unit 1 chn 4th yr.doc

8/10/2019 unit 1 chn 4th yr.doc

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health nursing encourages for e)pressed felt need, active participation and self

responsibility for self care at various levels of health and illness continuum of an

individual in the community.

etting for community health nursing practice

homes

ambulatory service settings

schools

occupational health setting

residential institutions

the community at large

!hilosophy of Community Health Nursing

*hilosophy is an attitude to wards life and reality. %he +urses philosophy is anintegral part of the frame work for community health nursing. It influences how the nurse

will function with families, groups and coworkers in a community and is based upon beliefsabout health and about nursing.

%he philosophy of community health nursing devices from acceptance of certain concepts

and facts as a foundation for working with people.

%he essential dignity and worth of the individual

!ach individual possess potentialities and resources for managing their own lives

%he importance of freedom to e)press one-s individuality

%he great capacity for growth within all social beings

%he right of an individual for basic necessities %he need for individuals to struggle and strive to improve their life and environment

%he right of the individual to be helped in times of need and crises

cope of Community Health Nursing

". community health nursing services:-community health nursing services

including nursing care of the family in sick and healthi. Community health nurses able to'

b. provide primary health care in the community

c. conduct routine antenatal and postnatal servicesd. conduct deliveries when re&uired

e. carry out immunization

f. promote health of the children by conduct under five clinics and referringcases who re&uire medical care


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g. assess the social and environmental and nutritional needs of community

and get the help of social workers to meet these needs

. Industrial nursing services: - nurses are employed in industries. %here is a

provision for appointment of medical and nursing staff in factories where $// or

more workers are employed. %he broad areas of nursing in this are preemployment e)amination and periodic health check up, care of sick, first aid,

industrial sanitation and safety etc.

0. chool health nursing:-school health nursing is not yet well developed inIndia. %he school health renders services to promote and protect the health of the

school children. She provides her services in areas like health education, early

education of diseases, immunization, first aid, dental health, school sanitation,

maintenance of health records, follow up and referral services1. "omiciliary nursing services: the areas where domiciliary nursing is practiced

in this country are maternity services and services for illness and accidents at the

home setting.

$. #ental health nursing services:many developing countries have mental healthsupervision and diseases prevention services today. %hese services include early

diagnosis treatment, rehabilitation, psychotherapy, use of modern psychotropicdrugs and after care services.

2. #CH and family planning: - the public health nurse plays a ma(or role in the

3C4 and 5amily planning services. It comprises antenatal and postnatal andchild care services

6. $ehabilitation centers: rehabilitation means restoration of all treated cases to

the highest level of function ability. +ursing is an important component in the

rehabilitation of the disabled at the community level.7. %eriatric nursing services: the number of old people is increasing in the world

today. %he need of old is different and they need more care than the younger age

groups.#. International health agencies:plays a role in collecting health relates data and

takes active part in programme planning, implementation and evaluation

!urpose of Community Health Nursing:-

%he basic purpose of community health nursing is to further community health

through the selective application for nursing and public health measures, within the framework of the total community health effort.

%oals and &ims of Community Health Nursing

&ims:-

%o increase the capability of families, groups and communities to cope health and

illness problems.

%o support and supplement the efforts of other professionals in restoration and

preservation of health.

%o control or counteract as much as possible physical and social environmental

conditions that threaten health or decrease the en(oyment of life.


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and to take necessary actions which can help improve their health life style and

health

9bservation of environmental condition with respect to physical, biological and

psychosocial aspects which effect health and welfare of the family and community

at large. ny condition which threatens the out break of any disease must be reported

to the authority and the concerns health worker to take action 9bservation of resource available to has to help family and community people to

use them intelligently in meeting their health need

0.,ducator

!ducates individual, families and community both during sick or have any health

problem and well given at clinics, home, school work place etc.

%he ultimate aim of community health nursing is to help people gain health

knowledge, modify health attitude, health behavior and develop competency to

become self dependent, self reliant in dealing their health matters etc.

* &dvocate

s an advocate, the community health nurse stands between the individual8family8

community and various specialized services.

*eople are ignorant about the various services which are available, she e)plains

them about the service available and guides them how to use their services as aneffective advocate the community health nurse needs to possess certain &ualities

which are a: willingness to take risk, b: assertiveness c: communicability d:

resourcefulness.

. &dvisor:-

%he community health nurse acts as an advisor. She gives suggestions advice on

practical situations which re&uire immediate actions and where there is no scope ofhealth education.

5or e)ample n antenatal mother having threatened abortion or child with acute

pneumonia etc.

She may also advise ancillary staff on various (ob related activities. She shows

concerns to their problems and helps them to solve the problems.

/* Change agent

%he community health nurse acts as a change agent i. e. she serves as a potentate or

catalyst. It means that she is able to make others more effective by increasing theircapabilities to'

": Cope up with their health problems

: *rovide care to themselves.

0* #anager

Community health nurses are e)pected to function as manager of family health care,school health care, community health care, any specific programme or pro(ect etc.

She may be e)pected to manage by her self or together with medical officer and

other personnel.

s manager she plans, organizes, coordinates, supervises, guides, directs, reports,

and evaluates.

1* !lanner


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+urse plans family health care by making health assessment, setting up goal and

ob(ectives, identifying alternative action, implementing and evaluating the care

given.

She also gets involved in over all planning of community health care or in planning

of any specific program for any particular group or for whole community.

)2* "irector and co-coordinator +urse has to communicate to personnel about (obs to be performed, directs and

motivates them to do their (obs, supervises and guides them to perform various

activities to reach the desired ob(ectives.

She must ensure effective byway communication between her as a manager and the

personnel and also among the personal themselves.

))* Controller and evaluator

+urse identifies the difficulties; she then takes corrective measures according to the

situations so that intended ob(ectives are attained

)+* 3eader

Community health nurse functions as a leader when she performs the role of nurse

manager. She leads the group by giving them directions, ensuring bywaycommunication, providing supervision and guidance and by cocoordinating theiractivities and infrastructure etc.

)4* Collaborator

%he community health nurse collaborates with all the health team members i.e.

she works (ointly with them in helping family and community people to meettheir health needs.

%he community health nurse needs to be assertive and verbalize her role and

responsibilities to the team members so that her presence on the team is felt andidentified.

)* $esearcher

+urse may conduct independent studies to improve community health nursing

practice.

%he practice of community health implies involving epidemiological approach to

deal with problems.

She may range from the simplest in&uiry to most comple) epidemiological

studies. %herefore the community health nurse performs a researcher role incommunity health nursing practice.

!rinciples of Community Health Nursing

Community health nursing principles are essential because they ensure relevant, safe and

correct practices to meet health needs of individuals, families, groups and community.

)* Community health nursing is community focused5 it is therefore essential to 6now

the defined community5 ma6es a map and establishes effective wor6ing relationship

Community health nurses must know her area, boundaries and important land marks,

people in general, community leaders, their lifestyles, their resources and also the vital


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events. It helps in providing need based comprehensive healthcare services and in

achieving community health goals.

+* Community health nursing is based on identified community health nursing needs

and functions within total community health programmes

Community health nurses must always identify health and nursing needs of the assignedcommunity .Community health nurses working in community need to know health care

delivery system, health policies, health goals and ob(ectives, health care programmes to

deal with various national health problems as planned and implemented by the govt atvarious levels of health care delivery system.

4* Health education5 guidance and supervision are integral part of community

health nursing services

She must educate community, give them more information which creates interest, help

them to develop certain skills, guide and supervise them to continue such practices and

give care. %eaching should be simple, understandable, specific scientifically correct and

of practical value.

* Health services should be realistic in terms of available resources

lways plan and provide services based on health needs and money material and

manpower available. It re&uires proper estimation, prioritization and procuring more

recourse according to situations and feasibility.

.* 7he health wor6er is responsible to the authorized health authority and functions

with in the policies5 general goals and ob(ectives set by the health agency

Community health nurse or any other health worker may be employed by the Center,

State, and Corporation, 3unicipality, or voluntary health agency. %he health workerneeds to know, understand, follow the health policies and goals and ob(ectives of health

agency and accordingly plan and implement health care services.

/* ,ffective health wor6er irrespective of position or place of wor65 functions as a

team

She must be knowledgeable of duties and responsibilities of all the members of health

team so that lapses and over lapses can be prevented in making community healthassessment, planning, implementation and evaluation of health care services.

0* In community health5 community and the individual are the unit of all health care

services

*eople-s health is influenced by various factors which are pertaining to their biology,lifestyle, environment and resources the health of the people can be promoted and

preserved by organized health care services for the community at large and by providing

these services to the people in the family setting

1* !rofessional relational ships and eti8uette are essential in community health

services

It is very important for community health nurse to establish professional working

relationship with health and health aliened agencies who are contributing towards health

and welfare of the people. %hese may include ayurvedic, unani and homeopathic and

other social welfare organizations. %he community health nurse should also get to know


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and establish friendly relationships with health practitioners like


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In )422-)/22&", ?havamisra wrote ?havaprakasha .%his is the

most renowned Indian treatise during the period. It contains ane)haustive list of diseases and their symptoms and complete list of

drugs including many not mentioned in early works. It includes

etiology and treatment of syphilis, a disease, brought into India, by

*ortuguese seamen. In )/22 !ast India Company established ?ritish


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In )942:-The All India Institute of Hygiene and public health, Calcutta was established

with aid from


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In )9.'Contributory health service scheme was started at +ew =elhi.

The central social welfare boardwas set up

National water supply and sanitation programmewas inagurated.

The national Leprosy control programmewas started .

VDRL antigen productionwas set up in Calcutta.

The prevention of food adulterationactwas passed by parliament.

In )9..''ational )ilarial control programmewas commenced as part of first five year

plan. %he central Feprosy teaching and


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minimum additional staff re&uired for the primary health centers to take over the

maintenance work of malaria and small po).

In )9/0'A small family normcommittee was set up to recommend suitable incentives tothose accepting the small family norm and practicing family planning.

In )9/1'%he small family committee-s report was submitted. bill of registration of

birth and death was passed by the parliament.In )9/9'The fourth fie year planwas launched, with an outlay of rupees "2,661 crores,

out of which


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In )914'

+ational leprosy control programme was renamed as National leprosy

eradication programme.

+ational health policy was approved

uinea worm eradication programme was launched

In)91'?hopal gas tragedy, the worst ever industrial accident in history occurred, on thenight of =ecember 80,taking a toll of at least 0/// people and fewer than $/,///affected.

In )91.'seenth fie year planwas launched. 7niersal immuni6ation programmewas

launched.

In )91/'%he environment protection act "#72 promulgated.

In )910'+ew / point programme was launched. +ational =iabetes control and I=S

control programme was launched.

In )919'Blood safety programmewas launched.

In )99+'4ighth fie year planwas launched.

Child survival and safe motherhood programme was launched !CSSM" on /th

august. 5irst +ational I=S Control *rogramme @"##"###:

In)994'3eised 'ational Tuberculosis programme with =9%S introduced as pilot

pro(ect in the country.

In )99'


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+aturopathy, Hnani, Siddha and 4omoeopathy !A:7SH"in +ovember, //0 with

a view to providing focused attention to development of !ducation


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In "#$2, 3iss drenwala was appointed as the +ursing dvisor to overnment of India.

%he development of +ursing in India was greatly influenced by the Christian

missionaries, Dorld Dar, ?ritish rule and by the International agencies such as D.4.9.H+IC!5,


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In "#70 common wealth nurses federation south sian sector conducted a seminar on role

of nurse in delivery primary health care. %+I has initiated various programmes on

primary health care at national regional level.

?y the evolvement of 45 concept the emphasis is shifted from the disease oriented care

model to the community oriented health care model in nursing education.

"#76 G 4igh power committee was appointed on nurses working condition related matters. to be recommended.

+38F4> promoted to supervisory posts must undergo courses in administration

and management.

Specific standing orders are made available for each +38F4> to function

effectively in the field.

de&uate provision of supplies, drugs etc are made.


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I+C. ?asic health activities are helped out by training S4 workers through

+


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"/.9rganising, planned group classes regarding the sanitation, nutrition,

child care , family welfare services and parent craft to the various

members in the community.

Supervises the work of 3*4D health visitors and dias.

"". Conducts epidemiological investigations in the field of communicabledisease such as %?, se)ual transmitted diseases leprosy etc.,

".She coordinates her work with other member of health team working

in the community.

"0.She revises the plans, programmes in her area and collect the vital

statics, conducts research to study the e)isting health problems, evali

effectiveness of various health problems in order to standardized.

"2.She trains conducts orientation and inservice training classes in her

area to the nursing students and other nursing staff.

"6.She acts as a coordinator between individuals of the community

"7.She acts as a consultant and talks on behalf of the individual or family

with village leaders and other members of the health team.

"#.She plans the budget ,gets the e&uipment re&uired, organises primary

health centre and to its associated health centres.

/.She manages various health programs campaigns in her area.

".She acts as a administrator at different levels of the community health

nursing services to evaluate and puts all possible trials into practice to

improve &uality &uantity of care to the total community.

pecialised functions of community health5 Nurse:

It includes in areas of maternal health, family welfare, child health,

school health, communicable diseases control, geriatrics, chronically ill

and industrial health etc

$ole of nurse in giver maternal health services:

&ntenatal period:

Contacts every e)pected mother in the early pregnancy and help her to

seek ade&uate antinatal care.

9bserve antenatal visits schedule strictly.

In community every pregnant women is e)pected to have minimum of

$ visits by the nurse and 0 visits by the doctor at home if not a


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pregnant women can go for primary health visits one month till 7th

month and once in "$ days till # month and once in a week there after.

ntenatal mother should receive minimum of "// iron and folic

tablets during her pregnancy and in(ection %% Istdose as soon as

pregnancy is confirmed. She should identify high risk pregnancy cases like the hypertension,

diabetics by doing thorough check up at home she should educate

pregnant women regarding diet, antenatal e)ercises, importance of

rest and sleep, care of the new born, breast feeding techni&ues.

G She tries to promote for institutional delivery .She prepares the

mother physically and psychologically for delivery; keeps the

e&uipment ready for conducting the delivery.

G She maintains ade&uate and accurate records of the e)pectant

mothers in the community.

G She prepares the couple for planned parent hood.

"uring 3abour:

G Beeps the necessary e&uipment ready

G She prepares place for conducting delivery

G She prepares mother for delivery by cleaning private parts, gives

enema, e)amines position of foetus and the foetal heart sounds and

uterine contractions.

G 9bserves dilatation of the cervi), general condition of the mother,

records the time of the ruputure of membranes.

G Identifies obstetrical emergencies like card prolapse, prolonged labour

and refers the cases immediately.

G Conducts the delivery in a clean way, inspects the placenta for any

abnormalities.

G *rovides immediate care for new born baby and takes care of the

mother.

G


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G !ducates the importance of colostrum, breast feeding techni&ues, and

early ambulation.

G She emphasis on importance of immunisation of new born baby.

$ole of community health nurse in school health service:

G School health services refers to the initiation, maintenance,improvement of health of school children and personnel. School health

nurse has an important role in providing school health services. %hey

include'

)* Health eBamination: *eriodic medical e)amination observation and

organising periodic medical checkup by physicians helps to identify

the abnormalities in the children at early stage. She refers the cases and

thus follows visits in the school.

. She takes steps to prevent spread of communicable diseases among the

students

G She maintains the records of health for all students

G She conducts immunization services for various common

communicable diseases at school

G She participates in organisation of various health campaigns

organised by traditional medical practitioner.

G She render first aid care for all the students if they become sick or

in(ured in school premises like the accidents , epilepsy, fainting etc.,

G She maintains a hygienic school environment specially at drinkingand eating places.

G She provides for improving environmental sanitation and promotes

students for pollination.

G She plays an important role in providing nutrition.

G She participates in mid day meal programme or the nutrition

programme or she may distribute specific nutrient or supplement

nutrition like 4yderabad mi) to the children.

G %he topics she may include are personal hygiene , dental hygiene,healthy school environmental, importance of well balanced diet etc.

G She tries to guide and counsel the children who has problem with

school environment or children with the behavioural problems like

drug addiction, nonobedience , long abscentism, (uvenile

deli&uency.

$ole of Nurse in Immunization services:


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G She informs people regarding immunization schedule.

G She tries to overcome the misconcepts of the public like regarding

immunization.

G She organises immunization session which is convenient to the

community in reference to place and time.G She assess the whole community to know the number of children who

re&uire vaccination, immunization, no. of defaullers and reasons for it

so that she can calculate the drug or vaccines re&uired for each session.

G She conducts the immunization session by maintaining strict cold chain

and by giving the vaccine with proper techni&ue for

eg: =*% /.$ mlI83

?C I8= /.$ ml

G +ot conducting immunization session directly under the sun , and notkeeping vaccine carriers under the sun.

G Beeping the drug on the ice packs while immunization, maintaining

proper temperature between 7M"by storing vaccines etc., in order to

maintain potency.

G She teaches the care which the mother has to take during immunization

like not to apply hot fomentations on the ?C or =*% vaccination.

G She follows strict aseptic techni&ues while immunization and follows

instructions of manufactures physician regarding dosage and mode

of administration.

eg= ivingpolio vaccine after checking for potency.

G She observes for any side effects or reactions after the immunization

session.

G She maintains the record of immunization for each child which

includes details like name , age, se) vaccination, name dose of

vaccine and due date.

G She makes the community to follow the students of the immunization

for their child.G She sends report to the medical officer on utilisation of the

immunization and any reactions formed.

$ole of Nurse in industrial nursing:


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She plays a ma(or role in pre and periodical e)amination

of the employees.

*rovides care to the sick and in(ured

3aintains health records

ives health education to change the behavior

S?

D49 defines a skilled attendant as an accredited health professional G such as amidwife, doctor or nurse G who has been educated and trained to proficiency in the skills

needed to manage normal @uncomplicated: pregnancies, childbirth and the immediate

postnatal period, and in the identification, management and referral of complications inwomen and newbornsN

=uring pregnancy, skilled attendants monitor the progress of the pregnancy, detect

complications, provide preventive measures, develop birth and emergency plans with the

woman and her family and advise women on health, lifestyle and nutrition in pregnancy.

=uring childbirth, skilled attendants monitor the progress of labour, are vigilant for

complications and stay with the women and support them in many ways. %hey know how

to manage abnormalities such as breech delivery and, in a team of various professionals

with obstetric, neonatal and anaesthesia skills, they deal with complications as severe aseclampsia or obstructed labour.


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In the postnatal period, the range of care varies from helping mothers and babies in

breastfeeding to managing complications such as severe postpartum bleeding, infection

or depression. If babies have problems either because of preterm birth or complications ofbirth, they receive timely and appropriate treatment. Skilled attendants also provide

counselling on postnatal contraception to the mothers.

*reventing the mothertochild transmission of 4I> is another task of skilled attendants.

It starts in pregnancy with 4I> testing, providing antiretroviral therapy, counselling oninfant feeding and advising on safer se) practices including the use of condoms and

continues in childbirth by choosing appropriate obstetric practices and supporting the

mother in her choice of feeding the baby and family planning counselling.

@$: %he world health report //$ G 3ake every mother and child count. eneva, Dorld

4ealth 9rganization, //$ @http'88www.who.int8whr8//$8en, accessed "1 ugust //7:.

*ark-s 7eBt boo6 of preventive and social #edicine "#th edition Aabalpur. 38s

?anaras das ?aharot publishers. //6.

3 =har, >foundations of community medicine@ "stedition +ew =elhi, Surabh

printers pvt ltd. //2.

=r. 3rs Basthuri sundar


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Spradley, ?. D., llender , A. . @"##2:. "ommunity health nursing- "oncepts

and practice@1th ed.:. *hiladelphia' Fippincott. Stanhop, 3., Fancaster, A.@//1:. "ommunity public health nursing@2th ed.:.

St. Fouis' 3osby Jear ?ook.

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