Introduction to Community Health Nursing

What is a Community?

Derived from a Latin word “comunicas” which means a group of people

A group of people with common characteristics or interests living together within a territory or geographical boundary

A social group determined by geographical boundaries and/or common values and interests. Its members know and interact with each other. It functions within a particular social structure and exhibits and creates certain norms, values and social institutions (W.H.O).

Functions of Community

To determine the use of space for living and other purposes
To make available the means for production and distribution of necessary goods services
To protect and conserve the health, life, resources and property of individuals
To educate and acculturate newcomers, i.e. children and immigrants
To transmit information, ideas, and beliefs
To provide opportunities for interaction between individuals and groups

Waht is Health ?

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (W.H.O, 1946).

Health and Community Systems

Health is man’s greatest possession, for it lays solid foundation for his happiness
Good health is essential to economic and technological development
Healthy community is the infrastructure upon which is built an economically viable (workable/ feasible)society
Community itself is composed of a number of subsystems like an organism

Subsystems of Community

Socio-cultural system
Political system
Economic system
Educational system
Recreational system
Religious system
Environmental system
Communication and transport system
Health care delivery system

Community Health and Public Health

• Community health refers to the healthy status of the members of the community to solve the problems affecting their health and to the totality of a health care provided for the community

• Public health is the science and arts of Preventive disease, Prolonging lifespan. Promoting health and efficiency through organized community efforts

Purposes of Community Health

• To ascertain the nature and extent of disease and disability in the community

• To take suitable measures to

Promote healthful living
Prevent disabilities
Correct remedial defects
Treat illness, and
Rehabilitate those with handicaps

• To evaluate the progress and success of current programs

• To conduct research into community causes and diseases, and investigate through research, improved methods and techniques

• To provide necessary organization of medical, health and nursing care required to deal with community ill-health

• To educate the public in prevention of health hazards

Objectives of Community Health

Increasing the average span of human life
Decreasing the mortality rate, particularly IMR and MMR
Decreasing the morbidity rate
Increasing the physical, mental and social well-being of individual
Increasing the pace of adjustment of the individual to his environment
Providing total health care to enrich quality of life

Determinants of Community Health

• Health is multi-factorial

• Four principal factors affecting both individual and group health

1 - Human biology

• Include an individual’s

genetic inheritance
the process of maturation and aging
Complex network of structures & systems that compose the human body

2 - Environment

• Include both the physical world that surrounds us and the people who inhibit that world

• Environment classified as internal and external

• Internal (each and every component part, tissue, organ and their harmonious functioning)

• External an individual is exposed after conception birth such as;

physical (housing, water, air, light, noise)
Biological (living things, man, microorganism, animals, plants), and
Psycho-social (individual ways of living and lifestyle, at home, at office, at school)

3 - Life style

• Includes ways of living, personal hygiene, habits and behavior

• Healthy life style helps to promote health and poor life style has ill effects on health

4 - Health care services

• All those personal and community services for prevention and treatment of disease and promotion of health. E.g., immunization services , MCH services, pure water supply, basic sanitation prevent many diseases

• Unequal distribution of health services and health personnel leads to increase in the incidence of disease occurrence

Principles of Community Health

• Availability of health care for all

• Promotive and preventive aspects of health care

• Integration of curative and preventive care

• Active involvement of individuals and communities in planning and providing care

• Development of maximum potential for self care

• Utilization of all levels and types of healthy manpower

• Inter-sectoral approach

The health continuum: Illness- Wellness

Health involves a range of degrees from optimal health at one end to total disability or death at the other, it is often described as a continuum.

This health continuum shows that there are various degrees of illness as well as wellness. This continuum shows us that most people could improve their health to optimum wellness, conversely, everyone could also deteriorate to premature death. This health continuum applies not only to individuals but also to families and communities.

Moving from the center to the left shows a progressively worsening state of health.

Moving to the right of center indicates increasing levels of health and wellbeing.

The treatment paradigm (drugs, herbs, surgery, psychotherapy, acupuncture, and so on) can bring you up to the neutral point, where the symptoms of disease have been alleviated.

The wellness paradigm, which can be utilized at any point on the continuum, helps you move toward higher levels of wellness.

Wellness is not a static state. High-level wellness involves giving good care to your physical self, using your mind constructively, expressing your emotions effectively, being creatively involved with those around you, and being concerned about your physical, psychological, and spiritual environments.

Components of Community Health Practice

Community health practice can best be understood by examining six basic components, which when combined, encompass its services and programs.

Promotion of health
Prevention of health problems
Treatment of disorders
Rehabilitation
Evaluation
Research

1. Promotion of health

It includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness.

Health promotion programs and activities include many forms of health education such as;
Teaching the danger of drug use
Demonstrating healthful practices like regular exercise, and
Providing more health promoting options like heart healthy menu selection

It also encompasses the development and management of preventive or primary health care system responsive to community health needs.

2. Prevention of health problems

Prevention means anticipating and averting problems or discovering them as early as possible to minimize possible disability and impairment

It practiced on three levels in the community health; primary, secondary and tertiary prevention

1) Primary prevention: it obviates (avoid) the occurrence of a health problem; it includes measures taken to keep illness or injuries from occurring, e.g.

Community Health Nurse who encourages elderly people to install and use safety device, such as grab bars by bath tubs or hand rails on steps, to prevent injuries from fall.
Health department help to control and prevent communicable disease such as Hepatitis B or Poliomyelitis by providing regular immunization programs.
Instructing overweight individuals on how to follow a well balanced diet while loosing weight to prevent from nutritional deficiency.

2) Secondary prevention: it involves efforts to detect and treat existing health problems at the earliest possible stage when disease or impairment already exist. Secondary prevention attempts to discover a health problem at a point when intervention may lead to its control or eradication, for example;

Hypertension and cholesterol screening in many communities help to identify high risk individuals and encourages early treatment to prevent heart attacks or stroke.
Teaching breast and testicular self examination, encouraging regular mammograms, and pap smears for early detection of possible cancer, and providing skin testing for T.B when children are one year of age.

3) Tertiary prevention: it attempts to reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function. The persons involved have an existing illness or disability whose impact on their lives is lessened through tertiary prevention. For example

Treatment and rehabilitation of person after a stroke to reduce impairment,
Post-mastectomy exercise program to restore functioning, and
Early treatment and management of diabetes to reduce problems or slow their progress.

3. Treatment of disorders

It focuses on the illness end of the continuum and is the remedial aspect of community practice. This occurs by three methods;

(1) Direct services to people with health problems (such as direct health care, health screening, education, and referral services)

(2) Indirect services that helps people to obtain treatment (in case community agency unable to provide needed care and refer individual/ groups concerned to a more appropriate resource)

(3) Development of programs to correct unhealthy conditions. (such as health department develop new regulation for industrial waste disposal as a result of increased water supply pollution or initiate a chemical dependency counseling and treatment centre for alcoholism and drug abuse

4. Rehabilitation

Involves efforts to reduce disability and as much as possible, restore function. People whose handicaps are congenital or acquired through illness or accident, such as stroke, heart condition, amputation, or mental illness, can be helped to regain some measures of lost function or to develop new compensating skills.

For example: a factory worker who lost his leg in an industrial accident received good medical and nursing care prosthetic fittings, and physical and occupational therapy; he then retained to assume an office job.

5. Evaluation

It is the process by which community health practice is analyzed, judged and improved according to established goals and standards. Evaluation should be an integral part of every kind of health service, from individual practice to national and international program.

6. Research

It is systematic investigation to discover facts affecting community health and community health practice, solve problems, and explore improved methods of health service. Community health practitioners conduct and use scientific investigations at all levels, from federal agencies to regional and local group.

Community Health Nursing - Short Notes for Nursing Students | POST RN BSN Nursing Resources