APOLLO COLLEGE OF NURSING,

HYDERABAD-96

COMMUNITY HEALTH NURSING

DEPARTMENT
 UNIT I INTRODUCTION

 
• a) Community health nursing.
• b) Definition, concept and dimensions of health.
• c) Promotion of health.
• d) Maintenance of health.
 UNIT - 1
COMMUNITY HEALTH NURSING

INTRODUCTION

• Community living is an essential feature of human life because

human beings can live in company of other people, help each
other and fulfill their physical, social, emotional and spiritual
needs.

• The community may vary from a small and simple village set
up of 50 to 100 families to a very big and complex
metropolitan city like Delhi.
 Cont…
• Whatever may be the size and complexity of
community, it influences the health and well being of
its people.

• Many prevailing diseases are existing due to

environmental conditions , cultural practices,
biological aspects of human beings and resources
which are available in the community
 Cont…
• Diseases are Cholera, Typhoid, Tuberculosis ,
Polio, Tetanus , sexually transmitted diseases
which are communicable; cancer , cardio
vascular and blood disorders, nutritional
deficiency diseases etc.
• Which are non-communicable and many
psycho-social diseases/ problem such as
alcoholism and drug abuse , child abuse/
women abuse , poverty and fertility etc.
• People in the community may be
suffering from these diseases and
problems , but all are exposed to the risk
of these diseases and problems.
• These problems can not be dealt with by
affected individuals alone because these
are community related problems .
• Some of the examples of such diseases are
• Cholera,
• Typhoid,
• Tuberculosis,
• Polio,
• Tetanus,
• Sexually transmitted diseases.
 Non communicable
• Cancer,
• Cardiovascular and Blood disorders,
• Nutritional deficiency diseases etc. which are
non communicable and many
• Psycho-social diseases/problems such as
Alcoholism
• Drug abuse, Child abuse/Women abuse,
• Poverty and Fertility etc.
• Although only some people in the community
may be suffering from these diseases and
problems, but all are exposed to risk of these
diseases and problems.
• These problems can not be dealt with by
affected individuals alone because these are
community related problems.
 CONT…
• It is the joint responsibility of the
• entire community,
• affected families and
• local organized bodies to combat these
problems by organizing comprehensive health
care services, which shall include health
promotion, specific protection, early diagnosis,
treatment and rehabilitation for the entire
community.
 CONT…
• Health of the people is thus a community
function and community is the focus of
all health care services.
• It is therefore desirable of all health
personnel to understand the conceptual
aspects of community Health.
 Definition of Community Health
Nursing (ANA,2000 ）
• Community health nursing is a synthesis of nursing and
public health practice applied to promoting and
preserving the health of populations.

• Treat “ Population as a Whole”

• Focus on individual, family, groups, community

• Utilizing Health promotion, health maintenance, health

education, and management, coordination, and continuity
of care for meeting population needs.
 Characteristics of Community Health
Nursing
• It is a field of nursing
• It combines public health and nursing
• It focus in population and environment factors
that may impact to people’s health
• It emphasize in health promotion, illness
prevention, and wellness
 Characteristics of Community Health
Nursing

 It promotes client responsibility and self-care

 It uses aggregate measurement and

analysis
 It use principle of organizational theory
 It involves inter-professional collaboration.
 Philosophy of Community Health
Philosophy of Community Health pertains to underlying
ideas and beliefs which governs its practices. These
are
1) Philosophy of individual's right of being healthy.
2) Philosophy of working together under a competent
leader for the common good.
3) Philosophy that people in the community have
potential for continued development and are
capable of dealing with their own problems if
educated and helped.
4) Philosophy of socialism.
 HISTORY AND DEVELOPMENT IN INDIA :

• The preparation of nursing personnel for public health

work was started in this country in 1918, when the
“lady reading health school ” was established in Delhi.
• Later such schools were established in other parts of
the country to train lady health visitors.
•
 CONT…
• The Lady Reading Health School now conducts a
variety of training courses , including diploma course in
public health nursing .

• At the dawn of Independence,the Bhore committee

(1946) recommened the replacement of partially
trained workers such as lady health visitors by ‘Public
Health Nurses’ in order to promote health work on
more efficient lines.
• In 1946 , the college of nursing (later renamed as Raj
kumari Amritkaur College Of Nursing ) was established to
serve as a model in nursing education. In 1952 , the first
10-months course in Public Health Nursing for trained
nurses was started at the ‘ All India Institute of Hygiene
and Public Health ‘, Calcutta .
• Many other states followed suit offering 10-months
course in public health for trained nurses. More advanced
courses ( M .Sc and Doctorate ) are now available in
Public Health Nursing .
• In 1956, the Indian Nursing Council
recommended that the lady health visitor’s
training should be discontinued and that all
nursing schools should integrate Public Health
Nursing content into their basic curriculum ,
so that trained nurses will be able to work as
Community Health Nurses in the community
or as Staff Nurses in Hospitals.
 Concepts of health

• Health is a fundamental human right and a

world wide social goal.

• It means it is essential to the satisfaction of

basic human need as and to an improved
quality of life.
 CONT…

• An understanding of health is the basis of all

health care.
• Health is not perceived by the same way by all
members of a community including various
professional groups.
 Definitions and meaning

• Most of the people find difficulty to define

although they are confident of its meaning.
Some of the following definition of health are
• " The condition of living sound in body , mind
or spirit especially freedom from physical
disease or pain
 CONT…

 A condition of quality of the human

organism expressing the adequate functioning
of the organism is given conditions genetic
and environment."
 Definition of health

• "The widely accepted definition of health.'

• The state of complete physical, mental, and

social well-being and not merely' the absence
of disease or infirmity.
 PHILOSOPY OF HEALTH CHANGING
CONCEPTS:

• The several organs of the body are functioning

adequately in themselves and relation to one
another which implies a kind of equilibrium or
homeostasis :-
• Health is fundamental human right
• It is a world wide social goal.
 CONT…
• Health is central to the concept of quality of
life.
• It is an integral part of socio- economic
development.
• A condition relatively stable but which may vary
as human being adapt to internal and external
stimuli.
 Cont…
• In a world of continuous change, new
concepts are bound to emerge based on new
patterns.
• 1) Bio-Medical concept:
• Health has been viewed as a free from
diseases, then the person was considered
healthy
• This concept known as the biomedical concept
has the basis in the Germ theory of Disease.
 Cont…
• In biomedical model for all its spectacular
success in treating disease was found
inadequate to solve some of the major health
problems of mankind.
• E.g: Malnutrition, chronic diseases, accidents,
drug abuse, mental illness, environmental
pollution, population explosion.
 ECOLOGICAL CONCEPT OF HEALTH

• Ecologically health is not static. It is a state of

dynamic equilibrium between man and his
environmental forces including specific agents.
• The state of equilibrium will depend upon the
nature of interaction between host, agent and
environment.
 Cont…
• If this equilibrium is lost due to any factor in
agent, in individual( host) or his environment,
the individual is no more healthy.
• Ecological concept of health thus implies that
health fluctuates depends upon the state of
equilibrium among agent, host and
environment.
 Cont…
• Due to disequilibrium the individual gets sick,
tries to maintain balance and recover from
sickness and becomes well again.
• Thus health implies the relative absence of
pain & discomfort and a continuous
adaptation and adjustment of the
environment to ensure optimal functioning.
 Cont…

• Thus health implies the relative absence of

pain & discomfort and a continuous
adaptation and adjustment of the
environment to ensure optimal functioning.
 Psychological concepts

• Health is not only a biomedical phenomenon

but one which is influenced by social,
psychological, cultural, economic and political
factors of the people
 Holistic Concept Of Health
• Optimal health implies wellness in all
dimensions of human being.
• The individual is one whole comprised of
body, mind, soul and social entity which are
blended together and not in isolated
compartments.
• He/she performs various functions related to
physical, mental, social and spiritual aspects.
 Cont…
• But he/she functions as a whole in relation to
himself/herself and his/her environment and
attains a certain level of health and well being
which promotes quality life ie. Effective and
useful living.
• This concept of health refers to holistic health.
 CONTINUM OF HEALTH
• Health not only fluctuates depending upon the
health equilibrium but also there are variations in
the degree or levels of health. It ranges from
optimal health to total disability or death.
• This range of health refers to continuum of
health.
• There is a centre point which demarcates
between health and disease sides of continuum.
 Cont…
• There are different levels or degrees of health
like there are degrees or severity of disease.
• The health side of the continuum is known as
health grid and disease side of the continuum
is known as disease grid.
 Cont…
• Primary level preventive measures which include
health promotion and specific protective
measures are implemented to move towards
optimal health.
• Secondary and tertiary level preventive measures
which include early diagnosis and treatment,
prevention of disabilities and rehabilitation
measures are implemented to recover from
disease and move towards optimal health.
• The continuum of health also reflects time
dimension from beginning of life to death.
• As we move through various stages of life our
health status fluctuates from optimal health
to state of various levels of health and
degrees of deviations at each stage of life, and
finally to death.
 RELATIVE CONCEPT OF HEALTH
• Concepts revealed in so far indicate that health is
relative and not absolute.
• It is related to ones environment, life style,
physiological changes that take place in various
stages of life span and resources etc.
• The individual interacts with these factors and
tries to adjust and modify.
• At any given point in time, one can locate any
one on the continuum according to his/her level
of health and that is not a fixed point for that
person.
• At any given point in time, one can locate any
one on the continuum according to his/her level
of health and that is not a fixed point for that
person.
• He/she may either improve or deteriorate and
accordingly he or she will shift on the continuum.
• The tendency is towards improving and
promoting health by taking appropriate
preventive measures.
 Dimensions of health
• Health is a multi-dimensions for example the
physical, mental, social, spiritual, economical,
vocational, and political. As knowledge grows
the dimensions are expanding and interact
with one another. Each has its own nature and
per descriptive purpose will be treated
separately.
 Cont…
• Other known medical dimensions are
philosophical, cultural, socio-economical,
environmental, educational, nutritional,
curative and preventive dimensions which are
influencing the health
 DIMENSIONS OF HEALTH

PREVENTIVE
CURATIVE
PHILOSOPHICAL

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CULTURAL

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PHYSICAL OTHERS

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EDUCATIONAL
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NUTRITIONAL
ENVIRONMENTAL
SOCIO- ECONOMICAL
 Physical dimension
• It is easy to understand because the state of
physical health implies the nation of perfect
functioning of the body.
• The signs of physical health is an individual are
• A of good complexion
• Clean skin
• Bright eyes
• Not too fat
• A sweet breath
• A good appetite
 Cont…
• Sound sleep,
• Regular activity of bowel and bladder
movements,
• Smooth easy co-ordinated body movements,
• Normal growth and developmental in the
young and growing individual
 Mental dimensions
• Good mental health is the ability to respond
to the many varied experience of life with
flexibility and a sense of purpose.
• “The mental health is defined as a state of
balance between the individual and
surrounding world ,a state of harmony
between the relatives of the self and that
other people and that of environment”. The
mental health is essential component of
health. The scientific foundation of mental
health are not yet clear.
 Psychological have mentioned the
following characteristics ;
• A mentally healthy person is free from
internal conflict.
• He is well adjusted. He is able to get along
well with others, the accept criticism and is
not easily get upset.
• He reaches for identity.
• .
• He has a strong sense of self esteem.
• He knows himself, his needs, his problems and
goals.
• He has good self control, balance, nationality.
• He faces problems and tries to solve the
problems intelligently.
 Social dimension
• Social well being implies has money and
integration within the individual between the
individual and other members of the society
and between individual and the world in
which they live.
 Spiritual dimension
It refers to that part of individual which reaches
out and strives of meaning and purpose in life.
• It includes integrity, principles morals and
ethics, the purpose in life, commitment to
some higher being and belief in concepts that
are not subject to “ state of art explanation.
 Emotional dimension:

• Historically the mental and emotional

dimension have been seen as one element.
These two influence the human health
 Vocational dimension:
• It is one of the major dimension, works often
plays a role in promoting both physical and
mental health. The importance of this
dimension is explored when individuals
suddenly loss their job or faces mandatory
retirement for many individuals. The
vocational dimension may be a source of
income.
 PROMOTION AND MAINTENANCE OF
HEALTH
• Promotion of health is core of nursing. At the
beginning of the 20th century, a macro
concept , “health promotion ” began to take
shape. It was realized that public health had
neglected and the citizen as an individual.
Later on one more goal was added to public
health that is health promotion and
maintenance of individuals.
• It was initiated as Personal Health Services
such as mother and child health , school
health , industrial health , mental health and
rehabilitation ,services.
• Since the government assumed direct
responsibilities for the health of the
individuals , two great movements were
proposed.
• Provision of “ basic health services ” through
primary health centres and sub centres for
rural and urban areas.
• 1946 Bhore committee in India had also
recommended the establishment of health
centres for providing integrated curative and
preventive services.
• The second greatest movement was the
whole community must take imitation for the
community development programme,
however the establishment of P.H.Cs and sub
centres are much helpful mainly in rural
areas.
• Promotion of health is one of the important
aspect of primary prevention. It is a holistic
approach designed to protect against specific
disease “agents” and hazards in the
environment.
• It utilizes the knowledge of early onset of
disease, agent, host and environment.
• Primary prevention may be accomplished by
measures designed to promote general
health, well being , and quality life of people.
• Promotion and maintenance of health is
mainly to concern an individual’s attitude
towards and they take initiative about
positive, responsible measures for their family
and community and health life.
 Cont…
Promotion of health is “ the process of enabling
people to increase control over and to improve
health ”. It is intended to strengthen the host
through various approaches like :
1.Adequate nutrition .
2.Sanitary environment.
3.Life style and behavioral changes.
4.Self care .
5.Health education.
6.Utilisation health services.
7.Public information.
8.Legislative and restrictive measures.
9.National and International co-ordination.
10.Others.
Aim: Elimination of risk factors eg :
Hppertension,Obesity by following approaches.
1.Adequate Nutrition : It is the nutritious food
distribution to poor and needy people.
Conducting child feeding and education
programmes because dietary changes are
paramount for individuals. Maintenance of
normal body weight, through healthy nutritional
habits and exercise.
Eg: Avoidance of more sweets.
 2.Sanitary Environment
• It is necessary to promote and maintain
health.
• The history has shown that many infectious
diseases have to be controlled through
environmental modifications.
• A comprehensive approach to health
promotion and maintenance is required to
environmental changes.
3.Life style and Behavioural changes :
• Promotion of health comprises a broad spectrum
of activities. Identify the target group and to
educate them. To facilitate environmental and
behavioral adaptations to promote and protect
health.
• Personal hygiene deals with practices that help in
the maintenance and Promotion of individual ,
physically, mentally, socially and spiritually.
• It maintain a good physical health muscle
strength. Eg : Exercises.
• Maintain clean mouth , keep the eyes , ear , nose
in a healthy condition and free from infection.
• Maintain healthy skin.
• Preserve energy and maintenance of resistance
to prevent infection.
• Posture should be erect. Good posture helps the
body system to function with the least
expenditure of energy, thus reducing fatigue.
• Good posture aided by a well adjusted emotional
life.
• Good general health free from physical defects.
• Maintenance of good relationship to each other.
• Rest : with rest one recovers rapidly back to
normal.
• Relaxation : is necessary to relieve fatigue.
4.Self Care : It is an important element in
community based health programme in
patient participation.
5.Health Education : The public require
preventive advice on all risk factors and
related health bahaviour. Many number of
diseases could be prevented with adequate
early information because it is essential to the
fullest attainment of health.
6.Utilisation Of Health Services : All M.C.H . and
school, other health services should be
utilised .
7.Public Information : To create public
awareness about this hazards through mass
media.
8.Legislation And Restrictive Measures :
legislation and restrictive measures , have
been suggested in the following areas.
Health warnings through advertisements.
Restriction on smoking in public areas , and no-
smoking
9.National And International Co-Ordination: It
is required because mainly of political, non
political influences at local , national and
international levels.
10.Others :
Marriage counseling.
Sex education
Periodic health screening.
Genetic counseling.