Unit -6

Community health nursing

approaches, concept , roles
and responsibilities of
community health nursing
personnel
Community health nursing approaches

Problem
Nursing Epidemiologi
solving
process cal approach
approach

Empowering
Evidence
people to
based
care for
approach
themselves
 Nursing process approach
• Nursing process is a critical thinking process that
professional nurses use to apply the best available
evidence to caregiving and promoting human functions
and responses to health and illness (American Nurses
Association, 2010).
• Nursing process is a systematic method of providing
care to clients. The nursing process is a systematic
method of planning and providing individualized
nursing care.
Assessment is the systematic and continuous
collection, organization, validation, and documentation
of data (information).
Collection of data: Data collection is the process of
gathering information about a client's health status. It
includes the health history, physical examination,
results of laboratory and diagnostic tests, and material
contributed by other health personnel.
 Diagnosis

It is the second phase of the nursing process. In this

phase, nurses use critical thinking skills to interpret
assessment data to identify client problems.
 PLANNING

Planning involves decision making and problem

solving. It is the process of formulating client
goals and designing the nursing interventions
required to prevent, reduce, or eliminate the
client's health problems.
•Nursing interventions
• A nursing intervention is
any treatment, that a nurse
performs to improve
patient's health.

•TYPES OF NURSING
INTERVENTIONS

a. Independent
interventions
b. Dependent interventions
c. Collaborative
interventions
 IMPLEMENTATION

Implementation consists of doing and documenting

the activities. The process of implementation
includes Implementing the nursing interventions
and Documenting nursing activities .
 Evaluation

It is a planned, ongoing, purposeful activity in which

the nurse determines the client's progress toward
achievement of goals/outcomes and the effectiveness
of the nursing care plan.
 Epidemiological approaches ( cont)
• Definition
Epidemiology has been defined by John M. Last in 1988
as:-
"The study of the distribution and determinants of health-
related states or events in specified populations, and the
application of this study to the control of health
problems”
 Epidemiological approaches ( cont)
• Asking questions
The key information can be approached through a series
of questions
A. Related to health events
• What are the actual and potential health problems its
manifestations and characteristics?
• When does it happen in terms of day , month , season
etc ?
 Epidemiological approaches ( cont)
B. MAKING COMPARISON
This approach is to make comparisons and draw inferences.
Comparison may be made
between different population at a given time
eg. Rural with urban population
between sub group of population
eg. Male with female population
between various periods of observation
eg. Different seasons
Epidemiological
approaches
( cont) Related to health
action

what action should

be taken by the
community to
prevent and manage
the problem ?
 TOOLES OF MEASUREMENT

RATIO

RATE

PROPORTIONS
A RATE measures the occurrence of some particular event (development of disease or the
occurrence of death) in a population during a given time period

RATIO Another measure of disease frequency is a ratio. It expresses a relation in size

between two random quantities. The numerator is not a component of the denominator

PROPORTION A proportion is a ratio which indicates the relation in magnitude of a part

of the whole. The numerator is always included in the denominator. A proportion is usually
expressed as a percentage
 PROBLEM SOLVING
APPROACH

DEFINITION
A systematic approach to defining the problem and creating a vast
number of possible solutions without judging these solution.“
Problem solving is a cognitive processing directed at achieving a goal
where no solution method is obvious to the problem solver"
 Step 1 Identify the problem
Problem
solving Step 2
Exploring the
problem
process
Step 3 Set goals

Step 4 Look alternatives

Select the best

Step 5
solution
Step 6 Implementation

Step 7 Evaluation
 PROBLEM Cause- and –effect
SOLVING diagram
TOOLS Pareto chart
Flow chart
Histogram
Check sheet
Scatter diagram
Brain storming
 CAUSE AND EFFECT DIAGRAM
• The Cause-and-Effect Diagram helps to identify all the
possible factors causing a specific problem. Also known
as Ishikawa or Fishbone diagram, it resembles the
skeleton of a fish. The problem statement is represented
as the fish's head. The purpose of the cause-and- effect
diagram is to identify probable causes of the problem
statement summarized in the box at the fish's head.
 PARETO CHART
• A Pareto chart (named after the 19th-century economist
who devised this type of analy sis) is a vertical bar
graph used to determine the most serious of a group of
problems, so that priorities may be set. This analysis is
based on the assumption that problems have different
levels of importance, and that organization always face
more problem than their time and resource can address.
To construct a Pareto chart
• 1. Select the issues or causes to be ranked.
• 2. Select a measure for comparison, typically frequency
(number of occurrences) or cost. If you do not have a
direct measure for a cause or problem, try using a
percentage.
• 3. List the issues or causes from left to right on the
horizontal axis in order of decreasing frequency or cost.
• 4. Analyze the chart and choose the most significant
issues for review.
 Flow chart
• Flow charts are analytical tools commonly used to
identify problems. They illustrate the flow of an activity,
a process or a set of interrelated decisions or
communications from beginning to end.
 Histogram
• A histogram is a bar chart mainly used to show the frequency of
certain activities. In a histogram, the horizontal axis signifies some
quality being measured, while the vertical axis measures frequency
• 1. Gather data.
• 2. Divide the data into manageable categories. The number of
categories (the bars in the graph) will determine how much of a
pattern will be visible. For example, appropriate categories might be
zero to four days' leave used per year, five to nine days' leave per
year, 10 to 14 days' leave per year and 15 or more sick days used per
year.
3 Construct the histogram based on your
data, with the vertical axis representing
frequency, and in this case, the number of
employees. The horizontal axis would
represent the categories of leave used as
established above.
4. Analyze the histogram to determine
whether employee sick-leave patterns
seem un- usual or problematic.
 CHECK SHEET
• A check sheet is used to compile, summarize and
track observations, interview results or other data. It
can help translate opinions into facts by showing how
often an event occurs or the amount of time an
activity requires.
• Visually, a check sheet is simply a series of rows and
columns denoting activities and categories.
 STEPS – CHECK SHEET
• 1. Determine the activity you wish to track.
• 2. Design a form that is clear and easy to use, making
sure that all columns are clearly labelled, with enough
space to enter the data
• 3. Record the data on the form in a consistent manner.
• 4. Analyze the data.
 SCATTER DIAGRAM
• The scatter diagram is another tool for determining
cause-and-effect relationships. A scatter diagram charts
two variables on vertical and horizontal axes to
determine whether there is a relationship between
them-typically, whether one variable is a cause of the
other.
 BRAIN STORMING
• Brainstorming" is a technique for generating useful ideas
through open, freewheeling discussion among team
members. Brainstorming is intended to expand available
alternatives, look beyond obvious solutions, encourage
innovation, shift points of view, challenge tradition, reduce
inhibitions and tap the team's creative resources.
 METHODS OF BRAIN
STORMING
A )The unstructured approach in which everyone contributes ideas
spontaneously, with a designated scribe or "facilitator" recording them
B) A structured format, in which each team member takes a turn at
presenting ideas
C) a written, or "pen-and-paper" method, in which participants record
their ideas on slips of paper and submit them to a facilitator or team
leader.
After choosing an appropriate brainstorming method, the team leader
should state a problem or discussion topic. This topic or problem
should be clear and concise. Place the statement on a flip chart so
EVIDENCE BASED
APPROACH
 STEPS OF EVIDENCE BASED APPROACH

Define an appropriate Formulate the Set criterion for Search for & find the
problem area of problem as a identifying relevant, published body of
uncertainity. question. quality evidence. evidence.

Specify the strength

Summarise the body
Abstract the findings of the evidence
Sort to identify the of evidence & form
& evaluate the supporting the
relevant evidence. recommendations or
individual reports. recommendations/dec
make decisions.
ision

Disseminate findings
to appropriate
stakeholders.
 USES
• EBA minimizes biases
• Classify scientific articles in to the grade of evidence
 Empowering People to care for themselves
(con)
• Community empowerment refers to the process of
enabling communities to increase control over their
lives. "Communities" are groups of people that may or
may not be spatially connected, but who share
common interests, concerns or identities.
Empowering People to care for themselves
• Empowerment' refers to the process by which people gain control over
the factors and decisions that shape their lives.
• It is the process by which they increase their assets and attributes and
build capacities to gain access, partners, networks and/or a voice, in order
to gain control.
• "Enabling" implies that people cannot "be empowered" by others; they
can only empower themselves by acquiring more of power's different
forms (Laverack, 2008).
• It assumes that people are their own assets, and the role of the external
agent is to catalyze, facilitate or "accompany" the community in acquiring
power.
Empowering People to care for themselves
• Community empowerment, therefore, is more than the
involvement, participation or engagement of
communities.
• Community empowerment necessarily addresses the
social, cultural, political and economic determinants
that underpin health, and seeks to build partnerships
with other sectors in finding solutions.
• Community empowerment is a process of re-
negotiating power in order to gain more control. It
recognizes that if some people are going to be
empowered, then others will be sharing their existing
power and giving some of it up.
 primary health care
• In 1978 the World Health Organization through Alma Ata
Declaration introduced primary health care for all
through full participation of individual, families and
communities for health development.
Definition
Primary health care is essential health care based on practical, scientifically sound
and socially acceptable method and technology which is made universally
accessible to individuals and families in the community through their full
participation and at a cost that the community and country can afford to maintain
at every stage of their development.
It focuses on promotive, preventive, curative, rehabilitative and emergency care
to meet the main health problems in the community, giving special attention to
the vulnerable groups such as mother and child.
 Elements and components of
primary health
care
• Health Education -Concerning Prevailing health
problems and the method of preventing and
controlling them.
• Promotion of food supply and proper nutrition
• Maternal and child health care, including family
planning
• Adequate & Safe Water Supply
• ‘’Immunization against major infectious diseases
 primary health care in India
• In 1977 , the government of India launched a rural health
scheme based on the principle of “ placing people’s
health in people”s hands”.
• VILLAGE LEVEL
• One of the basic tenets of primary health care is universal
coverage and equitable distribution of health resources.
To implement policy at village level
ASHA Schemes
ICDS schemes
Training for local dais
 ASHA
• Asha must be resident of village –a women (
married/widow/ divorced) preferably in the age group 25
to 45 years with formal education up to eight class .
Having communication skill and leader ship qualities.
The general norm of selection of one ASHA for 1000
population.
 Roles and responsibilities of asha

• Asha will take step to create awareness and provide

information to the community on determinants of
health such as nutrition, basic sanitation and hygienic
practices, hygienic practices, healthy living and working
conditions information to existing health services and
the need for timely utilization of health and family
welfare services.
• She will counsel women on birth preparedness ,
importance of safe delivery breast feeding and
complementary feeding immunization, contraception
and prevention of common infection.
• ASHA will mobilize the community and facilitate them in
accessing health and health related services available
at the Anganwadi / subcenter/ primary health center
such as immunization/ antenatal check up
/supplementary nutrition.
• She will work with village health and sanitation
committee of gram panchayath to develop a
comprehensive village health plan .
• Asha will provide primary medical care for minor
aliments such as diarrhea, fever, and first aid for minor
injuries. She will provider of DOTS ( Directly observed
treatment ) short course under revised national
 ICDS SCHEME
• Anganwadi worker
Under ICDS ( Integrated child development service)
scheme there is an Anganwadi worker for population of
400-800. there are 100 such worker for in each ICDS
project. She undergoes training in various aspects of
health , nutrition , and child development for 4month.she
is part time worker and provide services rendered which
include health check up, maintance of growth chart,
immunization, health checkup, supplementary nutrition,
health education, and referral services.
 LOCAL DAIS
• A scheme training for dais initiated during 2001-2002 .
The scheme was initiated districts. An extensive
programme has been under taken under rural health
scheme . To train all categories of local dais ( traditional
birth attendants)in the country to improve their
knowledge in the elementary concepts of maternal and
child health and sterilization, bedside obstetric skills.
 principles

Equitable distribution

Manpower development

Community participation

Appropriate technology

Intersectorial coordination
 sub center level
• The subcentre is the peripheral outpost of the existing
health delivery system in rural areas. They are being
established on the basis of one subcentre for every
5000 population in general and one for every 3000
population in hilly, tribal and backward areas.
• services such as immunization, antenatal, natal and
postnatal care, prevention of malnutrition and common
childhood diseases, family planning services and
counselling. They also provide elementary drugs for
minor ailments such as ARI, diarrhoea, fever, worm
infestation etc.
Comprehensive health care
The term "comprehensive health care" was first used by the Bhore
Committee in 1946. By comprehensive services, the Bhore
committee meant provision of integrated preventive, curative and
promotional health services from "womb to tomb" to every
individual residing in a defined geographic area. The Bhore
Committee defined. comprehensive health care as having the
following criteria:
(a)provide adequate preventive, curative and promotive health
services,
(b)be as close to the beneficiaries as possible,
(c) has the widest cooperation between the people. the service
and the profession,
(d)is available to all irrespective of their ability to pay,
(e)look after specifically the vulnerable and weaker sections of the
community
 Prevention and control of local endemic disease
 Appropriate treatment of common diseases and
injuries
 Provision of essential & basic household drugs
for the community
 Promotion of Mental health