COMMUNITY HEALTH NURSING-II

IV-B.Sc. (N)
LONG ESSAY
1. Write the objectives of national health programme? Explain national programme for
control of blindness.
&
2. A) List out the causes of blindness
B) Write in detail about the NPCB
Ans:
Objectives:
 Reduction of infant mortality and maternal mortality.
 Universal access to public health services such as women’s health, child health, drinking
water, sanitation and hygiene, nutrition and universal immunization.
 Prevention and control of communicable and non-communicable diseases.
 Population stabilization, gender & demographic balance.
 Access to integrated comprehensive primary health care.
 Promotion of healthy lifestyles.
NPCB:
Introduction
National Programme for Control of Blindness and Visual Impairment (NPCB&VI) was
launched in the year 1976 as a 100% centrally sponsored scheme (now 60:40 in all states
and 90:10 in NE States) with the goal of reducing the prevalence of blindness to 0.3% by
2020. Rapid Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed
reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07).
 Prevalence rate of blindness and targets
Prevalence of Blindness - 1.1%. (Survey 2001-02).
 Prevalence of Blindness - 1. %. (Survey 2006-07).
 Current Survey (2015-18) in progress. The projected rate of prevalence of blindness is
0.45%.
 Prevalence of Blindness target - 0.3% (by the year 2020).
Main Causes of blindness
Cataract (62.6%) Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%),
Surgical Complication (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment
Disorder (4.70%), Others (4.19%) Estimated National Prevalence of Childhood Blindness /Low
Vision is 0.80 per thousand.
Main objectives:
 To reduce the backlog of avoidable blindness through identification and treatment of
curable blind at primary, secondary and tertiary levels, based on assessment of the overall
burden of visual impairment in the country;
 Develop and strengthen the strategy of NPCB for “Eye Health for All” and prevention of
visual impairment; through provision of comprehensive universal eye-care services and
quality service delivery;
 Strengthening and up-gradation of Regional Institutes of Ophthalmology (RIOs) to become
centre of excellence in various sub-specialities of ophthalmology and also other partners
like Medical College, District Hospitals, Sub-district Hospitals, Vision Centres, NGO Eye
Hospitals;
 Strengthening the existing infrastructure facilities and developing additional human
resources for providing high quality comprehensive Eye Care in all Districts of the country;
 To enhance community awareness on eye care and lay stress on preventive measures;
 Increase and expand research for prevention of blindness and visual impairment;
 To secure participation of Voluntary Organizations/Private Practitioners in delivering eye
Care.
NPCB Programme strategy
 Setting up of more PHC/Vision Centres to broaden access of people to eye care facilities.
 To extend financial support to NGOs for treatment of other eye diseases like Diabetic
Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation,
Vitreoretinal Surgery, Treatment of Childhood Blindness, free of cost to poor people.
 Integration of existing ophthalmic surgical/ non-surgical facilities in each district, State by
associating few units to next higher unit.
 Inclusion of modern ophthalmic equipment in eye care facilities to make it more versatile to
meet modern day requirement.
 Upgradation of software for Management Information System for better implementation and
monitoring and monitoring.
 Digitalization of eye care services – IEC messages, whats app. Groups for stakeholders etc.
 Provision for setting up Multipurpose District Mobile Ophthalmic Units in District Hospitals
for better coverage.
 3. LIST THE OBJECTIVES OF RNTCP? EXPLAIN THE DISTRICT
TUBERCULOSIS CONTROL PROGRAMME?
Ans:
Introduction:
The Revised National TB Control Programme (RNTCP), based on the internationally
recommended Directly Observed Treatment Short-course (DOTS) strategy, was launched in 1997
expanded across the country in a phased manner with support from World Bank and other
development partners. Full nation-wide coverage was achieved in March 2006. In terms of
treatment of patients, RNTCP has been recognized as the largest and the fastest expanding TB
control programme in the world. RNTCP is presently being implemented throughout the country.
Under the programme, diagnosis and treatment facilities are provided free of cost to all TB
patients. For quality diagnosis, designated microscopy centres have been established for every one
lac population in the general areas and for every 50,000 population in the tribal, hilly and difficult
areas. More than 13000 microscopy centers have been established in the country. Free treatment
services are available for TB at all Government hospitals, Community Health Centers (CHC),
Primary Health Centers (PHCs). DOT centers have been established near to residence of patients
to the extent possible. All public health facilities, subs centres, Community Volunteers, ASHA,
Women Self Groups etc. also function as DOT Providers/DOT Centers.
Goal of the programme:
The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut
transmission of infection until TB ceases to be a major public health problem in India.
Objectives of the programme:
 To reduce the incidence and mortality due to TB
 To prevent further emergence of drug resistance and effectively manage drug-resistant TB
cases
 To improve outcomes among HIV-infected TB patients
 To involve private sector on a scale commensurate with their dominant presence in health
care services
 To further decentralize and align basic RNTCP management units with NRHM block level
units within general health system for effective supervision and monitoring
Unique features of RNTCP
 District TB Control Society
 Modular training
 Patient wise boxes
 Sub-district level supervisory staff (STS, STLS) for treatment & microscopy
 Robust reporting and recording system
Strategies
 Case finding and Diagnostics- Use of sputum testing as the primary method of diagnosis
 Patient friendly treatment services and ensuring a regular, uninterrupted supply of drugs up
to the most peripheral level-DOTS
 Scale-up of Programmatic Management of Drug Resistance –TB (PMDT)
 Scale -up of Joint TB-HIV Collaborative Activities
 Integration with Health Systems
 Structure of RNTCP laboratory network
3 tier system

National Reference Labs (NRL): 6 NRLs at present

 Tuberculosis Research Centre (TRC), Chennai

 National TB Institute, Bangalore
 LRS Institute of TB and Respiratory Diseases, New Delhi and
 JALMA Institute, Agra
 Regional Medical Research Centre, Bhubaneswar and
 Bhopal Memorial Hospital and Research Centre, Bhopal

Intermediate Reference Labs: At State TB Training and Demonstration Centres (STDCs)

Designated Microscopy Centres (DMCs): At the periphery

 Each NRL will supervise sputum microscopy EQA of states designated under them
 The NRL will ensure proficiency of RNTCP staff for carrying out good quality diagnosis by
providing technical training to the STOs, STDC Directors, Microbiologists and Lab
Technicians of States

 The states will designate 1 IRLs in the STDC or Medical Colleges or in any Public Health
Laboratory of the State

 The designated IRL will conduct sputum microscopy EQA for the state and occasionally for
a neighbouring state or union territory

 The IRL will provide technical training to district and sub-district technicians and STLS
DOTS
“Directly Observed Treatment Short Course”
DRUGS USED IN DOTS:
 ISONIAZID
 RIFAMPICIN
 PYRAZINAMIDE
 ETHAMBUTOL
 STREPTOMYCIN
 COMPONENTS OF DOTS
 Political and administrative commitment
 Good quality diagnosis, primarily by sputum smear microscopy
 Uninterrupted supply of quality drugs
 Directly observed treatment (DOT)
 Systemic monitoring and accountability
Recommendations
 Strengthening and improving the quality of basic DOTS services
 Further strengthening and alignment with health system under NRHM
 Deploying improved rapid diagnosis at the field level
 Expand efforts to engage all care providers
 Strengthen urban TB Control
 Expand diagnosis and treatment of drug resistant TB
 Improve communication and outreach
 Promote research for development and implementation of improved tools and strategies.
 Govt of India had declared Tuberculosis as a notifiable disease on 7th May 2012. All
public and private health providers shall notify TB cases diagnosed and/or treated by them
to the nodal officers for TB notification

4. List the main objectives of ICDS? Explain the delivery of services rendered to mother
& children through ICDS programme?
Ans:
The Integrated Child Development Service (ICDS) Scheme providing for supplementary
nutrition, immunization and pre-school education to the children is a popular flagship programme
of the government. Launched in 1975, it is one of the world’s largest programmes providing for an
integrated package of services for the holistic development of the child. ICDS is a centrally
sponsored scheme implemented by state governments and union territories. The scheme is
universal covering all the districts of the country.
The Scheme has been renamed as Anganwadi Services.
Objectives

 To improve the nutritional and health status of children in the age-group 0-6 years;
 To lay the foundation for proper psychological, physical and social development of the
child;
 To reduce the incidence of mortality, morbidity, malnutrition and school dropout;
 To achieve effective co-ordination of policy and implementation amongst the various
departments to promote child development; and
 To enhance the capability of the mother to look after the normal health and nutritional
needs of the child through proper nutrition and health education.
Beneficiaries

 Children in the age group of 0-6 years

 Pregnant women and
 Lactating mothers

Services under ICDS

The ICDS Scheme offers a package of six services, viz.

 Supplementary Nutrition
 Pre-school non-formal education
 Nutrition & health education
 Immunization
 Health check-up and
 Referral services

Three of the six services viz. immunization, health check-up and referral services are related to
health and are provided through National Health Mission and Public Health Infrastructure. The
services are offered at Anganwadi Centres through Anganwadi Workers (AWWs) and Anganwadi
Helpers (AWHS) at grassroots level.

The delivery of services to the beneficiaries is as follows:

Services Target Group Service provided by

(i) Supplementary Children below 6 years, Anganwadi Worker and Anganwadi Helper
Nutrition Pregnant & Lactating (Ministry of Women and Child
Mothers (P&LM) Development (MWCD))

(ii) Immunization* Children below 6 years, ANM /MO

Pregnant & Lactating Health system, Ministry of Health and
Mothers (P&LM) Family Welfare (MoHFW)

iii) Health Check-up* Children below 6 years, ANM/MO/AWW

Pregnant & Lactating (Health system, MHFW)
Mothers (P&LM)

(iv) Referral Services Children below 6 years, AWW/ANM/MO

Pregnant & Lactating (Health system, MoHFW)
Mothers (P&LM)

v) Pre-School Children 3-6 years AWW

Education (MWCD)

(vi) Nutrition & Health Women (15-45 years) AWW/ANM/MO

Education (Health system, MoHFW & MWCD)
* AWW assists ANM in identifying the target group.
FUNDING PATTERN

 All components of ICDS except Supplementary Nutrition Programme (SNP) are financed
through a 60:40 ratio (central: state). The Supplementary Nutrition Programme (SNP)
component was funded through a 50:50 ratio. The North East states have a 90:10 ratio.
 Under SNP, beneficiaries are given hot meals along with take-home rations. For children,
the quantum of rations and meals received depends on their malnutrition levels. SNP is
provided for 300 days at the rate of Rs 8 per day for children and Rs 9.50 per day for
pregnant and lactating mothers. Severely malnourished children are allocated Rs 12 per
day. Adolescent Girls (11-14 years out of school) are allocated Rs 9.50 per day.
 All AWCs are also given the following

 Medicine Kit - AWCs - Rs 1,500/- per annum, Mini-AWC - Rs 750/- per annum.
 Pre-School Kit/ ECCE (including Training) - Rs 5,000/- per AWC/Mini-AWC per annum
(including the cost of PSE Kit, Activity Book, etc.)
 Administrative Expenses - AWCs - Rs 2,000/- per annum; Mini-AWCs - Rs 1,000/- per
annum
 IEC - AWCs Rs 1,000/- per annum
 Rent (per month) - AWCs/Mini-AWCs - Rural/Tribal - Rs 1,000, Urban - Rs 4,000,
Metropolitan - Rs 6,000
 Maintenance of building (for Government owned AWC buildings only) - AWCs/Mini-
AWCs - Rs 3,000/- per annum.
 Monitoring &Evaluation - AWCs/Mini-AWCs - Rs 1,500/- per annum.
 Equipment/Furniture (once in 5 years) - AWCs - Rs 10,000/-, Mini-AWCs - Rs 7,000/- to
cover the cost of water filter for serving safe clean water, furniture, equipment, etc.
 Flexi Fund - Rs 1,000/- per annum for disaster and naxal affected AWCs.

 For AWWs and AWHs

 The AWWs and AWHs are paid fixed honorarium per month as decided by the
Government from time to time. With effect from October, 2018, the AWWs and
AWHs are paid honoraria of Rs.4, 500/- per month and Rs.2250/- per month. Workers
of Mini-Anganwadi Centres are being paid honoraria of Rs.3500/- . In addition,
monthly performance linked incentive of Rs.250/- is also being paid to Anganwadi
Helpers for facilitating proper functioning of Anganwadi Centres (AWCs). Apart from
these, additional amount of honoraria is also paid by most of the State Governments
/UT Administrations from their own resources.
 AWWs and AWHs are provided a uniform (saris) in kind or cash (an honorarium of Rs
400) every year.
POPULATION NORMS FOR SETTING UP OF AWCs/MINI-AWCs

 There will be 1 Anganwadi centre (AWC) for population of 400-800; 2 AWCs for 800-
1600; 3 AWCs for 1600-2400 and thereafter in multiples of 800 -1 AWC.
 The norms for one AWC for Tribal/Riverine/Desert, Hilly and other difficult areas will be
300-800
 Norms for one Mini AWC will be 150-400.
 Norms for Anganwadi on Demand (AOD) - Where a settlement has at least 40 children
under 6 years of age but no AWC

5. DEFINE RCH PROGRAMME? EXPLAIN THE ROLE OF NURSE RCH PHASE

II?

Ans:
RCH Approach:
People have the ability to reproduce and regulate their fertility, women are able to go through
pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and
infant survival and wellbeing, and couples are able to have sexual relations, free of fear of
pregnancy and of contracting diseases.
RCH PHASE-I:
The programme was formally launched on 15th October 1997.
RCH PACKAGE COMPONENTS:
 FAMILY PLANNING
 Prevention and management of RTI/STDs/AIDS
 Child survival and safe motherhood
 Client approach to health care
RCH PHASE –II
Is Begun From 1st April 2005 Which Mainly Focused On reduce the maternal & child mortality
and morbidity with emphasis on rural health care. The major strategies are,
a) Essential obstetric care
 Institutional delivery
 Skilled attendance at delivery
 Policy decisions
b) Emergency obstetric care
 operationalizing first referral units
 Operationalizing PHCs and CHCs for round clock delivery services.
c) Strengthening of referral system
Role of a nurse in RCH programme
a) Essential obstetric care:
 To promote institutional delivery 50% of PHC and CHC would be made operational as 24
hours delivery centre
 For MOs/ANMs/LHVs–provide guidelines for conducting normal delivery and
management of obstetric complications
b) Emergency obstetric care:
 24 hrs delivery services including normal and assisted deliveries
 EmOC including surgical interventions like caesarean section.
 New-born care
 Emergency care of sick children.
 Full range of family planning services including laparoscopic services.
 Safe abortion services
 Treatment of RTIs/STIs.
 Blood storage facility
 Essential lab services
 Referral (transport) services.
c) Strengthening of referral system:
 Funds were given to panchayat for providing assistance to poor people in case of
obstetric emergencies.
 Involvement of local self-help groups, NGOs and women groups.
d) Medical and nutritional care to severe acute malnutrition children under 5 years of
age.
The services provided:
 24 hrs care and monitoring of the child
 Treatment of medical complications
 Therapeutic feeding
 Sensory stimulation and emotional care
 Counselling on appropriate feed, care and hygiene
 Demonstration and practice by doing of energy dense food
 Social assessment of family
 Follow-up of the children discharged from the facility.
e) Plan IEC to propagate the information on the special health services & scheme
Which include:
 JANANI SURAKSHA YOJANA scheme
 VANDEMATARAM scheme
 SAFE ABORTION SERVICES
 JANANI-SHISHU SURAKSHA KARYAKRAM (JSSK)
 IMNCI services
 6. Define epidemiology? Describe surveillance activities in India to control malaria
&HIV/AIDS.
Ans:
Definition:
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns
and determinants of health and disease conditions in defined populations.
Surveillance activities to control malaria:
Objectives of malaria surveillance:
a. Malaria surveillance is an integral part of Primary Health Care system
‘The disease load’ or ‘disease potential’ of malaria in the community is governed by
different parameters such as “infected persons”, ‘susceptible persons’, and “vector and
environmental conditions”. Although the case detection and its treatment is not the end of
all endeavors, early detection of a case and its radical treatment would reduce the risk of
infecting vector mosquitoes and thus reducing transmission of malaria in the community.
The timely collection and examination of blood smear is the key element in the National
Malarial Control Strategy. If all the detected cases are given radical treatment early, it will
certainly lead to depletion of the human reservoir of malaria parasite in the community.
 Fortnightly Domiciliary visits: Components of the activities under the active case
detection during fortnightly visits are:
 Search for a fever case or who had fever in between the visits of
MPW(multipurpose worker)
 Collection of blood smear from such cases
 Administration of appropriate anti-malarial(s)
 Fever Treatment Depots (FTDs): To avoid delay in detection of cases which
occur in between visits of MPW, it can be supplemented with establishment of
Fever Treatment Depots in villages especially in areas which are remote/
inaccessible and have low population density.

 Blood smear collection is important: Blood smear collection is necessary to have

parasite confirmation, especially in view of the fact that large areas in the country
have predominant infection with P.falciparum. There are some areas with poor
therapeutic efficacy of the chloroquine or sulfadoxine-Pyremethamine against
P.falciparum. In these areas, treatment is done with alternative drug regimen for
P.falciparum cases on microscopic confirmation of the diagnosis.
 b. Passive Case Detection (PCD): All the fever cases attending the hospital should be screened
for malaria and given presumptive treatment. In addition this is to be carried out at the village
level by voluntary workers drawn from local residents or voluntary agencies operating
locally or Anganwadi workers, private practitioners etc. it is of utmost importance that
passive collection of blood smears from fever case should be increased.
c. Rapid Fever Survey: In case of an epidemic outbreak, every village in the suspected
epidemic zone is covered in a short duration by deploying additional man power. House to
house visits are undertaken and all fever cases are screened by taking blood smears. These
blood smears are to be examined at the earliest preferably at a temporary field laboratory at
the village level.
d. Mass survey: As an alternative to Rapid Fever Survey, mass survey of the entire
population may be carried out in the suspected epidemic zone. Here all the population
irrespective of age, sex or fever status is screened by taking blood smear. Especially
children must be included in survey.

e. Drug Distribution Centre (DDC): Volunteers identified for running DDCs should be
imported one-two day induction/ orientation training in identification of fever cases,
administration of presumptive treatment, promotion of preventive measures like distribution
& impregnation of bed nets, larvivorous fish, source reduction etc. for vector control.
Surveillance activities to control HIV/AIDS:
Objectives of HIV/AIDS surveillance:
 To monitor trends in the prevalence of HIV infection over time by geographic & socio-
demographic parameters.
 To assess the prevalence of HIV infection in different population subgroups &
geographical areas.
 To identify groups or geographical areas for targeted intervention efforts (national, district,
local).
 To assist with public health decision-making.
 To target and prioritize prevention & care programmes.
  To monitor & evaluate prevention & care programmes.
 To generate data for use in HIV estimates and projections.
 To guide scientific research.
7. Describe briefly the general measures to control communicable diseases in India.
Discus the role of nurse in prevention and control of malaria.
Ans:
A communicable disease is one that is spread from one person to another through a variety
of ways that include: contact with blood and bodily fluids; breathing in an airborne virus; or by
being bitten by an insect.
List of some of the communicable disease & its preventive strategy:
a. Chicken pox: Through inhalation of airborne droplets & direct contact of weeping lesions
& contaminated linens.
Prevention: Mask patient. Provider should avoid contact if they’ve never had chicken pox.
Vaccination now available (1995) and part of childhood immunizations. Pt isolated until all
lesions crusted over and dry.
b. Common cold (viral rhinitis): Direct contact, airborne droplet, contaminated hands and
linens.
Prevention: Hand washing
c. Conjunctivitis (pink eye): Contact with discharge or upper respiratory tract of infected
persons (fingers, clothing, eye make-up). Communicable during course of active infection.
Prevention: Good personnel hygiene. Daily laundering of bed linens including pillowcase
and towels. Use wash cloth on unaffected eye first and then launder after use. No school
during acute stage. Treat with antibiotic eye medications.
d. Hepatitis: Inflammation of the liver due to multiple causes (virus most common)
Prevention: Most important is avoidance of contact with blood and body fluids of all
persons.
e. Hepatitis A: Infectious or viral transmit through fecal-oral route. Virus lasts on hands about
4 hours. More comm. latter half of incubation & most during 1st week of symptoms.
Prevention: Vaccines in active areas (active immunity). Good handwashing.
f. Hepatitis B: serum hepatitis transmit through direct contact (blood, semen, vaginal fluid,
saliva). Can become asymptomatic chronic carrier capable of transmitting disease to others.
Prevention: Vaccination 90% effective. Virus stable on surfaces with dried blood for 7
days.
g. Hepatitis C: Leading cause of cirrhosis & liver cancer. Contact with infected blood
primarily with IV drug use & sexual contact.
Prevention: Since 1989 screen blood for HCV. No vaccine due to high mutation rate.
h. HIV: A virus that attacks the immune system & causes AIDS (a collection of signs &
symptoms)
Prevention: Universal standard precautions Death is usually from the opportunistic
diseases that take advantage of the patient’s weakened systems.
i. Influenza (flu) Viral disease: Direct contact especially in crowded areas via airborne. The
virus can persist on surfaces for hours but indirect contact is less common. Contagious 1
day prior to being sick up to 3-7 days after 1st symptom
Prevention: Vaccination available annually; most effective if received from September to
mid-November. Treatment is symptomatic (rest, fluids, OTC med for fever &aches)
j. Measles (rubeola, hard measles): Inhalation of infective droplets & direct contact. Highly
communicable virus mostly before prodromal starts (early or impending disease time), to
about 4 days after rash appears.
Prevention: Handwashing critical. MMR vaccination part of childhood program.
k. Meningitis: Inflammation of meninges caused by bacteria & viruses. Respiratory droplets;
contact with oral secretions, crowding, close contact, smoking, lower socioeconomic status.
Viral meningitis can also be spread via contact with faces of infected person.
Prevention: Practice good handwashing. Mask for pt and self. Universal precautions. Post
exposure antibiotics started within 24 hours. Vaccination now part of childhood series
(Haemophilus influenza type B).
l. MRSA (methicillin resistant staphylococcus aureus): Usually spread from infected
patients via hands of HCW & inanimate objects (B/P cuff, stethoscope).
Prevention: Handwashing after any patient contact. Wear gloves when doing pt contact.
Protective gowns when in contact with infected linens. Avoid sharing of equipment. HCW
can be colonized with MRSA (not common) but often are not ill & are not at risk to other
healthy persons (peers, family).
m. Mumps (Acute viral disease): Resp droplets & direct contact with saliva of infected pt.
Communicable 3 days before to about 4 days after symptoms start. Risk of contracting
disease in minimal
Prevention: Standard BSI. MMR vaccination is standard for childhood immunizations.
Adults born after 1956 should get at least 1 dose of MMR.
n. Pertussis (whooping cough): Transmitted via respiratory secretions or in an aerosolized
form. Highly contagious except in 3rd phase. Communicability greatest before 2nd phase.
Prevention: Mask pt. DPT vaccination in childhood series (not sure how long immunity
lasts).
o. Pneumonia: Highest risk are the non-healthy populations.
Prevention: Masks. Vaccination available esp for children 65 and for those
postsplenectomy.
p. Rubella(German measles) : Inhalation of infective droplets
Prevention: Mask pt. MMR vaccination part of childhood program.
 q. SARS (severe acute respiratory syndrome): Respiratory droplets when coughing or
sneezing droplets into air. Can touch infectious material on environmental surfaces and
bring to your eyes, nose, and mouth by unwashed hands.
Prevention: Fit tested N-95 respirators for caregivers within 6 feet of patient. Patient to
also wear N- 95 mask. Caregivers to wear gloves, gowns, goggles, and face shields. Proper
handwashing extremely important. Wear protective gear when cleaning equipment and rig.
Avoid aerosolizing infectious material.
r. Scabies: Transmitted skin to skin contact. Transfer from underwear & bedclothes only if
immediate contact.
Prevention: Educate on mode of transmission & need for early diagnosis & tx. No work or
school until day after tx started. Contact isolation. Disinfection for clothes & bed sheets
used 48 hours prior to start of tx. Tx is a topical solution.
s. Shingles (varicella- zoster virus): Second outbreak of the chicken pox virus. Shingles
itself is not contagious but contact with someone with shingles could lead to chicken pox in
someone who never had it.
Prevention: After chickenpox, the virus is dormant in nerve tissue; as we age, the virus
may reappear as shingles when the dormant virus becomes active. Most common in
persons >50.
t. Tuberculosis (Tb): Most commonly through airborne resp droplets. Repeated exposure is
generally necessary to become infected so prolonged exposure increases risk.
Prevention: Universal precautions. Mask pt and self. The TB organism dies when exposed
to light & air. Skin test annually. If the TB skin test is positive, will still need to be
evaluated to determine if the TB is active. Incidence of TB rose in 1985, started to decline
in 1992 to date probably due to improved control programs. TB can be cured with meds.
u. Corona (covid-19): Most commonly through airborne resp droplets.
Prevention; Universal precautions. Mask pt and self.

8. Explain in detail the National leprosy eradication programme. Discus the role of
nurse in its prevention.
Ans:
Introduction:
The National Leprosy Control Programme (NLCP) was launched in 1955 in order to
control the number of leprosy infections. In 1983, the strategies for leprosy control were changed
and National Leprosy Eradication Program was launched. In the same year, multidrug therapy was
also launched. In 1991, the World Health Assembly resolved to eliminate leprosy at a global level
by the year 2000. In order to strengthen the process of elimination in the country, the first World
Bank supported project was introduced in India in 1993 and completed in 2000. The second World
Bank supported project happened between 2001-2002. In 2005, due to the declining number of
 Leprosy cases, the goal of NLEP was declared as elimination of leprosy at the national
level. In 2009, a special action plan for 209 high endemic districts in 16 states/union territories
were made.
Objectives:

 Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population in all districts
of the country.
 Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy.
 Reduction in the level of stigma associated with leprosy.

Components:

 Case Detection and Management

 Disability Prevention and Medical Rehabilitation
 Information, Education and Communication (IEC) including Behaviour Change
Communication (BCC)
 Human Resource and Capacity building
 Programme Management.

Role of a nurse in implementing the Strategies of NLEP:

 Diagnosis and treatment of leprosy- Services for diagnosis and treatment (Multi drug
therapy) are provided by all primary health centres and govt. dispensaries throughout the
country free of cost.
 Training- Training of general health staff like medical officer, health workers, health
supervisors, laboratory technicians and ASHAs are conducted every year to develop
adequate skill in diagnosis and management of leprosy cases.
 Urban leprosy control- To the Urban Leprosy control activities are being implemented in
urban areas having population size of more than 1 lakh. These activities include MDT
delivery services & follow up of patient for treatment completion, providing supportive
medicines & dressing material and monitoring & supervision.
 IEC- Intensive IEC activities are conducted for awareness generation and particularly
reduction of stigma and discrimination against leprosy affected persons.
 Involving NGO’s towards effective implementation of the programme throughout the nation.
 Disability Prevention and Medical Rehabilitation –For prevention of disability among
persons with insensitive hands and feet, they are given dressing material, supportive
medicines and micro-cellular rubber (MCR) footwear. The patients are also empowered with
self-care procedure for taking care of themselves.
 Special Activity in High Endemic Dist. - 209 Districts had reported ANCDR (Annual New
Case Detection Rate) more than 10 per lakh population. Special activity for early detection
and complete treatment, Capacity building and extensive IEC, Adequate availability of
MDT, Strengthening of dist. Nucleus, Regular monitoring & supervision and review,
 Regular follow up for neuritis and reaction, Self-care practices, Supply of MCR footwear in
adequate quantity and Improvement in RCS performance through camp approach are
planned in the above districts to reduce the disease burden.
 Supervision and Monitoring –Programme is being monitored at different level through
analysis of monthly progress reports, through field visits by the supervisory officers and
programme review meetings held at central, state and district level. For better
epidemiological analysis of the disease situation.
 Involvement of ASHA– A scheme to involve ASHAs was drawn up to bring out leprosy
cases from their villages for diagnosis at PHC and follow up cases for treatment
completion. To facilitate involvement, they are being paid an incentive as below:
 On confirmed diagnosis of case brought by them – Rs. 250/-
 On completion of full course of treatment of the case within specified time – Pauci
bacillary (PB) leprosy case – Rs. 400/- and Multibacillary (MB) Leprosy case – Rs.
600/-.The scheme has been extended to involve any other person who brings in or
reports a new case of leprosy.
 An early case before onset of any visible deformity – Rs 250
 A new case with visible deformity in hands, feet or eye – Rs 200

9. List the programmes undertaken by the government of India to promote nutritional

health of the people. Explain the responsibilities of community health nurse in
successful implementation of these programmes.

Ans:

List of nutritional programme in India

 Integrated Child Development Service Programme (ICDS): This is a unique

programme under which a package of integrated services consisting of
supplementary nutrition, immunization, health check-up, referral and
education service are provided to the most vulnerable groups even within
children and women, i.e. children up 6 years of age and expectant/nursing
mother, through a common focal point called Anganwadi (the courtyard
centres) in each of the village/urban slums.
Objectives:

 To improve the nutritional and health status of children in the age

group 0-6 years;
 To lay the foundation for proper psychological, physical and social
development of the child;
 To reduce the incidence of mortality, morbidity, malnutrition and
school dropout;
  To regulate effective coordination of policy and programme
implementation amongst various departments to promote child
development;
 To enhance the capability of the mother through proper nutrition
education for taking care of the normal health and nutritional needs
and health of the child
 Special Nutrition Programme (SNP): This programme was launched way back in
1970-71 for the same target group as in ICDS i.e. children below 6 years age and
expectant and nursing mothers. The programme is confined to tribal areas and slums.
Main activity under this programme is to provide supplementary feeding to the
beneficiaries for 300 days in a year
 Balwadi Nutrition Programme: Bal (children) wadi (home or centre) Nutrition
Programme is a contemporary of SNP and is being implemented since 1970-71.
The beneficiaries of SNP are basically from the disadvantaged section of
the society like tribal/scheduled caste people, urban slum dwellers and
also migrant labourers. The in-charge of the Balwadi Centre is an
honorary worker, like Anganwadi worker of ICDS, and is paid an
honorarium which is Rs. 200 per month for trained and Rs. 150 for
untrained. She is assisted by a helper who is also an honorary worker. The
Balwadis not only provide supplemental nutrition but also look after the
social and emotional development of children attending these Balwadis.
 Mid-day meal programme: The mid-day meal scheme (MDMS) is a school meal
providing program of the Government of India. Its aim is to improve the nutritional
status of school going children all over the country and improve literacy level of the
country. Its complete form was implemented in 2004 to addresses two major issues
that are food and education. Under this scheme, a wholesome meal is provided to all
children in the 6 to 14 age group studying in primary and upper primary classes in
government and government aided schools, making the nutritious meal a reality for
children who otherwise may not afford two square meal.
 Iodine deficiency goitre control programme: The Government of India launched a
100 per cent centrally assisted National Goitre Control Programme (NGCP) in
1962. In August, 1992 the National Goitre Control Programme (NGCP) was
renamed as National Iodine Deficiency Disorders Control Programme (NIDDCP)
with a view of wide spectrum of Iodine Deficiency Disorders like mental and physical
retardation, deaf mutism, cretinism, still births, abortions etc..
 Crèches for Children of Working and Ailing Women: The scheme, implemented
since 1975, has been designed to free the working, and in some cases ailing mothers,
from the task of looking after their children while they are on work or are sick. The
coverage under the scheme is available only to those children whose parent's total
monthly income does not exceed Rs. 1800. Children generally belong to casual
migrant vendors, construction labourers groups etc.
The services available to the children include sleeping and daycare facilities,
supplementary nutrition, immunization, medicines, entertainment and check-ups at
weekly intervals.

 Wheat Based Supplementary Nutrition Programme: The scheme was started with
the twin objective of providing supplementary nutrition to children and popularising
wheat intake. Min of Food places at the disposal of the Department of Women and
child Development about 100 thousand tonnes of wheat from the central reserves
annually and that Department, in turn, sub-allocates this wheat among States which
utilise the wheat mostly to produce wheat based ready-to-eat nutrition supplements.
With the spread of ICDS, this wheat or its products are increasingly being utilised for
distribution of supplementary nutrition in ICDS and mid-day-meal programmes the
wheat is supplied to the State Governments by the Food Corporation of India at the
same subsidised rates as for the public distribution system.
 World Food Programme Project: world Food Programme-UN provides food-stuffs
so that supplementary nutrition could be provided through the projects supported by
them.
 CARE Assisted Nutrition Programmes: Under the Indo-CARE Agreement of
1950, CARE-India extends food aid so that supplementary nutrition can be provided
to pre-school children of age less than six years and expectant/nursing mothers. The
CARE assistance is now dovetailed with ICDS projects and some of the ICDS
projects utilise this assistance for the nutrition component of the programme. The
programme covers ICDS projects in 10 States of the Indian Union. CARE has also
monetized oil received by it as donation for generating funds worth Rs. 100 million
for implementing activities supportive of ICDS programme.
 Tamilnadu Integrated Nutrition Project: this project located in the Southern State
of Tamilnadu, was started sometime in 1980-81 with the World Bank first time
extending assistance for nutrition programmes in India. Second phase of the project
with a life of six years has started in 1990-91. The target groups in this project are
also children up to 6 years of age and pregnant/nursing mothers. Like ICDS, pre-
school education is provided to children in 3 to 6 years group. The project seeks to
provide enhanced inputs in the areas of health, communications, training, project
management, operations, research, monitoring and evaluation.
 10. a. List out the national nutritional programmes in India.
b. Discuss the national nutritional anaemia prophylaxis programme in India

Ans:

Government of India has initiated several large scale supplementary feeding program. And
programmes aimed at overcoming specific deficiency disease through various ministers to craniate
malnutrition.

 Integrated Child Development Service Programme (ICDS).

 Special Nutrition Programme (SNP).
 Balwadi Nutrition Programme.
 Mid-day meal programme.
 Iodine deficiency goitre control programme.
 Crèches for Children of Working and Ailing Women.
 Wheat Based Supplementary Nutrition Programme.
 World Food Programme Project.
 CARE Assisted Nutrition Programmes.
 Tamilnadu Integrated Nutrition Project.
 National Nutritional Anaemia Prophylaxis Programme.

NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAMME

The programme was launched in 1970 to prevent nutritional anaemia in mothers and children.

Under this programme, the expected and nursing mothers as well as acceptors of family
planning are given one tablet of iron and folic acid containing 60 mg elementary iron which was
raised to 100 mg elementary iron, however folic acid content remained same (0.5 mg of folic acid)
and children in the age group of 1-5 years are given one tablet of iron containing 20 mg elementary
iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. This
programme is being taken up by Maternal and Child Health (MCH), Division of Ministry of Health
and Family Welfare. Now it is part of RCH programme.

Highlights of the same include the following

 The infants between 6-12 months should also be included in the programme as there is
sufficient evidence that iron deficiency affects this age also.
 Children between 6 months to 60 months should be given 20mg elemental iron and 100 mcg
folic acid per day per child as this regimen is considered safe and effective.
National IMNCI guidelines for this supplementation to be followed.

 For children (6-60 months), ferrous sulphate and folic acid should be provided in a liquid
formulation containing 20 mg elemental iron and 100mcg folic acid per ml of the liquid
formulation. For safety reason, the liquid formulation should be dispensed in bottles so
designed that only 1 ml cab be dispensed each time.
 Dispersible tablets have an advantage over liquid formulations in programmatic conditions.
These have been used effectively in other parts of the world and in large scale Indian studies.
The logistics of introducing dispersible formulation of Iron and Folic Acid should be
expedited under the programme.

The current programme recommendations for pregnant and lactating women should be
continued.

 School children, 6-10 year old, and adolescents, 11-18 year olds, should also be included in
the National Nutritional Anaemia Prophylaxis Programme (NNAPP).
 Children 6-10 year old will be provided 30 mg elemental iron and 250 mcg folic acid per
child per day for 100 days in a year.
 Adolescents, 11-18 years will be supplemented at the same doses and duration as adults. The
adolescent girls will be given priority.
 Multiple channels and strategies are required to address the problem of iron deficiency
anaemia. The newer products such as double fortified salts / sprinkles/ ultra-rice and other
micro nutrient candidates or fortified candidates should be explored as an adjunct or alternate
supplementation strategy.

11. A. Explain the national leprosy eradication programme.

B. Explain the role of a nurse in national leprosy eradication programme.

Ans:

Introduction:

The National Leprosy Control Programme was launched by the Govt. of India in 1955. Multi
Drug Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was
introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease
burden. India achieved the goal set by the National Health Policy, 2002 of elimination of leprosy as
a public health problem, defined as less than 1 case per 10,000 population, at the National level in
December 2005.

Objectives:

a. Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population in all districts
of the country.
b. Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy.
c. Reduction in the level of stigma associated with leprosy.
Components:

 Case Detection and Management

 Disability Prevention and Medical Rehabilitation
 Information, Education and Communication (IEC) including Behaviour Change
Communication (BCC)
 Human Resource and Capacity building
 Programme Management.

Role of a nurse in implementing the Strategies of NLEP:

 Diagnosis and treatment of leprosy- Services for diagnosis and treatment (Multi drug
therapy) are provided by all primary health centres and govt. dispensaries throughout the
country free of cost.
 Training- Training of general health staff like medical officer, health workers, health
supervisors, laboratory technicians and ASHAs are conducted every year to develop
adequate skill in diagnosis and management of leprosy cases.
 Urban leprosy control- To the Urban Leprosy control activities are being implemented in
urban areas having population size of more than 1 lakh. These activities include MDT
delivery services & follow up of patient for treatment completion, providing supportive
medicines & dressing material and monitoring & supervision.
 IEC- Intensive IEC activities are conducted for awareness generation and particularly
reduction of stigma and discrimination against leprosy affected persons.
 Involving NGO’s towards effective implementation of the programme throughout the nation.
 Disability Prevention and Medical Rehabilitation –For prevention of disability among
persons with insensitive hands and feet, they are given dressing material, supportive
medicines and micro-cellular rubber (MCR) footwear. The patients are also empowered with
self-care procedure for taking care of themselves.
 Special Activity in High Endemic Dist. - 209 Districts had reported ANCDR (Annual New
Case Detection Rate) more than 10 per lakh population. Special activity for early detection
and complete treatment, Capacity building and extensive IEC, Adequate availability of
MDT, Strengthening of dist. Nucleus, Regular monitoring & supervision and review,
Regular follow up for neuritis and reaction, Self-care practices, Supply of MCR footwear in
adequate quantity and Improvement in RCS performance through camp approach are
planned in the above districts to reduce the disease burden.
 Supervision and Monitoring –Programme is being monitored at different level through
analysis of monthly progress reports, through field visits by the supervisory officers and
programme review meetings held at central, state and district level. For better
epidemiological analysis of the disease situation.
  Involvement of ASHA– A scheme to involve ASHAs was drawn up to bring out leprosy
cases from their villages for diagnosis at PHC and follow up cases for treatment
completion. To facilitate involvement, they are being paid an incentive as below:
 On confirmed diagnosis of case brought by them – Rs. 250/-
 On completion of full course of treatment of the case within specified time – Pauci
bacillary (PB) leprosy case – Rs. 400/- and Multibacillary (MB) Leprosy case – Rs.
600/-.The scheme has been extended to involve any other person who brings in or
reports a new case of leprosy.
 An early case before onset of any visible deformity – Rs 250
 A new case with visible deformity in hands, feet or eye – Rs 200

12. A.Enlist the various vertical health programmes in India.

B.Explain the RNTCP.

Ans:

List of vertical health programme in India: A "vertical programme" is a component of the health.
System which has specific, defined objectives, usually quantitative, and relating to a single condition
or small group of. Health problems.

They are as below:

 National Iodine Deficiency Disease Control Programme.

 National Programme for Prevention & Control of Fluorosis.
 National Programme for control of Deafness.
 National Vector Borne Disease Control Programme.
 National Leprosy Eradication Programme.
 National Programme for Control of Blindness.
 National Tobacco Control Programme.

Refer the answer of question number 3

 13. A. list any four vector borne diseases.
B. explain the national anti-malaria programme with the role of nurse.

Ans:

Vector-Borne Disease that results from an infection transmitted to humans and other animals
by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases
include Dengue fever, West Nile Virus, Lyme disease, and malaria.

Vector Disease caused Type of

pathogen
Mosquito Aedes Chikungunya Virus
Dengue Virus
Lymphatic filariasis Parasite
Rift Valley fever Virus
Yellow Fever Virus
Zika Virus
Anopheles Lymphatic filariasis Parasite
Malaria Parasite
Culex Japanese encephalitis Virus
Lymphatic filariasis Parasite
West Nile fever Virus
Aquatic snails Schistosomiasis (bilharziasis) Parasite
Blackflies Onchoceriasis (river blindness) Parasite
Fleas Plague (transmitted from rats to humans) Bacteria
Tungiasis Ecto parasite
Lice Typhus Bacteria
Louse-borne relapsing fever Bacteria
Sandflies Leishmaniasis Bacteria
Sandfly fever (phlebotomus fever) Virus
 Ticks Crimean-Congo haemorrhagic fever Virus
Lyme disease Bacteria
Relapsing fever (borreliosis) Bacteria
Rickettsial diseases (eg: spotted fever and Q Bacteria
fever) Virus
Tick-borne encephalitis Bacteria
Tularaemia
Triatome bugs Chagas disease (American trypanosomiasis) Parasite
Tsetse flies Sleeping sickness (African trypanosomiasis) Parasite

Cont…refer answer of question number 7

14. A. List any four sexually transmitted diseases.

b. Explain the STD control programme.

Ans:

The term sexually transmitted disease (STD) is used to refer to a condition passed from one
person to another through sexual contact. An STD may also be called a sexually transmitted infection
(STI) or venereal disease (VD).That doesn’t mean sex is the only way STDs are transmitted.
Depending on the specific STD, infections may also be transmitted through sharing needles and
breastfeeding.

List of STD:

 Chlamydia.
 HPV (human papillomavirus) Human papillomavirus (HPV)
 Syphilis.
 HIV.
 Gonorrhoea.
 Pubic lice ('crabs')
 Trichomoniasis.
 Herpes.

Explain the STD control programme:

HISTORY:
 First cases was detected in USA in 1981.
 HIV/AIDS continues its expansion across globe.
 Soon after the first case of AIDS detected in India in 1986.
 NAC Programme constituted in 1987.
 STD control has been linked because sexual transmission of AIDS in STD cases is more 5
times.
  Behaviour changes is required amongst STD cases.

Sexually transmitted disease (STDs) are caused by different pathogens, but can be
recognized through mainly three syndromes.

 Urethral discharge
 Vaginal discharge
 Genital Ulcer.

The programme began in 1949 as a pilot project to control Venereal diseases. Recognizing
STD as one of the major determinant of transmission of HIV infection. The programme has been
merged in NACO.NACO after taking over the STD control programme in 1992

OBJECTIVES
 To reduce transmission of STD /HIV by reducing risk factors.
 To prevent the development of short & long term Morbidity /Mortality due to STD.
STD distribution:
 Male are more infected.
 Syphilis, Gonorrhoea, painless syphilis, Chancre in females.
 Age group 21- 35 yrs.
 Prostitutes, Industrial workers.
STRATEGIES TO CONTROL
 IEC for awareness and Promotion of Health Care seeking behaviour. For safer sex and use
of Condom.
 Adequate Management- Comprehensive case management.
 Increasing access to health care.
 To establishing 5 Regional training Centres (Mumbai,Calcutta, Delhi, Madras &
Hyderabad.)
 Development of 5 Regional Laboratories & 5 Regional reference centers.
 All medical colleges as Skin Leprosy –STD clinics and STD district hospital.
 15. LIST ANY FOUR NURSING THEORIES? EXPLAIN COMMUNITY HEATH
NURSING PROCESS?
Ans:
Nursing theory is “an organized framework of concepts and purposes designed to guide the
practice of nursing.
Major Types/classification of theories
Grand nursing theories
Grand nursing theories have the broadest scope and present general concepts and propositions.
Theories at this level may both reflect and provide insights useful for practice but are not designed
for empirical testing. This limits the use of grand nursing theories for directing, explaining, and
predicting nursing in particular situations. However, these theories may contain concepts that can
lend themselves to empirical testing. Theories at this level are intended to be pertinent to all
instances of nursing. Grand theories consist of conceptual frameworks defining broad perspectives
for practice and ways of looking at nursing phenomena based on the perspectives.
Mid-range nursing theories
Middle-range nursing theories are narrower in scope than grand nursing theories and offer an
effective bridge between grand nursing theories and nursing practice. They present concepts and a
lower level of abstraction and guide theory-based research and nursing practice strategies. One of
the hallmarks of mid-range theory compared to grand theories is that mid-range theories are more
tangible and verifiable through testing. The functions of middle-range theories includes to
describe, explain, or predict phenomenon. Middle-range theories are simple, straightforward,
general, and consider a limited number of variables and limited aspect of reality.
Nursing practice theories
Nursing practice theories have the most limited scope and level of abstraction and are developed
for use within a specific range of nursing situations. Nursing practice theories provide frameworks
for nursing interventions, and predict outcomes and the impact of nursing practice. The capacity of
these theories is limited, and analyses a narrow aspect of a phenomenon. Nursing practice theories
are usually defined to an exact community or discipline
Theories and Models for community health nursing
• Nightingale’s theory of environment
• Orem’s Self-care model
• Neumann’s health care system model
• Roger’s model of the science and unitary man
• Pender’s health promotion model
• Roy’s adaptation model
• Milio’s Framework of prevention
• Salmon White’s Construct for Public health nursing
• Block and Jostens’s Ethical Theory of population focused nursing
Nursing Process in Community Health Nursing
The nursing process directs the CHNs in providing care to meet a clients’ health needs,
whether the client is an individual, a family, group or community. Description of Nursing Process
as an efficient method of organizing thought process for clinical decision making and problem
solving
Nursing Process Characteristics & Community
Problem-solving process; management process; process for implementing change
Characteristics:
 Deliberative; adaptable; cyclic; sequential
 Client-focused; need-oriented; goal-oriented
 Interaction with community (communication, reciprocal interaction, paving way for
helping relationship, aggregate application)
 Forming of partnerships and building of coalitions.
Elements in community health nursing process
The nursing process directs the CHNs in providing care to meet a clients’ health needs,
whether the client is an individual, a family, group or community.
Elements includes
 Problem identified
 Reason
 Objectives
 Nursing intervention
 Evaluation
Problems identification:
A systematic, dynamic way to collect and analyze data about a client, the first step in delivering
nursing care. Assessment includes not only physiological data, but also psychological,
sociocultural, spiritual, economic, and life-style factors as well.
It’s again classified into
 Actual problems:-The problems which identified which is directly related to the person
himself or herself minor/major sickness may be minor aliments or any other systemic
problems
 Potential problems:-The problems which is indirectly affects the person, family or whole
community like community related problems like communicable problems, sanitation
problems etc.,
Diagnosis/reason:
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or
potential health conditions or needs. The reason for problem reflects not only that the patient is in
pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict
within the family, or has the potential to cause complications.
Objectives:
Based on the problem identification and diagnosis, the nurse sets measurable and achievable short-
and long-range goals for this patient that might include moving from dependent to independent at
least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals;
resolving conflict through counseling, or managing pain through adequate medication
Nursing intervention/Implementation:
Nursing care is implemented according to the care plan, so continuity of care for the patient during
sick period and in preparation for terminating the cares to be assured. Care is documented in the
patient’s record.
Evaluation:
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated,
and the care plan modified as needed.
Problems Reason Objectives Nursing evaluation
identified intervention
 16. Define theories .explain the health promotion models and explain any one.
Ans:
Nursing theory is “an organized framework of concepts and purposes designed to
guide the practice of nursing.
(Or)
Nursing Theory is an organized and systematic articulation of a set of statements
related to questions in the discipline of nursing.
Concepts are linguistic labels that are assigned to objects or events and are the building
blocks of theories.
Conceptual definitions describe and clarify the phenomenon and explain how the concepts
is exposed in empirical reality.
Theoretical statements or propositions are statements about the relationship between two
or more concepts and are used to connect concepts to revise the theory
Health promotion models:
There are several theories and models that support the practice of health promotion and
disease prevention. Theories and models are used in program planning to understand and explain
health behaviour and to guide the identification, development, and implementation of interventions.

When identifying a theory or model to guide health promotion or disease prevention

programs, it is important to consider a range of factors, such as the specific health problem
being addressed, the population(s) being served, and the contexts within which the program is
being implemented. Health promotion and disease prevention programs typically draw from
one or more theories or models.
Among those,
 Pander’s health promotion model.
 Ecological Models
 The Health Belief Model
 Stages of Change Model (Trans theoretical Model)
 Social Cognitive Theory
 Theory of Reasoned Action/Planned Behaviour
Pander’s health promotion model:-
The Health Promotion Model was designed by Nola J.... Pender's model focuses on
three areas:
 Individual characteristics and experiences,
 Behaviour-specific cognitions and affect, and
 Behavioural outcomes.
The theory notes that each person has unique personal characteristics and experiences that
affect subsequent actions.

HISTORY
 Pender (1969) began her research about how people make decisions with her doctoral
dissertation. It was first published in 1982.
 HPM proposed a framework for integrating nursing and behavioural science
perspectives on factors influencing health behaviours
 The framework offered a guide for exploration of the complex biopsychosocial
processes that motivate individuals to engage in behaviours directed toward the
enhancement of health.
 The initial model had seven cognitive perceptual factors and five Modifying factors
Cognitive perceptual factors Modifying factors
 Importance of health Demographic characteristics
 Perceived control of health Biological characteristics
 Definition of health Interpersonal influences
 Perceived health status Situational influences
 Perceived self-efficacy Behavioural factors
 Perceived benefits
 Perceived barriers
ASSUMPTIONS
 Person seek to create conditions of living through which they can express their unique
human health potential.
 Person value growth in directions viewed as positive and attempt to achieve a
personally acceptable balance between change and stability.
 Individuals seek to actively regulate their own behaviour.
 Individual in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed overtime.
  Health professional constitute a part of the interpersonal environment, which exerts
influence on the persons throughout their life span.
 Person have the capacity for reflective self-awareness including assessment of their
own competencies
 Self-initiated reconfiguration of person environment Interactive patterns is essential to
behavioural change.
Theoretical propositions
 Prior behaviour and inherited and acquired characteristics influence beliefs, affect and
enactment of health – promoting behaviour.
 Persons commits to engaging in behaviours from which they anticipate deriving
personally valued benefits.
 Perceived barriers can constrain commitment to action, a mediator of behaviour as
well as actual behaviour.
 Perceived competence of self-efficacy to execute a given behaviour increases the
likelihood of commitment to action and actual performance of the behaviour.
 Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behaviour.
 Positive affect towards a behaviour results in greater perceived self-efficacy, which
can in turn, result in increased positive affect.
 When positive emotions are associated with a behaviour, the probability of
commitment and action is increased.
 Persons are more likely to commit to and engage in health promoting behaviours
when significant others model the behaviour, expect the behaviour to occur, and
provide assistance and support to enable the behaviour.

Conceptual frame work of pander’s health promotion model:-

HEALTH PROMOTION MODEL VARIABLE
Individual characteristics and experiences
 Prior related behaviour
- Frequency of similar behaviour in the past.
- Direct and indirect effects on likelihood of engaging health promoting behaviours.
 Personal factors
Personal factors categorized as biological, psychological and sociocultural factors.
These factors are predictive of a given behaviour and shaped by the nature of the target
behaviour being considered.
 Personal Biological Factors
• Include variables such as age, gender, body mass index, pubertal status, aerobic capacity,
strength, agility or balance.
 Personal psychological factors
• Include variables such as Self-esteem, self-motivation, personal competence, perceived
health status and definitions of health.
 Personal Sociocultural factors
• Include variables such as Race, ethnicity, acculturation, education and socioeconomic status
  Behavioural specific cognition and affect
• Perceived benefits of action
• Anticipated positive outcomes that will occur from health behaviour
• Perceived barriers to action
• Anticipated, imagined or real blocks and personal costs of understanding a given behaviour
• Perceived self-efficacy
• Judgment of personal capability to organize and execute a health promoting behaviour.
.
 Activity related Affect
Subjective positive or negative feeling that occur before, during and following behaviour
based on the stimulus properties of the behaviour itself.
• Interpersonal influences
• Cognition concerning behaviour, belief, attitude of the others.
• Inter personal influences include norms, Social support and modelling
• Primary sources of interpersonal influences are families, peers and health care providers.
• Situational influences
• Personal perceptions and cognitions of any given situation or context that can facilitate or
impede behaviour
• Situational influence may have direct or indirect influences on health behaviour.
 Behavioural outcome
• Commitment to plan of action
• The concept of intention and identification of a planned strategy leads to implementation of
health behaviour
• Immediate competing demands and preferences
• Competing demands are those alternative behaviour over which individuals have low
control because there are environmental contingencies such as work or family care
responsibilities.
• Health promoting behaviour
• End Point or action outcome directed toward attaining positive health outcome such as
optimal wellbeing, personal fulfilment and productive living.
META PARADIGM
Person
 Refers to the individual who is the primary focus of the model. Each person has
unique personal characteristics and experiences that affect subsequent actions.
 It is recognized that individuals learn health behaviours within the context of the
family and the community.
Environment
Refers to physical, interpersonal and economic circumstances in which persons live the
quality of the environment depends on the absence of toxic substances, availability of
restorative experiences and accessibility
Health
Health is viewed as Positive high level state. According to Pender, the person’s definition of
health for himself or herself is more important than any general definition of health.
Nursing
Does not specifically define nursing. The role of nurse includes raising consciousness related
to health promoting behaviour, promoting self-efficacy, enhancing the benefits of change,
controlling the environment to support.
ACCEPTANCE BY NURSING COMMUNITY
• Practice: - Health promotion in nursing practice has proven to be a primary resource in the
addition of health promotion to the practice of nursing.
• Education: - Use widely among undergraduate and postgraduate Clinical education
• Research: - It is a tool for research retested the empirical precision of the model

NURSING PROCESS
 Assessment:-
- Prior related behaviour of the person
- Personal factors (biological, psychological and sociocultural factors)
- Assessment can be guided by the individual characteristics and experiences and the
behaviour – specific cognitions and affect.
 Nursing Diagnosis:-
The nursing diagnosis would be derived from the data collected in relation to these areas but
is not directly reflected in the model.
  Planning:-
Planning occurs in developing the plan of action to which client commits; again, the
planning process is not directly reflected in the model, although the outcome of that
process is reflected in the plan of action
 Implementation:-
It is the actual incorporation of the health promoting behaviour into the patient’s routine and
life. Eg: Exercise regularly, eating healthy diet
 Evaluation:-
Based on the achievement of the action outcome

17. Define home visiting? Discuss the steps of nursing process in community health
nursing.
Ans:-
Introduction:-
A nursing home visit is a family-nurse contact which allows the health worker to
assess the home and family situations in order to provide the necessary nursing care and
health related activities. In performing home visits, it is essential to prepare a plan of visit to
meet the needs of the client and achieve the best results of desired outcomes.
Definition:-
A home visit is defined as “The process of providing the nursing care to patients
at their doorsteps”.
Objectives of home visiting:-

1. To give care to the sick, to a postpartum mother and her new-born with the view
teach a responsible family member to give the subsequent care.
2. To assess the living condition of the patient and his family and their
health practices in order to provide the appropriate health teaching.
3. To give health teachings regarding the prevention and control of diseases.
4. To establish close relationship between the health agencies and the public for the
promotion of health.
5. To make use of the inter-referral system and to promote the utilization of
community services
Principles of home visiting:-

1. A home visit must have a purpose or objective.

2. Planning for a home visit should make use of all available information about the
patient and his family through family records.
 3. In planning for a home visit, we should consider and give priority to the essential
needs if the individual and his family.
4. Planning and delivery of care should involve the individual and family.
5. The plan should be flexible.
Steps in home visiting:-

1. Greet the patient and introduce yourself.

2. State the purpose of the visit
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place and then proceed to perform the bag technique.
5. Perform the nursing care needed and give health teachings.
6. Record all important date, observation and care rendered.
7. Make appointment for a return visit.

And refer ans of question number 15

18. List objectives of camps? Describe organization of MCH camps in community.

Ans:-

HEALTH CAMPS

Health camps for recruiting patients in clinical trials

NEED FOR HEALTH CAMPS

 Awareness Serves the poor and unprivileged population.(rural)

 Helps to minimize the burden at the site by referring only pre-screened patients.
 Large patient pool with different diseases and background can be recruited.
 Motivates uneducated participants
 Provides opportunities to receive better standards of treatment/healthcare

BENEFIT TO PEOPLE

Free diagnosis and treatment Helpful for patients who cannot afford to consult
physicians due to economic constraints in India.

IMPORTANCE OF HAVING HEATH CAMP

 Selection of patients for clinical trial for a particular indication satisfying their
eligibility criteria is much easier.
 Saves enrolment time Better patient retention by providing professional care &
supporting environment to patients.
  Less need for repeated monitoring visits, thus savings in time and cost.
 Maximizing site performance.
 Access to patients Improve patient’s awareness perception & education.
 Ease of business.
 Cost effective patient recruitment.
 Increase number of quality patients per site faster patient recruitment and timely
completion of studies.

TEAM MEMBERS
 Leader of that village
 Local political leader
 Specialist surgeon
 Physician
 Nurses
 Pharmacist
 Lab technician
 Voluntary health workers
 NGO ‘s
 Group D workers
TYPES OF HEALTH CAMPS
 General health camp.
 Maternal & child health camp.
 Eye camp.
 Diabetic health camp.
 Blood donation camp.
 Dental health camp.
 Community mental health camp.
 Obesity control camp.
 Health awareness camp.
 Community heath screen camp.

Steps or procedures in organizing MCH camp:-

Which mainly includes
 Basic need assessment for conducting the MCH camp.
 Identify the communication facilities to reach out the area.
 Get the consent from the concern authority to conduct the camp.
 Organize the health team members, logistical supply for initiating the camp.
 Plan for IEC propagation to reach out the population to get information regarding
camp.
 Before to the initiation trail run should conducted.
 Actual health camp should run with all documentation procedure for ethical safety
and documentation.
 Termination of the health camp by handing over all the necessary documentation to
the local & concerned authority for the further follow up.
 19. Define home visiting? Explain the steps in home visiting

Ans: - Refer ans of question number 17

20. Define family? Explain the role of community health nurse in family health
services.
&
21. Define family health? List the approaches of family health and discuss the role of
community health nurse in family health services.
Ans:-
FAMILY:-
“Family is a group of two or more persons related by birth, marriage, or adoption and
residing together in a house hold”
-US Bureau of census, 1980
(Or)
It is a group of biologically related individuals living together and eating from a common
kitchen.”
FAMILY HEALTH:-
A state of positive interaction between family members which enables each members
of the family to enjoy optimum physical, mental, social and spiritual wellbeing.
FAMILY HEALTH NURSING:-
Family health nursing is a nursing aspect of organized family health care services
which are directed or focused on family as the unit care with health as the goal. It is thus
synthesis of nursing care and health care. It helps to develop self-care abilities of the family
and promote, protect and maintain its health. Family health nursing is generalized, well
balanced and integrated comprehensive and continuous are requiring comprehensive planning
to accomplish its goal.
The goals of the family health nursing include optimal functioning for the individual and for
the family as a unit.”
AIMS OF FAMILY HEALTH SERVICES:-
 Reducing maternal mortality rate, maternal morbidity rate infant mortally rate.
 Spacing the birth of children.
 Providing help in solving the problem of malnutrition in family.
 Providing health education to the family, so that they can lead a healthy and good life.
PRINCIPLES OF FAMILY HEALTH SERVICES:-
 Nurse should have friendly relations with every family and should encourage the
families to have good relation with each other and in the community.
 It is essential to have the knowledge of all basic facts about the family e.g., its size,
occupation, customs, rituals, and education standard etc.
 Problems should be identified and assigned the priority level.
  Problems should be discussed with the family. For finding the solution of the
problem, opinion of the family members should be considered and the information
about the available health and development facilities should be given to them.
 Co-operation of the family members should be obtained to implement the desired plan
of action.
 Family should be encouraged to be self-sufficient to fulfil their needs and pay
attention to nutrition, health and family welfare.
 At every contact/visit, a message should be given that is impotent from the point of
view of family’s health.
 Participation of family members is essential in family health nursing services.
FAMILY AS UNIT OF HEALTHCARE SERVICES
 Health of an individual depends upon the health of the family.
 Family members have the interpersonal relationship and dependency on each other.
 Family size, structure, income, educational standard, environment etc., affect the
health standard of the family members.
 Important role as supportive groups
 Illness of one family members affects the total health care of the family
 Individual’s health problems can be tackled easily
 Customs, traditions, habits and socio-cultural aspects related to the health risk, illness
 Comprehensive health care can be provided to community through family health
care services.
 The successful family life cycle can be achieved by the family health care services
FAMILY CENTERED NURSING APPROCH:-
The four approaches included in the family health nursing care views are:
1. Family as the context
2. Family as the client
3. Family as a system
4. Family as a component of society
Family as the context: -
When the nurse views the family as context, the primary focus is on the health and
development of an individual member existing within a specific environment (i.e., the client’s
family).Although the nurse focuses the nursing process on the individual’s health status, the
nurse also assesses the extent to which the family provides the individual’s basic needs.
These needs vary, depending on the individual’s development level and situation. Because
families provide more than just material essentials, their ability to help the client meet
psychological needs must also be considered. Family members may need direct interventions
themselves.
Family as the client:-
 The family is the foreground and individuals are in the background. The family is
seems as the sum of individuals family members. The focus is concentrated on each and
every individual as they affect the whole family.
From this perspective, a nurse might ask a family member who has just become ill. Tell me
about what has been going on with your own health and how you perceive each family
member responding to your mother’s recent diagnosis of liver cancer.
Family as a system:-
The focus is on the family as a client and it is viewed as an international system in
which the whole is more than the sum of its parts. This approach focuses on the individual
and family members become the target for nursing interventions. Eg: the direct interaction
between the parent and the child. The system approach to the family always implies that
when something happens to one affected.
It is important to understand that although theoretical and practical distinctions can be made
between the family as context and the family as client, they are not necessarily mutually
exclusive, and both are often used simultaneously, such as with the perspective of the family
as system.
Family as a component of society:-
The family is seen as one of many institutions in society, along with health,
educational, religious, or economic institution. The family is a basic or primary unit of
society, as are all the other units and they are all a part of the larger system of society. The
family as a whole interacts with other institutions to receive exchange or give
communications and services. Community health nursing has drawn many of its clients from
this perspective as it focuses on the interface between families and communities.
Family health nursing practice like any nursing practice begins with the nursing process. By
using this process, the nurse practicing with family perspectives is potentially able to
effectively intervene at any of the levels. After an assessment of the individuals, family nit,
and supra system, the nurse is ready to begin to identify areas of concern or need.
ELEMENTS OF FAMILY NURSING PROCESS
 Assessment of client’s problem
 Diagnosis of client response needs that nurse can deal with
 Planning of client’s care
 Implementation of care
 Evaluation of the success of implemented care

ROLES OF COMMUNITY HEALTH NURSE IN FAMILY NURSING:-

 The roles of health care nurses are evolving along with the specialty. Each health care
setting affects roles that nurses assume with families, and many of these roles may occur in
the same setting as well.
 Health teacher:
The family nurse teaches about family wellness, illness, relations, and parenting, to name a
few. The teacher educator function is ongoing in all settings in both formal and informal
ways.
 Coordinator, collaborator, and liaison.
The family nurse coordinates the care that families receive, collaborating with the family to
plan care.

 Deliverer and supervisor of care and technical expert.

The family nurse either delivers or supervises the care that families receive in various
settings. To do this, the nurse must be a technical expert in terms of both knowledge and skill.
 Family advocate.
The family nurse advocates for families with whom they work; the nurse empowers family
members to speak with their own voice or the nurse speaks out for the family.
 Consultant.
The family nurse serves as a consultant to families whenever asked or whenever necessary. In
some instances, he or she consults with agencies to facilitate family centered care.
 Counsellor.
The family nurse plays a therapeutic role in helping individuals and families solve problems
or change behaviour.
 Case finder and epidemiologist.
The family nurse gets involved in case finding and becomes a tracker of disease.
 Environmental modifier.
The family nurse consults with families and other health care professionals to modify the
environment.
 Clarifier and interpreter.
The family nurse clarifies and interprets data to families in all settings.

 Surrogate.
The family nurse serves as a surrogate by substituting for another person. For example, the
nurse may stand in temporarily as a loving parent to an adolescent who is giving birth to a
child by herself in the labor and delivery room.
 Researcher.
The family nurse should identify practice problems and find the best solution for dealing with
these problems through the process of scientific investigation.
 Role model.
The family nurse is continually serving as a role model to other people through his or her
activities. A school nurse who demonstrates the right kind of health in personal self-care
serves as a role model to parents and children alike.
 Case manager.
Although case manager is a contemporary name for this role, it involves coordination and
collaboration between a family and the health care system. The case manager has been
formally empowered to be in charge of a case.
22. List common minor aliments? Explain the role of nurse in preventing minor
aliments at home?
Ans:-
INTRODUCTION
 Community health nurse is responsible to provide primary health care in the
community
 Treatment of minor ailments and emergencies is an important component of
community health nursing
 Nurse should be able to identify the signs and symptoms of a patient and treat them
according to the standing orders
 Minor ailments indicate slight illnesses and emergencies of smaller nature.
PRINCIPLES OF MANAGING MINOR ALIMENTS:-
 Ensure safe and healthful environment to the patient
 Treat the risk / injured person promptly to prevent any possible complication
 In case of infectious disease, take appropriate precautions to prevent the spread of
infection
 Keep continuous watch over the patients and vital signs during the period of care
 Help the patient to get well soon as possible
 Use the opportunities of health
 Education during the care
 Always remember the limitations in providing the treatment or follow the physicians’
instructions
 Help the family members in coping with the situation and prepare them for taking
care of patients at home
 Respect the beliefs of patient
 In case of serious conditions refer the patient without any delay

CLASSIFICATION OF MINOR AILMENTS:-

Minor ailments can be classified into two
1. GENERAL MINOR AILMENTS: - It include common accidents and emergencies which
need immediate first aid
In this category – injuries and falls, dog bite, burns, high fever, heat stroke, diarrhoea,
fainting etc
2. SYSTEMIC MINOR AILMENTS: - It include

 EYE:-
Eye accidents
Foreign bodies
Infections
Poor eye sight
Dry eyes
Night blindness
 Ear:-
Ear achge
Foreign body
Ottits media
Discharge
Deafness
 RESPIRATORY TRACT:-
Allergic rhinitis
Common cold
Sinusitis
Sore throat
Cough
Dyspnoea
Chest pain
Asthma
 CVS:-
Hypertension
Anaemia
RHD
 DIGESTIVE SYSTEM:-
Tooth ache
Stomatitis
Soreness in mouth
Constipation
Diarrhoea
Indigestion
Vomiting
Abdominal pain
Intestinal obstruction
 URINARY SYSTEM:-
Haemorrhoids
 Urinary system
Neuro muscular system
Reproductive system
Burning micturition
Retention of urine
Urinary infection
Renal stones
 NEURO MUSCULAR SYSTEM:-
Head ache
Back ache
Convulsions
Epileptic fits
 REPRODUCTIVE SYSTEM
Dysmenorrhoea
Heavy bleeding
Sores and discharges
Breast lump
MANAGEMENT OF MINOR AILMENTS
 ASSESSMENT – Taking history
 Performing quick physical examination
 FINDING THE CAUSE, MAKING THE DIAGNOSIS AND PLANNING FOR
CARE
 PROVIDING TREATMENT AND NURSING CARE
 EVALUATING THE CARE AND CONDITION OF THE PATIENT – If the
outcome is successful, plan for follow up
If condition does not improve or serious signs – refer to hospital
STANDING ORDERS
 Standing orders are directions and orders of specific nature. On the basics of these on
the non-availability of doctors nurses / health workers can provide treatment at home,
hospitals or health institutions and community
 Should be followed in temporary basics / or in emergency situation
OBJECTIVES
 To maintain the continuity of treatment of the patient
 To protect the life of the patient / to resuscitate him
 To create the feeling of responsibility in the members of health team
USES
 Providing treatment during emergency
 Enhancing the quality and activity of the health services
 Strengthening of primary health services in the community
 Decentralization of health responsibilities
  Developing the feeling of confidence and responsibility in nursing and other health
worker
 Protecting the general public from quacks
TYPES OF STANDINGD ORDERS
The authorized doctor and the registered community health nurse jointly releases standing
orders
 INSTITUTIONAL STANDING ORDERS
Standing order prepared with a view of the available resources, staff position and
objectivity of hospital Difference will be there b/w government and private hospitals

 SPECIFIC STANDING ORDERS

 Prepared for the trained medical personnel

 Technical knowledge and special skills are required
 These orders should compensate the need of a doctor
 Such orders enhance the quality of CHN
 GENERAL STANDING ORDERS
Common man is expected to follow some SO Eg – in case of diarrhoea – ORS
PACKET
STANDING ORDERS FOR TREATMENT OF MINORAILMENTS –
FEVER
 Examine the vital signs
 Gather information about other symptoms accompanying the fever – head ache
,nausea , vomiting , shivering cold running nose , allergy , skin infection , jaundice,
fits ,cough
 Provide rest and light meal to the patient
 Prepare blood slide to examine malaria parasite
 Give paracetamol tab
 Give lots of liquids to the patient
 If the fever is more than 102 deg F – tepid sponge
 Monitor the pattern of fever and wait for two days
 If the fever is accompanying with rashes- isolate the patient
 In case of delirium , convulsions , unconsciousness and hyperpyrexia accompanying
the fever refer the patient to the hospital
HEAT STROKE
 Person suffering should be kept in shade and in a well ventilated place
 Note the vitals
 Remove all clothes from the person and wrap in a wet sheet
 If the patient is conscious give him cold water mixed salt and other cold drinks
 Keep continuous observation over temp
 As soon as refer to hospital
DIARRHOEA – GI SYSTEM
 Monitor the symptoms of dehydration
 If the dehydration is severe or the patient is in the state of shock – refer him to
hospital
 Provide ORS to the patient
 Rice water , coconut water , lemon juice , light tea , banana should be given to the
patient
 If there is epidemic of diarrhoea sample should be send for stool test
 If cholera is prevalent immunization should be taken
 Food and water should be protected
 Notification should be done
 People should be educated about the control of flies
BURNS - SKIN
 Try to keep the burned body part immersed in water
 Check the spread of burns
 If the cloth has stuck to wound – DO NOT TRY TO REMOVE IT
 Rings , bangles , shoes , belts and other tight fitting articles to be removed
 Do not touch blisters unnecessarily
 Assess the percentage of burns
 Give primary treatment of shock if needed
 Give ORS if patient is conscious and not vomiting
 Provide analgesics if required
 Refer patient to further treatment
DROWNING - RS
 Loosen the clothes from chest
 Make the person lie on his abdomen and get the water out of lungs
 Resuscitate the patient immediately and send him to the health care centre / hospital
BITES - DOGBITE
 Thoroughly wash the wound with soap and water
 Use running water
 Apply Betadine or tincture iodine
 If the wound is excessive – check haemorrhage
 Stitches should be done only after 24 hours
 Give injection TT
 Do not kill the dog and observe for 10 days
 Send the patient for ARV therapy
SNAKE BITE
 Make the person lie down
 Don not allow to move
 Find out the kind of snake
 Tie tourniquet above the bite and continue to loosen it every half an hour
  Make a cut of 1 cm length and ½ cm deep at the place of bite and try to absorb poison
from the site ( there should not be any wound in the mouth of the person sucking )
 Clean the place with salt solution / water or ice
 Console the person and send to hospital
SCORPION BITE
 Remove the sting and put ice on it , after thoroughly cleaning the place
 Apply tourniquet above the place of bite and remove it after half an hour
 Give analgesic tablets and also the sweetened milk to drink
 If patient is in shock – send to hospital
FAINTING - CNS
 Lie down the person .his head should be at a slight lower level than feet
 If the person is sitting, keep the head bended b/w both the legs
 Person should get fresh air
 Once the person gain consciousness ask him to take deep breath and give him liquids
to drink
 If unconsciousness continue refer to hospital
INJURIES AND FRACTURES – SKELTAL
 Clean the wound with soap and water
 Apply the spirit around the place of wound
 Apply Betadine solution and bandage the wound with sterile solution
 Monitor the condition of the patient
 Treat the patient for shock
 Immobilize the fractured area
 Give analgesic and TT
WOUND- SKIN
 Wash the wound with clean boiled water and antiseptic solution
 Apply spirit around the wound
 Remove the foreign bodies present in the wound
 Bandage the wound using Betadine
 Give injection TT
 In case the wound is large and need suture , or caused by bullet or weapon refer to
hospital
Standing orders for MCH CARE
 Give tablets to check vomiting and nausea in early stages of pregnancy
 In case of toxaemia of pregnancy , advise her restricted salt diet and complete rest
 Send to hospital if there is oedema/ APH / PPH
 If the mother develop fever after delivery try to ascertain the cause
 Keep new-born in proper warmth
 Initiate breast feeding
Convulsions in children
 Lie down the child safely on a bed
 Loosen the clothes from the chest and let the fresh air come
 Clean the secretions from his mouth and let the respiratory tract function properly
 In case of fever give cold sponge
 Evaluate the cause
HEMORRHAGE
 Lie down the person on back
 Take BP
 Press a pad on the site of bleeding
 Give him liquids
 Try to find out the cause of bleeding
 Monitor the state of shock and in case of bleeding or condition of shock getting out of
control send the patient for further treatment
Unconsciousness
 Lie down the person in a well ventilated area
 Remove dentures
 Clean the secretions from mouth
 Loosen the clothes from neck , chest and waist
 Provide artificial respiration in case of blocked breathing
 Try to find out the reason
SORE THROAT - RS
 Record vitals
 Inspect for white patches – if yes its s/s of diphtheria– need hospitalization
 Take throat swab
 If pharyngitis – saline gargle
 Give aspirin tablets
 Advice honey syrup with lemon juice and hot water
 If history of recurrent illness need surgery
Cough - RS
 Find out the duration, type, colour and consistency of sputum, weight loss etc
 If TB is suspected refer to hospital for investigation
 Advice rest
 Give aspirin tablets
 Give steam inhalations
INFLAMMED EYES / EYE DISCHARGE
 Bathe eyes with water and clean with cotton swab
 Apply sulphacetamide eye drops
 Demonstrate cleaning and application of eye ointment
 Cover with sterile eye pad and bandage
 Refer if vision diminishes
  Infection that is not responding to treatment or
 Wounds / injuries
EAR ACHE AND DISCHARGE
 Clean the ears
 Apply sulphacetamide ear drops
 Give analgesics, if not coming down refer
 If discharge is present clean with boric acid and apply ear drops
 If s/s not subsiding refer
TOOTH ACHE - GI
 If tooth ache without fever give potassium permanganate solution mouth wash tds
 If with fever aspirin 5 gms for children and 10 gms for adults
 Advise dental care
 Encourage to eat amala , orange , lemon , guava ,, sprouted gram ,tomatoes , raggi and
bajra
 Ask patient to chew a clove with affected teeth
CONSTIPATION – GI
 Advise more fluids. Leafy vegetables
 Discourage laxatives and purgatives
ANEMIA – BLOOD DISORDER
 Encourage to eat ragi, GLV
 Advise dry fruits
 Advise oral iron supplements
 Get the stool examined for hook worms
BLEEDING NOSE
 Make patient sit with head erect and bend forward
 Loosen all clothes at neck
 Ask the patient to pinch nose at the junction of hard and soft palate
 Don’t let to blow the nose
 Check vitals
 Apply cold compress
 Refer to hospital
ROLE OF COMMUNITY HEALTH NURSE IN TREATING MINOR ALIMENTS
 History collection / assessment
 Finding out the actions/ complications and any specifications
 Vitals monitoring
 Identifying the needs and problems
 Nursing services under standing orders
 Implementing referral system
 Informing authorities – outbreak of diseases
 Keeping medicine kit ready
  Representing nurses view point in meting
 Being careful about limits
 Ensure safe and healthy environment

23. Define primary health care. Explain the community participation in promoting
primary health care with examples
(Or)
24. Enlist the functions of primary health centre and explain the role of a
community health nurse in PHC
Ans:
Introduction:-
It is an approach to health beyond the traditional health care system that focuses on health
equity-producing social policy. Primary health-care (PHC) has basic essential elements and
objectives that help to attain better health services for all.
Definition:-
“Primary health care (PHC) is essential health care made universally accessible to individuals
and acceptable to them, through full participation and at a cost the community and country
can afford”.
-WHO
Essential Elements of Primary Health Care (PHC):
There are 8 elements of primary-health care (PHC). That listed below-
1. E– Education concerning prevailing health problems and the methods of
identifying, preventing and controlling them.
2. L– Locally endemic disease prevention and control.
3. E– Expanded programme of immunization against major infectious diseases.
4. M– Maternal and child health care including family planning.
5. E– Essential drugs arrangement.
6. N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
7. T– Treatment of communicable and non-communicable disease and promotion of
mental health.
8. S– Safe water and sanitation.
Extended Elements in 21st Century:
1. Expended options of immunizations.
2. Reproductive health needs.
3. Provision of essential technologies for health.
 4. Health promotion.
5. Prevention and control of non-communicable diseases.
6. Food safety and provision of selected food supplements.
ATTRIBUTES OF PRIMARY HEALTH CARE
 Essential health care
 Universally accessible
 Acceptable
 Community based
 First point of contact
 Affordability
 Adaptability
 Appropriateness
 Community participation
 Continuity
 Comprehensiveness
 Coordination
PRINCIPLES/PILLARS OF PRIMARY HEALTH CARE (PHC):
Behind these elements lies a series of basic objectives that should be formulated in
national policies in order to launch and sustain primary healthcare (PHC) as part of a
comprehensive health system and coordination with other sectors.
MAIN PILLARS/PRINCIPLES OF PHC
1. Equitable distribution of health care– according to this principle, primary care and
other services to meet the main health problems in a community must be provided
equally to all individuals irrespective of their gender, age, and caste, urban/rural and
social class.
• Inequity in the availability of health services - major concern
• Supply of health care resources- more towards affluent areas
• Julian Tudor Hart - “Inverse Care Law”
Availability of good medical care tends to vary inversely with the need for it in the
population served
 First key principle in the primary health care
 Ensures that individuals with more compromised health conditions will
receive more health services
 Commitment to health equity focuses not only on ensuring program inputs but
also reducing differences in health outcomes
 Access to health care - horizontal equity & vertical equity
Horizontal equity - “equal access for equal needs”
 equal resources
  equal access to health care
 equal utilization of health services
 equal health
Vertical equity-unequal should be treated in proportion of their inequality
 Individuals with more need should have more treatment
 The central theme of “need” therefore determines equity
Aspects of equity in health and health care:
 Equity in access to health care
 Equity in health
 Effective coverage
Examples of equitable distribution in access to health care in India:
Tripura- helicopter service to reach the remote set of tribal hamlets
Andhra Pradesh- free bus passes to pregnant women for the Antenatal visits
Assam - Akha-ship to provide primary care services in Riverine Island through
boat clinics
Tamil Nadu – concept of birth resorts is introduced in remote and hilly areas for
institutional deliveries
2. Community participation-comprehensive healthcare relies on adequate number and
distribution of trained physicians, nurses, allied health professions, community health
workers and others working as a health team and supported at the local and referral
levels.
Types of participation
 Active participation: Cooperation + resources
 Passive participation: only cooperation
Advantages of community participation:
 Increases program acceptance and leadership
 Ensures that the program meets the local needs
 Cost of implementing the program may be reduced by using the local
resources
 Uses local/ familiar organizations and hence problem solving is efficient
 Commitments to the decision is facilitated
 Key to the sustainability
Examples of community participation in India:
 Village health guides, trained dais, ASHA
 Selected by the local community and trained locally
 Essential feature of health care in India
  Village Health and Sanitation Committee: Play multiple roles including IEC,
household surveys, preparation of health registers, organisation of meetings at
the village level, promoting household toilet, sanitation programme.
 Rogi Kalyan Samitis/ patient welfare society
 Jan Swasthya Abhiyan Initiative- People Rural Health watch
3. Multi-sectional/ Intersectoral approach-recognition that health cannot be improved
by intervention within just the formal health sector; other sectors are equally
important in promoting the health and self- reliance of communities.
Pre-requisites for Intersectoral Coordination:
 Proper orientation of policies and programme
 Formation of joint coordination committee at each level
 Defining role and responsibilities of participatory agencies
 Participatory decision making
 Developing formal system of interaction, discussion and debate
 Sharing of the problems faced in implementation
 Spelling out strategies and procedure
 Joint evaluation and monitoring
 Mechanism of co-ordination:
 List out names of different sectors
 Identify the NGOs and voluntary organisation
 Constitute the district level co-ordination committee
 Formulate specific task forces
 Jointly decide the objectives and areas
 Decide the role and responsibility
 Development a plan
Examples of intersectoral co-ordination-India:
 Convergence with Indian system of medicine (AYUSH)
 Co-ordination with rural health practitioners
 In Bihar, Janani- “Titli” & “Surya” clinics
 Co-ordination with non-governmental and civil organisation- mother NGO
schemes (MNGO), service NGO (SNGO)
4. Use of appropriate technology- medical technology should be provided that
accessible, affordable, feasible and culturally acceptable to the community.
Examples for the appropriate technology
 Use of coloured tapes for measuring mid upper arm circumference
 Use of ORS
 Tender coconut for oral hydration
 Growth chart maintenance for under five children
 ITN
 Jan Swasthya Sahyog:
 CMC Vellore and AIIMS
 Low cost techniques
  Detection of UTI costs less than Rs.2/test, anaemia less than Re 1, diabetes
and pregnancy at Rs.3
 Low cost mosquito repellent creams
 Simple water purification
 Informational technological advancements that have been proven to
ultimately enhancing the service delivery-
• Health Management Information System
• Telemedicine
5. Man power development-essential human resource in the medical &paramedical
should be planned to rise to meet the need for fulfilling the demand by training
necessary skills and need to involve volunteers as para & semi-professional till then.
OTHER PRINCIPLES IN PHC
6. Improvement in the level of health care of the community.
7. Favourable population growth structure.
8. Reduction in the prevalence of preventable, communicable and other disease.
9. Reduction in morbidity and mortality rates especially among infants and children.
10. Extension of essential health services with priority given to the undeserved sectors.
11. Improvement in basic sanitation.
12. Development of the capability of the community aimed at self-reliance.
13. Maximizing the contribution of the other sectors for the social and economic
development of the community.
Note: ref question no. 20, 21, 22 for nurses’ role

25. Explain the waste management in centres &clinics

Ans:-
Definition:-
A substance or object that is disposed, intended to be disposed or required to be disposed.
(Or)
“Proper disposition of a discarded or discharged material in accordance with local
environmental guidelines or laws”.
-(BUSINESS DICTIONARY)
(Or)
“Waste management is the collection, transport, processing, recycling or disposal, and
monitoring of waste materials.”
Types:
Human waste, municipal waste, hazardous waste, biomedical waste.
Classification of waste:
 Biodegradable wastes:
Those that can be decomposed by the natural processes and converted into the elemental
form. E.g. kitchen garbage, animal dung, etc.
 Non-biodegradable Wastes:
Those that cannot be decomposed and remain as such in the environment, persistent, can
cause various problems. E.g. Plastics, nuclear wastes, glass, etc.
Domestic waste
Is a waste that is generated as a result of the ordinary day-to-day consumptions of households
Includes: Remains of food, plastics, bottles, papers......
Output of daily waste depends on:
 Dietary habits.
 Life style, living standards.
 Degree of urbanization and industrialization.
Municipal wastes
 Also known as trash, garbage, refuse or rubbish.
 Is a waste type consisting of everyday items that are discarded by the public.
Municipal waste - composition
Composition varies according to consumption nature, municipality.
It includes: Food wastes, market wastes, plastic containers, product packaging materials.
Does not include: Industrial wastes, agricultural wastes, medical wastes.
Bio medical waste
"Bio-medical waste “means any waste, which is generated during the diagnosis, treatment or
immunisation of human beings or animals or in research activities or in the production or
testing of biologicals.
Bio medical waste composition:-
 WASTE CATEGORY TYPE OF WASTE

Category No. 1 Human Anatomical Waste

Category No. 2 Animal Waste
Category No. 3 Microbiology & Biotechnology Waste
Category No. 4 Waste Sharps
Category No. 5 Discarded Medicine and Cytotoxic drugs
Category No. 6 Soiled Waste
Category No. 7 Solid Waste
Category No. 8 Liquid Waste
Category No. 9 Incineration Ash
Category No.10 Chemical Waste

Solid waste management

 Storage.
 Collection.
 Separation.
 Transport.
 Disposal.
Storage:
 Proper storage while awaiting collection.
 Steel dust bin with close fitting cover.
 Public bins.
Collection:
 Gathering of solid wastes & recyclable materials.
 Transport after collection to the location where the vehicle is emptied.
Separation:
 Separation of different types of waste components.
Transport:
 From smaller collection vehicle to larger transport equipment.
 Then transported over a long distance to processing or disposal site.
Disposal:
 Getting rid of waste.
Methods of waste disposal:-
 Dumping
 Incineration
 Composting
 Manure Pits
 Deep burial
 Controlled Tipping or Sanitary Land-fill
DUMPING
 Refuse is dumped in low lying areas.
 As a result of bacterial action, refuse decreases considerably in volume and is
converted gradually into humus.
The drawbacks of DUMPING are:-
 The refuse is exposed to files and rodents.
 Drainage from dumps contributes to the pollution of surface and ground water.
 A WHO Expert Committee (1967) condemned dumping as “ a most insanitary
method that creates public health hazards, a nuisance, and severe pollution of the
environment”.
INCINERATION
 Refuse can be disposal of hygienically
 It is method of choice where suitable land is not available.
 Hospital refuse which is particularly dangerous is best disposed of by incineration.
 Incineration is practiced in several of the industrialized countries.
COMPOSTING
Composting is a method of combined disposal of refuse and night soil or sludge.

Organic matter

Bacterial action

Relatively stable
humus-like material

Manurial value for

the soil.

 The heat produced during composting -60 0 C or higher, over a period of several days-
destroys eggs and larvae of flies, weed seeds and pathogenic agents.
 The end-product is a good soil builder containing small amounts of the major plant
nutrients such as nitrates and phosphates.
Methods of composting
 Bangalore Methods (Anaerobic method)
 Mechanical Composting (Aerobic method)
BANGALORE METHODS: - (Hot fermentation process)
 Indian Council of Agriculture Research at the Indian Institute of Science, Bangalore.
  It has been recommended as a satisfactory method of disposal of town wastes and
night soil.
 Trenches are dug 90 cm deep, 1.5 to 2.5 m (5-8 ft.) broad and 4.5 to 10 m (15-30 ft.)
long.
 Depths greater than 90 cm (3 ft.) are not recommended because of slow
decomposition.
 First layer - 15 cm (6 in) thick is spread at the bottom of the trench.
 Second layer- night soil is added corresponding to a thickness of 5 cm (2 in).
 Third layer- refuse and night soil are added in the proportion of 15 cm and 5 cm
respectively, till the heap rises to 30 cm (1 ft.)
 The top layer should be of refuse, at least 25 cm (9 in) thickness.
 After 7 days - heat (over 60 deg. C) is generated in the compost mass - intense heat
which persists over 2 or 3 weeks- decompose the refuse and night soil and to destroy
all pathogenic and parasitic organisms.
 After 4 to 6 months, decomposition is complete and the resulting manure is a well
decomposed.
MECHANICAL COMPOSTING
 The entire process of composting is complete in 4 to 6 weeks.
 This method of composting is in vogue in some of the developed countries, e.g.,
Holland, Germany, Switzerland, and Israel.
 The Government of India is considering plants in selected cities.
 Cities such as Delhi, Nagpur, Mumbai, Chennai, Pune, Allahabad, Hyderabad,
Lucknow, and Kanpur have offered to join the Government for setting up pilot plants
for mechanical composting.
Manure pits
 The problem of refuse disposal in rural areas can be solved by digging ‘manure pits’
by the individual householders.
 The garbage, cattle dung, straw, and leaves should be dumped into the manure pits
and covered with earth after each day’s dumping.
 This method of refuse disposal is effective and relatively simple in rural communities.
Burial
 For small camps.
 A trench 1.5 m wide and 2 m deep is excavated
 The contents are used after 4 to 6 months
STEPS IN BMW MANAGEMENT:-

GENERATION

SEGREGATION

STORAGE
&COLLECTION

TRANSPORTATION

TREATMENT

DISPOSAL

Survey of waste generated

 Quantity
 Type
 Source
 Level of disinfection
Segregation and collection
 Done at point of Generation of waste
 Process where wastes of different types, hazardous nature and consistency are
separated.
 As per the categories.
 Colour coded containers
 Where? - Should be displayed.
 Local languages.
Storage of waste
 Holding of biomedical waste for such period of time, at the end of which waste is
treated and disposed of.
 Safe from tampering and access to rag-pickers.
 Not beyond a period of 48 hours.
 Biohazard symbol
Transportation of waste
 Vital link
 Source interim storage site final disposal
 Secured from the public as well as waste handlers.
 Minimal effort, spillage or disturbance to the waste.
 Frequency and timings of transport should be informed
 Keep proper documentation of the frequency.
Technologies for waste treatment
 Reduce its bulk and make it free from pathogenic organisms.
 Changes the physical, chemical or biological characteristics or composition.
 Hazardous non-hazardous
 Chemical disinfection Technology
 Thermal technology
 Mechanical Technology
 Irradiation technology.
Final disposal methods
 Incineration
 Deep burial
 Landfill

26. List any four nursing theories. Explain nightingale’s environmental theory.
Ans:-
A. List any four nursing theories:-refer question number 15
B. Nightingale’s environmental theory:-
A Brief History in the Life of Ms.Florence Nightingale (May 12, 1980 - August 13, 1910)
 She was born in Florence, Italy
 She believed that God called her to become a nurse
 The Mother of Modern Nursing
 The “lady with the lamp” – Crimean War
 She is a linguist, and educated in science, mathematics, literature and arts
 The first Nurse Educator and First Nurse Statistician
  July 6, 1851- entered in the nursing school of Ptr.Theodor Fleidner as the 134th
nursing student and graduated after 3 months.
 Became the “lady with the lamp” because she was carrying the lamp at night when
she was looking for wounded soldiers in the Crimean War.
 Became a heroine in Great Britain because of her role in the Crimean War.
 She reduced the mortality rate of the wounded soldiers from 42.7% to 2.2% because
of her intervention in the environment.
What is nursing?
“The act of utilizing the environment of the patient to assist him in his recovery”
-Nightingale (1869)
General Objectives:
 To be able to learn the relevance of the environmental theory in the nursing science
and practice.
Specific Objectives:
 To be able to know a brief history of MS. Florence Nightingale
 To be able to identify the purpose of the environmental theory
 To be able to understand how the environment affects patient outcomes
NIGHTINGALE’S ENVIRONMENTAL MODEL
13 CANONS OF NIGHTINGALE’S THEORY (1860)
 Health of Houses
 Ventilation and Warming
 Light
 Noise
 Variety
 Bed and Bedding
 Cleanliness of the Rooms and Walls
 Personal Cleanliness
 Taking Food – What Food?
 Observation of the Sick
 Petty Management

Five Environmental Factors –The absence of one produced lack of health or sickness
 PURE /FRESH
AIR

POTABLE
LIGHT
WATER

HEALTH

PROPER
CLEANLINESS
DRAINAGE

Metaparadigm in Nursing
1. Nursing:-
 Must place the patient in the best condition for nature to act upon him.
 It should provide for the patient the major components of the environment.
 Should fully maximize the reparative process of a patient by controlling the
environment.
 Nursing should provide care to the sick as well as the healthy
 Health promotions must be initiated by the nurse
2. Person:-
 She views the person as a passive recipient of care
 The nurse should control the environment
 The nurse should perform the task to and for the patient
3. Health:-
 “Health is a wellbeing and using every power that the person has to the full extent.
 “Disease” is a reparative process that the nature instituted for a want of attention
 Maintenance of health can be done through the prevention of disease by
controlling the environment.
 Health must be the goal of nursing therefore the nurse must assist
 The nurse must provide assistance for the patient to stay in balance with the
environmental factors.

4. Environment:-
  Physical environment is very important because everything that surrounds the
patient have an impact on their health
 She believed that sick, poor people could benefit from environmental
improvement.
Nightingale and the Nursing Process
Assessment Diagnosis Planning Intervention Evaluation
Must reflect the Planning is This should take This must be
a. Always what
response of the focused on place within the based on the
the client
client to the modifying the environment of effects of the
wants and
environment and environment of the client and changes in the
needs.
not the the client to having actions environment on
environmental enhance the that involves the the ability of the
b. The nurse
should use her problem. It must Client’s ability modification of client to regain
observation show the to respond to the environment health at the
skills significance of the the disease of the patient. least expense of
especially environment to process. The energy.
with the the health and desired Observation is
environment well- being of the outcome must to be used for
concerning client still be based on the evaluation.
the individual the
environmental
model.

27. Define records? List out the principles of records &reports. Describe the role of
nurse in maintence of records &reports.
Ans:-
INTRODUCTION
 All professional persons need to be accountable for the performance of their duties to
the public.
 Since nursing has been considered as profession, nurses need to record their work on
completion.
 Records are a practical and indispensable aid to the doctor, nurse and paramedical
personnel in giving the best possible service to the clients.
 Report summarizes the services of the person or personnel and of the agency.
Definition
Records
A record is a permanent written communication that documents information relevant to a
client’s health care management.
(Or)
A record is a clinical, scientific, administrative and legal document relating to the nursing
care given to the individual family or community.
REPORTS
Reports are oral or written exchanges of information shared between caregivers or
workers in a number of ways.
(Or)
A report is the summary of the services of person or personnel and of the agency.
PURPOSES
 Supply data that are essential for programme planning and evaluation.
 Provide the practitioner with data required for the application of professional services
for the improvement of family's health.
 Tools of communication between health workers, the family & other development
personnel
 Effective health records show the health problem in the family and other factors that
affect health.
 Indicates plans for future.
 Help in the research for improvement of nursing care.
PRINCIPAL
 Nurses should develop their own method of expression and form in record writing.
 Written clearly, appropriately and adequately.
 Contain facts based on observation, conversation and action.
 Select relevant facts and the recording should be neat, complete and uniform
 Valuable legal documents and so it should be handled carefully, and accounted for.
 Records should be written immediately after an interview.
 Records are confidential documents.
 Accurately dated, timed and signed
 Not include abbreviations, jargon, meaningless phrases
USES OF RECORDS & REPORTS:-
For the Doctor
 Serves as guide for diagnosis, treatment, follow up and evaluation of services.
 Indicate progress and continuity of care.
 Help self-evaluation of medical practice.
 Protect the doctor in case of legal issues. Records may be used for teaching and
research.
For the Nurse
 Provide with documentation of services rendered, i.e. shows health condition of the
client.
 Provide data essential for planning and evaluation of services for further
improvement.
 Serve as a guide for professional growth.
 Enable to judge the quality and quantity of work done.
 Serve as communication tool between staff and other members involved in care.
  Indicate plans for the future.
For Authorities
 Provide the management with statistical information necessary for decision in regard
to utilization of resources, planning for administrative control and future references.
 Help the supervisor evaluate the services rendered, teaching done and a person’s
action and reactions.
Types of records
Records maintained in community:-
 Cumulative or continuing records
This is found to be time saving, economical and also it is helpful to review the total
history of an individual and evaluate the progress of a long period.
 Family records
 All records, which relate to members of family, should be placed in a single
family folder. Gives the picture of the total services and helps to give
effective, economic service to the family as a whole.
 Separate record forms may be needed for different types of service such as
TB, maternity etc. all such individual records which relate to members of one
family should be placed in a single family folder.
 Eligible couple and child register
 Sterilization and IUD register
 MCH Card/ register
 Child Card/ register
 Birth and death register
 Sub centre’s/PHC/clinic register
 Stock & Issue register
 Reports of blood test of Malaria and Filaria
 Malaria parasite positive case register and others
Records maintained in hospital:-
 Patient’s clinical record
 Records of nurses’ observations – Nurses’ Notes
 Records of orders carried out
 Records of treatment
 Records of admission and discharge
 Records of equipment loss and replacement (inventory)
 Records of personnel performance.
How to improve record & report keeping:-
 Get into the habit of using factual, consistent, accurate, objective and unambiguous
patient information
 Use your senses to record what you did.
 Ensure there is a reasoned rationale (evidence) for any decision recorded.
  Ensure notes are accurately dated, timed, and signed, with the name printed alongside
the entry.
 Write the notes, where possible, with the involvement and
understanding of the patient or care taker.
 Errors should be corrected by putting a single line through the incorrect statement and
signing and dating it.
 Follow the SMART model (Specific, Measurable, Achievable, Realistic and Time-
based) or similar when planning care
 Write up notes as soon as possible after an event and, by law, within 24 hours, making
clear any subsequent alterations or additions
 Do not include jargon, meaningless phrases (for example 'slept well'), and offensive
subjective statements.
 It must be clear what was originally written and why it was changed, therefore
correction fluids should not be used.
 The NMC's position on abbreviations is that they should not be used (NMC,
2002c).e.g. 'PT' could mean patient, physiotherapist or part time; 'BD' could mean
twice or brought in dead.
Nurses role in maintaining records and reports
 The patient has a right to inspect and copy the record after being discharged
 Failure to record significant patient information on the medical record makes a nurse
guilty of negligence.
 Medical record must be accurate to provide a sound basis for care planning.
 Errors in nursing charting must be corrected promptly in a manner that leaves no
doubts about the facts.
 In reporting information about criminal acts obtained during patient care, the nurse
must reveal such information only to the police, because it is considered a privileged
communication.
 FACT :-
Information about clients and their care must be functional. A record should contain
descriptive, objective information about what a nurse sees, hears, feels and smells.
 ACCURACY:-
A client record must be reliable. Information must be accurate so that health team
members have confidence in it.
 COMPLETENESS:-
The information within a recorded entry or a report should be complete, containing
concise and thorough information about a client care or any event or happening taking
place in the jurisdiction of manger.
 CURRENTNESS:-
Delays in recording or reporting can result in serious omissions and untimely delays
for medical care or action legally, a late entry in a chart may be interpreted on
negligence.
 ORGANIZATION:-
 The nurse or nurse manager communicates information in a logical format or order.
Health team members understand information better when it is given in the order in
which it is occurred.
 CONFIDENTIALITY:-
Nurses are legally and ethically obligated to keen information about client’s illnesses
and treatments confidential.