Programmes in Community Health Nursing

1. Definition and Philosophical Foundation

"Essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford."

2. Objectives of Community Health Nursing Programmes

1. Develop understanding of health care planning, policies, and regulations in India.
2. Apply principles of epidemiology in community health practice.
3. Provide comprehensive primary health care to clients across all age groups.
4. Assess, diagnose, manage, and refer patients with communicable and non-communicable diseases at the community level.
5. Participate in the implementation of National Health Programmes (NHPs).
6. Provide maternal, newborn, child, and adolescent health care in urban and rural settings.
7. Conduct health education and nutritional assessment for different age groups.
8. Develop skills in environmental health and sanitation.
9. Participate in school health services and occupational health programmes.
10. Contribute to community-based mental health services.

3. Core Components / Units of the CHN Programme

Unit 1 - Concepts of Community Health and Community Health Nursing

• Definition of public health and community health nursing
• Dimensions and determinants of health
• Levels of prevention (primary, secondary, tertiary)
• Health problems of India - epidemiological overview

Unit 2 - Health Care Planning and Organization

• Organization of health care at district, state, and national levels
• Structure: Sub-centre → PHC → CHC → District Hospital
• Health care delivery infrastructure (NHM, ASHA, ANM, MPW)
• Health care policies and regulations in India
• Five-Year Plans and health planning

Unit 3 - Environmental Science, Environmental Health, and Sanitation

• Environmental health concepts - air, water, soil, and waste management
• Safe water supply, sewage, and solid waste disposal
• Housing and housing standards
• Occupational health hazards
• Total Sanitation Campaign / Swachh Bharat Mission linkages

Unit 4 - Nutrition Assessment and Nutrition Education

• Nutritional assessment methods (anthropometry, dietary surveys, biochemical)
• Malnutrition - types, causes, management (PEM, anaemia, vitamin deficiencies)
• Nutritional counselling for different age groups - infants, children, adolescents, pregnant women, elderly
• ICDS (Integrated Child Development Services) linkages

Unit 5 - Communication Management and Health Education

• Principles of health education
• Behaviour Change Communication (BCC)
• IEC (Information, Education, Communication) strategies
• Health counselling techniques - motivational interviewing, group discussions
• Media and interpersonal communication

Unit 6 - Community Health Nursing Approaches, Roles, and Responsibilities

• Roles of community health nursing personnel: clinician, educator, counsellor, case finder, researcher, supervisor, public health advocate
• Family health nursing - the family as a unit of care
• Home visits - planning, execution, documentation
• Community assessment and community diagnosis
• Community need surveys

Unit 7 - Assisting Individuals and Families to Promote and Maintain Health

• Life cycle approach - care across maternal, infant, child, adolescent, adult, and elderly stages
• Health promotion strategies (Ottawa Charter principles)
• Health screening camps and school health visits
• Emergency and first aid care at home

Unit 8 - Introduction to Epidemiology

• Epidemiological approaches and processes
• Disease surveillance and notification
• Epidemiological triad (host-agent-environment)
• Rates and ratios used in public health (IMR, MMR, CBR, CDR)
• Outbreak investigation

4. National Health Programmes (NHPs) - A Core Focus Area of CHN

4A. Communicable Disease Control Programmes

• Case detection and referral
• DOTS (Directly Observed Treatment) supervision
• Sputum collection and submission
• Health education on prevention, transmission, and treatment adherence
• Contact tracing and household visits
• Immunization administration and cold chain maintenance

4B. Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A)

• Antenatal Care (ANC): Minimum 4 antenatal visits, registration, iron-folic acid supplementation, tetanus toxoid, high-risk identification, referral
• Intrapartum Care: Institutional deliveries under Janani Suraksha Yojana (JSY), skilled birth attendance
• Postnatal Care (PNC): Monitoring of mother and newborn, breastfeeding support, family planning counselling
• Child Health: Growth monitoring, immunization, management of ARI and diarrhoea (IMNCI approach)
• Adolescent Health: RKSK (Rashtriya Kishor Swasthya Karyakram) - anaemia screening, menstrual hygiene, life skills education
• Family Planning: Counselling on spacing methods, IUCD insertion at PHC level, PPIUCD

4C. Non-Communicable Disease (NCD) Programmes

• Prevent and control common NCDs through behaviour and lifestyle changes
• Provide early diagnosis and management
• Build capacity at all levels of health care
• Train health workers including nursing staff
• Establish palliative and rehabilitative care capacity

• Health promotion through interpersonal communication, camps, posters
• Opportunistic screening of persons above 30 years for diabetes (glucometer) and hypertension (BP measurement)
• Referral of suspected cases to CHC

• NCD Clinic operation
• Confirmed case management
• Prescription of essential medicines
• Follow-up care coordination

• National Programme for Control of Blindness (NPCB) - cataract operations, school eye screening, nurse-led vision camps
• National Programme for Prevention and Control of Deafness (NPPCD) - early identification, hearing aid fitting
• National Tobacco Control Programme (NTCP) - cessation counselling, awareness campaigns

4D. National Mental Health Programme (NMHP)

1. Prevention and treatment of mental and neurological disorders and their associated disabilities
2. Use of mental health technology to improve general health services
3. Application of mental health principles in national development

• Training of primary health care workers in basic mental health skills
• Public education to reduce stigma
• OPD and indoor services for early detection and treatment
• School mental health services: life skills education and counselling
• College counselling services
• Workplace stress management programmes
• Suicide prevention services - helplines, counselling centres, sensitization workshops

4E. School Health Services Programme

• Promote health of school-age children
• Detect health problems early and provide treatment
• Establish healthy habits and health knowledge in children

• Periodic health examinations of school children
• Immunization, nutrition supplementation (mid-day meal linkage)
• Health education and life skills training
• First aid services
• Referral services for vision, dental, ENT, and mental health problems
• Maintenance of school health records

5. Primary Health Care Approach as the Foundation of CHN

1. Education on prevailing health problems and their prevention and control
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

• Equitable distribution - services reaching the rural poor and urban slums
• Community participation - ASHA, village health committees, Jan Aarogya Samiti
• Intersectoral coordination - health, agriculture, education, water, sanitation sectors working together
• Appropriate technology - use of simple, cost-effective interventions

6. Health Care Delivery Levels and Nurse's Position

7. Clinical Practicum / Field Posting Structure

• Urban community (2 weeks): Community needs assessment, home visits, surveys, participation in urban health centres
• Rural community (2 weeks): Sub-centre and PHC attachment, participation in immunization sessions, antenatal clinics, health camps

• Conducting home visits (minimum 2)
• Community health assessments/surveys
• Participation in at least 2 national health programmes
• Participation in school health programme (minimum 1)
• Communicable and non-communicable disease case studies

8. Important Community Health Nursing Competencies

1. Explore the evolution of public health in India and CHN
2. Explain concepts and determinants of health
3. Identify levels of prevention and health problems of India
4. Conduct a community health assessment (survey, diagnosis, planning)
5. Deliver antenatal, postnatal, child health, and family planning services
6. Screen, diagnose, manage, and refer communicable and non-communicable disease cases
7. Participate in all national health programme activities
8. Conduct health education using appropriate communication methods
9. Provide school health services
10. Apply epidemiological approaches to community health problems

Summary

• Epidemiological knowledge
• Environmental health
• Primary health care principles
• National health programme implementation
• Maternal and child health services
• NCD screening and management
• Mental health at community level
• School health
• Health education and BCC