CONCEPT OF COMMUNITY HEALTH ,COMMUNITY HEALTH NURSING , PRIMARY HEALTH CARE AND ROLE OF COMMUNITY HEALTH NURSE

1. BY
NISHA.P
ASSISTANT PROFESSOR
DEPARTMENT OF
COMMUNITY HEALTH
NURING

2. DEFENITIONS
The word community had its origin from Latin word COMMUNIS.
COMMUNITY :
A community is defines as social group determined by geographical
boundaries and or common value and interest ,its members known and interact
with each other .it functions within particular structure and exhibits and creates
certain norms, values and social interaction.
WHO-1947
community is defines as group of people living to in same place or having
a particular characteristics in common

3. CONTD..
COMMUNITY HEALTH:
community health refers to the health status of the members of the
community to the problems affecting their health and to the totality of the health
care provide for the community.
WHO -1971
community health nursing is defined as the art and science of maintaining
,protecting and improving health of people through organized efforts.
AMERICAN ASSOCIATION OF PUBLIC HEALTH

4. CONTD..
COMMUNTY HEALTH NURSING:
Community health nursing is a synthesis of nursing practice and public
health practice applies in promoting and preserving the health population. The
nature of this is a continuous and not episodic .The dominant responsibilities is
to the population as a whole. ANA- 1973
community health nursing synthesis of body of knowledge from the public
health science and professional nursing theories for the purpose of improving
the halth of entire community .this goal lies at the heart of primary prevention
and health promotion and its foundation for public health nursing practice.
APHA -1981

5. Health and Wellness
Health
 Each person has a personal perception of health. Some people describe their
state of health as good even though they may actually have one or more
diagnosed illness . That is because each person perceives health in relation to
personal expectations and values
Health is defined as a state of physical, mental and social well being not merely
the absence of disease or infirmity (WHO, 1948)
For example, a person may see himself/herself as health.

6. wellness
Wellness is a life – style aimed at achieving physical, emotional,
intellectual, spiritual and environmental well being..
The concept of wellness also allows for individual variability.
Wellness can be thought of a balance of the physical, emotional,
psychological, social and spiritual aspects of a Community. This is a
dynamic state.
These include, for example, stress management, nutritional
awareness, and physical fitness.

7. CONCEPT OF HEALTH
BIOMEDICAL CONCEPT
ECOLOGICAL CONCEPT
PSYCOSOCIAL CONCEPT
HOLISTIC CONCEPT

8. 1) Bio-medical Concept
Traditionally health has been viewed as an "absence of disease". This concept
was known as the bio-medical concept of health which dominated medical
thought during 20th Century.
The medical profession viewed the human body as a machine and disease as a
consequence of the breakdown of the machine and one of the doctors' tasks as
repair of the machine. Thus health in this narrow view became the ultimate goal
of medicine.
The criticism that is leveled against the bio-medical concept is that it has
minimized the role of the environmental, social, psychological and cultural
determinants of health.

9. 2) Ecological Concept
The ecologist put forward an attractive hypothesis which viewed
health as a dynamic equilibrium between individual and his
environment and disease as a maladjustment of human organism to
environment.
Ecologists Dubos said, "Health implies the relative absence of pain
and discomfort and a continuous adaptation and adjustment to the
environment to ensure optimum functions".
The ecological concept also captures imperfect man and imperfect
environment.

10. 3) Psycho-Social Concept
Contemporary development in social science reveals that health is
not only a bio-medical phenomenon, but one which is influenced by
social, psychological, cultural, economic and political factors of the
people concerned.
These factors must be taken into consideration while defining and
measuring health. Thus health is both a biological and social
phenomenon.

11. 4) Holistic Concept
The holistic model is a synthesis of the all above concepts. It recognizes the
strength of social, economic, political and environmental influences on health.
 It has been variously described as a multidimensional process involving the
well-being of a person in the context of his environment. This view corresponds
to the traditional view that health implies sound mind in a sound body and a
sound family in sound environment.
The holistic approach implies that all sectors viz. agriculture, animal husbandry,
food, industry, education, housing, public work, communications etc. have a
great effect on health

12. DIMENSIONS OF HEALTH
PHYSICAL
DIMENSION
MENTAL
DIMENSION
SOCIAL
DIMENSION
SPIRITUAL
DIMENSION
EMOTIONAL
DIMENSION
VOCATIONAL
DIMENSION

14. CONCEPTS OF COMMUNITY
HEALTH
1. All aspects of life contribute to health and wellbeing.
2. The relationship between the community and the individual is symbiotic.
3. Each community has a unique set of assets and inequities, and should be
approached accordingly.
4. Community health should be community-led, with community members
serving as co-producers.
5. Decisions by stakeholders involve trade offs.
6. Communities impact (and are impacted by) events and policies at regional,
national, and global levels.

15. PRINCIPLES COMMUNITY HEALTH
1. Health care should be shape around the life pattern of the
population .it should serve and meet the need of the community.
2. Primary health care should be an integral part of the national health
system and other services should be designed in support of the needs
of the peripheral level.
3.Health care activities should be fully integrated with the activities
of other sectors involved in community development

16. SCOPE OF COMMUNITY HEALTH
NURSING
1.HOME CARE :
 prevent the disease
 Preserve the health
 Promote the health
2. NURSING HOMES:
 They run privately
 Provide medical care services
Child services

17. Contd..
3. MCH AND FAMILY PLANNING:
Antenatal
Postnatal
4.SCHOOL HEALTH NURSING :
Health education
Early detection of disease
Immunization
First aid
School sanitation
Follow up.

18. Contd..
5.COMMUNITY HEALTH NURSING :
 Provide primary health care
To conduct routine antenatal and postnatal visits and to conduct deliveries
Conducting under five clinics
To assess environmental and social needs.
6. INDUSTRIAL NURSING SERVICES.
Medical and nursing staffs
Pre-employement check up .
First aid
Industrial sanitation

19. Contd.
7. DOMICILLARY NURSIG SERVICES:
Maternity services
Disease preventive services
8. MENTAL HEALTH NURSING
Mental health services
Rehabilitation
Psychotherapy
9. REHABILITATION CENTRES
Restoration of all treated cases to the highest level of functional ability.
10. GERIATRIC NURSING SERVICES

20. AIMS OF COMMUNITY HEALTH NURSING
 To promote health and efficiency.
 Prevention and control diseases and
disabilities.
 Need based health care to prolong life.

21. OBJECTIVES OF COMMUNITY HEALTH
NURSING
 To increase capability of individuals ,families ,group of people and community at large
 To strength the community resources
 To control and counteract the environment
 To improve the ability of the community to deal with their own health problems
 To strengthen the community resources
 To prevent and control communicable and non-communicable diseases
 To provide specialized services for mothers,children,adult,workers elderly
handicapped etc
 To conduct research
 To participate in preparing health personnel to function in community.
 To supervise ,guide and help other health personnel.

22. PRINCIPLES OF COMMUNITY HEALTH NURSING
1. Community health nursing is community focused, it is therefore essential to know
the defined community, make a map ,and establish a effective working relation ship.
2. It is based on identified community health needs and functions.
3. Integration of Health education, guidance and supervision with community health
nursing services.
4. Health services should be realistic in terms of available resources.

23. Contd..
5. Professional relationships and etiquette are essential in community health
nursing.
6. Community is in focus and than the individual which is the unit of all health
care services.
7. Community participation is the integral part of the community health services.
8. Individual and family members participation fully in all decision making
relating to attainment of health

24. Contd..
9. Effective health worker irrespective of position or place of work ,function as a
team
10. continuous services are effective services and community health nurse must
provide continuous health services.
11. well developed system of records and reports is essential for community
health services
12. Periodic and continuous appraisal and evaluation of health situation and
health services are basic to community health.

25. Contd.
13. Health services should be available and accessible to all without any
discrimination.
14. Health worker should be non political ,nonsectarian in his /her relationship.
15. Health worker must maintain professional dignity and must never accept any
gift or bribe.
16.Health should function within the policies ,general goals and objectives set by
the health agencies.

26. CONCEPTS OF COMMUNITY
HEALTH NURSING
1. The primary focus of the community health nursing practice is on
the primary health promotion.The community health nurse have to
evaluate the health status of people and group.
2. Community health nursing practice is extended to benefit not only
the individual but the whole family and community.
3. Community health nurse are generalized in terms of their practice
through life continuum ,its full range of health problems and needs.

27. Contd..
4. Contact with the client and the family may continue over a long
period of time which includes al ages and all types of health care.
5.The nature of community health nursing practice requires that
current knowledge derived from biological and social.
6.The dynamic process of assessing , planning ,implementation and
evaluation.

28. PRIMARY HEALTH CARE
A new approach to health care came in to
existence in1978 following an international
conference at Alma- ata (USSR) .this is known
as primary health care.it was first proposed by
the Bhore committee.

29. CONTD..
DEFINITION:
◦ Primary Health Care is essential health care made universally accessible to
individuals and families in the community by means acceptable to them,
through their full participation and at a cost that the community and country
can afford. It forms an integral part both of the country's health system of
which it is the nucleus and of the overall social and economic development of
the community. ALMA -ATA

31. CONTD..
1. Education on health problems and how to prevent and control them.
2. Development of effective food supply and proper nutrition.
3. Maternal and child healthcare, including family planning.
4. Adequate and safe water supply and basic sanitation.
5. Immunization against major infectious diseases.
6. Local endemic diseases control.
7. Appropriate treatment of common diseases and injuries.
8. Provision of essential basic medication.

32. OBJECTIVES OF PRIMARY HEALTH CARE
To increase the programs and services that affect the healthy growth and
development of children and youth.
To boost participation of the community with government and community
sectors to improve the health of their community.
To develop community satisfaction with the primary health care system.
To support and advocate for healthy public policy within all sectors and levels
of government.
To support and encourage the implementation of provincial public health
policies and direction.

33. CONTD..
To provide reasonable and timely access to primary health care services.
To apply the standards of accountability in professional practice.
To establish, within available resources, primary health care teams and
networks.
To support the provision of comprehensive, integrated, and evidence-based
primary health care

34. PRINCIPLES OF PRIMARY HEALTH CARE
PRINCIPLES
COMMUNITY
PARTICIPATION
APPROPRIATE
TECHNOLOGY
INTERSECTORAL
COOR
EQUITABLE
DISTRIBUTION

35. 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

36. COMMUNITY PARTICIPATION
Overall responsibility is of the State and central government ,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.
It is now considered that ASHA and Anganwadi worker are essential features of
primary health care in India

37. INTERSECTORAL 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 and other sectors

An important element Intersectoral approach is planning with other sectors to
avoid duplication.

38. 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.

39. ROLES AND RESPONSIBILITIES OF
COMMUNITY HEALTH NURSE:
1. Clinician,
2. Educator,
3. Advocate,
4. Managerial,
5. Collaborator,
6. Leader,
7. Researcher.

40. Contd..
1. Clinician Role or Direct care provider:
The clinician role in the community health nurse means the nurse ensures health
care services, not just to individuals and families but also to groups and
populations of the community.
For community health nurses the clinician role involves certain emphasis
different from basic nursing, i.e. – Holism, health promotion, and skill expansion

41. Contd..
2. Educator Role:
It is widely recognized that health teaching is a part of good nursing
practice and one of the major functions of a community health nurse
(Brown, 1988).
Assesses the knowledge, attitudes, values, beliefs, behaviors,
practices, stage of change, and skills of the community people and
provides health education according to knowledge level.

42. Contd..
3. Advocate Role:
The issue of clients’ rights is important in health care today. Every patient or
client has the right to receive just equal and humane treatment.
 A community health nurse is an advocate of patient’s rights about their care.
They encourage the individuals to take the right food for maintaining health, the
right drugs for the treatment, and the right services at the right place where ever
needed.
They provide sufficient information to make necessary health care decisions,
promote community awareness of significant health problems.

43. Contd..
4. Managerial Role:
As a manager the nurse exercises administrative direction
towards the accomplishment of specified goals by assessing
clients’ needs, planning and organizing to meet those needs,
directing and controlling and evaluating the progress to
assure that goal are met.

44. Contd..
5. Collaborator Role:
Community health nurses seldom practice in isolation.
They must work with many people including clients, other nurses,
physicians, social workers, and community leaders, therapists,
nutritionists, occupational therapists, psychologists, epidemiologists,
biostatisticians, legislators, etc. as a member of the health team
(Fairly 1993, Williams, 1986).

45. Contd..
6. Leader Role:
Community health nurses are becoming increasingly active in the
leader role. As a leader, the nurse instructs influences or persuades
others to effect change that will positively affect people’s health.
The leadership role’s primary function is to use a change of health
policy based on community people’s health; thus, the community
health nurse becomes an agent of change.

46. Contd..
7. Research Role:
In the researcher role community health nurses engage in systematic
investigation, collection, and analysis of data to solve problems and
enhance community health nursing practice.
Based on the research result community nurse improve their service
quality and improve community people’s health.