Unit 8

9/26/2019 JaypeeDigital | eBook Reader
Nursing
Foundation:
Concepts and
Perspectives (For
Post Basic BSc
Nursing)
SECTION 2
Jogindra Vati
CONCEPT OF NURSING
SECTION 1: CONCEPT OF NURSING AND
PROFESSIONAL ORGANIZATIONS PRACTICE
 1: Development Of Nursing As A Profession:
Its Philosophy And Objectives
 2: Responsibilities And Expanded Role Of A
Nurse
 3: Development Of Nursing Education In India
 4: Professional Organizations And Regulatory
Bodies
 5: Career Planning And Development
• Primary Health Care Concept I
SECTION 2: CONCEPT OF NURSING PRACTICE • Primary Health Care Concept II 50
• Nursing Care Concepts
Primary Health Care

6
 Concept I
Chapter Outline
Competencies
Introduction
Primary health care

De ning primary health care
Changing concepts of primary health Care in India
Principles of Primary Health Care
WHO’s Strategies of primary health care
Characteristics of sound Primary Health Care
Activities Essential for Primary Health Care
Community oriented nursing

Concept and De nitions
Historical Development
Principles of Community Oriented Nursing
Characteristics of Community Oriented Nursing
Work Settings in Community Oriented Nursing
Components of Community Oriented Nursing

TOC Index 
Role of Community Nurses in India
Key points
Chapter End questions
Suggested reading
COMPETENCIES
https://www.ijccm.org/eReader/chapter/9789351527886/ch6 1/20
After completion of this chapter, the learner will be able to:
De ne primary health care (PHC)
Nursing Understand basis and changing concept of PHC

Foundation: List down the principles of PHC
Concepts and
Discuss WHO’s strategies of PHC
Perspectives (For
Post Basic BSc Explain characteristics and activities essential for PHC
Nursing) Understand the concept and meaning of community oriented nursing
Jogindra Vati
Appreciate historical development of community oriented nursing

Enumerate the principles, characteristics and work settings of community
PROFESSIONAL ORGANIZATIONS oriented nursing
Describe the components of community oriented nursing
 2: Responsibilities And Expanded Role Of A Discuss the role of community nurses
Nurse
Understand the concept of family, family life cycle, different types of families
 4: Professional Organizations And Regulatory Discuss characteristics and functions of a family
Bodies
Understand the concept of family health, family nursing and family oriented
SECTION 2: CONCEPT OF NURSING PRACTICE
nursing
Explain different approaches and related theories.

INTRODUCTION
As per our constitution, health is a fundamental right of every citizen. Each state

has its responsibility for the health of its people. However, health care services
vary from state to state. Health care is holistic in nature as it includes all the
aspects of care ranging from preventive, promotive, curative and rehabilitative
level. It is wholesome of care from domiciliary to hospital settings. In India it is
the responsibility of government to provide the health services to the outreach
of people through various programmes. Health services are provided as per the
need of the people.

PRIMARY HEALTH CARE
DEFINING PRIMARY HEALTH CARE (PHC)
Primary Health Care (PHC) is termed as ‘Essential’ health care. It is the rst
level or primary level of health care provided at primary health centre, sub-
centre, so that the essential services are up to reach or at the door step of local
people through Accredited Social Health Activist (ASHA), multipurpose health
workers, trained Dias. It is very close to people, where most of their health
problems can be identi ed, dealt and resolved. This care will be as per need of
the area and limitations. There should be a provision for the referral in the
health system. The concept of primary health care has been changed from time
to time.
TOC Index 
PHC is essential health care that is a socially appropriate, universally
accessible, scienti cally sound rst level care provided by a suitably trained
workforce supported by integrated referral systems and in a way that gives
priority to those most in need, maximises community and individual self-
reliance and participation and involves collaboration with other sectors. It
includes: health promotion, illness prevention, care of the sick, advocacy and
community development.
Primary health care is viewed as an approach that focuses on the person

not the disease, considers all determinants of health; and integrates care when
there is more than one problem, uses resources to narrow differences; forms
the basis for other levels of health systems; addresses most important
problems in the community by providing preventive, curative and rehabilitative
services and organizes deployment of resources aiming at promoting and
Nursing maintaining health.
Foundation: 52
Concepts and According to World Health Organization (1978) primary health care is
Perspectives (For de ned as ‘an essential health care; based on practical, scienti cally sound, and
Post Basic BSc socially acceptable method and technology; universally accessible to all in the
Nursing)
community through their full participation; at an affordable cost; and geared
Jogindra Vati
toward self-reliance and self-determination (WHO and UNICEF, 1978).

PROFESSIONAL ORGANIZATIONS
CHANGING CONCEPTS OF PRIMARY HEALTH CARE IN INDIA
 2: Responsibilities And Expanded Role Of A The concept of primary health care in India dates back in the Vedic period, in
Nurse
the Indus-Valley Civilization (3000 BC). At that time ‘Arogya’ or ‘health’ was the
concern in daily life of people which include physical, mental, social and
Bodies spiritual well being. Even in Ayurveda (1400 BC), the emphasis was on health
 5: Career Planning And Development promotion and health education. Later on, preexisting health services were lost
SECTION 2: CONCEPT OF NURSING PRACTICE due to various reasons especially because of the onslaught of series of foreign
aggressions and regimes. During British period, there was focus on medical
care, care of sick and injured only in the big cities and meant for selected
people. However, some preventive measures were provided for the control of
epidemics, and dispensaries were opened in some remote villages. Provincial
health departments were established in 1919 (Roy S, 1985)
 After Independence: After independence, under various committees, ve
years plans, UNICEF/WHO in their joint health policy, 1965; International
Conference at Alma Ata (USSR0,1973; National Health Policy, 1983; and ‘The
Millennium Developmental Goals’, 2000; National Rural Health Mission (NRHM),
2005-2012 had focus on primary health care.
Committees’ recommendations on PHC: The basis for primary health care

was laid down by Bhore Committee (1946) on ‘Health Survey and Development’.
On its recommendation, the community development programme was launched
in October 1952 as the rst integrated all-round rural development programme,
and proposed to establish one primary health centre for each community
development block. Each PHC had three sub-centers, being looked after by a
trained midwife for providing MCH services.
The term ‘comprehensive health care’ was used by Bhore Committee in

1946. The concept of Primary Health Care was limited to provide the
comprehensive health care at rst contact. According to Bhore Committee,
comprehensive health care includes: the provision of adequate preventive,
curative, and promotive health services; should be close to the bene ciaries as
possible; there should be cooperation between people, the service and the
profession; available to all irrespective of their ability to pay; pay attention
speci cally the vulnerable and weaker section of the community; maintain
healthy environment both at home and working places.
This concept of health care led the basis for national health planning and
TOC Index  establishment of three tier health system especially the rural health services
based on primary health centres and sub centres in India. Thereafter changes
have been taken place as per various committees constituted time to time such
as: the Mudaliar Committee (1961), the Mukherjee Committee (1966), the
Kartar Singh Committee (1974) and the Srivastava Committee (1975).
Focus of ve year plans on PHC: The ve year plans also initiated for all
round development. In the rst ve-year plan (1951–56), the focus was on
improving the living standard over a period of time. Various programmes were
instituted, facilities were expanded and education and training facilities were
increased. In the subsequent ve year plans, the health and family planning
services were the focus. During the fth plan (1974-80), the family planning
programme was integrated with the MCH and nutrition programmes. During the
tenth ve year plan (2002-2007) the emphasis was given to improve and
enhance the quality of primary health care in urban and rural area. It laid down
Nursing objective targets. The main purposes of these ve year plans are to strengthen
Foundation: the basic health services through three tier health system, population control,
Concepts and
control or eradication of communicable diseases and development of health
Perspectives (For
manpower resources.
Post Basic BSc
Nursing) UNICEF/WHO views on PHC: Primary health care is viewed and termed as
Jogindra Vati
‘Basic health Services’ by UNICEF/WHO in their joint health policy in 1965. A
basic health service is understood to be ‘a network of coordinated, peripheral
PROFESSIONAL ORGANIZATIONS and intermediate health units capable of performing effectively a selected
 1: Development Of Nursing As A Profession: group of functions essential to the health of an area and assuring the
availability of competent professional and auxiliary personnel to perform these
Nurse
functions.’
Focus of International Conference at Alma Ata (USSR) on PHC: Since 1975,
Bodies the WHO had been developing the concept of achieving health for all by 2000
 5: Career Planning And Development AD. Before Alma Ata declaration, the concept of primary health care was limited
SECTION 2: CONCEPT OF NURSING PRACTICE to provide the basic health services or comprehensive health care at rst
contact.
But after International conference jointly organized by the WHO and UNICEF
in Alma Ata, U.S.S.R. in 1978 with 134 countries and 67 non-governmental
organizations in attendance, health care is termed as ‘primary health care ’ and
it gave wider meaning to primary health care. According to Alma Ata conference
 ‘primary health care is essential health care made universally accessible to
individuals and acceptable to them, through their full participation and at a cost
the community and country can afford’. This concept of primary health care is
equally applied to all the countries and widely accepted to attain health for all
by 2000AD.
According to Alma Ata Declaration, at a minimum, primary health care

comprised eight elements: health education, adequate nutrition, maternal and
child health care including family planning, basic sanitation and safe water,
control of major infectious diseases through immunization, prevention and
control of locally endemic diseases, treatment of common diseases and
injuries, and the provision of essential drugs (UNICEF). It also includes training
of health guides, health workers and health assistants and referral services,
mental health, physical handicaps and health and social care of the elderly.
Targets of National Health Policy (1983): The government of India, after the
declaration of Alma-Ata (1978), worked out in detail the various issues
providing primary health care. The reports by the two working committees
formulated the basis for formulating ‘National Health Policy’ in 1983 to achieve
health for all. It had laid down various speci c goals and indicators to be 53
achieved by 1990 and 2000 AD. The goals are: to reduce the infant mortality
rate from level of 125 (1978) to below 60; to raise the expectation of life at birth
from the level of 52 years to 64; to reduce the crude death rate from level of 14
per 1000 population to 9 per 1000; to reduce the crude birth rate from level of
33 per 1000 population to 21; to achieve a Net Reproduction Rate to one; to
TOC Index  provide potable water to entire rural population.
The millennium developmental goals: In September 2000, representatives

from 189 countries met in New York to adopt the United Nations Millennium
Declaration. There are eight goal, 18 targets and 48 indicators to achieve by the
year 2015. The goals and targets are depicted in Table 6.1:
Focus of National Health Policy (2002): A new national health policy was
framed in 2002, keeping in view of changes in the demographics and other
determinate factors related to health with the objectives to achieve an
acceptable standard of good health of the people. The focus was on preventive
and rst line curative initiatives at the primary health level. The diseases like
tuberculosis, malaria, HIV/AIDS, blindness were given the emphasis. It laid

down speci c goals to be achieved by year 2005, 2007, 2010, and 2015. The
following schemes are in operation:
Nursing
Foundation: To provide the primary health care at village level, under village health guide
Concepts and scheme (October, 1977), there were village health guides. They were mostly
Perspectives (For women, but in May 1986, according to a circular from Government of India,
Post Basic BSc male health guides would be replaced by female health guides and they would
Nursing) be rst contact with the people. The eligibility for training of a village health
Jogindra Vati
guide was at least VI standards, permanent resident of community of the local
community, were trained for 3 months of duration of 200 hours with stipend of
PROFESSIONAL ORGANIZATIONS Rs 200 per month. The training programme was continued till ninth plan (1997-
 1: Development Of Nursing As A Profession: 2002).
 2: Responsibilities And Expanded Role Of A All categories of local Dais (traditional birth attendants) were trained for 30
Nurse
days to improve their knowledge on basic concepts of maternal and child health
and obstetric skills under the training of local Dais Scheme . Each Dai was paid
Bodies Rs 300 under the supervision of Health Worker females or ANM/Health
 5: Career Planning And Development assistant (Female).
Anganwadi workers (AWW) are the most important link between the rural
poor and good healthcare under the ICDS (Integrated Child Health Development
Scheme, launched on 2nd October 1975) , the world’s largest and most unique
programmes for early childhood development and to combat child hunger and
malnutrition. The AWW is a health worker, chosen from community and they
have to undergo a 4 months training in health, nutrition and child-care.

Table 6.1 The millennium developmental goals and targets
Goal Target/S
Eradicate extreme Halves the proportion of people living in extreme poverty

hunger and poverty (less than one dollar in a day) in between 1990 and 2015
Halve, between 1990 and 2015, the proportion of people who

suffer from hunger.
Achieve universal Ensure that by 2015, children everywhere, boys and girls alike,
primary education will be able to complete a full course of primary schooling
Promote gender Eliminate gender disparity in primary and secondary

equitable societies education, preferably by 2005, and in all levels of education
and empower no later than 2015
women
Reduce child Reduce by two-third, between 1990 and 2015, the under- ve
mortality mortality rate
Improve maternal Reduce by three quarters, between 1990 and 2015, the
health maternal mortality ratio
TOC Index 
Combat HIV/AIDS, Have halted by 2015 and begun to reverse the spread of
malaria and other HIV/AIDS
diseases Have halted by 2015 and begun to reverse the spread of
malaria and other major diseases
Ensure Integrate the principles of sustainable development into

environmental country programs and reverse the loss of environment
Nursing sustainability resources
Foundation: Halves, by 2015, the proportion of people without sustainable

Concepts and access to safe drinking water and basic sanitation
Perspectives (For
Have achieved by 2020, a signi cant improvement in the lives
Post Basic BSc
Nursing) of at least 100 million slum dwellers
Jogindra Vati
Develop a global Develop further an open, rule based, predictable, non-

partnership for discriminatory trading and nancial system
development Address special needs of the least developed countries
Address the special needs of landlocked developing
Nurse countries and small island developing states
 3: Development Of Nursing Education In India Deal comprehensively with the debt problems of developing
countries through national and international measures in
Bodies
order to make debt sustainable in the long-term
SECTION 2: CONCEPT OF NURSING PRACTICE In cooperation with developing countries, develop and
implement strategies for decent and productive work for
youth
In cooperation with pharmaceutical companies, provide

access to affordable essential drugs in developing countries
In cooperation with the private sector, make available the

 bene ts of new technologies, especially information and
communicable technologies.
54
She is the in-charge of an Anganwadi which covers a population of 1000. About
10 Anganwadi workers are supervised by a Supervisor called Mukhyasevika.
Four Mukhyasevikas are headed by a Child Development Projects O cer
(CDPO).
The Anganwadi centre provides supplementary nutrition, non-formal pre-

school education, nutrition and health education, immunization, health check-up
and referral services. Along with Village Health Guides, the Anganwadi workers
are the link between community and health services and all other services by
the young children. There are 13.31 lakhs Anganwadi and mini-Anganwadi
Centres (AWCs/ mini-AWCs) operational out of 13.72 lakhs sanctioned AWCs/
mini-AWCs, as on 31.01.2013.
At the sub-centre level, the mother and child healthcare, family planning and
immunization are provided. One male and one female multipurpose health
worker is posted in the sub centre. The work of health workers is supervised by
the male and female health assistants respectively. One female health assistant
supervises the work of 6 female HWs. At primary health centre, there is health
worker female/ANM, health Assistant male, health assistant female/LHV and
other staff.
ASHA and National Rural Health Mission (2005-2012): National Rural

TOC Index  Health Mission (NRHM) is a strategic framework to implement the National
Health Policy 2002. NRHM is an ambitious strategy of the government,
launched by Honorable Prime Minister of India on 12th April 2005 for a period
of seven years (2005–2012) for providing integrated comprehensive primary
health care services, especially to the poor and vulnerable sections of the
society. It was an attempt to introduce a lay village level health worker and has
been undertaken by 10 States and 1.2 lakhs
At the village level, to complement the work of ANM, ASHA (Accredited

Social Health Activist) is selected through a selection procedure to ll the gaps
in the health care delivery system. ASHA is trained community based link
worker and acts as bridge between the Government functionaries and Tribal
and Non-tribal population who nd it di cult to access the health services.
Later on and in order to increase the accessibility to health services, over
Nursing 400000 female ASHA, on per 1000 population ( exible for tribal hilly and
Foundation: deserted areas) in 18 high focus areas (including eight Empowered Action
Concepts and
Group (EAG) states, eight north eastern states/union territories and the state of
Perspectives (For
Jammu and Kashmir and Himachal Pradesh) with poor health indicators/weak
Post Basic BSc
Nursing) health infrastructure.
Jogindra Vati
At sub health centre level, it is recommended that there should be: an
additional ANM at each sub centre; about 21983 new sub centres need to be
PROFESSIONAL ORGANIZATIONS established as per the 2001 population norms; total requirement for the country
 1: Development Of Nursing As A Profession: is estimated about 200000 ANMs.
 2: Responsibilities And Expanded Role Of A At primary health centre, there should be three staff nurses against the
Nurse
availability of one staff nurse; posting/appointments of AYUSH doctors, over
and above the medical o cers posted in PHCs; an additional 24000
Bodies MBBS/AYUSH doctors to provide 24x 7 hours service; additional 46000 staff
 5: Career Planning And Development nurses at bedside; an additional 4436 PHCs as per the 2001 population norms.
At community health centre, there should be a functional 30 bedded rural
hospital at the CHC level; round the clock hospital services with specialist
facilities, seven specialist against 4 at present and 9 staff nurses against 7 at
present; a separate AYUSH set-up; an additional 3332 CHCs; upgradation of
CHCs to 1 PHS in phases; and all CHCs are to be made rst Referral Units to
provide emergency obstetrics and newborn care.

National Urban Health Mission (NUHM): The Union Cabinet in its meeting
held in April 2012 approved the continuation of the National Rural Health
Mission (NRHM) and the other sub-mission under NHM till 31.3.2017. Under
other sub-mission, the Union Cabinet gave its approval to launch a National
Urban Health Mission (NUHM) as a new sub-mission under the over-arching
National Health Mission (NHM) (1st May, 2013). Under the Scheme the
following proposals have been approved:
One Urban Primary Health Centre (U-PHC) for every fty to sixty thousand
population.
One Urban Community Health Centre (U-CHC) for ve to six U-PHCs in big
cities.
One Auxiliary Nursing Midwives (ANM) for 10,000populations.
One Accredited Social Health Activist ASHA (community link worker) for 200
to 500 households.
The scheme will focus on primary health care needs of the urban poor. This
Mission will be implemented in 779 cities and towns with more than 50,000
population and cover about 7.75 crore people.
(Http://Pib.Nic.In/Newsite/Erelease.Aspx?Relid=95385, MoHFW, New Delhi,
1st May 2013)

PRINCIPLES OF PRIMARY HEALTH CARE

TOC Index 
The principles of primary health care are: social equity or equitable distribution,
nation-wide coverage, self-reliance, inter-sectoral coordination and community
involvement in the planning and implementation of health programs. According
to Declaration of Alma-Ata (1978), the principles for primary health care are as
follows:
Re ect and evolve from the economic conditions and socio-cultural and
political characteristics of the country and its communities and be based on
the application of the relevant results of social, biomedical and health
services research and public health experience.
Address the main health problems in the community, providing promotive,

preventive, curative and rehabilitative services accordingly.
Involve, in addition to the health sector, all related sectors and aspects of
Nursing national and community development, in particular agriculture, animal
Foundation:
husbandry, food, industry, education, housing, public works.
Concepts and
Perspectives (For Promote maximum community and individual self-reliance and participation
Post Basic BSc in the planning, organization, operation and control of primary health care,
Nursing) making fullest use of local, national and other available resources; and to this 55
Jogindra Vati end develop through appropriate education the ability of communities to
participate.
PROFESSIONAL ORGANIZATIONS Be sustained by integrated, functional and mutually-supportive referral
 1: Development Of Nursing As A Profession: systems, leading to the progressive improvement of comprehensive health
care for all and giving priority to those most in need.
Nurse Rely, at local and referral levels, on health workers, including physicians,
 3: Development Of Nursing Education In India nurses, midwives, auxiliaries and community workers as applicable, as well
 4: Professional Organizations And Regulatory as traditional practitioners as needed, suitably trained socially and technically
Bodies
to work as a health team and to respond to the expressed health needs of the
community.

WHO’S STRATEGIES OF PHC
Reduce excess mortality of poor marginalized populations: PHC must ensure

access to health services for the most disadvantaged populations, and focus
 on interventions which will directly impact on the major causes of mortality,
morbidity and disability for those populations.
Reduce the leading risk factors to human health: PHC, through its
preventative and health promotion roles, must address those known risk
factors, which are the major determinants of health outcomes for local
populations.
Develop sustainable health systems: PHC as a component of health systems
must develop in ways, which are nancially sustainable, supported by
political leaders, and supported by the populations served.
Develop an enabling policy and institutional environment: There must be a
policy integrated with other policy domains, and play its part in the pursuit of
wider social, economic, environmental and development policy.
CHARACTERISTICS OF SOUND PRIMARY HEALTH CARE
Appropriateness: Appropriate means whether the service is needed at all in

relation to essential human needs, priorities and policies, the service has to
be properly selected and carried out by trained personnel in the proper way.
Availability: Availability of care means that care can be obtained whenever
people need it.
Adequacy: Adequacy of care means that the service is proportionate to
requirement and there should be su cient volume of care to meet the need
TOC Index  and demand of a community.
Accessibility: The services are reachable and convenient geographically,
economically and culturally.
Acceptability: Acceptability of care depends on a variety of factors, including
satisfactory communication between health care providers and the patients,
whether the patients trust this care and whether the patients believe in the
con dentiality and privacy of information shared with the providers.
Affordability: It means that the cost should be within the means and
resources of the individual and the country.
Assessability: Assessability means that medical care can be readily

evaluated.
Accountability: Accountability refers the feasibility of regular review of
Nursing nancial records by certi ed public accountants.
Foundation:
Concepts and Completeness: Completeness of care requires adequate attention to all
Perspectives (For aspects of a medical problem, including prevention, early detection,
Post Basic BSc diagnosis, treatment, follow up measures, and rehabilitation.
Nursing) Comprehensiveness: Comprehensiveness of care means that care is
Jogindra Vati
provided for all types of health problems.

Continuity: Continuity of care requires that the management of a patient’s
PROFESSIONAL ORGANIZATIONS care over time be coordinated among providers.

Nurse ACTIVITIES ESSENTIAL FOR PRIMARY HEALTH CARE
 4: Professional Organizations And Regulatory According to World Health Organization following are the supportive activities
Bodies
essential for successful implementation of primary health care:
SECTION 2: CONCEPT OF NURSING PRACTICE Community involvement and participation.
Intra- and inter-sect oral coordination.
Development of effective referral support.
Development and mobilization of resources.
Involvement of managerial processes.
 Health manpower development.

Medical and Health Services Research including innovative approaches.
Development and application of appropriate technology.

COMMUNITY ORIENTED NURSING
CONCEPT AND DEFINITIONS
Community oriented nursing: Community oriented nursing is the nursing that

has its primary focus on health care of the community or a population of
individuals, families and groups in any of setting. It is the outgrowth of personal
services to mothers and children to prevent maternal and child morbidity and
mortality, provide basic health services to the community and establish referral
linkages to hospitals and community as well.
According to Murray, community oriented, population focused nursing

practice involves the engagement of nursing in promoting and protecting the
health of population and focus is on the whole and reaches out to help not only
those seeking care but also those not seeking care. It examines the health
needs of the speci c groups within the population; seeks to identify trend or
patterns of the health needs of the particular group; and identi es, implements,
and evaluates strategies aimed at improving the health of the group as a whole.
TOC Index  56
Various terms are used for the community orientation from time to time as
hygiene, public health, preventive medicine, social medicine, community health,
community medicine.
Public health nursing: Public health nursing the branch of nursing

concerned with providing nursing care and health guidance to individuals,
families and other population groups in settings such as the home, school,
workplace and other community settings such as medical and health centers
(Parkashamma, 2005)
It is the art and science of prolonging life, promoting health and preventing
disease through organization of community efforts. Public health nursing refers
to composition of nursing services and health promotion of the population. It is
Nursing aimed to: improve sanitation, control of community epidemics, prevent the
Foundation: transmission of infection and provide education about the basic principles of
Concepts and
personal hygiene (Daniel M, Equlinet M , 2006).
Perspectives (For
Post Basic BSc Public Health Nursing is the practice of promoting and protecting the health
Nursing)
of population using knowledge from nursing, social and public health sciences.
Jogindra Vati
The practice is population-focused with the goals of promoting health and
preventing diseases and disability for all people through the creation of
PROFESSIONAL ORGANIZATIONS conditions in which people can be healthy (ANA, 2007).
Its Philosophy And Objectives Public health nursing is a specialty practice of community oriented,
 2: Responsibilities And Expanded Role Of A population-focused practice that involves assessment of health conditions,
Nurse
risks and resources of various groups within the population, especially those
deemed high risk (Murray, 2013).
Bodies
Community health nursing: According to ANA, 2000, community health
nursing is a synthesis of nursing and public health practice applied to
promoting and preserving the health of population.
It combines all the basic elements of professional, clinical nursing with

public health and community practice. It is a specialized eld of nursing that
focuses on the health needs of communities, aggregates and in particular
vulnerable populations. It is a practice that is continuous and comprehensive
 directed towards all groups of community members. It combines all the basic
elements of professional, clinical nursing with public health and community
practice. It synthesizes the body of knowledge from public health science and
professional nursing theories to improve the health of communities (Mengistu,
D. and Misganaw, E. , 2006)
Http://Www.Cartercenter.Org/Documents/Ethiopia_health/Lecture/Plain/N
urse/Comm_hlth_nsg_ nal.Pdf)

HISTORICAL DEVELOPMENT
Before independence: In India, the beginning of community oriented nursing can

be traced far back in the past, at the time of early civilization when deliveries or
the child birth services were carried out at home by dais, who used to be the
hereditary family member or village woman providing child birth services.
They usually have the practices by observing and conducting the deliveries. The
rst attempt to train dais was made by Miss. Hewlett, a Christian Missionary in
Amritsar in 1886 (Wilkinson, 1958) and further strengthened by Lady Curzon
(who established he Victoria Memorial Fund in 1900). In 1918, two English
nurses (Miss Gri n and Miss Graham) started training dais in safe childbirth
practices at Nicholson Road in Delhi under Maternity and Child Welfare
Scheme. It has grown in 19th century and come up with lady health visitors, rural
midwives, maternity assistants and auxiliary nurse midwives.
TOC Index  The rst training school was started in 1951 at St. Mary’s Hospital, Taran-
Taran (Punjab) with the aim to replace the rural midwives and dais in PHCs and
elsewhere. The numbers of ANM training school were increased to 263 by
1962. The entrance quali cation was seventh standard pass. In 1977 the INC
reviewed, revised and restructured the then existing ANM syllabus to prepare
MPHW (F). The curriculum was designed to have18 months of vocational
training and 6 months of general education to t into the 10 + 2 level of
vocational education under 10 + 2 + 3 scheme of general education.
In 1921, the training of Lady Health Visitors (LHVs) started at Nicholson

Road in Delhi. In 1926, Lady Health Visitors (LHVs) training school was shifted
to a new building at Bara Hindu Rao and called it Lady Reading Health School.
The training of LHVs was initially for nine months and was later increased to 18
months.
Nursing
Foundation: After independence: The emphasis was made by the Bhore Committee,
Concepts and 1946, Mudaliar Committee (1954) for a professional public health nurse and
Perspectives (For midwife and to replace LHVs. The training of Health Visitors was discontinued
Post Basic BSc from September 1977. The schools are used for promotional training course for
Nursing) ANMs. Six months promotional training is given to ANMs with at least ve years
Jogindra Vati
experience. The curricula for six months promotional course is prescribed by
INC. By ‘90s, two types of courses remained: a) Regular Course for 18 months,
PROFESSIONAL ORGANIZATIONS and b) Integrated Course of Midwifery Cum Health Visitor training for two and
 1: Development Of Nursing As A Profession: half years. Entrance quali cation was matriculation. Today, there is no direct
entry to LHV course.
Nurse
Public Health Nursing (Diploma course) was started in the RAK College of
Nursing, New Delhi in 1951 on the recommendation of the Bhore Committee.
Bodies Later on this course was taken up in All India Institute of Hygiene and Public
 5: Career Planning And Development Health, Calcutta in 1952.
A three months orientation course in public health nursing with emphasis
on MCH was started for nurses in three orientation centres at Singur,
Poonamallee and Najafgarh in 1954-55, to meet the shortage of health visitors
in some states. The Public health nursing course was started in Kerala, Indore,
Nagpur and Ahmedabad. The Public health nursing was integrated in all the
degree courses to prepare graduates to work as public health nurses as well as
 clinical nurses. Table 6.2 depicts the development of community oriented
nursing in India. 57
Table 6.2 Development of community oriented/health nursing in

India after independence
Committees Recommendations
Bhore
Establishment of preliminary training schools for midwives, public
committee
health nurses
1946: Health
Establishment of Nursing Colleges with provision for advanced
survey and
courses in training of public health supervisors
development
committee Training of Public Health Nurses: Fully quali ed with midwifery
training
All India Nursing Council
Shetty
Establishment of training centres in District Headquarters hospitals
committee 1954
for auxiliary nurses and midwives
a provision for minimum standards of nursing personnel in public

health service with one midwife to 100 births in rural areas and one
midwife to 150 births in towns and cities and one public health
nurse or health visitor to 10000 population.
The trained dais should be continued for some years under

supervision.
TOC Index 
ANMs could be appointed to supplement nursing services in the
hospitals and wards, which are not used for training nurses.
Hospital nursing service staff and public health nursing service

staff should be combined into a single cadre.
Mudaliar
Three grades of nurses: basic nurse with four years of training
committee
(including six months midwifery and six months Public Health
1959-61: Health
Nursing Nursing); Auxiliary Nurse Midwife training for two years; and the
survey and
Foundation: nurse with a degree.
planning
Concepts and career development and higher training e.g. Public Health
Perspectives (For committee
Male health workers were introduced into public health initially to
Post Basic BSc
Nursing) work in speci c national health programmes in small pox, malaria,
Jogindra Vati cholera and leprosy.
SECTION 1: CONCEPT OF NURSING AND The Chadha

Basic health workers (BHW) one for 10000 population at PHCs to
PROFESSIONAL ORGANIZATIONS Committee
conduct vigilance operations for malaria, collect vital health
(1963)
Its Philosophy And Objectives statistics, and take up family planning, environmental sanitation
 2: Responsibilities And Expanded Role Of A and health education activities under supervision of F.P Health
Nurse
Assistants.
Bodies Mukharji
BHWs would work along with ANMs for providing basic health
 5: Career Planning And Development Committee
services at the sub centres except for family planning
SECTION 2: CONCEPT OF NURSING PRACTICE (1965)
Separate staff for family planning program
The Kartar Singh

Recommended Multi Purpose Workers (Female ) in place of ANM
Committee
and ‘male health worker’ in place of malaria surveillance worker,
(1973)
vaccinations, health education assistant and Family Planning
 health assistants
A PHC per 50.000 population with 16 subcentres, each covering

population 3000-3500
Each subcentre should have one female and one male health
worker
one female and one male health supervisor at PHC level to monitor
the activities of staff of 3-4 subcenters
Training of all the worker should be integrated
The Shrivastav
Consolidated the recommendations of the Kartar Singh
Committee
Committee.
(1974-75)
Creation of Village Health Guide (VHG) or community health
volunteers for community itself t o provide comprehensive health
services
Creation of MPW and Health assistants (HA) in between the VHG

and MO incharge PHC
Working group
one SC for 5000, one PHC for 30000, and one CHC for 100000
on Health For All
population
in 1981
The training capacity of existing ANM schools was augmented and
new schools were opened to meet the needs of female health
workers in the new subcentres.
TOC Index  ANMs with at least ve years experience were deputed for six
months promotional training course to prepare them to take on the
post of Health Supervisor (F) and. The training of health visitors
under the old system was discontinued
In 1983, the
No qualitative difference in the job of any of the public health
National Health
nursing personnel.
Policy
Emphasis was given on orientation training to nursing personnel
for implementing the new strategies.
Various committees formulated time to time to revise the type of

manpower and their roles for the community care. The High Power Committee
on nursing (1987) recommended for ANMs and ANM Schools of Nursing
Nursing attached to district hospitals should be a liated to Senior Secondary Boards.
Foundation: Appointment of ANM/LHV is also recommended (Table 6.3). 58
Concepts and
Perspectives (For
Table 6.3 Recommendations of high power committee on Nursing
Post Basic BSc
(1987) in relation to community oriented/health nursing
Nursing)
Jogindra Vati Recommendations
Two levels of nursing personnel, viz. Professional Nurses (Degree level) and Auxiliary
PROFESSIONAL ORGANIZATIONS Nurses/Vocational Nurses
Its Philosophy And Objectives All ANM Schools of Nursing attached to district hospitals should be a liated to Senior
 2: Responsibilities And Expanded Role Of A Secondary Boards
Nurse
 3: Development Of Nursing Education In India Specialty courses at post-graduate level should be developed at certain special centres
 4: Professional Organizations And Regulatory of excellence, e.g. AIIMS, PGI Chandigarh. All Indian Institute of Hygiene andPublic
Bodies
Health
SECTION 2: CONCEPT OF NURSING PRACTICE Community nursing experience should be as per requirements of the INC. Necessary
transport and accommodation should be available at Primary Health Centres for safety,
security and meaningful learning of students
Appointment of ANM/LHV to be recommended
ANM/LHV promoted to supervisory posts must undergo courses in administration and
 management
Speci c standing orders are made available for each ANM/LHV to function effectively in
the eld
PRINCIPLES OF COMMUNITY ORIENTED NURSING
The client is the ‘unit of care’

Consider population as a whole
There is a focus on individual, family, groups and community at any of
settings
Health promotion and health prevention is the priorities
Select strategies that create healthy environment, social and economic
conditions
Actively reach out to all who might bene t
Use available resources
Collaborate with other professionals and organization.

CHARACTERISTICS OF COMMUNITY ORIENTED NURSING
It is a combination of community health, epidemiology, and nursing

TOC Index 
Population and environmental factors are the main concern
Emphasis should be on prevention at promotion and rehabilitation
It is the responsibility of individual for the promotion and self-care
Use epidemiological measurement for analysis and monitoring
Collaborate with other professionals.
According to Daniel and Misganaw (2006), there are six important
characteristics of community health nursing as:
It is a specialty eld of nursing
Its practice combines public health with nursing
It is population focused.
It emphasizes on wellness and other than disease or illness
It involves inter-disciplinary collaboration
Nursing
Foundation: It promotes client’s responsibility and self-care.
Concepts and
Perspectives (For
Post Basic BSc
WORK SETTINGS IN COMMUNITY ORIENTED NURSING
Nursing)
Jogindra Vati
Community oriented nursing is practiced in wide variety of settings that include
promoting health, preventing illness, maintaining health, restoration,
PROFESSIONAL ORGANIZATIONS coordination, management, and evaluation of health of individuals, families and
 1: Development Of Nursing As A Profession: community as a whole. The practice may be in hospitals, referral hospitals in
special departments, e.g. in neonatal, skin, etc. district hospitals; community:
Nurse Community health centre, primary health centres, sub centres; day care centres;
 3: Development Of Nursing Education In India schools; industries, etc. In community settings, the focus is on promoting self-
 4: Professional Organizations And Regulatory care of the individuals.
Bodies
COMPONENTS /ELEMENTS OF COMMUNITY ORIENTED NURSING
Community Oriented Nursing (CON) incorporates six basic components or

elements to practice (Fig. 6.1):
Figure 6.1: Components of community oriented nursing
Promotion of health: Community oriented nursing focus towards promoting

TOC Index  the health of individuals and aggregates in any setting through health
education, providing support and environmental conditions conducive to health.
Prevention of health problems: Other component in the community oriented

nursing is on prevention of health problems. It aims on primordial, primary, 59
secondary and tertiary prevention. Primordial prevention aims to prevent the
risk factors and efforts are directed through individual and mass education. For
example education on healthy life styles to prevent chronic diseases. Primary
prevention is aimed at interventions in the pre pathogenesis phase of the health
problem to promote general health and well being, and quality of life of people
through speci c protective measures focused on mass and high risk strategy.
Mass strategy is directed to bring socioeconomic, behavioral and life style
changes towards positive health. Secondary prevention is done through early

nursing diagnosis, remedial action and referral system. Tertiary prevention is
aimed to reduce the disability and impairment. It includes the rehabilitation
Nursing measures and team approach, so that the person become adapts to the defect
Foundation: and lead quality life.
Concepts and
Perspectives (For Treatment of disorders: It focuses on the illness and towards the remedial
Post Basic BSc aspects of problem. It is more or less secondary prevention. The direct services
Nursing)
are provided through home visiting, referring to facilities and involving in the
Jogindra Vati
community programmes.
SECTION 1: CONCEPT OF NURSING AND Rehabilitation: It involves efforts which seek to reduce or limit disabilities or
impairments as much as possible, and restore functions; e.g. rehabilitating the
Its Philosophy And Objectives person suffering with stroke, head injury or immobility due to any other reason.
 2: Responsibilities And Expanded Role Of A This is tertiary type of prevention.
Nurse
 3: Development Of Nursing Education In India Monitoring and evaluation: It is the process by which the nursing practice is
 4: Professional Organizations And Regulatory monitored, judged, and improved according to nursing diagnosis and objectives.
Bodies
It provides direction for future nursing care planning.
Research: It will provide evidence on to the factors affecting community
health and community health practices, solve problems, and explore and plan
improved methods of community health nursing services.

ROLE OF COMMUNITY NURSES IN INDIA


In the present scenario, in India the Auxiliary Nurse Midwives (ANMs) and Lady
Health Visitors (LHVs) are the functionaries in taking preventive, promotive and
rehabilitative primary healthcare services to the doorsteps of people. They
provide public health services and provide vital maternal and child care health
services to the community.
Role of ANMs: The role of ANMs changed with development of health

system. The ANM was responsible for health services through the Sub Centre
during rst ve years plan at the time of comprehensive community health
development which was initiated in 1951. Maternal and child health services
were provided through Primary Health Centres (PHCs) and Sub Centres (SCs) in
rural areas with ANMs in Sub Centres and one medical o cer and two health
visitors at PHCs.
In 1974, when they were designated as Multi Purpose Health Workers

Female (as recommended by Kartar Singh Committee) were responsible to
provide integrated package of maternal and child health, nutrition, family
welfare, preventive and curative (minor ailments) services to rural communities.
Their performance was supervised by Lady Health Visitors who were
designated as Health Supervisor Female.
Role of LHVs: The LHV was responsible for supervising and training dais
and midwives, conducting clinics in peripheral units and attending cases
requiring hospitalization. In 1974, Lady Health Visitors who were designated as
Health Supervisor Female and they were supervising ANMs
TOC Index 
Role of district public health nurses: The District Public Health Nurses
(DPHNs) originally part of the Maternal and Child Health division of Department
of health. They are primarily responsible for monitoring maternal and child
health services in the district. They maintain records and registers, supervision
and administrative work, training and education.
Administrative: They perform various administrative functions for which

they spend time at the district headquarters; they are the link between the eld
level workers and the managers at the district. They actively participate in
several districts, regional and state level meetings.
Supervisory: It is their responsibility to monitor the performance of the

grassroots level nursing staff, solve their problems or bring them to the notice
of the district level o cials. During the eld day on activities which could be
Nursing called “mentoring” of Female Health Workers which includes guiding workers,
Foundation: checking registers, listening to and solving problems of the worker and assess
Concepts and
work of the health workers i.e. the Female Health Workers (FHWs), Female
Perspectives (For
Health Supervisors (FHS), Block Health Visitors (BHVs), Accredited Social
Post Basic BSc
Nursing) Health Activist (ASHA), Trained Birth Attendants, Anganwadi Workers, Male
Jogindra Vati Multipurpose Health Workers and other workers like Gram Arogya Mitra, and
Community Based Health Volunteer.
PROFESSIONAL ORGANIZATIONS Maintaining record and reports: They also compile the monthly reports and
 1: Development Of Nursing As A Profession: submit to the state o ce. They are involved in the compilation of various
reports related to reproductive and child health, child immunization, maternal
Nurse
and infant deaths, various schemes and vertical programmes, out of which one
 3: Development Of Nursing Education In India is a weekly report, others are to be compiled once a month. The DPHN helps the
 4: Professional Organizations And Regulatory MandE assistant in data entry. They spend time in activities like ling records
Bodies
and reports, and planning their tour programme.
SECTION 2: CONCEPT OF NURSING PRACTICE Education: They attend training of trainers (TOT) for almost all important
national level programmes such as IMNCI, Immunization, and Disease
Surveillance. They organize trainings for the community level health workers as
either coordinators or trainers.
Role of PHNs in hospitals/public health schools: In few hospitals, PHNs

are posted in the selected areas e.g. neonatal areas, skin outpatient
 departments, family planning clinics, public health schools in selected referral
hospitals, providing teaching, health education and research related activities in
the hospital setting as well in the community of their outreach.

KEY POINTS
Primary Health Care (PHC) is a rst level socially appropriate and universally
accessible, affordable essential health care provided at primary health centre,
sub-centre and at the door step of local people by the trained health
professionals.
The concept of PHC in India dates back in the Vedic period, in the Indus- 60
Valley Civilization (3000 BC) and changed from time to time from
comprehensive health care to basic health service to health for all to
integrated comprehensive primary health care services.
Strategies of WHO are reducing excess mortality of poor marginalized
populations, reducing leading risk factors to human health, developing
sustainable health systems, and an enabling policy and institutional
environment.
Appropriateness, availability, adequacy, adaptability, acceptability,
affordability, assessability, accountability, completeness,
comprehensiveness, and continuity of care are the features of PHC.
Community oriented nursing is the nursing that has its primary focus on
health care of the community or a population of individuals, families and
TOC Index 
groups in any of setting aiming at improving the health of the group as a
whole.
Various committees formulated time to time to revise the type of manpower
and their roles for the community care.
The components of Community Oriented Nursing include promotion of
health, prevention of health problems, treatment of disorders, rehabilitation
monitoring and evaluation, and research.
Multipurpose Health Workers, ANMs, LHVs, are the functionaries providing
preventive, promotive health services to the population at large; the public
health nurses at district level provide administrative, supervisory and
documentation functions and at the hospital level providing educative,

teaching and follow up services.

Nursing
Foundation:
CHAPTER END QUESTIONS
Concepts and
Perspectives (For

Post Basic BSc
Nursing)
Jogindra Vati
I. ESSAY TYPE QUESTIONS
List down the principles of primary health care and community oriented
PROFESSIONAL ORGANIZATIONS nursing.
Describe changing concepts of primary health care in India.
 2: Responsibilities And Expanded Role Of A Discuss the major development of community oriented nursing in India.
Nurse

Bodies II. SHORT NOTES
SECTION 2: CONCEPT OF NURSING PRACTICE Primary Health Care (PHC)
Community Oriented Nursing
Elements of Primary Health Care (PHC)
Components of Community Oriented Nursing
 III. MULTIPLE CHOICE QUESTIONS
Circle the alphabet before the best answer:
1. The concept of primary health care in India dates back in:
(a) 1000 BC
(b) 2000 BC
(c) 3000 BC
(d) 4000 BC
2. In 1400 BC, health promotion and health education was emphasized by:
(a) Siddha
(b) Ayurveda
(c) AYUSH
(d) Homeopathy health system
3. During British period provincial health departments were established in:
(a) 1919
(b) 1921
(c) 1923
(d) 1925
4. The basis for primary health care was laid down by:
TOC Index  (a) Mudaliar committee
(b) Bhore committee
(c) Kartar committee
(d) Srivastava committee
5. Which Five Year Plan (FYP) has given the emphasis on improving and
enhancing the quality of primary health care?
(a) 1st FYP

(b) 5th FYP
(c) 10th FYP
(d) 12th FYP
6. Primary Health Care is termed as ‘basic health services’ in one of the health
policy:
Nursing
Foundation: (a) UNICEF/WHO, 1965
Concepts and
(b) Alma-Ata (USSR), 1978
Perspectives (For
Post Basic BSc (c) National Health Policy, 1983
Nursing) (d) UN Millennium Declaration, 2000
Jogindra Vati
7. Govt. of India proposed to replace ‘village health guide’ by ‘female health

guides’ for the rst contact with people in the year:
(a) 1970
Its Philosophy And Objectives (b) 1977
Nurse
(c) 1986
 3: Development Of Nursing Education In India (d) 1988
Bodies 8. The most important health functionary link between rural poor and good
 5: Career Planning And Development health care under ‘Integrated Child Health Development Scheme’ (ICDS) is:
(a) Village health guide
(b) Multipurpose health worker
(c) Auxillary nurse midwife
(d) Anganwadi health worker
9. A trained community based link worker at village level who acts as a bridge
 between the Government functionaries and tribal- nontribal population:
(a) ANM
(b) ASHA
(c) MPHW (M)
(d) MPHW (F)
10. ANM syllabus was restructured by INC to prepare MPHW (F) in: 61
(a) 1960
(b) 1965
(c) 1971
(d) 1977
11. In which year training of health visitors was discontinued?
(a) 1972
(b) 1977
(c) 1981
(d)1986
12. Public health nursing (Diploma course) was rst started in:
(a) Delhi
(b) Kerala
(c) Nagpur
TOC Index  (d)Indore
13. Community oriented nursing can be practiced in:
(a) Community
(b) Hospitals
(c) Primary health centres
(d)Any setting

ANSWER KEYS
1. (c)
2. (b)
3. (a)
Nursing
Foundation: 4. (b)
Concepts and 5. (c)
Perspectives (For
6. (a)
Post Basic BSc
Nursing) 7. (c)
Jogindra Vati 8. (d)
9. (b)
PROFESSIONAL ORGANIZATIONS 10. (d)
11. (b)
 2: Responsibilities And Expanded Role Of A 12. (a)
Nurse
13. (d)
 4: Professional Organizations And Regulatory 1. Alligood, M.,and Fawcett, J.(2004). An interpretive study of Martha Rogers conception of
Bodies
pattern.Visions: The Journal of Rogerian Nursing Science, 12(1),8-13 (Cross Ref)
SECTION 2: CONCEPT OF NURSING PRACTICE 2. American Academy of Pediatrics: Task Force on the Family. (2003). Family pediatrics.
Pediatrics, 111, 1539-1587.
3. Ann, J.Z. (2005). Basic Psychology for Nursing in India. BI Publications.
4. Auyang, S. ,Y. (1999). Foundations of complex-system theories: in economics, evolutionary
biology, and statistical physics. Cambridge University Press. (Cross Ref)
 5. Government of India. (2002). National Health Policy. Ministry of Health and Family Welfare.
New Delhi. Government of India.
6. Kishore, J. (2009). National health programs of India. New Delhi: Century Publications.
7. Kamalam, S., (2008). Essentials in community health nursing practice. New Delhi: Jaypee
Brothers.
8. Marsije. L.M. (1997). A new textbook for nurses in India. Chenni: CMAI, B.I. Publication.
9. Murray, T. (2013). Distinguishing population-focused practice from community-based care. In
Murray T, Ellis, P. (ed). Community and Public Health Nursing: a population based perspective.
Philadelphia: Lippincott William andWilkins.
10. National Commission on Macroeconomics and Health. (2005). Report of the National
Commission on Macroeconomics and Health 2005. MOHFW, GOI.
11. Newman, M. (2010). Health as expanding consciousness. Retrieved on September 13, 2012,
from Http://Www.Healthasexpandingconsciousness.Org/Home/
12. Oshry, B. (2008). Seeing systems: unlocking the mysteries of organizational life. Berrett-
Koehler.
13. Park, K. (2010). Park's textbook of preventive and social medicine. 20th ed. Jabalpur:
Banarsidas Bhanot Publishers.
14. Parse, R.R. (1981). Man- living - health: a theory of nursing. New York: Wiley.
15. Philibin, C.A.N., Gri ths, C., Byrne, G., Horan, P., Brady, A.M. and Begley C.(2010). The role of
the public health nurse in a changing society. Journal of Advanced Nursing,66(4),743–752.
16. Planning Commission. Eleventh ve years plan (2007-2012). New Delhi: GOI.
17. Roy, S. (1985). Primary health care in India. Health and Population - Perspectives andIssues,
8(3), 135-167.
18. Sharma, B., Roy, S., Mavalankar, D., Ranjan, P., and Trivedi, P.(2010). The role of the district
public health nurses: a study from Gujarat. www.iimahd.ernet.in/publications/data/2010-02-
04Sharma.pdf. Accessed on 04-08-2010.
19. Srinivasan, K., and Sharan, R.(2006). Organization of Indian health bureaucracy and its delivery
system. Productivity, A Quarterly Journal of the National Productivity Council, India,46(4):477-
486.
20. Srinivasan, K., and Sarma, P.S. (2012, June). Study on workload of public health nurses and
other women health workers. Http://Mpra.Ub.Uni-Muenchen.De/39520/MPRAPaper No.
39520,posted 19. June 2012 12:57 UTC Sree Chitra Tirunal Institute for Medical Sciences
Nursing andTechnology
Foundation:
21. Tappen, R.M. (2001). Nursing leadership and management: concept and practice. (4th ed.).
Concepts and
Perspectives (For Philadelphia: F.A.Davis.
Post Basic BSc 22. WHO. (1978). Alma Ata 1978: primary health care, HFA. Sr. No.1
Nursing)
Jogindra Vati 23. WHO (1984). Public Health Paper, No.80
24. WHO. (2005). Situational analysis of public health nursing personnel in india: based on national
review and consultations in six states. Academy for Nursing Studies.
 1: Development Of Nursing As A Profession: www.whoindia.org/.../hsd_resources_situation_analysis_of_public_health_nursing_personnel.pdf
Its Philosophy And Objectives Accessed on 04-08-2010.
Nurse 25. Http://Www.Chna.Ca/
26. Http://Www.Nursingworld.Org
Bodies
27. Http://Www.Unicef.Org/Sowc09/Docs/SOWC09-Panel-2.2-EN.Pdf
SECTION 2: CONCEPT OF NURSING PRACTICE 28. Http://Www.Unmillenniumproject.Org/Goals/Gti.Htm Accessed On 9/7/2013

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Primary Health Care

Primary health care

Changing concepts of primary health Care in India

Principles of Primary Health Care

WHO’s Strategies of primary health care

Characteristics of sound Primary Health Care

Activities Essential for Primary Health Care

Community oriented nursing

Principles of Community Oriented Nursing

Characteristics of Community Oriented Nursing

Work Settings in Community Oriented Nursing

Components of Community Oriented Nursing

Chapter End questions

After completion of this chapter, the learner will be able to:

De ne primary health care (PHC)

Nursing Understand basis and changing concept of PHC

SECTION 1: CONCEPT OF NURSING AND

PRIMARY HEALTH CARE

DEFINING PRIMARY HEALTH CARE (PHC)

Primary health care is viewed as an approach that focuses on the person

Committees’ recommendations on PHC: The basis for primary health care

The term ‘comprehensive health care’ was used by Bhore Committee in

According to Alma Ata Declaration, at a minimum, primary health care

The millennium developmental goals: In September 2000, representatives

tuberculosis, malaria, HIV/AIDS, blindness were given the emphasis. It laid

Eradicate extreme Halves the proportion of people living in extreme poverty

Halve, between 1990 and 2015, the proportion of people who

Promote gender Eliminate gender disparity in primary and secondary

Ensure Integrate the principles of sustainable development into

Nursing sustainability resources

Foundation: Halves, by 2015, the proportion of people without sustainable

Develop a global Develop further an open, rule based, predictable, non-

In cooperation with pharmaceutical companies, provide

In cooperation with the private sector, make available the

The Anganwadi centre provides supplementary nutrition, non-formal pre-

ASHA and National Rural Health Mission (2005-2012): National Rural

At the village level, to complement the work of ANM, ASHA (Accredited

PRINCIPLES OF PRIMARY HEALTH CARE

Address the main health problems in the community, providing promotive,

WHO’S STRATEGIES OF PHC

Reduce excess mortality of poor marginalized populations: PHC must ensure

CHARACTERISTICS OF SOUND PRIMARY HEALTH CARE

Appropriateness: Appropriate means whether the service is needed at all in

Assessability: Assessability means that medical care can be readily

SECTION 1: CONCEPT OF NURSING AND

 Health manpower development.

COMMUNITY ORIENTED NURSING

CONCEPT AND DEFINITIONS

Community oriented nursing: Community oriented nursing is the nursing that

According to Murray, community oriented, population focused nursing

Public health nursing: Public health nursing the branch of nursing

It combines all the basic elements of professional, clinical nursing with

Before independence: In India, the beginning of community oriented nursing can

In 1921, the training of Lady Health Visitors (LHVs) started at Nicholson

Table 6.2 Development of community oriented/health nursing in

All India Nursing Council

a provision for minimum standards of nursing personnel in public

The trained dais should be continued for some years under

Hospital nursing service staff and public health nursing service

Jogindra Vati cholera and leprosy.

SECTION 1: CONCEPT OF NURSING AND The Chadha

The Kartar Singh