COMMUNITY HEALTH

NURSING
By Diribsa.T
 CHAPTER ONE
INTRODUCTION TO COMMUNITY HEALTH
NURSING

2
 Course objectives

 After completing this session, student will be able to:

 Define community, community health and health
 Describe types of community
 Identify the difference between community and population
 Explain model of health

3
Brain storming ???

What is community?

4
 Introduction..
• Community is a collection of people who share some
important feature of their lives.
• Is the collection of people holding common rights, sharing
common interests, living under the same laws and
regulations and share a sense of belonging to the group.
• Some communities may share almost everything, while
other communities may share only there common
interests.

5
 Types of community
 Geographic Community
 Common-interest Community
 Community of solution

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 Geographic Community

• Is a community demarcated by geographic boundaries

E.g. a community of Assosa town

• Easily mobilized to carry out intervention and address
needs specific to that community.

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 Common-interest Community

 Identified by a common interest or goal.

 A collection of people with an interest or goal that binds
the members together.
-e.g. Disabled individuals scattered throughout a large city
may emerge as a community
-Mothers Against Drunk Driving
 Focused on health related issue and join with community
health agencies to promote their agenda.
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 Community of solution
 Is a group of people who come together to solve a
problem that affects all of them.
E.g. a water pollution problem

9
What is community health?

10
 Community health
 Community health, as a field of practice, that seeks to

accomplish the goal of an optimally healthy community

through collaborative activities.

 Is the identification of needs, along with the protection and

improvement of collective health, within a geographically

defined area.

Examples; Health education, Environmental

protection, Immunization
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 Populations
 A group of people who share one or more
characteristics, but they do not necessarily interact
with one another and share a sense of
belongingness to that group.
E.g. Older adult with diabetic

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Who can define Health?

13
 Health
 Each person has a personal perception of health.
 Some people describe their state of health as good even
though they may actually have one or more diagnosed
illness.

14
 Cont..
 Health is defined as a state of physical, mental, and social well
being not merely the absence of disease or infirmity (WHO,
1948).
 Lamberton (1978) sees the opposite of health as being no
health and the opposite of illness as being no disease.
 Health is also conceptualized as a source for every day living.

15
 Models of Health

• There are various models of the concept of health

• Some models are based narrowly on the presence or
absence of illness
• Others are based more conceptually on health beliefs, and
holism.

16
 A. Clinical Model (Dunn, 1961)
 Interpreted health as the absence of signs and symptoms
of disease or injury.
 Dunn defined, in this model;

“Health as a relatively passive state of freedom from

illness, and a condition of relative homeostasis.”
 Many health care providers belief that when signs and
symptoms of disease are no longer present, the person is
healthy.
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 B. Host –Agent – Environment Model (Leavell, 1965)

• Helps to identify the cause of an illness.

• Host: Refers to the person who may be susceptible to an
illness
• Agent: is any factor (internal or external) that can lead to
illness by its presence.
• Environment: refers to those factors that may predispose
the person to develop disease.

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 Host –Agent – Environment model..

 Health and illness depends on the interaction of

these three factors.

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C. Health Belief Model (Rosen stock, 1974, as
Modified by Stone 1991)
 It’s a person’s ideas about health and illness.
 May be based on factual information, misinformation,
and false expectations.
 Influence health behavior positively or negatively
 Provides the understanding in which clients behave
their health.

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 Health Belief Model..
 Factors that influence persons belief’s:
 Personal expectation in relation to health and illness
 Earlier experience with illness or health
 Age
 Residence

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 Components of HBM
 Perceived susceptibility: its an individuals subjective
perception of the risk of acquiring the disease.
e.g. When a person is exposed to other person with an illness
 Perceived severity: an individuals feeling on the
seriousness of an illness.
 Perceived benefits: individuals perception of the
effectiveness of various action to reduce the threat or cure
the disease.
E.g. Promoting and applying preventive measures
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 Components of HBM

• Perceived barriers: an individuals feelings on obstacles in

performing recommended health actions. E.g. cost
• Self efficacy: is an individuals ability to take action to
achieve the desired outcome.

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 D. High – Level Wellness Model
 According to this model health is recognized as an
ongoing process toward the person’s highest potential
functioning.
 Dunn described high level wellness as the experience of
the person alive with the glow of good health.
 Health is when an individual is engaging in physical
wellness, emotional wellness, social wellness and
spiritual wellness.

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 E. Holistic Health Mode
• Is based on the belief that people cannot be fully understood if
examined solely in pieces apart from their environment.
• Health is the interaction of a person’s mind, body and spirit
within the environment.

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 Community health Nursing
• It is a specialized field of nursing that focuses on the
health needs of communities.
• It is a practice that is continuous and comprehensive
directed towards all groups of community members.

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 Characteristics of Community health Nursing
 It is a specialty field of nursing
 Its practice combines public health with nursing
 It is population focused.
 It emphasizes on wellness and other than disease or
illness
 It involves inter-disciplinary collaboration
 It promotes client’s responsibility and self-care

27
 Acute care and community – based care
 Acute care
 Used for people who are receiving intensive hospital
care
 Directed at resolving immediate health problems.
 Is part of the hospital care
 Clients have life threatening conditions and require
close monitoring

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 Community based care

• Is the art and science of prolonging life,

promoting health and preventing disease
• It is aimed to:

-Improve sanitation
-Control of community epidemics
-Prevent the transmission of infection
-Provide education about personal hygiene 29
What are the roles of community health
nurse?

30
 Roles of Community Health Nursing

 Clinician
 Educator
 Advocate
 Managerial
 Collaborator
 Researcher

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 Clinician role
 Nurse provides holistic nursing care to individuals, family,
group and population.
Educator role
 Health teaching is a part of good nursing practice and one
of the major functions of a community health nurse.
 Useful because
 Greater receptivity
 Wider audience can be reached

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 Advocate role

• Every patient or client has the right to receive just equal

treatment.
• Is the process of acting on behalf of the client.
• Safeguarding patient autonomy

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 Managerial role
• As a manager the nurse exercises administrative direction
towards the accomplishment of specified goals.
• Nurses serve as managers when they oversee client care,
supervise the staff, do case management, manage
caseloads, run clinics or conduct community health needs
assessment projects.

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 Collaborator role
• The community health nurse work jointly in a common
endeavor, to co-operate as partners.
• They must work with clients, other nurses, physicians,
social workers and community leaders, nutritionists,
psychologists, epidemiologists, biostaticians, etc.

35
 Research role
• Community health nurses collect and analyze data for
the purpose of solving problems and enhancing
community health.

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 Settings of community health nursing
practice
• The types of places in which community health
nurses practice are increasingly varied.
These settings can be grouped into five categories:
 Homes
 Out patient department (ambulatory service
settings)
 Occupational health setting (factories, industries)
 Social institutions (schools, Prisons, Orphanages)
 The community at large
What is quality of health care mean?

38
 Quality health care
• It is degree to which health services for individuals &
population increase the likelihood of desired health
outcomes & are consistent with current professional
knowledge.
• Quality care is a care that is safe, effective, efficient,
patient centered, and timely delivered.

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 Dimension of quality of health care

 Safety
⚫Risk of an intervention and risk in the environment

are reduced for both client and health care provider.

 Effectiveness
⚫ Degree to which the intervention is provided in the

correct manner to achieve the intended client outcome

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 Dimension of quality of health care…

 Efficiency
⚫Care has the desired effect with the minimum of waste

of resources
 Patient centered
⚫Clients are involved in health care decisions and
respect for their individual needs, expectations and
differences by health care providers.

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 Dimension of quality of health care…

 Timeliness

⚫Degree to which the intervention is provided at the

most beneficial time to the client

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 CHAPTER
TWO

NURSING PROCESS IN THE

COMMUNITY HEALTH CARE
  At the end of this chapter,
the students will be able to:-
 Define the term nursing
Learning process and identify its
components
Objectives
 Describe the level of
prevention
 Nursing Process
• It is a systematic problem solving approach to individualized
nursing care.
• A systematic way of
– Determining a client health status
– Isolating health concern and problems
– Developing the plans to remediate them
– Initiating actions to implement the plan, and
– Evaluating the adequacy of the plan in promoting wellness
and problem resolution

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 What are the
phases of nursing
process?

•One minute…!!!

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 Nursing  Consists of five phases:
 Community assessment
process  Community diagnosis
 Planning
cont..  Implementation and
 Evaluation

02/09/2025
 Is a systematic and continuous collection
of data about a community’s health status
to discover existing or potential health
problem.

It includes;
Community
assessment
• Collecting pertinent community data
• Organizing and interpreting the
collected data.
• Validation of the data
• Documentation

02/09/2025
 Major Aspects of community Assessment

Physical Health system Economic Safety and

Environment transportation

Policies and Communication Education Recreation

government

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 Brain storming ???

What are the methods of

community assessment ?

02/09/2025
  There are 4 methods
 Survey
Community  Descriptive
epidemiological studies
assessment  Community forum/
methods Town hall meetings
 Focus group

02/09/2025
 Source of community data
1. Primary data:
– It is obtained directly from the community.
– It offers the most accurate and comprehensive
information
2. Secondary data:
– Are data obtained from people who know the
community well and the records they create
– E.g. WHO, MOH, Hospitals, Health centers and Health
posts..
02/09/2025
Breakout
COMMUNITY
DIAGNOSIS

02/09/2025
 Is a real judgment or conclusions
about individual/ family/community
response to actual or potential
problems (ANA).

Community
diagnosis Is a statement that defines the health
problems or health risks of the
community.

02/09/2025
 Types of
community
diagnosis

1. Actual nursing diagnosis:

 Describe a human response to a
health problem that is being
manifested
2. Potential nursing diagnosis:
 Describes human responses to
health conditions that may
develop in a vulnerable
individual, family, or community
02/09/2025
 3.Possible nursing diagnosis:
When not enough evidence
supports the presence of the
Types of problem but the nurse thinks
that it is highly probable and
community wants to collect more
diagnosis.. information.
 E.g. Possible for impaired
skin integrity related to
unknown aetiology

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  It has three parts:-
1. Description of the problem
Types of 2. Identification of etiology
community related to the problem
3. The sign and symptoms that
diagnosis.. characteristics of the problem.

02/09/2025
 • Examples;
 Inadequate ANC r/t inadequate
Types of health service accessibility as
community evidenced by 70% of female
diagnosis.. delivering at hospital with no
antenatal care.

02/09/2025
Planning?

•Breakout

02/09/2025
  The formulation of guidelines that
establish the proposed course of
nursing action in the resolution of
nursing diagnoses.
 It is a process of determining how to
Planning give nursing care in organized,
individualized and goal directed
manner based on community
assessment and diagnosis.

02/09/2025
 1. Setting priorities
2. Setting goals and
objective
Globally written statement
Plannin describing the intended
g change in the client’s
behavior, response, or
involve outcome
s 3. Determining nursing
interventions
4. Recording the plan of
care
02/09/2025
 Breakout
• If you had someone with
the following problems,
which problem would you
need to treat immediately?

• Diarrhea

• Ineffective breathing
pattern

• High risk impaired skin

integrity

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Implementation

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 Implementation..
Is putting the plan into actions

Carrying out the activities delineated in the

plan, either by nurse or other professionals or
the communities.
It involves community , nurses and other
health care providers to meet the pre-
established goal.
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 Evaluation

Is a process of determining Is process of determining whether

whether the planned actions met a goal is met, partially met or not
client needs met.

02/09/2025
 Levels of prevention

Primary prevention
Refers to the prevention of an illness
before it has a chance to occur
Examples:
• Eating well balanced diet
• Regular exercise program
• Maintaining weight
Aims
• Health promotion
• Protection against illness
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 Secondary prevention

Includes the early This allows for prompt It is directed forwards

detection of actual or intervention and health maintenance for
potential health possibly a cure of a patients experiencing
hazards disease or condition. health problems

02/09/2025
 Secondary
prevention..
 Has two sub-levels
a. Early detection of disease
b. Prompt treatment
e.g. Antibiotic treatment of
streptococcal pharyngitis aimed at
preventing rheumatic fever

02/09/2025
 Tertiary Prevention

Aimed at avoiding further deterioration of

an already existing problem

Occurs after a disease caused extensive

damage

Examples -Rehabilitation after stroke

02/09/2025
 Chapter three

HOME HEALTH
SERVICES

This Photo by Unknown author is licensed under CC BY-ND.

  On completion of this of this unit,
students will be able to;
 Define home visiting and home service

Learning  Explain purposes home health service

objective  Describe phases and activities of home

visiting
 List main areas to be assessed during
home visiting
Home health service

 Refers to all the services

and products provided to
clients in their home, to
maintain, restore, or
promote their physical,
mental, & emotional
health.
  To prevent institutionalization
Purposes  To maximize clients level of
of home independence
health  To minimizes the effects of
services existing disabilities through non-
institutional services.
  Increasing elderly population:
 Growing of HIV/AIDS
Factor populations: for better
influencing
understanding of client need at
the
home.
growing of
 Advanced technology: technology
home
health allows all the services at home
services level.
 Raising the cost of health care
 Demands for consumer satisfaction
 Advantage

1. The family is seen in a familiar

atmosphere
2. All family members can be seen &
assessed by one person at one visit
3. The health workers, who know the
neighborhood, are aware of local
problems, priorities, customs,
difficulties, & resources.
 Advantage..
4. High risk families can be identified
& visited as a priority
5. The health workers, can observe,
assess, & act up on obvious and
latent health problems.
Health workers can follow these
problems, at subsequent visit.
6. Much can be assessed at one time.
E.g. personal hygiene, water supply,
sanitation, waste disposed, food
storage
 1. Time consuming
2. Limited equipment can only be
carried to home
3. Appointment might be not kept
Limitations
4. Destruction in the home makes
construction difficult
5. Certain homes may be
geographical not reachable
 Objectives of Home Visiting

 To create close relation ship with

communities and families
 To discover the condition in which
the family lives & to identify how
these conditions affect their health.
 To promote family health by health
education adapted to their levels of
growth and development
 Objectives of Home Visiting
 To monitor the use of skill learned in
health education
 To demonstrate to the family how to
administer health care needed by
others family members.
 To refer to appropriate specialized
services.
 Kinds of Home Care
• Home for the aged. This is a kind
of home health care provided for
the elder greater than 65 years of
age, who need a minimum care
which is often characterized as
“supervised living care.”
 Kinds of Home Care..
• Basic home. It is a home for those
individuals who need assistance in activity
of daily living (ADL) including
administration of medication.
• Skilled home. It is a home for those
individuals with serious health problems
who need 24 hours nursing care or
supervision.

This Photo by Unknown author is licensed under CC BY.

 Principles of home visiting
1. Family members should be included
in all phases of the care process
2. The health workers are guests in the
clients home there fore only make
these interventions that the clients
agrees with
3. Mutual health team – client goal and
intervention may require long
periods to achieve, therefore,
patience is necessary
 Principles of home visiting..

4. Home visiting can be done by health

professionals
5. The health team function
autonomously in the family health
care provision.
6. The health team is a visitor at a
client therefore; the team must not
wait to be motivated.
 Phases and activities of home
visiting
Phase 1. Initiation phase
• Clarify purpose of home visiting
• Share information to family member
 Phases and activities
of home visiting..
Phase 2. Pre-visit phase
 Initiate contact with family
 Determine family willingness
 Schedule home visiting
 Review records
 Phases and activities of home
visiting..

Phase 3. On home phase

 Introduction him/her self
 Warm greeting
 Social interaction (to develop trusting
r/s
 Implement nursing process.
 Phases and activities of home
visiting..

Phase 4. Termination phase

• Review visit with family
• Plan for future visit
 Phases and activities of home
visiting..

Phase 5. Post – visit phase

• Record visit
• Plan for next visit
 Areas to be assessed
during Home visiting
1. General cleanliness
2. Solid waste disposal
3. Latrine
4. Personal hygiene
5. Vaccination of <1yr infants
6. Vaccination of women
7. ANC
 Areas to be assessed
during Home visiting

8. Feeding of children <2 yrs

9. FP
10. Presence of insects / rodents in the
house
11. Presence of sick person in the house
and action taken.
FAMILY ASSESSMENT
 Family assessment

• Is the process of collecting data about the

family structure, and the relationships and
interactions among individual members
• Family assessment requires a significant
amount of time
• Assessment can be done through
interviewing and questioning, observing
interactions between members, and utilizing
a family assessment instrument
• The two ways family assessment are
– Genogram and
– Ecomap.
 Genogram

• Is a format for drawing a family tree

that records information about
family members and their
relationships over a period of time
• Usually three generations
• It is a method of mapping the
structure of the family and to record
the health history of all members
• Reveals information about genetic
and familial diseases.
• Provides a quick overview of family
complexities graphically
Genogram
70 65 48 82
Lung heart car breast
cancer disease accident cancer

62 60
diabetes breast
cancer
 Ecomap
• is a visual representation of a family in
relation to the community
• It demonstrates the nature and quality of
family relationships
• useful in identifying the strengths of family
networks and what resources they have
available during stressful times
Characteristics
of healthy
family
• Facilitative interaction among
members
• Enhancement of individual
development
• Effective structuring of relationship
• Active coping effort
• Healthy environment and lifestyle
• Regular link with the border
community
 Factors Affecting Family Health

• Balance diet
• Personal and environmental sanitation
• Economic status
 CHAPTER FOUR

SCHOOL AND PRISON HEALTH

SERVICE

02/09/2025
Objectives
• At the end of this lesson the students will be able to:
Mention goal and objectives of SHS
Describe major component of SHS
Analyzes the programs of SHS
List common health problems in school
List the main purposes of PHS
 Explain the common health problems among prisoners
List the responsibilities of community health nurse in
PHS
Identify contributing factors to the spread of disease
among prisoners.
02/09/2025
1. School Health Service (SHS)
• School health is that phase of community health
service that promotes the well-being of the child
and his education for healthful living.
• A school health program refers to all activities
that contribute to the initiation, maintenance and
improvement of the health of school children
and personnel.
• This program includes health learning, health
practice during school hours and health
services.
02/09/2025
1. School health service (SHS)…
• Goal
– To support the educational process by helping to
keep children healthy, by teaching students &
teachers preventive health measures.

02/09/2025
1. School health service (SHS)…
• Objectives of SHS
Promote health and develop concern of there own heath.
Detect disease and deviation from normal heath at an
early stage and arrange for promote, treatment and
follow up.
Prevent communicable disease and non communicable
disease.
Provide a healthy and safe environment in all round for
development of child physical, mental, social, emotional
and moral well-being.
Help children to make the best use of educational
facilities….
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Major components of SHS

1. Health service
2. Environmental protection and control
3. Health education

02/09/2025
Major components of SHS…

1. Health service
Health promotion
Health screening
Surveillance of immunization status
Counseling
Minimum routine examination
Case finding for early detection of health problems
 Treatment of minor ailments
Case managements
Simple first Aid and Accident control like fall injury
Care of pupils with special health needs
02/09/2025
Major components of SHS…

2. Environmental protection and control

Construction of toilets and waste disposal
 Use of toilet
 Water supply
 Proper waste disposal
Cleanliness of the compound

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Major components of SHS…

3. Health education
 Teaching about first aids

 Teaching about personal hygiene

 Teaching about environmental sanitation
 RH education
 Nutrition education

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 Common health problems among
school children

Accident and injuries

 Communicable diseases

 Behavioral problems

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Role of community nurse in school Health program

As a member of school heath team and participate

in planning and coordinating heath program.
The nurse is the school health consultant
Control the development and maintenance of a safe
and healthful environment.
Demonstrate technique for teacher’s heath
inspection and procedures.
02/09/2025
Role of community nurse in school Health program
Assist in screening physical, mental and other
special examination of children in school.
Assist in communicable disease control.
 Help to set up facilities and demonstrate first aid
procedures.
Conduct health program
Assist in school medical examination and follow up

02/09/2025
2. PRISON HEALTH SERVICES (PHS)

• Prison is a place where individuals are kept in

custody for a certain period of time for any
wrong deeds they commit knowingly on
unknowingly having political, social and
economic nature.

02/09/2025
Main Purpose of Prison Health Service (PHS)
To solve the immediate health problems of the
prisoner both physical and mental.
 Prisoners do have a right to get health service
To prevent transmission of diseases
To teach prisoners the basics of health and change
their behavior.
To prevent the spread of infections and especially
chronic ones like TB, Leprosy from the prisoner to
the community
 To train the prisoners as first aiders.
02/09/2025
Common Health Problems in the Prison

Psychological health problem

 Problem of food poisoning (dysentery)
 Febrile illness like relapsing fever, typhoid, typhus
 Intestinal parasites
Chronic diseased like TB
Skin infections

02/09/2025
Common Health Problems in the Prison…

Malnutrition
Gastroenteritis
 Urinary tract infection
Arthralgia
Homosexuality
 Sexually transmissible diseases (STD’s)

02/09/2025
Major stressors specific to the condition are:
Loss such as loss of job, freedom, family contacts,
dignity, food choices
Privacy and sexual activities.
Threats such as the threats of homosexual, physical
discomfort, sleeping, eating and other personal
functions.
 Drugs or alcoholic withdrawal, feelings of
infidelity (lack of religion, belief)

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Sources of Diseases

 Prisoners who join the prison with diseases

 The prison itself

02/09/2025
 Factors responsible for the origin and
spread of diseases in prisons
 Poor housing
 Inadequate ventilation
 Overcrowding
 Malnutrition
 Poor personal hygiene
 Poor environmental hygiene
 Poor waste disposal
 Prolonged stay in prison
 Lack of knowledge…
02/09/2025
Responsibilities of the PHN during PHS

Work with prison administrators and the prisoners

 Organize prisoners and form health committee in
the prison
 Identify health and health related problems of the
prisoners using a developed checklist.
Make a plan and encourage them to solve the
identified problem
 Identify the resources of the prison.
 Work with other health professionals

02/09/2025
Responsibilities…

Work to solve the identified problems

 Screening of the prisoners
 Treating the sick
 Health education
 Delousing of the prisoners
 Waste disposal system
 Make a follow up

02/09/2025
 CHAPTER FIVE
ENVIRONMENTAL HEALTH

119
 Session objective
 At the end of this chapter, the students will be
able to:-

Define environmental health

Explain components of environmental health

Describe models of environmental health

intervention

1
2
0
One
minute…
!!!
Environmental
health..???

3
 Environmental health
• Is referred as all external factors to a
person
that influence human health.

• Is a practice of assessing,
correcting, controlling, and
preventing those factors which
have a deleterious effect on the
physical, mental, and social
wellbeing
3/30/2024 of present and future 12
2
 Components of
Environmental Health
 Personal hygiene: Hygiene of human
body and clothing.
 Water supply: Adequacy, safety, quality
of water for
domestic, drinking and recreational
use.
 Human waste disposal: Proper excreta
disposal and liquid waste management.
 Solid waste management: Proper
application of storage, collection,
disposal
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3
 Components of
Environmental Health..
 Vector control: Control of rodents and
arthropods that transmit disease
 Food hygiene: Food safety and
wholesomeness in its production, storage,
preparation, distribution and sale, until
consumption.
 Healthful housing: Physiological needs,
protection against disease and accidents,
psychological and social comforts in
residential and recreational areas
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 Components of
Environmental
Health..
 Institutional health: Communal hygiene and

sanitation in schools, prisons, health facilities,

refugee camps, public offices ,religious areas
and settlement areas.
 Air pollution: Sources, characteristics,

impact and mitigation both at in-door and

out- door .
 Occupational health: Hygiene and safety
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 Components of Environmental Health..

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  According to the Federal
Ministry of Health, more than
80% of communicable
diseases in Ethiopia are
Environmental
health believed to be preventable
Intervention using environmental health
Models
interventions.
 Generally, there are
two
A. intervention
Clinical intervention
model
models:
B. Public health model
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 Environmental health
Intervention Models..
Clinical intervention model:
• Looks at treating the sick person
Public health model
• Looks at how to stop people
getting sick in the first place by
providing a healthy environment.
• Concentrates on the maintenance of
health through education and keeping
the environment safe.

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  Improving human health and

protecting it from environmental

 hazards.
Working in coordination with
Role of Nurse in local authority, and higher
Environmental levels of administration.
Health
 Designing and developing plans of
action
for environmental health
 Initiating and implementing
hygiene,
sanitation and environmental
programs.
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  Contributing in policy and
guide line
development and advocacy
 Engage in research activities
Role of Nurse in
related to environmental
Environmental
Health health
Communicating risk
information with individuals and

communities
Assessing environmental
health risks in various settings.

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