community health nursing

1. B.Sc. NURSING II YEAR
COMMUNITY HEALTH NURSING-I
UNIT – I-INTRODUCTION
Prepared by
Mrs. K. Indumathi,
M.Sc. Nursing
Asst.Professor
1

2. 2
OVERVIEW
•Introduction to Community health nursing
•Definition
•Concept
•Dimenstions
•Measurement of health and diseases
•Vital statistics
•Maintenance of health

3. 3
INTRODUCTION
Community health implies in integration of
Preventive, Promotive and Curative aspects of
health services.
concerned with
The nurse most directly
giving health
individuals and families in
education and
the
care to
community

4. DEFINITION
COMMUNITY: It is a social group determined
with geographical boundaries, common values
and interests. It’s members know and interact
with each other. It functions within a particular
structure and exhibits and creates norms, values
and social institutions
4

5. HEALTH
Health is a state of complete physical, mental,
social, spiritual wellbeing, and not merely an
absence of disease or infirmity.
5

6. NURSING
Nursing is a service which includes care to the sick,
care of the whole patient, the care of patient’s
environment, health education and health services
to the individual family and society for the prevention
of disease and promotion of health.
6

7. COMMUNITY HEALTH NURSING
It is defined as nursing services organized by a
community or agency to carry out nursing aspects
of community health programme in homes,
schools, industries or in the health centers
7

8. DEFINITION OF
COMMUNITY HEALTH NURSING
•Community health nursing is a synthesis of
nursing and public health practice applied of
promoting and preserving the health of people.
The practice is general and comprehensive. It is
not limited to a particular age group or diagnosis,
and continuing, not episodic.

9. Philosophy of community health
nursing
Individuals right
of being healthy
Working together
towards common
goal
Social systems
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10. Aims of community health nursing
•To improve quality of life
•To reduce risk factors
•To improve standard of living
•To strengthen self care activities of individuals
10

11. Objectives
•To prevent, promote, maintain and restore the
community health
•To reduce morbidity and mortality rate among
community
•To increase the life span for individuals
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12. COMMUNITY HEALTH
Well
12
health
system
Establishing
responsibility
towards health
Control of
communicable
and non
communicable
functioning diseases
Education
Safe
environment
COMMUNITY
HEALTH

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PRINCIPLES OF COMMUNITY HEALTH
NURSING
•Nursing services should be planned according to the
need of the community
•Community nurses should function in collaboration
and coordination with other personnel to achieve
optimum community health.
•Community health nurse should be qualified and are
accountable, responsible and authorized health
authority for her services

14. 14
Cont…
• Job condition should be conductive for optimum
satisfaction
• Health services should be based on the felt needs
• All CHNs and supervisors should function as a team
• Professional relationship and etiquette are essential in
community health services
• Health services should be available to all
irrespective of their age, sex and status
• The CHN should never accept money or gifts
people

15. 15
Cont…..
• Health service should be realistic in terms of
available personnel & facilities
• Follow up services
• Evaluation of services
• Facilities for further training & continuing education
• Influential people should help in carrying out the
health activities

16. CONCEPT OF COMMUNITY HEALTH
NURSING
Promoting
health and
wellness
Preventing
illness
Restoring
health
Care of dying
16

17. SCOPE OF COMMUNITY HEALTH
NURSING
ce
• Home care
• Nursing homes
• MCH and family planning
• School health nursing
• Health care services
• Industrial nursing services
• Domiciliary nursing service
• Geriatric nursing service
• Mental health nursing servi
• Rehabilitation centers
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18. 18
FUNCTIONS OF CHN
•Comprehensive health care to individuals,
families and groups
•Develops goals to meet needs- action
programme, evaluating progress
•Assistance to family in improving environmental
conditions
•Providing safe environment in home, school and
industry
•Providing supportive services to doctor such as
early symptom detection

19. 19
Cont….
•Demonstration and teaching of skilled nursing care
of the sick in home
•Supervising the work of dais, midwives
•Helping in the adjustment of social and emotional
conditions that affect health
•Coordination of work with health care
professionals
•Revising and revitalizing plan and programmes
•Epidemiologic investigations in field of
communicable diseases

20. 20
Cont…
•Organizing planned group classes in health
•Development and utilization of facilities
•Responsible for planning, implementation &
evaluation of a practical plan of nursing
administration
•Involving in research and collection of vital statistics

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QUALITIES OF CHN
•Educational qualification
•Interest
•Understanding in people’s behaviour
•Sincerity
•Empathy
•Friendly
•Charitable
•Resourceful

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Cont….
•Cooperative responsible
•Initiative
•Skillful in
• Observation
•Communication
•Interviewing
•Technical skills
•Ability to
•Interpret
•Judge
•Take decisions

23. CONCEPTS OF HEALTH
disease, then the person was considered
healthy. This concept known as biomedical
concept.
Biomedical concept
Traditionally health has been viewed as an
absence of disease, and if one was free from
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24. 24
Cont…..
•It has the basis in the germ theory of disease.
•The medical profession viewed the human
body as a machine, disease as a consequence
of the breakdown of the machine and one of
the doctors task as repair of the machine.

25. •Deficiencies in the biomedical concept gave
rise to other concepts.
•Health as a dynamicequilibrium between man
disease a
organism to
and his environment and
maladjustment of human
environment.
Ecological concept
25

26. 26
•Dubos defined “health
absence of pain and
implies the relative
discomfort and a
continuous adaptation and adjustment to the
environment to ensure optimal function”.
•The ecological concept raises two issues-
imperfect man and imperfect environment.

27. Contemporary developments in social science
revealed that health is not only a biomedical
phenomena, but one which is influenced by
social, psychological, cultural, economic and
political factors of the people concerned.
Psychological concepts
27

28. 28
Cont….
•These factors must be taken in to consideration
in defining and measuring health.
•Thus health is both a biological and social
phenomena.

29. •The holistic model is a synthesis of all the
above concepts.
•It recognize the strength of social, economic,
political and environmental influences on
health.
Holistic concept
29

30. 30
Cont…
• It has been variously described as a unified
or multidimensional process involving the well-
being of the whole person in the context of his
environment.
•This approach implies that all sectors of society
have effect on health.

31. 31
Cont…
•Agriculture, Animal Husbandry, Food, Industry,
Education, Housing, Public Works,
Communications and Other Sectors.
•The emphasis is on the promotion and
protection of health.

32. DIMENSIONS OF HEALTH
Health is multidimensional.
• Physical dimension
• Mental dimension
• Social dimension
• Spiritual dimension
• Vocal dimension
• Emotional dimension
• Others
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33. Physical dimension
33
•The stage of physical health implies the notion
of “perfect functioning” of the body.
•It conceptualizes health biologically as a state
in which every cell and every organ is
functioning at optimum capacity and in perfect
harmony with the rest of the body.

34. CONT….
The signs of physical health in an individual
are:
A good complexion,
A clean skin,
Bright eyes,
Lustrous hair with a body well clothed with firm
flesh, not too fat,
A sweet breath,
A good appetite,
Sound sleep,
Regular activity of bowels and bladder and
smooth, easy,
Coordinated bodily movements. 34

35. 35
Evaluation of physical health
•Self assessment of overall health
•Inquiry in to symptoms of ill-health and risk factors
•Inquiry in to medication
•Inquiry in to levels of activity
•Inquiry in to use of medical services
•Standardized questionnaires for cardiovascular
diseases, respiratory diseases.
•Clinical examination
•Nutrition and dietary assessment
•Biochemical and laboratory investigations.

36. Mental dimension
36
•Mental health is not mere absence of mental
illness.
•Good mental health is the ability to respond to
many varied experiences of life with flexibility
and a sense of purpose.
•Mental health has been defined as a state of
balance between the individual and the
surrounding world, a state of harmony between
oneself and others, a coexistence between the
realities of self and that of other people and that
of the environment.

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The characteristics of a mentally healthy person
are
•A mentally healthy person is free from internal
conflicts: he is not at war with himself.
•He is well-adjusted, ie., he is able to get along well
with others.
•He searches for identity.
•He has a strong sense of self-esteem.
•He has good self-control balances
•He faces problems and tries to solve them
intelligently.

38. Social dimension
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•Social well-being implies harmony and integration
within the individual, between each individual and
the world in which they live.
•It has been defined as the quantity and quality of
an individual’s interpersonal ties and the extent of
involvement with the community.

39. 39
Cont….
•The social dimension of health includes the level of
social skills one possesses, social functioning and
the ability to see oneself as a member of a large
society.
•Social health
management
is rooted in positive material
and positive human environment
which is concerned with the social network of the
individual.

40. Spiritual dimension
40
•Spiritual health refers to part of the individual which
reaches out and strives for meaning and purpose of
life.
•It is the intangible something that transcends
physiology and psychology .
•It includes integrity, principles and ethics, the
purpose in life, commitment to some higher being
and belief and belief in concepts that are not
subject to state of the art explanation.

41. Emotional dimension
41
•Historically the mental and emotional dimensions
have been seen as one element or as two closely
related elements.
•Mental health can be seen as knowing or cognition
while emotional health refers to feeling.
•The mental and emotional aspects of humanness
may have to viewed as two separate dimensions of
human health.

42. Vocational dimension
42
•The vocational aspect
dimension
of life is a new
•It is a part of human existence
•When work is fully adapted to human goals,
capacities and limitations, work often plays a
role in promoting both physical and mental
health.

43. 43
Cont….
•Physical work is usually associated with an
improvement in physical capacity, while goal
achievement and self-realization in work are a
source of satisfaction and enhanced self-esteem.
•Vocational dimension may be a source of income

44. Others
Philosophical dimension
Cultural dimension
Socio-economic dimension
Environmental dimension
Educational dimension
Nutritional dimension
Curative dimension
Preventive dimension
44

45. VITAL STATISTICS
45
Introduction
Vital statistics constitute an essential tool in
demography like statistical study of population and
public health. They provide answer to various health
related questions

46. 46
Origin of vital statistics
John Graunt (1620- 1674)
Who studied the weekly bills of mortality
and discovered Urban death and Rural death.
He is called father of vital statistics
William Farr ( 1807 – 1883)
Who analyzed the vital events , which serve
as Yard stick for measuring the health status
of the population.
He is called Father of Medical Statistics

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Definition
Vital statistics may be defined as the systematic
collection and compilation and presentation,
analysis and distribution of statistics pertaining to
vital events are recorded. E.g., live birth, deaths,
marriages etc that occur in the community.

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Classification of Vital Statistics
• Mortality Statistic
• Morbidity Statistics
• Fertility Statistics
• Population Statistics

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Methods of collecting Vital Statistics
• Population Census Method
• Civil Registration Method
• Sample Registration System
• Model Registration System / Rural survey
of causes of Death
• Medical certification of causes of death
• National Sample survey
• Institutional Records / Hospital Records

50. 50
Methods of collecting Vital Statistics
• Community survey Reports
• Notification Disease Register
• Epidemiological surveillance Report
• Environmental health Records
• Other Health Manpower Statistics
• Population Surveys
• Miscellaneous Sources

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Uses of Vital Statistics
•To find out what are the leading causes of
morbidity and mortality.
•To know what is the age, sex, class and area
wise distribution of various health related
variables
•To find out what is the composition of the
population and what are the future trends
•To know what health program should be given
priority
•To compare the present health statistics with
past statistics

52. 52
Uses of Vital Statistics
•For planning and administration of health services
•To determine the priority of health problems
•To discover the solution for any health problem
•To estimate future needs and demand
•To promote health legislation
•For the evaluation of the health program success
or failure
•For the prediction of health trends.

53. 53
Method of calculating Mid Year
Population
•Natural Increase Method
•Arithmetic Progression Method
•Geometric Progression Method

54. 54
Arithmetic Progression Method
Eg: The population of Avadi in 2009- 5,10,000
and in the year 2018 – 6,20,000. Calculate the
mid year population in 2007.
•Population in 2018 = 6,20,000
•Population in 2009 = 5,10,000
•So the difference = 1, 10,000 is for 10 year
• So Per year is 1,10000/10 = 11,000

55. 55
 Mid year population always should be
calculated from end February to 1st of July ( so
that is 6 year and 4 months)
 = 6 1/3= 19/3
 11,000 x 19/3 = 69,667
 Now the calculation is Pt = Po + rt
 t = period in year after the last census.
r = Annual increase rate
Pt = population at the required time
Po = population at the last census

56. Calculation of incidence and prevalence
Rate
Incidence Rate = No of new cases
X 1000
Total Population
Prevalence Rate = new cases + Existing cases
Total population
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57. 57
Mortality rates
• Crude Death Rate = Total no of death
- x 1000
Mid Year Population

58. Perinatal Mortality Rate =
Still birth + Death under 1 week
x 1000
Total live birth + Still birth
ASFR ( Age specific fertility Rate )
ASFR = No of birth in specific age of women
- - - - - - - - - - - -- x1000
No of women in sp. Age with mid year
population
58

59. Calculate the following
TFR ( Total fertility Rate )
TFR = Sum of all specific fertility rate x width of each
age group
- -
1000
GFR ( Gross fertility Rate )
GFR = No of live Birth
- x 1000
No of women between the age Gp of (15- 49)
59

60. Healthy Lifestyles
•Wellness is determined partly by lifestyle choices.
•Studies by the National Institute of Aging show
that:
- Moderate alcohol use
- Safe environments
- Social supports
- Regular health care
• Healthy eating
• Physical activity
• Mental stimulation
• Not smoking
• Active social engagement
are important in maintaining health and
independence.
MAINTENANCE OF HEALTH
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61. Other Factors Related to Wellness
•Fitness: can prevent heart disease,
hypertension, and lower back pain.
•Preventive care: including immunizations
and health care screening tests.
•Spiritual health
•Safety: prevention of injuries and
accidents, emergency preparedness,
CPR.
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62. Other Factors Related to Wellness
•Nutrition: prevent diseases like
osteoporosis and cancer, proper nutrients.
•Tobacco Addiction
•Stress Management
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63. Healthy Lifestyles-Health Maintenance
Practices
•Become aware of the obvious and not-as-
immediately obvious situations that trigger stress.
•Minimize or avoid exposure to those situations.
•Establish good dietary habits.
•Eat well balanced, nutritious meals.
•Moderate intake of salts, fats, white sugar,
caffeine, and alcohol.
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64. Practices Cont..
•Establish a pattern of regular
cardiovascular exercise.
•Contributes to a positive mental attitude.
•Avoid smoking.
•Smokers are at a much greater risk of dying
from heart disease, respiratory disease, and
cancer.
•There are no “safe cigarettes”.
•Chewing tobacco and snuff should also be
avoided.
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65. Practices Contd..
•Learn how to relax.
•Relaxation brings to the body enormous
restorative energy.
•Getting enough sleep is also important.
•Develop and maintain social supports.
•Feeling connected to family, friends,
classmates, work colleagues, and/or to
community, social, political, or religious
organizations plays a vital role in the
maintenance of one’s mental well-being.
65

66. Practices Contd..
•Conflicts.
•Expect conflicts to occur, but learn to deal
with them in a head-on manner.
•An unnecessary burden is created when
conflicts are allowed to go unaddressed for
too long.
66

67. Practices Cont..
•See your doctor regularly for preventive care.
•Preventive services the following:
•Tests/screenings
•Measurements
•Advice about diet, exercise, tobacco, alcohol
and drug use, stress, and accident
prevention.
•Immunizations.
•Special tests at certain times in your life.
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68. 68
Practices Contd..
To take care of your health, you need to feel
comfortable talking with your doctors and nurses.
• Ask questions: if you don’t understand what they
are saying, ask them to explain.
• Tell providers your health history as well as
your health now: mention family history of
diseases and conditions; provide a complete list of
medications you are taking, etc.
• Follow up: Call the provider if you have questions
or need more information after you leave.

69. Health Maintenance Practices
Every day you have a chance to
make good choices about your
health.
• Set small goals instead of
large ones that you won’t be
able to meet.
• Reduce your risk for heart
disease.
• Watch your weight.
• Eat right.
• Stay active.
• Prevent skin cancer.
• Prevent injuries.
• Take medicines correctly.
• Make smart choices
about sexual and
reproductive health.
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70. 70
Health Maintenance Practices
Overcome depression.
Warning signs:
•Feel sad, hopeless, or
guilty most of the time.
•Feel tired or lack energy.
•Thoughts of suicide or
death.
•Sleep either too much or
too little.
•Change in appetite – lost
or gained weight.
•Lost interest and
pleasure in daily
activities.
•Problems making
decisions or thinking
clearly.
•Depression treated
with counseling,
medicine, or both.
•Treatment works
gradually over several
weeks.

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High Risk Behaviors
•Appropriate safety
practices are
essential.
• Sexual behaviors:
abstinence,
monogamy, seeking
health care for
signs of sexually
transmitted
infections.
•Obtain appropriate
health screenings.
•Don’t use tobacco
or illegal drugs.
•Don’t drink and
drive.
•Use seat belts and
other safety
equipment.
•Take gun safety
classes.

72. Alternative Health Practices
•Health or medical practices are called
“alternative” if they are based on untested,
untraditional, or unscientific principles,
methods, treatments, or knowledge.
•If the “alternative” health practice is offered
along with conventional medicine, it is referred
to as “complementary” medicine.
72

73. Holistic Health Care
•Care that promotes physical, emotional, social,
intellectual, and spiritual well-being by treating
the whole body, mind, and spirit.
•Each person is recognized as a unique person
with different needs.
•Uses many methods of diagnosis and treatment
in addition to traditional Western medical
practice.
73

74. 74
Be A Role Model
•To be a good health care employee, you must
consider your own health and be a role model
for your patients.
•Getting lots of sleep, maintaining good nutrition,
and exercising daily are examples of healthy
behaviors.
•Take care of your own health so that you can be
productive and have a positive impact on your
patients.

75. 75
Conclusion
•Health is not simply the absence of disease.
•It is the state of optimal physical and mental well
being.
•Taking personal responsibility for your health care
by developing positive health behaviors is the
most cost-effective way to ensure a longer,
healthier, perhaps more fun, and ultimately more
productive life.

76. 76
Reference
• Dhaar G.M, Robbani.I, (2006)Foundations of community
medicine, (I edition), Elsevier publication, New Delhi.
• Gupta.M.C, Mahajan.B.K,(2003) Book of preventive &
social medicine, III Edition, Jaypee brothers medical
Publishers, New Delhi.
• Park.K,(2011) Text Book of Preventive & Social medicine”,
24th Edition, Banasidas Bhanot Publication, Jalandhar
city.
• Kamalam.S,(2012) ,Essentials in community health
nursing practice (2nd Ed), Jaypee brothers, New Delhi.
• TNAI, A community Health Nursing Manual ,TNAI
publications, New Delhi.
• Ghai .O.P, Piyush, Essentials of Preventive medicine ,
Vikas publishing house pvt ltd, New Delhi.

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THANK YOU