Community Health Nursing

Content

• Community
• Health
• Community Health
• Community Health Nursing
 Aims of CHN
 Objectives of CHN
 principle of CHN
• The word has its origin from Latin word ‘COMMUNIS’.
• It is derived from two Latin words namely “com and munis”
• In English “com” means “Together”.
• “munis” means “To Serve” Means “serve together” It means
‘community’ is an organization of human beings framed for the
purposes of serving together.
Community

• A group of individuals & Families living together in a defined

geographic area usually comprising a village, Town or cities is
called community.
• A community is a social group determined by a geographical
boundaries & or common values & interest. Its members
know & interact with each others. Its functions within a
particular social structure & Exhibits & create certain norms,
Values & social institutions. The individual belongs to the
broader society through his family & community.
WHO
Community Health
• Community health is defined in a broader way of community
organized efforts for maintain, protecting & improving the health of
people.
• Community health refers to the health status of the members of the
community, to the problem affecting their health and to the totality
of health care provided to the community.

Community Health Nursing

• Community health nursing is a field of nursing practice for which
there exist a body of knowledge & related skills which is applied in
meeting the health needs of communities, families & individual in
their normal environment such as at home ,at school & at place of
work. American nurses association
Aim of CHN

• To promote health and efficiency

• Prevention and control diseases and disabilities
• Need based health care to prolong life
Objectives of CHN
• Increase the average span of human life.
• Decrease the morbidity rate .
• Decrease in mortality rate, particularly IMR and MMR.
• Increase the physical, mental and social wellbeing of individual.
• Increase the pace of adjustment of the individual to his environment.
• Provide total care to enrich quality of life.
• Provide antenatal, intranatal and postnatal care to ensure safe pregnancy
and delivery.
• Immunization.
• Provide under five children care.
• Health education.
• 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 care .
• To conduct research.
Principles of CHN

• Meet the community.

• Identification of health problems and needs.
• Setting priorities among health problems.
• Planning and problem solving.
• Intervention and implementation.
• Evaluation.
1. Meet the community - It is the first necessary to meet the
community in order to:
• Establish contact with community leaders.
• Obtain consent of the local leaders for a base line survey of the
health situation.
2. Identification of health problems and needs - Various approaches
may be used to identify community health problems and health
needs they include:
• Base line survey
• Scrutinizing (close observation) the record of PHC and sub centers
• Specific question regarding disease common in the area.
• Question regarding births, deaths, disability, failure to work
3. Setting priorities among health problems:
• Frequency with which the problem occur (prevalence)
• Seriousness of the problem for individuals and society.
• Urgency of the problem.
• Feasibility or susceptibility to control the problem within the financial
resource limitations

4. Planning and problem solving:

• Having recognized that a problem or need exist, the community health
nurse must decide what action should be taken by the health team.
• Health team will be capable of taking any action.
• Planning involves questions of setting objectives and defining solution to
the problem
5. Intervention and implementation:
• The community health nurse carryout activities decide upon as a
being most effective in order to fulfill the recognized need.
• This phase contains all the tasks, procedures and practice which are
performed by nurses.
6. Evaluation:
• Evaluation will measure the extent to which the problem has been
solved or the need met.
• Evaluation provides feedback that can lead to program modification.
• Evaluation makes the program more effective
Others:
• It should be planned based on the needs of the community.
• It is based on identified needs and functions.
• Integration of health education, guidance and supervision.
• Health service should be realistic in terms of available resources.
• Community participation is the integral part of the community health
services.
• Health services must be continuous.
• Proper record and reports.
• Proper evaluation of health services.
• Health services must be available to all without any differences
Communication

• Communication is derived from Latin word “COMMUNIS” which

mean “to share”.
• Communication is the process by which two or more person
exchange ideas, facts, feelings or impression in ways that gain
“common understanding” of meaning intent, and use of message.
-Paul Lea Gens
Purpose of communication

• To exchange new ideas with each other.

• To provide information
• To help to motivate people.
• To accept ideas.
• To simply information or facts to another person.
• To achieve co-ordinate action.
• To express feelings or emotion.
Types of Communication
Communication Skill

• Listening: An active skill which required great concentration, if

patients cues are to be picked up.
• Silence: Allow people tie to think and assimilate that has been said.
• Acknowledgement: Indicate that you had heard the message.
Example: saying yes.
• Encouragement: By showing interest
• Pick up cues.
• Reflection: Encourage talking about topic or problem by
emphasizing the fact.
• Open questioning: Example-how you feel today.
• Empathy: Show that you understand the point of view which will
encourage them to talk in more depth.
Elements of Communication Process

1. The sender
2. Encoding: It is the sender’s perception of message or idea.
3. The message
4. The channel
5. Decoding: The steps or process of translating message to be
understandable by the receiver is known as decoding.
6. The receiver
7. Feedback
8. Noise
Channel of Communication

• Vertical Communications:
• Upward communication: Subordinates transmit their
expectations, problems , suggestions for organizational
improvement.
• Downward communication: It is the traditional channel
of communication to which the manager relay
information to the subordinates in regard to
organizational goal , strategies etc.
• Horizontal communication: Communication occurs between peers at
the same level. These could take place among managers who are
managing different hierarchical level or among the employees working
at the same level.
• Diagonal communication: Managers or employees interact with
other managers and employees from other department who are not
at the same hierarchical level,
• Grapevine communication: The information flows haphazardly
between people at all hierarchical levels usually involves 3 or 4
people at a time. This type of communication is subject to error and
distortion.
Barrier

• Physiological barrier: difficulties in hearing expression.

• Psychological barrier: emotional disturbance, level of
intelligence, language or comprehension difficulties.
• Environment barriers: noise, invisibility
• Cultural barrier: level of knowledge and understanding,
custom, belief, religion , attitudes, language variation,
cultural difficulties.
MCQ

1.The slogan ”Health for all” was

a.1997AD
b.2000AD
c.2022 AD
d.2014 AD

2. Aims of community Health Nursing is;

a. Decrease the morbidity rate.
b. Health Education.
c. To promote health and efficiency.
d. Meet the community.
3. The word communication depend on
a. Latin word
b. Greek word
c. France word
d. English word

4.Receiving message and converting into thought is

a. Encoding
b. Decoding
c. Noise
d. Messaging
4.Communication skill except;
a. Sender
b. Listening
c. Reflection
d. Empathy

5.Vertical communication includes;

e. Diagonal communication.
f. Grapevine communication.
g. Upward communication.
h. Technology to communicate.
6.Barrier of communication is;
a. One –way communication.
b. Informal communication.
c. Non-verbal communication.
d. Environmental barrier.

7. In Nepal, the best medium of communication is:

a. Radio
b. Pamphlets and magazines.
c. Film
d. Television.
Health Education
Definition

Health Education like general education is concern with change in

knowledge, attitude and behavior of the people. In it’s most usual form
it , can concentrate on developing such health practices as are beloved
to bring about the best possible state of well being.”
Aims of Health Education;
• To ensure that health is valued as an assets in the
community.
• To equip the people with skills, Knowledge and
attitude to enable them to solve their health
problem by their own action and efforts.
• To promote the development and proper use of
health service.
• To help people to develop positive attitude and skill
to protect from disease and improve their health.
Process of Health Education;
• To assess the patient learning needs.
• To establish the teaching and learning objectives.
• To constitute the teaching plan.
• To implement the teaching learning plan.
• To evaluate the teaching and learning.
Method of Health Education
1.Individual method
2.Group method
3.Mass method

1. Individual method
a. Interview: Planned or structured interview and spontaneous or unstructured
interview.
b. Counseling: steps of counseling are:
• Rapport building.
• Finding way to solve the problem.
• Privacy maintenance.
• Clients need or problem identification.
• Patience maintenance.
2. Group Method;
a. Demonstration.
b. Brain storming(creative ideation).
c. Role playing.
d. Group discussion(6 to 12 person).
e. Field trip or study trip.
f. Panel discussion(3-4 person).
g. Problem solving.
h. Symposium.
i. Main lecture(feed-back taken).
j. Case study.
k. Project assignment.
l. Workshop(15 participants).
3.Mass method
a. Lecture.
b. Exhibition.
c. Campaign.
MCQ
1.What is the best method for skill development?
a. Role play b. Group discussion
c. Demonstration d. Brain Storming

2.Counselling means
a. Motivating the individual b. Empowering the
individual.
c. Forcing the individual d. Advising the individual

3. Objectives of health education are

a. Informing, Forcing and guiding b. Informing, motivating and
guiding
c. informing, counselling and guiding d. Informing, guiding and
supervision
4.Which of the following is the mass method of communication?
a. Counselling b. Role play
c. Group discussion d. Lecture

5. In small group discussion no. of people required are

a.5-10 b.4-8
c.6-12 d.7-14

6.Which of the following is a mass method of communication?

a. Radio b. Miking
c. Pamphlet d. Postering
7. Which of the following term is used in relation to health education
a. Brainstorming c. snowballing
c. Known to unknown d. All of the above
Primary Health Care
Contents

• Concepts of PHC
• Definition of PHC
• Elements of PHC
• Function
• Principle of PHC
• Role of nurses in PHC
• Responsibilities of nurses in PHC
Concepts of PHC

The primary health care centre (PHC) is the basic structural and
functional unit of the public health services in developing countries
to provide accessible, affordable and available primary health care to
people. OR ‘Primary Health care centres sometimes referred as
public health centres.
• It forms an integral part of both the country’s health system of which
it is the central function and the main focus and of the overall social
and economic development of the community.
• In 1977 the world health assembly established a goal “health for all
by 2000.” This goal has now been adopted by many countries
throughout the world. In Nepal his ,Majesty Government has taken
up the goal for all the health and for this purpose HMG is
implementing PHC throughout the country.
Definition of PHC

• Primary health care often abbreviated as PHC, is defined as “Essential

health care based on practical, scientifically sound and socially
acceptable methods and technology made universally accessible to
individual and families in the community through their full
participation and at a cost that the community and the country can
afford to maintain at every stage of their development in the spirit
of self reliance and self-determination.”
Elements of PHC
(8 essential health service in primary health care(ELEMENTS)
1. E- Education for health.
2. L-Locally endemic disease control.
3. E-Expanded program for immunization.
4. M-Maternal and child health including responsible
parenthood.
5. E-Essential drugs.
6. N-Nutrition
7. T-Treatment of communicable and non-communicable
disease.
8. S-Safe water and sanitation.

Two new elements are added now these are

9. M-Mental health .
10. D-Dental health.
Elements of PHC
Education concerning prevailing health problems and the methods
of presenting and controlling them
Promotion of food supply and proper nutrition
An adequate supply of safe water and basic sanitation
Maternal and child health care including family planning
Immunization against infectious disease
Contd...

 Prevention and control of endemic disease

 Appropriate treatment of common disease and injuries
 Provision of essential drugs
 Other elements
 Dental health
 Mental health
Principle of PHC

Accessibility of health services to all population.

Community participation toward achievement of PHC.
Emphasis on services that are preventive and promotive rather than
curative services.
Use of appropriate technology.
Intersectoral coordination or multisectoral coordination.
Main function of PHC

• Provision of medical care

• Maternal child and family planning
• Prevention and central of locally endemic disease
• Safe water supply and basic sanitation
• Health education
• Referral services
• Training of health guides for health workers
• Basics laboratory services
• Collection of vital statistics
Role of Nurse in PHC

 Care Provider
 Organizer
 Educator
 Advocator
 Counsellor
 Problem solver
Responsibilities of Nurse in PHC

• Health promotion
• Illness prevention
• Antenatal and postnatal care
• Child and family health nursing
• Treatment of sick people
• Rehabilitation and palliation
• Community development
• Education and research
MCQ

1. When was the Alma ata conference held?

a. 1972
b. 1988
c. 1978
d. 1990
2. Following all are the element of primary health care except.
a. HIV|AIDS
b. FP|MCH
c. Safe water and sanitation.
d. Provision of essential drug.
3. Health for all by 2000AD is
a. Target
b. Objective
c. Goal
d. Strategy

4.WHO is formally establish in

e. 7 April 1948
f. 7 April 1946
g. 7 April 1956
h. 7 April 1958
5. Which of the following is not included in elements of PHC?
a. Health education
b. MCH
c. Immunization
d. Accessibility of health service

6. Which of the following is the principle of primary health care?

e. Health education.
f. Dental health.
g. Mental health.
h. Community participation.
Note:; In 1977 the world health assembly established a goal health for
all by 2000.
Gender Issues
Sex and
Gender
Sex: A genetic/physiological or biological characteristic of a
person, which indicates whether one, is male or female.

Gender: Gender refers women’s and men’s roles and

responsibilities that are socially determined. Gender is related
to how we are perceived and expected to think and act as
women and men because of the way society is organized, not
because of our biological differences. (PAHO 1977)
Sex and
Gender
Sex: biological category; differences are determined,
universal & unchangeable.

Gender: social category; learned, change over time, with

wide variations within & between cultures.
Sex and Gender
Sex is the biological difference between males and
females.

Gender refers to the economic, social and cultural attributes(feature

regarded as a characteristic) and opportunities associated with being
male or female in a particular social setting at a particular point in time.
Gender Equity and
Equality
Gender equality means equal treatment of women and
men in laws and policies, and equal access to resources
and services within families, communities and society at
large.

Absence of discrimination based on a person’s sex with

respect to opportunities, the allocation of resources or
benefits, and in access to services.
Gender Equity and
Equality
Gender equality refers to the equal opportunity of men
and women to access and control social and economic
resources that are valued by society. This does not
imply that men and women, or different groups of men
and women, be treated the same or be represented in
the same numbers. Rather, the aim is to enable men
and women to participate fully as equal partners in
decisions that affect their lives.
Gender Equity and
Equality
Gender equity: Fairness and justice in the distribution
of benefits and responsibilities between women
and men.
The concept recognizes that women and men have
different needs and power, and that these differences
should be identified and addressed in a manner that
rectifies(correct) the imbalance between the sexes.
It often requires women-specific programmes and
policies to end existing inequalities.
 Gender Equity and
Equality
Gender equity integrates a notion of fairness into how men and women
are treated. To ensure fairness, gender equity goals and strategies often
include measures that aim to address the historic disadvantage of
women or men in particular spheres of life. Gender equity aims to
realize gender equality.
Gender
Discrimination
Gender discrimination refers to any distinction,
exclusion or restriction made on the basis of socially
constructed gender roles and norms which prevents a
person from enjoying full human rights.
 Gender
Discrimination
 The gender gap in education, Nutrition and Health
Care
 Much of women’s work is invisible
 Women have less access to money and productive
assets
 Women lack political power and are not
sufficiently represented in parliaments
 Values and norms are at the core of persisting
gender inequalities
Definition of gender based violence
The Declaration on the Elimination of Violence Against
Women, adopted by the United Nations General Assembly in
1993, defines Violence Against Women as:

“Any act of gender based violence that results in, or is likely to

result in, physical, sexual, or psychological harm or suffering to
women, including threats of such acts, coercion(threat or force)
or arbitrary deprivation of liberty, whether occurring in public
or private life”
NewYork,UnitedNations,23February1994
Nepali women and girls are vulnerable to both
–domestic and
–public violence, such as rape, sexual abuse in
the workplace, and
–human trafficking.

•Moreover, harmful traditional practices, such as

–dowry-related violence,
–Deuki(offering infant girls to temples where they live
without education or proper care),
–Chhaupadi(keeping menstruating women in a shed
away from the home), and
–accusations of witchcraft, can also be life threatening.
Types of GBV
1. Based on place of occurrence
•Domestic
•Custodial
•Public violence & trafficking
•In conflict situation
•Special form of violence in Nepal

a. Domestic violence
•Most common form of GBV.
•Violence between two intimately linked partners of opposite sex.
•Physical, verbal, emotional, psychological and/or sexual battering
of women/men by her/his partner or spouse.
–Examples: threats or intimidating words; hitting, using a weapon,
rape, imprisonment, financial control, abusive or demeaning
language.
b. Custodial violence
• The protective care or guardianship of institutions/
people or system (laws, policies etc.)

Most common form of custodial violence

•Imprisonment- By authority people
•By colleagues.
•Refugee camp
•Rehabilitation centre
c. Public violence & Trafficking
•Ranges from teasing to forced prostitution & mass rape.
• Public places vehicle, street, school, working places,
hatbazaar etc.
•Trafficking of women and children

d. GBV in conflict situation

•Conflict increases all forms of GBV.
• Mass displacement leading to more vulnerability of
women and children.
Examples: Mass rape, military sexual slavery,
forced prostitution, forced marriage and
pregnancy.
• Women forced to offer sex for survival, or in exchange for
food, shelter or protection.
Causes of
GBV
1. Society
 Norms granting men control over female behavior
 Acceptance of violence as a way to resolve conflict
 Notion of masculinity linked to dominance, honours
or aggression
 Rigid gender roles
2. Community
 Poverty
 Low socio-economic status
 Unemployment
 Peer influence
 Isolation of women and family
3. Relationship
 Early part of cohabitation( Having sexual relationship
without being married)
 Marital conflict
 Male control of wealth and decision making in the family

4. Individual perpetrator
 Young age
 Gender being male
 Witnessing marital violence as a child
 being abused as a child
 Alcohol abuse
Consequences of GBV
Fatal
 Homicide
 Suicide
 Maternal deaths
 AIDS related death

Non fatal
 Physical impact
 Impact on reproductive health
 Functional disorders
 Negative/ injurious health behaviours
 Impact on mental health
Preventive Measures To Combat Against GBV In Nepal:
 Launch awareness program about the superstitions
of witchcraft practices
 Strong enforcement mechanism in regards to combat
violence against women should be made
 Conduct women empowerment and skill development
training
 Alert civil societies and encourage them to disseminate
the issue of Gender Based Violence
 Strong Laws and Policies to combat violence against
women should be made
 Institute fast- court to provide speedy remedy to victims of
violence against women
 Role of Nurses/Health workers
Nurse or health care providers are the key person in
dealing with violence against women. They come
across women who have been victims of rape, incest,
and physical violence ;midwives , nurses, obstetrician
gynecologists general practitioners and other doctors
attend women who may show sign of abuse though
they do not come specifically to the health providers
to report it. Health professionals play important role
in helping to detect cases of violence against women,
addressing the consequences and refer women to
other specialized agencies for the legal, medical, and
social help.
 Nurses and health workers can do the
following to help women

 Show sympathetic attitude towards the women and make it

likely that women will reach out for help.
 Maintain the privacy and confidentiality of the client
information and records.
 Be attentive to possible symptoms and signs of abuse and
follow up on them.
 Provide appropriate medical care and document in the
client’s medical records, instances of abuse, including
details of the perpetrators.
 Refer patient to available community resources.
Respect confidentiality: All the discussion must occur in private,
without their family members present. This is essential to
building trust and ensuring her safe.
Promote access to community services: know and share
resources in your community : a shelter for battered women
counselors, support group, legal services.
Help her plan for future safety: what has she tried in the past to
keep herself and her children safe? Is it working? Does she have
a place to go if she needs to escape?
 Respect her autonomy: respect her right to make
decisions about her situation , when she is ready .
She knows what is best under the circumstances
 Acknowledge the injustice: the violence perpetrated
against her is not her fault. No one deserves to be
abused.
 Believe and validate her experiences: listen to her and
believe her. Acknowledge her feelings and let her know
she is not alone.
 Guidance for health
workers
The following recommendations are helpful while dealing with
domestic violence in clinical setting:-
1. Do not be afraid to ask –many women are silently
hoping someone will ask rather than disclosing the
issues.
2. Create a supportive non- judgmental environment-let
her tell story .
3.Be alert for “red flags”- several injuries or conditions should
raise suspicion for abuse, they are:
 Chronic, vague complaints that have no obvious
physical cause
 Injuries that do not match the explanation of how they
were sustained
 A partner who is overly attentive, controlling or unwilling to
leave the women’s side.
 Physical injury during pregnancy
 A history of attempted suicide or suicidal thoughts
 Delay between injury and the seeking of treatment
 4. Assess her situation for immediate danger. Find out whether the
women feels that either she or her children are in immediate danger .
 5. Explain that she has medical and legal rights . The penal codes of
the country protects the women and children for their rights.
 6. Be prepare for follow-up.
 7. Display posters and leaflets on domestic violence, rape and
sexual
abuse, where these are available.
 8.When possible, avoid prescribing mood-altering drugs to women
who are living with an abusive partner ,since these may endanger their
ability to predict and react to their partner’s attack.
 9.Develop and maintain contacts with women's groups and other
governmental and nongovernmental agencies, which offer support to
women experiencing violence.
 1. A process of being fair to men and women is
a. Gender Integration
b. Gender Equity
c. Gender Stereotypes
d. Gender discrimination

2. Social structure that institutionalize

male physical, social and economic
power over women
a. Gender Discrimination
b. Masculinity
c. Patriarchy(father or male is head of
family)
d. Feminity

3. Ignoring or failing to address the gender

dimensions is called
a. Gender discrimination
b. Gender Blind
c. Patriarchy
d. Gender Oppression
4. Having the same number of men and
women at all levels within the organization to
ensure equal representation and participation
in all areas is
a. Empowerment
b. Gender Equity
c. Gender Balance
d. Gender Role

5. ‘Gender and Politics of History’ is written

by
a. Gerda Learner
b. D D Kosambi
c. David Cathy
d. Joan Scott

6. A practice whereby a woman has two or

more husbands at the same time
a. Polygamy
b. Hypogamy
c. Polyandry
d. Exogamy
7.A practice whereby a man has two or more
wives at the same time
a. Polygamy
b. Hypogamy
c. Polyandry
d. Exogamy
COMMUNITY
RESOURCES
• Community : A group of individuals and families living together in a
defined geographic area usually comprising a village, town or city is
called community.

• Resources : Resources are some things such as land , sea , mineral

or natural energy that exist in a country can be used to increase
its wealth.
• Resources Refers to everything necessary to do the job that in the
actual work, place, equipment ,supplies, budget and people and
time
. Resources are human labor ,physical plant and raw materials
available for use in implementing institutional goal ,[Protect and
Goddard, 1998]
• Community Resources : Available of something that an organization or
an individual has and can use is known as resources and availability of
these resources in community is called community resources.
Community resources can play important role for the betterment of
life style as well as the health status of the community people.
Community resources may be National / International, Government /
Non Government as well as local institutions. These resources are
found in community and they were helping directly and indirectly in
the community development. Resources are needed to meet the
health need of a community .No nation even a rich has enough
resources to meet all needs of the all health care. Therefore an
assessment of available resources, their proper allocation and efficient
utilization are important considerations for providing efficient health
care services.
Some example of community resources are
given below:
• Human resources : Community leaders, health or other technical
personal as well as non technical personnel , traditional healers,
FCHVs , TBAs , school teachers, Agricultural workers.

• Materials Resources : Building, computers ,telephone vehicle, freeze

or refrigerator , electricity , budget and time, etc.
• Community organization : Bank , Club, [mothers club , youth club ],
post office Dispensary ,Sahakari , animal husbandry , HP,SHP,
School
,VDCs.

• International health organization : International health organization

are usually divided into three groups: multilateral organization ,
bilateral organizations, International Non –government organization
 Home Visiting
Home visiting is the process of providing the nursing care at their door
step. A home visiting give a more accurate assessment of the family
structure and behavior in the natural environment understanding their
barriers, their culture, circumstances, resources and others.
Purpose of home visit;
• To identify actual problem of the family.
• To investigate any source of infection.
• To motivate the use of family planning.
• To give health teaching on personal hygiene.
• To refer cases to the appropriate agencies.
Principles of Home Visiting

• Need Based: home visiting should be planned and conducted based

on the identified needs of the people 
• Priority based: the home visit should give to the existing problem in
the family. It may be maternal and child health services or antenatal
checkup 
• Regularity: plan for regular home visiting programs based on family
needs. It should be conducted at regular intervals 
• Flexibility: the community health nurse should adopt a flexible
approach based on prevailing circumstances at home 
• Scientific based: be sure of the scientific soundness of the subjects
used for discussion. Use of technical skills includes hand washing an
inspection 
• Analysis based: collect facts about the home, the patient and the
environment and make an objective analysis of the facts as an initial
step in visiting the home 
• Developing relationship: work with the person and family plan jointly.
Home visiting helps to establish good working relationship in the
family 
• Sensitivity: the community health nurse should be sensitive to the
persons feeling and needs at the time of the visit. Listen to the family
and understand the other person’s point of view
• Educative: evaluate your own work remember the quality of care is
more important than the number of home visits. It is essential to
evaluate home visits from time to time.
ADVANTAGES OF HOME VISIT 

• The nurse can directly observe home and family atmosphere.

• The nurse can directly observe the care given to patient by the family
members 
• It is possible to discover new health problems 
• The family members will be more relaxed in their own surroundings 
• The family gains confidence and feels to clear their doubts
• This helps to apply the gained knowledge and skills in the homes
assisting and solving individuals and families health problems
Steps of Home Visiting
• Fact finding
• Data Collection and analysis
• Planning action with family
• Action and health education
• Follow up
• Evaluation
Bag Technique

A community nursing bag is an essential item in her daily nursing

practice, which contain a equipment and supplies including medicines.
The nursing bag is a vehicle for carrying the materials and equipment
needed during home visit to attend family health care needs.

Principles of bag technique

1. cleanliness
2. Boiling
3. Protect and take care of bag
Compartment in the bag
1.Sterile compartment- 1
2. Clean compartment- 1
3. Side pocket- 3
Immunization
Immunization
• Immunization is the process whereby a
person is made immune or resistant to an
infectious disease, typically by the
administration of a vaccine.

• Vaccines stimulate the body's own immune

system to protect the person against
subsequent infection or disease.

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Immunity
• Immunity is defined as ability of the body to
recognize, destroy & eliminating antigenic
materials, foreign to its own. 
Or
• Immunity is an important mechanism by
which the body is able to withstand or resist
many infections in everyday life.

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How immunity help the body?
• Immunity provides specific antibodies against
specific antigens.
• It provides resistance to re-infection & non
susceptibility to a given disease.
• It has certain capacity to distinguished foreign
body or antigen for body & react accordingly.
• It neutralized & destroyed antigens.

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Classification of immunity
Immunity divided into two types 
• Natural immunity
• Acquired immunity

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101
102
A. Natural immunity
• Natural immunity is possessed by man &
animals either from birth.  Or is acquired
during growth by virtue of its species, racial or
individual peculiarities antigen. It is the
natural resistance to illness which is
developed before the contact with an antigen.

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It is further divided into three types.
a. Species immunity:
• Certain species acquire immunity against
certain disease for e.g hens against tetanus &
dogs &rats against tuberculosis.

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b. Racial immunity
• Some people possess certain immunity by
their genetic during birth. Black People do not
suffer easily from yellow fever.

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c. Individual peculiarities
Although many people exposed to infection,
but only some people develop the disease
during epidemic.
Among those who develop it may suffer
more severely than other all, these difference
are due to individual peculiarities of the
person. 

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B. Acquired immunity
a. Passive immunity
b. Active immunity

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a. Passive immunity
• Passive immunity can be acquired by an
individual when antibodies produced in one
body are transferred to another person.

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• Passive immunity is two types.
1. Passive natural immunity
2. Passive artificial immunity

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1. Passive natural immunity
• Passive natural immunity is transfer of natural
antibodies across the placenta to the fetus or
from the breast milk to the baby only for
some months (3-9 month ) against certain
disease like diphtheria, tetanus, measles&
chickenpox.

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• These antibodies depend upon the immunity
state of the mother .
• If mother has high immunity, the antibodies of
particular disease or if another has no
immunity against these disease, no antibodies
of that particular disease will be transferred.
• So it is most important to immunized against
above target disease.

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2. Passive artificial immunity
• The serum that contain specific antibodies
gives immunity when injected into animals.
This immunity is of short duration & is of
particular value in treatment of lacking
antibody in the blood during accident, injury &
disease.

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• It is used for curative & prophylactic purposes.
Antiserum is an immune serum fluid prepared
to give against certain disease.

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b. Active immunity
• Active immunity is the immunity which
individuals develops as a result of infection or
when a person comes in contact with
pathogenic organism. The body produce self
antibodies to fights against the infection.

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• Active immunity are two types.
1. Natural active immunity
2. Artificial active immunity

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1. Natural active immunity
• It is acquired when a person gets disease like
chicken pox, measles etc
2. Artificial active immunity
• It is acquired by administration of vaccine
which contain micro- organism or their toxide
or combination of these two.

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Types of immunizing agents
The immunizing agents may be classified as
a. Vaccines,
b. Immunoglobulin's and
c. Anti sera.

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a. Vaccine
• Vaccine is a substance prepared from disease
causing agent or its toxic produced that
stimulated for the production of specific
antibody.

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Types of vaccine
• Currently available vaccines protect us from
diseases caused by selective pathogens:
bacteria and virus.
• Vaccines are usually categorized based on the
constituents of the vaccines.

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i. Live vaccines
ii. Inactivated or killed Vaccines
iii. Toxoids
iv. Cellular fractions
v. Combinations

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i. Live vaccines
• Live vaccines (e.g., BCG, measles, oral polio)
are prepared from live (generally attenuated)
organisms.

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• In general, live vaccines are more potent
immunizing agents than killed vaccines, the
reasons being :
live organisms multiply in the host and the
resulting antigenic dose is larger than what is
injected,

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 live vaccines have all the major and minor
antigenic components,
live vaccines engage certain tissues of the
body, as for example, intestinal mucosa by the
oral polio vaccine.
Immune respond similar to natural infection.

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Example of live vaccine
• Bacterial – BCG, oral typhoid, Hib
• Viral - Oral polio, yellow fever, measles,
rubella, mumps Chicken pox , small pox,
Influenza, Rota virus, Japanese encephalitis. 

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ii. lnactivated or killed Vaccines
•  Organisms killed by heat or chemicals, when
infected into the body stimulate active
immunity.
• They are usually safe but generally, less
efficacious than live vaccines.

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• Killed vaccines usually require a primary series
of 2 or 3 doses of vaccine to produce an
adequate antibody response, and in most
cases "booster" injections are required.
• The duration of immunity following the use of
inactivated vaccines varies from months to
many years.

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• Killed vaccines are usually administered by
subcutaneous or intramuscular route.

• The only absolute contraindication to their

administration is a severe local or general
reaction to a previous dose.

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Example;
• Bacterial – Typhoid ,Cholera, Pertusis,Plague
• Viral- Rabies , polio (salk) , Influenza, Viral
Hepatitis B, Hepatitis A, Japanese
encephalitis.

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iii. Toxoids
• Certain organisms produce exotoxins, e.g.,
diphtheria and tetanus bacilli.
• The toxins produced by these organisms are
detoxicated and used in the preparation of
vaccines.

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• The antibodies produced neutralize the toxic
portion produced during infection, rather than
act upon the organisms.
• Toxoids are highly efficacious and safe
immunizing agents.
• Example: Bacterial:– Diphtheria, Tetanus 

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Cellular fractions
• Some vaccines are prepared from extracted
cellular fractions,
• e.g., meningococcal vaccine, hepatitis B
vaccines.
• Their efficacy and safety appear to be high.

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v. Combinations
• If more than one kind of immunizing agent is
included in the vaccine, it is called a mixed or
combined vaccine.
• The aim of combined vaccines is to simplify
administration, reduce costs and minimize the
number of contacts of the patient with the
health center .

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The following are some of the well-known
combinations :
• DPT (Diphtheria, pertusis, tetanus)
• DT (Diphtheria-tetanus)
• DPT+ Hb+ Hib
• DPT+ Hb
• MMR (Measles, mumps and rubella)
• DPT+ Hib ( Hemophilus influenza ‘B’)

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Antisera
• Passive immunization
• Prepared from non human resources as horse
• May cause serum sickness and anaphylactic
shock
• These are given against tetanus, diphtheria,
botulism, gas gangrene & snake bite.

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Immunoglobulins
• Are soluble proteins secreted by activated B cells and
plasma cells in response to an antigen
• Are capable of binding specifically with that antigen
• They attach to foreign substances, such as bacteria, and
assist in destroying them.
• There are five classes of antibodies: IgD, IgM, IgG, IgA, and
IgE

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 IgG (75% of total immunoglobulins)

• most abundant antibody

• Appears in serum and tissues(interstitial fluid)
• Assumes a major role in blood borne and tissue infection
• Enhances phagocytosis
• IgG is transferred to the fetus through the placenta and
protects the infant until its own immune system is functional &
its half life is about 21 days.

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 IgA(15% of total Ig)

• Appears in body fluids(blood, saliva, tears, breast milk and

pulmonary, gastrointestinal, prostatic and vaginal secretions)
• Passes to neonate in breast milk for protection
• It provides defence mechanism at the mucous membranes
against local infection.
• Its half –life is about 6-8 days.
• IgA in breast milk protects the gastrointestinal tract of neonates
from pathogens.

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 IgM(10% of total Ig)

• IgM usually circulates in the blood, accounting for about 10% of

human immune globulins
• Appears as the first immunoglobulin produced in response to
bacterial and viral infections
• Indicates recent infection
• It has half –life is 10 days.

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IgD (0.2% of total Ig)

• Appears in small amounts in serum

• IgD may be involved in the induction of antibody production
in B cells, but its exact function remains unknown.
• Its half –life is about 2-8 days.

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IgE (0.004% of total Ig):

• Takes part in allergic and some hypersensitivity reactions

• Responsible for immediate anaphylactic reaction
• Half life is 2 – 3 days

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