COMMUNITY HEALTH

NURSING
 INTRODUCTION

• Community health nursing is a specialized area

of nursing practice. It is a unique blend of

nursing and community health woven into a
service.
• It is the practice of promoting and protecting

the health of populations using knowledge from

nursing sciences and public health sciences
• Unlike other specialties of nursing, community

health nursing lays major emphasis on primary

level prevention and focuses on the entire
community.
DEFINITION
According to American Nurses Association (ANA)

• “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
diagnosis group. It is continuous and not episodic. The
dominant responsibility is to the population as a whole.
Therefore, nursing directed to individuals, health maintenance,
health education, co-ordination and continuity of care are
utilized in a holistic approach to the management of the health
care of individual, family, group and community.”
 OBJECTIVES OF
COMMUNITY HEALTH
NURSING
Objectives of CHN
• To increase capability of individuals, families, groups

and community to deal with their own health and

nursing problems.
• To strengthen community resources.

• To control and counteract environment.

• To prevent and control communicable and non-

communicable diseases.
• To provide specialized services for mothers, children, adults,

workers, elderly handicapped and eligible couples.

• To conduct research and contribute to the further refinement

and improvement of community health nursing practice.

• To participate in preparing health personnel to function in

community for community health care services.

• To supervise, guide and help health personnel in carrying out

their functions effectively

 PRINCIPLES OF
COMMUNITY HEALTH
NURSING
1. The community health nurse should be qualified.

2.Community health nursing is community focused,

it is therefore essential to know the defined
community, make a map and establish effective
working relationship.

3.Health services should be based on the felt needs.

3. Effective worker irrespective of position or place
of work, functions as a team.
4. Professional relationships and etiquette are
essential in community health services.
3.Health education, guidance and supervision are
integral part of community health nursing
services.
4.Health services should be realistic in terms of
available resources.
5. Health services should be available and
accessible to all without any discrimination

6. Community health nurse should never accept

any gifts or money as bribe.

7. Community health nurse should be non-

political, non secretarial in his/her relationship
8. Health services should realistic in terms of
available personnel and facilities.

9. Follow up services are effective services and it

is must in community health.

10. Periodic and continuous appraisal and

evaluation of health situation and health services
are basic to community health
11. Facilities for further training and continuous
education should be provided by the health
authority.

12. Community involvement is integral part of

community health nursing practice.
13.Individuals and families participate fully in all
decision making relating to attainment of health.

14.Well developed system of records and reports is

essential for community health services.

15.In community health ,community is the focus

than the individual which is the unit of all health
care services.
16.The health worker is responsible to the
authorized health authority and functions within
the policies, general goals and objectives set by the
health agency.
 PRINCIPLES OF
COMMUNITY HEALTH
NURSING
(MNEMONICS)
• Education is primary tool and responsibility.
• Made services should be available to all regardless of race
creed and socioeconomic status.
• Policies and objectives of agencies is fully understand by
nurse.
• Organizing of health with family as a unit of service.
• Work as a member of health team.
• Existing active organization is utilized.
• Recording and reporting are accurate.
• Monitoring and evaluation of services periodically done.
• Existing indigenous resources of community based.
• Needs of clients is recognized and serves as the basis of
community health.
• Training and development as opportunities for community
SCOPE OF
COMMUNITY HEALTH
NURSING
• The scope of community health nursing is wide
as community.
• Community health nursing is practiced as an
organized health practice to achieve the goals
and aims of community health.
• The goal of community health is to
promote ,preserve health, to restore health when
it is impaired and minimize suffering and
distress and promote quality living.
 Home care

Domiciliary
nursing Nursing Home
services

Geriatric MCH and

nursing Family
services Planning

SCOPE OF
COMMUNITY
HEALTH
NURSING

Rehabilitation School health

centres Nursing

Community
Mental health health nursing
services

Industrial
nursing
1.Home care
• A large number of clients can be adequately

cared for at home by extending certain hospital

services.
• The hospital takes up the responsibility in

coordinating these services by providing

personnel or equipment.
• Community Health Nurse can provide health
services to the people suffering from chronic
illnesses, geriatric population, children and
women at their door steps.
2. Nursing Homes
• The nursing homes are privately run.

• They have better medical facilities than the

government hospitals because they charge more fees.
• Nurses work in these nursing homes very competent

and provide nursing services to the client attending

these nursing homes.
• 3. MCH and Family Planning
• The public health nurse plays a major role in

the MCH and Family planning services.

• Nurses provide antenatal, postnatal and child

care services in these centre.

• They identify the pregnant and lactating
mothers and provide folow up care during
pregnancy and postnatal period.
• They also provide family planning counseling

services to couples.
4.School Health Nursing
• School health nursing is a primary component

of primary health care.

• Community health nurse are members of school

health team and provide school nursing services

to students and staff.
• The school health nurse renders services to
promote and protect the health of school children.
• She provides her services in the areas like health

education, early education of diseases,

immunisation, first aid, dental health, school
sanitation, maintenance of health records, follow up
and referral services.
• 5. Community health nursing services
• It includes nursing care of the family in the

sickness and health.

• The community health nurses should be able to

provide primary health care in the community.

• conduct routine antenatal, postnatal visits and

neonatal care ,immunisation , promote health

• 6. Industrial nursing services
• Nurses are employed in industries.

• There is provision for appointment of nursing

and medical staff in factories where 500 or

more workers are employed.
• The broad areas of nursing in this are

pre-employment and periodic health check up

care of sick

first aid

industrial sanitation and safety

organisation of services to women and children,

rehabilitation of the ill and disabled workers and

administration
7. Domiciliary Nursing Services
• The areas where domiciliary nursing is practised

in this country are maternity services, health

supervision and disease prevention services and
services for illness and accidents.
• There is limitless for organising domiciliary

visits.
8.Mental health nursing services
• Many developing countries have mental
health services today.
• The services include early diagnosis and

treatment, rehabilitation, psychotherapy, use of

modern psychotropic drugs and follow up
services.
• Mental health nursing is yet to be developed in

India.
• 9. Rehabilitation Centres
• Rehabilitation means restoration of all treated

cases to the highest level of functioning ability.

• Nursing is an important component in the

rehabilitation of the disabled.

10.Geriatric Nursing Services
• The number of old people is increasing in the

world today.
• The need of the old is different and they need

more care than younger age groups.

• Nurse also work in geriatric home to cater the

health needs of old people

COMMUNITY HEALTH
NURSING
APPROACHES
• The following approaches are to be utilized by

community health professionals.

I. Persuasive Approach
II. Enforcement
III. Team approach
IV. Community involvement
V. Intersectoral Approach
 1. PERSUASIVE APPROACH

• It implies convincing people through dialogue

and educate them to change or modify their

health behaviour.

• Community health nurses make use of this

approach in all types of nursing interventions

• related to health promotion and specific

protection, early recognition, diagnosis and

treatment and disability limitation and

rehabilitation.
 2. ENFORCEMENT

• It implies use of more coercive measures such

as use of legislation.

• e.g. prohibition of drug abuse, child abuse,

immunization as a condition to school

admission etc. and use of authority

•
• e.g. giving strict instructions or orders to do

certain things especially when it is a question of

life and death during emergency situations such
as difficult labour, acute broncho-pneumonia etc.

• Community health nurse make use of such

measures in life threatening emergency situations

 3. TEAM APPROACH

• It is very essential to deal with varied and

complex health needs and problems of people

at large.
• It is just not possible for any one profession or

discipline to provide such care.

• Community health nursing is one of the

professions and community health nurses along

with their auxiliary nurses and female health
supervisors help to meet nursing needs of the
community as a whole.
• Other members of the team who are usually

there include
• Physicians, clinical specialists, public health

engineers, health statistians, epidemiologists,

health educationists, counselors, social workers,
clinical psychologists, pharmacologists, lab
technicians and village level health workers.
4. COMMUNITY INVOLVEMENT

• Health of individuals living in a defined

community is not only their “right” but also

their “responsibility” to take care of their own
health and also of community at large.
•
• Without peoples help, co-operation or participation,

it is neither possible to make health care services

accessible and acceptable to them nor it is feasible
to achieve community health goals and aims.
• Community involvement and participation is
recognized as one of the crucial supportive approach
for successful implementations of community health
care services.
5. INTERSECTORAL APPROACH

• Health of people at large cannot be attained by

health sector alone because there are many

factors which affect peoples health but they are
not under the purview of health sector
• e.g. food production and distribution, water,
sanitation, housing, environmental protection and
education.
• Each one is dealt by separate sector and contributes

to health and socio economic development.

• It is felt necessary to have proper co-ordination

between the health and all other sectors concerned

at all levels.
 PHILOSOPHY OF
COMMUNITY HEALTH
NURSING
 INTRODUCTION
The philosophy of community health nursing includes the
following beliefs and ideas;
1.Philosophy of individual’s right of being healthy
2.Philosophy of working together under a competent
leader for a good command
3.Philosophy that people in the community have a
potential for continued development and are capable of
dealing with their own problems if educated and helped.
4.Philosophy of socialism.
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.

• Indian constitution provides directives to ruling

political party to design health care delivery system

to promote and preserve this right by providing
effective health services to all without any
discrimination.
 2.Philosophy of working together under a competent
leader for a good command
• Starting from the stone age, human beings have learnt to

live together in meeting their needs.

• This willingness to share the responsibility of helping each

other is the basis of modern concept of community health.

• Based on this philosophy emphasis is given on community

organization; people's participation; working through

community groups/ people, with the people for the people
for their mutual benefit; change in behaviour and health
practices.
3.Philosophy that people in the community have a potential
for continued development and are capable of dealing with
their own problems if educated and helped.

• An individual with average intelligence can learn and deal

with his/her own needs, modify his /her lifestyle, adjust to

his/her changing environment, modify his/her environment
learn to solve his/her own problems.
• Based on this philosophy, emphasis is given to health

education at all levels of care in community health, may it

be at home, health center, place of work, school,
community places or hospitals
4.Philosophyofsocialism

• Socialism as one of the social system where in the

community/society as a whole has the ownership and the
control of all means of production and distribution e.g. food,
housing, material production of all kinds, education,
health ,transportation etc should be shared with all people.
• There should not be any type of discriminations rather weaker

sections should be helped to have these means and facilities.

• This philosophy implies that society has the obligations to

protect and ensure health of the people. Social and political

system is responsible t plan and organize a system to provide
services to all.