Community health nursing first unit.pptx

• CONTENTS
• DEFINITION & CONCEPT OF COMMUNITY HEALTH NURSING
• HISTORICAL DEVELOPMENT
• PRINCIPLES :CHNG
• QUALITIES OF CHN
• ROLES & RESPONSIBILITIES OF CHN
• APPROACHES TO CHNG PRACTICE
APPLICATION OF NURSING THEORIES IN CHNG
NURSING PROCESS & APPLICATION OF NP
COMMUNITY IDENTIFICATION-PURPOSE, METHODS
COMMUNITY SURVEY

COMMUNITY HEALTH NURSING-MEANING
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 .Its not limited to a particular
age or diagnostic group.It is continuous and not episodic.The dominant responsibility
is to the population as a whole. Therefore, nursing directed to individuals,families or
groups contributes to the health of the total population.
Health promotion ,health maintenance, health education, coordination and continuity
of care are utilized in a wholistic approach to the management of the health care of
individual, family, group and community.

COMMUNITY HEALTH NURSING -DEFINITION
• Community health nursing has been defined by the
division of community health nursing practice for which
there exists a body of knowledge and related skills which
is applied in meeting the health needs of communities
,families, and individuals in their normal environment
such as at home, at school and at place of work.
- ANA

Service rendered by a professional nurse with the
communities, groups, families , individuals at
home, in health centers in clinics, in schools, in
places of work for the promotion of health,
prevention of illness, care of the sick at home and
rehabilitation.
-RUTH FREEMAN

• The community health nursing is defined as a
synthesis of nursing and public practice applied to
promoting and preserving the health of people .The
practice is general and comprehensive .It is not limited
to a particular group or diagnoses and is continuing.
-American nurses association (ANA)

BASIC CONCEPTS OF COMMUNITY HEALTH
NURSING
• Community health nursing believes that health is a
fundamental human right and an integral part of
growth and development.
• It supports entire community, as well as individuals,
families, and aggregates as a focus for community
health nursing practice.
• Community health nursing identifies the need of
holistic care approach.

• Community health nursing supports that community-
based efforts and community involvement is essential for
risk reduction.
• Community health nursing honours the social and
cultural differences and values of individuals and
community about health and supports the health
promoting behaviour in an acceptable manner.
• Community health nursing realizes that multidisciplinary
team activities and programmes are essential to attain
the objectives of community health.
• Community health nursing believes in the overall

CONCEPTS OF CHN PRACTICE
CHN
PRACTICE
COMMUNITY
COMMUNITY
HEALTH
COMMUNITY
PARTICIPATION
COMMUNITY :
AS A PATIENT

COMMUNITY
• It is a social group determined by geographic
boundaries , common values and interests
• Its member knows and interact with each other;
exhibits and creates norms, values and social
institutions
• Community health nurse need to examine
regularly their practice and effects of personal ,
structural and functional dimensions of

COMMUNITY HEALTH
• 3 common characteristics – status, structure and
process
• Status means- mortality and morbidity rates, life
expectancy, risk factors, mental health indices,
crime rates, community satisfaction etc.
• Structure – community health services, resources
and quality of community structure
• Process – promotion of effective community action
or wellness; meeting collective needs by identifying

COMMUNITY AS A PATIENT
• CHN practices for healthful change for whole
community
• Focus of care is collective/ common
• Change may sought through individuals, families,
groups, institutions, but change is intended to
affect whole community not just for an individual
or specific group

COMMUNITY PARTICIPATION
• All intervention/ planning strategies require
partnership of the community
• Participation should be active, informed, flexible
and negotiable at every stage of change process

• To increase the life expectancy.
• To decrease the infant mortality rate (IMR),
maternal mortality rate (MMR) and other
morbidities..
• To prevent disabilities, providing rehabilitation
services..
• To provide health care services (community
treatment).
• To find the cause-effect relationship.

• To make the community diagnosis.
• To help the NGOs and other organizations working
in the field of community health.
• To assess the need and priorities of vulnerable
groups, pregnant mothers and children.
• To provide referral services at various health care
levels.
• To provide complete well-being of community and
maintain their optimum level of functioning (OLOF)

HISTORICAL DEVELOPMENT
• ANCIENT PERIOD
• BRITISH PERIOD
• POST INDEPENDENCE PERIOD
-BEFORE FIVE YEAR PLANS
-AFTER FIVE YEAR PLANS

ANCIENT PERIOD
 Vedic period  Post Vedic period

Atharvaveda stated about medicine, personal
hygiene, prevention of sickness etc
Manu samhita deals with physical , mental,
social and spiritual life
Ayurveda and siddha medicine were in practice
Hygiene was adopted
Sick persons are cared by oldmen and women
in home and institution
Indus valley civilization had planed cities
houses and drainage system

Post Vedic period
 Buddhism-principles of non
violence, helping the sick,
poor and needly people, self
discipline
 More doctors in field of
medicine
 King Ashoka(220-250BC)
introduced state medical
system
 Surgery was not practiced
 Decline of Buddhism (700AD-
1850AD) practice of medicine
and public health
 Muslim rules introduced
Arabic system of medicine-
Unani system(1000AD)

British period
 In 1757 British
established rule-civil
and military services
 1859-East India
company taken
administration of India
 1859-royal commission
came to India to study
problems in India,
appointed 5 persons
from Bengal, Bombay,
Madras
 1864-sanitary commission
introduced with one
sanitary commissioner
officer and stastical officer
 1888-merged with Direct
general of Indian medical
services

 Other act passed-
Birth and death
registration act(1873)
Vaccination act (1880)
Indian factory act
(1885)
 1896-plague commission
setup
 1911-indian research
fund association (ICMR)
 1918-nutrition research
and laboratory at conoor
 1919- local gov
administration changes
to provisional
government

 1930-Simon commission
set up
 1935-Federal list,
provincial list, concurrent
list enacted
 1939-madras public health
act
 1940-drug control act
passed
 1943-bhore committee est
 1952-public health nursing
course started in new
Delhi
 1953-shifted to All India
institute of hygiene and
public health

 1960-public health
nursing course started in
Kerala, Indore,Nagpur
and Ahemedabad
 1946- Vellore and Delhi
started college of
nursing
 1959-GNM course
started along with public
health nursing

Development of public health nursing
during British period
1990-Lady Curzon took action
to train dais
1990-Lady Chelmsford league
formed
1921-Lady Reading health
school started in Delhi
1952-public health nursing
course started in college of
nursing

course shifted to All India
Institute of Hygiene and public
health
1946- two college of nursing
started
1959-integration of public
health nursing with GNM
course
course started in
kerala,Indore, Nagpur,
Ahmadabad

Development of Public health
Nursing during British period

Early 20th century consider
development of public health nursing.
Need for trained health visitors and
public health nurse – untrained dias
in midwifery practice
1990 Lady Curzon initiative to train
dais
Raised victoria memorial scholarship
fund

In 1919 Lady Chelmsford, raised a charitable fund
Founded Lady Chelmsford league for maternity and
child welfare services.
Indian Red cross society joined league

 In 1921, Lady Reading Health School was started in
Delhi
 To train health visitors for supervise dais – give better
services to mothers and children
 Initially period was 9 month(mother & children) later
changed to 18 month(whole family services)
 Similar schools started in Lahore, Calcutta, Madras,
Nagpur and Pune

In 1946 two college of Nursing started
 In Delhi affiliated to the University of Delhi (giving
a degree of Bsc(Hons) in Nursing
In Vellore affiliated to the university of Madras
giving degree of Bsc.Nursing

In 1952, Public Health Nursing courses was started
in college of nursing in New Delhi
Recommended by Bhore committee
For supervision, guidance and generalized health
and nursing services to people

In 1953 Public health nursing course shifted to All
India Institute of Hygiene and Public Health
(started in 1930)
In 1960 Public health nursing started in Kerala,
Indore, Nagpur, Ahmedabad

DEVELOPMENT SINCE
INDEPENDENCE
1947 ONWARDS

Soon after independence , independence act 1947
came into operation on 26 Jan 1950
Act contains 3 lists
Described in 7th schedule of constitution at list
1(Union list),
list 2 (state list),
list 3(concurrent list)

Country's health system and health service
determined
Conference held by prime minister and health
minister in 1947,1948,1950 on Bhore committee
report

Post of Director General of Indian Medical services
and public health commissioner were abolished
Two positions later substituted by director general
of health services responsible for both medical and
public health services

In 1950 planning commission constituted which is
responsible for 5 year plans
In 1952 central council of health setup-close
collaboration between center and state

POST INDEPENDENCE PERIOD
• Before five year plans
• After five year plans

Before five year plans After five year plans
 1947-establishment of
ministry of health
 1949-india become
member of WHO
 1950-Planning commission
constituted
 1950-five year plans
emerged
 1952-central council of
health setup ; close
collaboration between
center and states

HISTORY OF COMMUNITY
HEALTH NURSING IN KERALA

Royal proclamation of 1879 made
vaccination compulsory
Initiated measures to prevent spread
of cholera
1928 under Travancore government
with help of Rockefeller foundation
parasite survey conducted

1951-Govt
medical college
started
1954-school of
nursing shifted to
Medical college
campus
1956 foundation
for medical care
system accessible
to all citizens
1972-four year
degree
programme in
nursing
1963-School of
nursing upgraded
to college of
nursing
1960-diploma
programme in
teaching and
administation
1983-admission
made through
entrance
1987- started
post graduate
programme in
nursing
1990- msc
nursing admission
through entrance
examination

PRINCIPLES OF COMMUNITY HEALTH
NURSING
• Health services should be based on the needs of
individuals and the community. Health
programmes should be concerned with the
solution of health problems and the resources
available. Nurse should have good knowledge of
the community, so that immediate problems of
the individual can be solved effectively.

• Health services should be suitable to the budget;
workers and the resources.
• Family should be recognized as a unit and the
health services should be provided to its
members .Active participation of family should be
provided to its members.
• Health services should be equally available to all
without any discrimination of age, sex, caste,
religion, political learning and social or economic
level etc.
• Health education is an important part of

• Community health nursing should be provided
continuously without any interruption similarly taking
care about follow up treatment is also necessary.
• Preparation and maintenance of records and reports is
very important in community health nursing
.Demographical programmes and services are evaluated
on the basis of these records. These should also be
preserved for research purposes .
• It is necessary that nurses and other health workers,
working in the community should be guided and

• Other than being alert and devoted to her duties
community health nurse ,
-should be responsible for professional development
-Should not accept any gift or money in lieu of her services
-Should continuously receive in service training and continuing
education during her service period and otherwise.
-Should be apolitical ,secular, without any prejudice and tolerant
towards all religions while working
- Should follow professional ethics and standards in her work and
behaviour
-Should feel responsible towards the goals and philosophy of the
health institution she belongs to.
-Should have job satisfaction

• Effective team spirit is a must in the team working for
community health.
• Arrangements should be made for the timely evaluation
of services provided by community health nurse.

QUALITIES OF COMMUNITY HEALTH NURSE
• EDUCATIONAL QUALIFICATION
DIPLOMA IN GENERAL NURSING & MIDWIFERY, BSC
NURSING/POST BASIC NURSING
• COMMUNICATION SKILLS
• OBSERVATION SKILLS
• ABILITY TO LEAD AND TAKE DECISIONS

ROLES & RESPONSIBILITIES
• CARE PROVIDER ORGANIZER
• SENSITIVE OBSERVER DIRECTOR & CO-ORDINATOR
• EDUCATOR CONTROLLER & EVALUATOR
• ADVOCATE LEADERSHIP ROLE
• CONCERNED ADVISOR COLLABORATOR
• CHANGE AGENT RESEARCHER
• MANAGER
• PLANNER

APPROACHES TO COMMUNITY HEALTH
NURSING PRACTICE
• PERSUASIVE APPROACH
• ENFORCEMENT
• TEAM APPROACH
• COMMUNITY INVOLVEMENT
• INTERSECTORAL APPROACH

APPROACHES
• Nursing theories and nursing process
• Epidemiological approach
• Problem solving approach
• Evidence based approach
• Empowering people to care for themselves

NURSING THEORIES APPROACH
• The term of community health is defined by meeting the
needs of a community by identifying problems and
managing interactions with in the community.

Basic elements:
The six basic elements of nursing practice in corporated in
community health programmes and services are:
Promotion of healthful living
 Prevention of health problems
 treatment of disorders.
Rehabilitation.
 Evaluation
Research

Major settings:
 Homes
 Ambulatory care settings
 Schools
 Occupational health settings
 Residential institutions.
 The community at large

ESSENTIAL CHARACTERISTICS OF NURSING SERVICE:
1. Community focused oriented, population focused
2. Population focus implies that a nurse uses population based skills
such as epidemiology, research in community assessment and
community organizing as the basis for interventions
3. Relationship based care:
 Establish and maintain a reciprocal caring relationship with the
community
 Involves listening, participatory dialogue and critical reflection
 Involves socio-political elements of practice such as advocacy.
Community empowerment and movement to action

Theories and models for community health nursing:
A) commonly used theories are
1. Nightingales theory of environment
2. Parse's human behaviour theory
3. Milio's frame work of prevention theory
4. Salmon white's construct for public health nursing.
5. Block and jostens ethical theory of population focused nursing
6. Canadian model
7. Leininger's culture care diversity and university theory.

• The commonly used models are:
• 1. Betty Neumann's health care system model
• 2. Rogers model of the science of unitary man.
• 3. Pender's health promotion model
• 4. Roy's adaptation model.
• 5. Orem's self-care model
• 6. Minnesota wheel-the public health interventions model.

•Roy’s adaptation model
•Nola j penderson model

• Using different nursing theories apply each to the following
community health situation
o Epidemiological approach
o Problem solving approach
o Evidence based approach:
o Empowering people to care for themselves

Epidemiological approach:
• The epidemiological approach to problems of health and disease
is based on two major of foundations:
A) asking questions
B) making comparison

a)Asking questions:
Epidemiology has been defined as a means of learning or asking
questions and getting answers that lead to further questions. It is goal
directed and continuous person makes a number of attempts and Actions
to solve the problem.
 What is the problem?
 What is the morbidity?
 Where it happen?
 How many affected?
 What you did to reduce problem?
 What medication you administered?

b) Making comparisons:
o Main aspect in epidemiology is to make comparisons and draw
inferences
o The comparison may be between two groups. One group having
the disease
o In making comparisons the epidemiologist tries to identify the
characteristics of host and environmental factors.
o Before making comparisons, both the group must be similar based
on age, sex similar characteristics.
o It requires standardization, definition, classification, criteria and
nomen cloture.

Problem solving approach:
o Problem can be expressed as arising of obstructions is attaining or
reaching the desired motive or objective or the failing of attempt.
o It is the process which begins at the stage of thinking to attain the
desired goal.
o Good problem solving skills empower managers in their
professional and personal lives
o Rational and creative problem solving approaches were used

PROBLEM SOLVING PROCESS
Identify
explore
Set
goals
Look at
alternati
ves
Select
best
alternativ
es
Implem
ent
Evaluate

• Important facts of problem solving
o It is goal directed and continuous
o Person makes a number of attempts and actions to solve the
problem.
o Problem solving is a special form or set of thinking, reasoning
whether simple or complex.
o Process stops after achieving the goal
o Every person expresses his individual differences is important in
solving the problem.
o It takes a long time to solve problems for the first time while later
on the time taken to solve the problem is reduced consciously

• Factors affecting problem solving:
o Size of the problem
o Complexity of problem.
o Structure of problem
o Motive of solution seeker.
o How extensive is the process of problem solving
o Previous experience and practice of the person solving the problem
o Similarities are the problem situation and the solution of problem.

Problem solving tools
• Cause and effect diagram
• Pareto chart
• Flow chart
• Histogram
• Check sheet
• Scatter diagram
• Brain storming

Evidence based approach:
o Evidence based approach is required to establish policies.
o Nurses with master degree should be encouraged to provide
evidence and use evidence to improve or change nursing
practices.
o An academic atmosphere should be created in working place.
o For identifying and using evidence an information should be
encouraged.
o In hospital there should be one responsible person for research
activity.
o Nurse educator. Should do a short course training on evidence
based and research.

• EBA prominent on national and international
agendas for health policy and health research
• 3 impact levels
Intersectoral assessment
National health care policy
Evidence based medicine in every day practice
• Process of systematically reviewing , summarizing
and assessing quality of published research

STEPS
• Define problem
• Formulate problem
• Set criteria
• Search for and find published body of evidence
• Sort it for relevant evidence
• Abstract findings
• Summarize the body of evidence and form
recommendations or make decisions
• Specify strength of evidence
• Disseminate findings

•Empowering people to care for themselves:
• Most people want to be cared for safely in their own home as long as
possible
• The care should be assessed and planned with an individual and adapted
to their changing situation.
• It will reduce the delay care in the home setup.
• Minimise the risk and increases safety needs in home.
• Reduce the length of stay in hospital.

• Empowering people to manage their own care particularly old age
people.
• Improve medicine knowledge at home level.
• Improve the quality of life
• Increase accesses or adaptation.
• To support activities of daily living

COMMUNITY HEALTH NURSING PROCESS

COMMUNITY HEALTH NURSING PROCESS
• Scientific method of assessing and solving the health
problems of community
• Systematic , rational method of planning and providing
nursing care for the prevention of disease and promotion
of health of the community

COMMUNITY MAPPING
• Community mapping has an important place in the community health
nursing process.
• Community map gives a comprehensive view of specific region, its
asset or resources, demography, institutions and other salient features
of the community.
• Community mapping acts as a guide tool during community health
nursing process.

Indication of the community mapping
• providing guidance / directions to field health workers
• primary step of community health nursing process
• identification of boundaries / area of sub-community
• finding the resources / assets in the survey area
• collecting data regarding survey/work
• helping in research work

ADVANTAGES
• Better use of available resources
• Increasing the mobility and activities of health centers
• Easy transportation, effective communication
• Time efficiency/ saving
• Improving community participation
• Help in implementing plan and work
• Can be done by using computer

• While preparing the community map you should keep the following points
in mind:
• Draw map according to the scale, i.e., If the scale given is 1 cm = 1 km
then
• The place which is 10 kms away from the centre should be marked at 10
cms
• Give appropriate symbols to indicate the place and give the key on the
lower
• Comer for example the symbol shows railway line.

• Mark the directions in the map using standard abbreviations.
• Keep the map updated by making necessary modifications
corresponding to
• The changes occurring in the community.
• Mark the directions on the map so that a person referring to the map
• Understands which side of a map faces north - south - east - west.
• Place the map of the community on the board in the community
health
• Center for ready reference and guidance

OBJECTIVES OF COMMUNITY HEALTH
NURSING PROCESS
• To identify the community's actual or potential health
problems/health care needs.
• To formulate nursing strategies to meet out the
identified community health needs.
• To deliver nursing interventions to fulfil the needs.
• To evaluate the rendered nursing care in the community.

Importance of community health nursing process
-continued community oriented care.
- Maximum use of resources available in the community
- Improvement of the community health team functioning.
- Community partnership in each step of community
health nursing process.
-Job satisfaction of the community health nurses.
-Increased community health status.
- Professional growth of community health nurses.
-Quality assurance in community health nursing.

STEPS OF COMMUNITY HEALTH NURSING
PROCESS
• Community identification
• Knowing population and composition
• Finding health and allied resources
• Applying nursing process in :
Nursing assessment
Nursing diagnosis
Planning
Implementation

PHASES OF COMMUNITY HEALTH NURSING
PROCESS
• Community identification (assessment phase)
• Planning phase
• Action phase
• Evaluation phase

COMMUNITY HEALTH NURSING PRACTICE
PROCESS
• ASSESSMENT PHASE Community identification
-Planning of data collection: categories of
information
-Method and techniques
-Data collection
-Data analysis
- profile and diagnosis

• PLANNING PHASE
• ACTION PHASE
• EVALUATION PHASE
Community health planning
-Analysing health problems:2nd level
assessment
-Establishing priorities
-Setting goals and objectives
-Formulating community health actions
Implement action plans
-Considering nursing interventions
-Review and revise if needed
-Mobilisation of resources
-Facilitating working environment
-Implementing and documentation
Evaluation
- Concurrent Quantitative
- Terminal Qualitative

COMMUNITY IDENTIFICATION
• Primary step of CHN process
• Basic need of CHN process
• To identify place or space, person or people, function

COMMUNITY IDENTIFICATION DATA
(ASSESSMENT PHASE)
Systematic process of knowing and exploring the defined community
for assessing its health status and determining the possible factors
affecting the health of people in the community.

PURPOSES
• Provides comprehensive knowledge about the profile of the
community.
• Provides opportunity for establishing working relationship and
gaining acceptance in the community.
• Helps in making community diagnosis.
• It is instrumental to community health planning
• it promotes community participation

(ASSESSMENT PHASE)
CATEGORIES OF INFORMATION
• Geographical area :geographical location/boundary of a
community, physical set up, natural resources, important
landmarks and institutions, environmental sanitation.
• Population characteristics: size , density , composition,
vital events, vulnerable/ high risk groups, social structure(
social stratification, social control system, community
organisation and group dynamics , leadership pattern, life
style, communication system)
• Social system

Geographical area:
• Size, census blocks, climate, name of area, map of the area, location
etc.
• Geopolitical boundaries: politics in our country has an important
effect on the geographical area and administration of community. So
electoral position and local administration of community must be
specified.
• Means of transportation: foot, bullock-cart, bus, boat, train, air etc.
• Physical environment: land use patterns, housing conditions etc, It
determines the climate, resources, health threats and dangers

• Important landmarks and institutons , incudes: community centers,
panchayat office, schools, post office, anganwadi, religious centers,
bank etc.
• It helps in locating houses.
• Environmental sanitation
• Control of all those factors in man’s physical environment which
exercise or may exercise a deleterious effect on his physical development,
health and survival.
• Includes control of housing, food, water, refuse and excreta, waste
water, air, vectors etc
• CHN should identify strong and weak points of environmental
sanitation of community which will form basis for community health

Person or people:
• It includes the demographic and social characteristics of the
community.
• It is a well-established fact that without people, there is no meaning
of community.
• For the identification of community, demographic set-up of
community should be properly identified.

(ASSESSMENT PHASE)
Sources of information
• Geographical aspects: maps, local administrative bodies
• Population aspects:census , registration departments of births and
deaths , epidemiological surveilance
• Social system: local politicaland administrative bodies.

function:
• it includes the main functionaries of the community, which may be
different in urban and rural communities in our country.
• It also implies the following
maintenance of social control.
Employment/unemployment/partial/seasonal employment status of the
community.
 Socialization of new members.- Production, distribution system and
consumption of goods and services.
Adaptation of ongoing and expected changes.
 Provisions of mutual aid, cooperation.
Description of functions related to cast or religion etc.

APPROACHES AND METHODS
• Community forum method
• Observation method
• Questioning method
• Record review method
• Conversation /discussion method
• Other methods

COMMUNITY FORUM METHOD
• Refers to holding a formal and informal meeting with community
people, leaders and organized groups which may include panchayat
members, school teachers, mahila mandals etc.
• Initial meeting can be open discussion, for establishing the
interpersonal relationship.
• Later, the meetings can be planned properly with specific objectives.
• It is useful and relatively less expensive method of gathering the
historical perspective, community social structure, life style, social
events and resources available and also the problems encountered,
actions need to be taken etc

OBSERVATION METHOD
• basic method for collecting first hand information.
• It helps gaining the information regarding geographical area, environmental
conditions, population density, beliefs, norms, power system and problem
solving etc.
• Observation visits can be formal and informal
• informal visits are done to get familiar with the area , the set up, and to have
a general view.
• Formal observation visits are done with specific objectives and to attain
specific data. e.g. Mapping, natural resources.
• An observational checklist can be used as a tool to collect the information.

• Refers to the method used to elicit the needed information by asking
relevant questions.
• Can be in form of informal conversation with people, face to face
interview of key informants, sample population etc.
• Provides information on: social structure, life style, health problems,
health services and allied services, demographic information etc.
• Key informants can be formal and informal leaders.
• Interview of sample population is effective method of data collection.
• Questioning method requires the use of planned interview schedule
and questionnaire to elicit information through interviews and self
answering questioning respectively.

RECORD REVIEW METHOD
• Information like: housing conditions, socio-economic status,
demographic information, vital events, morbidity etc can be collected
through records.
• A record review checklist can be used as a tool .
• A checklist can be developed on the basis of the information to be
obtained from the records.

CONVERSATION/ DISCUSSION METHOD
• Conversation/ discussion with health personnel can generate information
on community problems in past, present, services rendered, difficulties
encountered etc.
• Discussions with other organizations can also be helpful in attaining
information regarding functioning of their organization and about
establishing working relationship
• meetings need to be planned like community forum method.

OTHER METHODS
It includes:
• physical examination
• clinical examination
• investigations
• these methods involve the use of standard screening instruments
like B.P. App., Audiometers, weighing scale etc.
• Listening is another good method of data collection in community.

֍Define the community to be studied : name, address, level of
community: rural/ urban
֍Determine the objectives for community identification : state the
purposes of community identification
֍Determine specific informations : identify the sources from where
the information can be obtained
֍Identify the population and sampling unit under study : people, key
informants, records etc. Select the respondents when the sampling
unit is a family and household.

֍Decide on the sample size and sampling method
֍Decide on the methods and instruments of data collection : it
depends on guidelines etc.
֍Organize and conduct survey the type of data to be collected
֍Develop the instruments decided : interview schedule, observation
checklist, community forum

TIPS IMPORTANT FROM PRACTICAL POINT OF
VIEW

Before visiting, know about the customs expected by the visitors.
Identify the leaders, greet them in traditional ways, introduce and
explain the purposes.
 Dress up appropriately in a manner acceptable by the local people
Do not act as a stranger or superior. Empathies with them
 mix up with the people, accept their hospitality.

Watch and listen them attentively, answer their queries and consider
their point of view.
Make only those commitments which can be fulfilled.
Avoid unnecessary arguments, criticism and comments.
 Be neutral in any kind of disputes in the family or village
maintain confidentiality

DATA ANALYSIS
• Refers to putting all the information collected into an order, compile,
summarize according to variables studied.
• It helps in making data meaningful and understandable, to be able to
describe the community profile, identify the health problems and their
possible associated factors

• Coding , key punching, organising and arranging of data : Coding,
organizing and arrangement of the data for tallying and compiling
• Presentation of data from tally sheet :Presentation of the data into the
tables and graphs for descriptive analysis.
• Statistical analysis of data : Statistical analysis for more specific and
precise analysis.
• Interpretation of data : Interpretation of the data for determining
possible associations, drawing inferences and compare the findings
with national data
• Reporting of the findings : include the community profile, making
community diagnosis.

COMMUNITY PROFILE AND DIAGNOSIS
The community identification process helps to determine community profile
and help in drawing conclusions or make diagnosis of its health needs and
health problems from interpretation of data collected
• Community diagnosis
written statement of communities health need and health problems which are
assessed from data collected
Diagnosis focuses on wide range of factors influencing health and wellness
status of the community.
• Diagnosis may change overtime and need to be evaluated and restated
periodically.

• According to WHO definition, it is “a quantitative and qualitative
description of the health of citizens and the factors which influence their
health. It identifies problems, proposes areas for improvement and
stimulates action”
• The process includes four stages: initiation, data collection and analysis,
diagnosis and dissemination.
• It should preferably comprise three areas:
- health status of the community
- determinants of health in the community
- potential for healthy city development

• The production of the community diagnosis report is not an end in
itself, efforts should be put into communication to ensure that
targeted actions are taken.
• Framing the community nursing dx
– description of the problem, response, or state-come from the
inferences of community
– identification of factors etiologically related-causes
– signs and symptoms that characterize the problem/concern; they may
come from other subsystems.
– Nursing diagnosis is the final, summary statement

Examples of community health nursing diagnosis
• incomplete immunization status of preschool children due to limited
access to immunization clinics/lack of knowledge of importance of early
immunizations as evidenced by immunization completion rate of 37%
based on survey data
• inadequate family planning services due to clinic days twice a month as
evidenced by the crude birth rate 50% higher than city.
• Potential for disability and loss of productive years of life among the
residents of community related to lack of access to area medical resources,
inadequate financial resources for needed medicines, and lack of
knowledge regarding disease etiology as evidenced by higher adult and
infant mortality rates.

• Individual nursing diagnosis
• Family nursing diagnosis
• Environmental nursing diagnosis

• Based on community diagnosis.
• It is a systematic process and involves logical decision making at
each step of its process.
• It includes four steps
COMMUNITY HEALTH PLANNING(PLANNING
PHASE)

1. Analysing health needs/health problems
2. Establishing priorities
3. Setting goals and objectives
4. Formulating community health action plan to achieve the
objectives.

Analyzing of health problems
• clarify nature, extent and factors associated with the problem.
• More specific information has to be gathered. Also known as problem
oriented assessment and its second level of assessment.
• Also analyze the availability of the resources relevant to resolve the
problems.
• Helps in setting goals and objectives and also to formulate action
plan.
• Other sector personnel should also be involved in the analyses

Establishing priorities
• refers to ranking of health problems identified by determining their
relative importance on the basis of predetermined criteria.
• It is necessary because of limited resources available and many
problems to deal with.
• It requires consideration of the problems, impact, their consequences,
community readiness to solve it etc

Type of health problem:
• health deficits i.e. Instances of ill health, failure to thrive.
• Health threats i.e. Factors that predispose or conducive to diseases
and accidents.
• Foreseeable crises or stress points i.e. Anticipated periods of unusual
demands on the people in terms of adjustments and resources.

Extent of problems
• refers to extent of prevalence of the problems.
• May range from high prevalence and low prevalence depending upon
the number of people affected, timing of prevalence and seriousness of
the problem

Severity of the consequences of the problem
• Refers to nature and magnitude of the resultant problems. ie. Impact
of the problems.
Salience
• refers to community’s perception and evaluation of the problems in
terms of seriousness and urgency of the attention needed.

Preventive potential
• whether the problem can be prevented, controlled and eradicated.
Modifiability of the problems
• refers to the possibility of resolving problems. Depends upon the
availability of resources relevant to solve the problem.

SETTING GOALS AND OBJECTIVES
• Once priorities are set up, relevant goals and objectives are made.
• Objectives are precise, specific statements determining actions relevant
to goal.
• Goals and objectives give directions and determine relevant actions.
• Helps in evaluating the actions planned and implemented.
• eg. To identify and reduce the incidence and prevalence of malnutrition
in under five children in a defined community in a period of one year.

• Eg. The goal of TB control programme is to decrease mortality and morbidity due to TB
and cut transmission of infection until TB ceases to be a major public health problem in
india.
• Objectives of the programme:
• To reduce the incidence of and mortality due to TB
• To prevent further emergence of drug resistance and effectively manage drug-resistant TB
cases
• To improve outcomes among HIV-infected TB patients
• To involve private sector on a scale commensurate with their dominant presence in health
care services
• To further decentralize and align basic RNTCP management units with NRHM block level
units within general health system for effective supervision and monitoring

• Specific objectives of this goal could be:
– to assess G&D of all under fives
– to identify children at risk
– to medically examine all malnourished children
– to do regular supervision of the children
– to monitor nutritional status of all children
– to educate mothers regarding the nutrition.

IMPLEMENTATION OF COMMUNITY HEALTH
(ACTION PHASE)

• Implementation refers to putting the plan into action to achieve the
set goals and objectives of community health.
According to Ruthfreeman
3 types of nursing interventions
• Supplemental
• Facilitative
• Developmental

• Refers to the identification of the appropriate community health and
nursing actions and preparing an operational plan to be implemented
to achieve the established goals.
• For any objective there can be possible plans of action criteria:
– agency policy
– resources available
– nature of problem
– community’s interest and feasibility
– competencies of health personnel
– practicability and efficiency

EVALUATION PHASE
• Evaluation is the process of ascertaining the effectiveness of
something or some organized activity or programme in relation to
some set of standards and criteria.

EVALUATION
Types of evaluation
• Quantitative evaluation & qualitative evaluation
• Terminal evaluation & concurrent evaluation

Community health nursing first unit.pptx

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