LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY, OGBOMOSO

FACULTY OF NURSING SCIENCE

DEPARTMENT OF COMMUNITY/PUBLIC HEALTH NURSING

NSG 301: COMMUNITY HEALTH NURSING I

LECTURER: MRS OKEDIJI A. I

Introduction to Basic Concepts of Community Health Nursing and Primary

Health Care

Introduction

Community Health Nursing (CHN) and Primary Health Care (PHC) are
fundamental components of the healthcare system aimed at promoting health,
preventing diseases, and improving access to healthcare services within
communities. 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. This lesson provides
an overview of the basic concepts of CHN and PHC and their significance in
public health practice.

Definition of Terms:

Community Health Nursing (CHN): According to American Nursing

Association,“Community health nursing is a synthesis of nursing practice and
public health practice applied in promoting and preserving the health of
populations. CHN focuses on providing nursing care within the context of the
community. It involves promoting health, preventing diseases, and improving the
quality of life of individuals, families, and communities through various
interventions.

Primary Health Care (PHC): PHC is essential healthcare based on practical,

scientifically sound, and socially acceptable methods and technology made
universally accessible to individuals and families in the community through their
full participation and at a cost that the community and country can afford. PHC is a
holistic approach to healthcare that addresses the majority of a person's health
needs throughout their life. It is essential, universally accessible, and provided
through community participation and at an affordable cost.

Historical Development of Community Health Nursing and Primary Health

Care

Introduction

The historical development of Community Health Nursing (CHN) and Primary

Health Care (PHC) reflects the evolution of public health practices and ideologies.
This lesson provides insights into the historical contexts and key events that have
influenced the establishment and advancement of CHN and PHC.

1. Early Beginnings:

• 19th Century: The origins of CHN can be traced back to the mid-19th
century when pioneers like Florence Nightingale introduced principles of nursing
care in community settings during the Crimean War.

• Public Health Movement: The late 19th and early 20th centuries saw the
emergence of the public health movement, focusing on sanitation, disease control,
and health education to improve population health.

2. Alma-Ata Declaration (1978):

• Milestone Event: The Alma-Ata Declaration, adopted at the International

Conference on Primary Health Care in Alma-Ata, Kazakhstan, in 1978, marked a
significant milestone in the history of PHC.

• Key Principles: The declaration emphasized the importance of PHC as a

fundamental right and outlined principles such as accessibility, community
participation, and intersectoral collaboration.

3. Evolution of CHN and PHC Models:

• Florence Nightingale Model: Emphasized sanitation, hygiene, and health
education in community settings.

• Alma-Ata Model: Prioritized comprehensive, accessible, and community-

based primary healthcare services as the cornerstone of health systems.

4. Global Health Initiatives:

• WHO's Role: The World Health Organization (WHO) played a pivotal role
in promoting PHC and CHN globally, particularly through initiatives like the
Alma-Ata Declaration.

• Millennium Development Goals (MDGs): The MDGs, established in

2000, included targets related to maternal and child health, infectious diseases, and
access to healthcare, which aligned with the principles of PHC.

Contemporary Challenges and Innovations

• Health Inequalities: Persistent health disparities and inequalities continue

to pose challenges to the implementation of effective CHN and PHC.

• Technological Advancements: Innovations in healthcare technology,

telemedicine, and digital health have the potential to enhance the delivery of CHN
and PHC services, particularly in remote and underserved areas.

Impact of Historical Developments

• Policy Implications: Historical events and ideologies have shaped

contemporary healthcare policies and systems, influencing the prioritization of
PHC and CHN within national and global health agendas.

• Professional Practice: The evolution of CHN and PHC has influenced the
roles and responsibilities of healthcare professionals, emphasizing the importance
of community engagement, preventive care, and interprofessional collaboration.
Aims of Community Health Nursing (CHN)

The aim of community health nursing practice is

To promote health, efficiency, prevent and control diseases.

To reduce mortality and disability
To improve nutritional status
To increase life expectancy at birth.
To prolong life by providing need based well-balanced comprehensive
health care services to community at large through organized community
efforts.

Objectives of Community Health Nursing

 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 capabilities to deal with the
health problems in affective manner .People can be taught 'how to care for
themselves' through education guidance and supervision.eg. Helping young
mothers to give care to children in meeting their physiological, safety love
and security needs as to have normal growth and development of children.
 To strengthen community resources. Community resources include
manpower, money, material, their development, distribution and utilization.
Resources need to be strengthened distributed and utilize properly. For this
purpose and inter-sectoral approach is regarded where there is need for a
strong political, legal and administrative support.
 To control and counteract environment, it includes environmental protection
measures and changing reaction to environment when some protection
measures are not feasible. Protection measures are as follows:
- Safe drinking water
- Clean air and soil
- Safe disposal of refuse and excreta
- Good social security and safety
- Changing reactions
 - Mass immunization
- Mass screening
- Mass prophylactic treatment.
 To prevent and control communicable and non-communicable diseases this
includes application of all the three levels of preventive measures: primary
level, secondary level and tertiary level.
 To conduct research to build up knowledge and contribute to further
refinement and improvement of community health practice.
 To prepare health personnel in the community for Community Health Care
Services and supervise, guide and help health personnel in carrying out their
functions effectively.
Characteristics of Community Health Nursing

 Community health nursing is integral part of community health and is a

specialized field of nursing.
 Community health nursing synthesizes community health with nursing.
 The whole community is the client, mothers and children, workers, elderly,
handicapped eligible couples etc.
 It emphasizes on primary level prevention.
 It promotes self-care responsibility.
 It involves multidisciplinary team approach.
 Community health nursing is working for people, with people and by
people.
 Community health nursing is seeking support from and giving support to
personnel from other sectors working for welfare and development in the
community.
 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.

Scope of Community Health Nursing

 Home Care
 Nursing Homes
 MCH and Family Planning
 School Health Nursing
  Industrial Nursing
 Geriatric Nursing
 Mental Health Nursing
 Domiciliary Nursing
 Rehabilitative Services

Importance of CHN and PHC

• Health Promotion: CHN and PHC emphasize preventive measures and

health promotion activities to improve community health outcomes.

• Equity and Accessibility: They strive to ensure equitable access to

healthcare services, regardless of socioeconomic status or geographic location.

• Community Empowerment: CHN and PHC empower communities to

participate in decision-making processes related to their health, fostering a sense of
ownership and responsibility.

• Cost-Effectiveness: By addressing health issues at the primary care level,

CHN and PHC contribute to reducing healthcare costs and the burden on tertiary
healthcare facilities.

• Universal Health Coverage: PHC is a key component of achieving

universal health coverage, ensuring that all individuals and communities have
access to essential healthcare services.

Components of Primary Health Care

1. Promotive: Activities aimed at promoting health and preventing diseases

(e.g., health education, immunization).

2. Preventive: Measures to prevent the occurrence of diseases (e.g.,

screenings, vaccinations).

3. Curative: Treatment of common health problems and diseases at the

primary care level (e.g., basic medical care, first aid).
4. Rehabilitative: Support for individuals with disabilities or chronic
conditions to achieve maximum independence and quality of life.

Roles of Community Health Nurses

• Health Promotion and Education: Providing education and information on

health promotion, disease prevention, and self-care practices.

• Disease Prevention and Control: Conducting screenings, immunizations,

and health assessments to prevent and control the spread of diseases within
communities.

• Care Coordination: Facilitating access to healthcare services and resources,

particularly for vulnerable populations.

• Community Advocacy: Advocating for policies and programs that address

social determinants of health and promote health equity within communities.

Essential Qualities of a Community Health Nurse

1. Empathy and Compassion: The ability to understand and connect with

individuals and communities, demonstrating genuine concern for their well-
being.
2. Cultural Competence: Respecting and valuing cultural diversity,
understanding cultural beliefs, practices, and health traditions.
3. Communication Skills: Effective communication is vital for building
rapport, conveying information, and collaborating with community members
and healthcare teams.
4. Critical Thinking: Being able to analyze complex situations, make sound
judgments, and adapt interventions to meet the needs of diverse populations.
5. Flexibility and Adaptability: Willingness to adjust to changing
circumstances, work in different environments, and embrace innovative
approaches to care delivery.
 6. Advocacy: Being a strong advocate for the health needs and rights of
individuals and communities, promoting equitable access to healthcare
services and resources.
7. Collaboration: Working collaboratively with interdisciplinary teams,
community organizations, and stakeholders to address health disparities and
achieve common goals.
8. Resilience: Ability to cope with challenges and setbacks, maintaining a
positive attitude and commitment to improving community health outcomes.

Principles and Concepts of CHN and PHC

1. Accessibility: Healthcare services should be easily accessible to all

members of the community without discrimination.

2. Community Participation: Active involvement of the community in

decision-making processes regarding their health needs and priorities.

3. Holistic Approach: Addressing health needs comprehensively, considering

physical, mental, social, and environmental factors.

4. Intersectoral/Interdisciplinary Collaboration: Collaboration between

different sectors such as health, education, social services, and agriculture to
address the determinants of health. Working collaboratively with other healthcare
professionals, community members, and stakeholders to address complex health
issues.

5. Equity: Ensuring fair distribution of healthcare resources and services to

reduce health disparities among population groups.

6. Cultural Sensitivity: Respecting cultural beliefs and practices in healthcare

delivery to ensure services are acceptable and effective within diverse
communities.

7. Sustainability: Implementing sustainable healthcare strategies that meet current

needs without compromising the ability of future generations to meet their own
needs.
8. Empowerment: Strengthening individuals and communities to take control
of their health through education, advocacy, and capacity-building.

9. Health Promotion and Disease Prevention: Emphasizing preventive measures

and health promotion activities to improve community health and well-being

10. Evidence-Based Practice: CHN and PHC interventions are based on scientific
evidence, best practices, and research findings.

Key Components of Evidence-Based Practice

• Assessment: Systematic data collection to identify community health needs,

assets, and priorities.

• Intervention: Implementation of evidence-based interventions and

strategies to address identified health issues.

• Evaluation: Continuous monitoring and evaluation of the effectiveness of

interventions in achieving desired outcomes.

• Research: Conducting research to generate new knowledge, inform

practice, and improve healthcare delivery.

• Quality Improvement: Using data to identify areas for improvement and

implementing changes to enhance the quality of care.

Application of Scientific Principles in Practice

• Planning: Using scientific evidence and community assessment data to

develop targeted interventions and programs.

• Implementation: Implementing interventions based on established

protocols, guidelines, and best practices.

• Evaluation: Assessing the effectiveness of interventions through outcome

evaluation, process evaluation, and feedback from stakeholders.
• Adaptation: Being flexible and adaptable in response to changing
community needs and emerging evidence.

• Advocacy: Using scientific evidence to advocate for policy changes and

resource allocation to address community health needs.

Importance of Research and Data-Driven Approaches

• Informing Practice: Research findings and data analysis inform decision-

making and guide the development of evidence-based interventions.

• Improving Outcomes: Data-driven approaches help identify effective

strategies and interventions to improve community health outcomes.

• Accountability: Monitoring and evaluation based on scientific evidence

ensure accountability and transparency in healthcare delivery.

• Advancing Knowledge: Research contributes to the advancement of

knowledge in CHN and PHC, leading to improved practices and better health
outcomes.

Conclusion

Community Health Nursing and Primary Health Care play crucial roles in
promoting health, preventing diseases, and improving access to healthcare services
within communities. Understanding the basic concepts and principles of CHN and
PHC is essential for healthcare professionals to effectively contribute to
community well-being and health equity. The scientific principles and practice of
Community Health Nursing and Primary Health Care emphasize evidence-based
interventions, interdisciplinary collaboration, and data-driven approaches to
promote population health and well-being. Understanding and applying these
principles are essential for effectively addressing community health needs and
achieving positive health outcomes.

Introduction to Planning, Program, and Evaluation Methods in Community

Health Nursing and Primary Health Care

Introduction

Planning, program development, and evaluation are critical components of

effective Community Health Nursing and Primary Health Care. This lesson
provides an overview of these concepts and their significance in promoting
community health and well-being.

Importance of Planning, Program Development, and Evaluation

Planning: It ensures that resources are allocated effectively, goals are clearly
defined, and strategies are developed to address community health needs.

Program Development: Involves designing interventions and activities tailored to

meet specific health objectives and target populations.

Evaluation: Assessing the impact and effectiveness of programs helps in

determining their success, identifying areas for improvement, and informing future
planning efforts.
Steps in Planning and Program Development

Assessment: Conducting a comprehensive assessment of community health needs,

assets, and resources.

Goal Setting: Establishing clear, measurable objectives that reflect the desired
health outcomes.

Planning Strategies: Developing strategies and interventions to achieve the set

goals, considering evidence-based practices and cultural appropriateness.

Implementation: Putting the plan into action, involving collaboration with

community stakeholders and mobilization of resources.

Monitoring and Adjustment: Continuously monitoring progress, making

necessary adjustments, and ensuring accountability.

Evaluation Methods in CHN and PHC

Process Evaluation: Assessing the implementation process to determine whether

activities were carried out as planned and identify any challenges or barriers.

Outcome Evaluation: Measuring the extent to which program objectives and

desired outcomes have been achieved.

Impact Evaluation: Examining the broader effects of the program on health

outcomes, behaviors, and quality of life within the community.

Qualitative Methods: Using methods such as interviews, focus groups, and

observations to gather in-depth insights into participants' experiences and
perceptions.

Quantitative Methods: Utilizing surveys, questionnaires, and statistical analysis

to collect and analyze numerical data on program outcomes and effectiveness.

Application of Planning, Program Development, and Evaluation

Case Studies: Analyzing real-life scenarios involving community health issues

and developing comprehensive plans and programs to address them.
Group Projects: Working in teams to design and implement a community health
program, including planning, implementation, and evaluation phases.

Role-Playing Exercises: Simulating community meetings or health promotion

activities to practice communication skills and collaborative decision-making.

Conclusion

Planning, program development, and evaluation are essential processes in

Community Health Nursing and Primary Health Care, ensuring the delivery of
effective and sustainable interventions to improve community health outcomes. By
understanding these concepts and applying them in practice, nurses can contribute
significantly to promoting health and well-being within communities.
References:

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2016). Planning, Implementing,

& Evaluating Health Promotion Programs: A Primer (7th ed.). Pearson.

National League for Nursing. (2013). Outcomes and Competencies for Graduates
of Practical/Vocational, Diploma, Associate Degree, Baccalaureate, Master's,
Practice Doctorate, and Research Doctorate Programs in Nursing.

Stanhope, M., & Lancaster, J. (2019). Public Health Nursing: Population-Centered

Health Care in the Community. Elsevier Health Sciences.

World Health Organization. (1978). Declaration of Alma-Ata: International

Conference on Primary Health Care.