Community Health Nursing (CHN)

COMMUNITY

Characteristics of community

• Distinctiveness: Having defined geographical boundaries.
• Homogeneity: Similarity in psychosocial characteristics like language, lifestyle, customs, interests, traditions, etc.
• Closeness: Have face-to-face interaction and free communication.
• Self-sufficiency: There is a practice of mutual support and resource sharing that helps in community self-sufficiency.
• Solidarity or sense of togetherness: There is unity and cohesiveness among the members in the community
• Others:
• Social unit
• Group of people Locality/Territory
• Sense of belongingness
• Naturality
• Shared values and common interest
• Social institutions
• Common responsibility

HEALTH

Concept of Health

All community have their concept of health, as part of their culture. The oldest meaning of health is ‘absence of disease ‘ Changing concept of health Health is not perceived in the same way by various professional group, so confusion is developed about concept of health so there are various concept of health given below:

1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concep
5. Concept of well-being

1. Biomedical concept: According to this concept health is viewed as ‘absence of disease’ and if one person is free from disease, then he is considered a healthy person The medical profession viewed the human body as a machine, disease as a consequence of the breakdown of the machine and one of the doctor task as repair of the machine. This concept has minimized the role of environmental, social, psychological and cultural determinants of health This concept does not address the major health problems like malnutrition, accidents drug abuse mental illness chronic disease environmental pollution population explosion.
2. Ecological Concept: According to this concept health is a dynamic equilibrium between man and his environment and disease is a maladjustment of the human organism to the environment.
3. Psychosocial concept: According to this concept health is not only a biomedical phenomenon but one that is influence by the social psychological cultural economic and political factors of the people concerned.
4. Holistic concept: The holistic model is a synthesis of all the above concept. It recognizes the strength of social economical political and environmental influence on health. It describe multidimensional process that health implies a sound mind in a sound body in a sound family in sound environment this concept implies that all sector of society have an effect on health that is agricultural, animal husbandry food industry education housing public work communication and other sector
5. Concept of well-being: It implies improvement in the standard and quality of life:

• Standard of life: It refers to the standard of living and includes health, education occupation food consumption clothing housing recreation along with leisure, human rights, and social security.
• Quality of life: It is related to the individual feeling of satisfaction, happiness and sadness about a number of life concerns so increase the standard and quality of life to attain the feeling of well-being.

Definition of Health 

WHO-Definition "Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity". [WHO 1948]

The bibliographic citation for this definition is Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.

Other Definition

• 'The condition of being sound in body mind or spirit, specially freedom from physical disease or pain'  [Webster]
• ‘soundness of body or mind that condition in which its functions are duly and efficiently discharged' [Oxford English Dictionary]

New Philosophy of Health

• The new philosophy of health is stated below:
• Health is a fundamental human right
• Health is essential for a productive life
• Health is intersectoral
• Health is an integral part of development
• Health is central to the concept of quality of life
• Health involves individual, state, and international responsibility
• Health and its maintenance is a major social investment
• Health is a worldwide social goal

Dimension of Health

1. Physical dimension: Outlooks, clean skin, bright eyes, good appetite
2. Mental dimension: Identity, strong sense, criticism Social dimension
3. Spiritual  dimension: (holistic dimension)
4. Emotional dimension
5. Other dimensions: Cultural dimension, Socio-economic, Preventie, vocational dimension

COMMUNITY HEALTH NURSING

Background

• Community health nurse: She is a nurse who has additional qualifications for nursing responsibilities in the community
• Community health nursing is a synthesis of nursing & public health practice applied to promoting & preserving the health of people.
• Community health nursing means providing health services to patients & healthy people in the community.
• Community health nursing is guided by an assessment of population health status that is determined through a community.

Definition

• "Community health nursing is a field of nursing that is blend of primary health care & nursing practice with public health nursing." OR
• It is an art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number. OR
• Special field of nursing that combine the skill of nursing, public health & some phases of social assistance & functions as part of the total public health program for promotion health, the improvement of the condition in the social &physical environment, rehabilitation of illness & disabilities.
• Community health nursing is a comprehensive branch of nursing which based on the acronym @RAIOE:

Recognition

Assessment

Intervention

Organization

Evaluation

• Community health nursing is a field of nursing practice for which there exists a body of knowledge and related skills that is applied in meeting the health needs of communities, families and individuals in their normal environment such as at home, at school and at the place of work.
  

Philosophy of Community Health Nursing

Generally, philosophy implies three components; concern with knowledge, values & one’s belief about existence. Community health nursing supports all these in the following ways.

• Community health nursing is based on logical thinking & scientific methods.
• Community health nursing is committed to its own beliefs about professional practice.

Goal of Community Health Nursing

The goal of community health nursing The goal of nursing is often stated as the care of a definition of nursing. Nurses are now aware that they can be powerful in the condition needed to promote health for all thus the goal of community health nursing lies at the heart of primary prevention and health promotion health maintenance, disease prevention and treatment of minor ailments and restoration of health and rehabilitation. The overall goals of CHN is to help individuals, families, and communities in attaining the highest standard of health by:

1. Promotion of health
2. Health maintenance
3. Prevention of illness
4. Restoration of health
5. Treatment of minor ailments
6. Rehabilitation of the clients

Scope of Community Health Nursing

1. Education:

• Principal
• Vice Principal
• Professor
• Reader

2. Practice:

• School health nurse
• Occupational health nurse
• Home nursing
• MCH & family planning
• Geriatric nursing
• Rehabilitation nursing
• Health educator
• Collaborator
• Manager

3.   Research:

• Researcher coordinator
• Data collector
• Analyzer

4.   Administration:

• Public health nurse
• School health nurses
• Community health nurse

Responsibilities of Community Health Nurse in Community

1. Encourage the adoption of health beliefs, attitudes & behaviors that contribute to overall health of the population.
2. Support health policy changes to modify physical & social environment.
3. Assist communities, families & individuals to take responsibilities about health.
4. Initiate & participate in health promotion activities.
5. Reduces the risk of infectious disease outbreaks.
6. Applies epidemiological principles & knowledge of the disease process.
7. Uses appropriate technology for reporting & follow-up.
8. Help individuals & families to adopt healthy behavior.
9. Encourage behavior modification.
10. Work individuals, families & communities to maintain a safe environment.
11. Uses knowledge of health surveillance, data & trends to daily work.
12. Collect & store data.
13. Contribute to population health assessment

Significance of community health nursing

The unique as part of community health nursing practice a not neglecting direct individual client services or community-based nursing WHO defined the following three necessary components of community health nursing:

1. Community health nurses are responsible for ensuring that needed health services are provided in the community
2. The nurse set of vulnerable groups in a community is on a priority basis.
3. The client (individual, family, group, or community) must be a partner in planning and evaluating health care,

Principles of Community Health Nursing:

1. CHN is an established activity based on recognized needs & functioning with the total health program.
2. Community health nursing agencies has clearly defined objectives & purpose for services.
3. An active organized citizen group representative of the community health program.
4. Community health nursing recognizes the family & community as unit of services.
5. Health education & counseling for individual, family & community are integral part of community health nursing.
6. Recipients of health care should participate in planning related to goal for the attainment of health.
7. Community health nursing should function serve as an important member of the health team.
8. There should be provision for qualified nurses to make supervision for community health services
9. The community health nurse should not accept gifts from the patients.
10. Community health agencies should provide continuing education programs for nurses.

Educational Qualifications of CHN in Nepal:

Diploma in general nursing should be registered with Nepal Nursing Council.

Qualities of CHN 

1. Communication skills of CHN:

• Good speaker
• Interviewer
• Conversationalist
• Good teacher

2.     Observation skills of CHN:

• Should have the ability to observe physical, mental & emotional states.
• Should have the ability to recognize signs and symptoms of disease
• Should be capable to assessing the health level of individuals, family and community

3.     Ability to lead and take decisions of CHN:

• Should be able to take right and immediate decision according to the situation
• Should be capable to taking independent decisions
• Should be able to lead the health team

4.     Other qualities of CHN

• Should have knowledge of available resources and health problems of the community
• Should have an understanding of human behavior
• Should have managerial abilities
• Should be physically and mentally fit

Functions of Community Health Nursing:

I.      Managerial functions:

1. Assessment: Collecting information about the community

• Finding health problems.
• Finding the limits and availability of resources.
• Deciding the nature and role of nursing services
• Epidemiological survey.

2. Planning: Preparing plans to provide comprehensive nursing services to individual, family and community planning the distribution of work and cooperation among number of health team. Planning services in work areas (e.g. school, home, clinic) Amending and improving the plans of the program.

3. Supervision: Supervision the work of subordinates like, mother group, FCHv etc.

• Inspecting the work of other health workers e.g. health inspectors etc.
• Inspecting the care provided by members of family.

4. CO - ordination & co-operation: Establishing coordination & co-operation among the members of health team.

• Procuring cooperation of the influential people of the community in health work.
• Maintaining contact with Government & Non-Government, organization and other authorities.
• Participating in meeting.
• Working as a liaison between health officers & health workers

5. Evolution:

• Monthly self-assessment of the work
• Sending the report of working to higher officers/health authorities/agencies.
• Evaluating own work on the basis of clinical services, immunization, motivating eligible couples & progress of family welfare program.

II. Nursing functions of CHN:

• Providing comprehensive nursing services to the individuals, families and community.
• Assisting in the diagnosis & treatment of disease
• Guiding the family in taking care of the patient
• Regular home visit

III. Educational function of CHN: Educating individuals & group:

• Participating in school health education program
• Assisting in training programmers of nursing & health workers.
• Giving practical training about care of patient
• Educating about improvement & development of environment
• Preparation & intelligent use of audio-visual materials.
• Assisting in conducting surveys, demographical fact collection & presentation etc. for research purposes.

IV.  Other work of CHN:

• Appropriate use of referral services
• Assisting in establishing & functioning of clinical & health centers.
• Assisting duties among health workers
• Maintenance of health records & timely dispatch of report
• Assisting in health statistics work

Community Health and Nursing Services Program

Community health and nursing (CHN) services program was started as a pilot program in two local levels (Bhaktapur Municipality, Bagmati Province and Bardibas Municipality, Madhesh Province) in FY 2078/79 guided by the Community Health Program Guideline. The main objective of the program was to keep up-to-date health data of each individual in a family and promote healthy lifestyles so as to reduce communicable diseases and NCDs. With two phases in program, first phase (baseline data collection) records every individual’s socio-demographic and health-related information via CHNs under the purview of work and second phase (intervention phase) incorporates community directed and community-based health services in the life cycle approach (promotive and preventive). All these activities are recorded in Community Health Information System (CHIS)  via Community Health Toolkit (CHT) application. Community health nurses refer the community members to health facilities for needful treatment

Major Activities During Piloting in FY 2079/80

• Scaling up the program to Chandragiri Municipality. Currently, the program encompasses 3 Community Health Officers (CHOs) (one each at a local level) and 39 CHNs (10 in Bhaktapur, 14 in Bardibas and 15 in Chandragiri Municipality).
• Capacity building of CHNs on sexual and reproductive health, NCDs and mental health to implement the intervention phase of the program.
• A total of 14,020 households were identified in Bardibas and 12,863 households were covered for the baseline assessment.
  

Job Description of CHN: Download