community health nursing

1. Jose Amala Anilda.S M.SC(N)

2.  Nursing process is a systematic way to plan,
implement, and evaluate care for individuals,
families, groups, and communities.
Nursing has an organized structure that helps nurses
to efficiently apply their intellectual, psychomotor
and interpersonal skills.

3. Family:
 It is commonly defined as family is a group of
biologically related persons living together and
sharing the common kitchen and purse.
Family health:
 Family health is a condition including the
promotion and maintenance of physical, mental,
spiritual, and social health for the family unit and
for individual family members.

4. Family process:
 The nursing process considers the family, not the
individual, as the unit of care.
Family centered nursing:
 Nursing that considers health of the family as a
unit in addition to the health of individual family
members.

5. Family health nursing process:
 It is a dynamic systematic organized method
of critical thinking about the family. It is problem
solving with the family to assist successful
adaptation of the family to identified health care
needs.

6.  To identify health and nursing needs and problems
 To ensure family understanding and acceptance of
these needs and problems
 To plan and provide health and nursing services
with the active participation of family members.
 To help families develop abilities to deal with their
health needs

7.  To contribute to family performance of
developmental functions and tasks.
 To make use of promotive, preventive, therapeutic
and rehabilitative health and allied facilities and
services in the community.
 To educate, counsel, and guide family members to
cultivate good personal health habits, practice safe
cultural practices.

8.  Services without discrimination
 Periodic and continuous appraisal and evaluation
of family health situations
 Proper maintenance of record and reports.
 Provide continuous services.

9.  Health education, guidance, and supervision as
integral part of family health nursing
 Maintain IPR
 Plan and provide family health nursing with active
participation of family
 Services should be realistic in terms of resources
available

10.  Goal- directed
 Systematic
 Dynamic
 Applicable to families and community groups at
any level of health.
 Interpersonal and based on the nurse- client and
family members relationship.
 Useful for community diagnosis and family
diagnosis

11.  saves hospital beds that can be utilized for critical
cases
 cheaper than hospital nursing
 Patient under family health nursing enjoys privacy
and emotional support.
 Patients on family health nursing can continue
with their routine pursuits.

12.  It requires the nurse to carry portable laboratory
machinery to the patient home
 If the patient resides in a substandard house,
family health nursing could delay his recovery

13.  Family as the context
 Family as the client
 Family as a system
 Family as a component of society.

14.  Family as the context:
The primary focus is on the health and
development of an individual member existing
within a specific environment.
Family as the client:
The focus is concentrated on each and every
individual as they affect the whole family.

15.  family as a system:
This approach focuses on the individual and
family members become the target for nursing
interventions. Eg. The direct intervention between
the parent and the child.
Family as a component of society:
The family is a basic or primary unit of society,
as are all the other units and they are all a part of
the larger system of society.

16.  STEP-I: Assessment of client`s problem
 STEP-II: Diagnosis of client response needs that
nurse can deal with
 STEP-III: Planning of client`s care
 STEP-IV: Implementation of care
 STEP-V: Evaluation of the success of implemented
care

18. STEP-I:
Assessment of
client`s problem

19. It is the first major phase of family health nursing
process which helps to explore the family as a
client, its health needs and problems. It also finds
the possible underlying factors that affect the
health.

20. Family structure
Family environment
Daily routines
Family dynamics
Family needs

21.  Observation:
 Physical examination:
 Interview:
 Record review:
 Laboratory / diagnostic tests:

22.  Inform the family members before head the date of
data collection by which they can easily spare time
for you
 Develop trust with family members
 Developing good interpersonal relationship
 Do not give wrong information to the family
members
 Make sure the tools being used for measurements
are calibrated and in good condition
 Be systematic

23.  Do not pressurize the family members to get
information
 Ensure confidentiality
 Make them comfortable
 Listen attentively
 Record data as planned on the interview schedule/
observation checklist.

24. It includes the following steps:
 Sorting of data
 Clustering of related cues
 Distinguishing relevant from irrelevant cues
 Identifying patterns
 Comparing patterns
 Interpreting inferences and drawing
conclusions

25. According to Ruth freeman the family problems is
explained as:
 a) Health deficit
 b) Health threats
 c) Foreseeable crisis situation

26. Assessment of families:
 Assessment of environment condition
 Health status assessment
 Family health practices
 Family lifestyle

27. Assessment of health risk families:
 Health risk families are those who experience
a particular event or other events of any disease
repeatedly, that make them more prone towards
physical, psychological and environmental
response.

28.  Health records:
 Clinics
 Observation
 Physical health assessment

29. STEP-II:
DIAGNOSIS OF CLIENT
RESPONSE NEEDS THAT
NURSE CAN DEAL WITH

30. It focus and highlight wide factors which influence
health and wellness status of family members.
Types of diagnosis:
 Actual diagnosis: The actual problems are those
present in the patient at the time of assessment,
e.g. pain
 Potential diagnosis: A potential problems is one
which a patient has a high risk or that may occur in
the future. Eg. Decubitus ulcer.

31.  Defining area- who and what
 Identifying the needs from the community
perspective
 Specifying priority health needs of the community
 Identifying community resources for facilitating
health problems
 Setting priorities for action
 Community needs in proportion to national
capacity
 Mechanisms for intersectional co-operation in
planning

32.  1) State a human response and not a client need.
 2) Start the diagnostic statement with the human
response.
 3) Connect the first part (human response) to the
second part (etiology) with the term “related to”
not “due to” or “caused by”.
 4) Be sure that the first two sections are not just
restatements of each other.
 5) Do not mention a medical diagnosis in either of
the first two parts.

33.  Several factors may be involved in the etiology
(part two) so you can include them.
 7) Select an etiology that can be changed by
nursing intervention.
 8) Avoid judging the client as bad in any part of
the diagnostic statement.
 9) Avoid suggesting that any member of the health
care team is not doing his/her job.
 10) Put the cues that led to the diagnosis in the
third part (defining characteristics), preceded by
the phrase “as evidenced by”.

34. There are four parts to a community diagnosis;
 1. A description of the problem, response, or state
(risk, concern, issue, potential or actual),
 2. A statement of the aggregate, population,
community, or focus(boundaries). THIS DIFFERS
FROM THE NURSING DIAGNOSIS, the focus
is added
 3. An identification of factors etiologically related
to the problem ( factors), and
 4. Those signs and symptoms (manifestations)
that are characteristic of the problem.

35.  EXAMPLE: a risk of low birth rate among
pregnant adolescents in the downtown area
related to inadequate income and use of tobacco
as evidenced by insecure housing, use of the
food bank, unemployment rates, and smoking
rates among pregnant teens.
 NOTE: The italicized area indicates the “focus”
portion of the diagnosis (for teaching purposes
only).

36.  EXAMPLE: Ineffective marital and parental
role performance related to arrival of another
baby, heavy child-care responsibilities, and
inadequate family coping patterns as evidenced
by mother stating that she is feeling
overwhelmed, is unable to stop siblings from
fighting, and husband working overtime every
day.

37.  Hyperthermia related to injury/ infection/
inflammation
 Impaired behavior pattern related to substance
abuse/ alcohol intake/ addiction of drug
 Impaired bowel function related to consumption
of no vegetarian food/ cold water
 Disturbed body image related to snake bite/
agricultural hazards/ occupational hazards
 Impaired skin integrity related to pimples/ use of
cosmetics/ climatic conditions.

38.  Potential for breeding of rodents/ insects related to
unhygienic surroundings
 Sexual harassment related to alcohol consumption
 Sleep pattern disturbance related to mosquitoes/
bad smell/ noise
 Self care deficit related to lack of knowledge /
busy schedule/ lack of materials
 Potential for worm infestation related to open air
defecation/ open drainage/ breeding of flies

39. STEP-III: PLANNING OF
CLIENT`S CARE

40.  In this step, family health nursing care plan is
formulated to meet family health need and resolve
the problem. It involves some steps:
 Analysis of diagnosed health problems
 Establishing priorities
 Setting goal and objectives
 Formulating family health and nursing care
plan

41. Types of goals:
 Client focused
 Nurse focused
 Short- term
 Long- term

42. STEP-IV: IMPLEMENTATION
OF CARE

43. Implementation is the initiation and completion of
the actions necessary to achieve the objectives
defined in the planning stage. The plan of care has
been carried out and can be used as tool to evaluate
the effectiveness of the plan of nursing care.

44.  Definition of roles and tasks.
 The selection, training motivation, and supervision
of the manpower involved.
 Organization and communication
 The efficiency of the institutions such as primary
health centers, health centers, and hospitals.

45. Monitoring:
 It is day to day follow up activities during the
implementation to insure that they are proceeding
as planned and are on schedule. It is a continuous
process of observing, recording, and reporting.

46.  The nurse may assist the family by:
 Supplemental: direct care by CHN
 Developmental: to prepare family member for
giving care
 Facilitative: improve physical facilities by
modifying old facilities and adopting new one.

47. STEP-V: EVALUATION OF
THE SUCCESS OF
IMPLEMENTED CARE

48.  Evaluation measures the degree to which the
objectives and the targets are fulfilled and the
quality of the results obtained. It measures how
much output or cost effectiveness achieved.

49.  Structure evaluation
 Process evaluation
 Outcome evaluation
 Formative evaluation
 Summative evaluation

50.  Structure evaluation: in nursing process structure
evaluation tends to evaluate the total care plan
which include assessment, care plan, and adequate
resources to meet the plan.
 Process evaluation: it relate to evaluation of
implementation whether it is carried out properly
whether any intervention left.

51.  Outcome evaluation: it is the actual evaluation. It
is the evaluation of result whether goals are met
properly.
 Formative evaluation: it evaluates family health
and nursing care plan as it is planned and
implemented to determine its strength and
weakness at each stage and it progress towards
meeting the objectives.
 Summative evaluation: it concludes progress or
lacks of progress towards the goal after several
objectives based action are implemented

52. Tools for evaluation :
 Direct observation
 Questioning
 Record review

53.  The nursing process is a problem solving approach
used by nurses to meet the needs of the patient. It
is a deliberative method that relies on the use of
cognitive, interpersonal and psychomotor skills. It
is a cyclical, systematic process, rational method
of planning and providing nursing care. The
nursing process provides a framework for
accountability in nursing.

54.  G. Gnana prasuna, T. Vasundhara Tulasi. Text book of
community health nursing, 3rd edition, published by
frontline publishers. Pg.no: 248- 251
 Ayers, Bruno, community based nursing care,
published by Mosby publishers.
 Stanhope- Lancaster community health nursing, 4th
edition published by Mosby publishers. Pg.no: 498-519
 S. Kamalam , essentials in community health nursing,
concepts& practices 5th edition published by Jaypee
brothers.pg no: 22-42
 Judith Ann Allender, community health nursing,
concepts& practices, 5th edition published by
Lippincott

55.  B.Sridhar Rao , textbook of community health
nursing , 1st edition published by AITBS
 Family health care theory , practices and research ,
2nd edition, published by F.A Davis publishers, pg
no: 14-180
 P.M Thressiamma, procedures& theories of CHN,
1st edition published by jaypee brothers. Pg no: 40-
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