COMMUNITY LOG BOOK

Community Health Nursing (NUR123)

4-Year BS Nursing Year I, Semester II

Student Name :
SAP ID :

Subject Faculty: Sadaqat Aftab (Nursing Lecturer)

MSN*(UOL), B.Sc.N (UHS)

Lahore School of Nursing

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 Community Field Visits Index
No Educational/Community Visit Date/Day Signature
1. Rural Health Dispensary
1 (Male & Female)
Community Windshield Survey
2.
Basic Health Unit (BHU)
3.

Rural Health Centre (RHC)

4.

School health Survey

5.

Slaughter House
6.

7. Rehabilitation Center

8. Ali Raza Abad Community visit

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Clinical Objectives:
1. Identify different places besides hospitals, where nursing care is provided.
2. Identify role and responsibilities of staff working at each visited facility.
3. Identify health problems of people in their home situation, &provide care using the nursing
process and making referrals to the appropriate agency.
4. Identify local health resources in a community.
5. Identify the use of Primary Health Care services in a community setting.
6. Discuss the attitudes of the community towards significant health events such as Birth,
Family planning, Immigration.

7. Identify, treat & teach families to prevent common problems in home.

8. Describe the process of:
a. Water purification
b. Sewerage treatment
c. Milk preservation
d. Meat slaughtering, handling and distribution.
9. Utilize various methods of health education while providing health education.
10. Discuss the structure and function of health care facilities run by non-government organizations.

CLINICAL EVALUATION CRITERIA

Students are expected
to:

1. Have 100% attendance.

2. Actively participate in field work activities & pre/post conferences.
3. Develop effective and respectful working relationships with PHC/BHU/RHC team members.
4. Be sensitive to the needs of community including their right to participate in their own care
and to make decisions regarding their care.

5. Satisfactorily complete all clinical objectives with following clinical tasks/assessments.

 Visit summary/Reflective log is mandatory after each visit

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 WINDSHIELD SURVEY FORM
Community:_________________________
Date:_______________
Physical Environment:
Housing and Zoning Condition
Excellent Good Average
a) What is the age of the houses? 2-5Yrs 5-10 Yrs 10-20Yr Or More
b) Of what materials are they constructed? Cement Bricks Mud
c) Are all the neighborhood houses similar in 10-20Yr
age? 2-5Yrs 5-10 Yrs Or More
d) How would you characterize the differences?
Architecture Material Location
e) Are they detached from or connected to Partially
others? Attached Detached attached
f) Do they have space in front and behind? In front Behind In front +
Behind
g) What is their general condition? Excellent Good Average
h) Are there signs of disrepair— broken Many signs Something No any sign of
doors, windows, leaks, locks missing? of broken broken broken
i) Is there central heating, modern plumbing, Partially
and air conditioning? Yes No available
Open Space
a) How much open space is there? One acer Two acer Many acer
b) What is the quality of the space—green Excellent Good Poor
parks or rubble- filled lots? greenery greenery
c) What are the lot sizes of the houses? 5 Marla 10 Marla 20 Marla
d) Lawns? Yes No Fields
e) Flower boxes? Yes No A Few
f) Do you see trees on the pavements, a green If yes then how
island in the center of the street? Yes No many
g) Is the open space public or private? If yes then how
Yes No much
h) Used by whom? Common Politician Religious groups
people
Boundaries
a) What signs are there of where this Wall Field Road
neighborhood begins and ends?
b) Are the boundaries natural—a river, a
different terrain? Natural Artificial Mixed
c) Physical—a highway, railroad? High way G.T Road Railroad
d) Economic—difference in real estate or If yes then how
presence of industrial, commercial units Yes No much

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 along with residential?
e) Does the neighborhood have an identity, a If yes then What is
name? Yes No the name?
f) Do you see it displayed? Are there If yes then What is
unofficial names? Yes No the name?
"Commons" If yes then how
a) What are the neighborhood hangouts Yes No much
(popular place)?
b) For what groups, at what hours (e.g.
school yard, candy store, bar, restaurant, Children Adults Senior Citizens
park, 24-hour drugstore)?
c) Does a “common" have a sense of If yes then at
"territoriality" or is it open to the stranger? Yes No what extent?
Transportation
a) How do people get in and out of the Own Public Company buses
neighborhood? Car, bus, bike, walk? Vehicle transport
b) Are the streets and roads conducive to good If yes then at
transportation and also to community life? Yes No what extent?
c) Is there a major highway near the Yes No If yes, whom does
neighborhood? Whom does it serve? it serve?
d) How frequently is public After 1 hr After 2 hr Many times
transportation available?
Service Centers
a) Do you see social agencies, clinics, Yes No How many
recreation centers, signs of activity at the
schools?
b) Are there offices of doctors, dentists? Yes No If yes How many
c) Palmists, spiritualists? Yes No If yes How many
d) Parks? Yes No If yes How many
e) Are they in use? Yes No If yes At what
extent
Stores Out of reach
a) Where do residents shop? Near homes In streets
b) Shopping centers, neighborhood stores? Yes No If yes At what
extent
c) How do they travel to shop? In foot By vehicle Other transport
Street People Children Young men Old people
a) If you are traveling during the day, whom and women
do you see on the street?
b) An occasional housewife, a mother If yes How many
with a baby? Yes No
c) Do you see anyone you would not If yes How many
expect? Yes No
d) Teenagers, unemployed males? Yes No If yes How many
e) Can you spot a welfare worker, an If yes How many
insurance collector, and a door-to-door Yes No

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 salesman?
f) Is the dress of those you see If yes At what
representative or unexpected? Yes No extent
g) Along with people, what animals do you Pets Cattles Wild
see?
h) Stray cats, dogs, pedigreed pets, If yes At what
"watchdogs"? Yes No extent
Signs of Decay
a) Is this neighborhood on the way up or
down? On the way up Down
b) Is it "alive"? Yes No How
c) How would you decide? By Taking a By using senses
observation sample
d) Trash, abandoned cars, political posters,
neighborhood meeting posters, real estate If yes How many
signs, abandoned houses, mixed zoning Yes No
usage?
Race
a) Are the residents white, black, or is the White Black Other
area integrated?
Ethnicity
a) Are there indices of ethnicity— food If yes How many
stores, churches, private schools, Yes No
information in a language other the
English?
Health and Morbidity If yes What kind
a) Do you see evidence of acute or chronic of diseases
diseases or conditions? Yes No
b) Of accidents, communicable diseases, If yes What kind
alcoholism, drug addiction, mental Yes No of diseases
illness?
c) How far is it to the nearest hospital? 1 Km 2Km 5Km
d) Clinic? Yes No If yes how many
e) Do you see any political campaign posters? Yes No If yes how many
f) Is there a present headquarters? Yes No If yes how many
g) Do you see any evidence of a Yes No
predominant party affiliation?
Media a) Do you see outdoor TV antennas? Yes No If yes how many
b) What magazines, newspapers do residents Family Jang Dawn
read? magazine
c) Do you see Forward Times, Hampton If yes how many
Post, Enquirer, and Reader’s Digest in Yes No
the stores?
d) What media seem most important to Radio TV Other
the residents?

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BASELINE SURVEY OF COMMUNITY ASSESSMENT
1. Name of the area: …………………………………………………………………………

2. RURAL/URBAN…………………………….……………………………………………

3. Boundaries:………………………………………………….………………………………

4. Name of health centre: ………………………………………………………………..……

5. Name of the head of family: ………………………………………………….……………

6. Type of family: SINGLE……………………………..JOINT………………..…………..

7. Religion: Muslim/ Non Muslim ………… (SPECIFY THE SUB CAST)………………

MUSLIM…………… (SPECIFY THE SUB CAST) ……………..…..…..
CHRISTIAN………... (SPECIFY THE SUB CAST) ……………....……..
ANY OTHER……….(SPECIFY THE SUB CAST) ……………………..
8. Housing condition:
1 Type of house PACCA SEMI PACA KACCHA
II Rooms: NUMBERS ADEQUATE INADEQUATE
III Occupancy: TENENT OWNER MONTHLY RENT
IV Ventilation: ADEQUATE INADEQUATE NO VENTILATION
V Lighting: ELECTRICITY GAS LAMP OIL LAMP
VI Water supply: TAPE HANDPUMP WELL OPEN TANK
VII Kitchen: SEPARATE CORNER OF THE VERANDA
ROOM
VIII Drainage: ADEQUATE INADEQUATE NO DRAINAGE
IX Lavatory: OWN LATRINE PUBLIC LATRINE OPEN AIR
DEFECATION
X Law: OWN AT HOME PUBLIC LAWN FIELDS

9. FAMILY COMPOSITION:
Sr# Name Relationship with head Age Sex Education Occupation Income
1
2
3
4
5
6
7
8
9

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10. Total income of the family:
I Below 5000 IV Between 15001-20000
II Between 5001-10000 V Above 20000
III Between 10001-15000

11. Education status: Number of Persons

I. Not literate ……………………………
II. Primary education ……………………………
III. Middle school ……………………………
IV. High school ……………………………
V. Pre-University Course ……………………………
(Pre Degree Course)
VI. Graduate ……………………………
VII. Post graduate ……………………………

12. Transport and communication media:

I Transport IV Uses private buses
II Owns vehicles V Train
III Uses company buses VI Airoplanes

Communication & Mass media:

I Telephone (Mobile/ Public) V Post and telegraph
II Television VI E.mails
III Radio VII Loudspeakers/Announcements
IV Newspaper/magazine VIII

Language: Language Known:

I. Mother tongue I. English
II. Urdu II. Hindi
III. Sindhi III. Sindhi
IV. Punjabi IV. Urdu
V. Balochi V. Punjabi
VI. Pashtoo VI. Baloochi
VII. Hindi VII. Pashtoo
VIII. Specify others

13.Dietary Pattern:
Food available Food used Food preparation and storage
Traditional Ideal Unhygienic Hygienic
Rice
Ragi
Jawar
Wheat

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Vegetable
Fish
Meat
Egg
Milk and milk
products
pulses
Tubers

14.Statement of expenditure of family:

Sr# Items Amount spent Percentage of total expenditure
(approximate)
1 Food
2 Clothing
3 Housing (Rent)
4 Medicine
5 Children education
6 Recreation (movies, games etc.)
7 Smoking/ Liquor etc
8 Debt
9 Savings
10 Others
15. Is there any case of fever (if yes write detail in below table)
I. Rigors
II. Cough
III. Rash
IV. Others
Sr# Name Age Disease Treatment Remarks
1
2
3
4
16. Dose any have any type of skin disease (Itching, patches, rashes etc)
Sr# Name Age Disease Treatment Remarks
1
2
3
4

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17. Does anyone have cough more than two weeks?
Sr# Name Age Disease Treatment Remarks
1
2
3
4
18. Does anyone have any other illness?
Sr# Name Age Disease Treatment Remarks
1
2
3
4

19. Are they having any health problem?

Sr# Name Age Disease Treatment Remarks
1
2
3
4
20. Are any women pregnant if yes then write following codes?
I. Gravida (1st :a, 2nd : b, more than 2: c)
II. Has she been registered in health center?
III. Is she getting iron and folic acid?
IV. Has she had tetanus toxid?
V. Others

Sr# Name I. II. III. IV. V.

1
2
3
4

21. Have there been any vital statistics of birth?

Sr# Date of birth Sex Patient’s Name Treatment Remarks
1
2
3
4

22. Have there been any vital statistics of death?

Sr# Patient’s Name Sex Date of death Treatment Remarks
1
2
3
4

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23. Have there been any vital statistics of marriages?
Sr# Name Age Date of marriage Remarks
1 Bride
Bridegroom
2 Bride
Bridegroom

24. Are there any children below five years who have not received immunization
(Specify name, age and reason for not being immunized)
I. BCG Vaccination
II. DPT Vaccination
III. Poliomyelitis Vaccination
IV. Measles Vaccination
V. Vitamin A drops
Sr# Name Age Sex I. II. III. IV. V. Remarks
1
2
3
4
5
6
7
8

Special note if needed:

25. Is there any eligible couple (if yes then list on priority)
I. PS= Primary sterility
II. SS= Secondary sterility
III. EP= Early menopause
IV. Using a contraceptive method. If yes then specify type
V. Interested to undergo for: Vasectomy Tubal Ligation
VI. If not interested to adapt family planning methods then state the reasons:

Sr# Name Age Sex Priority-I Priority-II PS SS EM Remarks

1
2
3
4

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26. Is there any child between 0-5 years in family who shows signs of malnutrition?
I. Kwashiorkor?
II. Marasmus?
III. Vitamin A deficiency?
IV. Anaemia?
V. Rickets?

Sr# Name Age I. II. III. IV. V. Remarks

1
2
3
4
5
6
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27. Is the sullage water being disposed of hygienically? (If yes tick any one/all)
i. Drain ii. Soak pit iii. Kitchen garden
If not then state the reason

28. Is the rubbish being disposed off hygienically? (If yes tick any one/all)
i. Composing ii. Burning iii. Burying
If not then state the reason

29. Is excrete a being disposed off hygienically? Yes/No

If no then state the reason

30. Are the cattle and poultry housed hygienically?

i. Separate ii. Within house
Then state the reason

31. Is there a well or hand pump?

i. Is it maintained in good order? Yes/No
If no then state the reason
ii. When the well chlorinated last time? Mention the date: If Yes/No then
state the reason

32. Whether the house is kept clean?

If Yes/No then state the reason

33. When house was sprayed last time? Mention the date:
If Yes/No then state the reason

34. Is there breeding place of insects and rodents? Yes/No

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35. Are there any stray dogs in the vicinity? Yes/No.
If yes then write approximate number of dogs.

36. If anyone falls ill where do you get for treatment?

I. Hospital/Primary health centre
II. Sub centre primary health unit
III. Private nursing homes
IV. Indigenous doctor/ local vaidya

37. Are official health agencies services adequate? Yes/No

If Yes/No then state the reason

Note:
In addition to the above students are expected to obtain following information by observation and other
methods.
I. Description of the community location, topography, climate, history etc. Type of
government system, no. of schools and health care agencies. Balwadi or infection control
diseases (ICDS) centers, place of worship (e.g. Masjid, Church and Mander) and any other
information related to health.
II. List of target couple with details on priority basis.
III. Maintain record of road to health Card for knowing the degree of malnutrition under 5years
wherever necessary and use if need of nutritional assessment from prompt.
IV. Use problem solving approach/ construct good nursing care plan.
V. Remarks can be written in separate sheets quoting code.

Date of survey Name and signature of student

Faculty Signature: .

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VISIT TO RURAL HEALTH
DISPENSARY

pic

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 Dated ____________________ Subject: Visit of Dispensary

Respected Sir/Madam,
It is stated that, I have visited to Dispensary located at on dated
at time .

1. Staff of rural health Dispensary:

 Stationed Staff

 Outreach Staff.

2. Role/Responsibilities of Dispensary Staff:

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3. Services available at Dispensary

4. Deficiencies at Dispensary

5. Suggestions and Recommendations

6. Conclusion:

Reflection
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 VISIT TO BHU
BASIC HEALTH UNIT

pic

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 Dated ____________________ Subject: Report on Visit of BHU

Respected Sir/Madam,
It is stated that, I have visited to BHU located at on dated
at time .

7. Staff of Basic Health Unit (BHU):

 Stationed Staff

 Outreach Staff.

8. Role/Responsibilities of BHU Staff:

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9. Services available Basic Health Unit (BHU):

10. Deficiencies at Basic Health Unit (BHU):

11. Suggestions and Recommendations

12. Conclusion:

Reflection
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VISIT To RHC
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RURAL HEALTH
CENTRE

PIC

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Objective:

Dated: Subject: Report on Visit of RHC

Respected Sir/Madam,
It is stated that, I have visited RHC located on dated
at time .
1. Staff of Rural Health Centre
 Stationed Staff

 Outreach Staff

2. Role/responsibilities of RHC Staff:

3. Physical Facilities/Building of Rural Health Centre

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4. Services available at Rural Health Centre

5. Deficiencies at Rural Health Centre:

6. Suggestions and Recommendations

7. Conclusion:

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Reflection

25
VISIT TO SLAUGHTER HOUSE

PIC

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Objective:

Dated: Subject: Report on Visit of Slaughter House

Respected Sir,
It is stated that, I have visited slaughter house located on dated
at time .

1. Brief Orientation to Slaughter House:

2. Meat slaughtering, handling and distribution (Process description):

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3. Deficiencies at Slaughter House:

4. Suggestions/Recommendations:

5. Conclusion:

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Reflection

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VISIT TO COMMUNITY /
COMMUNITY SURVEY

PIC

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Objective:

Reported By:
Dated:
Subject: Report on Community Survey

Respected Sir/Madam,
It is reported that, I have visited to community of located
on dated at time .
1. Introduction to Community:

2. Physical Facilities/ Community Infrastructure:

3. Health Facilities/services:

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4. Education Facilities:

5. Community Issues/Problems observed:

6. Suggestions & Recommendations:

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7. Community Health Education/Service Project:
i. Background & Introduction to the Project:

ii. Resources (Material/Equipment) required:

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iii. Steps of Activity/Project taken:

(attach evidences)

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iv. Difficulties/Challenges faced and actions taken:

v. Future recommendations/suggestions:

Vi.Conclusion:

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Reflection

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VISITTOSCHOOL/SCHOOLSURVEY

PIC

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Objective:

Dated: Subject: Report on School Survey

Respected Sir/Madam,
It is reported that, I have visited to School named located

on dated at time .
1. Introduction to School/Profile:

2. Physical Facilities/Infrastructure:

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3. School Health Education Project:
i. Background & Introduction to the Project:

ii. Resources (Material/Equipment) required

iii. Planning:

(attach Teaching Plan here)

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iv. Implementation (Steps of activity taken):

v. Difficulties/Challenges faced and actions taken:

vi. Future recommendations/suggestions:

vii. Conclusion:

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Reflection

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 VISIT TO NGO
NON-GOVERNMENTAL
ORGANIZATION

PIC

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Objective:

Dated: Subject: Report on visit to NGO

Respected Sir/Madam, located

It is reported that, I have visited to NGO named

on dated at time .
1. Introduction to NGO/Profile:

2. Role/Responsibilities of NGO:

3. Challenges & Opportunities for future projects (if any):

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4. Recommendations/suggestions:

5. Conclusion:

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Reflection

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