COMMUNITY HEALTH NURSING

1. CHAPTER-II
COMMUNITY HEALTH NURSING-I
COMMUNITY HEALTH NURSING
UNIT TOTAL HOURS: 14
_______________________________________________________________________________________________
“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
1) Philosophy of individual’s right of being healthy
 Health is believed to be one of the rights of all human beings nationally and
internationally according to the WHO charter.
 Goal of health for all is based on the philosophy of individual’s right of being healthy.
 This philosophy encompasses all the aspects of the society i.e sociocultural, economic
aspects, so that there is no hindrance of any kind to attain these rights.
2) Philosophy of working together under a competent leader for the common good
 primitive ages of human ages, man has learnt to live together to meet
Their needs.

Each other.
 ople
Working through the community groups/people with the people,for the people for
Their mutual benefit,change in behavior and health practices.

Services.
3)Philosophy that people in the community have the potential for continual
development and are capable of dealing with their own problems if educated and
helped

2. o
o Modify his/her lifestyles adjust to his or her changing enviournment i.e he can learn
to solve his or her problems.
o
Towards individuals in home, health centre, place of work, school, and community
places or hospital.
o behaviours respective to health
4)Philosophy of Socialism
o Socialism as one of the social system in the community has control over production
And distribution eg:food, housing, material production of all kinds, education,
Transportation,etc. Should be shared with all people.
GOALS
1. To increase the capacity of families, groups and communities to cope with health
and illness problems
2. To support and supplement the effort of other professional restoration and
preservation of health.
3. To control or counteract as much as possible physical and social environmental
conditions that threaten health or decrease the enjoyment of life.
4. To contribute to the reinforcement and improvement of nursing practice and
public health practice and services.
OBJECTIVES
1. To increase the capability of community to deal with their own health problems.
 Provision of adequate information pertaining to their health problems,health issues
Can increase the community’s capability to deal with the health problems in a
Effective manner
 People can be taught “how to care for themselves” through education, guidance
And supervision.
 Eg: Helping young mothers to give care to the children in meeting their physiological,
 Safety, love and security needs so as to have normal growth and development of
Children.
 Continuous need based health education not only improves health knowledge and
Skills but also helps in developing positive attitude which brings change in health
Behavior.

3. 2.To strengthen community resources
 Community resources include manpower,money material their development,
Distribution their utilization.
 Resources need to be strengthened,distributed and utilized properly.
 For this purpose an intersectoral approach is regarded, wherein, there is need for a
strong political, legal and administrative support.
3. To control and counteract environment
 It includes environment protection measures and changing reaction to environment
 When some protection measures are not feasible.
 Protection measures are as follows:
I. Safe drinking water
ii. Clean air and soil
iii. Safe disposal of refuse and excreta
iv. Good social security and safety
Changing reactions
i. Mass Immunizations
ii. Mass screening
iii. Mass prophylactic treatment
4. To prevent and control communicable and non-communicable diseases
 This includes application all the three levels of preventive measures i.e:
1) Primary level
2) Secondary level
3) Tertiary level
5.To provide specialized services
 It provides specialized services for mothers,children,workers,elderly, handicapped and
eligible couples,etc
6. To conduct research
 To conduct research to build up knowledge and contribute to further refinement and
improvement of community health practice.
7. To prepare Health personnel
 To prepare health personnel in the community for community health care services.

4.  Ultimate aim of community health care services is to reduce morbidity, mortality and
disability, improve nutritional status and increase life-expectancy at birth.
Principles of community Health Nursing
1) Community health nursing is an established based on recognized needs and
functioning within the total health programme.
2) The community health nursing agency has clearly defined objectives and purposes
For its services
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 regardless
Of origin, culture or social and economic resources, and age, sex, creed, nationality,
Political affiliation
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) Recipients of health care should participate in planning relating to goals for the
Attainment of health
8) The community health nurse should qualify as a full-fledged nurse.
9) The community health nursing service should be based on the needs of the patient
And there should be proper continuity of services to patients.
10) Periodic and continuous appraisal and evaluation of health situation of the patients are basic
to community health nursing.
11) The community health nurse should function/serve as an important member of the

5. Health team.
12) There should be provision for qualified nurse to make supervision for community health
Services.
13) The community health nurse does not provide material relief to patients, but directs
The patient to appropriate community resources for necessary financial and social
Assistance.
14) The community health nurse should not accept gifts or bribes from the patients
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 forNurse
17) The nurses assume responsibilities of their own continuing professional development
Through acquiring higher and higher education and forming and strengthening the Professional
associations
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 time.
CONCEPT OF COMMUNITY HEALTH NURSING
• Community has influence on the health status of people. Nurses need to understand the
structure of community, so that appropriate planned section can be taken by them to achieve the
health of the community.

6. • Before understanding the concept of community health nursing, it is necessary to
understand the community and community health.
• Then there will be discussion on the services provided by the medical and paramedical
personnel to achieve the overall health of people of community.
The term "community health nursing" is composed of three major concepts:
Community - Client
Health - Goal
Nursing -The means
Two Major Fields of Nursing in that:
1. Hospital Nursing
2. Community Health Nursing
We generally use the terms community health nursing and public health nursing, and
community health nurse and public health nurse interchangeably.
The community is a social system, where interactions among individual occurs.it is
composes of subsustems such as socio cultural, political, educational, environmental and
religious. All these factors influences the health of community.so within the community there is
need to understand these subsystem to promote the health of community.
THE COMMUNITY HAS THE FOLLOWING CHARACTERISTICS:
group of people
Common place
Interaction among members
common culture
common language

7. same feeling
common attitude
more or less same type of life style
common values and interest
• CHARACTERISTICS OF COMMUNITY
1. Distinctiveness
2. Homogeneity
3. Closeness
4. Sense of belongingness
5. Sense of togetherness
6. Self-sufficiency`
A. Distinctiveness
Each community has defined as geographical boundaries having its beginning and end.
These boundaries are more remarkable in smalller communities than in larger
communities.
B. Homogeneity
There is similarity in psychological charecteristics of people living in the defined boundaries
of the community
Example-similarity in language life style, customs, tradition etc..
C. Closeness
The people in the community have face to face interaction and free communication.
The extent of closeness varies.
The community people frequently participate in common activities etc.

8. D. Sense of belongingness
The degree and intensity of this feeling may vary among members in the community.
E. Sense of togetherness
There is unity and cohesiveness among the members in the community which is based on
their interactions and sense of belongingness to community.
F. Self-sufficiency
The community provides all such means and facilities which help in meeting the basic needs
of its people i.e.-space to live, education, protection and security etc..
CHARACTERISTICS OF HEALTHY COMMUNITY
Awareness that we are community
Conservation of natural resources
Recognition of and natural resources
Participation of subgroups in community affairs.
Preparation to meet crisis
Ability to solve problems
Communication through open channels
Resources available to all
Setting of disputes through legitimate mechanisms.
Participation by citizens in decision making.
Wellness of high degree among its members.
FUNCTIONS OF HEALTHY COMMUNITY
It provides space for housing,shelter,for socialization and recreation
It provides safety and security by protecting the community members.

9. Linkage with social system outside the community for meeting needs of its members.
Provides opportunity for employment and sustenance.
Protection, distribution and consumption of goods and services.
Socialization and education for its members.
Provides opportunities for interaction amongst members, transmits information, ideas and
belief and provides support system.
THREE TYPES OF COMMUNITIES
1. common place- means geographical location
2. social system-social units and systems with the pattern of interactions
3. group of people
Community
WHO Define
“Community as social group determined by geographical boundaries, common values and
interest”
Health
WHO
"Health is a state of complete physical mental and social well-being, and not merely an absence of
disease or infirmity"
Community Health
WHO’s
“Community health refers to the health status of the community, to the problems, affecting their
health & to the totally health care provided to the community.
Acc. To AAPH

10. “The art and science of maintaining, protecting and improving health of the people through
organized efforts.”
Acc. To CEA. Winslow
“Community health is the science and arts of preventing diseases, prolonging life and
promoting health and efficiency through organized efforts”
Community health Nursing
ANA’s
“It is field of practice that synthesizes knowledge & skill from nursing & public health & applied
them toward preventing, promoting, curative & rehabilitative care to family & community.”
Acc. To AAPH
“Public health Nursing synthesizes the body of knowledge from public health sciences and
professional nursing theories for the purpose of improving the health of entire community.”
Acc. to WHO Expert Committee of Nursing
Special field of nursing that combines the skills of nursing, public health and some phases of
social assistance and functions as part of the total public health program for the promotion of
health, the improvement of the conditions in the social and physical environment, rehabilitation
of illness and disability.”
OBJECTIVE OF C.H. NURSING
1) To participate in the development of an over all health plan for the community.
2) To provide quality nursing services to individuals, families & communities.
3) To coordinate nursing services with various members of health team.
4) To participate in and/or conduct researches relevant to community health and community
health nursing services and disseminate their results for improvement of health.
PURPOSE OF C.H. NURSING

11. 1. To ascertain the nature & extent of disease & disability in the community.
2. To take suitable measures to….
-Promote healthful living.
-Prevent Disabilities.
-Correct re-medical defects.
-Treat illness & Rehabilitate those and handicaps.
3. To evaluate the progress and success of current programmes.
4. To conduct research in community causes and diseases.
5. To provide the medical & nursing care to common ill health.
6. To educate the public in prevention of health hazards.
IMPORTANCE OF COOMUNITY HEALTH NURSING
 Community health nursing is concerned with the people who are sick as well as the
healthy,young and old,male and female.
 At the same time community health nurse is responsible for family centred care rather
than an individual oriented one.
 The community health nurse job is not only limited to the sick but has equal
responsibility to prevent the disease and to preserve and promote the health of the people.
1. Home care
2. Nursing homes
3. Mch and family planning
4. School health nursing
5. Health care services
6. Industrial nursing services
7. Domiciliary nursing services
8. Geriatric nursing services
9. Mental health nursing services
10.Rehabilitation centers
11.
I. HOME CARE
 Nursing practices is applied in meeting the health needs of communities,
families and individual in their normal environment such as at home.
II. NURSING HOMES

12.  The community health team which provides nursingcare, treatment to the
sick and health counseling given in nursing homes.
III. Mch and family planning
 The public health nurse plays a major role in the mch and family planning
services.
 It comprises antenatal,postnatal and child care services.
IV. School health nursing
 The school health nurse provides services to promote and protect the health
of the school children.
 She provides services like early detection of disease,immunisation,first
aid,dentalhealth,school sanitation,maintainance of health records,health
education,follow up and referral services.
V. Health care services
 The purpose of health care services to improve the health status of the
population.it aims at mortality and morbidity reduction,increse in
expectation of life,decreased in population growth rate,improvements
innutritional status,provision of basic sanitation,health.manpower
requirements and resources development and certain other parameters such
as food production,literacy rate,levels of poverty etc…
VI. Industrial nursing services
 The nursing service at industrial area includes periodic health check up,care
of the sick,first aid,health counselling,industrial sanitation and
safety,organisation of services to women and children ,rehablitation of the ill
and disabled workers and administration.
VII. Domiciliary nursing services
 Community health nurse focused at domiciliary nursing services include
maternity services health supervision,and disease prevention services and
services for illness and accidents.
VIII. Geriatric nursing services

13.  Community health nurse should take care of old people in the community.
 The need of the geriatric nursing care is different and they need more care
than the younger age groups.
IX. Mental health nursing service
 Mental health nursing services of a community health nurse include early
diagnosis and treatment rehabilitation,psychotherapy,use of modern
psychotropic drugs and after care services.
X. Rehabilitation centers
 The community health nurese provide care in rehabilitation units.
 Nursing is an important component in the rehabilitation of the disabled.
COMMUNITY HEALTH NURSE
Community health nurse is a personnel, serving at the community level provides basic
promotive, preventive curative and rehabilitative services directly to the community.
The specific nursing activities which are performed by the nurse will vary according to
community needs and the structure of the primary health care system.
Qualities of community health nurse
1. A qualified community health nurse is one who has undergone basic general nursing,
midwifery training and postbasic education in community health nursing.
2. A community health nurse must have interest in people and in understanding human
behavour.
3. Sincerity and ability to empathize are basic qualities required for a nurse.
4. A well poised nurse has a friendly disposition,honest,charitable,resourdeful,and
cooperative and takes responsibilities with initiative.
5. Minimum essential skills of a nurse are observation,communication,interviewing,and
bedside supportive and technical skills.
FUNCTIONS OF COMMUNITY HEALTH NURSE
A. Client-oriented Roles
1. Caregiver

14. Uses the nursing process to provide direct nursing intervention to
individuals, families, or population groups
2. Educator
Facilitates learning for positive health behavior change
3. Counselor
Teaches and assists clients in the use of the problem solving process
4. Referral Resource
Links clients to services to meet identified health needs
5. Role Model
Demonstrates desired health-related behaviors
6. Advocate
Speaks or acts on behalf of clients who cannot do so for themselves
7. Primary Care Provider
Provides essential health services to promote health, prevent illness,
and deal with existing health problems
8. Case Manager
Coordinates and directs the selection and use of health care services to meet
client needs, maximize resource utilization, and minimize the expense of care
B. Delivery-oriented Roles
1. Coordinator/Care Manager
Organizes and integrates services to best meet client needs in the most
efficient manner possible
2. Collaborator
Engages in shared decision making regarding the nature of health
problems and potential solutions to them
3. Liaison
Provides and maintains connections and communication between clients
and health care providers or among providers
C. Population-oriented Roles
1. Case Finder

15.  Identifies clients with specific health problems or
conditions
 Geared toward awareness of population-level problems
2. Leader
Influences clients and others to take action regarding identified
health problems
3. Change Agent
Initiates and facilitates change in individual or client
behaviors or conditions or those affecting population groups
4. Community Developer
Mobilizes residents and other segments of the population to take
action regarding identified community health problems or issues
5. Coalition Builder
Promotes the development and maintenance of alliances of
individuals or groups of people to address a specific health issue
6. Researcher
Conducts studies to explain health-related phenomena and to
evaluate the effectiveness of interventions to control them
COMMUNITY HEALTH NURSING PROCESS
INTRODUCTION
Nursing process is orderly, systematic manner of determining the
patient’s problem, making plan to solve them, initiating the plan and
evaluating the extent to which the plan was effective in resolving the
problems identified
Community nursing process is an orderly, systematic process to solve
the problems of community.
DEFINITION:

16. Nursing process has traditionally been defined as a systematic method
for assessing health status ,diagnosing health care needs, formulating
plan of care,initiating plan & evaluating the effectiveness of the plan.”
“Nursing process is orderly, systematic manner of determining the
clients health status,/ specifies the problems defined as “alterations in
human need fulfillment”,/ making plans to solve them, /initiating and
implementing the plans, /and evaluating the extent to which plan was
effective in promoting the optimum wellness and resolving the problems
identified.”
- Yura And Walsh, 1988.
Characteristics of community nursing process
 It is the framework for providing nursing care to
client/family/community.
 It is orderly and systematic.
 It is interdependent (nursing care depends on decisions made by other
health care professional).
 It provides individualized care, client centered, uses the client strengths
(make use of positive aspects / strengths). For eg., exercise in improving
the health status of the client, client cooperation.
 It is appropriate for use throughout the life span.
 It can be used in all settings. (hospital, community, ambulatory and
home health care settings)
 Complements current role of customers in health care
PURPOSES
To maintain optimal wellness.
To provide quality care.
To provide quality of life.
To achieve purposes of nursing
COMPONENTS OF NURSING PROCESS

17. ASSESSMENT
It is continuous, systematic critical, orderly& precise method of
collecting, validating,analysing and interpreting information about
physical, psychological &social needs of an individual nature of self
care deficit and other factors influencing .
DETAILS OF INFORMATION
- Geographical
- Demographical
- Environmental
- Knowledge, attitude &Practice of Health.
- Health Problem &Influencing Factors.
GEOGRAPHICAL INFORMATION
Name of locality or area

18. Physical structure
Important landmarks
Seasonal variation &month
Map of the area
DEMOGRAPHICAL INFORMATION
Total population
Total families
Vital health events
Specific vulnerable groups
ENVIRONMENTAL:
Physical environment
Social environment
Environmental communication
Environmental resources
House Water supply Sanitation
SOCIAL ENVIRONMENT:
Social organization
Community organization
Voluntary welfare organization
Trade unions statutory bodies
Leadership structure
ENVIRONMENTAL COMMUNICATION:
Official &non official channels
Common meeting places
Events of communication
Media of communication
ENVIRONMENTAL RESOURCES:
Economic resources
Institutional resources
Human resources
Natural resources
COMMUNITY NURSING DIAGNOSIS
It is a statement of a potential or actual altered status of a patient
which is derived from nursing assessment and which requires
intervention from the domain of nursing practices.
A nursing diagnosis is a clinical judgment about individual,
family, or community responses to actual or potential health
problems/life processes. Nursing diagnoses provide the basis for

19. selection of nursing interventions to achieve outcomes for which the
nurse is accountable.
CHARACTERISTICS OF DIAGNOSIS
 Nursing diagnosis is unique in that it focuses on a client’s response to
a health problem, rather than on the problem itself, and it provides the
structure through which nursing care can be delivered.
 Nursing diagnosis also provides a means for effective communication.
- Holistic client, family, and community-focused care are facilitated
with the use of nursing diagnosis.
- Nursing diagnosis has an important impact on the health care
delivery system
 COMMUNITY HEALTH DIAGNOSIS
- It may be defined as “determining the pattern of health problems
in a community , including factors which influences this pattern.
Community health diagnosis has the aspects of social medicine.
ASPECTS OF SOCIAL MEDICINE:
Social Anatomy
Social Physiology
Social Pathology
Social Diagnosis
Social Therapy
SOCIAL ANATOMY
It deals with the structure & stratification of society according to :
Socioeconomic group, Professional group, Religions & castes ,Rural and
urban communities
SOCIAL PHYSIOLOGY :
It refers to the function of society, growth of society depends upon
birth rate, food supply.
SOCIAL PATHOLOGY:
it is pathology of families , group, societies or communities. Indicators
of health services- Doctors: patients, Nurse: patients, patients :bed
SOCIAL DIAGNOSIS
The of community health diagnosis is to identify the basic health needs and
current problem of the community By conducting the surveys whole
community is examined

20. SOCIAL THERAPY:
Refers to a community treatment or community health action as the of
step decided upon to meet the health needs of the community taking into
account the resources available & the wishes of the people , as revealed
by community health diagnosis.
COMPONENTS OF NURSING DIAGNOSIS
Basic two-part statements
The basic two-part statement includes the following:
Problem (P): statement of the client’s/community response.
Etiology (E): factors contributing to or probable cause of the
responses.
Eg: Activity Intolerance RT decreased oxygen-carrying capacity of cells.
Basic three-part statements
The basic three-part nursing diagnosis statement is called the PES
format and includes the following:
Problem (P): statement of the client’s/community response.
Etiology (E): factors contributing to or probable cause of the
responses.
Signs and Symptoms (S): defining characteristics manifested by the
client.
Eg: Potential for health hazards r/t to breeding of mosquitoes as evidenced
by presence of stagnant water

21. Example of some nsg diagnosis which can be used in community field
Knowledge deficit r/t to small family norms as evidenced by large
family .
Health seeking behavior regarding immunization.
Ineffective health maintenance
Impaired social interaction
Infant Feeding Pattern, ineffective
Growth & Development, delayed
Family Processes: alcoholism, dysfunctional
Communication, impaired verbal
Blood Glucose, risk for unstable
Impaired home maintenance
Impaired parenting
Anxiety
Activity intolerance
PLANNING
It is a systematic approach in developing a plan of action based on careful
assessment. Planning phase consist of :
Establishing priorities for the problems diagnosed.
Setting objective

22. Writing nursing intervention that will lead to achievement of
proposed objective.
Recording nursing diagnosis, reasons, objectives, and nursing
interventions.
The community health nurse plans the activities to render the
comprehensive, preventive, promotive nursing care to individual, famly and
community in various settings. These setting include anganwadi, college,
health centre etc
IMPLEMENTATION/INTERVENTION
Putting the plan into action and doing all the activities included in the plan
Collaborative implementation by nurse, other professionals or
clients.
Nurse is a catalyst and facilitator
Ultimate goal is to help people to help themselves toward their
optimal level of health
TYPES OF NURSING INTERVENTION
DEPENDENT INTERVENTION :
It is related to implementation of medical orders. Eg: discuss
about the medicine regimen with the patient as prescribed by doctor.
INTERDEPENDENT INTERVENTION:
Describe the activities that nurse carries out in cooperation with
other health team members. eg:sterile instruments to be used Takes out
the record Gets the clinic personnel to arrange the clinic
INDEPENDENT INTERVENTION :
These are the activities performed by the nurse without direct
doctor’s order. Eg: Community health nurse will Give group teaching and
health education Assist the patient to identify potential hazards at home
Evaluation
The last phase of the nursing process, follows implementation of the plan of
care, it’s the judgment of the effectiveness of nursing care to meet client
goals based on the client’s behavioral responses.
Process of Evaluating Client Responses
Collecting data related to the desired outcomes
Comparing the data with outcomes
Relating nursing activities to outcomes
Drawing conclusions about problem status
Continuing, modifying, or terminating the nursing care plan.
Relationship of Evaluation to Nursing Process