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COMMUNITY HEALTH NURSING I

UNIT I : INTRODUCTION TO COMMUNITY HEALTH NURSING

MUHAMMAD SULIMANPost RN BSc.N

ROYAL COLLEGE OF NURSING SWAT

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INTRODUCTIONHuman beings are social creatures. All of us, with rare

exception, live out our lives in the company of other people.

An Eskimo lives in a small, tightly knit community of close relatives; a rural Mexican may live in a small village with hardly more than 200 members. In contrast, someone from New York City might be a member of many overlapping communities, such as professional societies, a political party, a religious group, a cultural society, a neighbourhood, and the city itself. Even those who try to escape community membership always begin their lives in some type of group, and usually they continue to depend on groups for material and emotional support. Communities are an essential and permanent feature of the human experience.

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OBJECTIVES:In the end of this presentation the students will be able to: Define community, community health, community

health nursing, urban & rural communities Discuss the concepts of health, wellness, illness and

disease. Discuss the historical background of Community Health

Nursing from Public Health Nursing. Enlist the essential functions of community health

nursing. Discuss the roles of the Community Health Nurse in

community settings.

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COMMUNITYa group of people living in the same place or

having a particular characteristic in common.

community refers to a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging.

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Cont…It can be a society of people holding common rights and

privileges (e.g., citizens of a town), sharing common interests (e.g., a community of farmers), or living under the same laws and regulations (e.g., a prison community). The function of any community includes its members’ collective sense of belonging and their shared identity, values, norms, communication, and common interests and concerns (Anderson & McFarlane, 2004).

Although most communities of people share many aspects of their experience, it is useful to identify three types of communities that have relevance to community health practice: geographic, common interest, and health problem or solution.

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COMMIUNITY HEALTH

Community Health is a discipline concerned with the study and improvement of the health characteristics of different communities. Community health tends to focus on geographical areas, and includes primary, secondary and tertiary healthcare.

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PUBLIC HEALTH

Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.

Public Health includes community health. Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.

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Cont…It is concerned with threats to health based on

population health analysis. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services, environmental health, community health, behavioural health, health economics, public policy, insurance medicine and occupational health (respectively occupational medicine) are other important subfields.

A CH service might be responsible for delivery of a range of interventions in a local community, while the PH Service might be involved at a policy level looking at quality of water, traffic calming, or budgets for drugs.

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COMMUNITY HEALTH NURSINGCommunity health nursing is to “assist the

Individual, family and community in attaining their highest level of holistic health. To provide and promote healthy life style choices through education, public awareness and community activities.”

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URBAN & RURAL COMMUNITIES

Rural community is a society that is in a rural area ( country side ). An urban community is a society that is in an urban area ( town or city )

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URBAN COMMUNITYAn Urban Community is a big city or town. It is

considered an Urban Community if there are more than 2,500 people living in the community. Urban communities are often busy and crowded. Normally, the city is the most central location in a region. It is also referred to as downtown. In an Urban Community there are many buildings, houses, and people. People often live close together.

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RURAL COMMUNITYan area outside of cities and towns;According to the US Census Bureau, a rural community is

one that does not qualify as an urban community. Specifically, if a territory has more than 2,500 people per square mile, it is defined as urban. Areas with less than 2,500 would then be considered rural.

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HEALTH“a state of complete physical, mental, and social

well-being and not merely the absence of disease or infirmity”

“World Health Organization”

ILLNESS:

A highly personal state in which the person feels unhealthy, may or may not related to disease.

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WELLNESS

An integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable.

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an active process by which an individual progresses towards maximum potential possible, regardless of current state of health

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Historical Development of Community Health Nursing

The modern concept of community health and welfare is one which has taken many centuries to evolve. All ancient civilization particularly Egypt, India and China developed their own specific team of medicine.

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Historical Development of Community Health Nursing

• Egypt appeared to have been the first and the best in the field that had a fully developed medical system by 3000BC.

• China appeared around 450 BC.

• Indian system of medicine around 200BC

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In modern period changes in development of medicine and public health under different stages.

• Empirical health era (1800-1850)

• Basic science era (1850-1900)• Clinical science era (1900-

1950)• Public health science era (1950-1975)• Political science era (1975-

2000)

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Public Health Science Era (1950-1975)

In this period preventive oriented approach

started. Now it is being called an era of the

community centered approach.

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Political Health Science Era (1975-2000)

In this period the involvement of the community leaders and the members of the health program was practiced stage by stage.

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Early Home Care Stage (before mid 1800s)

1. Focus: Sick poor2. Nursing orientation: individuals3. Service: curative4. Agencies: Lay & religious orders

(St. Phoebe)

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District Nursing (mid 1800-1900s)

1. Focus: Sick poor2. Nursing orientation: Individuals3. Service: Curative/preventative4. Agencies: Voluntary & some government

(Willium Rathbone)

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Public Health Nursing (1900-1970)

i. Focus: needy public

ii. Nursing orientation: families

iii. Service: Curative/preventative.

Iv. Agencies: Voluntary & some voluntary

(Lilliam Wald)

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Community Health Nursing (1970 to present)

i. Focus: total community

ii. Nursing orientation: population

iii. Service: health promotion, illness prevention

iv. Agencies: many kinds, some independent practice

(Ruth Freedman)

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Development of public health in indo-Pakistan

1802- Vaccination started

1827- Vaccinators appointed

1875- Superintendent- general of vaccination Punjab

1880- Small pox vaccination Vs small pox inoculation

(injection)

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Development of public health in indo-Pakistan

1859- Royal commission focus curative care

but formation of local bodies 1888 looks after senators

1896- Plague

1904- Plague commission-strengthen PH services

1919- Reforms (improvement) government of India health

transferred to provinces

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Development of public health in indo-Pakistan

1946- Bhore committee-health survey

→ Health as basic human right

→ Preventive importance

→ Health care accessible

→ Community participation

→ Development of primary and secondary unit

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Development of public health in Pakistan

Starting with Bhore report- poor condition1947-1951 -start with five years plans, opening

of medical and nursing school, laboratory of medications.

1958 -revolutionary (new) government of Pakistan focused as preventive health was linked with Socio-economical care.- Many vertical programs existed.

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Development of public health Pakistan

1978- HFA-2000 basic health science, PHC, RHC,- Increase horizontal program-School health, training, and other

activities took birth, health care workers

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Communities:Essential Functions

• Production, distribution or consumption of items• Socialization• Transmission of culture• Provision of norms/social controls• Provision of mutual respect

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Communities:Four Critical Attributes

• Group orientation• Bond among individuals• Human interaction• Collective action

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Role of community Health nurses

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General roles Cont…

• Clinician/Care provider (Functional role)

In community health practice, providing nursing care

is different than in hospitals. This is because the target

of service expands beyond the individual to include

families, groups, and communities.

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• Functional role:• Case finding and referral of needed cases.• Complete history taken about each individual.• Assist in any examination done.• Know the first aid measures to implement it in

emergency.• Know the health services available in the

community and use the system of referral when needed.

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Cont..Community health nurse provides care in

following forms:

• Provide Geriatric care

• Provide antenatal and post natal care

• Provide Neonatal care

• Conduct the deliveries in the communities

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General role Cont…• Provide formal exercises to the bed ridden

individuals having paralysis• Provides the first aid• Provide nursing procedures like cold sponging

if fever is observed in any member of family in community

• Wound dressing• Treats minor illnesses

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• Educator:

Health teaching is part of good nursing care and

one of the major functions of the community

health nurse, mainly concerned with health

promotion.

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Educator role Cont…

• As educator, community health nurse focus on

the following teaching:

• Educates individuals, family and community for

the principles and techniques of proper

prevention of communicable diseases

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Health educator Cont…• She teaches about the proper diet in quantity and

quality• Teaches the personal, family and community

hygiene• Teaches the handling of first aid techniques for

emergencies like snake bite• Trains the traditional birth Attendants for normal

delivery and delivery in communities.

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Manager role Cont…

• Organizes and manages various programs of health and assume leadership of nursing team for supervision of nursing and other staff.

To manage resources for health programs and implement them effectively in the community.

FINANCINGSTAFFING

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Role conti….• Leader• Community health work in the community Guide them towards better health as leader.• Researcher

The researcher's role is an integral part of the community health nursing practice.The researcher's role at all levels helps to determine needs, evaluate effectiveness of care and develop theoretical basis for community health nursing.

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• Role in research and evaluation:

• Help in evaluating the health program.• Must have knowledge about how to keep

records related to the people who utilize the clinic.

• She must complete the questionnaire for purpose of accurate study.

• Analysis and evaluation of nursing practices to fulfill the statistical survey.

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THE ROLE OF THE COMMUNITY HEALTH NURSE IN THE CLINIC:

• Administrative role:

• Participate in the organization of health program in the institution.

• Delegation of work.• Plan of work hours.• Cooperation with other health members.• Systematic gathering of information for

evaluation.

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• Supervisory role:

• Understanding the policy of her agent.• Supervise the function of her staff.• Give in-service education program to the other

health team.• Guides group discussion with staff.• Guides her staff to overcome their difficulties

in work.

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• Advocate:

To speak in the community. She participates the

district Govt meeting and talks to

administration for the favor of talks for solution

of health care, social and financial problems

available in her constituency.

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APPLYING THE ROLE OF COMMUNITY HEALTH NURSE ACCORDING TO NURSING PROCESS (role in home

visit)

1. Assessment:

• Identifying the needs of the family before making the visit. By analyzing data available in the family records, know all family members; whether there are any children, if so, what are their ages; what the health problems of this family are; the environment of the house. Then actual visit.

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2. Planning:• Planning can be short term or long term, and

interventions can be implemented immediately over a long period of time.

• Short term plans are those which can be met in a few weeks time whereas long term plans are accomplished over many weeks or perhaps months or years.

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• In planning, the following are done:

– Setting the goal / objectives for the visit.

– Identifying the needs and health problems of the family.

– Specifying the actions to be carried out by the nurse

during the home visit e.g. health teaching about nutrition,

– Select proper place and time for carrying the visit.

– Prepare necessary equipment, instruments and material

which the nurse will need during the home visit i.e.

cotton, eye drops, etc.

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3. Implementation:

During the home visit, the nurse should:

Identify the traditions & customs and healthful practices of the

family.

Use effective therapeutic communication.

Use audiovisual materials in teaching, also available home

utensils and materials.

Emphasize to the family that this visit was made for them.

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Cont…. Tie the family with the center. Explain services

offered. Answer questions rose from family members

clearly. Do not record any word said by family

members in front of them.

4. Evaluation:• Evaluate whether the objectives were fulfilled

or not. If not, should know the reasons and correct it.

References

Sarah Coulter Danner.community helth.4th Ed.

Department of Nursing Oglala Lakota CollegeJapee tapa.Community health nursing.3rd Ed.1998

New Dehli,india.

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QUESTIONS??

THANK YOU