A TEXT BOOK FOR THE COMMUNITY HEALTH NURSING -1 INCLUDING NUTRITION & HYGIENE PSYCHOLOGY & SOCIOLOGY. F O R E W O R D Despite great achievements in health and technology, the world is facing considerable health challenges. These include the growing population of poor who do not have access to basic health and social care, the rapid environmental changes and degradation of the environment, the economic recession and crises in parts of the world that affects the financing of health care, and the inability of technology to face the epidemics and deadly threats from malnutri- tion and diseases such as HIV/AIDS, malaria and tuberculosis. Over the years, hygiene has been considered to be responsible for more deaths than the bullets. The concern of nurses is for people’s health – its promotion, maintenance, and restoration. Together with midwives and health workers, constituting the majority of the qualified health workforce in most health systems, they play vital role in bringing about health awareness and the necessary changes to address these challenges. Health promotion encompasses physical, mental and social well-being. Public health practitioners need to enhance their current professional work in health and social care, including counseling and therapy, preparedness for emergencies and crisis situations, and facilitating community involvement. Focus must be on the chang- ing needs of the local communities that are each of them unique. Neglect of public health also contributes to spiraling health costs. And not all people have access to medical care. Many tribal community people are in need of health and welfare service, but are not currently being served. More funds are needed for patient care, dental services, elderly services, health treatment, and community awareness programs regarding primary health care concepts and the contribution of nutrition to promoting health. To address these issues, there is a need of political will and commitment of all the stakeholders including the local government, public health practitioners, professional groups, and the private sec- tor. However, all things considered, it is each individual who has to care for his physical, mental, and social health. SWAMY BALANANDA, GUNTUR. PREFACE It is accepted that studying of community health Nursing is essential for all vocational MPHW students. I pleased to bring out this book framed according to the syllabus of state intermediate vocational education. The special features of this book are for the knowledge and understanding based on the chapters of Introduction to community health nursing; Nutrition, Hygiene, Psychology and sociology are extensively explained. Matter is brief and in simple manner. This will definitely boost the confidence of the students in writing the end examinations. Here the topics are explained based upon scientific principles have changed rapidly in both medicine and science. At the end of each chapter, there are important questions, which are useful for the student. Glossary and reference books are to be mostly useful for both students. I am confident that this book will definitely help to the stu- dents as well as teachers. I wish to thanks to the Board Of Intermediate education vocational, Hyderabad for giving opportunity to write this book. CH.SLEEVAMMA JL IN MPHW(F) GJC FOR GIRLS, KHAMMAM. Contents Section-A Unit-1 1 - 11 1. Community Health Nursing History and Development in India. 2. Qualities and functions of community Health Nurse. 3. Family Helath services. 4. School Health programmers. Unit-II 12 - 25 1. Principles 2. Planning 3. Techniques and evaluation 4. Equipment and their care 5. Reports and Records 6. Common ailments & Treatment Section-B NUTRITION AND HYGIENE Unit-I 26 - 50 Introduction to the study of Nutrition, definition, relation of nu- trition to health, relation of other factors of importance for Nutri- tional Status and health. Classification and functions of foods, bodybuilding, energy yielding and protective food. Nutrients – Carbohydrates, proteins, fats, vitamins, minerals, sources and daily requirements of each, caloric requirements, water and cellulose. Unit-II 51 - 62 Nutritive value of foodstuffs. Cereals –fruits – fats and oil. Pulses – milk and milk products, sugar. Vegetables – egg, meat and fish, coudiments, species and Beverages. Enriching subsistence diets with locally available stuffs. Unit-III 63 - 77 Improvement of diet, selection of foods. Nutritional requirements for special groups, vulnerable groups, improving maternal nutrition and child Nutrition. Hypertension, diabetes. Unit-IV 78 - 95 Preparation and preservation of foods General principles of cooking Methods of cooking, effects of cooking on nutrients and common food stuffs. Preservation of foods - household methods, food hygiene, simple house hold measures. Unit-V 96 - 109 Malnutrition Malnutrition and under nutrition, causes inter related of factors leading to malnutrition, infections, worm infections, defi- ciency diseases in the country including vitamin deficiencies. Protein – calorie malnutrition, cultural factors in nutrition food, food habits, food adulteration practices injurious to health, nutrition education principles of imparting nutrition knowledge. HYGIENE Unit-VI 110 - 129 1. Introduction to hygiene and healthful living 2. Concept of health and disease. 3. Factors influencing health and healthful living b. Physical Health 1. Skin care, cleanliness of clothing. 2. Care of the hair, preventive pediculosis 3. Dental care and oral hygiene 4. Care of hands, care of nails 5. Hand washing 6. Hygiene of elimination 7. Menstrual Hygiene 8. Posture, prevention of postural defects 9. Exercises, rest, relaxation and sleep 10. Care of the foot 11. Care of the eyes, ear, nose and throat 12. Food values – nutritious diet selection preparation and han- dling of food. Unit – VII 130 - 155 1. The periodic health examination. 2. Immunization 3. Detection and correction of defects 4. Prevention and early treatment of common ailments - com- mon cold, indigestion, constipation, headache. 5. Health in the home 6. Home as a center for healthful living 7. Household measures for disposal of refuse, waste. 8. Latrines, sanitation, ventilation. 9. Safety in the home, common home hazards 10. Sanitation to animal sheds, insects and pets. Unit – VIII 156 - 158 1. Mental Hygiene 2. Factors contributing to mental health. 3. Characteristics of the mentally healthy person. Section – C PSYCHOLOGY AND SOCIOLOGY PSYCHOLOGY : Unit – I 159 - 166 Factors influencing Human Behavior Heredity & environment Basic needs, drives or urges Early learning, value system, attitudes, personality, self concept of body and mind its relation ship. Unit-II 167 - 179 Life stages and behavioral patterns. Behavioral patterns in childhood, adolescence, adults and aged. Unit – III 180 - 190 Emotions and defense mechanism. Meaning and importance of emotions, expression and con- trol. Positive and negative emotions. Emotion & health, specific emotions - fear, anger, love, jeal- ousy, stress, illness, and behavior. Purpose of defense mechanism. Common defense mechanism. Adjustment, conflict & frustration. Unit – IV 191 - 202 Social Behavior Interpersonal relations, acceptance of the individual, indi- vidual differences, appreciation, recognition, approval in social relation, group standards and conformity, behavior adaptations, maintaining effective inter personal relation ship, self understanding. Unit – V 203 - 210 Learning motivation and change in Behavior Motives, incentives, goals and aspirations, significance, motivation in improving health practices, changing attitudes and habits. Motivating individuals and groups to improve health prac- tices, conditions of learning, methods of learning. SOCIOLOGY: Unit – VI 211 - 219 Introduction Groups – Primary and secondary in group and out groups, structure, activities of groups organization of groups, urban and rural, administrative patterns of panchayats and corporations, crowd, public audience. Unit – VII 220 - 226 Corporation competition, conflict, assimilation, adjustment. The individual and process of specialization. Community health services and social process. Change and development in the community. Unit-VIII 227 - 234 Social controls. Traditions and customs. Folkways and mores. Laws, traditions and habits affecting health. Social problems, antisocial practices. Unit – IX 235 - 243 Social stratification – caste, class, mobility, status, region- alism. Marriage, odd family. Marriage patterns. Family types. Functions of family. Joint family, nuclear family/modern family. Unit – X 244 - 353 The community. Rural Community – Characteristics. Charges in the village, community development. Major r ural problems. Urban community characteristics, changes and adjust ments to urban development, major urban problems. GLOSSARY : 254 - 259 REFERENCE BOOKS : 260 SECTION - A COMMUNITY HEALTH NURSING UNIT - I a. Introduction. “Health is Not mainly an issue of doctors, social services and hospitals. Health is an issue of social Justice. There is no time to lose. We have the goal of “Health for all by 2000 AD”. This is the call of the world health organisation. and India has taken up the challange. Formerly, Health care has been for those living near enough to a hospital or a doctor in times of need and for those who could spend money for medicines and treatement. The great majority of people stayed in the village when sick and even today many suffer and die without proper help. Attempts have been made to meet the health needs of the people of India by means of primary health centres and the training of Auxilary Nurse Midwives to go out from these centres to the homes of the people. The number of ANMS trained were never suffecient and more than half of them after traininng went to work in hospitals. In fact, their tranining was given mainly in the hospitals environment, with title experience and under- standing of health needs of people, families and communities in rural areas History and development of community Health Nursing: Early history (Vedic period) Indus valley civilizations 3000 BC there were planned cities , houses built with public baths with drain- age. People practiced proper environmental Sanitation 1400 BC Ayurveda and Siddha Systems of medicine come into existence which suggested development of comprehensive concept of health. Post Vedic Period - (600 BC - 600 AD) Medical education was introduced in the ancient Universities of Taxila and Nalanda. During Budha period hospital system was developed for men and women and for animals. This was exapanded during king Ashoka, Moghal Period (1000 AD) Unani Medicine which (Arabic system) was introudced through Greek medicine which has become a part of Indian medicine. Nursing and medicine are closely linked together. Nursing is regarded on the “Science of Care” and medicine as the “Science of Cure”. As the science of cure, medicine 1 Community Health Nursing -I is concerned with the diagnosis and treatment of illness. As the scienceof care, nursing is concerned with the care of people who are ill. The care and cure functions are complimentary ; both are neces- sary and important aspects of health care for the people. Nurses were recruited in India for the first time in 1914, being attached to the Queen Alexandra’s military nursing Service, which was founded by Florance Nightingale. In 1927, after the first world war, it was named as “Indian military Nursing Service”. In 1871 the Govt of Madras started the training for nurses. During 1874 - 80. The Christian Mission Hospitals in India started tranining courses for nurses. The Roman Cathalic Nuns served as nurses in many Govt., Hospitals in India as well as in Hospitals run by religions orders. Auxilary Nurse Midwives: The use of auxilary Nursing Personal to ease the shortage of professional nurses put into practices in India. A 2 Yrs., course for the training of ANMS was first started in 1951 at St. Mary’s Hospitals, Punjab. By 1962 therewere 263 courses being offered in India. The ANM is trained in midwifery with same Nursing skills and oreintation to public health and Family Planning. In 1977 the ANM Course was completely revised by the Indian Nursing Council and expanded to include Sociology, Health education and communication skills and decided to change ANMS to multipupose workers and designate them as multipurpose health workers (Female). By 1978 there were 329 ANM Schools Functioning in the country. The existing ANMS are given an orientation course for a period of 10 weeks to give them additional knowledge and skills required by the multipurpose work- ers, and this programme is scheduled to be completed by 1983. In most states, the name of ANMS has how been changed to Health Work (Female). It is envisaged that by the end of the VI five year plan. There will be one Health worker (F) for every 5,000 population in the country and they superrwise the duties of ANMS. The ANMS are responsible for MCH and family planning work in an area of 5,000 population. She is most important person plays a role in rural health services are taken care of by specially trained multipurpose Health workers, male and female. Community : Community Health Nursing 2 3 Community Health Nursing -I Community means a group of people living in a certain local- ity such as a village, who have common interests. They meet and react with one another. They may have different interests also and not get on well with one another. Some are rich, others poor, some eat too much. Other may go hungry, some have power and influence and may like to give orders. Others have no power and suffer injus- tices. The best kind of community is one in which every one cares about all the other members of the community. As a health worker you will be working with the community to help them in solving their problems especially to be more healthy in every way. Community Health: Community health includes the state of health of the mem- bers of the community, the problems effecting their health and the health care provided for the community. In community health work we help people to find out and think about their health prob- lems and what can be done to improve the health of the whole com- munity. Then we work together with the people and others in the health team to plan and carry out the problems of health care. B) QUALITIES AND FUNCTIONS OF COMMUNITY HEALTH NURSE: Qualities of Community Health (Worker) Nurse: As a health worker living and working in a community, you may at first feel a stranger. You will realise that people are watching what you do, what you say and how you react to them. If your ap- pearance, words and behaviour displease or shock people, if you seem to be proud and different or have a habit of gossiping, then you will not be accepted by the community and can do no effective work there. Student health worker need guidance and help in how to bahave acceptably. There is a code of ethics for nurses published by the International Council of Nurses which May also guide the Health worker. In brief it is as follows: 1. Have respect for life, dignity and rights of people, and serve them all without regard to race, religion, Colour, age, Sex, Politics or Social Status. 2. Have respect for the values, customs and spiritual beliefs Community Health Nursing 4 of people. 3. Do not passs on personal information except to the right person. 4. Keep up a high standard of work and personal conduct. 5. Maintain a good relationship and Co-Operation with Co- workers in the health team, and community. Other points which are important for the health Workers to remember and practice are as follows: 1. Always be neat and clean in appearance, and walk with purpose and good posture. This will make you feel good and make a good impression on others. 2. Take special care of your own health of body and mind, and set a good example in your personal life and habits practice what you teach. 3. Be Cheerful and enthusiastic in your work, and keep a sense of humour. 4. Be disciplined in your use of time keep up punctuality cleanlines and order. Have respect for property other than your own. 5. Be obediant to your superior officers (with intelligence) and uphold their authority. Show them proper respect, and use correct channels of communication. Keep to service rules. 6. Try to understand other people and the reasons for what they do and say. Be tactful, patient, sympathetic and kind in your attitude to them. 7. Always be ready to help people with concern and care, but refuse to receive bribes. 8. Develop good friendships and interests apart from your work. Try to have a hobby and healthy relaxation. 9. Use every chance to go on learning, by reading books and journals and news papers. Also learn from people who can be helpful to you personally and to improve your work. 10. Be disciplined in your spiritual life, in order to have resources to help others in distress of spirit. 5 Community Health Nursing -I FUNCTIONS OF COMMUNITY HEALTH NURSE (WORKER):- The Community Health Nurse must be prepared to play a much wider role than is offered by her work in hospitals. There is much greater element of decision, making. Management skills, administration of programmes, teaching and acting as a team leader, as well as a member of the health team are all important perhaps the most crucial requirement is that the nurse must be prepared to learn from the people, and share leadership with them when it is necessary and to plan with them. The functions of a community health nurse have been clas- sified broadly under the following heads: 1. Administration. 2. Communication. 3.. Nursing. 4. Teaching. 5. Research. 1. Administration :- The nurse is responsible for the day- to-day assignment of the nursing staff and supervision of these personnal. She provides direction and leadership to those whom she supervises. She is reasponsible for planning, implementation and evaluation of a practical plan of nursing administration with in the primary health centre and its associated sub centres. 2. Communication :- This involves ability to maintain good working relationship with members of the health team, related agen- cies and the community. She is a link between the patient, The family and the doctor. She participates in the staff and community meetings. 3. Nursing :- She provides comprehensive nursing care to individuals and families. This includes family care of the preg- nant women, before, at the time of and after delivery, care of the new born, the premature, the infant, toddler, the school child, nu- trition and family planning. 4. Teaching :- Knowledge and skills of methods of individu- als and group teaching, preperation and use of simple teaching aids; training of dais and health workers ; participation in student training programmes, if any. Community Health Nursing 6 5. Research :- These is probably far more research relavant to nursing than nurses realise. A good deal of knowledge derived from sociology and physchology is relevant to public health nursing, Viz., infant feeding and weaning, mother and child relation ship nursing needs and practices in the community, utilization of the existing nursing services, job analysis of nursing personel in the team. C. FAMILY HEALTH SERVICES: The term “Family Health” Covers a broad filed. Its is one of the major activities of the world health organisation. It is devided into the following sub-areas: a. Maternal child health services. b. Family planning services. c. Nutrition. d. Health education. The broad objectives of the family Health services are: a. To reduce meternal and child martality and morbidity rates. b. Spacing of children. c. To solve the problems of malnutrition at the family level and d. To educate all members of the family in the basic require- ments of healthy living. (a) Meternal and Child Health. The Need for MCH Services :- There are 4 main reasons why mother and child health care must be given top priority in terms of providing health services:- 1. Mothrs & Children below the age of 15 yrs., make up the majority of the population. 2. Mother and children constitute a “Special risk” or vulnerable group. 3. By improving the health of mothers and children we improve the health of the family & community. 4. Ensuring child survival is a future investment for the family & Community. Definition: According to who is “The promotive, preventure, Cura- tive and rehabilative care for mothers and childrens. 7 Community Health Nursing -I Objectives of MCH care: The Objectives of MCH care have been difined as below: a). Reduction of Material, perinatal, infant and child mortality & Mor- bidity. b). Promotion of reproductive health. c). Promotion of physical and Psychological development of the child and adokscent within the family. The ultimate objective of MCH care is life long health. The Role of Nurses in MCH Care:- The functions are explained under 4 headings as follows: 1. Direct Care Provides:- a) Antenatal Care i.e, Care of the women during Pregnancy. b) Intranatal Care i.e,care of women at the time of delivery. c) Post Natal care i.e, care of the women after delivery. d) Child care : i.e., child survival activiteis i.e., - Immunization. - Promotion of breast feeding. - Growth monitoring. - Weaning. - Oral rehydration, when necessary - Birth spacing.. 2. Health Communication and Education: The groups that require priority attention are . - Dais. - Mothers. - Family. 3. Supervision and management :- The Community health Nurse will have to supervise the work of dais, ANMS& Female workers. That means supervision of records, individual conference and counselling. 4. Research & Evaluation influence the Welfare of mothers and Childrens:- (b) Family planning Services Family planning being a national programme. The main role of a health worker in family planning services are:- 1. Education and Counselling.