Unit I

Community health nursing practice is synthesis of nursing practice and public

health practices which in general and comprehensive services are provided and arenot
initiated to a particular case and diagnostic group.
Community Health Nursing: Includes all services organized by community or agency
to carry out all nursing aspects of health in schools, home, industries, health institutions
and such other centers.
Community health nursing daws knowledge from various disciplines like medicine,
surgery, obsterics, gynecology, pediatrics, health education , sociology, phycology etc., She
acts as a liaison between hospital and community. In the present trend community health
nursing will by opted by the people who likes to work with people from different culture.
An European conference on nursing administration 1959 defined a public health nurse as
The nurse mostly concerned directly with giving health education and care to individuals
and their families in community
The specific nursing activities performed by the nurse will vary according to community
needs and the structure of health care agency where she is working.
A qualified public health nurse is one who has undergone training in basic general
midwifery and public health nursing or any graduate nurse or post graduate nurse.

Characteristics of community health nursing

It is a field of nursing: Comprehensive, quality nursing care at the level of the
with their participation and willingness is best provided in community health
nursing.

It combines public health with nursing: The principles, concepts, strategies from basic
nursing practice are incorporated to provide priority of preventive and health promotive
strategies, apply concepts of epidemiology and its methods for various diseases, controls
or prevents influence of environmental factors on health, applies principles underlying
management and organization to community health and applies knowledge in public
health policy analyses and development.

It is population-focused: concerned with the personal and environmental health of the

population groups. The population oriented focus requires the observation of
relationships.
It emphasizes wellness: It deals with both well and ill persons , but emphasis is given on
positive health or wellness by to prevent health problems and promoting health .They
identify high risk groups and institute preventive programmes. A wellness emphasis
requires taking initiative and making sound judgements.

It involves interdisciplinary collaboration: Coordination and cooperation with

team members promotes a great effort in dealing with health aspects of
community. Community health nursing maintains a good team effort.
It promotes clients responsibility and self care: Consumer participation is
promoted when clients are treated as partners on the health care team. Community

health nursing encourages for expressed felt need, active participation and self
responsibility for self care at various levels of health and illness continuum of an
individual in the community.
Setting for community health nursing practice

homes
ambulatory service settings
schools
occupational health setting
residential institutions
the community at large

Philosophy of Community Health Nursing

Philosophy is an attitude to wards life and reality. The Nurses philosophy is an
integral part of the frame work for community health nursing. It influences how the nurse
will function with families, groups and co-workers in a community and is based upon beliefs
about health and about nursing.
The philosophy of community health nursing devices from acceptance of certain concepts
and facts as a foundation for working with people.
The essential dignity and worth of the individual
Each individual possess potentialities and resources for managing their own lives
The importance of freedom to express ones individuality
The great capacity for growth within all social beings
The right of an individual for basic necessities
The need for individuals to struggle and strive to improve their life and environment
The right of the individual to be helped in times of need and crises

Scope of Community Health Nursing

1. community health nursing services:- community health nursing services

including nursing care of the family in sick and health
i. Community health nurses able to:
b. provide primary health care in the community
c. conduct routine antenatal and postnatal services
d. conduct deliveries when required
e. carry out immunization
f. promote health of the children by conduct under five clinics and referring
cases who require medical care

g. assess the social and environmental and nutritional needs of community

and get the help of social workers to meet these needs
2. Industrial nursing services: - nurses are employed in industries. There is a
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 examination and periodic health check up, care of sick, first aid,
industrial sanitation and safety etc.
3. School health nursing:- school health nursing is not yet well developed in
India. The school health renders services to promote and protect the health of the
school children. She provides her services in areas like health education, early
education of diseases, immunization, first aid, dental health, school sanitation,
maintenance of health records, follow up and referral services
4. Domiciliary nursing services:- the areas where domiciliary nursing is practiced
in this country are maternity services and services for illness and accidents at the
home setting.
5. Mental health nursing services: - many developing countries have mental health
supervision and diseases prevention services today. These services include early
diagnosis treatment, rehabilitation, psychotherapy, use of modern psychotropic
drugs and after care services.
6. MCH and family planning: - the public health nurse plays a major role in the
MCH and Family planning services. It comprises antenatal and postnatal and
child care services
7. Rehabilitation centers: - rehabilitation means restoration of all treated cases to
the highest level of function ability. Nursing is an important component in the
rehabilitation of the disabled at the community level.
8. Geriatric nursing services: - the number of old people is increasing in the world
today. The need of old is different and they need more care than the younger age
groups.
9. International health agencies: plays a role in collecting health relates data and
takes active part in programme planning, implementation and evaluation
Purpose of Community Health Nursing:The basic purpose of community health nursing is to further community health
through the selective application for nursing and public health measures, within the frame
work of the total community health effort.
Goals and Aims of Community Health Nursing
Aims: To increase the capability of families, groups and communities to cope health and
illness problems.
To support and supplement the efforts of other professionals in restoration and
preservation of health.
To control or counteract as much as possible physical and social environmental
conditions that threaten health or decrease the enjoyment of life.

To contribute to the refinement and improvement of nursing practice and of public

health practice and service.
To promote and preserve health, to restore health when it is impaired, minimize
suffering and distress and to promote quality living.
These goals can be achieved by providing comprehensive
health and nursing services as mentioned above to the entire community and by working
with individual, families and group in the community with an aim of self care. Self care
activities include practice of wholesome personal habits and life style, following of
specific protective measures reporting early when sick, understanding prescribed
treatment and precautions for spread of disease to others and for occurrence of relapse.
Objectives of Community Health Nursing

To increase capability of individuals, families, groups and community to deal with

their own health and nursing problems.
To strengthen community resources and to make people to best utilize them
To promote measures to control and protect environment
To prevent and control communicable and non communicable diseases
To provide specialized services for mothers, children, adults, workers, elderly
handicapped and eligible couples etc
To conduct research and contribute to the further refinement and improvement of
community health nursing practice
To participate in preparing health personal to function at the level of the community
To supervise, guide and help health personnel in carrying out their functions
effectively

Roles of Community Health Nurse

They are:
1. Care provider
The community health nurse provides care to entire family, group of people and even
the community at large.
Provides comprehensive care for the entire range of health and disease continuum
with emphasis on promotion of health and prevention of disease.
The care is continuous in nature and not episodic.
The care is provided in the clinic, home, school and work place depending upon
health problems/medical conditions, medical prescriptions, nursing needs/ nursing
problem, complete competency of individuals, family members etc.
2. Observer
Observation of people with respective any evidence of ill health etc and to take
necessary action including giving information to medical officer
Observation of lifestyle of people with respect to any evidence of poor health
knowledge, health attitude, health behaviour and practice which effect their health

and to take necessary actions which can help improve their health life style and
health
Observation of environmental condition with respect to physical, biological and
psychosocial aspects which effect health and welfare of the family and community
at large. Any condition which threatens the out break of any disease must be reported
to the authority and the concerns health worker to take action
Observation of resource available to has to help family and community people to
use them intelligently in meeting their health need
3. Educator
Educates individual, families and community both during sick or have any health
problem and well given at clinics, home, school work place etc.
The ultimate aim of community health nursing is to help people gain health
knowledge, modify health attitude, health behavior and develop competency to
become self dependent, self reliant in dealing their health matters etc.
4. Advocate
As an advocate, the community health nurse stands between the individual/family/
community and various specialized services.
People are ignorant about the various services which are available, she explains
them about the service available and guides them how to use their services as an
effective advocate the community health nurse needs to possess certain qualities
which are a) willingness to take risk, b) assertiveness c) communicability d)
resourcefulness.
5 Advisor: The community health nurse acts as an advisor. She gives suggestions advice on
practical situations which require immediate actions and where there is no scope of
health education.
For example- An antenatal mother having threatened abortion or child with acute
pneumonia etc.
She may also advise ancillary staff on various job related activities. She shows
concerns to their problems and helps them to solve the problems.
6. Change agent
The community health nurse acts as a change agent i. e. she serves as a potentate or
catalyst. It means that she is able to make others more effective by increasing their
capabilities to:
1) Cope up with their health problems
2) Provide care to themselves.
7. Manager
Community health nurses are expected to function as manager of family health care,
school health care, community health care, any specific programme or project etc.
She may be expected to manage by her self or together with medical officer and
other personnel.
As manager she plans, organizes, co-ordinates, supervises, guides, directs, reports,
and evaluates.
8. Planner

Nurse plans family health care by making health assessment, setting up goal and
objectives, identifying alternative action, implementing and evaluating the care
given.
She also gets involved in over all planning of community health care or in planning
of any specific program for any particular group or for whole community.
10. Director and co-coordinator
Nurse has to communicate to personnel about jobs to be performed, directs and
motivates them to do their jobs, supervises and guides them to perform various
activities to reach the desired objectives.
She must ensure effective byway communication between her as a manager and the
personnel and also among the personal themselves.
11. Controller and evaluator
Nurse identifies the difficulties; she then takes corrective measures according to the
situations so that intended objectives are attained
12. Leader
Community health nurse functions as a leader when she performs the role of nurse
manager. She leads the group by giving them directions, ensuring byway
communication, providing supervision and guidance and by co-coordinating their
activities and infrastructure etc.
13. Collaborator
The community health nurse collaborates with all the health team members i.e.
she works jointly with them in helping family and community people to meet
their health needs.
The community health nurse needs to be assertive and verbalize her role and
responsibilities to the team members so that her presence on the team is felt and
identified.
14. Researcher
Nurse may conduct independent studies to improve community health nursing
practice.
The practice of community health implies involving epidemiological approach to
deal with problems.
She may range from the simplest inquiry to most complex epidemiological
studies. Therefore the community health nurse performs a researcher role in
community health nursing practice.
Principles of Community Health Nursing
Community health nursing principles are essential because they ensure relevant, safe and
correct practices to meet health needs of individuals, families, groups and community.
1. Community health nursing is community focused, it is therefore essential to know
the defined community, makes a map and establishes effective working relationship
Community health nurses must know her area, boundaries and important land marks,
people in general, community leaders, their lifestyles, their resources and also the vital

events. It helps in providing need based comprehensive healthcare services and in

achieving community health goals.
2. Community health nursing is based on identified community health nursing needs
and functions within total community health programmes
Community health nurses must always identify health and nursing needs of the assigned
community .Community health nurses working in community need to know health care
delivery system, health policies, health goals and objectives, health care programmes to
deal with various national health problems as planned and implemented by the govt at
various levels of health care delivery system.
3. Health education, guidance and supervision are integral part of community
health nursing services
She must educate community, give them more information which creates interest, help
them to develop certain skills, guide and supervise them to continue such practices and
give care. Teaching should be simple, understandable, specific scientifically correct and
of practical value.
4. Health services should be realistic in terms of available resources
Always plan and provide services based on health needs and money material and
manpower available. It requires proper estimation, prioritization and procuring more
recourse according to situations and feasibility.
5. The health worker is responsible to the authorized health authority and functions
with in the policies, general goals and objectives set by the health agency
Community health nurse or any other health worker may be employed by the Center,
State, and Corporation, Municipality, or voluntary health agency. The health worker
needs to know, understand, follow the health policies and goals and objectives of health
agency and accordingly plan and implement health care services.
6. Effective health worker irrespective of position or place of work, functions as a
team
She must be knowledgeable of duties and responsibilities of all the members of health
team so that lapses and over lapses can be prevented in making community health
assessment, planning, implementation and evaluation of health care services.
7. In community health, community and the individual are the unit of all health care
services
Peoples health is influenced by various factors which are pertaining to their biology,
lifestyle, environment and resources the health of the people can be promoted and
preserved by organized health care services for the community at large and by providing
these services to the people in the family setting
8. Professional relational ships and etiquette are essential in community health
services
It is very important for community health nurse to establish professional working
relationship with health and health aliened agencies who are contributing towards health
and welfare of the people. These may include ayurvedic, unani and homeopathic and
other social welfare organizations. The community health nurse should also get to know

and establish friendly relationships with health practitioners like RMP, Doctors, local dais
etc.
9. Community involvement is integral part of community health nursing practice
The community health nurses working in community health setting must encourage
community involvement i.e. village leaders, panchayats members, informal leaders like
teachers, religious leaders, mahila mandal leaders. Community health nurses need to
identify these people, establish working relationship, create awareness about community
health and its means and ways organize them in to health committee, self help groups etc.
depending upon the requirement and possibilities.
10. Individual and families participate fully in all decision making relating to
attainment of health
The family as a whole and individuals member in the family with in a community is
responsible for their own heath and they have a right for their own health. The
community health nurse must recognize and respect families right to decide its self
regarding health goals.
11. Continuous services are effective services and community health nurse must
provide continuous health services
Community health nurse must keep continuous contact with individual, family and
community and provide comprehensive services not only during sickness but when
people are well.
12. Well developed system of records and reports is essential for community health
services
Records and reports if maintained properly are effective means for continuous care, for
evaluation of what is being done and what needs to be done further.
13. Periodic and continuous appraisal and evaluation of health situation and health
services are basic to community health
Evaluation is done on the basis of health goals, programmes planned and records and
reports maintained.
14. Health services should be available and accessible to all without any
discrimination of their origin, color, cast, religion, political affiliation, socio economic
status, age and sex
15. Health worker should be non political, non sectarian in her relationship
The community health nurse should not interfere with peoples political and religious
beliefs. She should understand and respect them
.
16. Health worker must maintain professional dignity and must never accept any
gift or bribe
17. Health services should be realistic in terms of available personnel and facilities
18. Professional interest should be developed and maintained
19. Facilities and interest for further training should be developed among all nurses
working in the community

Historical development of community health in India

The history of health in India goes back through the centuries to about
3000BC.The beginnings are shrouded in the mist of ancient myths. The experience and
concern in health development date back to Vedic period between 3000-1400 BC.The
Indus valley civilization showed relics of planned cities and practice of environmental
sanitation.
According to Dr.wheeler on the basis of his research studies from south Arikmedu
(Pondicherry) to north Mohenjo-Daro and Harappa, only one culture has been followed.
An ideal healthful living of people such as every house of Mohenjo-Daro and Harappa
has separate good water supply. In every back of the house, there was a wide royal street
and by the side of the street there was an arrangement of some drinking water. Actually
this was followed by Dravidians who lived at that time. After the invasion of Aryans the
Dravidians migrated to south. The specialist of pictograph reader Father Hears says that
the fact that ancient people of Mohenjo-Daro were proto-Dravidians, a fact also hinted by
Sir John Marshal that is there was a link between all that is the Dravidian culture,
including Mohenjo-Daro and Karnataka.
The Ayurveda and other system of medicine practiced during this time suggests the
development of comprehensive concept of health by the ancient sages of India.
A brief description of chronological events related to development health in India as
given below.
PUBLIC HEALTH IN ANCIENT AND MEDIEVAL PERIOD: 3000BC:-In the Indus valley civilization, one finds evidence of well developed
environmental sanitation programmes such as underground drains, public baths
etc. Arogy or health was given high priority in daily life and this concept of
health included physical, mental, social, and spiritual well being.
2000BC:-Rigveda marks the beginning of Indian systems of medicine.
Medicine was considered part of Vedas or scriptures. Ayurveda, A science of
life and Art of living said to be founded by sage Atreya.Good health implies
an ideal balance between Tridoshic factors ie..Wind, Bile, Phlegm (Vata, Pitta,
and kapha) according to ayurveda.Health promotion and health education were
also emphasized by following Dinacharya.
1000BC:-Atharveda mentions the twin aims of medical sciences as health and
longevity, curative treatment hygiene, and dietetics are considered important in
treatment.Beneficial effects of milk are described.
800BC:-A codification of medical knowledge scattered through Vedas by
Bhelacalled Bhela Samhita.
700BC:-A codification of medical knowledge by Agnivesasaid to be disciple
of Atreya called Agnivesa Samhitabecame the basis of later for Charaka.
600BC:-A treatise by kasyapa mainly dealing with pediatrics.
500BC:-Chivaravastu a book written by unknown author is found. It mentions
prince Jivika,the court physician of Bimbasara,king of Magadha as a
marvelous physician and surgeon. He is credited with such difficult operations
such as piercing the skull to operate on the brain, surgery of eyes etc.and
medical treatment of dropsy, internal tumors and varicose veins.
272-236BC:-King Ashoka a convert to Buddhism built number of hospitals.
More emphasis was laid on the preventive aspects .Doctors, Nurses and

midwives were to be trustworthy and skillful. The nurses were usually men
and old women. This period saw famous medical schools at Taxila and
Nalanda
200-100BC:-Patanjali explored the yoga system of philosophy of mental and
physical discipline the starting point of yoga therapy later continued.
100BC:-Charaka samhita,the first classical exposition of Indian system of
medicine deals with almost all the branches of medicine
,anatomy,physiology,etiology,prognosis,pathology,treatment procedure and
sequence of medication and extension Materia medica for more than 600
drugs. This treatise formed the basis of the Atreya school of medicine in India
in 100AD.
The qualifications of attending nurse, enshrined in the charaka Samhita,ie
knowledge
of
preparation
and
compounding
of
drugs
for
administration,cleverness,devotedness to patient under care of both mind and
body.
200-300 AD:-Sushruta samhita appears to have been revised by
Nagarjuna,laid main emphasis on surgery. This great treatise describes
more than 300 operations ,43 different surgical processes and 121 different
types of instruments. The Materia Medicais also extensive covering
more than 650 drugs of animals,plants and mineral origin. This treatise
forms the basis of the Dhanwantri school (300AD)
500-600AD:-Vagbhata wrote Astanga Fridays,(8 limbs and heart).The
eight limbs refers to eight traditional branches of ayurvedic knowledge,ie
Therapeutics,surgery,ENT,Mental, superstitious diseases, infantile
diseases,treatment,toxicology,arresting physical and mental decay and
rejuvenation or regaining lost virility,potency,and procreative ability. This
book incorporates teachings of sages Atreya,Dhanwantri,and Rasayana
school of medicine.

600-800 AD:-Sodhala (700AD), two treatises, Gandhanigraha,a

medical treatise and Sodhala a medical lexicon.

700-800 AD, wrote MadhavaNidhana.This is a compilation from

the earlier works of Agnivesa, Charaka, Sushruta, and Vagbhata.It
is useful as chemical guide. It is the best Ayurvedic work on
diagnosis of diseases.
In 800-1300AD,a number of treatises were written in India during
the period.Arkaprakasha ,a book on tincture extraction was written.
The period also witnessed a spurt of writing on the Rasa
Chikitsa system, Rasa Hridaya by Govind vagbhata,
Rasaratnakara
by
Sidda
Nityananda,Rasaratna
Samyukta
by
Vagbhata,Rasarnava
by
sambhu,Rasendrachintamani by Ram Chandra and
rasendra choodamani by Somadeva.

 In 1300-1600AD, Bhavamisra wrote Bhavaprakasha .This is the

most renowned Indian treatise during the period. It contains an
exhaustive list of diseases and their symptoms and complete list of
drugs including many not mentioned in early works. It includes
etiology and treatment of syphilis, a disease, brought into India, by
Portuguese seamen.
In 1600 East India Company established British Rule in India:PUBLIC HEALTH IN BRITISH INDIA:-By the middle of 18th century, the British had
established their rule in India, which lasted till 1947.The significant events in the history
of public health during this period are given below.
In 1757:-the British had established their rule in Indias civil and military services were
established.
In 1825:-The quarantine act was promulgated.
In 1859:-A royal commission was appointed to investigate the causes of extremely
unsatisfactory condition of health in British army stationed in India. The commission
recommended the establishment of a Commission of public health in each presidency
and pointed out the need for protection of water supplies, construction of drains, and
prevention of epidemics in civil population for safeguarding the health of British army.
In 1864:-Sanitary commissioners were appointed in the three major provinces, Bombay,
Madras, and Bengal. The civil surgeons/District medical officers became ex-officio
district health officers.
In 1869:-A public health commissioner and a statistical officer were appointed with the
Government of India.
In 1873:-A birth and death registration act was promulgated.
In 1880:-vaccination act was passed.
In1881:-The first Indian Factories Act was passed. The first all Indian censuses was
taken.
In 1885:-The local self government, act was passed. Local bodies came into existence.
In 1888:-The Government of India directed that sanitation should be looked after by local
bodies, but no local public health staff was created to look after sanitation.
In 1896:-A severe epidemic of plague occurred in India, which awakened the government
to the urgent need of improving public health. The plague commission was appointed.
In 1897:-The epidemic diseases act was promulgated.
In 1904:-The plague commission in its report recommended the reorganization and
expansion of public health departments and establishment of laboratory facilities for
research and production of vaccines and sera.
In 1909:-The central malaria Bureau was founded at kasauli.
In1911:-The Indian research fund Association was established for promotion of
research.(now ICMR)
In 1912:-The government of India decided to help the local bodies with grants, and also
sanctioned the appointment of deputy sanitary commissioners and health officers.
In 1918:-The lady reading health school, Delhi was established.
In 1919:-The Montague Chelmsford constitutional reforms
led to the transfer of
public health, sanitation and vital statistics to the pioneer under the control of an elected
minister. This was the first step towards decentralization of health administration in India.

In 1930:-The All India Institute of Hygiene and public health, Calcutta was established
with aid from Rockefeller Foundation. The child marriage restraint act came into effect
fixing the minimum age of marriage at 14 for girls and 18 for boys.
In1931:-A maternity and child welfare Bureau was established under the Indian Red
Cross Society.
In 1935:-The Government of India act, 1935, revitalized the 1919 act, giving greater
autonomy to the provinces.
In 1937:-The central advisory board of health was set up with the public health
commissioner as the secretary and representatives from provinces and Indian states as
members to coordinate the public health activities in the country.
In 1939:-The Madras public health Act was passed, which was the first of its kind in
India. The first rural health training centre was established at Singur, near Calcutta with
aid from the Rockefeller foundation. The Tuberculosis Association of India was
established.
In 1943:-The Health Survey and development committee (Bhor committee) was
appointed by the Government of India to survey the existing position in regard to the
health conditions and health organization in country and to make recommendations for
future development.
In 1946:-The Bhor committee submitted its report. The committee recommended a short
term and a long term programme for the attainment of reasonable health services based
on concept of modern health practice.
PUBLIC HEALTH IN POST INDEPENDENCE ERA:India became independent in 1947 for the first time in Indias long history a
democratic regime was set up with its economy geared to a new concept,the
establishment of a welfare state. The burden of improving the health of the people and
widening the scope of health measures fell upon the national government.
The following changes had occurred in post independence era:In 1947:-Ministries of health were established at the centre and states. The posts of
Director general. Indian Medical service, and of public health commissioner with the
government of India were integrated in the post of Director general of health services,
who is the principal advisor to the union government on both medical and public health
matters.
In 1948;-India joined WHO as a member state. The ESI act was passed.The report of
environmental Hygiene committee was published.
In 1950:-The constitution of India came into force in 1950,and India became a republic.
The planning commission was setup by govt of India.
In 1951:-The beginning of first five year plan with a total outlay of Rs2, 356 crores.The
BCG vaccination programmes was launched in the country.
In1952:-The community development programme was launched on October 2nd 1952,for
the all around development of rural areas. Provision of medical relief and preventive
health services were part of the programme.Primary health centers were set up.
In 1953
National Malaria Control Programme was commenced as part of the first Five
year plan.
A nation wide Family planning programme was started.
A model public health act was started.

In 1954:-Contributory health service scheme was started at New Delhi.

The central social welfare board was set up
National water supply and sanitation programme was inagurated.
The national Leprosy control programme was started .
VDRL antigen production was set up in Calcutta.
The prevention of food adulteration act was passed by parliament.
In 1955:-National Filarial control programme was commenced as part of first five year
plan. The central Leprosy teaching and Research institute was established at Madras. A
Filarial training centre at Kerala was set up.
In 1956
The second five year plan was launched with an out lay of 4800 crores out of
which 225 crores were earmarked for health programmes.
Central health education bureau was established
In 1957:-Influenza pandemic swept the country.
In 1958:-The national Malaria control programme was converted to National malaria
eradication programme.
In 1959:-Mudaliar committee was appointed by Govt of India to survey the progress
made in field of health. The National Tuberculosis Institute at Bangalore was established.
In 1960:-The school health committee was constituted by the union health ministry to
assess the present standards of health and nutrition of school children and suggest ways
and means to improve them.
In 1961:-The third five year plan was launched with an outlay of Rs 7500 crores out of
which Rs 342 crores were provided for health programmes.The report of Mudaliar
committee was published.
In 1962:-the central family planning institute was established at Delhi by amalgamating
the family planning training centre and family planning communications and action
research centre.
The national small pox eradication programme was launched.
The school health programme was initiated.
The national Goiter control programme was initiated.
In1963: The applied nutrition programme was launched by the government of India with
aid from UNICEF,FAO and WHO.
Extended Family programme was launched.
The Chadha committee established a norm of one basic health worker for every
10,000 population.
National institute for communicable diseases was established.
1964: National institute for health administration and education was established in New
Delhi
In 1965:-Director ICMR recommended Lippies loop as safe and effective for a mass
programme. IUCD was introduces.
In 1966:-A committee of health secretaries under the chairman ship of
Mukherjee,secretary,ministry of health, govt of India was constituted to look into the

minimum additional staff required for the primary health centers to take over the
maintenance work of malaria and small pox.
In 1967:-A small family norm committee was set up to recommend suitable incentives to
those accepting the small family norm and practicing family planning.
In 1968:-The small family committees report was submitted. A bill of registration of
birth and death was passed by the parliament.
In 1969:-The fourth five year plan was launched, with an outlay of rupees 16,774 crores,
out of which Rs 840 crores were allocated to health and Rs 315 crores to family planning.
The central births and deaths registration act was promulgated. School health
committee was formed.
In 1970:-The drugs order was promulgated. All India hospital family planning
programme was started
In 1971:-The family pension scheme for industrial workers came into force. The medical
termination of pregnancy was submitted.
In 1972:-The MTP act came into force on April 1 st 1972.The national nutrition
monitoring bureau was set up under the Indian council of medical research with
headquarters at NIN,Hyedrabad.
In 1973:-The national programme of minimum needs was incorporated in fifth five year
plan. A provision of rupees 2803 Crores was made for this programme which covered
elementary education programme, rural health, nutrition, rural roads and water supply,
housing, slum improvement and rural electrification
The Kartar Singh committee submitted its report recommending the formation of a new
cadre of health workers designated Multi purpose health workers for the delivery of
health ,family planning, health assistants,Auxillary nurse-midwives etc.
In 1974:-The fifth five year plan was launched on april,1st 1974,with total outlay of
rupees 53,411 crores of which Rs 37,250 crores were in public sector and Rs 16,161
crores in private sector. A sum of Rs 796 crores were allotted to health and Rs516 crores
to family planning.
In 1975: The ESI act was amended.
ICDS
On July 5 th India was declared free from small pox
In 1976: Indian Factories act was amended.
The prevention of food adulteration act came into force.
National programme for prevention of blindness was formulated.
In 1977:-Eradication of small pox was declared. Rural health scheme was launched.
Goal of Health for all by 2000 came into force.
In 1978:-Expanded programme on immunization was launched. The slogan Health for
all by 2000 AD came in to force at Alma Ata Declaration.
1979: World Health Assembly endorsed the declaration of Alma Ata on primary
health care.
In 1980:-small pox was officially declared eradicated from entire world by world health
assembly on May 8th.
In 1982:-The new 20 point programme was announced. Also National health policy was
announced.

In 1983: National leprosy control programme was renamed as National leprosy

eradication programme.
National health policy was approved
Guinea worm eradication programme was launched
In1984:-Bhopal gas tragedy, the worst ever industrial accident in history occurred, on the
night of December 2/3,taking a toll of at least 3000 people and fewer than 50,000
affected.
In 1985:-seventh five year plan was launched. Universal immunization programme was
launched.
In 1986:-The environment protection act 1986 promulgated.
In 1987:-New 20 point programme was launched. National Diabetes control and AIDS
control programme was launched.
In 1989:-Blood safety programme was launched.
In 1992:-Eighth five year plan was launched.
Child survival and safe motherhood programme was launched (CSSM) on 20th
august.
First National AIDS Control Programme (1992-1999)
In1993:-Revised National Tuberculosis programme with DOTS introduced as pilot
project in the country.
In 1994: Return of plague, after 28 years of silence occurred.
PNDT (prenatal diagnostic test act) ACT
In 1995:-ICDS was renamed as Integrated Mother and Child Development services.
(IMCD)
In 1996:-Pulse polio immunization, the largest single day public health event took place
on Dec9th 1995,and 20th Jan 1996and the second phase was conducted on 7 th December
1996 and 18th Jan 1997.
In 1997:-Reproductive and child health programme was launched in place of CSSM.
Ninth five year plan was launched. Leprosy control programme was integrated with
health services.
In 1998-99:-National family health survey-2was undertaken covering 90,000 women
aged 15-49 years. National malaria eradication programme renamed as National Anti
malaria programme. During NACP-II (1999-2006)
In 2000:-Government of India announced National population policy-2000.
In2001:-India stages first census of the century.
In 2002:-National health policy was announced. Tenth five year plan was launched.
Emergence of SARS.
In 2003:-Parliament approves the cigarettes and other Tobacco products.
National vector borne disease control programme approved as Umbrella
programme for prevention of vector borne diseases viz..Malaria, Filaria, kalaazar, dengue and Japanese encephalitis.
Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was
created in March,1995 and re-named as Department of Ayurveda, Yoga &

Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003 with

a view to providing focused attention to development of Education & Research in
Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy systems .
In 2004: Vandemataram scheme was launched.
Revised programme of Nutritional support to primary education (mid day meal
scheme) was launched.
Integrated Disease Surveillance Project (IDSP) was launched by Honble Union
Minister of Health & Family Welfare in November 2004
In 2005:-RCH-II was launched
-Janani suraksha yojana was launched
-National Rural health mission (NRHM)was launched, ASHA scheme
-India achieved leprosy elimination target by end of 2005.
Health Statistics Information Portal
In 2006;-WHO released new pediatric growth chart based on breast fed children.
-Ban on child labor as domestic servant
-RNTCP covers whole country since March 2006.
2007: Eleventh five year plan

Historical development of community health nursing in India

Pre- independence
Military nursing
Military nursing was the earliest type of nursing. In 1664 the East India Company started
a hospital for soldiers in a house at Fort St.George, Madras. The first sisters were sent
from St Thomas' Hospital, London to this military hospital.
Maternity
In 1797 a Lying-in-Hospital (maternity) for the poor of Madras was built with the help of
subscriptions by Dr.John Underwood. In 1854 the Government sanctioned a training
school for midwives in Madras.
Florence Nightingale

Florence Nightingale was the first woman to have great influence over nursing in
India and had a close knowledge of Indian conditions, especially army. She was

interested in the nursing service for the civilian population, though her first
interest was the welfare of the army in India.
In 1865, Miss Florence Nightingale drew up some detailed "Suggestions on a
system of nursing for hospitals in India". Graduates were sent out from the
Nightingale School of Nurses at St.Thomas Hospital, England to start similar
schools in our country. St Stephens Hospital at Delhi was the first one to begin
training the Indian girls as nurses in 1867.

Training schools

In 1871, the first School of Nursing was started in Government General Hospital,
Madras with 6 months Diploma Midwives program with four mid-wife students.
Four lady Superintendents and four trained nurses from England were posted to
Madras. Between 1890 and 1900, many schools, under either missions or
government, were started in various parts of India. In the yearly twentieth century,
National Nursing Associations were started.
In 1897, Dr. B. C. Roy did great work in raising the standards of nursing and that
of male and female nurses.

The 20th century

In 1908, the trained nurses association of India was formed as it was felt
necessary to uphold the dignity and honor of the nursing profession.
In 1918, training schools were started for health visitors and dais, at Delhi and
Karachi (The lady reading health school, Delhi ).Two English nurses Miss Griffin
and Miss Graham were appointed to give training to and to supervise the nurses.

In 1926, Madras State formed the first registration council to provide basic
standards in education and training. The first four year basic Bachelor Degree
program were established in 1946 at the college of nursing in Delhi and Vellore.

With the assistance from the Rockfeller Foundations, seven health centers were
set up between 1931 - 1939 in the cities of Delhi, Madras, Bangalore, Lucknow,
Trivandrum, Pune and Calcutta.

Post independence

In 1947, after the independence, the community development programme and the
expansion of hospital service created a large demand for nurses, auxiliary nurse
midwives, health visitors, midwives, nursing tutors and nursing administrators.
The Indian Nursing Council was passed by our ordinance on December 31, 1947.
The council was constituted in 1949.

In 1956, Miss Adrenwala was appointed as the Nursing Advisor to Government of India.
The development of Nursing in India was greatly influenced by the Christian
missionaries, World War, British rule and by the International agencies such as W.H.O.
UNICEF, Red Cross, UNSAID etc. Indian nursing council recommended all states that
health visitors training should be discontinued and to integrate public health nursing in
the basic nursing curriculum.

The first masters degree course, a two-year postgraduate program was begun in
1960 at the College of Nursing, Delhi. In 1963, the School of Nursing in
Trivandrum, instituted the first two years post certificate Bachelor Degree
program.

The associations such as International Council of Nurses, the nurses auxiliary of

the CMA of India, T.N.A.I. Indian nursing council and State level Registration
Council are closely connected with promotion and the upliftment of the nursing
profession.

In 1961: Mudiliar committee recommended for replacement of partially trained

lady health visitors by public health nurse in order render efficient care. Health
visitors used to supervise ANM and train dai and now this work is purely done by
MPHW.
In 1963 Chadah committee recommended to replace unipurpose workers as ANM
In 1973 The Kartar Singh committee submitted its report recommending the
formation of a new cadre of health workers designated Multi purpose health
workers and to train nurses for 18 months for the delivery of health ,family
planning in place of health assistants, Auxiliary nurse-midwives etc.

In 1963 MPHW Chadha Committee recommended for the replacemetn of unipurpose

workers as ANM and in.
1973 Kartar Singh committee recommended to replace AHM as female health worker or
male health worker and to train nurses for 18 months.
In 1977 under rural health scheme multi purpose health worker scheme was started; from
that time onwards the name ANM was replaced by MPHW male/female. MPHW was
mostly looked after by mother and child health ,family welfare and the Immunization
services.
Later various orientational refreshes courses have been organised from time to time and
more colleges of nursing were started which was offering the graduate, post graduate
courses which includes the public health nursing as 1/3 of its total educational programme
is also recommendation by Indian nursing council.
1977 INC revised curriculum for ANM in order to prepare candidates with high school
certificate as health workers, subsequently more colleges of nursing come up eg:
Hyderabad, Indore, Bombay, Jaipur.
In 1982 W.H.O expert committee meeting in Geneva on training of nurses teachers has also
emphasized on primary health care concept.

In 1983 common wealth nurses federation south Asian sector conducted a seminar on role
of nurse in delivery primary health care. TNAI has initiated various programmes on
primary health care at national & regional level.
By the evolvement of HFA concept the emphasis is shifted from the disease oriented care
model to the community oriented health care model in nursing education.

1987 High power committee was appointed on nurses working condition &
related matters. Recommendations of high power committee on nursing and nursing
profession for community nursing services

The committee recommends that Gazetted ranks be allowed for nurses working as
ward sister and above (minimum class II gazetted). Similarly the post of Health
Supervisor (female) is allowed gazetted rank and district public health nurse be
given the status equal to district medical/ health officers.
Community nursing services

Appointment of ANM/LHV to be recommended.

ANM/LHV promoted to supervisory posts must undergo courses in administration
and management.
Specific standing orders are made available for each ANM/LHV to function
effectively in the field.
Adequate provision of supplies, drugs etc are made.
Recording system be simplified.
Posts of public health nurses and above are given gazetted status.
Recommendations nursing staff for community nursing services

1 ANM for 2500 population (2 per sub centre)

1 ANM for 1500 population for hilly areas

1 health supervisor for 7500 population (for supervision of 3 ANM's)

1 public health nurse for 1 PHC (30000 population to supervise 4 Health

Supervisors)

1 Public Health Nursing Officer for 100000 populations (community

health centre)

2 district public health nursing for each district.

2005: Conducting Training for ANMS, LHVS and Staff Nurses as a Skilled Birth
Attendant was initiated through NRHM and the S.B.A module was released through

INC. Basic health activities are helped out by training ASHA workers through
NRHM.

General functions of Community Health Nurse:

The community health nurse also plays he same as she is offering in
hospital as administrates, managers, educator, researcher ,supervisor,
teacher etc., It is expected to have one nurse per 2000 population in
order to provide comprehensive nursing services. She provides basic,
promotive, preventive, curative and rehabilitative services directly to
the community. The specific nursing activities which are performed by
the community nurse will vary according to community needs and
prevailing health problems and the number of staff working in her area,
transportation facilities available etc.,She is prepared to give specific
and generalised services in home, industry and schools. The
educational experience and the attitude of community health nurse also
influences her activities in community.
In general community health nurse carries out the following functions:
1.Planning, identifying, execution and evaluation of care.
2.Providing comprehensive care to the individuals, families and groups by
teaching, counselling and guidance.
3.Demonstrates and teaches skilled nursing care to family members of
sick, chronically ill in the home.
4.Cares for the chronically ill, handicapped & disabled in the community.
5.Provides assistance to the families in improving environmental
conditions.
6.Helps the families in the adjustment of social, emotional aspects of
health.
7.Provides preventive health care services like immunization,
supplementary nutrition.
8.Renders treatment and follow up care of mentally ill & elderly people as
both of these groups or intended to become increasingly community
based rather than which hospital based.
9.Development and utilisation of other branches of health for welfare of
community.

10. Organising, planned group classes regarding the sanitation, nutrition,

child care , family welfare services and parent craft to the various
members in the community.
Supervises the work of MPHW health visitors and dias.
11. Conducts epidemiological investigations in the field of communicable
disease such as TB, sexual transmitted diseases & leprosy etc.,
12. She co-ordinates her work with other member of health team working
in the community.
13. She revises the plans, programmes in her area and collect the vital
statics, conducts research to study the existing health problems, evali
effectiveness of various health problems in order to standardized.
16.She trains & conducts orientation and inservice training classes in her
area to the nursing students and other nursing staff.
17.She acts as a co-ordinator between individuals of the community
18.She acts as a consultant and talks on behalf of the individual or family
with village leaders and other members of the health team.
19.She plans the budget ,gets the equipment required, organises primary
health centre and to its associated health centres.
20.She manages various health programs & campaigns in her area.
21.She acts as a administrator at different levels of the community health
nursing services to evaluate and puts all possible trials into practice to
improve quality & quantity of care to the total community.
Specialised functions of community health, Nurse:
It includes in areas of maternal health, family welfare, child health,
school health, communicable diseases control, geriatrics, chronically ill
and industrial health etc
Role of nurse in giver maternal health services:
Antenatal period:
Contacts every expected mother in the early pregnancy and help her to
seek adequate antinatal care.
Observe antenatal visits schedule strictly.
In community every pregnant women is expected to have minimum of
5 visits by the nurse and 3 visits by the doctor at home if not a

pregnant women can go for primary health visits one month till 8th
month and once in 15 days till 9 month and once in a week there after.
Antenatal mother should receive minimum of 100 iron and folic
tablets during her pregnancy and injection TT I st dose as soon as
pregnancy is confirmed.
She should identify high risk pregnancy cases like the hypertension,
diabetics by doing thorough check up at home she should educate
pregnant women regarding diet, antenatal exercises, importance of
rest and sleep, care of the new born, breast feeding techniques.
She tries to promote for institutional delivery .She prepares the
mother physically and psychologically for delivery; keeps the
equipment ready for conducting the delivery.
She maintains adequate and accurate records of the expectant
mothers in the community.
She prepares the couple for planned parent hood.
During Labour:
Keeps the necessary equipment ready
She prepares place for conducting delivery
She prepares mother for delivery by cleaning private parts, gives
enema, examines position of foetus and the foetal heart sounds and
uterine contractions.
Observes dilatation of the cervix, general condition of the mother,
records the time of the ruputure of membranes.
Identifies obstetrical emergencies like card prolapse, prolonged labour
and refers the cases immediately.
Conducts the delivery in a clean way, inspects the placenta for any
abnormalities.
Provides immediate care for new born baby and takes care of the
mother.
Reports the birth of baby to registration dept.
Post Partum Care:
She gives care to the mother and baby at home
She teaches about care of the perineum, observes and corrects food
intake (consume)
Checks the general condition of the mother and baby.

 Educates the importance of colostrum, breast feeding techniques, and

early ambulation.
She emphasis on importance of immunisation of new born baby.
Role of community health nurse in school health service:
School health services refers to the initiation, maintenance,
improvement of health of school children and personnel. School health
nurse has an important role in providing school health services. They
include:
1. Health examination: Periodic medical examination & observation and
organising periodic medical check-up by physicians helps to identify
the abnormalities in the children at early stage. She refers the cases and
thus follows visits in the school.
2. She takes steps to prevent spread of communicable diseases among the
students
She maintains the records of health for all students
She conducts immunization services for various common
communicable diseases at school
She participates in organisation of various health campaigns
organised by traditional medical practitioner.
She render first aid care for all the students if they become sick or
injured in school premises like the accidents , epilepsy, fainting etc.,
She maintains a hygienic school environment specially at drinking
and eating places.
She provides for improving environmental sanitation and promotes
students for pollination.
She plays an important role in providing nutrition.
She participates in mid day meal programme or the nutrition
programme or she may distribute specific nutrient or supplement
nutrition like Hyderabad mix to the children.
The topics she may include are personal hygiene , dental hygiene,
healthy school environmental, importance of well balanced diet etc.
She tries to guide and counsel the children who has problem with
school environment or children with the behavioural problems like
drug addiction, non-obedience , long abscentism, juvenile
deliquency.
Role of Nurse in Immunization services:

 She informs people regarding immunization schedule.

She tries to overcome the misconcepts of the public like regarding
immunization.
She organises immunization session which is convenient to the
community in reference to place and time.
She assess the whole community to know the number of children who
require vaccination, immunization, no. of defaullers and reasons for it
so that she can calculate the drug or vaccines required for each session.
She conducts the immunization session by maintaining strict cold chain
and by giving the vaccine with proper technique for
eg: DPT 0.5 ml I/M
BCG I/D 0.5 ml
Not conducting immunization session directly under the sun , and not
keeping vaccine carriers under the sun.
Keeping the drug on the ice packs while immunization, maintaining
proper temperature between 2-8C by storing vaccines etc., in order to
maintain potency.
She teaches the care which the mother has to take during immunization
like not to apply hot fomentations on the BCG or DPT vaccination.
She follows strict aseptic techniques while immunization and follows
instructions of manufactures & physician regarding dosage and mode
of administration.
eg: Giving polio vaccine after checking for potency.
She observes for any side effects or reactions after the immunization
session.
She maintains the record of immunization for each child which
includes details like name , age, sex vaccination, name & dose of
vaccine and due date.
She makes the community to follow the students of the immunization
for their child.
She sends report to the medical officer on utilisation of the
immunization and any reactions formed.
Role of Nurse in industrial nursing:

 She plays a major role in pre and periodical examination

of the employees.
Provides care to the sick and injured
Maintains health records
Gives health education to change the behavior

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SBA
WHO defines a skilled attendant as an accredited health professional such as a
midwife, doctor or nurse who has been educated and trained to proficiency in the skills
needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate
postnatal period, and in the identification, management and referral of complications in
women and newborns?
During pregnancy, skilled attendants monitor the progress of the pregnancy, detect
complications, provide preventive measures, develop birth and emergency plans with the
woman and her family and advise women on health, lifestyle and nutrition in pregnancy.
During childbirth, skilled attendants monitor the progress of labour, are vigilant for
complications and stay with the women and support them in many ways. They know how
to manage abnormalities such as breech delivery and, in a team of various professionals
with obstetric, neonatal and anaesthesia skills, they deal with complications as severe as
eclampsia or obstructed labour.

In the postnatal period, the range of care varies from helping mothers and babies in
breastfeeding to managing complications such as severe postpartum bleeding, infection
or depression. If babies have problems either because of preterm birth or complications of
birth, they receive timely and appropriate treatment. Skilled attendants also provide
counselling on postnatal contraception to the mothers.
Preventing the mother-to-child transmission of HIV is another task of skilled attendants.
It starts in pregnancy with HIV testing, providing antiretroviral therapy, counselling on
infant feeding and advising on safer sex practices including the use of condoms and
continues in childbirth by choosing appropriate obstetric practices and supporting the
mother in her choice of feeding the baby and family planning counselling.
(5) The world health report 2005 Make every mother and child count. Geneva, World
Health Organization, 2005 (http://www.who.int/whr/2005/en, accessed 14 August 2008).

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