Y.A.

Sulaiman
 COMMUNITY HEALTH NURSING
Community health nursing: According to ANA 1980 is a synthesis of nursing practice and public
health practice applied in promoting and preserving the health of population. It is not limited to
a particular age or diagnostic group, It is continuous not episodic.

Community Health Nursing Is defined as a systematic and continuous process of promoting and
preserving the Health of population that covers individuals at all status and age groups.

Public health: It is the art and science of preventing illness, prolonging life and promoting health
through organized efforts of the society.

Community health: It refers to the health status of the members of the community, to the
problems affecting their health and to the totality of the health care provided for the community.
Aims and Objectives
1) Health Promotion.
2) Disease Prevention.
3) Rehabilitation.
1) Health promotion:
WHO (2016), Health promotion is the process of enabling people to increase control over their
own health. It covers a wide range of social and environmental interventions that are designed
to benefit and protect individual people’s health and quality of life by addressing and preventing
the root causes of ill health, not just focusing on treatment and cure.

2) Disease prevention:

WHO, Disease prevention Refers to minimize the burden of diseases and associated risk factors.
It comprises of:
Primary prevention refers to actions aimed at avoiding the manifestation of a disease.
Primary prevention services and activities include:

• Immunization.
• Pre-exposure prophylaxis of children, adults and the elderly.
 • Education on behavioral and medical health risks, and measures to reduce risks at the
individual and population levels.
Secondary prevention deals with early detection and treatment to prevent disabilities when
this improves the chances for positive health outcomes.
Secondary prevention includes activities such as:

• Population-based screening programmes for early detection of diseases;

• Provision of chemo-therapeutic agents for treatment of diseases..

2) Rehabilitation:
WHO (2020), Rehabilitation is defined as “a set of interventions designed to improve functioning
and reduce disability in individuals with health conditions in interaction with their environment”

Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease
or illness, or because their functioning has declined with age.

CONCEPT OF HEALTH
The World Health Organization (WHO) defines health as ‘a state of complete physical, mental
and social wellbeing and not merely the absence of disease or infirmity’ (WHO, 1948).
A major criticism of this view of health is that it is unrealistic, because it ‘leaves most people
unhealthy most of the time’ (Smith, 2008)
There are three major concepts of Health.
• Biomedical concept
• Ecological concept
• Psychosocial concept.
• Holistic concept.
• Biomedical concept: Health is “absence of disease” Based on germ theory of disease, if
one is free from disease than he is considered healthy.
• Ecological concept: Ecological concept is the relationship between individual to one
another and to their physical environment.
Ecologists believe that health is dynamic equilibrium between man and his environment, and
disease is mal-adjustment of the human organism to his environment. Example, Malnutrition,
Accident, Drug abuse, Mental illness,
• Psychosocial concept: Health is encompasses the relationship between Mental,
Emotional, Social and Spiritual well being of an individual.
If an individual has no issue regarding Mental, Emotional, Social, and Spiritual well-being, is
considered healthy.
• Holistic concept: Health is achieving physical, Mental, Emotional, Social, and spiritual
well-being. Holistic believe that Health is a state of balance between an individual's
physical, mental, Emotional, Social and spiritual needs, therefore person will be healthy
when those needs are achieved.

SCOPE OF COMMUNITY HEALTH NURSING.

1) School Health Nursing

2) MCH And Family Planning Services
3) Industrial Nursing
4) Domiciliary/Domicilary Nursing
5) Mental Health Nursing
6) Nursing Home Care
7) Geriatric Care
8) Rehabilitation services
PRINCIPLES OF COMMUNITY HEALTH NURSING.

Group Work:

1) Explain twelve (12) Principles of Community Health Nursing?

 MATERNAL AND CHILD HEALTH CARE SERVICES.

Concept of Safe motherhood:

These are all activities, programs, campaign and communication purposely designed to provide
mothers with relevant information to guide them before pregnancy, during pregnancy and after
childbirth and ensure the safety of the mother and child.

Safe motherhood means ensuring that all women from different levels have access to the
information and services they need concerning pregnancy and childbirth. Women need to be safe
through pregnancy and childbirth.
Safe motherhood involves series of initiatives, practices, protocols and service delivery
guidelines structured to give mothers high-quality gynecological, family planning, prenatal,
delivery and postpartum care, in order to achieve optimal health for the mother, fetus and infant
during pregnancy, childbirth and postpartum
It includes:
• Family Planning
• Antenatal care (care during pregnancy) and counseling with focus on high risk pregnancies
• Clean/safe delivery
• Basic Maternity Care
• Essential Obstetric care
• Postnatal care (care after child birth)
Infant welfare:

Overview:

The Maternal and Child Health Service (Infant Welfare) began in Victoria in 1917 when, in response
to high levels of infant morbidity and mortality Due to infant abuse neglect care, the first voluntary
infant welfare centers began to emerge. The first centers were established in Richmond and Carlton
and received a Council subsidy.

Other volunteer centers soon followed and in 1918 the Victorian Baby Health Centers Association
was formed.
In 1934 the Victorian Baby Health Centers Association established a Mobile Infant Welfare Service
for country mothers. In the early 1940s the Department of Health (VA 695) began its Mobile Service.
Vans were used as mobile centers as well as providing accommodation for the nurses on the circuit.
By the early 1950s the Department of Health had set up Mobile services in seven areas of the State,
four of which were still operating in 1976.

Infant welfare clinics in Lagos were first started in 1928, the work being carried on as far as possible
upon the same lines as at home.
Clinics are held four afternoons a week; a European medical officer and nursing sister being in
attendance at each clinic, as well as five African health visitors.

Definition of Infant welfare:

Infant welfare is defined as the social welfare service concerning support and care that helps
infant from 0 to 2 years to achieve highest level of health, intellectual giftedness and talent. While
providing them with education that is suitable for their mental and physical developmental
characteristics

Infant welfare facilities:

Infant welfare clinics: Infant welfare clinic is a medical facility that specializes in the health and
well-being of infants.
Nursery facilities: is the place for infant to play, crawl and learn to toddle. In nursery facility
there are low pieces of furniture and play support facilities to encourage children to pull
themselves up and give opportunities for taking their first steps.

Infant welfare centers: The function of the Infant Welfare Centre is the education of the Mother
in all that belongs to the health of the baby and the young child. Its chief aim, therefore, is to do
preventive Nursing work.

Infant welfare Ministries, agencies and organizations:

• State Ministry of women affairs
• State Ministry of Health
• Federal Ministry of women affairs
• Federal Ministry of Health
• CRAGON Child Rights Advocacy Group Of Nigeria
• NACCRAN National Council of Child Rights Advocates of Nigeria
• UNAIDS United Nations AIDS Programme
• UNDP United Nations Development Programme
• UNICEF United Nations Children Fund

Services at infant welfare facilities.

• Health care services
• Nutritional services
• Hygiene management
• Safety management
• Educational service

Location of infant welfare facilities.

Locational Conditions of the Facilities are:
1) Facilities shall be located At least 50 meters away from certain dangerous facilities.
2) Facilities shall be located at Safe and Ventilated area.
3) Facilities shall be located within Vegetation.
4) Facilities shall be located at area with access to road.
 Structure and Equipment Standards of infant welfare Facilities.

The structure and equipment of a facility shall be adequate for the characteristics of the infants
using them. Facilities shall be equipped as follows.

• Nursing room.
• Kitchen.
• Bathroom.
• Toilet.
• Playground.
• Water supply and drainage facilities.
• Facilities for protection from emergency disasters.
• Transportation facilities.

Operation at infant welfare Facilities.

1. Nurse infant ratio:

Class Age 0 Age 1 Age 2

Teacher/Nurse- 1:3 1:5 1:7

Infant Ratio

2. Operation time of infant welfare facilities:

Infant welfare facilities are operated six days a week, over twelve hours on weekdays; working
hours can be adjusted according to the guardian’s working schedule.
Its operated all year round except on public holidays, but according to local and facility conditions,
may be operated on public holidays after consultations between guardians and the head of the
facility.

SCHOOL HEALTH NURSING

Healthy and Safe School Environment:

Overview:

A healthy and safe physical school environment promotes learning by ensuring the health and
safety of students and staff. The physical school environment encompasses the school building
and its contents, the land on which the school is located, and the area surrounding it.

Definition: A healthy and safe school environment is defined as an environment that support
students’ health and well being and helps to build a strong foundation of learning.

A healthy and safe physical school environment promotes learning by ensuring the health and
safety of students and staff.

Healthy school environment comprises of:

• Safe and healthy school infrastructure.
Students are provided with clean and good learning environment including
a) Safe school compound
b) Adequate and well ventilated classroom
c) Comfortable hostel with clean toilet facilities
d) Adequate water and sufficient light supply
All students deserve access to a clean and safe environment with good air quality.

• Adequate teachers.
Adequate teachers principals and school staff with knowledge and skills are provided to
make sure that students learns property.
 • Access to Health services.
Access to health services is necessary to ensure students are healthy and ready to
learn. Making health services available at schools is an efficient and cost-effective way to
reach children who spend their days at school. Access to care from a school nurse, improves
wellness and academic achievement.

• Play support facilities.

Play support facilities such play ground, multimedia Centre, and resource room are provided to
support and enhance learning

The Comprehensive School Health Program

Today, school health has evolved into what is termed a comprehensive school health programs
(CSHP). The committee believes that the general goal of a CSHP is to establish a system of home,
school, and community support to assure that students are provided with a planned sequential
program of study, appropriate services, and a nurturing environment that promotes the
development of healthy, well-educated citizens. It comprises of:

1) School Health Program

2) School Resource Program
3) School Visit Program

1) School Health Program

The Three-Component Model:

The three-component model is considered the traditional model of school health programs.
Originating in the early 1900s and evolving through the 1980s, this model defines a school
health program as consisting of the following three basic components:

1. Health instruction is accomplished through a comprehensive health education

curriculum that focuses on increasing student understanding of health principles and
modifying health-related behaviors.
 1. Health services includes prevention and early identification and remediation of student
health problems.
2. A healthful environment is concerned with the physical and the psychosocial setting
and such issues as safety, nutrition, food service, and a positive learning atmosphere.

The Eight-Component Model:

The Division of Adolescent and School Health of the Centers for Disease Control and Prevention
has promoted the eight-component model, and it has received widespread attention and
adoption by many states in recent years.

In the 1980s, the three-component model was expanded to include additional components
(Kolbe, 1986; Allensworth and Kolbe, 1987). According to this model, a comprehensive school
health program contains the following eight essential components:

1) Health education consists of a planned, sequential, curriculum that addresses the

physical, mental, emotional, and social dimensions of health.
2) Physical education is a planned, sequential, curriculum promoting physical fitness
and activities that all students could enjoy and pursue throughout their lives.
3) Health services focuses on prevention and early intervention, including the
provision of emergency care, primary care, access and referral to community
health services, and management of chronic health conditions. Services are
provided to students as individuals and in groups.
4) Nutrition services provides access to a variety of nutritious and appealing meals,
an environment that promotes healthful food choices, and support for nutrition
instruction in the classroom and cafeteria.
5) Health promotion for staff provides health assessments, education, and fitness
activities for faculty and staff, and encourages their greater commitment to
promoting students' health by becoming positive role models
6) Counseling, psychological, and social services include school-based interventions
to counsel psychological and social issues of students, and referrals to community
heath care providers.
 7) Healthy school environment, healthy and school environment is defined as an
environment that support students’ heath and well being and helps to build a
strong foundation of learning.
8) Parent and community involvement engages a wide range of resources and
support to enhance the health and well-being of students.

2) School Resource Program.

The school resource program is primarily focusing emphasis on source of information for student
as resource, the term resource is defined as any source of information that leads to acquisition
of knowledge, Resource include Books, Journals, Magazines, Computers.

This program comprises of:

Resource Facilities: Is a collection of resources gathered together for the purpose of knowledge,
this includes Library, Demonstration room, and ICT.

Catalog Services: Catalog Services refers to arrangement of resources in an ascending order to

help learner identity the information needed.

Personnel Involvement: In the Library, Demonstration room and ICT there should be a personnel
responsible for guiding student on how to find relevant information needed.

Healthy School Environment: A healthy school environment will address a school’s physical
condition during normal operation (e.g., ventilation, moisture, temperature, noise, and natural
and artificial lighting), and protect occupants from physical threats (e.g., crime, violence, traffic,
and injuries) and biological and chemical agents in the air, water, or soil as well

3) School Visit Program

For effective development of healthy, well-educated citizens there should be a concise visit to
resource centers and resource persons in general, student visit should be organized to some
centers that gathered different sources of information and different people with knowledge from
different perspective. School Visit Program include:
Resource Center: This is Centre that comprise of different resource facilities and Resource
Persons, like National Library, Teaching Hospitals, Specialist hospitals.

Resource Person: A person with knowledge from different perspectives, based on the concept of
School Visit Program resource persons should be available for student to acquire effective
knowledge at either Elementary, High school or Tertiary level of education.

Visitation Services: When there is a presence of resource centers and Resource Persons, Visit
should be organized by schools management to appropriate resource center based on the needs
of school curriculum. Students will be escorted to visit resource center as well as resource
persons for the purpose of knowledge acquisition.

Healthy School Environment: This is the environment that support well being of students and
teachers for effective knowledge acquisition.

Outcome of Comprehensive School Health Programs

At this preliminary stage, the committee has proposed a set of optimal outcomes for CSHPs—a
vision of what these programs ought to be and what they might be able to do. The feasibility of
these outcomes and possible strategies for achieving them will be examined in the committee's
full report. The optimal outcomes can be categorized into three general areas:

1. student outcomes,
2. programmatic and organizational outcomes, and
3. community outcomes.

Student Outcomes
Students will assume personal responsibility for avoiding social, emotional, and physical health-
compromising behaviors and for engaging in health-promoting behaviors. Students' health
needs—preventative, emergency, acute, and chronic—will be addressed to allow students to
reach the highest possible level of educational achievement and personal health.
Organizational Outcomes
The relationship between health status and educational achievement will be evident in the
policies and programs of the school. The school 's health emphasis will be integrated across all
activities. Linkages among program components, disciplines, and participating agencies will be
clearly defined and regularly evaluated. Individual and group health problems will be identified
and managed with appropriate prevention, assessment, intervention or referral, and follow-up
measures.

Community Outcomes
The community will be actively involved in determining the design of a school health program
and in supporting and reinforcing the goals of the program. This design will include assurance
that schools are safe, with an environment conducive to learning and health promotion, and that
policies and procedures are in place to enhance the use of schools as a community resource for
health.

DOMICILIARY/DOMICILARY NURSING.
PREVENTION OF INFECTIOUS DISEASES:
Infectious disease.

Definition:
Infectious disease is defined as any disease that can be transmitted from person to person or
from one person to community.

Infectious diseases can be caused by many pathogens, including bacteria, viruses, fungi, and
parasites that may cause illness and disease which can be transmitted from person to person.
 Classification of infectious diseases.

1) Clinical classification is based on the main clinical manifestations (symptoms and signs) of
the disease.

2) Epidemiologic classification is based on the main mode of transmission of the disease.

1) Clinical classification:
Classification is based on the main clinical manifestations of the disease. This way of classification
is important in helping you to treat the symptoms and signs that are common to (shared by)
individuals who suffer from different diseases. Clinical classification is illustrated by the example
given below.

• Diarrhoeal diseases
• febrile illnesses

2) Epidemiologic classification:
This classification is based on the main mode of transmission of the infectious agent.

• Waterborne diseases: transmitted by ingestion of contaminated water.

• Foodborne diseases: transmitted by the ingestion of contaminated food.
• Airborne diseases: transmitted through the air.
• Vector-borne diseases: transmitted by vectors, such as mosquitoes and flies.

Prevention of infectious Diseases.

Minimizing the transmission of infectious diseases is a core function of Community Health
Nursing.
In health Care and Community health Nursing practice, infection control includes various
measures that prevent and contain the spread of infectious disease. These measures include:

Community diagnosis:
Immunization is a successful and cost-effective public health strategy that saves millions of lives
each year. Governments can support vaccination coverage by ensuring that vaccination is free
or affordable, by ensuring that all children are vaccinated (with limited exceptions for medical or
religious reasons), and that vaccinations are documented.

Screening:
Screening individuals to determine if they have been infected with or exposed to an infectious
disease is a core public health strategy. Early treatment has important public health benefits;
for example, people receiving treatment for tuberculosis and HIV infection are less likely to
transmit the infection to others. Routine, voluntary HIV testing benefits both affected individuals
and their intimate partners by facilitating early access to prevention, care and treatment
services.

Chemoprophylaxis/ Adequate treatment:

Provision of adequate treatment to those infected is a primary measure of preventing the disease
transmission to the entire population. Government should provide free drugs to those infected
at any level, this will ensure that all individual’s infected with the disease received adequate
treatment at all level.

Compulsory treatment orders:

Although the right to consent to medical treatment is a fundamental individual human right,
there are circumstances in which public health authorities may be justified in ordering the
compulsory diagnosis and treatment of individuals. Public health laws should authorize
compulsory treatment orders only in circumstances where the person in question is unable or
unwilling to consent to a diagnostic procedure or treatment, and where their behaviour creates
a significant risk of transmission of a serious disease. For example,

Isolation:
Limiting contact with infectious persons
Isolating persons who have or may have been exposed to a serious contagious disease, in order
to prevent transmission, is a long-established public health strategy that may be applied to both
individuals and groups. Where an outbreak of a serious, contagious disease occurs, it will often
be impractical or impossible to accurately identify cases and carriers of disease.
Provision of Safe water: Drinking water sources are subject to contamination and require
appropriate treatment to remove disease-causing agents. Today, the most common steps in
water treatment used by community water systems (mainly surface water treatment) include:

Hand hygiene:
Hand washing, also known as hand hygiene, is the act of cleaning hands with soap and water to
remove microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the
hands..

Sanitation:
Sanitation refers the safe management of solid waste and animal waste. Inadequate sanitation
is a major cause of infectious diseases such as cholera, typhoid and dysentery world-wide.

Health Education:
Health education is a combination of teaching learning experiences designed to help individuals
and communities improve their health, by increasing their knowledge or influencing their
attitudes.

Therefore, Community need to be educated about infectious disease that are common in their
society, this will prevent the community from getting infected as well as reducing the infection
rate.

Immunization:
To maximize immunization coverage, national vaccination plans should provide for free or
affordable immunizations that are available from most health care providers,
“Overwhelming evidence demonstrates the benefits of immunization as one of the most
successful and cost-effective health interventions known”.6 Immunization avoids about 2–3
million deaths each year, as well as serious disability from vaccine-preventable diseases including
Yellow fever, diphtheria, tetanus and pertussis, rubella, rotaviruses, polio, pneumococcal
diseases, mumps, measles, human papillomavirus, polio, hepatitis B, and Haemophilus
influenzae type b.
 IMMUNIZATION.

Definition of Terms

Immunity: Is a system of providing protection against pathogens or protection from an infectious

disease.

Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific
disease, protecting the person from that disease..

Immunization: Is defined as the process of introducing vaccines in to the body system there by
stimulation immune system to produce antibodies against particular pathogens

Mechanisms of Antibodies production:

Group Work:

1) Discuss Mechanisms of Antibodies Production?

Classification of vaccines

1) Live attenuated vaccines:

The virus or bacteria is functional/alive but has been weakened so it can replicate in the body
several times and generate an immune response without causing the disease, e.g.
chickenpox, measles, mumps and rubella, rotavirus, and shingles vaccine viruses. The BCG
vaccine contains live weakened tuberculosis bacteria.

After immunization, the weakened vaccine viruses or bacteria replicate (grow) in the vaccinated
person. This means a relatively small dose of virus or bacteria can be given in order to stimulate
an immune response.

2) Inactivated or dead vaccines:

Inactivated vaccines do not contain live viruses or bacteria. Viruses in these vaccines are
inactivated or split, e.g. polio or influenza vaccines in New Zealand, and bacteria killed. New
Zealand does not have a killed bacteria vaccine on the Immunization Schedule, but a travel-
related vaccine is available for purchase. They cannot cause the disease but the inclusion of
adjuvants (immune enhancers) in the vaccine help generate an immune response.

These types of vaccine can be safely given to a person with an impaired immune system response.

3) Subunit vaccines:
These vaccines present proteins or sugars derived from the disease-causing organism.

Protein vaccines:
Protein vaccines may include fragments extracted from a virus or bacteria such as inactivated
bacterial toxoid proteins, e.g. tetanus and diphtheria vaccines, or be engineered without
the disease-causing organism, e.g. virus-like particles in hepatitis B and human papillomavirus
(HPV) vaccines.

Pure polysaccharide vaccines:

Some vaccines only include sugar/carbohydrate (polysaccharide) molecules found on the outside
of some bacteria, e.g. some vaccines to protect against pneumococcal or typhoid disease. This
type of vaccine can generate a protective immune response in older children and adults and
cannot cause the disease.

Nucleic acid-based vaccines:

Nucleic acid-based vaccines use the hosts own cell machinery to make the antigen, which is then
presented to the immune system. While RNA is encapsulated into lipid nanoparticle and injected,
DNA is fired directly in the host cells using a brief electrical pulse.

DNA vaccines are thought to be more effective than protein- or antigen-based vaccines because
the antigen can sometimes be degraded or consumed by the body before the immune system
can generate a full attack against the antigen.

At present, different types of nucleic-acid vaccines are in developmental, pre-clinical and clinical
evaluation phases, e.g. for prevention of human immunodeficiency virus (HIV), influenza
and malaria diseases and treat some cancers. This vaccine platform is also being used to develop
vaccines to prevent COVID-19 disease.
 Routes of Vaccines administration

(WHO)

Vaccine vials and Ampoules.

Single-Dose Vials: A single-dose vial (SDV) contains one dose and should be used one time for
one patient. SDVs do not contain preservatives

Multidose Vials: A multidose vial (MDV) contains more than one dose of vaccine. Because MDVs
typically contain a preservative to help prevent the growth of microorganisms, they can be
entered or punctured more than once.

Single dose Ampoules: A single dose ampoules contains only one dose of vaccine to be served to
single patient.
 Cold chain System.

The cold chain:

The system used for storing vaccines in good condition is called the cold chain. It is sometimes
referred to as the vaccine supply chain, or the immunization supply chain.

The cold chain consists of a series of links that are designed to keep vaccines within and UNICEF
WHO recommended temperature ranges, from the point of manufacture to the point of
administration.

Cold chain begins with the cold storage unit at the manufacturing plant, extends to the transport
and delivery of the vaccine and correct storage at the provider facility, and ends with
administration of the vaccine to the patient
 Vaccine storage and temperature monitoring.

Storage Facilities:

• Refrigerator
• Freezer
• Cold room
• Boxes:
➢ Ice pack
➢ Ice cube
➢ Ice blanket
Vaccines Temperature Monitoring.
Temp: 2 – 8 degree Celsius

Cold Chain Monitor (CCM):

The Cold Chain Monitor (CCM) is a paper-based temperature monitoring device using time-
temperature sensitive indicators which change colour irreversibly and at a constant rate.
Indicator strips are attached to a card on which instructions for use are printed.

CCMs provide a warning when excessive heat exposure occurs during transport. They are used
primarily to monitor the international shipment of freeze-dried vaccine consignments where dry
ice is used. CCMs may also be appropriate for national vaccine shipments where the delivery
takes several days.

Indicator strip is mounted behind three equal sized windows marked ‘A’, ‘B’ and ‘C’ so that users
can clearly identify three distinct stages in the colour change process.
Dial Thermometer (DT)
The vapour pressure dial thermometer is a mechanical device that uses a metal pointer on a
circular scale to indicate temperature measurements. The device has two primary components;
the metal pointer or needle, and a temperature sensor.

The sensor is liquid, gas filled or vapour-tension-based which works on the principle of expansion
and contraction. As the liquid expands or contracts in response to the temperature changes, the
resulting pressure moves the needle on the scale.

Vaccine Vial Monitor (VVM):

The VVM is a round indicator, printed directly on the vaccine vial label or affixed to the top of
the vial or ampoule. The inner square of the VVM is made of heat-sensitive material that is
initially light in colour and becomes darker when exposed to heat over time. By comparing the
colour of the square to the reference ring, health workers can determine the extent to which the
vaccine has been exposed to heat. The vaccine can be used as long as the colour of the inner
square is lighter than that of the reference ring.
 Immunization schedule.

Group Work:

1) Explain Routine Immunization Schedule?

 WATER SUPPLY AND BASIC SANITATION

Water:
Water is a clear, colorless, odorless, tasteless liquid that freezes into ice below 0 degrees
centigrade and boils above 100 degrees centigrade.

Sources of water

Water is not just essential to our health, but we also use it for numerous household tasks such
as cooking, bathing, cleaning, and drinking; there are two main sources of water.
1) Surface water:
o Lakes
o Streams
o Rivers
o Storage reservoir
2) Ground water
o Well water/borehole
o Spring water
o Infiltration water

Water Treatment.
Drinking water sources are subject to contamination and require appropriate treatment
to remove disease-causing agents. Today, the most common steps in water treatment
used by community water systems (mainly surface water treatment) include:

• Coagulation and Flocculation

Coagulation and flocculation are often the first steps in water treatment. Chemicals with
a positive charge are added to the water. The positive charge of these chemicals
neutralizes the negative charge of dirt and other dissolved particles in the water. When
this occurs, the particles bind with the chemicals and form larger particles, called floc.
 • Sedimentation
During sedimentation, floc settles to the bottom of the water supply, due to its weight.
This settling process is called sedimentation.
• Filtration
Once the floc has settled to the bottom of the water supply, the clear water on top will
pass through filters of varying compositions (sand, gravel, and charcoal) and pore sizes,
in order to remove dissolved particles, such as dust, parasites, bacteria, viruses, and
chemicals.
• Disinfection
After the water has been filtered, a disinfectant (for example, chlorine, chloramine) may
be added in order to kill any remaining parasites, bacteria, and viruses, and to protect the
water from germs when it is piped to homes and businesses.
Water Distribution Systems.
A water distribution system simply means water supply network with pipes that carry potable
water from a centralized treatment plant or wells to water consumers in order to adequately
deliver water to satisfy residential, commercial, industrial and fire fighting requirements Water
distribution systems consist of an interconnected series of components. They include:

• pipes
• storage facilities
• components that convey drinking water (electric pump
 Sanitation.
Sanitation refers the safe management of solid waste and animal waste. Inadequate sanitation
is a major cause of infectious diseases such as cholera, typhoid and dysentery world-wide.
Refuse(waste) Disposal, treatment and Recycling.
Waste may be Solid or Liquid.

1) solid waste: is defined as the trash produced by homes, businesses, schools, and other
organizations within the community. It differs from other waste generated such as
construction debris, agricultural waste, or industrial waste.
2) Liquid waste: is defined as a product been discarded by human activity, it includes waste
from toilets, kitchens, and laundries.
Disposal: waste should be disposed property in to waste vin with different labels as Paper,
Plastic, Bottle, Can/Tin. Waste products will be dispose in to the appropriate vin, this allows
easy recycling and incineration.
Treatment: Three methods for treatment of waste are identified:
• Incineration is a waste treatment process that involves the burning of solid waste.
Specifically, incinerators burn the organic material within the waste stream.
• Composting: It involves decomposition of organic wastes by microbes by
allowing the waste to stay accumulated in a pit for a long period of time. The
nutrient rich compost can be used as plant manure.
• Sanitary Landfill: This involves the dumping of wastes into a landfill. The base is
prepared of a protective lining, which serves as a barrier between wastes and
ground water, and prevents the separation of toxic chemicals into the water zone.
Landfill is a hole in the ground designed for the burying of solid waste.

Recycling is the process of reclaiming raw materials and reusing them to create new goods.
Example include metal, plastic, glass and paper.
Health-care waste management.
Types of heath care waste.
Waste and by-products cover a diverse range of materials, as the following list illustrates:
 • Infectious waste: waste contaminated with blood and other bodily fluids (e.g. from
discarded diagnostic samples),cultures and stocks of infectious agents from laboratory
work (e.g. waste from autopsies and infected animals from laboratories), or waste from
patients with infections (e.g. swabs, bandages and disposable medical devices);
• Pathological waste: human tissues, organs or fluids, body parts and contaminated animal
carcasses;
• Sharps waste: syringes, needles, disposable scalpels and blades, etc.;
• Chemical waste: for example solvents and reagents used for laboratory preparations,
disinfectants, sterilants and heavy metals contained in medical devices (e.g. mercury in
broken thermometers) and batteries;
• Pharmaceutical waste: expired, unused and contaminated drugs and vaccines;
• Cytotoxic waste: waste containing substances with genotoxic properties (i.e. highly
hazardous substances that are, mutagenic, teratogenic or carcinogenic), such as cytotoxic
drugs used in cancer treatment and their metabolites;
• Radioactive waste: such as products contaminated by radionuclides including radioactive
diagnostic material or radiotherapeutic materials; and
• Non-hazardous or general waste: waste that does not pose any particular biological,
chemical, radioactive or physical hazard.

The sources of health-care waste:

• hospitals and other health facilities
• laboratories and research centres
• mortuary and autopsy centres
• animal research and testing laboratories
• blood banks and collection services
• nursing homes.

Heath care waste management:

Management of heath waste care doesn’t require recycling, it is generally by
• Landfill for human body waste, and
• Incineration for sharp objects and plastic containers
 GUIDANCE AND COUNSELLING
Guidance: is a mean of directing the individual to specific options that are suitable for solving his
problems.

Counselling: is the service offered to the individual who is under going a problem and need a
professional help to overcome it.

Guidance and Counselling: Is the process of systematic interaction that encourages individuals
to confront issues and work toward effective change to enhance well-being.

Approach to Guidance and Counselling

In the process of Guidance and Counselling, the ‘GEEHF’ approach is considered:

• Greet the individual people you are working with by name: show respect and trust, tell them
that the discussion is always confidential.

• Enquire about their problems as well as listening to any measures they have already taken
to solve the problem. Ask them how they believe that you can help them.
 • Explain any relevant measure to follow in solving their problems. Ask some questions in
order to check their understanding of important key points and repeat those key points in
their own words if necessary.

• Help them to make their own decisions and guide them to look at various alternatives. Help
them to choose solutions which best fit their own personal circumstances.

• follow-up and make arrangements for further visits, or referral to other agencies. If a follow-
up visit is not appropriate, then you should give them the name of someone they can
contact if they need help.

Types of Guidance and Counselling

Health

Education
Personal
al
Types of
Guidance
and
Councelling
Vocationa
Social
l

Avocation
al

1) Heath Guidance and Counselling:

Health Guidance and Counselling is a mean of directing and encouraging individuals toward
specific options that are suitable for solving their heath needs.

• Marriage Counselling
 • Family Planning Counselling
• Nutritional Counselling
2) Educational Guidance and Counselling:
Educational Guidance is defined as the guidance which individuals needs while learning in
educational institutions or schools. It stands to help them to sort out and solve the problems
they face there. It include guidance and counselling on:

• Course choice
• Study skills
• Writing skills
• Exam techniques
3) Vocational Guidance and Counselling:
The selection of occupation or job for every individual should be done in accordance with his
needs, interests, abilities, attitudes, capacities etc. the community members are guided in
selecting good job base on their interests. As a result of this all the individuals will be recognized,
accepted and regarded as positive assets for themselves as well as for the society.

• Resume/C.V. Preparation
• Job search skills
• Interview skill
4) Avocational Guidance and counselling:
An avocation is an activity that someone engages in as a hobby outside their main occupation.
Therefore, the community members are guided in selecting a hobby that will be useful for self
and community as well.
5) Social Guidance and Counselling:
The main aim of social guidance and counselling is to assist individuals in their growth process by
exploring a range of coping strategies so that they can better deal with the problems they face
both now and in the future in order to become fully functioning members of society.
Social Guidance counselling incorporates a wide range of concerns including:
• Addressing specific problems,
 • Coping with a crisis,
• Improving relationships and self-esteem,
• Dealing with conflicts,
• Exploring thoughts and feelings and
• Developing coping strategies
6) Personal Guidance and Counselling:
Personal guidance and Counselling is concerned with building personality (Character) of an
individual to be socially acceptable. In personal guidance and Counselling person will be guided
to develop some characters that are well recognized and respectful in their society. For
example, a person with abusive behavior will be regarded as irresponsible in the society,
therefore this person will be guided on total abstinence

Importance of Guidance and Counselling

Guidance and Counselling is important to the community in various ways, these include:

• It develops readiness for choice and changes to face new challenges.

• It helps the community members to identity weaker sections of the society and motivate
them toward actions.
• It minimizes incidence of indiscipline.
Guidance and Counselling helps:

• To facilitate early diagnosis, treatment and follow-up of health problems

• To reduce health-related risk behaviours.

• To improve community achievement through health knowledge and improving health

skills and behaviours.

COMMUNICATION SKILLS IN COMMUNITY HEALTH NURSING

Communication skills allow the individual to understand and be understood by others.
Communication skills are abilities to be used when giving and receiving different kinds of
information.
These include actively listening in conversations, giving and receiving critical feedback and public
speaking.

1) Active listening
2) Adapting communication style
3) Friendliness
4) Confidence
5) Giving and receiving feedback
6) Volume clarity
7) Empathy
8) Respect
9) Understanding nonverbal cues

1) Active listening
Active listening means paying close attention to the person who is speaking to you. People who
are active listeners are well-regarded by their coworkers because of the attention and respect
they offer others.

2) Adapting communication style

Different styles of communication are appropriate in different situations. To make the best use
of communication skills, it’s important to consider audience and the most effective format to
communicate with them.

3) Friendliness
In friendships, characteristics such as honesty and kindness often foster trust and understanding.
The same characteristics are important in heath education. When working with others, approach
interactions with a positive attitude, such as asking someone how they’re doing, smiling as they
speak can help foster productive relationships.

4) Confidence
In the community, people are more likely to respond to ideas that are presented with
confidence. There are many ways to appear confident, including by making eye contact when
addressing community members, sitting up straight with shoulders open and preparing ahead
of time.
5) Giving and receiving feedback
Strong communicators are able to accept critical feedback and provide constructive input to
others. Feedback should answer questions, provide solutions or help strengthen the heath
education in the community.
6) Volume and clarity
When speaking, it’s important to be clear and audible. Adjusting speaking voice so that you can
be heard in a variety of settings, and it’s critical for communicating effectively. Speaking too
loudly may by disrespectful or awkward in certain settings.
7) Empathy
Having empathy means that to understand and share the emotions of others. This
communication skill is important in both team and one-on-one settings. In both cases, other
people’s emotions need to be understood and select an appropriate response.

For example, if someone is expressing anger or frustration, empathy can helps acknowledge and
diffuse the emotion.
8) Respect
A key aspect of respect is knowing when to initiate communication and respond. In a team or
group setting, allowing others to speak without interruption is seen as a necessary
communication skill tied to respectfulness. Respectfully communicating also means using time
with someone else wisely, asking clear questions and responding fully to any questions been
asked.
9) Understanding nonverbal cues
A great deal of communication happens through nonverbal cues such as body language, facial
expressions and eye contact. When listening to someone’s, attention should be forwarded to
what they’re saying as well as their nonverbal language.
 FOOD SAFETY AND HYGIENE

Food safety is a closely related but broader concept that means food is free from all possible
contaminants and hazards. In practice both terms may be used interchangeably.

Food hygiene are the conditions and measures necessary to ensure the safety of food from
production to consumption. Food can become contaminated at any point during slaughtering or
harvesting, processing, storage, distribution, transportation and preparation. Lack of adequate
food hygiene can lead to foodborne diseases and death of the consumer.

Within this overall aim, the specific objectives for food hygiene are to:

• Prevent food spoilage, i.e. changes that make food unfit for consumption due to microbial
or chemical contamination.

• Inform and educate people about simple and practical methods of keeping food safe to
protect themselves against foodborne diseases.

• Protect food from adulteration (intentional contamination).

• Ensure proper practice in the food trade to prevent the sale of food that is offensive or
defective in value and quality.

Misbranding. Misbranding is when any label, writing or other printed or graphic matter on a food
container is false or misleading. Misbranding violates food safety regulations and is unlawful.
Food labelling should include the following facts about the food:
• character (type of food)

• origin (country)

• constituents (what is in the food)

• amount in the container

• date of production and expiry date (this is the date when the food is no longer safe to eat).
Adulteration is when the normal content of the food has been intentionally changed by adding
something to it that is not essential; for example, diluting milk with water and selling it as whole
milk. Adulterated food could be unsafe for a number of reasons.
Contamination is the undesired presence of harmful microorganisms or substances in food. Food
can be contaminated by unhygienic practices in storage, handling and preparation, and may
compromise food safety and palatability.

Principles of safe food preparation.

Principles for safe food preparation are outlined as:

• Choose foods that are not easily damaged by transportation, accidents or by storage.

• Use safe water in food preparation and for washing fruits and vegetables to be eaten raw

• Cook foods thoroughly, especially meat because this can help to kill any microorganisms
that might be present in the food.

• Eat cooked foods immediately after they are cooked, rather than leave them out and eat
later. Delays in eating cooked food can lead to the growth and reproduction of
microorganisms in the cooked foodstuff.

• Store cooked food carefully at an appropriate temperature. It should either be kept cold,
ideally in a refrigerator, or it should be kept hot.

• If food must be reheated, be sure to reheat it thoroughly.

• Protect food from animals including insects, rodents and other animals..

Policy to Regulate Food Preservation.

Food preservation is the process of treating and handling food to stop or greatly slow down
spoilage caused or accelerated by microorganisms. In preservation, the growth of bacteria,
fungi and mold are prevented and oxidation of fats which causes rancidity is retarded.

Food preservation methods include;

 1) Drying,
2) Frying,
3) Salting,
4) Smoking,
5) Heating,

Government action on increasing food preservation in Nigeria include the following policies

1) Preservation of Fruits and Vegetables

Preservation of fruits and vegetables should be immediately after harvest. The preparation
should be within 4 and 48 hours. The fruits or vegetable have to be thoroughly cleaned to remove
any dirt. The cleaning process usually involves washing the product. Other preparation may
include sorting, peeling, cutting, blanching and drying before preservation.

2) Storage Technologies
In Nigeria, Government laid a policy for storage is at three levels, namely:

• Grass root storage (in the farm)

• Middle level storage (at home)
• Large or commercial level storage (in the market)
a) Grass root storage (in the farm): The policy laid by Government for farm storage
technology includes; storage in gourds, pot, drum, tins, pit, hanging on trees, platforms,
baskets, polythene bags, sacks, and calabashes.
b) Middle level storage (at home): The middle level storage policy include food stuffs are to
be stored in medicated store room or mud walled rhombus and cribs for rural dwellers
c) Large or commercial level storage (in the market): The policy on commercial level storage
techniques are for large scale farmers, traders, exporters and agro-based companies.
They structures are mainly silos and ware houses.