This chapter comes under fourth unit of Community health Nursing subject for fourth year BSc Nursing students. This helps the students to get detailed information about concepts,elements, principles of primary health care & role & responsibilities of Community Health Nursing Personnel

1. CONCEPTS IN COMMUNITY
HEALTH NURSING
Unit - 4

2. Approaches in
community
health nursing
● EPIDEMIOLOGICAL
APPROACH
● EVIDENCE BASED
APPROACH
● PROBLEM SOLVING
APPROACH
● NURSING THEORIES &
NURSING PROCESS
● EMPOWERING PEOPLE
TO CARE FOR
THEMSELVES

3. NURSING
PROCESS

4. ● The nursing process involves the series of intellectual
steps or thinking activities leading the nursing
interventions such as assessment, nursing diagnosis,
planning, implementation & evaluation.
● Community health nursing is assisting sick individuals to
become healthy & healthy individuals achieve optimum
wellness.

5. Steps / Phases of Nursing Process
A - ASSESS (what is the situation)
D - DIAGNOSE (what is the problem)
P - PLAN (how to improve/ stabilize the problem)
I - IMPLEMENT (putting plan into action)
E - EVALUATE (did the plan work)

6. Community assessment helps to:-
● Identify community needs
● Clarify problems
● Identify strength & resources

7. Methods of data collection
● Informant interviews
● Participant observation
● Questioning methods
● Record review
● Discussion

8. Steps in community identification
● Identify the community & establish definition & meaning of
community
● Identify areas of family health assessment (Basic
information, resources)
● Environmental considerations (Intra mural & extramural)
● Health status & health practices of the family
● Demographic information
● Family life styles
● Risk factors (hereditary, development, lifestyle, socio
economic, environmental)

9. Community diagnosis
● It is defined as determining the pattern of health problems
in a community including factors which influence this
pattern.
● The problems can be identified under:-
1. Health status problems
2. Health resources problems
3. Health related problems

10. The 3 part community nursing diagnosis format proposed by
Muecke:-
1. Risk of ……..
2. Among …….
3. Related to ……
Eg:- Risk of antenatal mother with anemia among low
socioeconomic families related to lack of regular health
screening, illiteracy, lack of knowledge regarding nutrition

11. PRIMARY
HEALTH CARE

12. Concept of health care

13. ● Health care implies more than medical care.
● It embraces a multitude of services provided to individuals
or communities by agents of the health services or
professions, for the purpose of promoting, maintaining,
monitoring or restoring health.
● Health care is a public right & its the responsibility of the
government to provide care to all people in equal
measures.

14. Levels of health care
PRIMARY
CARE
LEVEL
SECONDARY
CARE LEVEL
(First Referral
Level)
TERTAIRY
CARE
LEVEL

15. Changing concepts in health care
1. COMPREHENSIVE HEALTH CARE
● It was first used by BHORE committee in 1946.
● The criterias are:-
a) Provide adequate preventive, curative & promotive health
services
b) Be as close to the beneficiaries as possible
c) Has the widest cooperation between the people, services & the
profession
d) Available to all irrespective of their ability to pay
e) Look after specifically vulnerable & weaker sections in
community
f) Create & maintain healthy environment at home as well as in

16. 2. BASIC HEALTH SERVICES
3. PRIMARY HEALTH CARE
● It was introduced by WHO in 1978 through Alma Ata
Declaration.
● The Alma Ata Conference defined primary health care as:-
● “An essential health care made universally accessible to
individuals & acceptable to them, through their full
participation & at a cost the community & country can
afford”.

17. Elements of primary health care
1. Health education - concerning prevailing health problems
& the method of preventing & controlling them.
2. Promotion of food supply & proper nutrition
3. Maternal & child health care including family planning
4. Adequate & safe water supply
5. Immunization against major infectious diseases
6. Prevention & control of local endemic diseases & injuries
7. Provision of essential & basic household drugs for the
community
8. Promotion of mental health

18. Concepts / Principles of Primary health
care
1. EQUITABLE DISTRIBUTION
2. MANPOWER DEVELOPMENT
3. COMMUNITY PARTICIPATION
4. APPROPRIATE TECHNOLOGY
5. INTERSECTORAL COORDINATION

19. Roles & Responsibilities of Community
Health Nursing Personnel

20. ● Family health services
● Information education
communication (IEC)
● Management information
system : Maintenance of
records & reports
● Training & supervision of
various categories of health
workers
● National health programmes
● Environmental sanitation
● MCH &family welfare
● Treatment of minor ailments
● School health services
● Occupational health
● Organisation of clinics, camps
● Waste management in centre,
clinics etc.

21. Family health services
Family : Universal / basic social institution
Definition of family
The family is a group of persons united by ties of
marriage, blood or adoption, constituting a single household;
interacting & communicating with each other in their
respective social roles of husband & wife, mother & father,
son & daughter, brother & sister; & creating & maintaining a
common culture.

22. Definition of family health
Family health is a dynamic changing relative state of well
being, which includes the biological, psychological, spiritual,
sociological & cultural factors of individual members & the
whole family system.
Definition of family health nursing
Family health care nursing is the process of providing for
the health care needs of families that are within the scope of
nursing practice.

23. Objectives of family health nursing
1. To identify health needs, nursing needs & problems of
each family.
2. To ensure family understands & accept needs & problems
3. To plan & provide health & nursing services with the active
participation of family members.
4. To help families develop abilities to deal with their health
needs & health problems independently.

24. 5. To help family make intelligent use of promotive,
preventive, therapeutic & rehabilitative & health & allied
facilities & services in the community.
6. To educate, counsel & guide family members on the
cultural practices & maintaining wholesome physical,
psychological & spiritual environment.

25. Purposes of family health nursing
Family health nursing care provides opportunities to make
direct observations of:-
● Home environment , family structure, familial roles &
relationships, lifestyle, cultural practices, resources, group
dynamics etc, & make family health assessment.
● Family’s identification with neighbourhood & community.
● It provides opportunities to contact & interact with most of
the family members & establish rapport with the family as
a whole.

26. ● Family members are relaxed at home settings, hence have
more time & privacy & feel free to raise questions, seek
clarification & sort out their problems.
● It makes feasible to plan & provide comprehensive family
health care with major emphasis of promotive & preventive
care.
● It also makes possible to have active participation of
family members in planning & implementing family health
care services

27. ● It provides opportunities to make direct observation of
care given by family members & accordingly for
supervision & guidance.
● It provides opportunity to maintain continuity of family
health care.

28. Family Centered Nursing Approach
MILY
FAMILY AS
CONTEXT
FAMILY AS A
COMPONENT
OF SOCIETY
FAMILY AS A
SYSTEM
FAMILY AS
CLIENT
FAMILY

29. Role Of Nurse In Family Health
● Health educator
● Coordinator, collaborator
or liaison
● Deliverer & supervises the
care & technical expert
● Family advocate
● Consultant
● Counselor
● Case finder &
epidemiologist
● Environmental modifier
● Clarifier & interpreter
● Researcher
● Role model
● Case manager

30. INFORMATION, EDUCATION & COMMUNICATION
{IEC}
● IEC combines strategies, approaches & methods that enable
individuals, families, groups, organisations & communities to
play active roles in achieving, protecting & sustaining their
own health.
● Information:- It means telling something to an individual
about a person or a thing or a subject.
● Education:- It is a gradual process of learning through which
a person gains knowledge & understanding of a subject.

31. ● Communication:- It is a two process of giving information or
sharing ideas between 2 or more than 2 persons.
● Message:- It is what is transmitted in the communication
process & message content is related to the behaviour that
needs to be changed or encouraged.

32. COMMUNICATION
ELEMENTS OF
COMMUNICATIO

33. Functions of communication
● Sharing of information or
idea
● Increasing knowledge
● Influencing people for
change in attitude &
beliefs
● Bringing about
behavioural change
● Persuasion & negotiation
● Motivation
● Counseling
● Giving instructions
● Reaching a decision
● Building human
relationship
● Entertainment

34. Barriers of communiaction
● Poor planning
● Inadequate knowledge
● Too much or too less
information
● Unaware of knowledge,
attitude & practice of
community
● Failure of understand
cultural differences
● Poor communication
skills
● Poor presentation
● Selection of inappropriate
channels & media
● Inappropriate language
● Technical errors
● Insufficient feedback
● Inadequate
communication material

35. Role & responsibility of a CHN in planning &
organising a communication programme
● Identify the communication needs of a community
● Prioritize the needs & decide the topic for communication
● Identify the target audience & assess their knowledge, attitude &
practices
● Define communication goal & objectives
● Give a name to the programme with specific logo
● Prepared media implementation plan for each day

36. ● Identify suitable channel, media & techniques for communication
● Develop suitable social messages & material
● Prepare communication material
● Train communicators
● Prepare budget & ensure its availability
● Decie duration, time & palace for organizing the programme
● Implement the programme, assess the impact & reinforce the
messages.

37. HEALTH INFORMATION TECHNOLOGY
● Also known as ELECTRONIC MEDICAL RECORDS
● It is a system where medical professionals store the
information usually contained in a patient chart on a
computer rather than on a paper.
USES
● Improving healthcare quality
● Prevents medical errors
● Reduces healthcare costs

38. ● Increases administrative efficiencies
● Decreases paperwork
● Expands access to affordable care
● Early detection of infectious disease outbreaks
● Improved tracking of chronic disease management.

39. HEALTH INFORMATION SYSTEM (MIS)
● It is a process whereby health data are recorded, stored,
retrieved & processed for decision making.

40. Uses:-
● To measure the health status of the people & to quantify their
health problems & medical & health care needs
● For local, national & international comparisons of health status
● For planning, administration & effective management of health
services & programmes
● For assessing whether health services are accomplishing their
objectives i terms of their effectiveness & efficiency
● For assessing the attitudes & degree of satisfaction of the
beneficiaries with the health system
● For research into particular problems of health & disease.

41. PUBLIC HEALTH
Health promotion, disease surveillance,
disaster Mx, environment protection,
school health, laboratories Mx.
HEALTH SYSTEM Mx
Developing & implementing health
policies, programmes & projects,
mobilizing & allocation for the above
projects & services.
Individual care, primary care,
secondary care, tertiary care,
reproductive health of women,
child health

42. Drawbacks in Health information system
● No coordination effort in district, state & central level
● Duplication & gaps in data collection, reporting, use &
management of data due to poor coordination of each
department
● Fragmented data in different directions
● Computers issued by government are not in working conditions
● The data collected mostly are incomplete, unreliable & unused
● Overburden of work at gross root level & no in time submission
of reports.

43. RECORDS
● They are essential channel of communication in the healthcare
system.
● A record is written communication which conveys specific
information to a person or group of people.

44. Purposes of records
● Communication
● Legal documentation
● Planning care
● Statistics
● Education
● Audit
● Reimbursement
● Health care analysis

45. Principles of record writing
● Records must be written clearly & legibly
● Records are legal documents & should contain facts based on
observation, conversation & action
● Select relevant facts & factors in the situation & record them
briefly & clearly
● Records are used as basis for research & evaluation hence
accuracy & completeness is essential
● Record systems are essential for efficiency & uniformity of
services, so develop efficient filling system

46. ● Records should provide periodic summary to determine
progress & to make plans
● Records should be written immediately after an interview &
should be neat & concise
● Records are valuable documents & they should be carefully
handled
● Records are confidential documents, not to be shown or
discussed other than those providing health services.

47. Types of records
1. CUMULATIVE or CONTINUING RECORD
2. FAMILY RECORD

48. Eg: of records at UHC & PHC
● Eligible couple
● Male & female sterilization
cases
● Condom distribution
● Oral pills
● MTP
● Birt, death register
● Dai follow up
● Malaria slides taken &
radical treatment cases
● Disease morbidity &
mortality
● Summary of village
● IEC activities
● Minor ailment register
● Referral register
● Drug stock register
● Under 5 clinic register
● IUD register
● Drug/injection register

49. REPORTS
● Reports are oral, written or computer based communication
intended to convey information to others.
● Reports summarizes the services of the nurse & or the agency.

50. Purposes of report
● To show the kind & amount of services rendered over a specified
period
● To illustrate progress in reaching goals.
● Act as an aid in studying health conditions in planning
● To interpret the services to the public & to the other interested
agencies.

51. Types of reports
1. ORAL REPORT - They are given when the information is for
immediate use, & for permanent. Eg: reports from dais, ASHA
worker, village health guide etc
2. WRITTEN REPORT - They are written when the information
is to be used by several people or is more or less of permanent
value. They can be used for administrative or management
purpose. Eg: reports prepared by PHN, FHW etc.

52. Policies for maintaining record system
● Family folders must be kept neatly in numerical order & village
wise
● Each family should have a family folder & must be register in the
village register.
● The family health cards of main & sub families living in one
house are kept in one family folder.
● The village wise family register gives the family folder number,
house number, name of the head of the family & its members,
date of birth

53. ● Each family should have a family index card
● Newly admitting antenatals should be registered in respective
village antenatal register.
● Morbidity cards must be made when necessary
● A record of daily activities must be made for the purpose of
making out monthly & yearly report.

54. TRAINING & SUPERVISION OF VARIOUS
CATEGORIES OF HEALTH WORKERS
Supervision refers to directing, investigating, helping & advising the
subordinates in the performance with the purpose of achieving the
essential objectives

55. Objectives
● To help their subordinates to do their duty skillfully & effectively
● To develop subordinates capacity to the fullest extent
● To promote effectiveness of the subordinates
● To motivate subordinates in their career development & to
maintain high morale
● To promote teamwork

56. Purposes
● To oversee the work of others & establish control to improve the
quality of work as well as effectiveness of the worker
● Supervision aims at improving the quality of work, promoting
morale, motivation & team spirit among the workers.
● It is also used to evaluate the performance of the healthcare
worker in the actual work place & provide technical advice &
support.

57. Methods of supervision
● Individual conference
● Group conference
● Direct observations
● Review of records
● Orientation
● Continuing education
● Staff meeting

58. Skills of
supervisor
● Interpersonal
skills
● Conceptual skills
● Technical skills