COMMUNITY HEALTH NURSING-UNIT-1 (Community Health Nursing Unit-1)

(Part-1)

💚a) Definitions: Community,
Community health, community
health nursing
💚b) Concept of health and disease,
dimensions and indicators of health,
Health determinants
💚c) History & development of
Community Health in India& its
present concept.
💚d) Primary health care, Millennium
Development Goals
💚e) Promotion and maintenance of
Health

 INTRODUCTION OF COMMUNITY HEALTH & COMMUNITY HEALTH NURSING( Introduction of Community Health and Community Health Nursing):

Community is one of the most useful means to improve people’s health services or provide care. Because information about the factors affecting health is available from the community itself, the health status of the people can be known and where the access to health care services is not sufficient, it can be provided by community health, community health services, nurses and other health workers.

HEALTH – Health (Health) :

In 1948, the W.H.O (World Health Organization)  gave the definition of Health, which is as follows is.

” Health is a state of complete physical, mental, social and spiritual well-being and the absence of disease or infirmity. “

As per WHO

“Health is a state or complete physical, mental, social and spiritual well being and not merely an absence of disease or infirmity.”

However, health is a constantly changing process, making it difficult to maintain this goal. Health is common in most cultures. In fact, every community has its own concept of health, health is a fundamental and basic right of every individual which is also included in the Constitution.

♦ Community

Define Community :

(1) A community can be described as a group of persons who interact socially because of shared goals and interests (McEwen & Nies, 2019).

A community can be described as a group of individuals who interact socially because of shared goals and interests (McEwen & Nies, 2019).

(2)  All the people who live in a particular place, area, etc. when considered as a group.

When all the people living in a particular place, area, etc. are considered as a group.

(3)  A group of people with a common characteristic or interest living together within a larger society.

A group of people with a common characteristic or interest living together within a larger society

Thus, a community is a society in which a large group of people live in a specific geographical area and meet their basic needs. Such a group includes women, men, youth, children, etc. and they have different attitudes, beliefs and religions. Such a group is called a community.

♦ Community Health (Community Health) :

Community health is defined as the group of individuals living in a society who aims to maintain, protect and improve the health of the people. ” Community health is the group of individuals living in a society who aim to maintain, protect and improve the health of the people. “

Community health provides preventive, promotional, curative and rehabilitation services

💚 Define community health (Define – Community Health ) :

“Community health is the focus of the health of the entire population, where there are populations with similar health concerns and characteristics. Overall, community health means the health status of the people who are members of that community, their health and the care available in the community for problems that affect their health. Community health is an organized form of treatment, prevention or provision of preventive and health-related services”.

💚 Define community health nursing (Define – Community Health Nursing ) :

COMMUNITY HEALTH NURSING:

“Community health nursing is a synthesis of public health nursing practices applied to the promotion and preservation of the health of the population. Community health nursing means providing health services to the sick and healthy people in the community. Community health nursing is guided by the assessment and determination of the health status of the population in the community. “

or

“Community health nursing “It is a field of nursing that combines nursing practice with primary health care and public health nursing.”

or

A specialized field of nursing that combines the skills of nursing, public health and social assistance and some phases of work as part of a total public health program to promote health, improve the social and physical environment, and rehabilitate illness and disability.

COMMUNITY HEALTH NURSING:

This is a vast area of ​​nursing practice and has a very close relationship with human well being. The aim of this is to maintain community health by using defined public health measures. In which there is no limitation to provide general and comprehensive treatment for a particular person or group of diseases, it has to be provided continuously and it is a continuous process.

In this, the responsibility of providing services to the entire community lies with nurses, so nursing has developed towards providing health services to everyone in the community, including individual families, specific groups such as children, industrial workers, in which nursing or family services can be provided at their homes, schools or workplaces. In this way, one has to understand one’s responsibility and work. For example. To strengthen the polio immunization program, political support should be sought and health education should be provided on a large scale and polio vaccination should be done to children.

The services provided by the nursing profession in the community are called Community Health Nursing.In 1956,I.N.C. introduced this subject in nursing and trained general nursing students and informed them about nursing services. Nursing services are planned keeping in mind the aim of ensuring that the necessary health services are available to the people in the community in sufficient quantities.

💚 To enlist scope of community health nursing. (Enlist the scope of Community Health Nursing)

Scope of Community health Nursing Nursing):

1. Education:
   Principal, Vice Principal,
   Professor,
   Leader
2. Practice (Practice):
   School Health Nurse, Occupational Health Nurse,
   Home Nursing MCH and Family Planning Geriatric Nursing,
   Rehabilitation Nursing Health Education
   Collaborator Manager
3. Research:
   Research Coordinator Data Collector
   Analyzer
4. Administration:
   District Public Health Nursing, School Health Nurse
   Community Health Nurse

💚 To explain nurses responsibility in community health nursing.

• To encourage the adoption of health beliefs, attitudes and behaviours that contribute to the overall health of the populationTo support health policy changes for the modification of the physical and social environment.
• To encourage community, family and individual responsibility for health.To initiate and participate in health promotion activities.
• To reduce the risk of infectious disease outbreaks. To apply knowledge of disease processes and epidemiological principles.
• Use appropriate technology for reporting and follow-up.Help individuals and families adopt health behaviors.
• Encourage behavior modification.Work with individuals and families to maintain a safe environment.
• Use health surveillance data and knowledge in daily work with friends. To collect and store data.
• To contribute to population health assessment.

💚 To describe concept of health

Concept of Health:

In all communities, the concept of health is a part of their culture. The very old meaning of health is “the absence of disease”. The concept of health is not understood in the same way by different professional groups. Therefore, confusion develops about the concept of health. Therefore, different concepts about health are given below.

1. Biomedical Concept
2. Ecological Concept
3. Psychosocial concept
4. Holistic concept
5. Concept of Well Being Being)

💚 To describe various changing concept of health (Describe various changing concept of health.)

1. Biomedical Concept

• According to this concept, health means “absence of disease”. If a person is free from disease, then he is considered a healthy person.
  From the medical profession, the human body is a machine.
• Disease means The consequence of the machine is that it breaks down and the only job of the doctor is to repair the machine.
• This concept has reduced the role of the environment in social, psychological and cultural determinants.
• This concept does not address major health problems such as malnutrition, accidental drug abuse, mental disease, chronic diseases, environmental pollution, population explosion, etc.

2. Ecological Concept

• This concept is the dynamic equilibrium between the human and its environment and diseases are the imbalance of the human organism with the environment.
• This concept shows the issue between imperfect men and imperfect environment. is.
• Good adaptation of a person with the environment gives a long life and good health care services give a life with good qualities.

3. Psychosocial Concept

This concept according to health is not only a biomedical phenomenon but also a social, psychological, cultural, economic and political phenomenon of the people concerned. (Political) Factors have an influence.

Health is a Biological and Social Phenomena.

4. Holistic Concept

• Holistic Concept is a synthesis of all concepts.
• Health is a Multi Dimensional Concept therefore it recognizes the strength of social, economic and political and environmental influences on health.
• It describes a multidimensional process that Health means a Healthy Family in a Healthy Body in a Healthy Mind and a Healthy Environment.(Sound Mind,Sound Body Sound Family in Sound Environment)
• This concept suggests that all fields of society have an impact on health. Which includes Agriculture, Animal Husbandry, Food, Industry, Education, Housing, Public Works and other fields.

5. Concept of Well Being

It indicates an improvement in the standard and quality of life. It refers to the standard of living which includes health education, food, utilization, clothes, housing, entertainments along with human rights and social safety.

Quality of life:

It is related to the individual feelings of Satisfaction, Happiness and Sadness about numerous problems of life, hence increasing the standard and quality of life to achieve a feeling of Wellbeing.

💚 WHO -definition

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

• Other definition:
  A state of being healthy in body, mind, or spirit, especially free from physical disease or pain. (Webster).
• The new philosophy of health is as follows.
  Health is a fundamental human right.
• Health is essential for a productive life.
  Health is intersectoral.
• Health is an integral part of development.
  Health is central to the concept of quality of life.
• Health involves individual, state and international responsibility.
  Health and its maintenance are major social investments. Health is a universal social goal.

💚 Concept of well being:

• Well being is an important word used in the definition of health. Through which health can be managed. Which includes Standard of living, level of life.
• Standard of living  means the standard of living of a person can be determined by per capita income. In which every thing like income, occupation, housing standard, level of health, cars, recreation, services etc. is included.
• Level of Living i.e. education, occupation, working and housing condition, Social Security, clothing are included.
• All the above mentioned indicators are important components for well being.
• Quality of life ‘s indicators’ PQL I P P= means Physical Q = means quality L = means Life I = means Index,
• Suggested by WHO This is an indicator, through which three events are linked.

(1) I.MR = Infant Mortality Rate

(2) Life = Acceptance

(3) Literacy = Literacy

💚 Factors affecting health maintenance (Factors affecting health maintenance):

(1) Balance diet

(2) Sef drinking water

(3) Good Housing

(4) Proper disposal of waste

(5) Socio economic condition

(6) Environment

(7) Heredity (Inheritance)

(8) Small Family

(9) Occupation

(10) Health and Family Welfare Services

(11) Life Style

💚 Disease (disease-rog)

WHO has defined health but not disease because…..
It has many shades from symptomatic to dangerous manifest disease.

• Some diseases are acute and some are chronic.
• Some diseases have a carrier state.
• In some cases, one organism causes more than one disease. (Streptococcus).
• And in some cases, the same disease can be caused by more than one organism. (Diarrhea)
• Some diseases last for a short time and some for a long time.
• Some diseases have vague borderline symptoms.
• The end point of the disease is variable, such as disability or death of the host.
• The term “disease” means “without ease” when something is wrong with the body’s function.

💚 To define the disease

According to Webster’s:

A condition in which the health of the body is impaired. A change in the human body that interferes with the performance of important work, from a state of health.

According to the Oxford English Dictionary:

A condition of the body or of some part or organ of the body in which its function is impaired or distorted.

From an ecological point of view (Ecological point of view):

The maladjustment of the human organism with the environment.

Other definition..

Disease is the opposite of health, i.e. any deviation from the normal function or state of complete physical or mental health.

Disease means when a disease organism enters the body and succeeds in causing disease, it is called disease When the body is disturbed, it is called illness.

There are different theories for the disease concept:

(1) Super Natural Theory (Super Natural Theory) :

This theory talks about natural powers. In earlier times, diseases believed to be caused by divine power, such as smallpox, chickenpox, leprosy, were believed to be caused by sins of the previous time.

(2) Germ Theory:

It is believed that some type of germ causes disease. .This theory was presented by scientists named Louis Pasteur in 1895, in which he stated that disease occurs due to the entry of any bacteria or microorganism into the body.

(3) Theory of Multiple Cause (Theory of Multiple Causes):

In this, more than one reason is responsible for the occurrence of the disease. For example, if someone has tuberculosis, his financial status, etc. are responsible for it. In this way, more than one reason is responsible.

💚 To enlist dimension of health.

dimension of health:

1. Physical Dimension
2. Mental Dimension
3. Social Dimension
4. Spiritual Dimension
5. Emotional Dimension
6. Vocational Dimension
7. Other Dimension

💚 To describe various dimensions of health

1.Physical Dimension:

• Full body function is a sign of good physical health.
• Good complexion
• Healthy skin
• Bright eyes
• Shiny hair and no excess fat along the body
• A sweet taste
• Good appetite
• Good sleep
• Regular bowel and bladder function
• Easy and coordinated body movements
• All vitals are within normal range.

2.Mental Dimension:

• It is the ability to respond to life’s diverse experiences with flexibility and a sense of purpose.
• A good sign of a mentally healthy person is
  Free from internal conflict, well-adjusted
  Accepting criticism and not easily upset. Inventive for self-identification
  Strong sense for self-esteem He knows himself (necessary problems and goals)
  Self-control Faces problems well and tries to solve them intelligently.

3.Social Dimension:

• A person’s social skill level is the ability to perform social functions and see themselves as members of society.

4. Spiritual Dimension:

• It is related to the soul and feelings of man. It is a belief in the universal aspect of the universe.
• Which resolves both internal and external conflicts.
• Helps individuals find the meaning and purpose of life.
• Provides a philosophy of life. Direction, ethics, values ​​and principles of living a high life.
• Keeps strength and confidence to face real life situations.

5.Emotional Dimension:

This feeling is related.

6.Vocational Dimension:

• This is a part of human existence.
• It plays a role in promoting both physical and mental health.
• It provides satisfaction and self-esteem.

7. Other Dimension:

• Philosophical Dimension,
• Cultural Dimension,
• Socioeconomic Dimension,
• Educational Dimension,
• Nutritional Dimension Dimension),
• Cultural Dimension,
• Preventive Dimension etc…

To know importance of indicator of health (indicate the importance of indicator of health):

• Health is multidimensional. Dimensions are affected by a number of factors. Health is very complex, so many indicators are used to measure health.
  
• Measure the health status of a community.
• Compare the health status of two communities or two nations.
  
• Distribute health resources to assess health care needs.
  
• Evaluate and monitor health programs.
• Measure the extent to which the objectives and targets of the program are achieved.

💚 To enlist the health indicator (Enlist the health indicator.)
Mortality indicator Morbidity indicator

• Disability indicator (Disability Indicator)
• Nutritional Status Indicator
  
• Health care Delivery Indicator
• Social and mental health indicator
  
• Life Expectancy At Birth
• Environmental Indicator Indicator)
  Utilization Rate other Indicators

💚 To describe the health indicator.

1.Mortality Indicator (Mortality Indicatore)
Crude Death Rate, Infant Mortality Rate,
Maternal Mortality Rate, Child Mortality Rate,
Under 5 Mortality Rate, Disease Specific Mortality.

2. Morbidity Indicator
Includes the incidence and prevalence of communicable and non-communicable diseases in the community.

3. Disability Indicator
Incidence and prevalence of cases of inability to perform a full range of activities due to illness, blindness, deafness, mental and social handicap.

4. Nutritional Status Indicator (Nutritional Status Indicatore)
Measurement of mid arm circumference, height, weight of under 5.
Measurement of weight height of school children. Prevalence of low birth weight (<2.5 kg)

5. Health care delivery indicator
Doctor population ratio, doctor nurse ratio
Population bed ratio, population ratio at sub-center primary health center and community health center

6. Social and Mental Health Indicator
Incidence of alcohol and drug abuse and Prevalence, Child Abuse, Neglected Women, Abuse, Child Crime, Suicide, Road Traffic Accidents

7. Life expectancy at birth Increase or decrease in expected age influences the health status of people.

8. Environmental Indicator
Air Pollution, Water Pollution, Radiation Solid Waste
Noise Food and Exposure to toxic substances in drinks

9.Utilization Services:
Which include health services used by people
Infant immunization, bed occupancy rate,
Bed turnover ratio,Etc.

10.Other Indicators:
Health Policy Indicators, Socio Economic Indicators,
Basic Needs and Indicators All Indicator for health etc.

💚 To define health & health determinants(Health and health determinants):

Determinants of health:

That is, Personal, Social, Economic and Environmental Factors that influence health status.

💚 To enlist important determinants of health (list the necessary determinants of health)

• Environmental determinants
• Political System
• Biological determinants
• Behavioral determinants
• Socioeconomic determinants
• Healthcare delivery system determinants

💚 To explain health determinants

▲ Environmental Determinants:
The environment has a direct impact on the health of individuals, families, and communities. Both internal and external factors of the environment influence our health. Air, water, noise, radiation, housing, waste management, etc. all affect health status and quality of life.

▲ Political system determinants:
The political system has a major impact on the social environment in which we live. No health program can be implemented properly without strong political.
Social, political, environment, economic, development, law and order, regulation of public health and good level of performance.

▲ Biological Determinants:
Hereditary and genetic determinants have an impact on physical and mental retardation, metabolic disorders, chromosomal abnormalities, etc. which are of genetic origin. It is the responsibility of the nurse to provide proper genetic counseling to people who are at risk of being genetically impaired.

▲ Behavioral determinants:
Health is a mirror of a person’s lifestyle. Because defects and bad habits have an adverse effect on a person’s health. Community health nurses should be aware of the patient’s or individual’s behavior patterns to improve their health status. Risk-taking behavior based on carelessness and misconceptions affects people’s health.

▲ Socioeconomic determinants:
Socioeconomic status has a major impact on the health status of any country. Education, economy, occupational opportunities, housing, nutritional level of per capita income etc. determine the health care system and health resources.

▲ Health care delivery system determinants:
Health care delivery system plays a major role in the field of health. Tertiary care has more importance in equal distribution of facilities, availability of health personnel in rural areas, inadequate referral services, lack of resources etc. determine the health status of an individual, family and community.

💚 Level of Health Care:

Health services are generally organized at three levels. Each is supported by a higher level to which patients can be referred. Which level is as follows.

(1) Primary health care.

(2) Secondary health care.

(3) Tertiary health care.

(1) Primary health care :

This is the first level between the patient & health care system where essential health care is provided. Most of the health problems are solved at this level. This level is closest to the people. This level is provided by PHC and its sub-centers. (cold, fever)

(2) Secondary health care:

This Care is provided to patients with more complex problems at this level. Essential curative care is provided at this level, and is provided by community health centers. This level serves as the first referral unit in the health system. Whata :- 1..c, wai, gravely situated)

 (3) Tertiary health care:

Super specialist care is provided at this level. This care is provided by regional or central level institutions. These institutions not only provide highly specialist care, but also provide care and teaching by trained and specialized staff. This level is solved from the primary level if there are any questions.

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