Question and Answers from Unit-I Community Heath Nursing for II Year BSc Nursing students

1. SUYOG COLLEGE OF NURSING
COMMUNITY HEALTH NURSING-I
II Year BSc Nursing
UNIT-I Questions & Answers
Mrs.Nagamani.T, HOD,
Dept of Community health Nursing
Suyog College of Nursing

2. 1. Define Health
The World Health Organization (WHO) defined "Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity."
2. Community Health nurse
community health nurse is a specially prepared registered nurse whose work combines elements of both
primary care nursing and public health practice and takes place primarily outside the therapeutic institution.
3. Community health Nursing
“Community health nursing is a synthesis of nursing practice applied in promoting and preserving the health
of the population. Community health implies integration of curative, preventive and promotional health
services. The aim of community diagnosis is the identification of community health problems.
4.Four levels of Prevention
1. Primordial prevention. The primordial prevention strategy is applied to reduce the development of risk
factors before their appearance.
2. Primary prevention. Primary prevention is the action taken to prevent the development of disease. It
removes the possibility of the occurrence of disease.
3. Secondary prevention. It is the action taken to stop the progress of the disease at the initial stage and
prevent complication.
4. Tertiary prevention. It came into action when disease advances beyond early stages
5. Concept of health
Concept of health
There are four major concepts of health
1. Biomedical concept- This concept is based on the germ theory of disease, proposed by Robert Koch.
The postulates of germ theory of disease states that-
 Microorganisms are responsible for the disease.
 These microorganisms can be isolated from the diseased host and can be purely cultured in laboratory
 The isolated organisms in pure culture when injected to healthy susceptible host can produce same
disease
 The microorganisms can be isolated from experimental host, both in smear and culture.
2. Ecological concept- This concept states about equilibrium between host (Human), infectious agents and
the environment they share. So, health is dynamic equilibrium between human and their environment.
3. Psychosocial concept- This concept states about social cultural and economic as well as psychological
factors in defining health and disease.
4. Holistic concept- This concept includes all biomedical, ecological and psychosocial concept in defining
health and disease.
 Health- “Health is defined as a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity”. (WHO)

3. 6. Dimensions of health
There are five (5) dimensions of health: physical, mental, emotional, spiritual, and social. These five (5)
dimensions of health provide a full picture of health as a change in any dimension affects the others. This
interrelationship between the dimensions of health is one of the key aspects that you need to understand for
Preliminary PDHPE.
Physical
The physical dimension of health refers to the bodily aspect of health. It refers to the more traditional
definitions of health as the absence of disease and injury. Physical health ranges in quality along a continuum
where a combination of diseases such as cancer, diabetes, cardiovascular disease or hypertension are at one
end and a person who is at optimum physical condition (think health not fitness) is at the other.
Mental
Mental health refers to the cognitive aspect of health. Often mental health is linked to or includes emotional
health, I want to distinguish the two. Mental health is more the functioning of the brain, while emotional
health refers to the a persons mood often connected to their hormones. Mental health then includes many
mental health issues such as Alzheimers and dementia. It refers to the persons ability to use their brain and
think. This may be to solve problems or to recall information, but the focus is on the cognitive aspect of the
person.
Emotional
Emotional health is about the persons mood or general emotional state. It is our ability to recognise and
express feelings adequately. It relates to you self esteem as well as your ability control your emotions to
maintain a realistic perspective on situations. The relationship between emotional and mental health is clear
and as such some illnesses relate to both, such as: depression and anxiety.
Spiritual
Spiritual health relates to our sense of overall purpose in life. People often find this purpose from a belief or
faith system, while others create their own purpose. A person who has purpose to life is said to be healthier
than those who don’t see a purpose to life.
Social

4. The social dimension of health refers to our ability to make and maintain meaningful relationships with
others. Good social health includes not only having relationships but behaving appropriately within them and
maintaining socially acceptable standards. The basic social unit of relationship is the family, and these
relationships impact a persons life the most. Other key relationships are close friends, social networks,
teachers, and youth leaders.
7. Positive health
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity"and the ability of the individual to lead socially and economically productive health.
8. Health promotion and maintenance
According to WHO health promotion is "the process of enabling people to increase control over, and to
improve, their health.
Interventions of health promotion
Health promotion is the process of enabling people to increase control over, and to improve, their health. It
is a positive concept emphasising personal, social, political and institutional resources, as well as physical
capacities.
Health maintenance is a guiding principle in health care that emphasizes health promotion and disease
prevention rather than the management of symptoms and illness.
The nurse provides and directs nursing care that integrates health promotion and maintenance.
 Adequate Nutrition
 Sanitary Environment
 Behavioural and life style changes
 Health Education
 Self Care
 Utilization of health services
 National and International coordination
 Public information
 Legislative and restrictive measures
 Prevention of accidents
 Education
 Health Checkups
 Maintenance of records and reports
 Counseling services ( Marriage counseling, Genetic counseling, Sex education)
9. Define Health Education
Health education is a social science that draws from the biological, environmental, psychological, physical and
medical sciences to promote health and prevent disease, disability and premature death through education-
driven voluntary behavior change activities.
• Health education is the development of individual, group, institutional, community and systemic strategies
to improve health knowledge, attitudes, skills and behavior.

5. • The purpose of health education is to positively influence the health behavior of individuals and
communities as well as the living and working conditions that influence their health.
10. Define Holistic health
A health attitude in which an individual’s physical and mental state and life experiences form the basis for his
or her state of health.
a relative state in which one is able to function well physically, mentally, socially, and spiritually in order to ex
press the full range of one's unique potentialities within the environment in which one is living.
11.Ecological concept of health
Ecology is defined as the science of mutual relationship between living organism and their environment.
Human ecology is a part of the science of ecology.
According to the ecologists health is viewed as a dynamic equilibrium between man and environment, and
disease is viewed as an imbalance between the two. Dubos defined health as ‘Health implies relative absence
of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal
function’. Human ecological and cultural adaptations do determine not only the occurrence of disease, but
also food security and population explosion. The ecological concept revolves around two issues: Man and
environment. Adaptation of man to natural environment can result in prolonged life expectancies and better
quality of life even in the absence of modern health amenities.
12. Bio medical Concept of health
Traditionally health was considered as ‘absence of disease’. An individual was considered healthy, if he is free
from diseases. This concept is referred to as biomedical concept. Medically human body is equated to a
machine, and disease was looked as breakdown of machine while doctor was considered as the repairer of
the machine. Thus, health became the ultimate goal of medicine.
Criticism: Biomedical concept has minimized the role of other determinants of health namely social,
environmental, psychological and cultural. Thus, was found inefficient in solving major health related
problems (drug abuse, accidents, malnutrition, etc.).
13. Optimum Health
According to the World Health Organization (WHO), health is defined as: “A state of optimal well-being, not
merely the absence of disease and infirmity.” Optimal well-being requires a balance that comprises the whole
person.
14. Role of a community health nurse in the community
Community health nurses are an integral part of public health initiatives. The American Nurses Association
(ANA) defines public health nursing as "the practice of promoting and protecting the health of populations
using knowledge from nursing, social and public health sciences."
The objectives of the public health nurse should be:
1. To participate in the development of an overall health plan for the community
2. To provide quality nursing services to the people
3. To co-ordinate nursing services with various members of the health team
4. To participate/conduct research relevant to community health
Community health nurses oversee the health and well-being of individuals and groups within their
communities. They perform both clinical and nonclinical duties, but their primary responsibilities are:
 Administering vaccines
 Coordinating immunization clinics, blood donation drives and other outreach programs

6.  Providing educational information and handouts about relevant healthcare topics, including smoking,
STDs, pregnancy, nutrition and disease prevention
 Treating superficial wounds and injuries
 Caring for individuals and families who live in remote areas
 Offering basic diagnostic services, such as glucose and blood pressure monitoring
 Identifying barriers to care and optimal health
 Developing interventions to bridge gaps in care or understanding
 Assessing the community's needs
 Conducting research
 Tracking the health of populations over time
Community health nurses regularly work closely with members of the public. This frequent contact helps
them assess the most pressing issues facing community members as well as "encourage lifestyle changes …
and offer education on healthy living — particularly to the most vulnerable in society,"
15. Levels of health Care
There are 3 different levels of health care systems which are primary, secondary, and tertiary. In this post,
you’ll get to know more about these health care systems. These referral systems are interlinked or
interconnected to one another.
Primary Level of Care
 Devolved to cities and municipalities
 Usually the first contact between the community members and other levels of the health facility.
 Center physicians, public health nurses, rural health midwives, traditional healers.
Secondary Level of Care
 Given by physicians with basic health training.
 Usually given in health facilities either privately owned or government-operated.
 Infirmaries, municipal, district hospital, out-patient departments.
 Rendered by specialists in health facilities.
Tertiary Level of Care
 Referral systemfor the secondary care facilities.
 Provided complicated cases and intensive care.
 Medical centers, regional and provincial hospitals, and specialized hospitals.

7. 16. Principles of Community health Nursing
Community Health Nursing (CHN) is a vital part of Public Health and there are 12 principles the govern CHN.
 The recognized need of individuals, families and communities provides the basis for CHN
practice. Its primary purpose is to further apply public health measures within the framework of the total
CHN effort.
 Knowledge and understanding of the objectives and policies of the agency facilities goal
achievement. The mission statement commits Community Health Nurses to positively actualize their service
to this end.
 CHN considers the family as the unit of service. Its level of functioning is influenced by the
degree to which it can deal with its own problems. Therefore the family is an effective and available channel
for the most of the CHN efforts.
 Respect for the values, customs and beliefs of the clients contribute to the effectiveness of
care to the client. CHN services must be available sustainable and affordable to all regardless of race, creed,
color or socio-economic status.
 CHN integrated health education and counseling as vital parts of functions. These encourage
and support community efforts in the discussion of issues to improve the people’s health.
 Collaborative work relationships with the co-workers and members of the health team
facilities accomplishments of goals. Each member is helped to see how his/her work benefits the whole
enterprise.
 Periodic and continuing evaluation provides the means for assessing the degree to which
CHN goals and objectives are being attained. Clients are involved in the appraisal of their health program
through consultations, observations and accurate recording.
 Continuing staff education program quality services to client and are essential to upgrade
and maintain sound nursing practices in their setting. Professional interest and needs of Community Health
Nurses are considered in planning staff development programs of the agency.
 Utilization of indigenous and existing community resources maximizing the success of the
efforts of the Community Health Nurses. The use of local available ailments. Linkages with existing
community resources, both public and private, increase the awareness of what care they need what are
entitled.
Primary Levelof
Health care Services
•Villege Health Unit
•Sub Centre
•Primary Health
Centre
Secondary Levelof
Health care Services
•Community Health
centre
•District Hospital
Tertiary Levelof
Health care Services
•Speciality
Hospitals
•Teaching Hospitals
•Super Speciality
Hospitals

8.  Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the CHN
programs. Organized community groups are encouraged to participate in the activities that will meet
community needs and interests.
 Supervision of nursing services by qualified by CHN personnel provides guidance and
direction to the work to be done. Potentials of employees for effective and efficient work are developed.
 Accurate recording and reporting serve as the basis for evaluation of the progress of planned
programs and activities and as a guide for the future actions. Maintenance of accurate records is a vital
responsibility of community as these are utilized in studies and researches and as legal documents.
17. Scope of community health Nursing
Community health nurses do everything in their capacity to improve the health of the public and reduce all
social and environmental determinants of illness.
Community health nurses provide nursing services by examining patients’ health. They are distinguished from
other nurses based on their roles and responsibilities. They work as a part of the community that conducts
home visits as well as special clinic and health education activities.
These nurses work in various locations with different groups of people. Depending on where they choose to
work, they may have less or more direct contact with other individuals of the community. The scope of
community health nursing is explained below. These are a few common spaces where these nurses work.
1. Community health centers
This is a setting where the community health nurses work with the members of the community to discuss
their medical needs. They also run campaigns and develop resources around important topics like family
planning, sexual health, and other preventative care. They are in contact with the member of the community
only. Community health nurses may also work outside the community health center to have contact with a
wider cross-section of the community.
2. Correctional facilities
This is a setup where many people are held in close proximity. Community health nurses work to limit the
spread of various communicable diseases. They also run programs for the staff and inmates and implement
various disease control protocols. They work very closely with the state and local health departments.
3. Schools
The scope of Community health nursing expands at the school level as it can help children lead healthier lives
and manage their problems better. Community health nurses provide education on good health and illness
prevention to students in schools. They also help students overcome any health issues the students might be
facing. In case any student is experiencing abuse or neglect, these nurses help them address such issues as
well.

9. 4. Aid organizations
Organizations such as the Red Cross and Doctors without Borders have many community health nurses
working for them. These nurses work with disaster relief, access to clean drinking water, and how to counter
contagious disease along with other needs similar to the work at any community health center.
5. Government agencies
Community health nurses working in a government agency setup have minimal direct contact with the
members of the community. They work on the development of policies and their implementation. They aim
at creating a change on a large scale for different groups.
Responsibilities of a community health nurse
The scope of community health nursing is vast. It is not limited to certain workspaces and responsibilities.
Below, we have tried to cover the major responsibilities of a community health worker.
 Plan, implement and evaluate prevention activities and programs
 Quick response in case of epidemic outbreaks
 Counsel patients and conduct health screening
 Provide health education at the school level and develop educational plans for individuals
 Enhance the ability of individuals to seek mental health treatment and address social needs
 Demonstrate nursing techniques for home care of the ill and injured
 Observe patient-family interaction at home
 Assess various physical, social, and health statuses of individuals and families
 Provide health care in line with other health professionals to improve patient health
 Refer patients to appropriate clinics when medical intervention is required
 Identify the outbreak of health issues in the community
 Work with various cultural patterns and identify the health outcomes of the same
 Record patient data, complete state form and daily nursing report
 Coordinate health-related services in allotted programs
This was the scope of community health nursing.
18.Enumerate the functions of Community health nurse
Community health nurses, like all nurses, engage in the role of managing health services.
Planner/Programmer
Identifies needs, priorities, and problems of individuals, families, and communities
1. Formulates municipal health plan in the absence of a medical doctor
2. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned
staff personnel
3. Provides technical assistance to rural health midwives in health matters
Provider of Nursing Care
Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace
1. Develops the family’s capability to take care of the sick, disabled, or dependent member
Community Organizer
Motivates and enhances community participation in terms of planning, organizing, implementing, and
evaluating health services
1. Initiates and participates in community development activities

10. Coordinator of Services
Coordinates with individuals, families, and groups for health related services provided by various members of
the health team
1. Coordinates nursing program with other health programs like environmental sanitation, health
education, dental health, and mental health
Trainer/Health Educator
Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots
1. Conducts training for RHMs and hilots on promotion and disease prevention
2. Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health
and health related services
3. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes
4. Conducts pre-marital counseling
Health Monitor
Detects deviation from health of individuals, families, groups, and communities through contacts/visits with
them
Role Model
Provides good example of healthful living to the members of the community
Change Agent
Motivates changes in health behavior in individuals, families, groups, and communities that also include
lifestyle in order to promote and maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation
Researcher
Participates in the conduct of survey studies and researches on nursing and health-related subjects.
Coordinates with government and non-government organization in the implementation of
studies/research.
In additionto these a CHN shall;
 Plan, implement and evaluate prevention activities and programs
 Quick response in case of epidemic outbreaks
 Counsel patients and conduct health screening
 Provide health education at the school level and develop educational plans for individuals
 Enhance the ability of individuals to seek mental health treatment and address social needs
 Demonstrate nursing techniques for home care of the ill and injured
 Observe patient-family interaction at home
 Assess various physical, social, and health statuses of individuals and families
 Provide health care in line with other health professionals to improve patient health
 Refer patients to appropriate clinics when medical intervention is required
 Identify the outbreak of health issues in the community
 Work with various cultural patterns and identify the health outcomes of the same
 Record patient data, complete state form and daily nursing report
 Coordinate health-related services in allotted programs

11. This was the scope of community health nursing. Though it is not limited to just these responsibilities.
19.Characteristics of Community health Nursing
It is known as the nursing practice in the community, with the primary focus on the health care of individuals,
families, and groups in a community.
The goal of community health nursing is to protect, preserve, promote or maintain health.
Community health nursing is a field of nursing that combines nursing practice with public health science to
formulate a community-oriented and population-focused practice.
It synthesizes the knowledge from the public health sciences and professional nursing theories to improve
the health of communities and vulnerable populations.
 It is a field of nursing.
 It combines public health with nursing.
 It is population focused.
 It emphasizes prevention, health promotion, and wellness.
 It promotes client responsibilities and self-care.
 It uses aggregate measurement and analysis.
 It uses principles of organizational theory.
 It involves inter professional collaboration.
20. Goals of Community Health Nursing
The goal of community health nursing is to
 Promote healthy lifestyle.
 Prevent disease and health problems.
 Provide direct care.
 Educate community about managing chronic conditions and making healthy choices.
 Evaluate a community's delivery of patient care and wellness projects.
 Institute health and wellness programs.
21. Importance of Community Health Nursing
The significance or importance of community health nursing has explained the below:
1. Community health nursing offers unique challenges and opportunities for expanding nursing’s focus
from the individual and family to encompass communities and the opportunity to impact the health
status of populations.
2. Direct responsible for the community to maintain the community health.
3. Community nursing is concerned with the interchange between population groups and their total
environment.
4. Community health nursing is most importantly population-focused.
5. Determining the needs of populations at risk and the opportunity for designing interventions to
address their needs.
22. Define Primary Health care
Primary health care (PHC) is essential health care made universally accessible to individuals and acceptable to
them, through full participation and at a cost the community and country can afford. It is an approach to
health beyond the traditional health care system that focuses on health equity-producing social policy.

12. Primary health-care (PHC) has basic essential elements and objectives that help to attain better health
services for all.
23. Elements of Primary Health Care (PHC)
There are 8 elements of primary health care (PHC). That listed below-
1. E-Education concerning prevailing health problems and the methods of identifying, preventing,
and controlling them.
2. L– Locally endemic disease prevention and control.
3. E– An expanded program of immunization against major infectious diseases.
4. M– Maternal and child health care including family planning.
5. E– Essential drugs arrangement.
6. N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
7. T– Treatment of communicable and non-communicable diseases and the promotion of mental
health.
8. S– Safe water and sanitation.
Extended Elements in the 21st Century:
1. Expended options of immunizations.
2. Reproductive health needs.
3. Provision of essential technologies for health.
4. Health promotion.
5. Prevention and control of non-communicable diseases.
6. Food safety and the provision of selected food supplements.

13. 24. Principles of Primary Health Care (PHC):
 Equity
 Community Participation
 Intersectoral Coordination
 Appropriate Technology
 Preventive approach
Equity/Equitable Distribution
The first key principle in primary health care strategy is equity or equitable distribution of health services.
Health services must be shared equally by all people irrespective of their ability to pay and all ( rich or poor,
urban or rural) must have access to health services. Currently health services are mainly in towns and
inaccessibility to majority of population in the developing world.
Community Participation
Overall responsibility is of the State. The involvement of individuals, families, and communities in promotion
of their own health and welfare is an essential ingredient of primary health care. PHC coverage cannot be
achieved without the involvement of community in planning, implementation and maintenance of health
services.
Inter sectoral Coordination
Declaration of Alma –Ata states that PHC involves in addition to the health sector all related sectors and
aspects of national and community development, in particular education, agriculture, animal husbandry,
food, industry, education, housing, public works and communication.
To achieve cooperation, planning at country level is required to involve all sectors.
Appropriate Technology
Technology that is scientifically sound, adaptable to the local needs, and acceptable to those who apply it
and those for whom it is used and can be maintained by the people themselves with the resources of the
community and country can afford.
Preventive approach
A Community Health Nurse is responsible for providing awareness among the public on various prevailing
health problems and measures to control these problems.
25. Determinants of health
Many factors combine together to affect the health of individuals and communities. Whether people are
healthy or not, is determined by their circumstances and environment.
The determinants of health include:
 the social and economic environment,
 the physical environment, and
 the person’s individual characteristics and behaviours.
The context of people’s lives determine their health, and so blaming individuals for having poor health or
crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of

14. the determinants of health. These determinants—or things that make people healthy or not—include the
above factors, and many others:
 Income and social status - higher income and social status are linked to better health. The greater the
gap between the richest and poorest people, the greater the differences in health.
 Education – low education levels are linked with poor health, more stress and lower self-confidence.
 Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and
roads all contribute to good health. Employment and working conditions – people in employment are
healthier, particularly those who have more control over their working conditions
 Social support networks – greater support from families, friends and communities is linked to better
health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
 Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of
developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active,
smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
 Health services - access and use of services that prevent and treat disease influences health
 Gender - Men and women suffer from different types of diseases at different ages.