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COMMUNITY HEALTH NURSING

NSc 305
NURSING PROCESS IN THE COMMUNITY

The nursing process is a systematic way of determining a client health status, isolating health
concern and problems, developing the plans to remediate them, initiating actions to implement
the plan, and finally evaluating the adequacy of the plan in promoting wellness and problem
resolution. The nursing process defines interactions and interventions with the client system,
whether that system is an individual, a family, an integrate or a community.

The nursing process commonly consists of five phases:

• Community assessment;

• Community diagnosis;

• Planning;

• Implementation and;

• Evaluation.

PHASES OF NURSING PROCESS IN THE COMMUNITY

1. ASSESSMENT

Assessment is the first step of the nursing process, which means to collect and evaluate
data/information about a community’s health status to discover existing or potential needs as a
basis for planning.

Community Assessment: This is the process of searching for and validating relevant community
based data according to a specified method, to learn about the interaction among the people,
resources and environment. Community assessment includes; Collecting pertinent community
data Analyzing and interpreting the collected data.

Community need assessment:- is the process of determining the real or perceived needs of a
defined community of people. In some situation; an extensive community study becomes first
priority. In others, all that is needed is a study of one system (e.g., health system, educational
system …etc.) or organization (e.g., women association …etc).

A. Physical Environment Just as physical examination is important to individual patients, so is

examination of the community physical environment.

Inspection: inspection uses all sense organs and is done by walking survey in the community, or
micro-assessment of housing, open spaces, boundaries, transportation service centers, markets

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places, meeting street people, signs of decay, ethnicity, religion, health and morbidity, political
media.

Auscultation: is listening to the community residents about the physical environment.

Vital signs: observe the climate, terrain, natural boundaries such as rivers and hills.

Community resources: look for signs of life such as notices, posters, new housing and
buildings.

System review: hosing age, architecture, building materials used, signs of disrepair, running
water, plumbing, sanitation, windows (glasses)..etc. Also business facilities and churches.

B. Health and social system: Differentiate between facilities located within the community and
those located outside. For Hospital asses for number of beds, staffing, budget, health center,
clinics, or health posts, public health services, private clinics, pharmacies, dental and other
services. Signs of drugs or substance abuse, alcoholism. Social services include counseling and
support, clothing, food, shelter and special needs as well as markets and shops.

C. Economics Financial characteristics. Labor force characteristics, employment status of the

general population greater than 18 years of age. Occupational categories and percentage of
persons employed by government, farmers, skilled, unskilled, professional, types of
business/industry.

D. safety and transportation: police, sanitation (water source, solid waste disposal, sewage and
air quality) and fire services. Primary means of transportation; walking, taxi, bus, train, private
car, and air services. Frequency and affordability of public/private transport, and standard of
roads.

2. COMMUNITY ANALYSIS AND NURSING DIAGNOSIS

Community analysis is the process of examining data to define needs strengths, barriers,
opportunities, readiness, and resources. The product of analysis is the “community profile”.

Analysis is necessary to determine community health needs and strength as well as to identify
patterns of health responses and trends in health care.

Steps in Community analysis

• Data categorization (demographic, geographic, socioeconomic, health resource and services…

etc)

• Data summarization (rates, charts graphs…etc.)

• Comparing data (with similar data, identification of data gaps, incongruence…etc)

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• Draw inferences (draw logical conclusions from the evidence) that lead to community
diagnosis.

Community nursing diagnosis is a statement that defines the health strength, health
problems or health risks of the community. Nursing diagnosis is a real clinical judgment or
conclusions about human response to actual or potential problems. A community diagnosis
forms the basis for community based intervention.

GOALS OF COMMUNITY DIAGNOSIS

 Analyze the health status of the community

 Evaluate the health resources, services, and systems of care within the community

 Assess attitudes toward community health services and issues

 Identify priorities, establish goals, and determine courses of action to improve the
health status of the community

 Establish an epidemiologic baseline for measuring improvement over time.

PURPOSES OF COMMUNITY DIAGNOSIS

1. It helps in identification and quantification of health problems.

2. Help in identification of those individuals or groups at risk or those who needs health care.

3. It helps to identify community needs and problems.

4. It helps to decide strategies for community involvement.

5. Effectively help in understanding the social, cultural, and environmental characteristics of

community.

6. it can be used to help the community becomes conscious of its existing problems and find
solution

Indicators of health

Community is diagnosed using health indicators and indicators of health are variables used for
the assessment of a community health. Indicators can be classified as follows

 Mortality indicators

 Morbidity indicators

 Disability rates

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 Nutritional status indicators

 Health care delivery indicators

 Utilization rates

 Indicators of social and mental health

 Environmental indicators

 Socio-economic indicators

 Health policy indicators

 Indicators of quality of life

 Other indicators

Steps in community Diagnosis

 Defining area- who and what

 Identifying the needs of community
 Specifying priority health needs of the community
 Identifying community resources for facilitating health problems
 Setting priorities for action
 Community needs in proportion to national capacity
 intersectional co-operation in planning

PARTS OF NURSING DIANOSIS

A nursing diagnosis has three parts

• Description of the problem (specific target or groups)

• Identification of factors/etiology related to (r/t) the problem

• The sign and symptoms (the manifestations) that characteristics of the problem.

Examples;

Inadequate ANC r/t inadequate health information or service accessibility as evidenced by 70%
of female delivering at hospital with no antenatal care.

Poor nutritional status of under five children in the community r/t knowledge deficit regarding
weaning diet as evidenced by growth monitoring chart.

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High infant mortality r/t inadequate ANC, maternal nutrition, and unhygienic delivery practice as
evidenced by IMR 75 /1000 live births.

3. PLANNING

It is a logical, decision making process of design an orderly, detailed programs of action to

accomplish specific goals and objectives based on assessment of the community and the nursing
diagnosis formulated. Activities in planning include:

• Setting priorities involves: Assigning rank/importance to client’s needs, Determining the

order in which the goal should be addressed. The goal can be immediate, intermediate or long
range goal.

• Establishing goal and objectives: Goal is a broad statement of desired end results. Objectives
are specific statement of the desired outcomes.

• Planed actions: are specific activities or methods of accomplishing the objectives or expected
outcomes.

• Outcome measurements: Is judging of the effectiveness of goal attainment. How and when
was each objective met, why not?

• Recording the plan

4. IMPLEMENTATION

Implementation is putting the plan into actions and actually carrying out the activities
delineated in the plan, either by nurse or other professionals. It is the action phase of the nursing
process. Community interventions are the therapeutic actions designed to promote and protect
the community health, treat and remediate community health problems and support the
community as it changes over time. Key areas of nursing intervention in the community are:

• link the community members with the available resources

• pulls together information and resources to assist community in addressing its health concern
and problems

• marinating its strength through facilitation, education, organization, consultation and direct
care.

TYPES OF NURSING INTERVENTION

Supplemental: i.e. doing things for the families, groups and community at a large which they
are not able to do eg. Nursing care of sick at home or in centre or in any setting

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Facilitative: i.e. removing barrier, obstacles etc. she helps them to mobilize and develop their
resources. The nurse need to know community resources- health and health allied, know their
functions and establish functional relationshipwww.drjayeshpatidar.blogspot.in

Developmental i.e. helping families, groups and people at large to develop and improve their
capacities. Educating members to recognize their health problems, health needs, find solutions,
mobilize and develop their resources and abilities to implement action etc.

5. EVALUATION

It is systematic, continuous process of comparing the community’s response with the outcome
as defined by the plan of care. The ultimate purpose of evaluating interventions in community
health nursing is to determine whether planned actions met client needs, if so how well they were
met, and if not why not. Evaluation requires a stated purpose, specific standards and criteria by
which to judge and judgment skills.

UNIT V: SCHOOL HEALTH PROGRAM

INTRODUCTION/DEFINITION
School health is an important branch of community health. according to modern concept, school
health service. The beginning of school health service in India date back to 1909, in Baroda city.
In 1961 the five year plan, many state provided for school health and school feeding program.

This could be defined as any health programme/ services carried out within the school to solve
the problem of the school child which is aimed at ensuring that children participate fully and
actively in all school activities.

AIMS AND OBJECTIVES OF SCHOOL HEALTH PROGRAM

 To pay attention to early diagnosis of any disability so that early treatment can be
instituted before the child’s condition becomes uncontrollable.
 To improve the children general health status.
 To make sure that every child is as fit as possible to gain maximum benefits from his/her
education.
 To promote high level of sanitary condition in the school.
 To prevent the occurrence of communicable diseases among the school children.
 To prevent the spread of communicable diseases among the children.
 To provide emergency care for school children and if necessary and their teachers.
 To diagnose and treat any handicapped child.
 To ensure that physico-social environments of the school is free from dangers.
 To install principle of healthy living in the school’s children and members of staff of the
school by giving examples from health personnel demonstration & health education.

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SCOPE Of SCHOOL HEALTH PROGRAM

 Appraisal of the health status of the school children

 Promotion of sanitary conditions in the school environment
 School nutrition programs
 Control of communicable diseases in the school setting
 Treatment of common ailments among schoolchildren including the provision of
emergency care for injuries and sudden illness.
 Counseling services to children, parents/guardian, teachers and other staffs in the school.
COMMON HEALTH PROBLEMS AMONG CHILDREN
 -Diseases of the skin—scabies, ringworm etc
 -Parasitic infection such as malaria, intestinal worms etc
 -open wound topical ulcers etc
 -R T I, e.g. asthma, pneumonia, bronchitis, etc
 -ear and eye infection e.g. otitis media, conjunctivitis, visual and auditing impairment
 -Accidents e.g R T A, fall from height
 -Anaemia, e.g. SCD
 -Dental carries
 -rheumatic fever & rheumatic heart disease
 -malnutrition

SERVICES PROVIDED

 Health check up
 Prevention of communicable disease
 Spot treatment
 Referral services
 Free spectacles
 Free super specialty treatment for Heart , Kidney and Cancer disease including renal
transplant
 IEC activities
 Nutritional Services(mdm, Applied Nutritional Program,specfic Nutrition)

STRATEGIES

 A State level Steering Committee, under the chairmanship of the Health Minister.
 The Steering Committee takes important policy decisions regarding the School Health
Programme
 Meeting of all stake holders.
 Micro planning at PHC level .

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 State level master plan.

 Primary, secondary and tertiary care.

THE BASIC STRENGTH OF SCHOOL HEALTH PROGRAMME

 * Widely accessible Communication network

 * Easily retrievable health data
 * Through micro planning for the entire project
 * Appreciation & reward system for the peripheral health provider
 * Dedicated team for the programme
 * Designated referral centers for the screened out children
 * The beneficial results obtained so far
COMPONENT OF SCHOOL HEALTH SERVICES

HYGIENE INSPECTION; it’s very important to teach the school children the positive health
habit concerning hygiene such as washing hands before and after meals, washing hands after
using latrines. All this will help to prevent the contagious diseases from spread among the
children.

HEALTH EDUCATION; this is an integral part of school health services, its meant to give the
students the opportunity to develop an insight into the implication of negative attitude to issue
affecting their health such as hazard of smoking , alcohol, chemical abuse, sexually transmitted
disease and above all enrollment into secret cult.

MEDICAL EXAMINATION; this is one the activities of school health services where by routine
examination is carried to every child either before or immediately after entering into school, In
order to give the school the general health status of the child. A questionnaire is usually filled by
the school nurse or C H O with the assistance of the parents that involves many points including
developmental history, social development, home condition, general muscular, auditory,
memory, passed/present medical/surgical history, family medical/surgical history etc.

IMMUNIZATION; many children remain un immunized by the time they enter school especially
in the rural areas, therefore as part of school health services, immunization should be offered on
continuous basis because some children failed to receive immunization during early childhood so
they should routinely be vaccinated in order to have protection against such preventable diseases.

TREATMENT OF MINOR AILMENTS; it’s the responsibility for every school to provide
emergency healthcare to every child who fall sick in the school or get injured. It should be a
policy for each school that their teachers should be able to identify child with sudden illness and
injuries.

In case of any emergency situation the school should be ready to;

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--have first aid kit

--notify the parents/guidance immediately

--transport the victim to the nearest and most appropriate medical institution after first aid
treatment has been given

SUPERVISION OF FOOD VENDORS; food is very essential for growth & development of
every child. It’s an important service of the school health program to ensure the hygiene of being
supplied to children in school. The commonest form of contamination is from excreta either by
means of fingernails or flies or even the skin of food handlers/vendors, therefore b4 food
handlers/vendors can be allowed to sell food in school and community, they must be sent to
school for screening to exclude some infectious diseases e.g. typhoid fever, t.b. hepatitis, yellow
fever, cholera etc, their home must also be subjected to thorough inspection by the public health
officer/sanitary inspectors b4 being contacted to handle or sale food in the school.

FAMILY LIFE EDUCATION; this is another component of school health services that teaches a
child the nature of the family, how the family came into being which is through marriages, and
also part of the family life education is to teach a child sex education and the implications of
having sex before marriage.

DAILY INSPECTION AND ASSESSMENT OF THE SCHOOL CHILD

it’s the responsibility of the teacher to carryout observations every day before students enter class
or before first class begins.

The aim of daily observation and periodical inspection by the school Nurse or teachers
include:

1. To detect children suffering from diseases e.g chicken pox, cholera, diphtheria etc.
2. To send the sick child home
3. To report the sick immediately within 24hours to a school health clinic or hospital.
4. To check the school child who went to school clinic or hospital.
5. To observe if the child practices good health habits in daily living.
6. To provide education regarding health and formation of good health habits.

ROLE OF NURSES IN SCHOOL HEALTH PROGRAMS: actually the school health

program is carried out by the school medical officer or community health officer (CHO)with
the help of school nurse who assume a major part of health program responsibilities and
works in collaboration with other para medicals and trained teachers.

1. Health supervision: this includes like health assessment, vision & hearing screening and
identification of any deficiency in respect to health.

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2. Health counselling: this involves providing interpretation of health information, guidance

& counselling regarding health behavior and recommendations on student health
condition.
3. Health education: which involve planning, promoting and implementing health
instructions as well as providing consultation services in health related matters.
4. Establishments and enforcements of school policies and programs for the protection and
promotions of health of the students.
5. Maintenance of school environment conducive for healthy living.
6. Building some components in the curriculum that have a significance for health .
7. Management of health services like screening programs and emergency care services.

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