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COMMUNITY HEALTH NURSING III

By: Muhammad Ibrahim Ansari,

FOR ANY CORRECTION WARMLY WELCOMED TO: exlarkanian_ansari2002@yahoo.com 1

BY: MUHAMMAD IBRAHIM ANSARI

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COMMUNITY HEALTH NURSING III

IN THE NAME OF ALMIGHTY ALLAH

I dedicate these CHN III notes towards my worthy

PROFESSIONAL TEACHERS
(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 societys 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 (NEBs) 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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COMMUNITY HEALTH NURSING III

Unit No # 01 * SCHOOL HEALTH SERVICES *


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.

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Duties of the Medical officer:


He conducts the periodic and routine medical inspection of school children. He arranges for the immunization of school children mostly booster doses. By the lecture and demonstration he educates the teachers in recognizing the ailments in practice of first aid, general hygiene of the environment ventilation seating arrangement. Inspection of the water supply and sanitary such as toilet room, kitchen etc. He makes periodical visits of hostel and advise the authorities for the white wash of hostel after every two years. Treats and refer the cases.

Functions of School Health Service:


Medical inspection of school children Detection and correction of defects. Follow up service. 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

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School Health Problems:


Mal nutrition Improper ventilation Dental carriers Poor sanitation Parasites Rigid school atoms Worm infestation Ignorance Eye defect Over crowding E.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
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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

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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. The floor space per child should be 15 square feet. 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 seat. 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; First introduce yourself to the child or childs parents and ask if you examine the child A. 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: ________________________________________

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B. Head & Neck: Neck examination: ________________________________________ Head (Size, shape, Head circumference): ______________________ Eyes: ___________________________________________________ Ear: ____________________________________________________ Nose: __________________________________________________ Face: __________________________________________________ Mouth: ________________________________________________ Hairs: _________________________________________________ Throat: ________________________________________________ C. Respiratory System Respiratory rate: _________________________________________ Breath Sounds: __________________________________________ D. Cardio-Vascular System Pulse (Rate, Rhythm, Volume): _____________________________ Blood Pressure: _________________________________________ Chest deformity: ________________________________________ Apex beats: ____________________________________________ Heart sound: ___________________________________________ Gastro-intestinal System a. Oral Cavity: Lips: _________________________ Gums: ________________________ Teeth: ________________________ Tongue: ______________________ Mouth: _______________________ Mucus membrane: ______________ b. Abdominal Cavity: Shape: _______________________ Movement of the intestine: _______ Peristaltic movement: ___________ Tenderness: ___________________ Umbilicus position: _____________ Pubic hair: ____________________ Hernia (any) : __________________
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F. Central Nervous System: Memory capacity: _______________ Mental function: ________________ Neurological assessment: _________

Unit No # 02 * OCCUPATIONAL HAZARDS *


Definition: This is concerned with physical, social and mental well being of the worker in relation to the work and working environment, his adjustment to the work and adjustment of the worker Occupational Hygiene This is concerned with the identification, measurement And controlling the risk according to physical, chemical and biological factors, which effects the human health in the environment

Aims and objectives of the Occupational Health:


Promotion and maintenance the physical, 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

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Role of the Nurse in Occupational Health:


Primary Health Care Provider: It includes the health screening and early detection of the disease. Emergency services, routine physical examination. Counselor: Assisting in personal emotional problems and to promote the mental health and prevent from crisis. Advocate: He/ She talks on the behalf of the workers Managerial or administrating role: Nurse designs and implementing nursing services with in organization, 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. Monitor or Assessor: Nurse assesses and monitors the workers who are exposed to harmful substances and procedures and Monitors work place for potential hazards. Professional Member of the Health Team: Many include safety manager and physician. Nurse should have to collaborate with team members to promote the health workers through the provision of safe work place. Researcher: Nurse collects data concerning health status of the worker. Environmental Role: Nurse assesses the environment and facilities in the organization and also maintains the healthy working environment and detection of environmental hazards.

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COMMUNITY HEALTH NURSING III

Functions of Occupation Health Services


Placing the people in suitable work by pre-employment medical examination. 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. 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) 2. Skin disorders Such as dermatitis, eczema, allergic etc 3. Motion sickness Occur due to vibration 4. Heat Stroke-heat rashes and Cramps Due to high temperature 5. erythematic Cataract Due to ionizing radiation

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COMMUNITY HEALTH NURSING III

Common Occupational Hazards 1. Heat and Cold Heat causes heat stroke and heat rashes Cold causes chilblain frost bite, Hypothermia 2. Light
Poor light causes strain, head ach, eye pain, and congestion of cornea.

Excessive light cause blurring vision, discomfort and visual fatigue 3. Noise: May cause temporary or permanent deafness 4. Vibration: Causes motion, sickness, and vertigo 5. Radiation: Cataract erythema etc 6. Dust-fume-smoke: Cause asthma allergic and asthma 7. Asbestos: Cause asbestosis 8. Silica: Cause silicosis 9. Cotton dust: Bysinosis (lung disease) 10. Mechanical hazards: Causes injury and disability 11. Zoonatic hazard: Cause rabies, anthrax etc 12. Toxic hazards: Eg: fertilizers, antiseptic, 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, 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. 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. 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

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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, well balanced. 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

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Unit No # 04 *Rehabilitation*
Define Rehabilitation:
Definition:
The rehabilitation is process by which the disable person can achieve maximum physical, social and mental efficiencies and can live and independent life in the society.

List the trades in which persons are trained?


Persons are trained in various trades. Printing Painting Tailoring Farming Carpentering Leather work Shoes making Handicrafts etc

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Unit No # 05 *Maternal and Child Health*


Define M.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, immunization etc

Responsibilities of Nurse in M.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, MR, MMR etc at the clinic Provides T.B.A (Trained birth attendant) training Provides referral services

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Unit No # 06 *Public Health*


Define Public Health Definition: Public health is science and art of preventing disease , prolonging life and promoting health through organized community efforts.

Role or Functions of Public Health Nurse


Teaches and supervises the mid wives, family numbers and other people in the community. She takes care of the disabled people and help them to prevent from complications. Report to the physician about the complication and environmental problems. Provides group instructions to the sick and surprise them. Give treatment the minor ailments. Educate to community for immunization, family planning etc and about food, water and sanitation. Maintain certain necessary record , plan pubic health school programme and manage the clinical work. Participates in the surveys, studies and researches the health problems.

Role of L.H.V:
L.H.Vs are Primary Health Care provider so her functions are based on community needs and related health problems. Towards completion of her training the responsibilities of her are: Maternal and child health services. Child survival services (prevention and control). Health education. community participate co-ordinate Referral services. First aid Keeping the record and reports. Training of Dai. Identification and use of community resources. Prevention of communicable diseases.
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Mental Health Services:


Definition: It is branch of community health nursing deals with mentally disordered person. Description: It is realized that a person with mental disordered deprives his personality, can not know even ordinary health care, so that he need full support. It is too difficult to provide care to mentally ill person because usually they are not co-operative hence they require tactful nursing care, including psychological treatment. It is duty of medical team find out that how mentally ill person can co-operate, either on punishment or on rewards (appreciations). 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. How to feed him How to behave with others. How to prevent him from accidents etc. 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.

Structure and Organization of Community authority over on other.


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.

Line Of Authority:
It is work (messages & power) done systematically, where authority is use downward and upward, It should be/can be observed and evaluated by every on to find out the efficiency of organization.

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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).

Types of Group:
1. 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 .The members of this group has sense of belonging with each other family, neighbor, playmates and worker group. 2. Secondary Group:It is large and formal group they organized and related temporarily, interactions is not frequent or closed each one do work as a part of machine members are not involve emotionally PNC, PNA, WHO, UNICEF, political instruction organizations. 3. Tertiary Group:A social group which is tertiary on time and importance this group is temporary and easily under go to change. E.g around of people organized to protect against crime, corruption etc.

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Role Of Nurse in Community Organization:


1. Communicator:The communicator nurse is link person between community and governmental or non-governmental organization for the health related affairs. 2. Motivator:Stimulator the inner feeling of individual by telling stories and presenting the fact figures. He/she encourage people for to achieve the goals of primary health care through the health habits. 3. Facilities: The health programmes and provides services according the health needs of the community. 4. 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. Giving advance advises and knowledge and treatment to solve their health problems. 5. Problem Solver:Helping people to solve their problems under them own resources. 6. Adviser:Advise the community to solve their problems. Through their participate and efforts to adopt the principals of primary health care and change the unhealthy habits to healthy habits. 7. Change Agent:Changing their behavior (of person) towards the healthy (person through the health education, providing health and keeping example for himself).

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Unit No # 07 *Health Education*


Define Health Education
Definition:
This is the process that informs, motivates and helps the people to adopt and maintain healthy practices and life style and change the unhealthy habits, attitudes and behavior.

Aim and Objectives:

To help people to achieve health by their own sources/activities. To develop the sense of responsibilities for improvement of health of individuals & families. To develop scientific knowledge, attitude and skill to develop correct habits. To alter behavior this may lead them to cause disease. To create interest in him for their own well being and community sanitation. Health education should be on principal of active interest. This should be based on principal of active learning Educate from known to un-known points. Use the language which is easily understandable. Reinforcing the messages by repeating them and using different method. Provide opportunities for the people to learn by doing. Nurse should develop good human relationship through educational approach. Community leader must be taken in the consideration.

Principles of Health Education:

Barriers in Communicating Health Education:


Physiological barriers Ex: difficulty in hearing and expression. Psychological barriers. Ex: Emotional disturbance, neurosis, depressive etc. Environmental barriers. Ex: Noise and congestion. Cultural barriers. Ex: level of knowledge, custom , religion, belief etc.
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Steps in carrying Health education programme:


Meeting with primary health care staff. Identification of community leader. Identification and selection of health problem. Meeting with leader and discussing problems which are identified. Plan for collecting single base line data, conducting base line surveys with help of leader. Group meeting with community members to feed back the result of survey and to decide on plan of action. Selection, collection and preparation of necessary material i-e Audiovisual material etc. Orientation of leader. Implementation of programme. Follow up the necessary service and facilities. Evaluate the programme.

Methods of Health education:


Lecture. Mass media: Television and radio. Films Audio-cassettes. Pamphlet booklet charts Posters stickers and flannel graph. Exhibitions (A.V) Flip chart. Group discussion panel discussion (4 to 8 person discuss). Seminar Demonstration Role play interview Task force Case study. Brain storming. Open form. Field strip. Buzz session Skits.

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Small Group discussion:


This is the method in person discuss on the topic & the persons are qualified for the topic. OR This is excellent method to teach the adult people. In this method people learn from each other. There should be leader to ensure the participations of every one member, good moral & good group action during discussion. There should be record keeping person to write the agreement & essential points of discussion.

Advantages of group discussion:


Active role of learners improve their attitude towards the topic. Suitable for changing the behavior This group comprises the chairman who introduces the speakers and delivers speech to audience. it consist of record keeping person who records the important points. Good for education of self confidence and learners.

Disadvantages of group Discussion:


It needs qualified speakers. Planning consumes lot of time. Speaker may become over confidence. May use language which is difficult. May deviate from topic. There may be conflict and noise (if leader is effective)

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Role Play Method


This is method in which two or more actors act their role under said direction and time. OR In this method two or more person performing give role according situation under some directions, the actors are told their role before performance.

Advantages of Role Play Method


This is interesting method & good for presentation of facts. Stimulate the emotions of participants (learns) Effectively memorized. Develop communication skills. Large group of people are taught.

Dis-advantages Role Play Method


Criticism after the role playing. It may not play effectively. Role may not be played effectively. Role may not be played seriously. Require referral which consumes time. Preparation requires special skills. Too long role play may bore the audience. It is too expensive.

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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 something. This method is also good for small group, b/c has too ensured the participation of every one & process should be under stand by every one. It is important that every member or one or two members (learners) repeat the method.

Advantages of Demonstration Method


The learners are more likely to retain & understand. Effectively memorized b/c it is practical method. Reinforcement of some method make person more confident. Teacher evaluate the students properly b/c limited students. Enables logical step by step presentation.

Dis-advantages Demonstration Method


Limited learner participates. Expensive Consumes much more time. Require equipments for procedure. Require qualified persons.

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. The experts are ready to give the answer of the questions which are asked by the audience (Other group members).

Exhibition:
In this method some pictures are provided to educate the people. It needs well preparation & meaning full chart, pictures or other visual aids. The things which are to be shown should be placed on the suitable place, with having adequate light on it. There should be a person to explain or answer the questions.

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Lecture Method:
This is method of oral presentation of subject to large group of people & is one way method.

Advantages of Lecture Method


It conveys enthusiasm. Large group of people are instructed at a time . It is easy method of giving oral presentation Saves times & resources. Gives an opportunity to explain the relationship if theory & particle Provide additional information that is not included in text book.

Dis-advantages of Lecture Method


May be difficult for learners to understand at a time. This requires ability. It requires experts. Limited feed back. The audience may be bored or tired.

Counseling method:
Counseling method is an educational tod for helping individuals & families in their health problems. It is conversation of ideal among the two or more people having common interest & problem.

Advantages of counseling method:


Promote good health habits. Encourage self learning. Self satisfaction for the learner. Help the teacher to evaluate satisfactory.

Dis-advantages of counseling method:


Complete planning is required. Time consuming. Average teacher have no time. Average teachers have no knowledge.

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Mass media:
This is method in which the person are instructed by the mass media e.g. T.V, Radio, charts etc. OR It is tool of communication & health education. a) Pamphlet:Pamphlets are printed message & include pictures. The pamphlets on the health topic may be prepared locally or may supply by the department/ higher authority. Pamphlets are handed over to people. b) Posters:There are so large than the pamphlet. Posters are usually provided by health department. The posters are displayed on the walls. The posters may prepare locally on the white paper the little, meaning full, short messages should be written to understand immediately. c) Flip Chart: It is series of charts bounded together such as each chart is viewed by turning back. It is presentation of many ideas that can not be presented on one chart.

Radio/ T.V:
It is vast media for communication. It is one way communication. It is useful media to keep the people well informed about social problems, current social changes, declaration publicity of health polices, environment & biological & social health hazards.

Advantages:
It is most widely available. It is popular in rural areas. It is cheap & easy to operate. 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. This required considerable preparation of time. Available broad casting may not obtain

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Interview:
Advantages: Ensure privacy. Gives the sense of care and confidence to students.

Dis-advantages:
Time consuming. Require experience.

Flannel Graph
A board is prepared which is covered with flannel or rough cloth. The pictures are ready in order to place on board through the pins. The picture may be removed again. The board should be placed at good light/site, so that all the viewers see & can understand properly.

Seminar
Refer to group of person who have prepared themselves on particular topic or problem & will speak to audience.

Symposium
In this person speak on selected subject each expert presents as aspect of subject briefly & there is no discussion among the members.

Buzz session
Refers to large group into several small groups & discuss assigned topic.

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Evaluation
Evaluation of health education
The evaluation is the process of finding out how things are being done.

Purpose of Evaluation
To find out the achievement and efforts of health education. To observe awareness change of behavior of client. To determine the limitation of health education. Vital part of learning.

What to Evaluate
Knowledge gained by learners. Practice is healthy or not. Number of health session Number of the people attended to health education programme. Effectiveness of health education How much understanding by audience. Attitude is changed or not.

Technique of evaluation
Self evaluation. Teacher & student evaluate each other. Silent observation. Instructor asks questions. Test & examination. Short evaluation at the ends of the session. By health workers while visiting of homes. Survey & community visiting. Meeting with individuals, families, leader etc.

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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, individuals, families & the community.

Purpose of community Assessment


To determine the health needs of the community. To identify the health status of the community. To identify actual or potential health problems of community. To informs the needs of the health of community to the health planner & policy maker of the health.

Three Areas of the community Assessment

1. Geographical information 2. Demographic Information 3. Environmental information 1. Geographical information:


Name of the locality or area. Physical structure and boundaries. Important roads, streets and buildings. Seasonal variation & month. Getting or preparing the map.

2. Demographic Information:
The total information about total population with reference to age, sex, caste, education, occupation & income. Total families e.g. nuclear fail, joint family etc Vital health events i-e C.B.R, C.D.R, I.M.R, morbidity etc. Specific vulnerable groups i-e infant, toddler, expecting and lactating mother.

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3. Environmental information
i. Physical Factors: house = numbers type open space etc Water = potable, not potable, safe or unsafe etc Sanitation= Disposal of waste and waste water etc. Social organization = school, college, temples, Mosque etc. Community organization Leader ship structure as M.P.A, M.N.A etc.

ii. Social Factors:-

iii. Environmental communication: Common meeting places. Media = T.V, radio, newspapers, cinema etc.

iv. Environmental resources: Economic resources = Occupation, income etc. Institutional resources = Health institution, industrial & commercial agencies. Human resources = Doctor, Engineer, Teachers, nurses, lawyers etc.

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Demography
Definition:
It is the science of population & it is concern with size, structure, distribution & changes which occurs due to birth, death, in migration, out migration is called demography.

Population Dynamics
There are four ways in which the number of peoples in area can change. 1. No: of live birth (B) in the area. 2. No. of deaths in the area (D) 3. No. of persons moving into area. 4. No. of persons moving out of the area. Thus population of the area may change due to natural reason. (B-D) called natural increase & due to migration (IM-OM) called net migration So: Population growth = natural increase + net migration. OR Population growth = (B.D) = (IM-OM)

Define population growth Rate:


The rate at which the population of country or community is growing.

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 7.388600 = 84.4/100 =

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Basic Definitions
Fertility:This is actual reproductive performance of woman or couple.

Net migration:Total number of person added or subtracted from population.

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, analysis & interpretation of data in relation to vital events i-e births, deaths & sickness.

Health statistics
It is the study of life history of the community in relation to health i-e prevention & control of disease, control of population problem & family planning & programme planning & developing & preventing & curative services.

Sources OF Vital And Health statistics.


Census Births & deaths registration Record from hospital & primary health centre. Laboratory investigations School records.

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Define Fertility Definition:


The fertility refers to the number of live births a woman has- had. OR Fertility refers to human child bearing or reproduction & is confined to woman during their reproductive age i-e (15-49) years.

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 . Culturally every woman wants to a son cessation of breast feeding.

Basic Fertility Measures


1. Crude birth rate (C.B.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.B.R C.B.R = No. of births in a year x 100 Population in that year E.g: C.B.R = 40 x 100 = 13.3/1000 3000 2. General fertility rate (G.F.R) This is the total No. of live birth in a year upon No. of woman ages 15-49 years, Expressed by 100 in a population is called G.F.R G.F.R = No. of births in a year x 100 No. of woman ages 15-49 years e.g: G.F.R = 30 x 1000 = 15/1000 2000
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3.

Age specific fertility rate (A.S.F.R) It is adjusted for the age & determines the fertility rate of woman in each age group. Thus A.S.F.R = No. of live births to woman age in a year x x 100 No. 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.

Basic Mortality Rates:


1. Crude death Rate (C.D.R): This is number of deaths in a year divided by total population at mid year & multiplied by the 1000 C.D.R = No. of deaths in a year Population at mid-year No. of deaths are = 20 Total population = 5000 C.D.R =? According to the formula: C.D.R = 20 x 1000 = 4/1000 e.g:

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2. Age Specific Death Rate (A.S.D.R) This is the number death person of specific age group in a population in a year divided by total no. of person of that age multiplied by 1000 A.S.D.R = no. of person of age X in a year x 1000 No. of person that age Example: no. of death under five year age Total no. of children under five year A.S.D.R According to the formula A.S.R.D = 40 X 100 1000 =10 = 40 = 4000 = ?

3. INFANT MORTALITY RATE (I.M.R) This is the number of death of children under one year in a population divided by no. of live birth in that year multiplied by 100
I.M.R= No. 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.M.R = ? According to the formula: I.M.R = 36/400X 1000 = 90/1000 Example:

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4. Neo-Natal Mortality Rate (N.M.R): This is the number of death of children less than one month in a year, divided by no. of live birth in that year multiplied by 1000
N.M.R= No. of death of infants under one month of age in year X 1000

No of live births in that year a. Early Neo-Natal Mortality Rate (E.N.M.R): This is the number of death of children less than one week in a year, divided by no. of live birth in that year multiplied by 1000
.E.N.M.R= No. of death of infants under one week of age in year X 1000

Total no: of live births in that year b. Late Neo-Natal Mortality Rate (L.N.M.R): This is the number of death of children from one week to four week, divided by no. of live birth in that year multiplied by 1000
L.N.M.R= No. of death of infants from 1-4 week X 1000

Total no: of live births in that year c. Post Neo-Natal Mortality Rate (P.N.M.R): This is the number of death of children from 4-52 weeks or 01-12 months in a year, divided by no. of live births in that year multiplied by 1000
P.N.M.R= No. of death of infants during 4-52 weeks X 1000

Total no: of live births in that year

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5. Peri-Natal Mortality Rate (P.M.R): This is the number of deaths under one week plus still births, divided by total no. of live births plus still births multiplied by 1000
P.M.R= No. 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.R.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, in the under five years of age
The milk should be pasteurized and water should be boiled before giving to children.

General hygienic care should be given to infants Family planning should be applied to reduce the rate of mortality
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6. Maternal Mortality Rate (M.M.R): M.M.R= No. of deaths of women due to pregnancy; its complication or after delivery (child birth) X 1000
Total live births in a year

Causes of M.M.R:
Hemorrhage (APH, PPH) Anemia Septicemia Pre-eclampsia Repeated Pregnancy Mal-nutrition Mal-position of child Puerperal sepsis Toxemia

Prevention of M.M.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. Incidence Rate (I.R):

Incidence:
This is measures the probability that healthy people will develop a diseases during a specific period of time. This tells new cases in the population. Incidence Rate This is No: of new cases of disease in population at risk at a point in time multiplied by 1000. I.R = No: of new cases of disease x 100 Population at risk

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8. Prevalence Rate (P.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. P.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? P.R = No: of old & new cases of mal-nutrition< 5 years x 1000 Population of < 5 years children According to the formula: P.R = 48/1671x 1000 P.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. Age Specific death Rate (A.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.S.D.R = No: of deaths of specific age or age group x 1000 No: of persons in the population of that age 10. Cause Specific Death Rate (C.S.D.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.S.D.R = No: of deaths of specific cause during specific period x 1000 No: of persons in the mid point of that period
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11. Case Fatality Rate (C.F.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.F.R = No: of people during from specific disease during specific period of time No: of people with the specific disease during that period. THE END

SINDH NURSES EXAMINATION BOARD KARACHI,


COMMUNITY HEALTH NURSING III, ANNUAL/ SUPP: GUESS PAPER

1(a): Define School Health Services, Purposes, Components, functions & problems of School Health Services? (b): Define Health education, aims, Principles, barriers, 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, infant mortality & maternal mortality (any five)? (b): Health indicators? And different questions in the M.C.Qs about the survey (community assessment)? (d): Define the following? Demography Net migration Population pyramids Bio-statistics Prevalence Incidence N.B: Preliminary and Second year prescribed course should be revised to revision for the purpose to secure maximum marks in the examination.

FOR ANY CORRECTION or POSITIVE CRITICISM WARMLY WELCOMED TO: exlarkanian_ansari2002@yahoo.com

WISH YOU BEST OF FORTUNE.

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