1. History and development of Community Health NursingGuided by: Mr.

Ramakant
GaikwadPresented by : Mr. Ajay MagarPresented on: 09/02/11
2. 2.  “Health is Not mainly an issue of doctors, social services and hospitals. Health is
an issue of social Justice. There is no time to lose. We have the goal of “Health for
all by 2000 AD”. This is the call of the world health organization. and India has taken
up the challenge. Formerly, Health care has been for those living near enough to a
hospital or a doctor in times of need and for those who could spend money for
medicines and treatment.
3. 3.  The great majority of people stayed in the village when sick and even today
many suffer and die without proper help. Attempts have been made to meet the
health needs of the people of India by means of primary health center and the training
of Auxiliary Nurse Midwives to go out from these centre’s to the homes of the
people. The number of ANMS trained was never sufficient and more than half of
them after training went to work in hospitals. In fact, their training was given mainly
in the hospitals environment, with title experience and understanding of health needs
of people, families and communities in rural areas.
4. 4.  Community health nursing is one of the professions/disciplines which operates
within the realms/domain of community health and helps in meeting health and
nursing needs of the community. It plays a very important and challenging role in
promoting and protecting health of people. Unlike other specialties of nursing,
community health nursing lays major emphasis on primary level prevention and
focuses on the entire community. Before further discussion let us see the definition of
Community Health Nursing
5. 5.  “Community Health Nursing is a synthesis of Nursing practice and public health
practice applied in promoting and preserving the health of populations. The nature of
this practice is general and comprehensive. It is not limited to a particular age or
diagnostic group. It is continuing not episodic. The dominant responsibility to the
population as a whole. Therefore nursing directed to individuals, family or group
contributes to the health of total population. Health promotion, health maintenance,
health education, co- ordination and continuity of care are utilized in a holistic
approach to the management of the health care of individual, family, group and
community.”
6. 6.  Pre-vedic Period: The medical system that are truly Indian origin and
development are the Ayurveda and Siddha system. Ayurveda dy definition implies “
Knowledge of Life”. Its origin is traced far back to the Vedic times, about 5000BC.
During this period, medical history was associated with mythological figures, sages
and seers. Dhanvantari the Hindu god of Medicine is said to have been born as a
result of the churning of ocean during a tug war between gods and demons. According
to some authorities medical knowledge in the Atharvaveda gradually developed into
the science.
7. 7.  The experience and concern in health development and public health care dates
back to this Vedic period. In the Indus Vally Civilization (3000 BC) itself, one funds
evidence of well- developed environmental sanitation programmes such as
arrangements of good water supply, underground drainages, Public baths in cities etc.
8. 8.  In ancient India, the celebrated authorities in Ayurveda medicine were Atreya,
Charaka, Sustra and Vagbhatt. Atreya (about 800 BC) is acknowledged as the firdt
great Indian Physician and Teacher. Charaka a famous Ayuirvedic Medicine, Sustra a
father of Indian Surgery. From this early writings other authers wrote books. From
these writings we learn that surgery had advanced to a high level, also that doctors
 and the attendants (Nurse) must be the people of high character, Hospital were large
and well equipped.
9. 9.  Medical education was introduced in the ancient Universitiesof Taxila and
Nalanda. During Budha period hospital system was developed for men and women
and for animals. This was exapanded during king Ashoka, Moghal Period (1000 AD)
Unani Medicine which (Arabic system) was introudced through Greek medicine
which has become a part of Indian medicine. Nursing and medicine are closely
linked together. Nursing was regarded on the “Science of Care” and medicine as the
“Science of Cure”. As the science of cure, medicine is concerned with the diagnosis
and treatment of illness. As the scienceof care, nursing is concerned with the care of
people who are ill. The care and cure functions are complimentary ; both are
necessary and important aspects of health care for the people.
10. 10.  King Ashoka (272 BC-236 BC) a convert Buddhism, brought about period of
prosperity. Monasteries were built, houses for travelers were provided and hospitals
for both men and women and animals were founded. Prevention of disease became a
matter of first importance and hygiene practices were adopted. Cleanliness of the
body was religious duty. Doctors and midwives were to be trustworthy and skill full.
They must wear clean cloth and keep their nails cut short. Operations were precede by
religious ceremonies and prayers. The nurses were usually men or old women.
11. 11.  Women of India were favoured though restricted to activities in the home. No
doubt they cared for the sick members in the family. By 1 AD superstition and
magic had been somewhat replaced by more up to date practice. But , medicine
remained in the hands of priest-physician who refused to touch blood or pathological
tissues. Dissection was forbidden. This together with religious restrictions probably
helped to bring about decline in medicine and nursing professions.
12. 12.  During this period diagnosis was made on empirical basis and also the given
treatment was according to symptoms. So this era was called symptom oriented
oriented era. The health education was provided by lectures on authoritarian
instruction.
13. 13.  This period witnessed the invention of microscope, thermometer, BP apparatus
and other tools for detection and measurement of diseases. Laboratory investigations
were carried out to make This period was called as bacteria- oriented or disease
oriented era.
14. 14.  This is an era which witnessed her individual centered or patient centered
approach for taking care of the health and illness of the people. Clinical instructions
abd bed side teaching started in the field of medical education education. The
development of clinical techniques was initiated in medical science and technology.
15. 15.  In this period prevention oriented approach started. It was initiated by our
ancient Indians at the time of Indus Valley Civilisation. it is being called era of
Community centered approach, in which diagnosis and treatment at community level
emerged, clinical public health instructions, community- side teachings were
included in the field of medical education. Studies releted to community
development, community measurement and criteria planning techniques also started
Integration of social sciences, and public health sciences in this era took place.
16. 16.  In this period the involvement of the community leaders and members of the
community in planning and implementation of the health programmes was practiced
at this stage. The national level health planning was established by political
authorities of particular country by involving national and international health
 agencies to provide health for all. The people-centered approach has been
emphasized in this era.
17. 17.  Community health has now entered an era of individual responsibilities and
community participation. The traditional role of medical persons has been shifted
from diagnosis and treatment of individual illness to treatment of all health hazards of
community. Community diagnosis is based on collection and interpretation of
relevant data related to distribution of population according to age, sex, educational
status, marital status, religion, caste, birthrate, death rate, prevalence of disease etc.
18. 18.  Definition of Community Health development: “Community health nursing
development is defined as a nursing intervention that aims at assisting members of a
community to identify a communitys health concerns, mobilize resources, and
implement solutions.” Mosbys Medical Dictionary, 8th edition. © 2009, Elsevier.
19. 19.  Development in the broader sense is not only the improvement or progress in
the community health resources but individual progress in the professional aspect of
as community health nurse.
20. 20. Sr.No Year Events1 1918 The preparation of Nursing workers for public health
work started in Delhi, Lady Reading Health School2 1930 At Calcutta All India
Institute of Hygiene and Public Health was started3 1931 A Maternal and Child
Welfare Bureau was established by the Indian Red Cross Society.4 1939 Indian
Tuberculosis Association was started5 1943 Health Survey and Development
Committee was appointed by GOI under the Chairmanship of Sir Joseph Bhore.
21. 21. Sr.No Year Events6 1918 The preparation of Nursing workers for public health
work started in Delhi, Lady Reading Health School7 1930 At Calcutta All India
Institute of Hygiene and Public Health was started8 1931 A Maternal and Child
Welfare Bureau was established by the Indian Red Cross Society.9 1939 Indian
Tuberculosis Association was started10 1943 Health Survey and Development
Committee was appointed by GOI under the Chairmanship of Sir Joseph Bhore.
22. 22. 11 1952 Community Development Programme was launched on 2nd October for
overall development of rural areas. Central Council of Health constituted.12 1954
National water supply and sanitation scheme was inaugurated. National Leprosy
Control Programme was started. Food Adulteration Act was passed.13 1955 National
Filaria Control Programme started14 1958 National Malaria Control Programme was
changed to Eradication Programme15 1959 Mudaliar Committee was appointed to
review the progress made in health sector
23. 23. 16 1961 Mudaliar Committee report was published17 1962 Central Family
Planning Institute was established18 1971 MTP Act was passed, In 1972 came in
force.19 1973 Multipurpose Health Workers Scheme was introduced by Kartar Singh
committee report20 1975 India declared as FREE from Smallpox21 1977 Rural
Health Scheme was introduced
24. 24. 22 1978 The slogan “Health for All by 2000 AD came in force at Alma Atta
declaration in USSR underlined the primary health care approach.23 1982 GOI
framed National Health Policy. School Health Services started at trial bases24 1985
Universal Immunization Programme was launched on 19th November Indira Gandi’s
Birthday.25 1992 CSSM programme was launched on 20th August26 1995 Pulse
Polio Immunization Programme launched in December and January.26 1996 RCH in
place of CSSM with slight modification,launched in 199727 2000 GOI announced
National Population Policy28 2002 GOI announces Nationational AIDS Prevention
controlpolicy
25. 25. 29 2003 Launching of ART centres at MetroCentres,e.g. Sasoon30 2004 NTCP
Inclucated DOTS31 2007 Revision of National Population32 2008 , revised in 2009
Swine Flu awareness Programme and control Programme
26. 26.  1. Administration. 2. Communication. 3. Nursing. 4. Teaching. 5.
Research.
27. 27.  India has unique history of community health nursing and it has changed a lot
throughout history .
28. 28.  Queries? Suggestions? Additions?
29. 29. Thanks
30. 30. Books Park K, Parks Textbook of Preventive and Social Medicine, 20th Edition,
Banarasidas Bhanot, Jabalpur, 2010, Page No.1- 11,644-648. Kamalam.S, Essentials
in Community Health Nursing Practice, First Edition, 2008,Jaypee Brothers, New
Delhi, Page No. 3- 10, 12-15. Basavanthappa.B.T, Community Health Nursing,First
Edition,Jaypee Brothers, Mumbai, 2008, Page No. 10-12. Marsije.L.M, A new
textbook for nurses in India, CMAI, B.I. Publication, Chennai,1997, Volume I, Page
No. 3- 68. Journals e Journal of Community Medicine, http://www.ijcm.org.in/
Websites and Links http://www.peopletree.co.in/infoemployer.htm.
http://en.wikipedia.org/wiki/Nursing_in_India#mw-head

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1. HISTORICALDEVELOPMENTS OFCOMMUNITY HEALTHNURSING IN THE
WORLDwww.drjayeshpatidar.blogspot.comwww.drjayeshpatidar.blogspot.in
2. 2. HISTORICAL DEVELOPMENTS OFCOMMUNITY HEALTH NURSING IN
THEWORLD:-ANCIENT PERIOD:- The history of publichealth and public health
nursing can be tracedfar back in the past. In earliest times peoplestruggled for their
survival by devising theirown methods to deal with life events such asbirths, deaths
etc.www.drjayeshpatidar.blogspot.in
3. 3. HISTORICAL DEVELOPMENTS OFCOMMUNITY HEALTH NURSING IN
THEWORLD:- people were concerned about diseases and hadsome knowledge of its
treatment. Medical cartewas given by religious leaders or priests whowere revered by
the society.Record history of ancient civilization such asBabylonian, Hebrew, greek
and roman revealsthat they possessed knowledge of personalhygiene, community
responsibility and medicine.www.drjayeshpatidar.blogspot.in
4. 4. HISTORICAL DEVELOPMENTS OFCOMMUNITY HEALTH NURSING IN
THEWORLD:- They had well developed system ofenvironmental sanitation such as
safewater supply, drainage and sewagedisposal system. They also hadunderstanding
of contagious nature ofdiseases.www.drjayeshpatidar.blogspot.in
5. 5. HISTORICAL DEVELOPMENTS OFCOMMUNITY HEALTH NURSING IN
THEWORLD:- This resulted in rigid public healthmeasures like isolation of thesick,
Thequarantine of the families and sometimes of the communities. philosophy of the
time was that theindividual should provide for the basicneeds for himself and his
familywww.drjayeshpatidar.blogspot.in
6. 6. HISTORICAL DEVELOPMENTS OFCOMMUNITY HEALTH NURSING IN
THEWORLD:- his responsibility included the provison offood,shelter and clothing
and care in caseof illness. The community responsibilitywas to protect the individual
and hisfamily against illness that might be due tocommunal
life.www.drjayeshpatidar.blogspot.in
7. 7. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
BRITAIN:- development of modern public healthand nursing took place from the
middle of19th century both in England and Americaand various other countries as a
result ofoccurance of great epidemics of bubonicplague, leprosy, small pox, cholera
etc.www.drjayeshpatidar.blogspot.in
8. 8. HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
BRITAIN:- During 18th century and early 19thcentury England faced industrial
revolutionwhich created tremendous social impactsin terms of socio-
economicimbalance, exploitation ofworkers, slums, overcrowding, poorsanitation,
broken families, childabuse, maternal and child
healthproblems.www.drjayeshpatidar.blogspot.in
9. 9. HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
BRITAIN:- During 19th century inspite of the actbeing passed and implemented to
improvethe environmental sanitation, thesediseases continued to occur time andagain
in the western world. This wasbcause of the fact that epidemiology ofthe diseases
were not fully understood.www.drjayeshpatidar.blogspot.in
10. 10. Ms.HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
BRITAIN:- Florence Nightingle has beenrecognized as one of the foremestpioneers in
the public health and publichealth nursing movements in England.She is acclaimed as
the founder of modernnursing. She began her work whennursing services which were
establishedby religious order, had withered away withthe decline of church power and
influencewww.drjayeshpatidar.blogspot.in
11. 11. SheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
BRITAIN:- began her work when nursingservices which were established byreligious
order, had withered away withthe decline of church power and influence.Florence
Nightingle created an atmosphereof dignity and self respect for
nursing.www.drjayeshpatidar.blogspot.in
12. 12. InHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- America, similar developments tookplace in the field of public health
andpublic health movement gainedmomentum in 1850, when lemuelShattuck, a
publisher and bookseller, submitted a report on sanitaryconditions of Massachusetts to
itslegislature and also published the same.www.drjayeshpatidar.blogspot.in
13. 13. InHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- his report he put forward specificrecommendations regarding a systemof
sanitary inspection, collection ofvital statistics school
healthprogramme.www.drjayeshpatidar.blogspot.in
14. 14. InHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- 1872, American health association, anational level profession
organization ofcommunity health workers wasestablished. This association
initiatesvarious public health campaigns and hasconsistently worked for
improvingstandars of community health services.www.drjayeshpatidar.blogspot.in
15. 15. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- field of public health bradend underthe influence of scientific advances
inmicrobiology, social and behavioralsciences. Thus in late 19th century and atthe
beginning of 20th century a newconcept began to take impetus that statehas the direct
responsibility for the healthof people.www.drjayeshpatidar.blogspot.in
16. 16. HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- Public health activities not only includedthe activities of improved
sanitation andcontrol of communicable diseases butaalso preventive and promotive
services tomothers,children,school children,workersand
elderly.www.drjayeshpatidar.blogspot.in
17. 17. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- need for the application of principlesof personal hygiene, care and
healthteaching was felt in all these public healthservices for controlling mortality
andmorbidity among mothers, children andworkers etc. and improve and promotetheir
health.www.drjayeshpatidar.blogspot.in
18. 18. ThisHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- phase of public health gave origin topublic health nursing. During this
period,the foundation of district nursing throughprivate, voluntary efforts was
laid.www.drjayeshpatidar.blogspot.in
19. 19. ByHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- 1890, twenty one such organizationsexisted in USA. In 1893, Lillian
wald, thepioneer in public health nursing, foundedthe hennery street settlement, which
grewin to a well organized health centre withvisiting nurse services for the
surroundingcommunity.www.drjayeshpatidar.blogspot.in
20. 20. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- rockfellers foundation of new yorkestablished in 1913, adepted public
healthas one of its field of interest. Thisfoundation assisted in establishment ofschools
of public health in united statesand other countries.www.drjayeshpatidar.blogspot.in
21. 21. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- American red cross society, thecommon wealth fund and
 keloggfoundation were the other volutary andprivate bodies which were very active
inthe development of public health andpublic health nursing
services.www.drjayeshpatidar.blogspot.in
22. 22. HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- During the early part of 20thcentury, there were specialized nurses inthe
field of public healthy like nurses inmaternal and chil;d health, veneraldiseases, other
communicablediseases, tuberculosis control etc.www.drjayeshpatidar.blogspot.in
23. 23. HISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- public health had entered a newera. Itwas faced with new emergent
healthproblems which were more serious butchronic and degenerative such
ascardiovasculardiseases, cancer, stroke, mental illnessand metasbolic
disorders.www.drjayeshpatidar.blogspot.in
24. 24. ThusHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- public health deal with wide range ofhealth problems and its activities
movedbeyond the traditional basic seven serviceswhich included communicable
diseasecontrol, environmentalsanitation, maternal and childhealth, health education,
medical andnursing care, nutrition, & vital statistics.www.drjayeshpatidar.blogspot.in
25. 25. TheHISTORY OF PUBLIC HEALTHAND PUBLIC HEALTH NURSINGIN
AMERICA:- field of public health, broadend,increasing emphasis was given on
primaryhealth care and preventive and promotiveservices, further as a result of
ALMA Atadeclaration of the “ goal of health forall’ through primary health care by
WHOand UNICEF in 1975.www.drjayeshpatidar.blogspot.in
26. 26. ANCIENTHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- PERIOD:- The development ofpublic health nursing in India startedmuch
later as compared to developedcountries of the west. But public health inIndia was in
practice much before itsdevelopment in western
countries.www.drjayeshpatidar.blogspot.in
27. 27. The IndianHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- history revealed its publichealth practice as early as 5000BC. Theperiod
can be classified as vedic periodand post vedic period. During the vedicperiod the
sacred books Upanishads andVedas- especially the atharvedadocumented all the
knowledge aboutmedicine,personal hygiene,prevention ofsickness
etc.www.drjayeshpatidar.blogspot.in
28. 28. The postHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- vedic period (500BC to 700)started with the rise ofBuddhism, Buddhism
emboied theprinciples of nonviolence, helping thesick,poor and needy people,
selfdiscipline,self education, charity towardsall men
etc.www.drjayeshpatidar.blogspot.in
29. 29. BRITISHHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- PERIOD ( 18TH century to1947):- The british had estabilished itsrule in
India in 1757 by establishing civiland military services. In 1859, theadministration of
India was taken over bythe crown from east India
company.www.drjayeshpatidar.blogspot.in
30. 30. In 1859, aHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- royal commission which cameto India to study theproblem, recommended
to establishsanitary commission of five persons eachin Bengal, Bombay and
madras.www.drjayeshpatidar.blogspot.in
31. 31. In1896,HISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- following the out break ofepidemic of plague, aplague commissionwas set
 up to investigate itsepidemiological aspects. As result ofinvestigation and
suggestion,www.drjayeshpatidar.blogspot.in
32. 32. In1912,HISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- the local government bodieswere made responcible to execute
varioushealth services according to over all plansand directions of central
government.www.drjayeshpatidar.blogspot.in
33. 33. In 1939HISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- some very importantdevelopments took place. The madraspublic health
act was passed for the firsttime in the country. The first rural healthtraining centers
was established at singurnear Calcutta with the support ofRockfeller
Foundations.www.drjayeshpatidar.blogspot.in
34. 34. In 1943,HISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- health survey and developmentcommittee existing health conditions
andhealth organization in the country and tomake recommendations about
thedevelopments in future.www.drjayeshpatidar.blogspot.in
35. 35. HISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING ININDIA:-
DEVELOPMENT SINCEINDEPENDENCE( 1947ONWARDS):-Before India
attained independence on15th august 1947, some of the provincesand princely states
of India were parted toconstitute Pakistan.www.drjayeshpatidar.blogspot.in
36. 36. ThisHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- effected change in demographic,Political and socio-economic aspects.
Atthe same time, a large number of peoplefrom Pakistan migrated to
India.www.drjayeshpatidar.blogspot.in
37. 37. TheHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- government of India at that timefaced a large number of socio-
economicand public health problems. But becauseof new constitutional policies and
theenthusiastic attitude of politicalleaders, administrators and the people ingeneral,
the government could manage toovercome initial difficulties,implementstrict public
health measures to preventepidemics.www.drjayeshpatidar.blogspot.in
38. 38. planningHISTORICAL DEVELOPMENT OFPUBLIC HEALTH NURSING
ININDIA:- commission was constituted tophelp government to plan out
integrateddevelopment plan for the entire countrywith in the available resourses for
adefined period of five years for its socoi-economic progress. The
planningcommission has been responsible for ten “five year
plans”.www.drjayeshpatidar.blogspot.in
39. 39. The professional issuesCOMMUNITY HEALTH NURSINGISSUES:-
challengingcommunity health nursing . first of allempowered community health
nursesneed to be able to address the
followingquestions.www.drjayeshpatidar.blogspot.in
40. 40. who is assessed by communityCOMMUNITY HEALTH NURSINGISSUES:-
what dohealthnurses: the individual, family, group, orcommunity ? what nursing
diagnosis docommunity health nurses assess? communityhealth nurses use ?
www.drjayeshpatidar.blogspot.in
41. 41. what types of nursingCOMMUNITY HEALTH NURSINGISSUES:-
interventions docommunity health nurses use in practice? differ with how do
interventions differdifferences in client focus ? withdifferences in client
focuswww.drjayeshpatidar.blogspot.in
42. 42. how is community healthCOMMUNITY HEALTH NURSINGISSUES:-
nursingevaluated for quality ofcare, cost, effectiveness, and outcomesassessment?
www.drjayeshpatidar.blogspot.in
43. 43. ASSESSMENT:- the previouslyCOMMUNITY HEALTH NURSINGISSUES:-
listedquestions, which challengecommunity health nurses suggestthat there may be
wide variety ofareas that are consideredappropriate and necessary forassessment in
community healthnursing.www.drjayeshpatidar.blogspot.in
44. 44. DIAGNOSIS:- with the lake ofCOMMUNITY HEALTH NURSINGISSUES:-
clarity interms of nursing assessment in communityhealth nursing, it follows that
nursingdiagnosis in community health nursing isequally
undevelopedwww.drjayeshpatidar.blogspot.in
45. 45. COMMUNITY HEALTH NURSINGISSUES:-Muecke (1984) critiques the
concept ofcommunity health diagnosis andproposes the following steps to
identification of the health risk ofidentifythe community of concern
thecommunity.www.drjayeshpatidar.blogspot.in
46. 46. specification of theCOMMUNITY HEALTH NURSINGISSUES:-
characteristics of thecommunity and its environment that specification of the
healthareetiologically associated with the risk indicators thatverify the
risk.www.drjayeshpatidar.blogspot.in
47. 47. COMMUNITY HEALTH NURSINGISSUES:-GOALS:- goeppingere (1984)
examines theprinciples issues of community helth nursingfrom the perspective of
what are the goals of community healththe following questions what are the target
system that communityhealthnursingpractice ? in what setting do community
healthnurses intend to change ? nursespracticewww.drjayeshpatidar.blogspot.in
48. 48. INTERVENTIONS:- A majorCOMMUNITY HEALTH NURSINGISSUES:-
nursingintervention issue is that of themeasurement of costs of communityhealth
nursing in the home health caresetting. Kovner categorizes alternatives into four
models. Per visit, acuity ofcare, hourly, and by
diagnosis.www.drjayeshpatidar.blogspot.in
49. 49. The setting for community healthCOMMUNITY HEALTH
NURSINGISSUES:- nursingpractice leads to a question of weathercommunity health
nursing is settingspecific. Is it community- oriented becauseit emphasizes the
collective need ? threenewer and related delopments in nursingcommunity setting
have been the nursingentrepreneurship, and parish
nursing.www.drjayeshpatidar.blogspot.in
50. 50. COMMUNITY HEALTH NURSINGISSUES:-EVALUATION:- measurement of
the outcomesof community health nursing care leads toavariety of questions what are
the consequences of organizing carearoundand issues. whatreimbursement
guidelines rather than atheory- based approach? level of focus of community health
nursingis most cost-effective: individual, families, groupor communities?
www.drjayeshpatidar.blogspot.in
51. 51. what are the effects of changesCOMMUNITY HEALTH NURSINGISSUES:-
inreferral patterns, level of illness of clientsreferred,intensity of what measures
ofservicesrequired, and quality of servicesdelivered ? patient outcomes interms of
behavioral or functionalchanges can be used to evaluate theinterventions of
community healthnurses ?www.drjayeshpatidar.blogspot.in
52. 52. what are the effects ofCOMMUNITY HEALTH NURSINGISSUES:- what
isdifferentmanagement procedures for specifictypes of clients ? the effect of
 variousmanagement structures and types ofagencies on the way home care isdelivered
?www.drjayeshpatidar.blogspot.in
53. 53. school nurses have played a significantpart inCURRENT ISSUES school health
programs. They needto be flexible, creative, and involved inrevising their role to fit
with newdirections, otherwise, the role of theschool nurse may be
jeopardized.Economic justification for services isnecessary and therefore, the value of
theschool nurse must be ascertained.www.drjayeshpatidar.blogspot.in
54. 54. National health objectives for the year2000 seek toCURRENT ISSUES increase
school- basededucation to prevent humanimmunodeficiency virus infection,
alcoholand other drug use, tobaccouse, injury, and sexually
transmitteddiseases.www.drjayeshpatidar.blogspot.in
55. 55. Health education has proven to beeffective atCURRENT ISSUES reducing risk
behaviorsassociated with the leading causes ofdeath, that is heartdiseases, cancer,
stroke, C.O.P.D. unintentional injuries, AIDS.etc.responsibility needs to be a
fundamentalcomponent of health care reform.www.drjayeshpatidar.blogspot.in
56. 56. TRENDS IN COMMUNITYHEALTH NURSINGThe major forces for
shapingnursing’ role in the health careenvironment are considered to increased
proportion of the Shifting payment system.be. increased competition amonghealth
careagedpopulation. providers.www.drjayeshpatidar.blogspot.in
57. 57. increased complexity of clientTRENDS IN COMMUNITYHEALTH
NURSING government intervention inneeds andseverity of client conditions.
costcontainment.www.drjayeshpatidar.blogspot.in
58. 58.  TRENDS IN HEALTH CARE DELIVERYTRENDS IN
COMMUNITYHEALTH NURSING LEADERSHIP AND NURSES AND
PRACTICECONSUMER TRENDS CHANGEwww.drjayeshpatidar.blogspot.in
59. 59. SCOPE OF COMMUNITY HEALTHNURSINGAreas of activities of community
those areas wherehealth fallsin to four catagories described below. the supervision
of food, wateractivities must be ona community basis and milksupply of a
community basis.www.drjayeshpatidar.blogspot.in
60. 60. those areas dealing withSCOPE OF COMMUNITY HEALTHNURSING
communicablepreventableillness, disabilities or premature death. diseases
includinginfestations, for examplediphtheria, pertusis, tetanus, TB, measles,
poliomyelitis, worm infestation etc.www.drjayeshpatidar.blogspot.in
61. 61. nutritional deficiences forSCOPE OF COMMUNITY HEALTHNURSING
example theconditions of mal-nutrition likemarasmus, kwashiorkor, substance abuse,
fornight-blindness, goiter, nutritional anaemia etc. Mentalexample drug abuseand
other substances abuse like alcohol. health and illness i.e. disorders ofemotion,
personality, behaviour etc.www.drjayeshpatidar.blogspot.in
62. 62. Occupational health includesSCOPE OF COMMUNITY HEALTHNURSING
prevention andtreatment of occupational illness & hazards. Non-communicable
diseases and conditionslike cancer, cardio- Dentalvasculardiseases, diabetes and
accidents. healthwww.drjayeshpatidar.blogspot.in
63. 63. MaternalSCOPE OF COMMUNITY HEALTHNURSING & child health
Problem of oldRehabilitation of victims of accidents andillness.
agewww.drjayeshpatidar.blogspot.in
64. 64. SCOPE OF COMMUNITY HEALTHNURSINGThose areas of health , medical
and providing facilitiesnursingwhich need organized official leadership. for
undergraduates, postgraduates and continuingeducation programmes in promoting of
 equitable distribution ofhealth man powerconcernedfields research.
www.drjayeshpatidar.blogspot.inand facilities
65. 65. HEALTH TECHNOLOGYDEFINITION:-Health technologies are evidence-
based when they meet well-definedspecifications and have beenvalidated through
controlled clinicalstudies or rest on a widely acceptedconsensus by
experts.www.drjayeshpatidar.blogspot.in
66. 66. HEALTH TECHNOLOGYHEALTH TECHNOLOGY
ASSESSMENT(HTA)Basic HTA Problem-oriented Technology-oriented
assessmentsOrientations Project-oriented
assessmentswww.drjayeshpatidar.blogspot.inassessments
67. 67. Regulatory agencies such as the Foodand DrugPURPOSES OF HTA
Administration (FDA) aboutwhether to permit the commercial use(e.g. marketing) of
a drug, device orother technologywww.drjayeshpatidar.blogspot.in
68. 68. Clinicians and patients about theappropriate use ofPURPOSES OF HTA health
careinterventions for a particular patient’sclinical needs and Health professional
associations aboutthe role of acircumstances technology in clinicalprotocols or
practice guidelineswww.drjayeshpatidar.blogspot.in
69. 69. Health care payers, providers, andemployers aboutPURPOSES OF HTA
whether technologiesshould be included in health benefitsplans or disease
managementprograms, addressing coverage (whetheror not to pay) and
reimbursement (howmuch to pay)www.drjayeshpatidar.blogspot.in
70. 70. Hospitals, health care networks, grouppurchasingPURPOSES OF HTA
organizations, and otherhealth care organizations about decisionsregarding technology
acquisition andmanagementwww.drjayeshpatidar.blogspot.in
71. 71. HEALTH TECHNOLOGYASSESSMENT PROGRAM (HTA)The primary goals
are to Health care safer by relying on scientificevidence and amake: Coverage
decisions of state agenciescommittee of practicingclinicians State purchased health
care moremoreconsistent costeffectivewww.drjayeshpatidar.blogspot.in
72. 72. Technology must improve the nethealth outcomeOHTACCRITERIA :- and/or
safety forpatients and/or providers orimprove health systems Technology must be at
least asbeneficial as anyefficiency.
establishedalternativewww.drjayeshpatidar.blogspot.in
73. 73. OHTAC1. Technology must be licensed by HealthCanada and have received
otherapplicable licensing or approvals fromappropriate governmental or
regulatorybodies (e.g. the Canadian Nuclear
SafetyCommission).www.drjayeshpatidar.blogspot.in
74. 74. How evidence (particularlyHEALTH TECHNOLOGIES ANDDECISION
MAKING: How aspectsHTA-basedevidence) is produced and used indecision
making. of health-care systemsfacilitate or impede the implementation
ofdecisions.www.drjayeshpatidar.blogspot.in
75. 75. Thank youwww.drjayeshpatidar.blogspot.in

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Transcript of "Professinalism and legal issues in Community Health Nursing

In India"

1. 1. PROFESSINALISM AND LEGAL ISSUES<br />

2. 2. "Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as
hard a preparation, as any painter’s or sculptor’s work; for what is the having to do
with dead canvas or cold marble, compared with having to do with the living body-
the temple of God’s spirit? It is one of the fine Arts; I had almost said, the finest of the
Fine Arts" <br /> Florence Nightingale (1868).<br />Introduction<br />
3. 3. “A set of activities, tasks and nurse duties carried out by the registered nurses, at
any time whenever it is required keeping the person’s health as their first priority”.<br
/>Professionalism-Meaning<br />
4. 4. Knowledge<br />Spirit of inquiry<br />Accountability<br />Autonomy<br
/>Advocacy<br />Innovation and Visionary<br />Collegiality and collaboration<br
/>Ethics and Values<br />Professionalism in Nursing- Attributes<br />
5. 5. Definition: <br /> Understanding of or information about a subject, which has been
obtained by<br /> experience or study.<br />1.Knowledge<br />
6. 6. Professionalism includes:<br />A body of theoretical, practical, and clinical
knowledge.<br />Being able to apply that knowledge.<br />Using theoretical and/or
evidence-based rationale for practice.<br />Cont……<br />
7. 7. Cont……<br />Synthesizing information from a variety of sources.<br />Using
information or evidence from nursing other disciplines to inform practice.<br
/>Sharing or communicating knowledge with colleagues, clients, family and
others.<br />
8. 8. “ Nurses can be more productive and healthy in safe, ergonomically sound work
environments, with access to the supplies, services and technology they need to
improve efficiency, and work life enhancements to reduce stress and ease the home-
work interface.”<br />Cont……<br />
9. 9. Definition:<br /> An inquisitive, inquiring approach to one’s own practice.<br />2.
Spirit of inquiry<br />
10. 10. Cont……<br />Professionalism includes:<br />Being open-minded and having
the desire to explore new knowledge.<br />Asking questions leading to the generation
of knowledge and refinement of existing knowledge.<br />Striving to define patterns
of responses from clients, stakeholders and their context.<br />Being committed to
life long learning.<br />
11. 11. Definition: <br /> Responsibility for one’s conduct or the willingness to be
answerable for one’s actions.<br />3.Accountability<br />
12. 12. Professionalism includes:<br />Understanding the meaning of self-regulation and
its implications for practice.<br />Using legislation, standards of practice and a code
of ethics to clarify and guide one’s scope of practice.<br />Cont……<br />
13. 13. Being committed to work with clients and their families to achieve desired
outcomes.<br />Being actively engaged in advancing the quality of care.<br
/>Recognizing personal capabilities, knowledge base and areas for
development.<br />Cont……<br />
14. 14. Definition:<br />Right of self-government; personal freedom.<br
/>Professionalism includes:<br />Working independently and exercising decision-
making within one’s appropriate scope of practice.<br />4. Autonomy<br />
15. 15. Recognizing relational autonomy and the effects of the context and relationships
on this autonomy.<br />Becoming aware of barriers and constraints that may interfere
with one’s autonomy and seeking ways to remedy the situation.<br />Cont……<br />
16. 16. Definition: <br /> An advocate is a person who supports or speaks out for a cause,
policy.<br />5. Advocacy<br />
17. 17. Professionalism includes:<br />Understanding the client’s perspective.<br
/>Assisting the client with their learning needs.<br />Being involved in professional
practice initiatives and activities to enhance health care.<br />Being knowledgeable
about policies that impact on the delivery of health care<br />Cont……<br />
18. 18. Definition: <br />Innovative: <br /> Bring in new methods, ideas, etc.; make
changes; introduce for the first time.<br />Visionary: <br />The act or faculty of
seeing, sight; imaginative insight; ability to plan or form policy in a far-sighted
way.<br />6. Innovation and Visionary<br />
19. 19. Professionalism includes:<br />Fostering a culture of innovation to enhance
nursing practice and client/family outcomes.<br />Showing initiative for new ideas
and being involved through taking action.<br />Influencing the future of nursing,
delivery of health care and the health care system.<br />Cont……<br />
20. 20. Definition: <br />A colleague is a fellow official or worker, especially in the same
profession or business.<br />Collaboratemeans to work jointly with, co-operate.<br
/>7. Collegiality and collaboration<br />
21. 21. Professionalism includes:<br />Developing collaborative partnerships within a
professional context.<br />Acting as a mentor to nurses, nursing students and
colleagues to enhance and support professional growth.<br />Acknowledging and
recognizing interdependence between care providers.<br />Cont……<br />
22. 22. Definition: <br /> Ethics: <br /> a system of valued behaviors and beliefs for
determining right or wrong and <br /> for making judgments about what should be
done to or for other human beings.<br />Ethics and Values<br />
23. 23. Professionalism includes:<br />Knowledgeable about ethical values, concepts and
decision-making.<br />Being able to identify ethical concerns, issues and
dilemmas.<br />Applying knowledge of nursing ethics to make decisions and to act
on decisions.<br />Cont……<br />
24. 24. Being able to collect and use information from various sources for ethical
decision-making.<br />Collaborating with colleagues to develop and maintain a
practice environment that supports nurses and respects their ethical and professional
responsibilities.<br />Engaging in critical thinking about ethical issues in clinical and
professional practice.<br />Cont……<br />
25. 25. PROFESSIONAL RESPONSIBILITIES<br />
26. 26. Membership<br />Communication<br />Changes in Nursing Practice<br
/>Diversity in the Population<br />Lack of Autonomy<br />Lack of Leadership
skills<br />Nature of the job<br />Shortage of Nurses<br />Limited Opportunities<br
/>Challenges in Nursing Professionalism <br />
27. 27. ETHICAL DILEMMAS<br />
28. 28. Autonomous Practice<br />Often in peoples home<br />Accountability to
multiple stake holders<br />Population health context<br />Ethical Challenges<br />
29. 29. Public right to know<br />Allocation of resources <br />Gifts<br
/>Surveillance<br />Maintaining therapeutic relationships <br />Maintaining
confidentiality<br />Ethics Issues in CHN Practice<br />
 30. 30. CHN Standards of Practice<br />Regulatory standards<br />Legislation <br
/>New ethical frameworks <br />CNA code of ethics<br />Ethics Guidance for
CHNs<br />
31. 31. Community Health Nursing Practice Model<br />
32. 32. Regulatory standards<br />Legislation<br />New ethical frameworks <br />CNA
code of ethics<br />Community ethics toolkit, etc.<br />Tools for Ethical Decision-
making for CHNs<br />
33. 33. Rural Health Issues<br />Self, Home, Community Care<br />Access to Acute
Care<br />Major Health Problem<br />Job Difficulties<br />Current Legal
Issues<br />
34. 34. Author : Susan Jane Fetzer<br />Title :<br /> Professionalism of Associate
Degree Nurses: The role of self actualization<br />Journal Abstract<br />
35. 35. General System Theory<br />Theory Application<br />
36. 36. CONCLUSION<br />
37. 37. THANK YOU<br />

Transcript of "Ethical and legal issues in community health nursing and"

1. 1. 1 ETHICAL AND LEGAL ISSUES IN COMMUNITY HEALTH NURSING

AND ITS IMPLICATIONS INTRODUCTION The community health nurse
experiences and many ethical conflicts are existing in health care delivery system. As
we began professional practice, it is essential to understand the law that defines the
nurse’s responsibility and duties. Especially the community health nurse must be very
careful while doing services in the community because; there is a team of people
working in the hospital. Whereas, in the community health nurses are alone and most
of the time she is in position of to implement the services at home. So, she must be
more careful and she should have enough knowledge on legal issues. The purpose of
this topic is to analyze traditional ethics and professional nursing and apply these
principles to the practice of community health nursing. DEFINITIONS ‘’ Ethics is a
system of moral principles, and rules of conduct recognized in respect to a particular
class of human actions or to a particular group of people.’’ Or Ethics is a branch of
philosophy dealing with values related to human conduct with respect to the rightness
and wrongness of certain actions and to the goodness and badness of the motives and
ends of such actions. DEFINITION OF LAW It is a standard or rules of conduct
established and enforced by the Government. These are intended to protect the public.
SOURCES OF LAW 1. THE CONSTITUTION: it is a system of fundamental laws or
principles that governs a nation or society. 2. STATUTES: laws that govern. It is
enacted by the legislative body or legislative law. Laws passed by council or
parliament. For example, nurse practice act. 3. ADMINISTRATIVE AGENCIES: the
rules and regulations established by executive branch of the government executive
officers, mayors are responsible for law enforcement. For example, INC, Board of
Nursing State/ Central level. 4. TORT LAW OR COURT DECISION: judicial and
decisional laws are made by the court to interpret legal issues. Court decisions can be
changed, but only with strong justifications. For example, patients rights / measles
vaccination.
2. 2. 2 TYPES OF LAW 1. CRIMINAL LAW: nurses found guilty of intentionally
administering fatal dozes of drug to the patients. 2. CIVIL LAW: one individual sues
another for money to compensate the loss. Incarceration-can is escaped from prison.
For example, malpractice cases can be tried in civil courts (monitory damages can be
claimed) 3. ADMINISTRATIVE LAW: an individual issued by a state board or
 council in violation of the nurse practice act. SIGNIFICANT LEGISLATIVE ACT 1.
SHEPARD TOWNER ACT 1921: grants in aid or funds to the state for
administration of programs to promote the health and welfare of mother and infants
(grants in aid for pregnant mothers). 2. SOCIAL SECURITY ACT 1935: allocation
funds on the basis of PH problem, economic need and need for training for health
personnel. 3. HOSPITAL SURVEY AND CONSTRUCTION ACT 1946: nationwide
health facilities planning to the states for hospital/ health centers construction. 4.
MCH AMENDMENTS ACT 1963: opened door for improved services to bring down
the perinatal mortality. (Implementation of MCH program.) 5.
NONCOMMUNIABLE DISEASE ACT 1965: comprehensive health planning for
program development. For example, cancer control program 6. HEALTH
MANPOWER ACT 1968: increased supply of health personnel by providing federal
money to educational institution for construction, training and special projects. 7.
OCCUPATIONAL SAFETY ACT 1970: protection to written against personal injury
or illness resulting from hazards working condition. LEGAL CONCEPTS
CRIME/TORTS: refers a wrong committed by a person against another person or
his/her property. CRIME: it is violation punishable by the state. TORT: it is a gross
negligence (e.g. Liquid, Phenol.) MISDEMEANOR: less serious crime punishable
with fines imprisonment for less than 1 year. FELONY: punishable by imprisonment
for more than 1 year. LITIGATION: it is process of bringing and trying a lawsuit.
PLAINTIFF: person or government bringing suit against another is called plaintiff.
For example, mother of terminally ill child threatening to bring charges in the
hospital. Court is the deciding authority. DEFENDANTS: one being accused a crime
in called defendant.
3. 3. 3 INTENTIONAL OR UNINTENTIONAL TORTS INTENTIONAL TORTS 1.
ASSAULT: it is a threat or an attempt to make bodily contact with another person
without that person consent. 2. BATTERY: it is an assault that is carried out with
willful angry and violent or negligent touching of another person’s body or clothes.
Examples: a. Forcibly removing patient’s clothes. b. Injection with force or weapon
refused by patient. c. Pushing a patient in floor or in the chair. 3. DEFAMATION: it
is an intentional tort makes derogatory remarks about another. a. Slander: oral
defamation of character. b. Libel: written defamation (petition.) For example, about
patient or co-workers. 4. INVASION OF PRIVACY: a. All information should be
confidential b. Interacting with family members c. Avoid unnecessary exposure d.
Checking of all gadgets or machines e. Carryout research activities f. Using tape
recorder, video or photos 5. FALSE IMPRISIONMENT: a person cannot be legally
forced to remain in health centers or hospital. (unjustified intention) 6. FRAUD:
willful and purposeful interpretation or misinterpreting the outcome of procedure of
treatment. (license may be prosecuted under the NP act). UNINTENTIONAL TORTS
1. NEGLIGENCE: an act of negligence may be enact of omission or commission. 2.
Malpractice or negligence 3. LIABILITY: it involves four elements that must be
established to prove that malpractice or negligence has occurred. 4. DUTY AND
DOCUMENTATION; execution of safety measures. 5. BREACH OF DUTY: failure
to note and report to higher authority about the seriousness. 6. CAUSATION: failure
to use appropriate safety measures. 7. DAMAGES: lengthened hospital stay and need
for rehabilitation. COMMON CAUSES OF LEGAL ISSUES Professional negligence
e. g. ignoring the seriousness. Practicing medicine without license in community.
Obtaining nursing license by fraud or allowing others to use your license Felony
conviction for any offence.
4. 4. 4 Participating in criminal abortion, e.g. quacks. Not reporting substandard
medicine or nursing care. Providing patient care while under the influence of alcohol
or drugs. Giving narcotics without an order. Falsely holding oneself as family
practitioner or nurse practitioners. PROFESSIONAL AND LEGAL REGULATION
OF NURSING PRACTICE Every state has ‘’ nurse practice act’’ that protects the
public define the legal scope. Nurse practice act- violation of rule can result in
disciplinary action. For example, medication, IPPI vials. Standards- guidelines issued
by councils-qualification, standards, rules and regulation, e.g. unrecognized courses.
Credentialing- the ways in which professional competence is ensured and maintained
Three processes can be used a. ACCREDITATION: education program is evaluated
and recognized by National Accreditation Board. b. LICENSURE: the state
determines certain requirement to practice as nurse. (e.g. negligence, malpractice,
wrong treatment and alcoholism) c. CERTIFICATION: entry level competence.
Specific knowledge and experience in specified areas needed. All the certificates
cannot be registered (e.g. nursing asst course.) CLIENTS RIGHTS AND
PROFESSIONAL RESPONSIBILITIES IN COMMUNITY HEALTH CARE
CLIENTS RIGHTS It is one of the earliest recognitions of clients rights concerning
health were made by the national convention of the 1973. Undergoing the theme of
basic human rights, the leaders of the revolution declared that there should only be
one patient to a bed in hospitals and hospital beds were to be placed at least 3 feet
apart(Annas,1978). This kind of direction by a government or legislating body in the
recognition and assertion of clients right has continued to be prominent in
consideration of thought to health and the right to health care as extensions of basic
human rights such as rights to informed consent to refuse treatment or to privacy have
apparently been aided by consumer groups and health care providers. BASIC
HUMAN RIGHTS RELATED TO HEALTH American Hospital Association was
studied and issued the results of its study, entitled ‘’ the Patient’s bill of rights.’’ The
document says that the traditional physician- patient relationship takes on a new
dimension when care is rendered within organizational structure.’’ The basic rights
includes the following:
5. 5. 5 1. Considerate and respectful care 2. Obtain complete medical information 3.
Receive information necessary for giving informed consent 4. Refine treatment 5.
Consideration of privacy 6. Confidential treatment of personal information and
medical records 7. Request services 8. Information on other institution and individuals
related to care and treatment 9. Refuse participation in research projects 10. Expect
reasonable continuity of care 11. Examination and explanation of financial changes
12. Know institutional regulations SOCIETAL OBLIGATIONS The ‘Presidents’
commission for the study of ethical problems reached several conclusions concerning
current patterns of access to health care and made significant recommendations for
changes. The commission concludes that: 1. Society has an ethical obligation to
ensure equitable access to health care for all. 2. The societal obligation is balanced by
individual obligation. 3. Equitable access to health care requires that all citizens be
able to secure an adequate level of 1. 4. When equity occurs through the operation of
private forces, there is no need for government involvement, but the ultimate
responsibility for ensuring that society obligation is met, through a combination of
public and private sector arrangements, rest with the federal government. 5. The cost
of achieving equitable access to health care ought to be shared family 6. Efforts to
certain nursing health care costs are important but should not focus on limiting the
attainment of equitable access for the least well served portion of the public.
PROFESSIONAL RESPONSIBILITIES In response to client’s rights, health care
 professionals incur particular duties or responsibilities which are supported by
professional code of ethics and are correlative to basic liberty rights of patients.
PROFESSIONAL CODE OF ETHICS Professional code of ethics is statements
encompassing rules that apply to persons in professional role there are some
professional ethics 1. Professional etiquette good manners based on loyalty. 2.
Knowing the lines of authority and responsibility. 3. Each person should be treated
with dignity. 4. When death occurs, they need empathy, support and understanding.
More practice is needed in an isolated area.
6. 6. 6 5. Should know what others are doing and be faithful in supporting each other. 6.
Coordinate with all. 7. Have partnership and cooperate with physician. 8. Good
communication based on giving and receiving. 9. The nurse relates in the community
as a worker and to improve health standards. 10. The nurse relates in the community
as a worker and to improve health standards ETHICAL PRINCIPLES IN
COMMUNITY HEALTH Relationships of ethical rules, principles and theories Rules
state that certain actions are to be performed because they are right (or wrong). An
example would be that ‘’ nurses always ought to tell the truth to the clients.’’
Principles are more abstract than rules and serve as the foundation of rules. For
example, the ethical principle of autonomy is the foundation for such rules as ‘’
always informed consent’’, tell the truth, and protect the privacy etc. theories however
are collection of principles and rules. They provide theoretical foundations for
deciding what to do when principles or rules conflict. Ethical principles simply
suggest which ethical principle will more likely to happen generally when moral
decisions have to be made. PRINCIPLE OF BENEFICIENCE It states ‘’we ought to
do good and prevent or avoid doing harm.’’ It includes the idea that beneficence is a
duty to help others gain what is of benefit to them but does not carry the obligation to
risk one’s own welfare or interiors in helping others. Application of theories in
community health The principle of beneficence can be applied for: 1. Balancing
harms and benefits to client population 2. In the use of cost benefit analysis in
decisions affecting client population COST BENEFICIAL ANALYSIS It is a specific
application of the principle of beneficence. To measure the benefits and costs of
alternative approaches to a problem or to decide how to distribute health program
funds. PRINCIPLES OF AUTONOMY: autonomy refers to freedom of action, as
chosen by an individual person who are autonomers and capable of choosing and
acting on plans they themselves have decided on. Application in community health
nursing principle of autonomy is applied in community health through considerations
with: 1. RESPECT FOR PERSONS: the client should be given a choice or even
considered in a treatment plan. The elderly have the right to determine their life and
health plans as they have the capacity to do so.
7. 7. 7 2. THE PROTECTION OF PRIVACY: since the relationship between client and
nurse is built on trust, the nurse has a responsibility to protect the privacy of clients
and their families as for as clients health is concerned. 3. THE PROVISION OF
INFORMED CONSENT: the elements are essential for adequate informed consent
information, comprehension and willingness. Informed consent is not valid without all
elements and no contract between client and nurse is ethically acceptable without
valid, informed consent. 4. FREEDOM OF CHOICE INCLUDING TREATMENT
REFUSAL: in community health nursing, respect for the client’s or guardian’s right
to refuse treatment may depend on nurse judgment of the competency of the client to
make such choices. 5. THE PROTECTION OF DIMINSHED AUTONOMY: the
person who is having diminished autonomy whether from physical or psychological
incapacities or immaturity are not considered purely to be autonomous persons. Yet
 respect for the principle of autonomy requires that practitioner recognize when
persons back the capacity to act autonomously and therefore an entity to protection in
health care delivery. PRINCIPLE OF JUSTICE It claims that equals should be treated
equally and those who are unequal should be treated differently according to their
differences. Application as theories in community health: different theories may be
may be appealed in deciding how to distribute health care resources. These theories
include: 1. ENTITLEMENT THOERY: the entitlement theory claims that everyone is
entitled to whatever they get in the natural lottery at birth and there is no
responsibility for government or its agencies to improve the lot of those less fortunate
than others. In this theory, inequalities between individuals in matters of health,
position and wealth are tolerated. Only aggression or harms against others and the
unjust acquisition of goods are prohibited. 2. UTILITARIAN THOERY: this theory
of justice claims that the best way to distribute resources among citizenry is to decide
how expenditures or the use of resources will achieve the greatest net of good and
serve the largest number of people. In this theory the needs and wants of some
individuals will not be satisfied, and they may indeed, be harmed in this process. This
would be considered unfortunate but this is distributing resources so that, the greatest
good for greatest number is achieved. 3. MAXIMIN THOERY: this theory of justice
first identifies the least advantaged number of community. For example, the
economically poor, the elderly the mentally retarded and children under one year of
age and decides they might be benefited rather than deciding or greatest not aggregate
benefit. Obviously this will create problems in case of limited resources. Thus, it is
possible that technologically advancement and the development of more sophisticated
health care goods cannot be made widely available to the public in times of limited
economic resources. The result is that interest and needs in matters of health may not
be satisfied within the system of justice. 4. EQUALITARIAN THOERY: the
equalitarian theory of justice claims that justice requires the ‘’ equality of net welfare
for individuals.’’ In this theory, the distribution of good in
8. 8. 8 community takes the needs of all citizens into equally. Thus everyone would have
to claim to an equal amount of all goods and resources, including health care. It
requires a. Establishing priorities for the distribution of basic goods and health
services in the community. b. Determining which population or individuals shall
obtain available health goods and nursing services. ETHICAL PRINCIPLES IN
DECISION MAKING 1. RESPECT: treating people as unique or equal 2.
AUTUNOMY: freedom of choice and exercise of people’s right- for careful
consideration. 3. BENEFICENCE: doing good or benefitting others (accessible to all).
4. NON-MALFEASANCE: avoiding and preventing harm to others. 5. JUSTICE:
irrespective of age, sex, caste, urban or rural- equal treatments. 6. FIDELITY:
Keeping promises should be kept confidential. If not, may lose faith and interest. 7.
VERACITY: telling the truth-actual information. NURSES RESPONSIBILITIES
Practice within scope of nurse practice acts. Observe agency policies and procedures.
Establish standards by using evidence based practice. Always prefer patient’s welfare.
Be aware of relevant law and understand limits. Practice within the area or individual
competence. Upgrade technical skills by attending continuing nursing education and
seeking certification. Following the standards of care and referral services. Ensure
patient safety. Proper action for needs and problems and appropriate treatment.
Monitor the program and proper reporting. Verify the medication errors and reactions.
LEGAL SAFEGUARDS OF CH NURSES 1. INFORMED CONSENT: granted
freedom, written or oral form (procedures, expected outcome, complication, side
effects, and alternative treatment. 2. CONTRACTS: exchange of promises between
 two parties. Agreement may be written or oral(e.g. patient and his family and health
care team) 3. COLLECTIVE BARGAINING: policies, legal procedures, up-to date
knowledge. 4. COMPETENT PRACTICE: it is most important and most legal
safeguard. Institutional policies and procedures should be adopted. 5. RESPECTING
INDIVIDUAL RIGHTS: developing rapport and working relationship with the
community. Keeping careful documentation of every activity. 6. PATIENT FAMILY
EDUCATION: discuss with family members. Tentative plans
9. 9. 9 7. EXECUTING PHYSICIAN ORDER: attempt to get order in writing/verbal
order. 8. DOCUMENTATION: actual , accurate, complete and essential. 9.
ADEQUATE STAFFING: under staffing is a problem that will reduce quality of care.
10. RISK MANAGEMENT PROGARM: identify analysis and treat the condition
avoid taking risk. 11. INCIDENT, VARIANCE, AND OCCURRENCE PROGRAM:
incident program for quality improvement for our safety. 12. SENTINEL EVENTS:
expected to play in a critical role in sentinel event( death or any other incident) 13.
BILL OF RIGHTS: quality of care, decision making, privacy and financial
information 14. GOOD SAMITARIAN LAWS: laws are designed to protect health
practitioners while giving care in emergency situations. 15. STUDENT LIABILITY:
legal responsibilities of student nurses include careful preparation by instructors.
LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS ASSOSIATED WITH
LEGAL ISSUES Serves as role model by nursing care. Updates of knowledge and
skills in field of practice. Reports substandard nursing care to higher authority.
Respectful relationship, caring and honest and reducing the possibilities of future
lawsuit. Prioritizes patient’s right and welfare of the family. Demonstrate vision risk
taking and energy in determining appropriate legal boundaries. Increases knowledge,
regarding sources of law that affects nursing practice. Minimize the risk using
appropriate equipment and products. Monitor and supervise subordinates increases
staff awareness of intentional torts to see that written protocols, policies, and
procedures to reduce liability. Provides educational and training for staff on legal
issues affecting nursing practice. APPLICATION OF ETHICS TO COMMUNITY
HEALTH NURSING PRACTICE THE PRIORITY OF ETHICAL PRINCIPLES In
community health nursing, ethical principles direct and guide nursing actions with
individuals and aggregate groups. The professional ethic, in general, places a greater
emphasis on the observance of the principles of autonomy and beneficence than the
principles of justice in most nursing actions. The ethical principle of beneficence is
given slightly less emphasis in the code for nurses. The principle of justice is not
strongly emphasized in the professional code of ethics. it is noted in passing that
nursing practice is not influenced by age, sex, race, color, personality or other
personal
10. 10. 10 attributes or individual differences in customs, beliefs, or attributes. The cod
estates that ‘’ nursing care is delivered without disease detection and prevention and
in health maintenance. ACCOUNTABILITY IN COMMUNITY HEALTH
NURSING Moral accountability in nursing practice means that nurses are answerable
for how they promote, protect, and meet the health needs of clients while respecting
individual rights to self-determination in health care. In community health nursing,
where the greater emphasis is on aggregates rather than individual clients, moral
accountability means being answerable for how the health of aggregate groups justice
are still important in community health nursing. Yet they are less important than the
principle of beneficence .in community health nursing the emphasis of the
professional ethic is slanted toward benefit to aggregates, which implies following a
rule of utility in planning, implementing, and evaluating community health nursing
 services. FUTURE DIRECTIONS Expanded role of nurse has increased the legal
accountability of the nurse practitioner who is certified to function as an independent
care giver. Thus, there is a current and future need for periodic assessment of the
moral and legal requirements of accountability in community health nursing services.
There is also the need to determine how existing programs and services will be
evaluated to determine the effectiveness of various nursing services in meeting
accountabily requirements. There is task that has yet to be accomplished by today’s
community health nursing leaders
11. 11. 11 SCOPE OF COMMUNITY HEALTH NURSING PRACTICE WHAT IS
COMMUNITY HEALTH? ‘’Community health refers to the health status of the
members of the community, to the problem affecting health and to the totality of
health care provided for the community.’’ COMMUNITY HEALTH PRACTICE
Community health practice is application of community health concepts to prevent
diseases and promote health and efficiency and prolong life of people at large through
organized community efforts. It implies making systematic assessment and diagnosis
of health status of people and their problems, planning and implementing
comprehensive health care services for the entire community with their active co-
operation and participation. In community health practice, the whole community is
the client and its objective is to provide need based comprehensive health care
services which include primary level prevention i.e. health promotion and provide
specific protection; secondary level prevention i.e. early diagnosis and treatment and
control of further spread of diseases; tertiary level prevention i.e. control of
disabilities and rehabilitation; evaluation research and training and education of health
personnel. Community health practice requires the skills of many different disciplines
e.g. Nursing, Medicine, Social Work, Nutrition, Preventive medicines, Epidemiology,
Biostatics, Demography, Engineering etc. functioning together as demographic team.
so that they are knowledgeable and skillful. They need to acquire knowledge about
community’s epidemiological aspects of health problems, health planning,
administration and delivery system that they are knowledgeable and skillful. They
need to acquire knowledge about community’s epidemiological aspects of health
problems, health planning, administration and delivery system. SCOPE OF
COMMUNITY HEALTH NURSING PRACTICE The community health nursing
practice encompasses: the goals and aim of community health services, the priority
practices/services, the focus of these priority practices and practice levels. 1. THE
GOALS AND AIM Community health nursing, which is nursing aspect of organized
community health practice, is committed to the goals and aims of community health.
The goals of community health are to promote and preserve health, to restore health
when it is impaired, minimize suffering and distress and to promote quality living.
These goals can be achieved by providing comprehensive health and nursing services
as mentioned to the entire community and by working with individual, families and
groups in the community with an aim of self care. Self care is an appropriate strategy.
It makes individual self dependent in promoting and preserving their own health,
preventing diseases and health problems, controlling their illness and health problems
and restoring their health. Self care activities include practice of wholesome personal
habits and life style, following of specific protective measures, reporting early when
sickless, undertaking treatment and precautions for spread of disease to others and for
occurrence of relapse.
12. 12. 12 2. THE PRIORITY PRACTICES The community health priority practices are
based on the concept of levels of prevention. These are as follows: PRIMARY
LEVEL OF PREVENTION: it is in the prepathogenesis phase of disease or health
 problems and includes all those measures which promote general health and
wellbeing of people and protect them from specific diseases and health problems e.g.
healthful living, environmental sanitation, wholesome diet, immunization and control
of air pollution etc. SECONDARY LEVEL OF PREVENTION: includes all those
measures which help in arresting the disease process, restore health and control
further spread of disease e.g. early diagnosis and treatment, health education,
immunization of population at risk, safe disposal and disinfection of infected
excrements, infected equipments and supplies etc. TERTIARY LEVEL OF
PREVENTION: includes all those measures which help in minimizing suffering ,
reducing or limiting the impairments and disabilities and promoting adjustment to
disabilities, medical rehabilitation, vocational, social, and psychological rehabilitation
etc. in community health practice, highest priority is given to primary level preventive
measures because these measures promote health and prevent diseases and health
problems and less emphasis is given to secondary and tertiary level prevention at the
primary level infrastructure 3. THE FOCUS AND PRACTICE LEVEL Community
health nursing which is aspect of organized community health practice is committed
to goals of community health i.e. to promote and preserve health, to restore health
when impaired, to minimize discomforts and to promote quality skills. It helps in
achieving these goals by providing comprehensive health and nursing care services to
the entire community. Thus community is the focus of community health nursing
services. Nurses in the community work with individuals, families and groups and lay
major emphasis on primary health care and less emphasis on secondary and tertiary
level of health care. The aim of such care is to make individual, family and
community self reliant in dealing with their own health problem in the long run. The
scope of community health nursing practice determines the modes of delivery of
health care services and its approaches. MODES OF DELIVERY OF HEALTH
CARE SERVICES AND NURSING INTERVENTIONS Two modes of delivery of
health services are identified by ANA, 1980. These include 1. SERVICE TO
INDIVIDUAL , FAMILIES AND GROUPS The community health nurses work with
individuals, families and groups in the community and provide direct health care
service to promote health, prevent disease and injury, to apply therapeutic measures,
to reduce or minimize discomforts and restore health and promote quality living. The
13. 13. 13 ultimate aim of such care is to develop competencies for self care. This is
attained through appropriate application of nursing interventions related to
comprehensive health care which are as follows: SUPPLEMENTAL
INTERVENTIONS: supplemental interventions are those actions which the
individuals / families are not able to do for themselves and the nurse does for them but
educate them and prepare them to do for them e.g. care of child with high fever or any
other problem. FACILITATIVE INTERVENTIONS: these are those interventions
which will help to remove barriers which interfere with to providing self care. The
barriers could be related to resources available, cultural practices and environmental
conditions e.g. helping family to procure or develop resources, creating awareness
regarding harmful cultural practices etc. DEVELOPMENTAL INTERVENTIONS:
these include education, supervision, guidance and counseling to help individuals and
families gain knowledge and develop competencies to promote and preserve their
health problems, seek medical care, give care when required and restore health.
SERVICES TO THE COMMUNITY AS A WHOLE: These modes of delivery of
health care services include services which are planned to deal with various aspects of
community that affect the health of entire community. In this, community health nurse
works with community and its subgroups, help them recognize their health problems,
 set priorities, help them utilize and develop their resources, self help groups etc. such
services ultimately affect the health of individuals, families and groups within the
community. Role of community health is not limited only to sick but has equal
responsibility to prevent the disease and to preserve and promote the health of people.
1. Home care: nursing practice is applied in meeting the health needs of communities,
families and individual s in their normal environment such as at home. 2. Nursing
homes: community health team which provides nursing care, treatment to the the sick
and health counselling given in nursing homes. 3. MCH and family planning: the
public health nurse plays a major role in the MCH and family planning services. it
comprises antenatal, postnatal and child health services. 4. School health nursing:
school health nurse provides services to promote and protect the health of school
children. she provides services like early detection of diseases, immunization, first aid
and dental health, maintenance of health records, school sanitation, health education,
follow up and referral services.
14. 14. 14 5. Health care services: the purpose of health care services is to improve the
health status of population. It aims at mortality and morbidity reduction, increase in
expectation of life, decrease in population growth rate, improvement in nutritional
status, provision in basic sanitation, health, manpower requirements and resource
development an certain other parameters such as food production, literacy rate, and
levels of poverty. 6. Industrial nursing services: the nursing services at industrial area
include periodic health checkups, care of sick, first aid, health counseling, industrial
sanitation, and safety, organization of services to women and children, rehablitaion of
the ill and disabled workers and administration. 7. Domiciliary nursing services:
community health nurse focused at domiciliary nursing services includes maternity
services health supervision and disease prevention and service for illness and
accidents. 8. Geriatric nursing services: community health nurse should take care of
old people in the community. The need of geriatric nursing care is different and they
need more care than the younger age groups. 9. Mental health nursing services: this
includes early diagnosis and treatment, rehabilitation, psychotherapy, use of modern
psychotropic drugs, and after care services. 10. Rehabilitation services: community
health nurse provides care, in rehabilitation units. Nursing is an important component
in the rehabilitation of the disabled. BIBLIOGRAPHY: 1. Guliani K.K, (2005),
‘’COMMUNITY HEALTH NURSING’’, 1st Edition, Kumar publication, Delhi. Page
no. 17, 34-37. 2. Kamalam S,(2012), ‘’ESSENSTIALS IN COMMUNITY HEALTH
PRACTICE’’, 2nd Edition, Jaypee Brothers publications, New Delhi. Page no. 615-
629 3. I Clement, (2009), “ BASIC CONCEPTS OF COMMUNITY HEALTH
NURSING”, 1st Edition, jaypee Publishers, New Delhi. Page No. 10-11.
15. 15. 15 SEMINAR ON TOPIC: SCOPE OF COMMUNITY HEALTH NURSING
AND ETHICAL AND LEGAL ISSUES IN COMMUNITY HEALTH NURSING
SUBMITTED TO: MISS AMANJOT KAUR (Lecturer) Swift College of Nursing
SUBMITTED BY: Ranjna Rani M.Sc. (N) 1ST Year DATE: 28/01/2013
16. 16. 16