CHN Visit Report (First visit)

Visit to: Basic Health Unit (BHU)

BSN 2nd Semester – Community Health Nursing I

1. Introduction
A Basic Health Unit (BHU) is the first-level primary healthcare facility in Pakistan that
provides preventive, promotive, and basic curative services. The visit helps CHN students
understand community health services, PHC principles, record-keeping, and referral systems.

2. Objectives of the Visit

After this visit, students will be able to:

1. Describe the structure and functions of a BHU.

2. Identify services offered under PHC (EPI, MCH, nutrition, sanitation).
3. Observe roles of health personnel (LHV, vaccinator, medical officer).
4. Assess sanitation, record-keeping, and patient flow.
5. Relate their observations to CHN-I curriculum requirements.

3. Location of BHU
 Name: _____________________________
 District / Tehsil: _____________________
 Date of Visit: ________________________

4. Staff of the BHU

Designation Number Role
Medical Officer (MO) __ Diagnosis, treatment, supervision
Lady Health Visitor (LHV) __ ANC, PNC, FP, deliveries
Staff Nurse __ OPD care, emergency care
Vaccinator __ Immunization (EPI)
Dispenser / Health Technician __ Medicines, injections
Midwife __ Normal deliveries
Sanitary Worker __ Cleaning, waste disposal
Chowkidar __ Security

5. Services Observed at the BHU

5.1 Curative Services
 OPD consultation
 Treatment of minor illnesses
 First aid
 Dressing of wounds
 Management of common infections
 Referral to RHC / THQ / DHQ if needed

5.2 Preventive Services

 EPI Immunization:
BCG, OPV, Penta, PCV, Measles, Hep B
 Growth monitoring
 Deworming
 Health education on nutrition & hygiene

5.3 Maternal & Child Health (MCH) Services

 Antenatal checkups
 Postnatal care
 TT vaccination
 Iron & folic acid supplementation
 Family planning (condoms, pills, injectables)

5.4 Family Planning Services

 Counseling
 Oral pills
 IUCD (if available)
 Injectables (Depo-Provera)
 Condoms

5.5 Laboratory Services

 Pregnancy test
 Blood sugar (RBS)
 Urine dipstick
 Hemoglobin (if available)

6. Physical Layout Observed

 Waiting area
 OPD room
  LHV / MCH room
 Immunization room
 Labor room
 Pharmacy / dispensary
 Laboratory
 Store room
 Toilets
 Waste disposal area

7. Infection Control & Sanitation

Observations:

 Handwashing stations: Present / Not present

 Use of gloves & masks: Adequate / Inadequate
 Sharp waste box (safety box): Yes / No
 Color-coded bins: Available / Not available
 Disposal method: Pit / Incinerator / Open dumping

8. Records & Registers Observed

 Immunization register (EPI)
 ANC/PNC register
 Family planning register
 OPD register
 Medicine stock register
 Birth register
 Referral register

Registers were:
Complete / Incomplete, Up-to-date / Not updated

9. Patient Flow
 Average daily OPD: ______
 Common complaints: Fever, diarrhea, cough, body aches
 Maternal cases: ______ per day/week
 EPI cases: ______ per day/week

10. Community Health Education

Topics commonly taught at BHU:

 Handwashing
 Breastfeeding
 Diarrhea management & ORS
  Personal hygiene
 Family planning
 Nutrition
 Safe drinking water
 Importance of immunization
 Danger signs in pregnancy

11. Problems Identified

Common issues observed:

 Medicines shortage
 Lack of staff
 Poor sanitation in waiting area
 Electricity issues
 Incomplete waste disposal system
 Limited lab services
 Overcrowding
 Weak referral system

12. Recommendations
1. Ensure continuous supply of essential medicines.
2. Improve cleanliness and waste management.
3. Provide regular training for staff.
4. Increase availability of laboratory tests.
5. Ensure regular electricity / backup generator.
6. Strengthen referral linkages to higher facilities.
7. Increase community awareness programs.
8. Improve water supply and sanitation system.

13. Conclusion
The BHU visit provided valuable understanding of primary healthcare services and
community health practices. Observing real-life PHC activities helped connect theoretical
knowledge with practical experience. The visit met the CHN-I curriculum objectives for the
BSN 2nd semester.

Visit to Water and sewerage plant (2nd visit)

1. Introduction
Community health nursing focuses on identifying environmental factors that affect
community health. Access to safe drinking water and proper sewerage disposal is essential
for preventing communicable diseases such as diarrhea, typhoid, hepatitis-A/E, cholera, and
skin infections.

This field visit was conducted to observe:

 Water treatment processes

 Water quality maintenance
 Wastewater management
 Sanitation practices in the community

2. Objectives of the Visit

By the end of the visit, students will be able to:

1. Describe the working of a community water filtration plant.

2. Identify common water treatment steps (sedimentation, filtration, chlorination).
3. Understand the structure of the sewerage system.
4. Recognize environmental and public health risks associated with poor sanitation.
5. Assess community awareness regarding safe water and hygiene.
6. Relate all observations to the CHN-I curriculum requirements.

3. Place of Visit
A. Water Filtration Plant

 Location: __________________
 Type: Government / Private / Community-based
 Capacity (Liters/day): __________

B. Sewerage Treatment / Disposal System

 Location: __________________
 Type: Open drainage / Underground sewerage / Treatment plant

4. Water Filtration Plant – Observations

4.1 Source of Water

 Tube well / Canal water / Bore / Municipal supply

4.2 Steps of Water Treatment Observed

1. Screening – removal of solid waste

2. Sedimentation – allowing heavy particles to settle
3. Coagulation / Flocculation – alum or chemicals added
4. Filtration – sand, gravel, carbon filters
5. Chlorination – disinfection (0.2–0.5 ppm chlorine)
6. Storage – clean, covered tanks

4.3 Water Quality Testing

 pH
 Turbidity
 Chlorine level
 Microbial testing (if available)

4.4 Advantages Identified

 Safe for drinking

 Prevents waterborne diseases
 Affordable for community

4.5 Weaknesses / Problems

 Irregular maintenance
 Low pressure during peak hours
 Occasional contamination due to pipeline leakage
 Insufficient chlorination

5. Sewerage System Visit – Observations

5.1 Type of Sewerage System

 Open drainage
 Underground sewerage
 Combined drainage system

5.2 Components Observed

 Manholes
 Sewage lines
 Treatment tank / oxidation pond (if present)
 Wastewater discharge point

5.3 Problems Identified

 Blocked drains
 Open manholes
  Stagnant water
 Mosquito breeding
 Bad odor
 Mixing of sewage with drinking water pipelines

5.4 Public Health Concerns

 Diarrhea
 Gastroenteritis
 Dengue & malaria (stagnant water)
 Skin diseases
 Environmental pollution

6. Community Interview Summary

(Interviewed: Residents / plant operator / sanitary workers)

 Awareness about boiling or filtering water: Good / Poor

 Complaints about sewerage overflow: Yes / No
 Satisfaction level with water supply: High / Medium / Low
 Common diseases reported: ____________

7. CHN Assessment According to

Curriculum
CHN-I Curriculum Requirements Covered:

✔ Environmental sanitation
✔ Water purification
✔ Sewage and waste disposal
✔ Community survey
✔ Disease prevention
✔ Health education

8. Health Education Provided to

Community
1. Importance of boiling/filtering water
2. Handwashing after toilet and before meals
3. Safe storage of drinking water
4. Keeping drains covered
5. Using ORS in case of diarrhea
6. Reporting leakages or sewerage blockages
7. Proper solid waste disposal
9. Problems Identified & Recommendations
Problems

 Leakage in pipelines
 Low chlorine levels
 Overflowing drains
 Mosquito breeding sites

Recommendations

1. Regular maintenance of water filtration plant

2. Ensure adequate chlorination
3. Repair broken sewerage lines
4. Community awareness programs
5. Installation of covered drainage
6. Routine water quality testing

10. Conclusion
The CHN visit provided important insight into how environmental factors such as water
purification and sewage disposal affect community health. Proper sanitation and safe drinking
water are critical for preventing diseases and improving quality of life. The visit fulfilled the
learning outcomes of BSN 2nd Semester Community Health Nursing – I.

HN Community Visit Report (3rd visit)

Visit to: Milk Processing Plant & Slaughter House
BSN 2nd Semester – CHN-I

1. Introduction
The CHN curriculum focuses on environmental sanitation, food hygiene, and prevention of
foodborne diseases. Visiting a milk processing plant and slaughterhouse helps nursing
students understand safe food production, storage, and inspection procedures that protect
public health.

2. Objectives of the Visit

After completing the visit, students will be able to:

1. Explain steps of milk collection, pasteurization, packaging, and distribution.

2. Identify hygienic practices required in milk handling.
3. Observe slaughtering processes and meat inspection procedures.
4. Assess environmental sanitation, waste disposal, and occupational hazards.
5. Relate findings to disease prevention and CHN-I curriculum requirements.

3. Location of Visits
A. Milk Processing Plant

 Name: __________________
 Address: _______________
 Type: Government / Private / Cooperative

B. Slaughter House

 Name: __________________
 Address: _______________
 Type: Municipal / Private / Traditional

4. Milk Processing Plant Visit –

Observations
4.1 Milk Collection
 Collected from farms / collection centers
  Tested for:
o Temperature
o Fat percentage
o SNF (solids-not-fat)
o Adulteration (water, starch, urea)

4.2 Processing Steps

1. Filtration & Clarification
Removes dust, dirt, hair, impurities.
2. Standardization
Adjusting fat level (full cream / toned / skimmed).
3. Pasteurization
o Method used: HTST / LTLT
o Temperature: 72°C for 15 seconds (HTST)
Purpose: Kills pathogenic bacteria.
4. Homogenization
Breaks fat particles to improve taste & consistency.
5. Cooling
Rapid cooling to 4°C to prevent bacterial growth.
6. Packaging
o Plastic pouches / bottles
o Date and batch number checked
7. Cold Storage & Distribution
Delivered in refrigerated vehicles.

4.3 Hygiene Observations

 Workers wearing gloves, caps, masks: Yes/No
 Handwashing stations: Present/Not present
 Equipment cleanliness: Good / Fair / Poor
 Pest control: Satisfactory / Unsatisfactory

4.4 Public Health Risks Identified

 Risk of contamination through dirty containers
 Improper pasteurization
 Storage at >4°C
 Adulteration risks
 Poor personal hygiene of workers

5. Slaughter House Visit – Observations

5.1 Animals & Pre-Slaughter Inspection
 Types: Cow / Goat / Sheep / Camel
 Checked by veterinarian for:
 o General appearance
o Lameness
o Skin diseases
o Signs of infection

5.2 Slaughtering Area

 Flooring: Cemented / Tiles / Broken
 Drainage: Good / Poor
 Lighting & ventilation: Adequate / Inadequate
 Separate area for sick animals? Yes/No

5.3 Slaughtering Process

1. Stunning / Halal slaughter method
2. Bleeding (blood collected or disposed)
3. Skinning
4. Evisceration (removal of internal organs)
5. Inspection of organs (liver, lungs, intestines)
6. Carcass washing
7. Chilling & storage

5.4 Meat Inspection

 Done by: Veterinarian / No inspector
 Conditions checked:
o Parasites
o Cysts
o TB lesions
o Liver flukes
o Abnormal smell or color

5.5 Waste Disposal

 Solid waste: Bones, skin, organs
 Liquid waste: Blood, wastewater
 Method used:
o Composting
o Rendering
o Open dumping
o Underground drainage
 Presence of flies, dogs, crows: Yes/No

5.6 Occupational Hazards

 Sharp objects
 Animal handling injuries
  Blood exposure
 Wet slippery floors

6. Community Health Concerns Observed

Milk Plant:

 Foodborne diseases (brucellosis, typhoid, diarrhea)

 Improper refrigeration
 Adulteration practices

Slaughter House:

 Meat-borne diseases (tapeworm, [Link], Salmonella)

 Cross-contamination
 Air pollution / foul odor
 Waste attracting pests

7. Health Education Provided

For Milk Plant Workers:

 Importance of personal hygiene

 Handwashing before handling milk
 Correct cleaning of equipment
 Safe storage at ≤4°C
 Avoid adulteration

For Slaughterhouse Workers:

 Wearing PPE (gloves, boots, apron)

 Safe knife handling
 Proper disposal of blood & organs
 Avoiding cross-contamination
 Vaccination (Tetanus, Hepatitis B)

8. Findings & Recommendations

Problems Identified

 Dirty drainage near slaughterhouse

 Poor waste disposal
 Inadequate handwashing facilities
 Lack of veterinary inspection
  Flies and stray animals
 Milk not cooled properly after collection

Recommendations

1. Regular veterinary inspections

2. Proper drainage and waste management system
3. Routine pest control
4. Worker training programs on hygiene
5. Use of stainless steel equipment
6. Ensure proper refrigeration at all stages
7. Strict enforcement of food safety laws

9. Conclusion
The visit to the milk processing plant and slaughterhouse provided practical knowledge of
food safety, hygiene, and environmental sanitation. Such visits help nurses identify potential
health hazards and educate the community to prevent foodborne diseases. The activity fully
supports the learning outcomes of Community Health Nursing – I (BSN 2nd Semester).