COMMUNITY HEALTH NURSING

(NUR 3205, NOTES

LESSON ONE 21/10/2023

LESSON TWO 28/10/2023

LESSON THREE 4/11/2023

LESSON ONE
1. introduction to community health Nursing
2. Concept in community health
3. Community assessment, diagnosis, outcome, identification,
planning intervention and evaluation
4. Community entry, boundary, orientation, asset inventory,
mapping, focus group discussion and interview

INTRODUCTION TO COMMUNITY HEALTH NURSING

DEFINITIONS OF THE COMMUNITY
A)
• A Community is a group of people living within a specified
geographical boundary which may consist of different
subgroups.
• There is usually a leader but there may be many formal or
informal leaders as well.
• Communities are not always homogenous there are many
different views, languages, ideas and approach to life.
However, its Members are governed by the same statutory
 laws.
B) Community is a group of organization interacting and sharing
of an environment with common characteristics belief,
values, resources preferences, needs, risks, etc

TYPES OF COMMUNITY

1) Geographic Community: This ranges from local

neighborhood, suburb, village, town, city or the planet as
a whole.
2) Community of Culture: This ranges from local clique, sub
culture, ethnic groups, religions multicultural or pluralistic
civilization or global communities culture of today.
3) Community based on identity: Group of people with
Community identity other than location, members often
interact regularly e.g.
a) Professional Community: These are groups of people with
same or related occupations e.g. Health professionals
consisting of nurses, doctors, pharmacists etc.
b) Virtual Community: Group of people primary or initially
communicating or interacting with each other by means of
information technologies e.g. Internet.

DEFINITIONS OF HEALTH
• Health according to the World Health Organization is a state
of complete physical mental and social wellbeing and not
 merely the absence of disease or infirmity.
• Health is a condition or quality of human organism which is
expressed by adequate functioning under genetic and
environmental conditions.
• Health is a state that allows the individual to adequately
cope with all demands of daily life whereas Ill-health is a
state of inadequate functioning of human organism under a
given genetic and environmental conditions. It is a deviation
from normal physiological and psychological functioning of
human organism

NURSING
Nursing is a profession that had its bases in the care of a
client/patient, it encompasses autonomous and collaborative care
of individuals of all ages, families, groups and communities, sick
or well and in all settings. Assist in Promotion of health and
prevention of illness, care of the disable and as well as the dying.
Nursing is a safety critical profession founded on 4 pillars
1. Clinical practice
2. Education
3. Research
4. Leadership

THE CONCEPT COMMUNITY HEALTH NURSING

The expanding roles of nursing include caring for the people
within and outside the hospital setting the 4 major concept of
community health nursing are
1. Person
2. Environment
3. Health
4. Nursing
All are aim to:
1. increase the capability of families groups and communities to
cope with health and illness problem
2. Controlling and counter acting as much as possible physical,
social and environmental conditions that threaten health or
decrease the enjoyment of life.
3. focus on community services that will address the needs of
the community as a whole. Encouraging healthy lifestyle and
preventing illness

COMMUNITY HEALTH NURSE/ NURSING

1. community based nursing care is a special area of nursing in
which the nurse put her professional skills to play in rendering
services to the community it is a field of Nursing Practice for
which there exists a body of knowledge and related skills
applied in meeting the health needs of an individuals, families
and communities in their normal environments such as home,
school, place of work or otherwise.
2. It is a Professional Nursing focusing on serving people
through organized community effort in their usual environments.

OBJECTIVES OF COMMUNITY HEALTH NURSING

1. To increase the capability of families groups and
communities to cope with health and illness problems
through.
a) Adequate information which will form basis for decision
making.
b) Positive attitude towards health care that are consistent with
effective health planning & actions at the level of family, group
and Community.
c) Professional guidance that will increase their ability to solve
problems
d) Self – reliance
2. To support and supplement the effort of other professional
workers or agencies in the control of disease and in the
restoration and preservation of health through
a) Monitoring and evaluation
b) Free flow of information
c) Inter- sectoral Collaboration
3. To control or counteract as much as possible physical and
social environmental conditions that threaten health or
decrease the enjoyment of life through.
a) Safe environment from health threats such as unnecessary
exposure to accident, communicable disease, inadequate or
 unsafe water supplies or indiscrimate access to harmful
habit forming drugs.
b) Environment that should be conducive to self-respect and
self-realization
4. To contribute to the refinement and improvement of nursing
practice or public health practice and service through:
a) Generation of relevant research questions.
b) Continuous systematic study and appraisal which must be
an integral part of professional practice.
c) Training orientation and re orientation of professionals in
practice.
d) Collaborative effort in multi-professional research right from
planning to implementation stage.

ROLES/RESPONSIBILITIES OF COMMUNITY HEALTH

NURSING

1) Nursing which include personal and therapeutic care, health

education, counselling and support
2) Public Health /Community Health Protective measures
including levels of care, disease investigation and
environmental control.
3) Health related: - Community & family development. These
are based on Principles of Community Health Nursing care
which are:
a) Nursing should be used as a channel of health care
b) The Community as a whole should be the focus of attention

ROLES AND FUNCTIONS OF COMMUNITY HEALTH NURSE AS

A MEMBER OF THE HEALTH TEAM
4. Nurses are key member of the healthcare team with vital role
in the community which includes promoting healthy lifestyle,
advocate for patient and provide health education, they
provide the community with the knowledge needed for healthy
living

1. The Community Health Nurse Provides and promotes

nursing services to families through:
a) Assuming direct responsibility for providing care or
supervising and directing others to provide care
b) Education of others on how to give nursing care e.g. other
Professionals individuals family, groups etc.
c) Carries out referral.
2. Uses nursing as a channel for strengthening family life and
for promoting personnel or family development and self
realization through:
a) Counselling
b) Communication process
3. Participates in disease control activities - through general
preventive measures, early identification of disease,
provision of care and supervision to reduce effects of
disease
a) Health Education and campaign
b) Screening processes and massive prevention
c) epidemiological alerts and investigations
4. Works with appropriate personnel in special setting, such as
school, working places to plan and implement nursing
phases of their health programs by:
a) Reviewing and interpreting Data
b) Monitoring and evaluation
c) Medical examinations
d) Serving as member of committees for health planning and
action.
5. Plans and evaluates nursing services for the population
group under her care by:
a) using demographic information
b) setting goals and objectives and plan outcomes for the
Community Health Nursing Services
c) Planning with the members of the health team the care and
services to be rendered.
6. Contributes to the decision and policy setting in the agency
and community by:
Writing and sending reports and recommendations to the
appropriate agencies for action.
7. Contributes to the extension of knowledge in nursing and
health care by engaging in surveys studies or research
through
a) proposing problems that need systematic study for their
 resolutions
b) planning and carrying out simple studies
c) participatory research.

COMMUNITY DIAGNOSIS/NEEDS ASSESSMENT

Community Diagnosis is an essential basic tool and one of the
major instruments used in community health, It helps to find out
the needs of the community. These needs can be felt needs, that
is, those identified by the community and perceived needs are
those identified by the health team.
The type of information sought during community diagnosis
includes: information about population, births deaths, age groups,
leaders, organization, health services rendered (modern and
tradition), manpower resources geographical characteristics,
environmental problems including infrastructures.
Thus th e purpose of community diagnosis is to have a solid basis
for making plans to meet specific identified needs.
DEFINITIONS
A) Community Diagnosis
- It is an organized process of identifying accurately the
natureand relative size of the health problems of a
community.
- It is a systematic examination of the health status indicators
 for a given Population that is used to identify key problems
in a community.
Community diagnosis:
- Identifies needs.
- Identifies resources, needs, constraints and problems.
- I dentifies physical, social and cultural characteristics of the
community.
- Identifies disease patterns.
- Identifiesdemographic characteristics of the community.
B) Needs Assessment
Process of identifying the community wants, strength,
weaknesses and constraints of which may have impact on the
health of the community.
There are 3 major types of needs in the community.
1) Felt Needs- This implies what people feel are their greatest or
biggest problems. These are things in the people’s lives.
(living conditions, ways of doing things, beliefs etc0 that
they feel if dealt with, will help them to be healthy.
2) Observed/Perceived Needs: These are needs, problems and
constraints identified by the health workers as those that
can have negative impact on the community.
3) Expressed Needs: These are needs, problems and
constraints on which health workers and/or community has
taken some measures of actions which may or may not have
adequately addressed the health issue(s).
C) Situation Analysis
It is a comprehensive review and assessment of the
community/District/LGA in other to determine or come into
conclusion about the situation of the communities which may
have direct or indirect impact on the health of the people.
D) Objectives of Community Diagnosis
- To determine what information needed to assess the
community.
- To select and use appropriate tools to collect information or
use available data.
- To plan and coordinate activities with other members of the
team.
- To evaluate data and determine health need priorities of the
community.
USES OF COMMUNITY DIAGNOSIS IN COMMUNITY
HEALTH/PRIMARY HEALTH CARE
- It provides for decision on whether to plan strategy for
program, the type of intervention and on which target group
it will be applied.
 - It provides basis for determining what resources will be
needed for an intervention program.
- It provides baseline for future measurement of changes in
community health problems.
- A descriptive community diagnosis can beused to show
occurrence or distribution of selected diseases or health
indicators.
An analytic community diagnosis can:
a) Identify groups needing care.
b) Determine causal factors of diseases in the community.
c) Determine attributes that can be risk markers for vulnerable
groups of individuals in the community.
d) Identify community syndromes e.g. malnutrition which can
be a community syndrome in poor areas, hypertension,
coronary heart disease which may be community syndrome
in affluent communities.
PRINCIPLES THAT GOVERN COMMUNITY DIAGNOSIS
1. The most effective way to improve the overall health status
of the community is through enhanced community based
services organized around Primary Health Care model
2. Comprehensive community health needs assessment that
provides baseline data is pre requisite to the development of
a long term community effort to improve the health status of
people living in the community.
ROLES OF COMMUNITY DIAGNOSIS IN COMMUNITY HEALTH
- It identifies needs used as basis for planning.
 - It identifies problems thereby leading to self-reliance.
- It identifies constraints which can then be addressed in the
planning process.
- It provides a baseline for evaluation of intervention.
RATIONALE FOR COMMUNITY DIAGNOSIS
- It provides realistic information specific to a community for
which definite relevant plans are made, in order to solve the
problems using identified resources, in a culturally
acceptable manner.
METHODS USED IN COMMUNITY DIAGNOSIS/ ASESEMENT
- Observation
- Interviews/Surveys
- Group discussion (focus group discussion)
- Review of existing records in the community clinics/ health
centres
- Screening of specific problems
TYPES OF DATA TO BE COLLECTED IN COMMUNITY
DIAGNOSIS
In assessing the community so as to determine factors (health,
economic and environmental) that can affect health of the
community the following data will be collected.
A. Demographic Data
1. Size of population
2. Composition of the population such as age, sex, marital
status and size of families, ethnic groups, social class and
religion
3. Birth rate (How many children delivered at a specific period
of time?)
4. Death rate (Age, specific death rate)
5. Infant mortality rate (causes of death)
6. Growth rate
7. Migration rate
8. Dependency ratio (number of defendants per breadwinner)
9. Life expectancy
B. Health Problems in the Community
1. Leading causes of death
2. Leading causes of morbidity
3. Nutritional Status
4. Vectors
5. Varying susceptibility to change
6. Lack of effective communication:
5. Between health and social welfare agencies
6. Between these agencies and the people
C. Diseases
1. Communicable diseases e.g. T.B., measles, HIVAID, Polio
2. Non-communicable diseases e.g. malaria, worm infestation;
and their Mode of spread
D. Health Facilities
1. Available Health centres
2 Facilities and resources
3 Road conditions to health centres
4 Hospitals
5 Number available
6 Distance to community
E. Nutrition Status
1. Availability of nutrients/ food at community and family
levels.
2. Food practices, habits and preparation.
3. Food taboos.
4. Breastfeeding, weaning and rearing practices.
5. Food selling places, food handlers, observation of regulation
related to food protection.
F. Environmental Aspect of the Community
1. Land Space
a) Urban versus rural
b) Ownership (Land tenure)
2. Land Quality
a) Fertile or arid
b) How utilized? (crops)
c) Adequacy of food supplies
3. Drinking Water
a) Sources of water supply in relation to pollution
b) Adequacy
c) Water treatment
4. Water disposal
a) Kinds
b) Safety
c) Adequacy
5. Climate
a) Temperature
b) Seasonal variations
c) Rainfall (drought and flooding).
6. Transportation and Communication
a) Roads (quality and seasonality)
b) Telephone
c) Radio
d) Television
e) Other means of transportation
f) Other means of transportation.
7. Economic
a) Industry
b) Agriculture
c) Employment versus unemployment
8. Housing
a) Types
b) Adequacy
Resources for Health and Social Welfare
1. Hospitals and/or health centers
 Location
 Size
 Services offered
 Organizational System
 Adequacy to meet community needs
 Financial support
 2. Agricultural and Environmental Services
3. Religious Structure (or Services)
4. Educational services (schools)
5. Social and recreational resources
6. Man power for these services

CUSTOMS/HERITAGE
1- History of the Community
New or established
Origin of various families
2- Established Customs, Beliefs or Taboos
 Puberty-rites, sexual attitudes and behavior
 Marital roles, relationships, types of marriages
 Traditional fertility regulation
 Childbearing and rearing
3 Meaning of children, including social value
4 Family customs or habits, including value systems
5 Clan or tribal royalties
6 Food habits, taboos etc.
7 Traditional Medical Practice and Beliefs
8 Manpower medicine man, healers etc.
9 Practice based on magic, spells, voodoo. herbs etc.
10Coordinator cooperation with modern scientific medicine.
LEADERSHIP
1. Identification and selection.
2. Nature of leadership.
 3 Network of leadership
4 Decision making
5 Communication
6 Delegation of responsibilities.
THE COMMUNITY
1) Exploration of how all the preceding factors affect health of
the community.
2) Uniqueness of each community.

STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

1. Identify boundaries of the community.
2. Make a map of the community showing the boundaries,
landmarks that is major. Roads, rivers and markets,
important land marks and settlements.
3. Make a list of resources available in terms of industries,
markets, churches, mosque, health care facilities personal
organizations e.g. transportation, Non- governmental
organizations. (NGO’S).
4. Find out about cultural practices and attitudes affecting
health, that is those that are useful or harm less or harmful.
5. Describe the social customs and important festivals of the
community.
6. Find out the major economic activities of the community.
7. Perform an interview survey of the community by:
a) Conducting focus group discussion. (note: focus group
 discussion is a group discussion that gathers together
people from similar back grounds or experiences to discuss
specific topic of interest).
b) Developing a survey instrument using suitable
questionnaires or oral questions.
8. Pretesting the instrument on colleagues or some members
of the community.
9. Revise the instruments taking into account information
gathered during the pretesting.
10. Have group discussion with health staff and with community
about sample survey.
11. Train interviewers and validate the result of their data.
12. Carry out interviews of the sample chosen using appropriate
sampling techniques.
13. Analyze data, summarize.
14. Write report.
15. Give feedback to the community and other health workers.
16. Discuss the report with the health workers.
17. Plan for discussion with the community.
18. Present to the community in a manner they will understand.
19. Discuss possible suggestion for solution.
20. Plan for community heath activities to solve identified
problems.
This is done in collaboration with the community.
PLAN FOR SITUATION ANALYSIS

 Situation analysis is conducted usually on the health

services provided to determine the ability of health services
to respond to problems found during community diagnosis.
 Types of information gathered during situation analysis:
 The analysis consists of a complete survey of health facilities
in the local Government area, their distribution, category of
personnel in the facilities and number in each category.
 It provides information in the number on the type and
volume of services provided in the facilities.
 Information on the number of settlements in each local
Government area, their population, presence of basic
infrastructures that affect health e.g. roads, electricity
telephones, portable water supplies and schools.
 Role of Situation Analysis
 To provide baseline data for implementation of community
health services/primary health care at local government
level, district and community levels.
 Instruments used for Situation Analysis
a) House Hold Questionnaire (Form H) used for holding
information e.g. members of the household, demographic
characteristics and documented illness episodes in the past
month.
b) Child questionnaire used to collect child information e.g.
immunization status, episodes of diarrhea.
c) Female questionnaire - information to be collected will be on
marital status, reproductive age, child bearing status, and
women who have never been pregnant, number of children,
dead or alive, knowledge on certain vital health matters
necessary for the survival of her children e.g. immunization
and nutrition, type of maternal and health services
(Antenatal, delivery & Post Paternal Services) during her last
pregnancy.

PLAN FOR SITUATION ANALYSIS

1. Contact the local Government Area
2. Obtain instruments from (FMOH, SMOH, and NPCHDA)
3. Train interviewers
4. Conduct situation analysis by collecting information on the:
 Socio economics status
 Public utilities and services
 Local government Primary Health Care (PHC) activities
 Local government area logistics and information supports
5. Collate data from the field
6. Report writing.
 COMMUNITY OUTCOME IDENTIFICATION
The community outcome process is a key component of the
local government where the identification of what is
important to the local government communities are carried
out by consultation planning and reporting processes.
It seeks to improve the social, economic, environmental and
cultural wellbeing of district, which result are utilized to
guide and priorities planning process for the community

PLANNING INTERVENTION AND EVALUATION

1. Planning is goal-oriented.
a. Planning is made to achieve desired objective.
b. Planning identifies the action that would lead to desired
goals quickly and economically.
2. It provides sense of direction to various activities.

3. Planning is looking ahead.

a. Planning is done for future.
b. It requires peeping into the future, analyzing it and
predicting it.
c. Thus planning is based on forecasting.
d. A plan is a synthesis of forecast.
e. It is a mental predisposition for things to happen in
future.
4. Planning is an intellectual process.
a. Planning is a mental exercise involving creative
 thinking, sound judgment and imagination.
b. It is not a mere guesswork but a rotational thinking.
c. Planning is always based on goals, facts and considered
estimates.
5. Planning involves choice and decision making.
a. Planning essentially involves choice among various
alternatives.
b. Therefore, if there is only one possible course of action,
there is no need planning because there is no choice.
c. Thus, decision making is an integral part of planning.

6. Planning is the primary function of management / Primacy of

Planning.
a. Planning lays foundation for other functions of
management.
b. It serves as a guide for organizing, staffing, directing
and controlling.
c. All the functions of management are performed within
the framework of plans laid out.
d. Therefore, planning is the basic or fundamental function
of management.
7. Planning is a Continuous Process.
a. Planning is a never-ending function.
b. Plans are also prepared for specific period of time and
at the end of that period, plans are subjected to
evaluation and review
 a. Planning leads to accomplishment of objectives at the
minimum possible cost.
b. It prevents wastage of resources and ensures adequate
and optimum utilization of resources.
8. Planning is Flexible.
a. Planning is done for the future.
b. Since future is unpredictable, planning must provide
enough room to cope with the changes in customer’s
demand, competition, govt. policies etc.
c. Under changed circumstances, the original plan of
action must be revised and updated to take care of the
altered conditions.

ADVANTAGES OF PLANNING

1. Planning facilitates management by objectives.

a. Planning begins with determination of objectives.
b. It highlights the purposes for which various activities
are to be undertaken.
c. In fact, it makes objectives more clear and specific.
d. Planning helps in focusing the attention of employees
on the objectives or goals of enterprise.

2. Planning minimizes uncertainties.

3. Planning facilitates co-ordination.
 a. It helps in finding out problems of work performance
and aims at rectifying the same.
4. Planning improves employee’s moral.
a. Planning creates an atmosphere of order and discipline
in organization.
b. Planning creates a healthy attitude towards work
environment which helps in boosting employees moral
and efficiency.
5. Planning helps in achieving economies.
6. Planning facilitates controlling.
a. It provides basis of controlling.
7. Planning provides competitive edge.
a. Planning provides competitive edge to the enterprise
over the others which do not have effective planning.
This is because of the fact that planning may involve
changing in work methods, quality, quantity designs,
extension of work, redefining of goals, etc.
b. Therefore, planning leads to best utilization of possible
resources, improves quality of production and thus the
competitive strength of the enterprise is improved.
8. Planning encourages innovations.
a. In the process of planning, managers have the
opportunities of suggesting ways and means of
improving performance.
b. Planning is basically a decision making function which
involves creative thinking and imagination that
 ultimately leads to innovation of methods and
operations for growth and prosperity of the enterprise.

DISADVANTAGES OF PLANNING
There are several limitations of planning. Some of them
are inherent in the process of planning like rigidity and
others arise from the shortcomings of the techniques of
planning and in the planners themselves.
1. Rigidity
a. Planning has the tendency to make administration
inflexible.
b. Planning implies prior determination of policies,
procedures and programmes and a strict adherence to
them in all circumstances.
c. There is no scope for individual freedom, and
application initiative.
d. The development of employees is highly doubted
because of which management might have faced lot of
difficulties in future.
e. Planning therefore introduces inelasticity and
discourages individual initiative and experimentation.
2. Time consuming
a. Planning is a time consuming process because it
involves collection of information, it’s analysis and
interpretation thereof. This entire process takes a lot of
time especially where there are a number of
 alternatives available.
b. Therefore, planning is not suitable during emergency or
crisis when quick decisions are required.
3. Probability in planning
a. Planning is based on forecasts which are mere
estimates about future.
b. These estimates may lack accuracy due to the
uncertainty of the future.
c. Any change in the anticipated situation may render
plans ineffective.
d. Plans do not always reflect real situations inspite of the
sophisticated techniques of forecasting because future
is unpredictable.
e. Thus, excessive reliance on plans may prove to be fatal.
4. False sense of security
a. Elaborate planning may create a false sense of security
to the effect that everything is taken for granted.
b. Managers assume that as long as they work as per
plans, it is satisfactory.
c. Therefore, they fail to take up timely actions and an
opportunity is lost.
d. Employees are more concerned about fulfillment of plan
performance rather than any kind of change.
External Limitations of Planning
1. Political Climate- Change of government from Congress to
some other political party, etc.
2. Labour Union- Strikes, lockouts, agitations.
3. Technological changes- Modern techniques and equipments,
computerization.
4. Natural Calamities- Earthquakes and floods.

COMMUNITY ENTRY
Is the process of engaging with a specific community or local
area in other to work and collaborate with their members in
addressing health needs?
It is a process where one gets to know the status of the
community and learns how best one can help the community
following the normal accepted steps which are
1. Planning
2. Entry the community
3. Following up and continued nurturing of the relationship

PRINCIPLES OF COMMUNITY ENTRY

1. Planning
2. Demography
3. Collaboration
4. Openness
5. Transparency
6. Action
7. participation
COMMUNITY BOUNDARY
This is the line defining the area in and around a community
within the jurisdiction of the community such as stream, rivers,
rails, line etc
 LESSON TWO 28/10/2023
1. Family and health
2. Community development
3. Family nursing process
4. Gender based violence
5. Substance abuse

1. FAMILY AND HEALTH

A Family is a fundamental social unit typically consisting

of individuals who are related by blood, marriage,
adoption, or a strong emotional bond.
Families come in various forms and can includes parents’
children, sibling and sometimes extended relative.
Families provide emotional support, care and sense of
belonging. They play a vital role in socialization,
upbringing and the transmission of cultural and societal
values.
Families can take on diverse structures including nuclear
families consist of (parent and children) extended families,
(including grandparent, aunt, uncles etc) and in blended
families they combine members from previous
relationship) and more.
The concept of a family can vary culturally and over time,
but it remains a cornerstone of human society.
DEFINITIONS OF HEALTH

We understand the meaning of health but still we find it difficult to

define. Different people have different perception of health. Some feel
that when an individual is free from any sickness or disease he is
healthy; others feel that an individual is said to be healthy if he is able
to perform activities of daily living normally. Still others feel that an
individual is healthy if he is well adjusted in social life and can function
effectively even in stressful situations. What exactly is meant by health?
You will be able to understand better if you go through the following
definitions.

a. The conditions of being sound in body, mind or spirit and

especially free from physical disease or pain (Webster 2020).
b. Soundness of body or mind; that condition in which their
functions are duly and efficiently discharged (Oxford English
Dictionary).
c. A condition or quality of the human organism expressing its
adequate functioning in given conditions -genetic and
environmental.
d. A state of relative" equilibrium of body, form and function
which result from its successful dynamic adjustment to
forces tending to disturb it. It is not passive interplay
between body substance and forces impinging upon it but an
active response of body forces working towards
readjustment." (Perkin)

HEALTH AND FAMILY WELFARE SERVICES

The health services cover a wide range of individual and

community services for prevention and treatment of disease
and promotion of health. Health and Family Welfare Services
aim at improving the health status of a population as a
whole
FAMILY HEALTH
The overall wellbeing of members of the family both
physically, mentally and emotionally resulting to healthy
life style.
It encompasses activities carried out by families in
address health issues, communication, support and sense
of unity within their accepted norms and values.
Families and health are interconnected; they play a vital
role in the wellbeing of their members thus:
1. Lifestyle eg diet, habits formation, choices, behaviour
etc
2. Support eg social and emotional support which play a
vital role in the development of coping mechanism.
Educational capacity and financial support
3. Genetic e.g transmission of gene or hereditary
component like disease that runs in a family, medical
family history is crucial in managing or preventing
certain health condition
COMMUNITY DEVELOPMENT

Is an organized process of improving wellbeing of the community

by ensuring their economic stability, health improvement and
quality of life?
It is aimed at identifying and addressing issues in the community
with active participation of the community members and
stakeholders for sustainability and progress of the said community
Community development deals with Community engagement
involving the community member in identifying, planning and
implementation of project that affect their life and Capacity
building for sustainability, it aids Services e.g. infrastructure,
Economic development e.g. business, job opportunity, Culture and
social issues e.g. housing and Environmental issue like sanitation
refuse disposal etc.

PRINCIPLES OF COMMUNITY DEVELOPMENT

1. Community empowerment
Empowering community members to actively participate in
decision making in issues related to the community, they
should have control over their development projects
2. Community involvement
Ensuring that the voice of the community members of all
status are heard and considered in development initiative
(the marginalized/vulnerable)
3. Asset based approach
Focusing on the strength, asset and existing resources within
the community and in building of capacity and empowerment
4. Partnership and collaboration with diverse stakeholders like
NGO and individual with government agency for the benefit
of the community
5. . sustainability: ensuring that community development
employ the culture of self-reliance on both environmental,
social and economic sustainability without dependency
6. Cultural sensitivity: preserving and respecting the tradition of
the community while implement any development initiatives
7. Bottom up approach: development approach from the grass
root based on community prioritized needs
8. Accountability and transference: holding stakeholders
accountable for their action
9. Capacity building: building the skills, knowledge and
capabilities of members to address their own needs
10. Holistic approach:
11. Adaptability: flexibility
ADVANTAGES OF COMMUNITY DEVELOPMENT
1. Poverty alleviation (job training, support for business)
2. Education (after school program, adult education)
3. Health care access (healthcare services, health facilities
and health education)
4. Infrastructure development (building road)
5. Social inclusion (involving marginalized and vulnerable)
6. Environmental sustainability (population)
7. Crisis response (disaster preparedness, response and
recovery)
8. Cultural preservation (cultural heritage and tradition)
9. Housing and urban development (urban planning and
affordable houses)
10. Youth and family support (adolescent dev programmed
11. Economic development (business support,
entrepreneurship, job creation)
12. Social service (counselling and mental health services)
13. Public safety (crime prevention, safer neighborhood)
14. Community organization (fostering on organization and
leaders)
15. Rural development (agriculture, infrastructure and
economic diversification)
16. Advocacy and policy change (legislation)

FAMILY NURSING PROCESS

Family nursing process is an organized approach for proving

care to families, it consists of the following steps assessment,
diagnosis, planning, implementation and evaluation
1. Assessment: (gather information about the family
structure, health history and dynamism which involve their
strength, weakness and resources so as to identify their
needs
2. Diagnosis: (formulate a nursing diagnosis that address the
family’s needs considering their dynamism and
interaction)
3. Planning: develop a care plan within their set priority
4. Implementation: (execute the care planned eg health
education, counselling and provide the care)
5. Evaluation: assess the feedback

ADVANTAGES OF FAMILY NURSING PROCESS

1. PROVISION OF holistic care

2. Family centered care
3. Individualized care
4. Preventive care
5. Improve communication
6. Coordination of care
7. Long term benefits
8. Emotional support
9. Cultural competence
10Continuity of care

GENDER BASED VIOLENCE

This is complex issue with multiple contributing factor

Addressing gender based violence requires a multifaceted
approach that must include changing societal attitude
improving access to education and economic opportunities
and strengthening legal protection and enforcement,
GVB refers to any form of discomfort aggravated by
violence towards and individual or group of individuals

Types of GENDER BASED VIOLENCE

1. Domestic violence
2. Dowry abuse
3. Sexual abuse
4. Isolation
5. Rape
6. Forced marriage
7. Verbal abuse
8. Physical abuse
9. Abuse of power
10. Child labor

CAUSES

1. Gender inequality
2. war and conflict
3. lack of awareness and education
4. weak legal system
5. Psychological factor
6. Family and social pressure
7. Alcohol and substance abuse
8. Cultural norms (women are submissive to their husbands)
9. Economic factors (poverty and financial stress)
10. Lack of education (ignorance)

SUBSTANCE ABUSE
this is a disorder characterize by harmful use of
psychoactive substances that are injurious to health eg
alcohol, drugs or otherwise if often lead addiction and
dependency
CAUSES OF SUBSTANCE ABUSE
1. Biological factor (genetic eg family history)
2. Psychological factor (problems)
3. Environmental factor (exposure and easy access)
4. Social and cultural influence (cultural norms eg religion
tribes)
5. Stress coping mechanism: (life circumstances)
6. Early exposure (young age)
7. Peer group pressure (love and belonging in adolescent)
8. Lack of support: (either from family or friends lead to
isolation)
9. Socioeconomic factor: (poverty and limited access to
education and economic opportunities)

PROBLEMS ASSOCIATED WITH SUBSTANCE ABUSE

Substance abuse can have serious negative consequence’s on and
individual physical and mental health as well as their social and
economic wellbeing which often require interventions, treatment
and support.
1. Impaired control: (unable to control their use, e.g addiction
and dependency)
2. Social impairment: (social or occupational functioning, may
result in neglecting responsibilities at work, school of home,
social conflict and strained relationship
3. Risky use: (eg use of alcohol while driving)
 4. Tolerance: (needed more, increasing quantity of drugs
intake)
5. Withdrawal syndrome (could be distress or fatal)
6. Physical health issue (HIV, liver disease, cardiovascular issue,
respiratory problem)
7. Mental health disorders (madness)
Complication of SUBSTANCE ABUSE
1. Physical health complication (organ damage, death,
disabilities)
2. Rejection
3. Madness

THE ROLE OF COMMUNITY NURSE IN THE MANAGEMENT OF

SUBSTANCE ABUSE
1. Health promotion services
2. Mental health support
3. Community advocacy
4. Data collection and reporting
5. Crisis response
6. Youth friendly center (youth engagement)
7. Prevention of relapse
8. Managing withdrawal syndrome
9. Support to families
10. Medical management (treatment of other diseases)
11. Health education
12. Early detection and prompt intervention
 13. Referral
14. Public awareness and advocacy
15. Rehabilitation
16. Parent and care giver support (encourage care and
support from parent and care givers)
17. Engage in school and community based awareness on
prevention
18. Community event and activities
19. Mental health services
20. Advocacy to stakeholders
21. Community involvement
22. Community support groups
Conclusion
<If you or someone you know is struggling with substance
abuse, it is important to seek help from medical
professional or support organization that specializes in
addiction treatment<

LESSON THREE 4/11/2023

COMMUNITY HEALTH NURSING

 (NUR 3205
1. Street hawking/ street begging
2. The Almajiri syndrome
3. The handicap
4. Overview on organization and coordination of Community
health services.
5. Diagnostic services in the community

1. STREET HAWKING AND STREET BEGGING

(a) Street hawking:

Refers to the act of carrying and selling of goods in public
areas or the display of goods on a portable and simple
setup
It is an informal street vending that is not licensed but can
be a source of income for individuals who do not have
formal business to make a living.

TYPES OF STREET HAWKING

1. Food hawking: (snack, fruits, fast-food, beverages etc.)
2. Clothing (shirts, scarves
3. Mobile cart Hawking: (mobile cart, various items like ice
cream)
4. Households items Hawking (utensils, cleaning supplies,
appliances)
5. Carrying and delivery services: (individual carry or deliver
goods for shoppers)
6. Flower Hawking: (bouquets, potted plant, single flower)
7. Street performance: (life entertainment where performance
collect tips from passersby.
8. Shoe shine services
9. Second hand good Hawking: (used items like clothing, toys
of household goods)
10. Book and magazine Hawking: (book, newspaper
magazine)
11. Electronic Hawking: (chargers, headphone, phone
accessories)
12. Art and craft Hawking: (handmade jewelry, artwork or
craft items)

ADVANTAGES
1. Income generation (provide a source of income, a means of
self-employment for/ and survival
2. Flexibility (in term of working hour and location, vendors
can choose where and when to sale their goods.
3. Low overhead cost or capital (less spending in establishing)
4. Entrepreneurship (development of business skills and life
experience)
5. Adaptability (vendors can quickly adjust to their product
offerings to match local demand and trends)
6. Job creation (job opportunity to support families and
communities)
7. Cultural preservations (artistic expression eg artisans and
craftsmen display)
8. Accessibility (improving access to consumer/ customer)
9. Quick market entry (start selling with less protocols)
10. Customer interactions (bargaining, building relationship
and customer loyalty)

DISADVANTAGES
1. Health and hygiene concern (e.g. perishable and food
handlers)
2. Income variability (unpredictable income, consumer
demand best on weather or locations or situation like
lockdown)
3. Environmental conditions (eg harsh/cool/ rain/wind etc.)
4. Legal regulatory issues
 5. Lack of benefit to health and social amenities (e.g health
insurance, retirement plan, vaccination etc.)
6. Social stigma (social and societal discrimination)
7. Lack of job security (prone to sudden disruptions, no
formal employment or stability of job)
8. Competition (leading to price wars and reduced profits)
9. Limited space (cannot sell variety of products)
10. Physical demand (long hours standing, walking the
whole day under the sun often injurious to health)
11. Security concerns (Molestation, harassment, theft etc)
12. Lack of benefits of social amenities eg insurance
13. Mental health issue
14. Insecurity (prone to unpredictable situations)

PROBLEMS ASSOCIATED WITH HAWKING IN RELATION TO

COMMUNITY HEALTH CARE
Street hawking lead to several health related problems for both
themselves and general public and these includes:
1 Infectious disease transmission (eg densely populated
community)
2 Mental health issues (high risk of depression drugs menace,
bad social habits, poor life style etc)
3 Exposure to harmful smokes and polluted air leading to
respiratory issues
4 Inadequate rest (leading to fatigue and stress)
5 Physical straining (standing for hour or carrying heavy load
leads to muscular skeletal problems and physical stress
6 Hygiene issue (inadequate access to clean water and
sanitation leading to poor personal hygiene and spread of
disease)
7 Food safety concerns (lack of access to adequate food and
its preparation leading to food borne illnesses)
8 Lack of access to health care
 9 Exposure to environmental conditions (eg harsh weather
extreme heat, cold, wind, rain that can effect health and
wellbeing)

THE ROLE OF THE COMMUNITY HEALTH NURSE IN

ADDRESSING STREET HAWKING PROBLEMS

1. Community engagement (community participation in

health planning and addressing issues pertaining their
healthcare)
2. Advocacy (to relevant stakeholders to support vendors)
3. Monitoring and evaluation to assess the impact of health
intervention
4. Preventive measures (immunization, vaccination, health
promotion, health education activities etc)
5. Collaboration with local authority, NGO, and stakeholder in
organization and implementation of health and safety
measures
6. Vaccination campaigns
7. Access to health care to community members
8. Disease surveillance and report
9. School Health education
10. Mental health support (advocacy, community nursing
process)

(B) STREET BEGGING

This is the act of asking for money, food, clothes or any other
form of assistance from a stranger in public place, carried out by
individuals perhaps experiencing hardship like lack of shelter,
extreme poverty, destitute etc

CAUSES
 1. Extreme poverty
2. Unemployment
3. Drugs use/abuse
4. Health problems, Illnesses
5. Mental problem
6. Poor upbringing
7. Community and government failure

TYPES
1. Disability Begging (due to disability like blindness)
2. Drugs and alcohol related begging (craving) a good example
is the political tout
3. Migrant begging (e. g IDP, Refugee)
4. Individual begging
5. Children begging
6. Begging for a cause (for a specific cause)
7. Professional begging (using manipulation that may not be
honest)
8. Mendicant (certain religious or spiritual groups practicing
begging as a form of religion devotion, seeking alms)

ADVANTAGES
1. Immediate assistance (immediate financial assistance)
2. No formal protocols
3. Sense of survival
4. Awareness and empathy (rises awareness and sense of
empathy within the community)

DISADVANTAGES
1. Cycle of poverty (may follow generation and dependency on
charity)
2. Health risk (Prone multiple health condition sickness)
 3. Safety concern (vulnerable to harassment, exploitation,
violence, harm etc)
4. Loss of dignity (erode sense of dignity and self-worth leading
to psychological and emotional distress)
5. Impact on children (dependence and lack autonomy, lack of
access to education)
6. Negative stereotyping (enforcing societal biases)
7. Public nuisance (disrupt public space and peace)
8. Resource misallocation (out of budget expenses)
9. Ethical and legal concern (some law are against begging)
10. Distraction from systemic issues and problem within the
community (by focusing on individual beggar can divert from
the broader systemic issues like unemployment)

THE ROLE OF THE COMMUNITY HEALTH NURSE IN ADDRESSING

PROBLEMS OF BEGGING
1. Assessment (identifying the causes for possible intervention
or identification of disease or injury)
2. Awareness campaigns (community outreach to raise
awareness about the challenges faced by beggars)
3. Community engagement
4. Collaboration (with other health professional,
nongovernmental organization and social workers to create
a comprehensive support network for street beggars)
5. Health data collection (for development and plan for
intervention)
6. Advocacy (Advocating for policy and program aimed at
addressing poverty and the root cause of street begging)
7. Health education/ health promotion
8. Referral (connecting them with appropriate health workers
eg mental health unit, social welfare services
9. Preventive care eg vaccination, reproductive health services,
disease surveillance etc
10. Psychosocial support eg counselling, health talk
11. Assistance with basic needs where possible
 12. Health and safety promotion (Safe practice and injury
prevention

2. THE ALMAJIRI SYNDROME

Almajiri laterally means a student or learner, however culture and
values most especially in the northern part of Nigeria view
Almajiri as
A young boy who is sent by his family to Islamic school popularly
known as sangaya or Almajiri school where they received religious
education .it is a social and educational issue mostly in the
northern part of Nigeria, particularly in state like Kano, Kaduna
and Borno.
Almajiri is often associated with the practice of sending these
children away from home to live with Islamic scholars or teachers
The Almajiri system has been a subject of concern due the
following reason:
1. Educational challenges (the Almajiri school concentrate on
religious education and often neglect the formal education
thus many Almajiri children lack access to quality formal
education
2. Social issues (the Almajiri issue can contribute a circle of
poverty)
3. Poverty and vulnerability (often live in challenging
condition, in poverty, malnourished and limited access to
health care and are highly vulnerable to exploitation, abused
and child labor
4. Public health concern (leaving in crowded unhygienic
condition leading disease outbreak)
Efforts has been made by the government and various
organization to address the Almajiri syndrome with the initiative
of access to formal education and provide social service to
Almajiri children while respecting their cultural and religious
condition. So as to create a more supportive environment for
Almajiri child and to be able to acquire both formal and religious
educations
CAUSES
The cause of Almajiri is rooted in historical, cultural, economic and
social factors.
1. Historical root (dating back to century, way children receive
Islamic education where it evolves into its current form
overtime\
2. Poverty (where parent could no longer cope)
3. Families limited financial resources (cannot effort formal
education)
4. Lack of access to quality education (limited formal education
opportunity)
5. Cultural and religious tradition. (the Almajiri system is deeply
entrenched in the culture and religion of northern Nigeria
6. Family influence (families see it as a way to ensure their
children education and becoming a devout Muslim)
7. Large family size (could not afford sending all the children to
formal school)
8. Almajiri school is an alternative for some individual that
could not afford formal education
9. Migration (refugee)
10. Lack of regulation lead to substandard conditions
contributing to the changed associated with the system
11. Economic exploitation (child labor, or force to beg on
the street)
12. Conflict and displacement (families are destroyed eg
the book Haram mayhem)
Efforts are being made to address the causes of Almajiri system
by providing access to formal education, improving economic
opportunities and regulating Almajiri school to ensure the
wellbeing of the children involved. However, much need to be
done to create a positive change.
ADVANTAGES OF ALMAJIRI TYPE OF EDUCATION
1. Religious education (strong foundation for Islamic education)
2. Preservation of tradition (pass down cultural and religious
practice from one generation to another)
3. Community solidarity (form close bond with their peers and
teachers)
4. Cost effective relatively cheap and usually free
5. May be integrated with formal education to have dual
purpose

DISADVANTAGES OF ALMAJIRI TYPE OF EDUCATION

1. Safety concern (vulnerable to harassment exploitation,
abuse, violence harm etc.
2. Public health concern (spread of disease due to overcrowds
3. Lack of dignity (usually face discrimination and social stigma
lead to loss of self-esteem and dignity)
4. Social isolation (not being with their families)
5. Cycle for poverty (dependency)
6. Poverty and vulnerability (living in challenging conditions
facing malnutrition and lack of access to health care)
7. Child labor and street begging (forced to beg under
exploitative conditions
8. Health issues
9. Lack of dignity
10. Poor upbringing
11. Loss of family bounding
12. Criminality
13. Illiteracy (could lost both)
14. Mental and psychological instability
15. Poor judgement
 WHAT IS THE ROLE OF A COMMUNITY HEALTH NURSE
IN ADDRESSING THE ALMAJIRI SYNDROME ISSUE?

1. Assessment
2. Advocacy
3. Collaboration
4. Health education
5. Community engagement
6. Mental health support
7. Preventive health care
8. Rehabilitative care
9. Emergency response
10. Collection of data and record keeping

3. THE HANDICAP
Is a person or persons afflicted with a condition or obstacle that
hinders the progress or success of their daily activities of living,
the affliction could be mentally, sensory or physically. It could
also affect one’s cognitive ability
CAUSES
1. Congenital malformations
2. Birth injuries
3. Poor upbringing
4. Loss of parents
5. Road traffic accident
6. Assault
7. Disease conditions
8. Age
9. Occupation

TYPES
 1. Educational handicap (learning difficulties)
2. Physical handicap
3. Sports handicap
4. Social handicap
5. Mental handicap
6. Economical handicap
7. Sensory handicap(mutism)

THE ROLE THE COMMUNITY NURSE IN THE CARE OF THE

HANDICAP
1. Assessment
2. Care plan development (on physical, emotional and social
care)
3. Family engagement
4. Immunization
5. emphaty
6. Advocacy
7. Collaboration
8. Health education
9. Community engagement
10. Mental health support
11. Preventive health care (e g care of the elderly)
12. Rehabilitative care to near normal where possible
13. Collection of data and record keeping
14. Emergency response
15. Monitoring and evaluation
16. End of life care
17. Assistance with activities of daily living
18. exercise

HANDICAP PREVENTION
1, Community enlightenment on its causes
4. equipped health and rehabilitative carters
5. immunization
 6. antenatal care
7. accessible and affordable health care
8. nutrition
9. exercise
10. mental health care support (substance abuse
prevention)
11. safety and care (fall prevention)
12. advocacy and collaboration
13. home health care

[Link] AND COORDINATION OF COMMUNITY

HEALTH SERVICES.
It is a health service that ensure the right services are
available and accessible in response to the needs of the
community with the collaboration of all stakeholders and
community participation.
It involves a systematic approach to delivering health care
to a specific geographical area or community, it involves
the following services:
1. Community assessment: involves the understanding
of the community health needs
2. Service providers which includes government, NGO,
Private sector etc
3. Primary care (basic medical care, preventive services,
clinical services etc)
4. Collaboration between different health providers
5. Resource allocation (Funds
6. Emergency preparedness (disaster response)
7. Quality assurance
8. Health promotion
9. Cultural competency
10. Monitoring and evaluation
11. Specialized services
12. Data collection and analysis
13. Mental Health Servicea
14. Immunization/ vaccination services
15. Maternal and child health services

[Link] DIAGNOSTIC SERVICES

Is a program usually design in the community

carried out to identify and treat a pressing issue or
illness like outbreaks, it is aimed at detecting
planning and monitoring health condition in the
community

TYPES

1. Home health diagnosis (Investigation at home)

2. Point of care testing (rapid test for malaria. HIV)
3. Premarital and genetics testing (HIV, Genotype,
VDRL, etc)
4. Telemedicine
5. Cardiac test (ECG Echo, stress testing)
6. Medical imagine (scan, MRI,)
7. Radiography test (X Ray mammography)
8. Laboratory (blood test, urine test, pathology
test)

THE ROLE THE COMMUNITY NURSE IN DIADNOSTIC

SERVICES
1. Assessment
2. screening
3. Explaining the procedure
4. Support
5. Record keeping
6. Reassurance
7. Coordination
8. Counselling before and after
9. Attending to needs
10. Recording procedure
11. Referral
12. Follow up