According to American Nursing
“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. it is 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 holistic approach to the
management of the individual, family group
and community. The nurse’s actions
acknowledge the need for comprehensive
health planning, recognize the influences of
social and ecological issues, give attention to
populations at risk and utilize dynamic forces
which influence change.
Philosophy of CHN
Philosophy of individual’s right of being
Philosophy of working together under a
competent leader for the common good.
Philosophy of CHN
Philosophy that people in the community
have the potential for continual
development and are capable of dealing
with their own problems if educated and
Philosophy of Socialism.
Aims of CHN
The aim of community health nursing
practice is to promote health and
To prevent and control diseases and
To prolong life by providing need based,
well balanced comprehensive health
care services to community at large
through organized community efforts.
1) To increase the capability of community to deal
with their own health problems.
2) To strengthen community resources
3) To control and counteract environment
4) To prevent and control communicable and non-
5) To provide specialised services
6) To conduct research
7) To prepare health personnel
Principles of CHN
1)Recognized needs and functioning within
the total health programme.
2)Clearly defined objectives and purposes for
3)An active organized citizens group of the
community group is an integral part of the
community health programme.
4)Community health nursing services are
available to the entire community
Principles of CHN
5)Community health nursing recognized the
family and community as units of service.
6)Health education and counseling for the
individual, family and community are the
integral part of community health nursing.
7)Participation in planning relating to goals for
the attainment of health.
8)The community health nurse should qualify as
a full-fledged nurse.
9)Based on the needs of the patient and there
should be proper continuity of services to
Principles of CHN
10) Periodic and continuous appraisal and evaluation of
11) The community health nurse should function/serve
as an important member of the health team.
12)There should be provision for qualified nurse to
make supervision for community health services.
13)The community health nurse directs the patient to
appropriate community resources for necessary
financial and social assistance.
14)Should not accept gifts or bribes from the patients
Principles of CHN
15)The community health nurse should not belong to one
particular section or political group.
16)Community health agency should provide a continuing
education programme for nurse
17)The nurses assume responsibilities of their own continuing
professional development through acquiring higher and
higher education and forming and strengthening the
18)The community health nursing services should develop
proper guidelines, in maintaining records and reports.
19)There should be proper facilities and job conditions.
20)The community health nurse should maintain professional
relationship with all leaders in the community and maintain
ethics at all times.
Quality assurance in CHN
Define quality assurance
Quality assurance can be defined as ”the
promise or guarantee that certain standards of
excellence are being met in care delivered.”
Goals of quality assurance
To ensure the delivery of quality client
To demonstrate the efforts of the health
care provider for the best possible
Two Approaches of Quality
Model quality assurance
The primary purpose of a quality
programme is to ensure the results of an
organized activity are consistent with
Steps in Model Quality Assurance
1)identify the sources needed
2)Describe the nature of the personnel
required to handle resources, supplies,
equipments, facilities and finance.
3)Once the resources are identified, then
policies, procedures, job descriptions
should be clearly laid down for use.
The primary approach used for process
evaluation includes the peer group
committee and the client satisfaction
Technique used for process evaluation
is direct observation, questionnaire,
interview, written audit and videotape of
client and provider.
For the purpose of evaluation the nurse
uses client’s admission data, acuity of the
problem and discharge data that may point
out changes in the level of dependence
Direct physical examination and interview
will help a lot measure the outcome.
This will help one to identify the causes
and problems associated with health care.
Evaluation, Interpretation and
Interpretation is one of the major
components of quality assurance
Evaluation of the process should be
carried out at major intervals and
periodic reports should be prepared.
Action is the final step in quality
The action must be based upon their
significance, economic benefits and
Health provider evaluation
It is essential to determine the individual
service provider’s contribution to the quality
assurance programme .
Punctuality and performance are needed to
evaluate the individual based on traditional
Objective oriented action tools are developed
in consultation with supervisor and the nurse.
Staff review committees are the most
common review committees designed to
assess the clent-specific aspects of
certain levels of care.
The audit is the major tool used to
ascertain the quality of care:
Process of Nursing Audit
Selection of a topic for study.
Selection of a explicit criteria for quality
Review of records whether criteria are met.
Peer review of all the cases that do not
meet the criteria.
Specific recommendations to correct the
Follow-up to determine whether problems
have been eliminated.
Types of Nursing Audit
Concurrent audit is used by Medicare and
Medicaid to evaluate care being received
by public health/home health clients.
Identification of the problems.
Provision of a mechanism for identifying
and meeting client needs during care.
Implementation of measures to fulfill
Provision of a mechanism for
communicating on behalf of the client.
1) Time consuming
2) Less cost efficient than retrospective Audit.
3)It does’t represent the total picture of the
care that the client will ultimately will
Retrospective audit or outcome audit
the quality of care through appraisal of the
nursing process after the client’s discharge
the health care system.
1) Comparison of actual practice to
standard of care
2) Analysis of actual practice findings
3) A total picture of the care given.
4) More accurate date for planning
1) Focus of evaluation is directed away from
2) Client problems are identified after
so corrective action can be only used to
the care of the future.
Community Nursing Theories
The model PRECEDE is an acronym for
predisposing, reinforcing and enabling causes in
educational diagnosis and evaluation.
Two basic propositions underscore the outcome
oriented PRECEDE model.1)Health and health behaviours
are caused by
2)Health education designed to influence the
behavior must be multi-dimensional.
Health Belief Model
It has 3 major components:
3)Variables affecting the likelihood of initiating
Contributory factors in Health Belief Model
Health promotion model
Pender (1987) developed this model to be used
as a complement to health protecting models
like Health Belief Model.
Determinants of health promotion behavior are
They include factors like:
Importance of health
Definition of health
Barriers to health-promoting behavior.
A conceptual framework refers to global ides
about individuals, groups, situations and
of interest to a discipline. A conceptual model
provides a reference platform for members of
discipline to guide their thinking, observation
Models applicable in CHN
1) System model
It is postulated by Von Bertalanffy(1952)
It focuses on the organization,
interaction, interdependency and
integration of parts and elements.
Application to Community Health Nursing
The community is a social system made
of interrelated subsystems.
The subsystems include economic,
educational, religious, health care,
political, welfare. law enforcement,
energy and recreational systems
They are interrelated and have a
specific orientation towards each other.
It is a way of thinking how changes occur
based on theories of development of the
According to Lewis,the change may be
both reactive and structural.
The reactive theory emphasizes the
influence of environment in development
programmes,and the structural theory
emphasizes the genetically determined
programme for development
Application to CHN
It is useful in working with infants and
children,because the major role of a
nurse working with them is to assess the
developmental progress and to promote
overall growth and development.
These models are based upon theories that
stem from philosophical writings such as those
of Cooley(1969) and Mead(1934).
The major concepts used in interaction models
are communication, perception, role playing
and self conception.
Application to CHN
Lucita M. Public health and community
health nursing in the new millennium. 1st
ed. Chennai: B.I Publications Private
Limited; 2006. p.88-93,136-43.
Gulani KK.Community health nursing:
principles and practices. 1st ed. Delhi:
Kumar Publishing House; 2008.p.33-46.
Stanhope M,Lancaste J. Community
Health Nursing:promoting health of
aggregates,families and individuals. 4th ed.