SCOPE OF COMMUNITY HEALTH NURSING

The scope of community health nursing is wide and it is described below:

1. Home care

A large number of clients can be adequately cared for at home by extending certain hospital services. The
hospital takes up the responsibility in coordinating these services by providing personnel or equipment.
The nurse practitioners in USA replace physicians in providing primary are. In order to carry out this
responsibility, the nurse requires certain additional skills like history taking and recognition of physical
signs for proper treatment.

2. Nursing homes

The nursing homes are privately run. They have better medical care facilities than the government
hospitals because they charge more fees. The nursing component in nursing homes is generally well
catered for.

3. MCH and Family planning

The public health nurse plays a major role in the MCH and family planning services. It comprises
antenatal, postnatal and child care services. During pregnancy or illness, people listen to the suggestions
and advices for their welfare. Since nurses are directly in touch with patients, they should be trained to
give proper and correct advice.

4. School Health Nursing

The School Health Nurse renders services to promote and protect the health of the school children. She
provides her services in the areas like, health education, first-aid, early education of
diseases ,immunization, dental health, school sanitation maintenance of health records, follow up and
referral services.

5. Community health nursing

Community health nursing includes nursing care of the family in sickness and health. The Community
health nurses must be able to:"

1."To provide primary health care in the community

2. To conduct routine antenatal and postnatal visits and to conduct deliveries when required

3. To carry out immunization

4. To promote the health of the children by conducting under five clinics and referring cases who
requires medical care

5. To assess the social, environmental and nutritional needs of the help of social workers to meet these
needs

6. Industrial Nursing Services

Nurses are employed in industries. There is provision for appointment of medical and nursing staff in
factories where 500 or more workers are employed. The broad areas of nursing in this are: pre-
employment and periodic health check-up, care of sick, first aid, industrial sanitation and safety,
organizations of service o women and children, rehabilitation of the ill and disabled workers and
administration.

7. Domiciliary Nursing Services

The areas where domiciliary nursing is practiced in this country are maternity services, health supervision
disease prevention services and services for illness and accidents. The scope is limitless for organizing
domiciliary visits.

8. Mental health nursing services

Many developing countries have mental health services today. These services include early diagnosis and
treatment, rehabilitation, psychotherapy, use of modern psychotropic drugs and aftercare services.

9. Rehabilitation centers

Rehabilitation means restoration of all treated cases to the highest level of functional ability. Nursing is an
important component in the rehabilitation of the disabled.

10. Geriatric nursing services

The number of old people is increasing in the world today. The need of the old is different and they
need more care than the younger age groups. In many countries the old people are visited by the nurses
and other health worker"

 Concept of health
 Biomedical concept
 Psychological concept
 Ecological concept
 Holistic concept

Concept of disease?
A disease is generally defined as any harmful deviation from the normal structural or functional state of
an organism, typically associated with specific signs and symptoms. This deviation disrupts the delicate
physiological balance, or homeostasis, of the organism.

There are different types of diseases depending on their etiology, such as infectious diseases, chronic
conditions, genetic disorders, and lifestyle-associated diseases.

Infectious diseases are caused by pathogenic microorganisms such as viruses, bacteria, fungi, or
protozoa.These diseases can spread from person to person through direct or indirect contact. Some

Chronic diseases are long-lasting conditions that typically progress slowly. 8 They include
noncommunicable diseases such as cardiovascular and chronic respiratory diseases, cancers, and
diabetes.8 These diseases are often influenced by a combination of genetic, physiological, lifestyle, and
environmental factors.8 Some infectious agents can also cause chronic conditions.9

Genetic diseases can be classified into single-gene disorders, chromosomal disorders, and multifactorial
disorders, such as cystic fibrosis, Down syndrome, and multiple sclerosis.6
Lifestyle-related diseases are associated with behavioral risk factors such as poor diet, lack of physical
activity, smoking, and excessive alcohol consumption.6 Common lifestyle-related diseases include
obesity, type 2 diabetes, and cardiovascular diseases.6

Notably, not only lifestyle-related factors affect the development of diseases; environmental factors
(pollutants found in the air or water, mold, pesticides, food choices, or grooming products) could change
the course of a disease.

Key components of disease

Understanding the key components of disease is vital for effective diagnosis, treatment, and
prevention.Etiology, the first component, describes disease causes, which can be biological,
environmental, or genetic.16 Recognizing these causes is essential for appropriate treatments and
preventive measures.

Pathogenesis, the second component, involves the sequence of events leading to disease development,
focusing on interactions between genetic predispositions, environmental influences, and immune
responses.

Symptoms vary widely but often include pain, dysfunction, and distress and require early recognition for
timely diagnosis and treatment. Diagnosis methods include physical exams, lab tests, imaging, and
genetic testing.

Treatment strategies vary and may include medications, surgery, lifestyle changes, and long-term
management for chronic diseases like diabetes and hypertension.

Dimensions of Health;

At Saint Joseph’s, we embrace the Jesuit ideal of “care for the whole person.” This means that we
recognize you are a multidimensional individual and all aspects of your life are equally worthy of care,
development and attention. To help support you as a “whole person,” we embrace nine dimensions of
well-being:

 Physical
 Emotional
 Intellectual
 Occupational
 Social
 Cultural
 Environmental
 Spiritual
 Financial

Each dimension affects the others and contributes to our health, happiness and quality of life. As we strive
to care for ourselves and others as a “whole person,” focusing on and understanding the nine dimensions
of well-being is essential.

Physical
Physical well-being involves all of the activities necessary to keep your body in top condition. It includes
participating in regular physical activity, eating a healthy diet, getting adequate sleep, making positive
choices and avoiding harmful habits.

Emotional

Emotional well-being involves the awareness, understanding and acceptance of a wide range of emotions
in ourselves and others. Emotional well-being recognizes that challenge, stress and conflict are
unavoidable, yet we can meet these challenges with optimism, and learn and grow from them.

Intellectual

Intellectual well-being encourages the pursuit of creative and mentally stimulating activities, whether
formally in the classroom or informally, as you explore the world and pursue your personal interests.
Intellectual well-being recognizes the importance of cultivating a love for learning and taking a lifelong
interest in expanding one's knowledge and developing new skills.

Occupational

Occupational well-being recognizes the personal satisfaction and life enrichment that we receive through
meaningful work. It involves exploring career options and choosing a career path that fuels your passion
and provides you with a sense of purpose.

Social

Social well-being recognizes the importance of cultivating healthy, nurturing, supportive relationships,
and fostering connection and a sense of belonging in your community. Maintaining your social well-being
involves becoming actively involved on campus and working to build a community that is friendly,
supportive and inclusive.

Cultural

Cultural well-being recognizes the importance of feeling connected to our cultural heritage and defining
our identity and place in our community and in the world. Cultural well-being also involves learning
about and appreciating the diversity of cultures in our community and celebrating the richness that this
diversity brings to our experiences.

Environmental

Environmental well-being recognizes the innate connection between ourselves and our environment, and
encourages us to live in a manner that is appreciative of nature and respectful of the Earth. Environmental
well-being may include spending time outdoors connecting with nature, developing environmentally
friendly habits, as well as caring for our personal spaces.
 Spiritual

Spiritual well-being recognizes our search for meaning in purpose and a connection to something bigger
than ourselves. For some, this includes religious or spiritual practices, while for others it consists of
contemplating and discovering personal meaning and values.

Financial

Financial well-being involves cultivating a positive relationship with money and developing the
knowledge and skills necessary to make sound financial decisions. It includes managing day-to-day
expenses while also working toward long-term savings goals and aligning budgeting decisions with
personal values and priorities.

The determinants of health include:

 the social and economic environment,

 the physical environment, and
 the person’s individual characteristics and behaviours.

The context of people’s lives determine their health, and so blaming individuals for having poor health or
crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control
many of the determinants of health. These determinants—or things that make people healthy or not—
include the above factors, and many others:

 Income and social status - higher income and social status are linked to better health. The greater
the gap between the richest and poorest people, the greater the differences in health.
 Education – low education levels are linked with poor health, more stress and lower self-
confidence.
 Physical environment – safe water and clean air, healthy workplaces, safe houses, communities
and roads all contribute to good health. Employment and working conditions – people in
employment are healthier, particularly those who have more control over their working
conditions
 Social support networks – greater support from families, friends and communities is linked to
better health. Culture - customs and traditions, and the beliefs of the family and community all
affect health.
 Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of
developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping
active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
 Health services - access and use of services that prevent and treat disease influences health
 Gender - Men and women suffer from different types of diseases at different ages.

Other Determinants
1. Individual Factors: These include personal behaviors and choices, such as diet, exercise, and substance
use. Genetic factors and individual characteristics also play a role in determining health outcomes.
2. Social and Economic Factors: Socioeconomic status, education, employment, and income level
influence health outcomes. Access to healthcare, social support networks, and community resources also
play a significant role.
3. Physical Environment: The physical environment, including housing conditions, access to clean water
and sanitation, and exposure to pollutants, can impact health.
4. Healthcare System: The availability, accessibility, and quality of healthcare services are crucial
determinants of good health. Factors such as healthcare infrastructure, health insurance coverage, and
healthcare professionals' expertise influence health outcomes.
5. Policy and Governance: Government policies and regulations related to healthcare, education,
employment, and social welfare have a significant impact on population health.
It is important to recognize that these dimensions and determinants of good health are interconnected and
influence each other. Addressing these factors holistically can contribute to improving overall health and
well-being.

Natural History of Disease

Definition ;
The natural history of disease is the course a disease takes in individual people from
its pathological onset ("inception") until its resolution (either through complete recovery or eventual
death). The inception of a disease is not a firmly defined concept. The natural history of a disease is
sometimes said to start at the moment of exposure to causal agentsKnowledge of the natural history of
disease ranks alongside causal understanding in importance for disease prevention and control. Natural
history of disease is one of the major elements of descriptive epidemiology
The subclinical (pre-symptomatic) and clinical (symptomatic) evolution of disease is the natural
progression of a disease without any medical intervention. It constitutes the course of biological events
that occurs during the development of the origin of the diseases (etiologies) to its outcome, whether that
be recovery, chronicity, or death.
Phases of disease
Pre-pathogenic period
In the pre-pathogenic period, the disease originates, but the patient does not yet present clinical symptoms
or changes in his/her cells, tissues, or organs. This phase is defined by the host conditions, the disease
agent (such as microorganisms and pathogens), and the environment

Pathogenic period
The pathogenic period is the phase in which there are changes in the patient's cells, tissues, or organs, but
the patient still does not notice any symptoms or signs of disease. This is a subclinical phase that can be
subdivided into two more phases:

Incubation period vs. latency period

In transmissible diseases (like the flu), we refer to this phase as the incubation period because it's the time
in which microorganisms are multiplying and producing toxins. It's fast-evolving and can last hours to
days

However, in degenerative and chronic diseases (like osteoarthritis and dementia), we refer to this phase as
the latency period because it has a very slow evolution that can last months to years.

Clinical period
The clinical period is when the patient finally presents clinical signs and symptoms. That is: when the
disease is clinically expressed and the affected seek health care. During this phase, if the pathological
process keeps evolving spontaneously without medical intervention, it will end in one of three ways:
recovery, disability, or death. Additionally, this phase can be broken down into three different periods:

1. Prodromal: the first signs or symptoms appear, which indicates the clinical start of the disease
2. Clinical: specific signs and symptoms appear, which allows the doctor to not only identify the
disease but also determine the appropriate treatment in hopes of curing the patient or at least
preventing long-term damages.
3. Resolution: the final phase in which the disease disappears, becomes chronic, or leads to death.

Health problems in india

Poor health is a major problem in India which contributes to the many health problems. Following are
three causes of poor health in India.

· High Birth Rate and Rapid Growth of Population

· Malnutrition

· Unsanitary Conditions and Housing

Health problems are classified in to

· Communicable disease

· Non-communicable diseases

· Nutritional Problems

· Environmental Sanitation problems

· Medical Care Problems

· Population Problems

1. Communicable Diseases Problem:

Communicable diseases continue to be the major problem in India, but many of them are controlled in
developed countries such as USA. It is estimated that nearly 54% of deaths in India are due to
communicable diseases.

Common communicable diseases found in India are

I. Malaria

Till today Malaria is a major health problem in India which is a big challenge to eliminate and control.
Malaria is transmitted by the bites of infected female anopheles mosquito(Parasite). If not treated properly
which can become life threatening. The National Malaria Control and Eradication Programmes launched
in 1953 and 1958 respectively. During 2016 1.09 millon cases were reported and about 331 deaths were
registered due to malaria. Whereas the scenario in 2017 was about 0.84 millon cases were reported and
about 194 deaths were registered dut to malaria
II. Tuberculosis

Tuberculosis is a leading communicable disease in India accounting for one-fifth of the world incidence.
Pulmonary Tuberculosis is contagious bacterial infection caused by

Mycobacterium Tubercle, which mainly affects lung. According to the Global TB report 2017 the
estimated incidence of TB in India was approximately 28,00,000 accounting for about a quarter of the
world’s TB cases. Every year about 1.2 million persons develop Tuberculosis of which 0.64 million cases
are sputum positive which is highly infectious and 0.32 million people die due to TB. The emergence of
HIV-TB co-infection and multidrug resistant TB has become a challenge today.

III. Diarrheal Diseases

Diarrheal diseases constitute one of the major causes of sickness and death specially in children below 5
years of age accounting for approximately 8% of all deaths among children below 5 years worldwide in
2016. Outbreaks of diarrheal diseases including cholera continue to occurs due to the poor environmental
conditions. Diarrheal diseases are caused by viral, bacterial and parasitic organisms.

IV. Acute Respiratory Infections (ARI)

Acute respiratory diseases are one of the major causes of sickness and death in children below 5 years of
age. During 2011, nearly 26.3 million episodes of Acute Respiratory Infection were reported with 2,492
deaths.

V. Leprosy

Leprosy is a chronic infectious disease which is caused by Mycobacterium Leprae. It mainly affects the
skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes. It is curable when the
treatment started in the early stages prevents disability. Multidrug therapy, made available by WHO free
of cost to all patients worldwide since 1995, provides a simple but highly effective cure for all types of
leprosy. Control of leprosy has improved significantly by Integration of basic leprosy services into
general health services to diagnose and provide treatment of the disease within easy reach(PHC). WHO
has launched a new global strategy in 2016 –2020: accelerating towards a leprosy-free world – which
aims to leprosy control and prevent disabilities.

VI. Acquired Immuno Deficiency Syndrome(AIDS)

Since AIDS was first detected in the year 1986 and worldwide it stands in third place. It is estimated that
by the end of year 2016, there were about 2.1million cases of HIV positive cases and 62000 people died
from AIDS related illnesses in the country.

2. Non Communicable Diseases Problem (NCD)

NCDs are the leading cause of death in the world, responsible for 63% of the 57 million deaths that
occurred in 2008.The majority of these deaths are due to cardiovascular diseases and diabetes, cancers
and chronic respiratory diseases. More than nine million of all deaths attributed to noncommunicable
diseases (NCDs) occur before the age of 60. Behavioral risk factors, including tobacco use, physical
inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebro
vascular disease.

Millions of deaths due to Non Communicable Diseases which can be prevented by promoting the public
awareness and participation.
Measures to Control Non Communicable Disease

· Stronger anti-tobacco controls - No smoking

· Promoting healthier diets

· Promoting Physical activity

· Reducing/Stop the use of alcohol;

· Improving people's access to essential health care.

3. Nutritional Problems

According to WHO, "Malnutrition refers to deficiencies, excess or imbalances in a person's intake of

energy and/or nutrients"

Malnutrition covers two broad spectrums of under nutrition and over nutrition.

Undernutrition: Refers to lack of proper nutrition, caused by not having enough food or not eating enough
food containing substances necessary for growth and health.

Over nutrition: Is a form of Malnutrition in which nutrients are oversupplied relative to the amounts
required for normal growth, development and metabolism.

According to World Bank report, India is ranking 2nd in the world of the number of children suffering
from malnutrition (i.e. Under weight (43.5), Stunting (47.9), Wasting (20) and overweight (1.9)).

Source: Asamadu et al, Nutritional Problems and Intervention Strategies in India, A technical Report
(2012)

a) Protein Energy Malnutrition- : Caused by the defeciencies of protein and calories. It occurs more
commonly among weaned infants and pre school children

Kwashiorkor is the deficiency of protein in the diet.

Marasmus - severe deficiency of protein and energy in the diet.

b) Vitamin Defeciencies: caused by the deficiency of vitamins in the diet.

· Vitamin A deficiency – leads to Night blindness and Xerophthalmia( dryness of cornea)

· Vitamin C deficiency – leads to Scurvy

· Vitamin D deficiency – leads to Rickets

c) Mineral defeciencies: caused by the deficiency of minerals in the diet

· Nutritional anemia – decreased haemoglobin in the blood due to the insufficient iron in the diet

· Iodine deficiency disorder (Goitre) – decreased iodine intake.

d) Out of these defeciencies the two major nutritional problems of India are
· Under Nutrition

· Nutritional Anaemia

4. Environmental Sanitation problem

Environmental sanitation is the most difficult problem to handle in our country which is multi-factorial
and multifaceted.

Major environmental problems in India are

· Air and water pollution

· Depletion of natural resources

Improper waste disposal and low level of sanitation leads to soil pollution and breeding places of insects,
flies and rodents.

· Sound pollution Traffic pressure.

· Degradation of land Industrialization and urbanization

· Radiation hazards

· Excessive use of fertilizers and chemicals in agriculture.

· Destruction of forests

· Increasing population, poverty, illiteracy,

· unemployment further increases environmental problems.

5. Medical Care Problems

In rural area 74% population doesn’t get benefit of modern curative and preventive health services.
Approximately 80% of health services are concentrated in urban area. Addressing to meet inadequate and
uneven distribution of doctors, and medical services between rural and urban is the challenging task to
health sector.

6. Population Problem

During Independence in 1947 India's Population was 30 crores. As on 2018 now it is the second most
populated country in the world, current population is 1.35 billion. The population problem is the
important problem faced by our country which affects all aspects of, sanitation, housing, health care and
environment.
Levels of Prevention ;

DEFINITION;

Prevention includes the actions required to eradicate, eliminate or minimizing the impact of
diseases. The various countries are using this strategy to control the prevalence of many major
diseases throughout .There are different levels of prevention.

Levels of Prevention

Primordial Prevention

A level of prevention that is applied before the emergence of risk factors. It is achieved by
providing health education. For Instance-
 Do not start smoking.
 Prevention of childhood obesity by teaching children good eating habits.
 Making bikeways to avoid road traffic accidents.

Primary Prevention

At this level of prevention, the risk factor is already present in the society but the disease has
not started. Health promotion is an important term which comes under primary prevention. This
strategy is followed by many countries and it enables people to lead a healthy lifestyle. Health
education is very important for implementation of this strategy.

Health promotion includes:

 Health education
 Environmental modification
 Nutritional intervention
 Lifestyle and behavioural changes

Examples of Primary Prevention are:

 Providing safe water

 Providing sanitary latrines
 Controlling Insects and Rodents
 Promoting Breastfeeding
 Promoting small family norms
 Improvement in overall socioeconomic status of population.
 Use of helmets and seat belts to protect against head injuries.
 Chemoprophylaxis
 Vitamin A prophylaxis

Secondary Prevention:

It is the mode of intervention in which the strategy is to diagnosing the disease early and starting
the treatment. Here the disease has started but there are no complications. The examples of
Secondary Treatment are:
  Active search for Malaria cases.
 School health examination and Health camps
 PAP smear
 MDT for leprosy
 DOTS for Tuberculosis
 Self breast examination
 In industries, The Post placement examination is done on yearly basis to see whether
the workers has developed the disease or not.

Tertiary Prevention

 The disease has progressed to a stage of irreversibility, complications are present. Now
the strategy is to limit further damage and this is achieved by disability limitations
and Rehabilitation. The concept of Disability includes:
o Disease- A person that suffers from an accident and lose his leg.
o Impairment- Loss or abnormality of physiological or psychological structure
o Disability - It is the restriction or inability to perform an activity.
o Handicapped- It is the person that cannot fulfill his roles and responsibilities.

Rehabilitations
It is the combined and coordinated use of medical , social , educational and vocational
measures for training and retaining the individuals to the highest possible level of functionality.
For example- Crutches for Polio and Blind schools.

Types of Rehabilitation
 Restoration of function
 Restoration of capacity to earn a livelihood
 Restoration of family and social relationship
 Restoration of personal dignity and confidence.

Social Integration
It is the tertiary level of prevention and is a form of rehabilitation. It includes :
 Reconstructive surgery
 School for blind
 Crutches for polio patient
 Providing hearing aids.

Conclusion :

To provide comprehensive health nursing services to the community need to apply the
concepts and components in a effective way to identify the needs & problems of the
individual , family & community.