INTRODUCTION TO COMMUNITY HEALTH NURSING

1. Presented by:
Mrs.Betty George
Asst.Professor
Department of Community Health Nursing

2.  Community – Latin word “COMMUNIS”.
 A community is a social group determined by geographical
boundaries and / or common values and interests.
 Its members know to interact with each other.
 It functions within a particular structure and exhibits and
creates certain norms, values and social institution.”
 Community is a collection of people.
 Community is a place.
 Community is a social system.
 Community is a highly important habitat of man.
 Health is related to individual.
 But concerted and cooperated effort to people in the
community is needed for individuals health.

3.  Community health Nursing is the synthesis of
nursing and public health practice applied to
promote and protect the health of population.
It combines all the basic elements of
professional, clinical nursing with
public health and community practice.

4. Concepts of community health nursing:
 Concepts of community health nursing Healthful community.
 Empowerment for health promotion.
 Prevention of premature death Prevention of disease, illness and
disability.
 Promotion and maintenance of health.
 Rehabilitation.
Other concepts includes:
 Physical health
 Emotional health
 Social health
 Environmental health
 Spiritual health
 Mental& Intellectual health

5.  Philosophy of individual’s right of being
healthy.
 Philosophy of working together under a
competent leader for the common good.
 Philosophy that people in the community
have potential for continued development
and are capable of dealing with their own
problems if educated and helped.

6.  Professional relationships and etiquette are
essential in community health services.
 Individual and families participate fully in all
decision making relating to attainment of health.
 Continuous services are effective services and
community health nurse must provide
continuous health services.
 well developed system of records and reports is
essential for community health services.

7.  Periodic and continuous appraisal and
evaluation of health situation and health
services are basic to community health.
 Health services should be available and
accessible to all without any discrimination.
 Health worker should be non – political,
nonsectarian in her / his relationship .
 Health worker must maintain professional
dignity and must never accept any gift or
bribe.

8. Characteristics of Community Health Nursing includes:
 Community health nursing is integral part of community
health.
 Community health nursing is a specialized field of nursing.
 Community health nursing synthesizes community health
with nursing.
 In community health nursing, the whole community is the
client.
 Community health nursing emphasizes on primary level
prevention .
 Community health nursing promotes self care
responsibility.
 Community health nursing involves multidisciplinary team
approach.

9.  Community health nursing is working for
people, with people and by people.
 Community health nursing is seeking support
from and giving support to personnel.
 Community health nursing is dealing with
wide range of health problems and health
needs and providing need based generalized
health services.
 Community health nursing is providing
continuous and not episodic care

10. Objectives of Community Health Nursing:
 To increase capability of individuals, families,
and groups and community to deal with their
own health problems.
 To strengthen community resources.
 To control and counteract environment.
 To prevent and control communicable and
non-communicable diseases .
 To provide specialized services for mothers,
children, adults, workers, elderly
,handicapped and eligible couples etc.

11.  To conduct research and contribute to the
further refinement and improvement of
community health nursing practice.
 To participate in preparing health personnel
to function in community for community
health care services.
 To supervise, guide and help health
personnel in carrying out their functions
effectively.

12. Principles of Community Health Nursing:
 Community health nursing is community
focused, it is therefore essential to know the
defined community, make a map and maintaining
effective working relationship.
 Community health nursing is based on identified
community health nursing needs and functions
within total community health programmes.
 Health education, guidance and supervision are
integral part of community health nursing
services.

13.  Health services should be realistic in terms
of available resources.
 The health worker is responsible to the
authorized health authority and function
within the policies, general goals and
objectives set by the health agency.
 Effective health worker irrespective of
position or place of work, functions as a team

14.  The primary role of the community health
nurse is to work within the community to
support population health and deliver
preventive health care services. ... Cultural
competency that enables effective practice
with diverse individuals, families, and groups
within the community of care.

15. Direct Care Provider
Educator
Counselor
Advocate
Manager
Case Finder
Coordinator
Good Observer
Good Leader
Health Planner
Collaborator
Epidemiologist
Participant in planning
Primary Health Care Practitioner
Role Model
Researcher

17. CHN
Principal
Vice principal
Professor
Reader
Asso.Professor
Asst.Professor
Lecturer
Tutor
Clinical
Instructor
•School health
nurse
•Occupational
health nurse
•Travel nurse
•Parish nurse
•Home nurse
•MCH & F.P
•Domiciliary nurse
•Rehabilitation
nurse
•Mental health
nurse
•Geriatric nurse
Co-ordinate
Conduct
DPHN
SHN
CHN
VHN

18. Introduction:
 Before one can fully grasp the nature of community health or
define its practice, it is helpful to understand the roots and
influencing factors that shaped its growth over time . Community
health nursing is the product of centuries of responsiveness and
growth. Its practice was adapted to accommodate the needs of a
changing society, yet it has always maintained its initial goal of
improved community health. Community health nursing
development has been influenced by changes in nursing, public
health and society that is traced through several stages.
Early history (Vedic period) Indus valley civilizations 3000
BC there were planned cities , houses built with public baths with
drainage. People practiced proper environmental Sanitation 1400
BC Ayurveda and Siddha Systems of medicine come into
existence which suggested development of comprehensive
concept of health.

19.  Pre – Independence Era Early History Indus Valley
Civilization(before 3,000 B.C) – planned cities
with drainage, houses and public baths built of
backed bricks (Environmental Sanitation)
 1400 B.C – Invasion of Aryans. Ayurveda and
Siddha medicine came into existence.
 Manu Samhita – prescribed rules and regulations
for personal health, dietetics, hygienic rituals,
unity of physical, mental and spiritual aspects of
life.
 Sarve Jana Sukhino Bhavatu – may all men be free
from diseases and may all be healthy

20.  Post vedic period (600 B.C – 600 A.D) – medical
education in University of Taxila and Nalanda
leading to the titles of Pranacharya and
Pranavishara .
 Hospital system was introduced for men, women
and animals by Rahula Sankirtyana .
 650 BC– 1850 A.D – Muslim rulers came to India.
Arabic system of medicine ( Unani ) introduced.
Due to political changes the medical education
and medical services became static and ancient
universities and hospitals disappeared

21.  British India 1757 – British established their
rule. Civil and military services established.
 1825 – Quarantine Act was promulgated.
 1859 – Royal commission was appointed.
Pointed out the need for the protection of
water supplies, construction of drains and
prevention of epidemics . Established
“Commission of Public Health”
 1864 – sanitary commission was appointed in
Madras, Bombay & Bengal.

22.  1869 – Public Health Commissioner & Statistical
Officer appointed.
 1873 – Birth and Death Registration Act was
promulgated.
 1880 – Vaccination Act was passed.
 1881 – Indian Factories Act was passed. First
Indian census was taken.
 1885 – Local Self Government Act was passed.
Local government came into existence.
 1888 – local bodies was directed to look for
sanitation but no local public staff appointed.


23.  1896 – severe epidemic of plague occurred in India. Plague
commission was appointed.
 1897- Epidemic Disease Act
 1904 – plague commission report submitted. It
recommended the reorganization and expansion of public
health department & establishment of laboratory facilities
for production of vaccines .
 1909 – Central Malaria Bureau at Kausali (Himachal
Pradesh)
 1911 – Indian Research Fund Association (now called as
ICMR) to promote research.
 1912 – Govt. India decided to help the local bodies.
Appointed Deputy Sanitary Commissioners & Health
Officers.

24.  1918 – Lady Reading Health School, Delhi &
Nutrition Research Laboratory, Coonoor was
established.
 1919 – First step in decentralization of health
administration.
 1920 – 21 – Municipality & Local Board Acts
passed containing legal provisions for
advancement of public health.


25.  1929:The Child Marriage Restraint Act( Sarda Act)
came into effect. (Girl – 14 yrs and Boys – 18 yrs)
 1930 – All India Institute of Hygiene and Public
Health, Calcutta established in aid with Rockfeller
Foundation.
 1931 – Maternity and Child Welfare Bureau
established .
 1935 – Government of India Act (1919) revitalized.
Health activities in the country grouped .
 1937 – Central Advisory Board of Health was set up
with Public Health Commissioner as Secretary and
representatives from provinces and Indian states as
members.

26.  1939 – Madras Public Health Act was passed.
First Rural Health training Centre was
established at Singur (west Bengal)with the
aid from Rockefeller Foundation. Tuberculosis
Association of India was established.
 1940 – Drugs Act was passed.
 1943 – The Health Survey and Development
Committee ( Bhore committee) was appointed
– to survey the existing position with regard
to health conditions and health organization.

27.  1946 – Bhore committee submitted its report.
It reviewed on the following and
recommended short and long term
programme to attain reasonable health.
Public health Medical relief Professional
education , Medical research, International
health.

28.  Post independence era 1947 – Ministries of
health established in state & center.
 Post of Director General of Health Services
was formed by combining the posts of Public
Health Commissioner& director general of
Indian Medical Service.
 1948 – India joined WHO as a member state.
 ESI Act passed in 1948.
 The report of the Environmental Hygiene
Committee was published.

29.  1949 – constituent Assembly adopted the
constitution of India(Article 246 covers all the
health subjects).
 Post of registrar general of India created in the
ministry of home affairs.
 The Indian Research Fund Association was
reconstituted as ICMR.
 1950 – planning commission was set up.
 1951 – First five year plan begin. BCG
vaccination programme launched.
 1952 – community development block launched.
Central council of health was constituted. Primary
health center was set up.

30.  1953 – NMCP commenced.
 National Extension programme was started
for rural development.
 Nation wide family programme was started.
 1954 – Contributory Health Service Scheme
was started at Delhi.
 The Central Social Welfare Board was set up.
 National water supply & sanitation
programme was inaugurated.
 NLCP was started.
 The prevention of Food Adulteration Act was
passed.

31.  1955 – NFCP was commenced.
 The central leprosy teaching and research institute
established in chengelpet.
 A filaria training centre was established at Ernakulum.
 The Hindu marriage act passed.
 National TB sample survey commenced.
 1956 – second five year plan launched.
 The central health education bureau was established.
Director for family planning was appointed.
 Demographic training & research centre established
in Bombay
 The TB center established in Madras.
 The immoral traffic act was passed.
 Trachoma control pilot project was established.

32.  1957 – influenza pandmeic swept the country.
 The demographic research centers was established in
Calcutta, Delhi & Trivandrum.
 1958 – NMCP converted into NMEP.
 Leprosy Advisory committee of the Govt. of India was
constituted.
 national TB survey was completed.
 1959 – Mudhaliar committee was appointed.
 Central expert committee was appointed under ICMR
to study the problems of cholera and chicken pox in
India.
 Rajasthan was the first state to introduce panchayath
raj.
 National TB institute was established at Bangalore.
 The national research laboratory at coonoor was
shifted to Hyderabad.

33.  1960 – School Health Committee was constituted.
 A National Nutrition Advisory Committee was
constituted.
 Pilot projects for eradication of small pox was
initiated.
 1961 – Third five year plan launched.
 The report of Mudhaliar Committee was published.
 The Central Bureau of Health Intelligence was
established.
 1962 – Central Family Planning Institute was
established in Delhi.
 National Small Pox Eradication Programme was
launched.
 The School Health Programme was initiated.
 National Goiter Control Programme was launched.
 The District Tuberculosis Programme was
formulated.

34.  1963 – Applied Nutrition Programme was
launched.
 National Institute of Communicable Diseases was
inaugurated.
 Contributory Health Service Scheme was changed
into CGHS.
 Extended family planning programme was
launched.
 Chadha Committee established a norm of one
basic health worker for every 1000 population.
 A drinking water board was set up.
 1964 – National Institute of Health
Administration and Education was opened in
collaboration with Ford foundation.

35.  1965 –Reinforced extended family planning
was launched.
 BCG vaccination on a house to house basis
introduced.
 1966 – Mukherjee committee was set up.
 Minister of health was also appointed for
minister of family planning.
 A separate department for family planning
was started.
 1967 – A small family norm committee was
set up.

36.  1968 – small family committee’s report was
submitted .
 A bill of registration of birth and death was
passed.
 The govt. of India appointed medical
education committee.
 1969 – fourth five year plan launched.
 The central births and deaths registration act
was promulgated.
 The report of the medical education
committee was submitted.

37.  1970 – The Drugs Order was promulgated.
 All India Family Planning Programme was
started.
 The population council of India was formed.
 The registration of births and deaths Act
came into force.
 1971 – The family pension scheme for
industrial workers came into force.
 MTP bill passed in parliament.
 An expert committee was appointed to draft
legislation on air pollution.

38.  1972 – MTP act came into force.
 1973 – The national programme for minimum
needs was incorporated with the fifth five
year plan.
 The government initiated a scheme of setting
30 bedded rural hospitals one for 4 PHC.
Kartar singh committee submitted its report.
 1974 – fifth five year plan launched.
Parliament enacted the Water Act.

39.  1975 – India became small pox free.
 Govt. of India accepted NMEP.
 ESI Act amended.
 Cigarettes Regulation Act was passed in
parliament.
 Shrivastav committee submitted its report.
 1976 – Indian Factories Act amended.
 The prevention of food adulteration act came
into force.
 The equal remuneration act was promulgated.
 New population policy announced.
 National programme for prevention of
blindness was formulated.

40.  1977 – National Institute of Health and Family
Planning formed.
 Rural health scheme was launched.
 Revised modified plan of malaria eradication
put into operation.
 1978 – child marriage restraint bill approved
in parliament.
 1979 – offices of family welfare and NMEP
were merged and named as Regional Office
for health and family welfare.
 1980 – sixth five year plan launched.
 Small pox was officially declared from entire
world.

41.  1981 – census was taken. The Air Act was
enacted.
 1982 – new 20 point programme was announced.
National health policy announced.
 1983 – NLCP called as NLEP.
 Guinea worm eradication programme launched.
 1984 – Bhopal gas tragedy occurred.
 Workmen’s compensation act came into force.
 Juvenile Justice Act came into force.
 1985 – seventh five year plan launched.
 A separate department of women and child
development was set up.

42.  1986 – The Environment Act promulgated.
Mental health bill was voted in parliament.
 1987 – new 20 point programme was
launched.
 Safe motherhood campaign was launched.
 National diabetes control programme and
national AIDS control programme initiated.
 1989 – blood safety programme was
launched.
 1990 – control of ARI programme initiated.
 1991 – decadal census was conducted.

43.  1992 – eighth five year plan was launched.
CSSD was launched. The Infant Milk
Substitute, Feeding Bottles and Infant Foods
Act came into force.
 1993 – RNTCP with DOTS introduced.
National Nutrition policy formulated.
 1994 – Return of plague.
 Panchayath Raj Act came into force.
 1995 –ICDS renamed as IMCD.
 The Legislation on Transplantation of Human
Organs was enacted.
 Expert Committee on Malaria submitted its
report and recommended Malaria Action Plan.

44.  1996 – PPI launched.
 Family planning programme made target free.
 Yaws eradication programme came into force.
 1997 – RCH launched. Ninth five year plan
launched.
 1998 – 99 – NFHS II undertaken.
 NMEP renamed as National Anti – Malaria
Programme.
 Phase – II of National AIDS Control Programme
became effective.
 National Policy for Older Persons announced.

45.  2000 – govt. of India announced national
population policy.
 Declared guinea worm free country. Signatory of
UN millennium declaration.
 National commission on population constitute.
 2001 – fist census of the century.
 National policy for empowerment of women
launched.
 2002 – National Health Policy announced.
 Govt. announced National AIDS Prevention and
Control Policy.
 Tenth five year plan launched. Emergence of
SARS.
 2003 – parliament approves the Cigarette and
Tobacco Products Act.
 NVBDCP approved.

46.  2004 – Vandematarum scheme launched.
 Revised programme of National support to primary
education launched.
 Low osmolality Ors introduced.
 IDSP launched.
 National guidelines on infant and young child feeding
formulated.
 2005 – RCH – II launched.
 JSY launched.
 NRHM launched.
 IPHS for community centers formulated.
 National plan of Action for children formulated.
 India achieved leprosy elimination target.

47.  2006 – WHO releases pediatric growth chart.
 Ban on child labor.
 RNTCP covers whole country.
 NFHS – II conducted.
 IMNCI launched.
 2007 – 11 th five year plan launched.
 NACP –III launched.
 IPHS standards for PHC and sub center formulated.
 Maintenance and welfare of parents and senior
citizens bill passed.
 2008 – Non communicable diseases programme was
launched.


48.  2009 – H1N1 outbreak.
 New ICDS mother and child protection card
came into force.
 2010 – ICMR announces nutrients
requirement for RDA for Indians.

49.  Conclusion Community health nursing is concerned with
the people who are sick as well the healthy, young and old,
male and female.
 Community health nurse is responsible for family centered
care rather than an individual oriented one.
 Community health and community health nursing draw
knowledge and practices from other discipline like
medicine, surgery, pediatrics, obstetrics, gynecology,
dentistry, health education and vital statistics.
 Thus the community health nursing aims to meet the
health needs of the individuals in their normal
environment (school, home, place of work).