Unit2 chn

 Community health nursing implies to the knowledge of the principles of
general nursing, social and public health.
 Comprehensive nursing which meet the health and nursing needs of the
community.
 It is concerned with the care of healthy families and non-hospitalized sick
individuals
 It also deals with nursing aspects of community health in homes, schools,
industries and health centers.
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 American Nurses Association (2000)
Community health nursing is, "a synthesis of nursing and public health
practice applied to promoting and preserving the health of population, '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".
BCCN

The philosophy implies three components, i.e. concern with knowledge,
values and beliefs about existence. Community health nursing supports all
three components as :
 Community health nursing is based on scientific knowledge and logical
thinking.
 Community health nursing is governed by code of ethics (values).
 Community health nursing is committed to its own beliefs about
professional practice (existence)
BCCN

 CHN believes that health is a fundamental human right and every member
of the community has an equal right to get health care in equal quantity,
irrespective of color, caste ,social status, area and religion.
 CHN believes that prevention from disease and promotion of health is the
road to achieve optimum level of health
 CHN supports the entire community as well as individual in health and
during sickness.
 CHN believes that advancement in science and community health has a
major role in promotion of health and prolonging life
 CHN believes in honoring the social and cultural differences and values of
individuals and community about health and supports the health promoting
behavior in an acceptable manner.
BCCN

 CHN believes and supports that community-based efforts and involvement
of community is essential in prevention of disease, promotion of health and
prolonging life.
 CHN believes and practices that health education is an important
component to achieve health of the population .
 Community health nursing believes that multidisciplinary team activities
and programs are essential to achieve the objectives of community health
 CHN believes that health care should be provided in such a way so as to
develop overall growth and well being felt and observed by the community.
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 to achieve the highest standard of health of the population, helping the
individuals, families and community
 to participate in activities in prevention of diseases and promotion of health
OBJECTIVES
 To reduce the morbidity and mortality rate of infants and mothers
 To control and prevent communicable diseases
 To provide promotive, preventive, curative and rehabilitative services to the
community
 To provide referral services at all levels of health care
 To increase the life expectancy
BCCN

 To find the cause and effect relationship
 To evaluate the health programs and make future plan
 To assess the needs and priorities of vulnerable groups, pregnant mother and
children and take appropriate action help other organization working in the
field of community
 To enhance the standard of nursing profession through conducting nursing
research, providing quality assurance in community health nursing and
performing the role of nurse epidemiologist
 To provide complete well-being of the community and maintain their
optimum level of functioning.
BCCN

The following principles should be observed while working in the
community:
 Health services should be based on the needs of individual and
community. It must be planned for the solutions of health problems.
Community health nurse should have good working knowledge in the
community so that she can immediately solve health problems of the
people effectively.
 Health services should be planned according to the budget, resources
and availability of health workers. They should be practical as well .
 There should be uniform distribution and availability of health services
without any discrimination of age, sex, caste, religion, social,
economical or political level.
 Family should be considered as a unit of providing health services to its
members and their active participation should be acquired.
 There should be continuity of health services without any interruption
and taking care of follow-up treatment is necessary.
BCCN

 Health education is an integral part of community health nursing. It should
be according to the need of the families, preplanned and scientifically true
and effective.
 Community health nurse should be nonpolitical in her relationship with
people. She should understand and respect the values, customs, culture and
religious beliefs of people and encourage them to practice the best that is in
their philosophy.
 Supervision and guidance of health workers is essential for the effective
health services to achieve best results.
 Maintenance of records and reports is very important in community health
nursing. Demographical programs and services are planned and evaluated
on the basis of records or reports.
 Community health nurse should feel responsible toward the goals and
philosophy of the health institution she belongs to and should have job
satisfaction.
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 Effective team spirit is must in the team working in community. There
should be coordination and cooperation among the member of the
community health team. There should be mutual respect and sincerity
irrespective of the designation and seniority to achieve the goal of
community health. Community health nurse should be aware of the role of
every member of the team.
 Community health authority should provide an opportunity for in-service
education program and continuing education to all the members of
community health team periodically to keep themselves updated.
 Community health nurse should be alert and devoted to her duties and
should be responsible for professional growth.
 Community health nurse should follow professional ethics and standards in
her work and behavior and should not accept any gift or money in lieu of
services.
 Evaluation of services is an important factor in community health nursing.
Review of community health nursing plans should be based on these
evaluations to determine further plans and goals.
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 The main emphasis of CHN is on prevention. There are 3 levels of
prevention-Primary. Secondary and Tertiary
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 She should be polite, sympathetic and hard working.
 She should be intelligent, good observer and quick in understanding
patient's physical, mental , social and behavioral problems.
 She should be sensitive to the health problems and health needs of the
community.
 She should have sound professional knowledge. Her qualification according
to the new concept should be diploma in General Nursing and Midwifery
and Post Basic Diploma in Public Health or university course in nursing i.e.,
BSc Nursing or Post Basic B Sc nursing.
 She should be kind and have patience to listen to clients problems
 She should have sound communication skills, good speaker, interviewer,
conversationalist and good teacher.
 She should have good interpersonal relationships with the community and
with the members of community health team.
BCCN

 She should be able to coordinate the services of other sectors working in the
field of health.
 She should be capable of assessing the health level of individuals, families
and community.
 She should have the ability to recognize the signs and symptoms of the
disease.
 She should be able to take right and immediate decision according to the
situation.
 She should be able to lead the health team.
 She should respect community's culture, customs and religious beliefs and
should inspire the community to practice healthy culture . She should have
knowledge of available resources and health problems of the community.
 She should have understanding of human behavior.
 She should have managerial skill and abilities.
BCCN

BCCN
Functions
Other
Function
Planning
Nursing
Function Administrative
Educational
Supervision
Coordination
&
Cooperation
Evaluation

 "Nursing process is a problem-solving approach and a tool involving the science and
art for the provision of quality nursing care to the individual, family and
community".
 It can be applied at every level of care. The word process is not only limited to the
nursing but also applied in various fields to achieve the desired results.
TYPES
1. Individualized nursing process:
 to solve the individual patients problems and most commonly used in hospital care
setting.
2. Family health nursing process:
 to solve the health problems of the family and is the basic component of family
health nursing.
3. Community health nursing process:
 to diagnose the health problems and meet the health needs of the community is
known as community health nursing process.
The goals of nursing process remain the same, i.e. to solve the health problems and
meeting the health needs, whether it is applied at any level of care.
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General Objectives
 To maintain health
 To prevent illness
 To promote recovery
 To restore health
 To provide support in peaceful death
Steps
There are five phases of nursing process
 l. Assessment
 2. Nursing diagnosis
 3. Planning
 4. Implementation
 5. Evaluation BCCN

ASSESSMENT:
Its an organized systematic and ongoing process of collecting data and is the
base of other phases. It is an independent nursing function and depends
upon the skill and description of nurses .
The tools of assessment include the following methods:
 Observation
 Interview
 Nursing history
 Clinical records
 Consultation
 Physical and psychological history
 Review and literature
BCCN

NURSING DIAGNOSIS
It is the result of the assessment phase. It is the statement of patients
problems derived from the systematic collection of data through the
assessment phase.
Steps of nursing diagnosis include:
 Analysis and interpretation of data
 Making and validating conclusion
 Comparing sign of clusters with defining characteristics
 Identifying the related factors
 Documenting the nursing diagnosis.
PLANNING
Planning involves the action designed to prevent, correct or minimize the
problems identified in the nursing diagnosis and setting priorities for
nursing action. The main objective of planning is to make the best possible
use of available resources to help the person to achieve the desired outcome
Objectives of planning
 To set priorities
 To set the time schedule for outcome
 To identify nursing intervention.
BCCN

IMPLEMENTATION
Implementation means putting the plan into action according to the set
priorities. It refers to the nursing activities performed to accomplish the
specified goals.
Responsibilities of nurses in implementation
 Reviewing the nursing care plan
 Scheduling the nursing actions
 Communicating the intervention
 Collaborating with other professionals
 Providing direct care
 Counseling and supervising nursing care
 Documenting nursing care.
BCCN

EVALUATION
 It is recording the outcome of the nursing action or extent to which the
expected outcomes was achieved.
 It is an ongoing process in caring and related to the previous phases of
nursing process, Evaluation may be formative (ongoing basis) and
summative (aftercare) of patient's discharge.
Steps of evaluation
 Identify the outcome criteria
 Comparing actual outcome with expected outcome
 Summarizing the result of evaluation
 Making connections and modifying care plan in cases of failure in achieving
the outcome
 Documenting the evaluation process
BCCN

The nursing process is generally applied to solve the health problems of
individual patient in hospital setting
 DEFINITIONS
"Community health nursing process is an orderly, systematic and rational
method of assessing the health problems and health needs, planning and
implementing nursing care for the prevention of disease and promotion of
health of the community”
 OBJECTIVES
 To identify community's actual or potential health problems/ health care
needs
 To formulate the plans of nursing action to meet the assessed health needs
 To implement the plans of nursing action to solve the health problems and
health needs
 To evaluate the nursing care provided to the community.
BCCN

Importance of Community Health Nursing Process
 Community health nursing process provides continuous and community-
oriented care to the community
 It utilizes maximum resources available in the community
 It improves the functioning of community health team
 There is participation of the community in each step of community health
nursing process
 It provides job satisfaction to community health nurses and other health
workers working in the community
 It contributes toward the professional growth of community health nurses
 Provides quality assurance in community health nursing
 It increases the community health status and makes community self-reliant.
BCCN

Components of Community Health Nursing Process:
 Community identification
 Knowing population composition
 Finding health and allied resources
 Applying nursing process in:
1. Community health nursing assessment
2. Community health nursing diagnosis
Planning
3. Implementation of community health nursing care services
4. Evaluation
5. Replanning
BCCN

1. COMMUNITY IDENTIFICATION
It refers to systematic process of knowing and exploring the defined
community for assessing the health status and finding out the possible
factors affecting the health of the community. There are various definitions
and dimensions of the community but three dimensions are present in all the
definitions. They are:
 Geographical area or place
 People
 Functions or social system
Geographical area or place:
 Geographical boundaries: Politics has an important role in particular
geographical area and administration of community
 Means of transportation: Buses, trains, bullock cart, Tonga horse (horse
driven cart), boat, foot
 Physical environment and land use patterns, housing conditions and roads
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People
 It includes the social and demographic characteristics of the community. The
structural characteristics of age, sex, caste, religion, education, and
socioeconomic status.
Functions of social system
It includes main functionaries of the community which may be different in urban
and rural communities . It includes the following :
 Physical environment
 Maintenance of social control
 Education
 Employment status of the community
 Health and social services
 Production, distribution and consumption of goods and services
 Communication
 Adaptation of ongoing and expected changes
 Socialization of new members
 Provision of mutual aid and cooperation
 Recreational.
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 Population Composition
 Health and Allied Resources
1.Health Resources:
 Health Institutions:
o (Hospitals, teaching hospitals, dispensaries, first referral unit, CHCs,
PHCs,SCs,CGHSc,ESI, nursing home, maternity hospital, Speciality
hospital in government or private health institutions)
o School & Industrial health services
o Mental health services
o Traditional healers
o Voluntary health association
o National health programs
 Health Service Resources: RCH , Elderly, Handicapped
2.Allied Resources:
 Natural Resources
 Financial aid services
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 International financial Support and schemes
 Voluntary agencies
 Transportation, education and communication resources
 Nutritional services
 ICDS scheme
 Employment services
 Educational and welfare agencies
 Social welfare agencies
 Legal resources
 Counselling services
 Professional resources: Journals, associations etc
 Communication: Newspapers, magazines, radio, TV, Internet
 Recreational facilities
 Social services and public services
 Industry
 Political organization
 Community development projects
BCCN

 It is an organized and systematic method of assessing the health status of an
identified Community . It includes Data Collection and Data Interpretation
a)Data Collection
1.Data Gathering ( obtaining existing information) egs: age, sex, caste ,
IMR
2.Data generation ( data which is not readily available)egs : rituals,
tradition, goals and needs, community knowledge
b) Data Interpretation
Data gathered and generated are interpreted by which health problem of a
community and community resources are identified
BCCN

BCCN
Data collection
•Informative Interviews
•Participant observation
•Secondary analysis of existing
data
•Surveys
•Windshield Survey
Validation
Data
Interpretation
Analysis
Inference
Diagnosis
need
Statement

 Its defined as “ to find the pattern of health problems in a community ,
including factors which influence this pattern”
 It is the scope of epidemiology and nursing from epidemiological aspect.It
is based on collection and interpretation of data related to demographic
structure, vital statistics, incidence and prevalence of disease in an area.
BCCN

 It may be directly related to health, e.g. malnutrition, malaria, diabetes,
mellitus, worm manifestation, etc.
 There maybe problems of health service system, i.e. lack of health
institutions, lack of resources and personnel's uneven distribution of health
facilities
 Problems related to awareness, i.e. lack of information, communication,
poor transport facilities, and poor media management.
 Low social status, i.e. illiteracy, unemployment, overcrowding community,
discomfort zones , pollution of air, water, sound, poor disposal management,
natural calamities, poverty, child and women abuse, lack of sex education
and poor water
 Community Nursing Diagnosis is derived from "Synthesis
of assessment data, that are based on the concepts of risk and health
needs and are situations that can be influenced by nursing
intervention"
BCCN

 ".Community health nursing diagnosis consists of three parts:
 1. Description of the problem
 2. Identification of factors etiologically related to the problem
 3. Signs and symptoms that are characteristics of the problem, e.g. health
indicators, verifying existence of the problems
 After making community health nursing diagnosis, priorities are set.
BCCN

 Planning is a logical decision making process.
 Planning refers to the “designing of an orderly detailed program of action
around a specific goal concerned with determining how to meet the needs
of individuals, families and community”
Purposes of planning are:
 To determine how to meet the community health care needs and solve its
health problems
 How to manage with limited resources for many problem of vast population
 To eliminate unnecessary expenditure.
Steps of planning includes:
 Analyzing and establishing priorities among community health problem
 Establishing goals and objectives
 Identifying intervention.
BCCN

 “It is the process of putting the planned activities into action.”
 The methods of implementation are the vehicles of work activities.
Factors affecting implementation
 Nurses role -she may be health educator, counselor, direct care provider, etc.
which affect the communityhealth nursing care implementation
 Selection of the type ofhealth problems
 Community's readiness to participate in problem resolution
 The characteristics of the social change process
BCCN

Methods of intervention/implementation:
 Small interacting groups: The formal groups (such as families, legislative
bodies, healthcare providers, and health care recipients) and informal
groups which include social groups ,neighborhood, etc. have the common
tie.
 Law advisors: They act as opinion leaders. They have higher position in the
community. The village sarpanch or panch, religious persons, teachers,
gram Sevak, old famous body of village, mukhiyas, ward member, key
informants, etc. all work as health facilitator. They are capable of bringing
changes in the community.
 Mass media: The mass media has brought a sizeable change in the health
behavior of the people. The impact of TV, computer, CDS, videos, internet,
newspaper and journals are the effective aids in intervention.
 Health policy and public health laws: The health policy and public health
laws protect and address collective human needs and to constraint
individual choice for the wellness of general public health. Thus they play
critical role in the adaptation of health for community behavior.
BCCN

 “Evaluation is the process of ascertaining the outcomes against the
objectives.”
It involves two aspects:
1. Evaluation of the nurse's performance
2. Evaluation of the behavioral changes in the community
 After implementing intervention, accomplishment of objective and the
effects of intervention activities are evaluated.
 Various tools can be used for evaluation of community health nursing
process.
 The progress records of community oriented health records direct the nurse
to perform appraisals during the implementation.
 Nurses should evaluate whether the intervention activities are effective.
 The cost benefits are also to be evaluated
BCCN

 The other tools of evaluation are:
 Survey
 Questionnaire
 Rating scales
 Vital statistics
 Observation (direct or indirect observation of behavior change)Process
recording
 If the objectives are met, community health nursing process is considered
successful. In case of failure, steps health nursing process are again
considered.
BCCN

Unit2 chn

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Unit2 chn