Introduction to Community Health Nursing
Definition of Terms
Health
1. A complete status of physical, mental and social well being of an individual and not
merely absence of a disease or infirmity. (WHO)
2. Dynamic state in the life cycle of a human being that implies continuous adaptation to
stresses in the internal and external environment through optimum use of one’s resources to
achieve maximum potential for daily living. (Imogene King)
Community
The word community has its origin in Latin where Com means together and Munity means to
serve. So community means “To serve together”.
Note: Social, physical and cultural aspects of the community have a major influence on an
individual’s health.
Definitions of Community
1. A group or collection of groups that inhabit a determined geographical area and whose
members live together in such a way that they share the basic conditions of common life (Talcot
Parsone)
2. A social group determined by geographical boundaries and/or common values and
interest. Its members know and interact with each other and it functions within a particular social
structure and exhibits and creates certain norms, values and social institutions. (WHO)
Community Health
Community health is the science and art of promoting health and preventing diseases through
organized community participation
Public health
Public health is the Science and Art of preventing disease, prolonging life, promoting health and
efficiency through organized community effort. (Winslow, 1920)
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Nursing Florence Nightingale
“Nursing is the act of utilizing the environment of the patient to assist him in his recovery
(Nightingale,1860).
Virginia Henderson
"The unique function of the nurse is to assist individuals, sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he would perform
unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to
help him gain independence as rapidly as possible"(Henderson, 1966). Community Health
Nursing
Community health nursing is a synthesis of nursing and public health practice applied to
promoting and preserving the health of populations.
•Treats “ Population as a Whole”
•Focus on individual, family, groups, community
•Utilizing Health promotion, health maintenance, health education, and management,
coordination, and continuity of care for meeting population needs. Characteristics of
community Health Nursing
•It is a field of nursing
•It combines public health and nursing
•It focus in population and environment factors that may impact to people’s health
•It emphasize in health promotion, illness prevention, and wellness
•It promotes client responsibility and self-care
•It uses aggregate measurement and analysis
•It involves inter-professional collaboration. The Setting of Community Health Nursing
•Homes
•Ambulatory service settings
•Schools
•Occupational health setting
•Residential institutions
•The community at large
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Community Health Nursing Concepts The Community Context
Definition of Community
A community is a group of people living in a certain geographical area and working together for
a common goal. They share the same resources such as water, climate, health services and
administration and leadership.
The community is made up of individual persons and each of these individuals belongs to a
family.
Individual
•Each individual is different and unique.
•Each has a mixture of characteristics, some of which they share with others and some of
which are part of a particular culture
•Individuals learn beliefs and customs about right and wrong
•Some individuals follow both traditional and modern set of ideas
•Individuals can only attain full health if they have wholesome growth best cultivated in
the family
The family
It is the smallest recognized of individual in a community and is the oldest institution known to
mankind.
The family is a group of two or more persons who share emotional bonds and material things,
usually live in same household, are related by blood, marriage or adoption and sexual
relationship is socially approved for the parents.
Functions of the family
•Bring sense of togetherness and balance between individual and shared (mutual) action
by each member, nurturance and trust, interdependence and ability to meet demands for
survival and development
•Socialization
•Teaching respect for individual members and their property
•Caring for its members and develop a sense of trust between and among its members
•Provide an environment for learning
•Inducing members to its religious faith and teaching respect and tolerance
•Sharing leisure and recreation together
•Provide security and refuge for its members
•Providing socially sanctioned environment for sexual experience among married adults
•Seeking health cares for its sick members and provides nursing care for its sick, disabled
and dependent members
•Maintain a healthy home environment conducive to the development of its members
Factors affecting family health Internal factors
•Family size
•Structure
•Type, member
•Relationship
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•Biological characteristics and values
External
•Family locality
•Terrain
•Climate
•Water supply
•Biological environment
•Housing and residence
Importance of family to the community
•Sexual function helps the society to stabilize through prescriptive and proscriptive rules
which contain sexuality
•Reproductive function of family helps the human species to survive
•Primary socialization of children and stabilization of adult for wider community.
•Fundamental and instrumental foundation of larger social structures.
•Roles and behaviors learned in family is a prototype model for role required in wider
society.
Functions of community
•Transmitting and sharing information, ideas and beliefs
•Educating its children about their culture socialization and welcoming newcomers into
the group culture (acculturation)
•Producing and distributing services and goods
•Provide companionship and support to individual members and smaller groups
•Sharing and utilization of space for living, schools e.t.c
•Protecting individual and group rights and welfare
Characteristics of a healthy community
•Safe and healthy environment, relatively free from natural and manmade hazards
•Community members have high standards of personal hygiene
•Adequate supply of safe water
•Availability of adequate nutrition
•Suitable housing
•Harmonious interpersonal relationship among members
•Availability and accessibility of health facilities
•Gainful occupational activities
•Sound communication infrastructure
•Communal approach to and participation in tackling community problems
Problems that affect the Health of community
•Unsanitary environmental
•Overcrowding
•Poverty
•Unclean and inadequate water supply
•Epidemic and endemic disease
•Unstable family life
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•Illiteracy and ignorance
•Poor leadership and lack of participation
•Adverse weather condition
•Poor infrastructure
•Political instability
Community sub systems
A community is made up of various sub-systems all of which have a bearing on how people live
and behave. For a community to function smartly the various sub systems must work in harmony
Socio-cultural System
This system is made up of all the customs and beliefs, family and kinships, leadership and power
structures in society. This sub-system exerts a powerful influence on the lifestyles of the
community members, their priorities and their attitudes and values towards health and illness.
For example some cultural factors promote either acceptance or stigma towards a certain illness.
High-risk behaviour may be a result of cultural traditions.
Political System
This sub-system is made up of the government and its development policies as well as political
organizations.
If there is political support towards improving health care delivery, the government provides the
mechanism and structure for the planning, implementation and evaluation of the health care
delivery system. The constitution of Kenya contains a declaration for the elimination of poverty,
ignorance and disease; a commitment to provide the highest level health possible to its citizen
and recognition of health as a human right, hence the establishment of the Ministry of Health and
several other ministries. Economic System
The government’s ability to provide health and other services to its citizens depends on the state
of the economy. The poorer the economy of the country, the more disadvantaged its people will
be. Low economic status is highly associated with malnutrition and communicable diseases.
Education System
Education is the main tool of changing behaviour and improving individual and community
health.
Low educational status perpetuates under-development, harmful traditions and superstitions. The
educational system can be effectively used to pass health related information and messages that
could significantly transform the perception of the communities on healthy living and prevention
of illnesses.
Religious System
The religious system may be a source of health promotion when its values and teachings
positively influence lifestyles and healthy behaviour, for example, forbidding smoking, and
alcohol consumption, pre-marital and extra-marital sex.
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On the other hand, religious teachings may promote ill health, for example, by forbidding the
followers from seeking treatment in hospitals.
Environmental System
Environmental sanitation is one of the leading promoters of individual and community health.
Clean water supply, proper disposal of waste and adequate housing are key to community
wellness. Environmental pollution is a cause of various illnesses.
Communication and Transport System
Communication includes all the means of contacting and exchanging information with one
another such as roads, bridges, railroad, telephone, television, radio, computers, internet, fax, and
postal services.
The communication system is important in spreading health messages. Transport aids in
communication by moving people from place to place.
Health Care system
The health care system exists to provide promotive, preventive, curative and rehabilitative
services in hospitals, nursing homes, clinics, health centres, dispensaries, and through special
health projects and programs.
The health care system is enhanced through linkages that bring together the government,
nongovernmental organisations, private institutions and individuals in providing continuous and
comprehensive health services. These linkages strengthen the multi-sectoral approach of
achieving health for all.
Aims of Community Health
Community health aims to achieve the following:
•Improved sanitation in the environment
•Prioritization of the community’s needs
•Control of communicable diseases
•Health education to promote healthy behaviour and practices
•Early diagnosis and prevention of disease
•Disease surveillance
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•Case/contact tracing and treatment
•Empowerment of all individuals to realize their rights and responsibilities for the
attainment of good health for all
Benefits of Community Health
A successful community health programme is one in which the community and health care
providers collaborate to achieve the following benefits:
•Increased life expectancy (life span) of every individual
•Decreased mortality rates particularly of mothers and children
•Decreased morbidity rates from all causes
•An increase in the total well being (physical, mental and social) of every individual
•An increase in the quality of life for all people
•Overall social and economic development of the population
•Equitable distribution of resources
Examples of Community Health Activities
•Health education, counseling, and the training of other health workers
•Community health assessment and diagnosis
•Information, education and communication
•Environmental sanitation and supply of adequate clean wholesome water
•Food hygiene and household food security
•Personal hygiene
•Vector and pest control
•Control of communicable diseases
•Provision of prenatal services to pregnant women
•Provision of family planning services
•Provision of child health/welfare services for children under five years old
•Provision of school health services
•Home visiting and home-based nursing care
•Occupational/industrial health
•Care of the disabled, the elderly, the disadvantaged, the chronically ill
•Inter-sectoral collaboration
Principles of Community Health (Alma Ata Declaration - WHO 1978)
•Availability of health care for all people and at a cost they can afford
•Promotive and preventive aspects of health care
•Integration of curative and preventive services
•Active participation of individuals and communities in the planning and provision of care
•Development of maximum potential for self-care
•Utilization of all levels and types of community manpower
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•Inter-sectoral approach
Principles of Community Health (Hentsch - 1985)
•Health care should be shaped around the life patterns of the population. It should meet the
needs of the community.
•Primary health care should be an integral part of the national health system.
•Health care activities should be fully integrated with the activities of the other sectors
involved in community development such as agriculture, education, public works,
housing and communication.
•The local population should be actively involved in the formulation and implementation
of health care activities, so that health care can be brought into line with local needs and
priorities.
•The health care offered should place a maximum reliance on available community
resources, especially those that have hither to remained untapped and should remain
within the cost limitations relevant to each country.
•The majority of interventions should be undertaken at the most peripheral practice level
of the health services and by the workers most suitably trained for performing these
activities.
Principles of Community Health Nursing
•Community health nursing services should be available to all, according to their health
needs regardless of sex, age, culture, religion, social or economic status, race, political
affiliation, ethnicity or nationality.
•A community health nursing programme must have clearly defined objectives and
purposes for its services.
•Community health nursing should not be a vertical programme. A community health
nurse must work with other stakeholders in the development, implementation, monitoring
and evaluation of the community health programme.
•Community health nursing should involve the community right through the planning
implementation and evaluation of the programme.
•The community health service should build the capacity of the community to run their
own health programme for the purpose of sustainability. These include training of the
Communities Own Resource Persons (CORPs).
•Health education and counseling for the individual, family and community are integral
parts of community health nursing.
•Community health nursing services should be based on the identified needs of the patient
and there should be continuity of services to the patient.
•Community health nursing should work within the community’s culture and norms
without compromising professionalism.
•Community health nursing is a service and there should therefore be no room to demand
favours, gifts or bribes from clients.
•Community health nursing is dynamic and the nurses should therefore actively participate
in continuing professional development so as to keep abreast with new developments.
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•Community health nursing services should develop proper guidelines and maintain proper
records and reports
Components of community health practice
1). Promotion of health
All efforts that seek to move people closer to optimal well being or higher levels of wellness e.g.
Health education, demonstrating healthful practices Aim:
•Increase the span of healthy life for all citizens
•Reduce health disparities among population groups
•Achieve access to preventive services for everyone
2). Prevention of health problem
Anticipating and averting problems or discovering them as early as possible to minimize possible
disability and impairment
Levels of prevention i. Primary prevention
Obviates the occurrence of a health problem and include measures taken to keep illness or
injuries from occurring; Involves anticipatory training and action on the part of the community
health professional who must project themselves into the future, envision potential needs and
problems then design programmes to counteract them e.g.
•Health education on dangers of drugs, smoking
•Installation of rails to prevent injury
•Immunization programmes
•Adequate Nutrition
•Individual Development
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•Adequate working environment and recreation, resting
•Pre-marriage counseling and education
•Genetic Counseling
•Regular Physical Examination ii. Secondary prevention
Are efforts to detect and treat existing health problems at the earliest possible stage when disease
or impairment already exists e.g.
•Screening for hypertension to identify high risk individuals
•Teaching breast self examination, Pap smear
•Identify cases in the community
•Screen and test
•Conduct special physical examination
•Treat and prevent the progress of illness
•Avoid the spreading of disease
Secondary prevention attempts to discover a health problem at a point when intervention may
lead to its control or eradication.
iii. Tertiary prevention
Attempts to reduce the extent and severity of a health problem to its lowest possible level to
minimize disability and restore or preserve function e.g.
•Treatment and rehabilitation of person after stroke
•Early treatment and management of diabetes
•Treat and stop the disease progression and avoid complication and side effect
•Limit the chance for disability
•Provide rehabilitation for physical and psychological well-being, occupational therapy,
availability of long-term care
3). Treatment of disorders
Direct services to people with health problems
4). Rehabilitation
Effort to reduce disability and as much as possible restore function; people with handicaps
mental conditions
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5). Evaluation of health and health care
6). Research, systematic investigations to discover factors affecting community health and
community health practice:
Community diagnosis, epidemiology, biostatistics Community
health nursing process
Nursing process: A systematic method for assessing health status, diagnosing health care needs,
formulating plan of care, initiating and evaluating the effectiveness of the plans Steps
1. Assessment
Is a systematic process of knowing and exploring a defined community for assessing its
health status and determining the possible factors affecting the health of people. Can be
accomplished by:
i. Holding formal and informal meetings with people, leaders, organized groups
ii. Surveys
2. Community Health diagnosis
Determining the pattern of health problems in a community
3. Planning
Strategies are developed to prevent, minimize or correct the problems identified during
diagnosis
4. Implementation
Translate the planning into practice according to the principles given.
5. Evaluation
Assess, appraise estimate the effectiveness
6. Recording/documentation
Roles and Functions of a community Health Nurse
1. Manager
•Organizing and managing health care programmes
•Supervising CHWs
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•Supervising community health nursing activities
•Team leader
2. Implementer
•Implementing community health actions/programmes • Creating community awareness
•Developing community’s ability to assess their health
•Share knowledge and skills with community on how to improve their health
3. Adviser
•Sharing technical health information with individuals, families and communities
4. Health Educator
•Teaching Individuals and families how to prevent disease and improve their health
5. Assessor/Identifier
•Assessing the health status of the community
•Identify existing and potential health needs/Problems
•Identify community resources
6. Planner
•Planning care, Community actions with other team members
•Evaluator
•Evaluating the performance and outcomes of community health activities
7. Researcher
• Carrying out surveys, studies and research to identify problems related to his/her work •
Case finder
8. Trainer
•Training other community health workers
9. Counselor
•Service oriented and general counselor
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10. Care giver/Provider
•Provide direct nursing care to patient/ clients where they need it
•Use the nursing process in providing care to the community
•Participate in PHC activities
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