me to enrich myself and good suggestions will be incorporated in next notes.

Muhammad Ibrahim Ansari

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Define School Health Service
This is the branch of preventive medicine which deals with inspection of school children and their health protection primarily in the environment of school.

Purpose or Aim of School Health Service
      Early detection of defects through the periodic medicine inspection. To the follow up services. Teaching of the staff of the school to the defects of school children. To minimize the chances of spread communicable diseases. To protect the children from environmental hazards this may cause injury disease and disabilities. Providing healthful environment to the school children.

Duties or Function of Nurse:
       He/ She is assisting a medical officer in planning the medical inspection in consultation with teacher. He/ She should record the height, weight and preliminary vision test. He/ She should participate in physical education children and help the educational authorities to exclude the unfit children. He/ She maintains the record of the abnormalities and keeps in form of progress. He/ She gives treatment to the minor ailments. He/ She visits the homes of children to continue the usefulness of the service. He/ She Supervises the health habits of the children and observe their nails, teeth, cleanliness etc.


By the lecture and demonstration he educates the teachers in recognizing the ailments in practice of first aid. COMMUNITY HEALTH NURSING III Duties of the Medical officer:    He conducts the periodic and routine medical inspection of school children. Treats and refer the cases. He arranges for the immunization of school children mostly booster doses.    Functions of School Health Service:             Medical inspection of school children Detection and correction of defects.Generated by Foxit PDF Creator © Foxit Software http://www. Follow up service. kitchen etc. Inspection of the water supply and sanitary such as toilet room. He makes periodical visits of hostel and advise the authorities for the white wash of hostel after every two years.foxitsoftware. Treatment of minor ailment Control of communicable disease Detection of the case of communicable disease Environmental sanitation such as inspection of buildings for ventilation etc Health education hygiene nutrition etc Accident prevention Parents and teachers meeting Training of teachers Referral services 5 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .com For evaluation only. general hygiene of the environment ventilation seating arrangement. For evaluation only.N.T disorder Poverty Communicable disease Lack of toilet facilities Skin disorders Equipments of School Clinic:                 Weighing machine Measuring tape Height measuring rod Snellen`s eye testing chart Tongue depressor Nasal speculum Ear speculum Vaccination equipment Sterilize Spirit lamp Wash basin and towel stand Mouth gauge Scissors Surgical forceps Disposable syringe and needle Torch 6 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .Generated by Foxit PDF Creator © Foxit Software http://www. COMMUNITY HEALTH NURSING III School Health Problems:                Mal nutrition Improper ventilation Dental carriers Poor sanitation Parasites Rigid school atoms Worm infestation Ignorance Eye defect Over crowding E.

Generated by Foxit PDF Creator © Foxit Software For evaluation only. COMMUNITY HEALTH NURSING III Drugs used in School Clinic:            Toothache solution Eye drops and ointment Ear drops Carminative mixture and tablets Cough syrup Analgesic and antipyretic Antibiotic Vitamin tablets and drops First aid kit Anti-allergic Life saving drugs Components of School Health Services:           Daily observation and inspection by nurse Medical examination by school MO Teacher training Immunization (Booster dose) Health education Healthful environment Nutritional programme Case management of the sick Treatment of case by medical Officer/ Nurse/ Teacher Referral of the cases 7 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .

Plus type desk: when there is gap between the edge of the seat and edge of desk Inspection of Physical Examination of the School Child: Physical examination of the School Child. General Physical Examination: Name of the child: _________________________________________ Age of the Child: _________________________________________ Weight of the Child: _______________________________________ Height of the Child: _______________________________________ Conscious level of the Child: ________________________________ Pallor of the Body: ________________________________________ 8 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Adequate light Adequate cross ventilation The black board should be designed just as every one student look easily The fans or many doors and windows in hot areas Provision of the minus desks or at least zero desks There should be refuse container in the class Minus type desk: when the edge of the desk over-hangs the edge of the For evaluation only. The floor space per child should be 15 square feet. COMMUNITY HEALTH NURSING III Criteria for the Class Room:           One class room should not more than 40 students It must have a verandah The height of the class Room should be 04 meters (12 feet). 08 meters (24 feet) long and 06 meters wide. First introduce yourself to the child or child’s parents and ask if you examine the child A.foxitsoftware.Generated by Foxit PDF Creator © Foxit Software http://www.

foxitsoftware. Cardio-Vascular System Pulse (Rate.Generated by Foxit PDF Creator © Foxit Software http://www. Volume): _____________________________ Blood Pressure: _________________________________________ Chest deformity: ________________________________________ Apex beats: ____________________________________________ Heart sound: ___________________________________________ Gastro-intestinal System a. COMMUNITY HEALTH NURSING III For evaluation only. Respiratory System Respiratory rate: _________________________________________ Breath Sounds: __________________________________________ D. . Oral Cavity: Lips: _________________________ Gums: ________________________ Teeth: ________________________ Tongue: ______________________ Mouth: _______________________ Mucus membrane: ______________ b. shape. Head circumference): ______________________ Eyes: ___________________________________________________ Ear: ____________________________________________________ Nose: __________________________________________________ Face: __________________________________________________ Mouth: ________________________________________________ Hairs: _________________________________________________ Throat: ________________________________________________ C. Head & Neck: Neck examination: ________________________________________ Head (Size. Rhythm. Abdominal Cavity: Shape: _______________________ Movement of the intestine: _______ Peristaltic movement: ___________ Tenderness: ___________________ Umbilicus position: _____________ Pubic hair: ____________________ Hernia (any) : __________________ 9 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 E.

which effects the human health in the environment Aims and objectives of the Occupational Health:       Promotion and maintenance the physical. Central Nervous System: Memory capacity: _______________ Mental function: ________________ Neurological assessment: _________ Unit No # 02 * OCCUPATIONAL HAZARDS * Definition: This is concerned with physical. chemical and biological factors. his adjustment to the work and adjustment of the worker Occupational Hygiene This is concerned with the identification.foxitsoftware.Generated by Foxit PDF Creator © Foxit Software http://www. COMMUNITY HEALTH NURSING III F. social and mental well being of worker Prevent the worker from accidents which depart from their work Protection of the worker from risk of the environment Placing and maintaining the workers in the suitable work Controlling the recognized risks and identifying the unrecognized risks To assist the ill and disable workers for the rehabilitation 10 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . measurement And controlling the risk according to For evaluation only. social and mental well being of the worker in relation to the work and working environment.

Environmental Role: Nurse assesses the environment and facilities in the organization and also maintains the healthy working environment and detection of environmental hazards. Researcher: Nurse collects data concerning health status of the worker. that will ensure a quality service to employee Educator or Teacher: Nurse teaches employees about good health and safety practice and motivate individual to improve their health. Nurse should have to collaborate with team members to promote the health workers through the provision of safe work place. Emergency services.Generated by Foxit PDF Creator © Foxit Software http://www. routine physical examination. Counselor: Assisting in personal emotional problems and to promote the mental health and prevent from crisis. COMMUNITY HEALTH NURSING III Role of the Nurse in Occupational Health: Primary Health Care Provider: It includes the health screening and early detection of the disease. Professional Member of the Health Team: Many include safety manager and For evaluation only. 11 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Advocate: He/ She talks on the behalf of the workers Managerial or administrating role: Nurse designs and implementing nursing services with in organization. Monitor or Assessor: Nurse assesses and monitors the workers who are exposed to harmful substances and procedures and Monitors work place for potential hazards.

foxitsoftware. Skin disorders Such as dermatitis. Motion sickness Occur due to vibration 4. COMMUNITY HEALTH NURSING III Functions of Occupation Health Services  Placing the people in suitable work by pre-employment medical examination.Generated by Foxit PDF Creator © Foxit Software http://www.  Maintaining the people in the suitable work  Provision of the treatment services  Controlling of the recognizing of hazards  Identification of un-recognized hazards  Screening for early evidence of non-occupational disease  Health education to worker in relation to their work  Control of environmental risk  Referring the complicated cases Define Toxicology Definition: The study of toxics effect of the chemical substance and physical agents and their adverse effect on the body is known as toxicology Occupational diseases 1. Heat Stroke-heat rashes and Cramps Due to high temperature 5. allergic etc 3. Respiratory disorders: Asthma (due to dust-fume-vapors etc) Bysinosis (due to exposure to cotton) Silicosis (due to silica-stone cutting) Asbestosis (due to asbestos fiber) Bronchogenic Carcinoma (due to smoke asbestosis etc) Allergic (Due to dust etc) For evaluation only. eczema. erythematic Cataract Due to ionizing radiation 12 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .

Radiation: Cataract erythema etc 6.  An adequate lighting and ventilation avoid most of the hazards  Recreational facilities and chances for good education for their Children should be provided  Women worker should have three months maternity leave  Provision of an adequate safe drinking water and proper sanitation  Satisfactory condition for female workers 13 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Silica: Cause silicosis 9. Asbestos: Cause asbestosis 8.  Cheap and well balanced diet is essential of the worker  Gloves to protect from dermatitis and handling the machine According to situation of the work. Zoonatic hazard: Cause rabies. Vibration: Causes motion. Hypothermia 2. and vertigo 5. Mechanical hazards: Causes injury and disability 11. discomfort and visual fatigue 3. sickness. eye pain. Toxic hazards: Eg: fertilizers. and congestion of cornea. head ach. antiseptic. anthrax etc 12. Light Poor light causes strain. Dust-fume-smoke: Cause asthma allergic and asthma 7. Heat and Cold Heat causes heat stroke and heat rashes Cold causes chilblain frost bite. Noise: May cause temporary or permanent deafness For evaluation only. Cleanliness dust gases and high lights etc  Periodic medical check up of worker  Placing the worker in job according to their capabilities  Informing and training about the job firstly before giving  Handsome salary should be gifted. Excessive light cause blurring vision. COMMUNITY HEALTH NURSING III Common Occupational Hazards 1.Generated by Foxit PDF Creator © Foxit Software http://www. Cotton dust: Bysinosis (lung disease) 10.foxitsoftware. may cause toxic effect Prevention of occupational hazards  The working hour should not more than 8hours in a day and one Hour for mid day rest  Periodic inspection of the industry to supervise ventilation.

foxitsoftware. well For evaluation only. semi-solid diet and Vitamins that improve the health  Give special attention to the hygienic care and diet  The environment should be an adequate that they do not feel any bore ness and tiredness  Support him physically when he have to go any where 14 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .Generated by Foxit PDF Creator © Foxit Software http://www. COMMUNITY HEALTH NURSING III Unit No # 03 *GERIATRIC SERVICES* Definition: This is concerned with service to the old person OR Geriatric service means nursing care of elder person to share his problems and help him to solve or minimize the problems of elder person Major problems of Geriatric/ Elders:         Hearing problem Vision problem Painful joints Problem of teeth (loss of teeth) Loss of memory power Digestive problems (passing urine and feaces) Change in behavior Feeling of ignorance Roles and Responsibilities of a Nurse regarding Geriatric Services  Should help the old person to remove their loneliness and sadness by developing therapeutic relationship  She should try to correct the defect under her professional approach  She should try to detect the problem of old person  Follow up the special problem of old person  Their may be some food like milk.

COMMUNITY HEALTH NURSING III Unit No # 04 *Rehabilitation* Define Rehabilitation: Definition: The rehabilitation is process by which the disable person can achieve maximum physical. List the trades in which persons are trained?         Persons are trained in various For evaluation only.Generated by Foxit PDF Creator © Foxit Software http://www. Printing Painting Tailoring Farming Carpentering Leather work Shoes making Handicrafts etc 15 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .foxitsoftware. social and mental efficiencies and can live and independent life in the society.

com For evaluation only. MMR etc at the clinic Provides T.foxitsoftware. immunization etc Responsibilities of Nurse in M.B.C.H Definition: The MCH is the branch of public health care which is concerned with the health supervision of the mother and child including family planning. COMMUNITY HEALTH NURSING III Unit No # 05 *Maternal and Child Health* Define M.Generated by Foxit PDF Creator © Foxit Software http://www. MR.A (Trained birth attendant) training Provides referral services 16 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .C.H:          Registration of pregnant women Provides antenatal and postnatal care to mother Provide family planning services Provide immunization service Provide education about the breast feeding and hygienic care of children Assess the mother for any abnormality and professional approach Maintain the record of statistics such as: CBR.

 Child survival services (prevention and control).  Towards completion of her training the responsibilities of her are:  Maternal and child health services. family planning etc and about food.V:  L. water and sanitation.  Maintain certain necessary record .  Educate to community for immunization.  Training of Dai.  Participates in the surveys.Generated by Foxit PDF Creator © Foxit Software For evaluation only.  Identification and use of community resources.H.  Health education.  Prevention of communicable diseases.  She takes care of the disabled people and help them to prevent from complications.  Provides group instructions to the sick and surprise them. prolonging life and promoting health through organized community efforts.V’s are Primary Health Care provider so her functions are based on community needs and related health problems. COMMUNITY HEALTH NURSING III Unit No # 06 *Public Health* Define Public Health Definition: Public health is science and art of preventing disease . Role of L.H. Role or Functions of Public Health Nurse  Teaches and supervises the mid wives.  First aid  Keeping the record and reports.  Report to the physician about the complication and environmental problems. plan pubic health school programme and manage the clinical work. 17 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . family numbers and other people in the community.  community participate co-ordinate  Referral services. studies and researches the health problems.  Give treatment the minor ailments.foxitsoftware.

so that he need full support. It is duty of medical team find out that how mentally ill person can co-operate. COMMUNITY HEALTH NURSING III Mental Health Services: Definition: It is branch of community health nursing deals with mentally disordered person.foxitsoftware.  How to feed him  How to behave with others.Generated by Foxit PDF Creator © Foxit Software http://www. The nurse can organized/arrange a clinic (which should be supervised by the psychiatrist) time to for specific treatment and special advises for various individuals. can not know even ordinary health care. It is too difficult to provide care to mentally ill person because usually they are not co-operative hence they require tactful nursing care. Structure and Organization of Community authority over on other. Line Of Authority: It is work (messages & power) done systematically. It should be/can be observed and evaluated by every on to find out the efficiency of organization. 18 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Description: It is realized that a person with mental disordered deprives his personality.  How to prevent him from accidents etc. The community nurse should have to trained his/her through his skillful nursing advises and he/she have to demonstrate such practices like:  How to get the agree ness of mental retarded person. either on punishment or on rewards (appreciations). The role and relationship with in organization some persons are put in A group made up by the individual each with in special position and part to play (describe role) is called community organization. including psychological treatment. where authority is use downward and For evaluation only.

corruption For evaluation only. COMMUNITY HEALTH NURSING III Group: Definition: It is nature that individual forms group often person plans with several group at the same time to need the different needs. Some groups are found naturally (Blood relation groups) and other formed for special talk to meet desirable needs (Governmental and social organization). interactions is not frequent or closed each one do work as a part of machine members are not involve emotionally PNC. E. Tertiary Group:A social group which is tertiary on time and importance this group is temporary and easily under go to change. Secondary Group:It is large and formal group they organized and related temporarily.foxitsoftware. PNA. UNICEF. political instruction organizations.The members of this group has sense of belonging with each other family. WHO. 3. 19 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Primary Group:It is small and long lasting with close contact face to face contact relationship such as family members are close friends. There is extensive and durable interaction it is formed group . Types of Group: 1. 2. neighbor. playmates and worker group.Generated by Foxit PDF Creator © Foxit Software http://www.g around of people organized to protect against crime.

5. 7. COMMUNITY HEALTH NURSING III Role Of Nurse in Community Organization: 1. 20 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Motivator:Stimulator the inner feeling of individual by telling stories and presenting the fact figures. Communicator:The communicator nurse is link person between community and governmental or non-governmental organization for the health related affairs.foxitsoftware. Through their participate and efforts to adopt the principals of primary health care and change the unhealthy habits to healthy habits. Adviser:Advise the community to solve their problems. Planner:He/she planes the health programme and meetings b/w the community and health team (especially specialists of the various department of health) for the health education. 3. He/she encourage people for to achieve the goals of primary health care through the health habits. 4. 6. 2. Facilities: The health programmes and provides services according the health needs of the community. Giving advance advises and knowledge and treatment to solve their health problems.Generated by Foxit PDF Creator © Foxit Software http://www. Problem Solver:Helping people to solve their problems under them own resources. providing health and keeping example for himself).com For evaluation only. Change Agent:Changing their behavior (of person) towards the healthy (person through the health education.

religion. Nurse should develop good human relationship through educational approach. Principles of Health Education: Barriers in Communicating Health Education:  Physiological barriers Ex: difficulty in hearing and expression. 21 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .  Psychological barriers.foxitsoftware.  Environmental barriers. custom . neurosis. belief etc. Reinforcing the messages by repeating them and using different method. COMMUNITY HEALTH NURSING III Unit No # 07 *Health Education* Define Health Education Definition: This is the process that informs. attitude and skill to develop correct habits. depressive etc.  Community leader must be taken in the consideration. motivates and helps the people to adopt and maintain healthy practices and life style and change the unhealthy habits. This should be based on principal of active learning Educate from known to un-known points. Ex: Emotional disturbance.Generated by Foxit PDF Creator © Foxit Software http://www. Use the language which is easily understandable. To develop scientific knowledge. attitudes and behavior. Provide opportunities for the people to learn by doing.        Health education should be on principal of active For evaluation only. Ex: level of knowledge. To alter behavior this may lead them to cause disease. Aim and Objectives:      To help people to achieve health by their own sources/activities. Ex: Noise and congestion.  Cultural barriers. To develop the sense of responsibilities for improvement of health of individuals & families. To create interest in him for their own well being and community sanitation.

Generated by Foxit PDF Creator © Foxit Software http://www.  Open form. Identification and selection of health problem.  Buzz session  Skits.foxitsoftware. collection and preparation of necessary material i-e Audiovisual material For evaluation only. Plan for collecting single base line data.  Films Audio-cassettes.  Brain storming.  Mass media:  Television and radio. conducting base line surveys with help of leader. Meeting with leader and discussing problems which are identified.  Pamphlet booklet charts  Posters stickers and flannel graph.  Seminar  Demonstration  Role play interview  Task force  Case study. Identification of community leader. Selection. 22 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .  Exhibitions (A. Evaluate the programme.  Field strip. Methods of Health education:  Lecture. Implementation of programme.V)  Flip chart. Orientation of leader. Group meeting with community members to feed back the result of survey and to decide on plan of action. Follow up the necessary service and facilities.  Group discussion panel discussion (4 to 8 person discuss). COMMUNITY HEALTH NURSING III Steps in carrying Health education programme:            Meeting with primary health care staff.

Speaker may become over confidence. good moral & good group action during discussion. Advantages of group discussion:       Active role of learners improve their attitude towards the topic. Disadvantages of group Discussion:       It needs qualified speakers.Generated by Foxit PDF Creator © Foxit Software http://www. it consist of record keeping person who records the important points. OR This is excellent method to teach the adult people. Planning consumes lot of time. There should be leader to ensure the participations of every one member. There may be conflict and noise (if leader is effective) 23 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . COMMUNITY HEALTH NURSING III Small Group discussion: This is the method in person discuss on the topic & the persons are qualified for the topic.foxitsoftware. Good for education of self confidence and For evaluation only. There should be record keeping person to write the agreement & essential points of discussion. May use language which is difficult. Suitable for changing the behavior This group comprises the chairman who introduces the speakers and delivers speech to audience. In this method people learn from each other. May deviate from topic.

It is too expensive. Advantages of Role Play Method      This is interesting method & good for presentation of facts. the actors are told their role before performance. Role may not be played seriously. Stimulate the emotions of participants (learns) Effectively memorized.Generated by Foxit PDF Creator © Foxit Software http://www. Develop communication skills. Large group of people are taught. Dis-advantages Role Play Method         Criticism after the role playing.foxitsoftware. Role may not be played effectively. Preparation requires special skills. OR In this method two or more person performing give role according situation under some directions. It may not play effectively. 24 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Require referral which consumes time. COMMUNITY HEALTH NURSING III Role Play Method This is method in which two or more actors act their role under said direction and For evaluation only. Too long role play may bore the audience.

It is important that every member or one or two members (learners) repeat the method. COMMUNITY HEALTH NURSING III Demonstration Method: This is the method in which the persons are taught practically by showing or dong experimentally. OR In this method teaching & learning are depends upon showing For evaluation only. Teacher evaluate the students properly b/c limited students. Reinforcement of some method make person more confident. b/c has too ensured the participation of every one & process should be under stand by every one. It needs well preparation & meaning full chart. Enables logical step by step presentation. Effectively memorized b/c it is practical method. There should be a person to explain or answer the questions. This method is also good for small group. Expensive Consumes much more time. Dis-advantages Demonstration Method      Limited learner participates.Generated by Foxit PDF Creator © Foxit Software http://www. pictures or other visual aids. Advantages of Demonstration Method      The learners are more likely to retain & understand. Panel Discussion: In this method panel of the 4 to 8 experts is arranged to assess on one topic or subject under the guidance of chair person. with having adequate light on it.foxitsoftware. Require qualified persons. The things which are to be shown should be placed on the suitable place. The experts are ready to give the answer of the questions which are asked by the audience (Other group members). 25 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Require equipments for procedure. Exhibition: In this method some pictures are provided to educate the people.

Generated by Foxit PDF Creator © Foxit Software http://www. COMMUNITY HEALTH NURSING III Lecture Method: This is method of oral presentation of subject to large group of people & is one way method. It requires experts. Dis-advantages of Lecture Method      May be difficult for learners to understand at a time. Large group of people are instructed at a time . Dis-advantages of counseling method:     Complete planning is required. The audience may be bored or tired. Advantages of counseling method:     Promote good health For evaluation only. Gives an opportunity to explain the relationship if theory & particle Provide additional information that is not included in text book. 26 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . It is conversation of ideal among the two or more people having common interest & problem. This requires ability. Help the teacher to evaluate satisfactory. It is easy method of giving oral presentation Saves times & resources. Average teachers have no knowledge.foxitsoftware. Time consuming. Advantages of Lecture Method       It conveys enthusiasm. Encourage self learning. Counseling method: Counseling method is an educational tod for helping individuals & families in their health problems. Self satisfaction for the learner. Average teacher have no time. Limited feed back.

a) Pamphlet:Pamphlets are printed message & include pictures. short messages should be written to understand immediately.  This required considerable preparation of time. OR It is tool of communication & health education. b) Posters:There are so large than the pamphlet. charts etc. Broad casting can be taped for replay Dis-advantages:  Listener reaction to the programme is not known except when broad casting is heard by listener. Pamphlets are handed over to people. It is presentation of many ideas that can not be presented on one chart.Generated by Foxit PDF Creator © Foxit Software http://www. It is one way communication. Advantages:     It is most widely available. It is useful media to keep the people well informed about social problems. COMMUNITY HEALTH NURSING III Mass media: This is method in which the person are instructed by the mass media e. Radio. It is popular in rural areas. T. Radio/ T. declaration publicity of health polices. The pamphlets on the health topic may be prepared locally or may supply by the department/ higher authority. It is cheap & easy to operate.  Available broad casting may not obtain 27 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .com For evaluation only.foxitsoftware. The posters may prepare locally on the white paper the little.g.V. current social changes.V: It is vast media for communication. environment & biological & social health hazards. meaning full. c) Flip Chart: It is series of charts bounded together such as each chart is viewed by turning back. The posters are displayed on the walls. Posters are usually provided by health department.

Buzz session Refers to large group into several small groups & discuss assigned topic.Generated by Foxit PDF Creator © Foxit Software http://www. The pictures are ready in order to place on board through the pins.  Gives the sense of care and confidence to students. Flannel Graph A board is prepared which is covered with flannel or rough cloth. The picture may be removed For evaluation only. COMMUNITY HEALTH NURSING III Interview: Advantages: Ensure privacy.  Require experience. 28 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Dis-advantages:  Time consuming. The board should be placed at good light/site. Seminar Refer to group of person who have prepared themselves on particular topic or problem & will speak to audience. so that all the viewers see & can understand properly. Symposium In this person speak on selected subject each expert presents as aspect of subject briefly & there is no discussion among the members.

Meeting with individuals. Number of health session Number of the people attended to health education programme. What to Evaluate        Knowledge gained by learners. Technique of evaluation          Self evaluation. Teacher & student evaluate each other. families. leader etc. 29 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Attitude is changed or not. Vital part of learning. Short evaluation at the ends of the session. To determine the limitation of health education.Generated by Foxit PDF Creator © Foxit Software http://www. Silent observation. To observe awareness change of behavior of client. COMMUNITY HEALTH NURSING III Evaluation Evaluation of health education The evaluation is the process of finding out how things are being done. Practice is healthy or not. Instructor asks questions.foxitsoftware. Purpose of Evaluation     To find out the achievement and efforts of health education. Test & examination. Effectiveness of health education How much understanding by audience. By health workers while visiting of For evaluation only. Survey & community visiting.

Environmental information 1.Generated by Foxit PDF Creator © Foxit Software http://www. sex. individuals. families & the community.g. I.  Specific vulnerable groups i-e infant.B. education. Physical structure and boundaries. morbidity etc.  Total families e. 2. joint family etc  Vital health events i-e C. occupation & income. To identify the health status of the community. To informs the needs of the health of community to the health planner & policy maker of the health. nuclear fail. Geographical information:      Name of the locality or area. Demographic Information:  The total information about total population with reference to age.M.foxitsoftware. Purpose of community Assessment     To determine the health needs of the community. To identify actual or potential health problems of community. Three Areas of the community Assessment 1. Seasonal variation & month. Important roads. Getting or preparing the map. expecting and lactating mother. streets and For evaluation only. C.R. Demographic Information 3. 30 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . toddler. caste.D. COMMUNITY HEALTH NURSING III Unit No # 08 *Community Assessment* Community Assessment The assessment is an organized & systematic process of collecting data from a variety of rresources to analyze the health states of patient.R.R. Geographical information 2.

Social Factors:- iii.  Human resources = Doctor.foxitsoftware.N. cinema etc. For evaluation only. not potable. income etc. COMMUNITY HEALTH NURSING III 3.P. 31 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . college. Environmental communication: Common meeting places. radio.  Media = T.V. M. nurses. iv.A etc. Environmental resources: Economic resources = Occupation.Generated by Foxit PDF Creator © Foxit Software http://www. Mosque etc. Environmental information i. newspapers. ii.  Social organization = school. Teachers.  Institutional resources = Health institution.A. Physical Factors: house = numbers – type – open space etc  Water = potable. industrial & commercial agencies. lawyers etc.  Community organization  Leader ship structure as M. Engineer. safe or unsafe etc  Sanitation= Disposal of waste and waste water etc.

of persons moving into area. of persons moving out of the area. of deaths in the area (D) 3. Population Dynamics There are four ways in which the number of peoples in area can change. No: of live birth (B) in the area. 2.Generated by Foxit PDF Creator © Foxit Software http://www. Thus population of the area may change due to natural reason. OR Population growth = (B. Dependency Ratio This is the ratio of population who are economically in active to those who are economically active & can be expressed by the Eq: as follow: Dependency ratio children + elders x 100 Working age = Dep: ratio = population below 15 +65 years or above Population15 to 64 The dependency ratio of Pakistan in 1995 was Pak (1995) 58192000 + 4179000 x100 7.foxitsoftware.D) = (IM-OM) Define population growth Rate: The rate at which the population of country or community is growing.388600 = 84. out migration is called demography. 4. in For evaluation only. No. structure.4/100 = 32 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . death. No. (B-D) called natural increase & due to migration (IM-OM) called net migration So: Population growth = natural increase + net migration. distribution & changes which occurs due to birth. COMMUNITY HEALTH NURSING III Demography Definition: It is the science of population & it is concern with size. 1. No.

foxitsoftware.Generated by Foxit PDF Creator © Foxit Software http://www. deaths & sickness. Population pyramid:The pictorial presentation of the age sex composition of population Sex Ratio:This is the ratio of male to the females in the population & can be obtained by dividing male population by female population & multiplied by 100 i-e Sex ratio = male population x100 Female population Vital static A science which deals with the applications of numerical method to vital facts. Bio statistics It is science for collection. Health statistics It is the study of life history of the community in relation to health i-e prevention & control of disease. Sources OF Vital And Health statistics. Net migration:Total number of person added or subtracted from population. COMMUNITY HEALTH NURSING III Basic Definitions Fertility:This is actual reproductive performance of woman or For evaluation only. 33 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .      Census Births & deaths registration Record from hospital & primary health centre. control of population problem & family planning & programme planning & developing & preventing & curative services. Laboratory investigations School records. analysis & interpretation of data in relation to vital events i-e births.

g: C. General fertility rate (G.R = 30 x 1000 = 15/1000 2000 34 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Expressed by 100 in a population is called G.B.B.F.B. of woman ages 15-49 years. Basic Fertility Measures 1.Generated by Foxit PDF Creator © Foxit Software http://www.R) This is total number of live birth in year divided by the population in that year multiplied y 1000 in the population called C. Causes of high fertility          Ignorance of family planning In effective family planning methods Psychologically love seeking Psychologically to being presents Lack of education Early marriage Force from elder to bear child Religion factors such as the children are gifted by god .com For evaluation only.R = No.foxitsoftware.g: G. Culturally every woman wants to a son cessation of breast feeding. OR Fertility refers to human child bearing or reproduction & is confined to woman during their reproductive age i-e (15-49) years.R C.F. of births in a year x 100 Population in that year E.R G.R = 40 x 100 = 13.R) This is the total No. of births in a year x 100 No.3/1000 3000 2.F. COMMUNITY HEALTH NURSING III Define Fertility Definition: The fertility refers to the number of live births a woman has. of live birth in a year upon No.B. Crude birth rate (C.had.R = No.F. of woman ages 15-49 years e.

R) It is adjusted for the age & determines the fertility rate of woman in each age group. Thus For evaluation only.F. of deaths are = 20 Total population = 5000 C.F.D. of woman aged “x” Control of high fertility  Introduction of family planning services  Effectiveness of family planning methods  Provide health education by showing facts & Dis-advantages of high fertility  Controlling of early marriage  Breast feeding to babies for two years. Age specific fertility rate (A.R = No.Generated by Foxit PDF Creator © Foxit Software http://www. Basic Mortality Rates: 1.D.foxitsoftware. COMMUNITY HEALTH NURSING III 3.g: 35 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .R = 20 x 1000 = 4/1000 e.R = No.D.D.S. Crude death Rate (C.R =? According to the formula: C.R): This is number of deaths in a year divided by total population at mid year & multiplied by the 1000 C. of deaths in a year Population at mid-year No. of live births to woman age in a year “x” x 100 No.

R = 36/400X 1000 = 90/1000 Example: 36 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .R According to the formula A. of live birth in that year multiplied by 100 I.R= No. of children under five year A.R = no.foxitsoftware. Age Specific Death Rate (A.D = 40 X 100 1000 =10 = 40 = 4000 = ? 3.M. COMMUNITY HEALTH NURSING III 2.S.M.D. of death of infants under one year of age in year X 1000 No of live births in a year No: of deaths of children under one year = 36 Total no: of live births = 400 I.D.D.R) This is the number of death of children under one year in a population divided by no. of person of that age multiplied by 1000 A.Generated by Foxit PDF Creator © Foxit Software http://www.M.S.R) This is the number death person of specific age group in a population in a year divided by total no.R. of death under five year age Total no. INFANT MORTALITY RATE (I. of person that age Example: no.M.S.S.R = ? According to the formula: For evaluation only. of person of age “X’ in a year x 1000 No.

M.M. of live births in that year multiplied by 1000 P.R= No. of live birth in that year multiplied by 1000 L. of death of infants from 1-4 week X 1000 Total no: of live births in that year c.M.M.M.R): This is the number of death of children from 4-52 weeks or 01-12 months in a year.M. of live birth in that year multiplied by 1000 For evaluation only.Generated by Foxit PDF Creator © Foxit Software http://www.R): This is the number of death of children from one week to four week.N. Late Neo-Natal Mortality Rate (L. divided by no.R): This is the number of death of children less than one month in a year.R= No. of death of infants under one week of age in year X 1000 Total no: of live births in that year b.R= No.N.M. of death of infants under one month of age in year X 1000 No of live births in that year a. of death of infants during 4-52 weeks X 1000 Total no: of live births in that year 37 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . of live birth in that year multiplied by 1000 N. divided by no.foxitsoftware.R= No. COMMUNITY HEALTH NURSING III 4.N.R): This is the number of death of children less than one week in a year. Neo-Natal Mortality Rate (N. divided by no. divided by no.N. Early Neo-Natal Mortality Rate (E.N.E. Post Neo-Natal Mortality Rate (P.N.

in the under five years of age  The milk should be pasteurized and water should be boiled before giving to children. of live births plus still births multiplied by 1000 P.foxitsoftware.R): This is the number of deaths under one week plus still births.M.R. COMMUNITY HEALTH NURSING III For evaluation only. Peri-Natal Mortality Rate (P.S should be given to children to prevent from severe dehydration  Appropriate feeding i-e: weaning diet should be started at 4-5 months  Milk feed should not be diluted  Domestic pots should be clean  Avoidance of usage of anti-diarrheal and anti-spasmodic drugs.  General hygienic care should be given to infants  Family planning should be applied to reduce the rate of mortality 38 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . of deaths of children under one week + still births in a year X 1000 Total no: of still birth + live birth in that year Causes of Children death:                 Low birth weight Acute Diarrhea Mal-Nutrition Acute Respiratory infection Bronchitis Pneumonia Apnea Difficulty in breathing Communicable disease Tuberculosis Hepatitis Tetanus Whooping cough Cord infection Birth injury Pre-maturity Control of Infants deaths:  Immunization against the seven target diseases  Breast feeding should be encouraged for all infants till two years  In all diarrheal cases O. divided by total no.M.R= No.Generated by Foxit PDF Creator © Foxit Software http://www.

R:          Hemorrhage (APH. PPH) Anemia Septicemia Pre-eclampsia Repeated Pregnancy Mal-nutrition Mal-position of child Puerperal sepsis Toxemia Prevention of M. of deaths of women due to pregnancy.M.R): M.R= No. Maternal Mortality Rate (M.M. I. Incidence Rate (I. COMMUNITY HEALTH NURSING III 6.M.R = No: of new cases of disease x 100 Population at risk 39 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Incidence Rate This is No: of new cases of disease in population at risk at a point in time multiplied by 1000. its complication or after delivery (child birth) X 1000 Total live births in a year Causes of M.R): Incidence: This is measures the probability that healthy people will develop a diseases during a specific period of For evaluation only.Generated by Foxit PDF Creator © Foxit Software http://www.R:       Adequate ante-natal and post-natal care Proper nutrition and well balanced diet Training of Midwives and other staff Introduction of family Planning Use of sterile equipments Delivery at safe and clean place 7.foxitsoftware. This tells new cases in the population.

D.R? P.R): This is number of deaths of specific cause during specific period of time per No: of people during that period multiplied by 1000 C.R = 28/1000 In the same population if new cases about 10 are suffered with mal-nutrition than incidence rate will be: Firstly 48 cases will be subtracted (because these cases are old & already mal-nourished) i-e 1671 – 48 = 1623 Incidence = 100/1623 x 1000 Incidence = 62/ 1000 9.Generated by Foxit PDF Creator © Foxit Software http://www.S. Age Specific death Rate (A. P. COMMUNITY HEALTH NURSING III 8.R = No: of deaths of specific cause during specific period x 1000 No: of persons in the mid point of that period 40 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 . Prevalence Rate (P.R = No: of deaths of specific age or age group x 1000 No: of persons in the population of that age For evaluation only.D.R = No: of new & old cases in a year x100 Total population Example in a population of 1671 children under 5 years of age we find 48 children with server mal-nutrition express P.R = 48/1671x 1000 P.S.D.R): This is number of deaths of specific age or age group divided by number of persons in the population of that age multiplied by 1000 A.R = No: of old & new cases of mal-nutrition< 5 years x 1000 Population of < 5 years children According to the formula: P.D. Cause Specific Death Rate (C.S.foxitsoftware.S.R): Prevalence: This measures the old & new cases of the disease in the population Prevalence Rate: This is No: of old & new cases of the disease in the population divided by the population multiplied by 10000.

foxitsoftware. FOR ANY CORRECTION or POSITIVE CRITICISM WARMLY WELCOMED TO: exlarkanian_ansari2002@yahoo.C. functions & problems of School Health Services? (b): Define Health education. ANNUAL/ SUPP: GUESS PAPER 1(a): Define School Health Services.Generated by Foxit PDF Creator © Foxit Software http://www. COMMUNITY HEALTH NURSING III. infant mortality & maternal mortality (any five)? (b): Health indicators? And different questions in the M.Q’s about the survey (community assessment)? (d): Define the following?  Demography  Net migration  Population pyramids  Bio-statistics  Prevalence  Incidence N.F. Principles. Case Fatality Rate (C.B: Preliminary and Second year prescribed course should be revised to revision for the purpose to secure maximum marks in the examination. steps & methods of Health education? 2(a): Define PHC? Elements and principles of the Primary health care? (b): Define MCH? And role of Nurse in the MCH? 3(a): Define causes of fertility.F.R = No: of people during from specific disease during specific period of time No: of people with the specific disease during that period. 41 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167 .com For evaluation only. Purposes. THE END SINDH NURSES EXAMINATION BOARD KARACHI. COMMUNITY HEALTH NURSING III 11. Components.R) This is No: of peoples dying from a specific disease during a specific period divided by No: of people with the specific disease during that period multiplied by 1000 C. WISH YOU BEST OF FORTUNE. aims.

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