4th Basic B.Sc. Nursing COMMUNITY HEALTH NURSING - II Winter

Fourth Basic B.Sc. Nursing Examination, Winter - 2023 (Phase - II)

COMMUNITY HEALTH NURSING - II

(upto A.Y. 2018-19, 2019-20 Admitted Batch)

Duration: 3 Hours

Max.Marks:75

Instructions:

1) Use black ball point pen only.

2) Do not write anything on the blank portion of the question paper. If written anything, such type of act will be considered as an attempt to resort to unfair means.

3) All questions are compulsory.

4) The number to the right indicates full marks.

5) Draw diagrams wherever necessary.

6) Distribution of syllabus in Question Paper is only meant to cover entire syllabus within the stipulated frame. The question paper pattern is a mere guideline. Questions can be asked from any paper's syllabus into any question paper. Students cannot claim that the question is out of syllabus. As it is only for the placement sake, the distribution has been done.

7) Use a common answer book for all sections.

Section - A

I. Short answer question (Solve any five out of six)

[5x5=25]

a) Bhore committee

b) National population policy

c) DOTS therapy

d) Scope of community health nursing

e) Structure of WHO

f) Principles of Home visit

🟦 a) Bhore Committee (1946)

Chairman: Sir Joseph Bhore
Objective: Review India’s health organization and recommend improvements.

Recommendations:

Integration of preventive and curative services at all levels.
Establish Primary Health Centres (PHCs) – 1 per 40,000 population.
Sub-centres for 3,000–3,500 population.
Train multipurpose health workers.
Emphasis on universal health coverage.

Impact: Foundation for modern Indian public health system.

🟩 b) National Population Policy (NPP, 2000)

Goal: Achieve population stabilization by 2045.

Immediate objectives:

Meet unmet contraception needs.
Reduce infant, child, and maternal mortality.
Achieve universal immunization.

Medium-term:

Reduce TFR to 2.1 (replacement level) by 2010.

Strategies:

Promote family planning.
Empower women through education & health.
Improve child survival.

🟥 c) DOTS Therapy (Directly Observed Treatment, Short-course)

Definition: TB treatment where a health worker observes the patient taking each dose.

Main components:

Political commitment.
Sputum microscopy for diagnosis.
Standardized supervised regimen.
Uninterrupted drug supply.
Record & report system.

Advantages:

Ensures treatment completion.
Prevents drug resistance.
Improves cure rates.

🟨 d) Scope of Community Health Nursing

Family health care – maternal, newborn, child, adolescent.
School health – health check-ups, education, first aid.
Occupational health – workplace safety.
Rural & urban health services – immunization, sanitation.
Disaster nursing – emergency care during disasters.
Geriatric care – elderly health promotion.

🟪 e) Structure of WHO

1. World Health Assembly (WHA): Supreme body, meets annually.
2. Executive Board: 34 members, 3-year term.
3. Secretariat: Headed by Director-General.
4. Regional Offices: Africa, Americas, SE Asia, Europe, Eastern Mediterranean, Western Pacific.
5. Headquarters: Geneva, Switzerland.

🟧 f) Principles of Home Visit

Purposeful – clear objective.
Planned – based on family needs.
Regular & flexible – adaptable to situations.
Family participation – involve members.
Confidentiality – protect privacy.
Resource utilization – use available services.

II. Long Answer Questions (any one out of two)

[1x15=15]

a) Define Law. Types of Law. Explain in detail about civil Law

b) Appreciate the national health and family welfare programme and the role of the nurse.

🟦 a) Law – Definition, Types, and Civil Law

🔹 Definition of Law

Law is a system of rules established and enforced by the governing authority to regulate the actions of individuals and organizations in society.

🟩 Types of Law

1. Public Law – Governs relationship between individuals and the state.

Constitutional Law – Structure & powers of government.
Administrative Law – Functions of government agencies.
Criminal Law – Offences against society.

2. Private Law – Governs relationships between individuals.

Contract Law – Agreements between parties.
Tort Law – Compensation for wrongs/damages.
Property Law – Ownership rights.
Family Law – Marriage, divorce, inheritance.

3. Substantive Law – Defines rights and duties.
4. Procedural Law – Explains process for enforcing laws.

🟥 Civil Law – Detailed Explanation

📌 Definition:
Civil law deals with rights and duties of individuals towards each other, excluding criminal offences.

🎯 Purpose:

Provide remedies & compensation for harm or loss.
Maintain peaceful relationships in society.

📂 Main Areas:

Contract disputes – Agreements, breaches.
Property disputes – Ownership, tenancy.
Torts – Negligence, defamation, injury.
Family matters – Divorce, custody, maintenance.

✨ Characteristics:

Involves plaintiff & defendant.
Burden of proof: Preponderance of evidence.
Remedies: Compensation or specific action.

🩺 Nursing Example:
A patient sues a hospital for medication error causing harm.

🟪 b) National Health & Family Welfare Programme – Appreciation & Role of Nurse

🔹 Appreciation

The National Health & Family Welfare Programme aims for better health indicators and population stabilization through preventive, promotive, curative, and rehabilitative services.

🏆 Achievements:

Reduced MMR & IMR through maternal & child health services.
Increased contraceptive use & awareness.
Control of TB, leprosy, malaria.
Expanded immunization coverage.
Improved health infrastructure (PHCs, CHCs).

🟩 Main Components:

Family Planning Services – spacing & permanent methods.
Maternal & Child Health – ANC, safe delivery, PNC.
Immunization – under UIP.
Adolescent Health – education, counseling.
Disease Control – HIV/AIDS, TB, malaria.
Nutrition Programmes – ICDS, mid-day meals.

🟥 Role of Nurse

1. Service Delivery:

ANC, PNC, safe deliveries.
Immunizations & contraceptive distribution.

2. Health Education:

Hygiene, breastfeeding, nutrition, family planning.

3. Disease Prevention:

Early detection & referral for diseases.

4. Counseling:

Family planning, adolescent health.

5. Record Keeping:

Registers for births, deaths, immunization, FP.

6. Community Mobilization:

Camps, awareness drives, Village Health Days.

7. Intersectoral Coordination:

Work with ASHAs, AWWs, NGOs, Panchayats.

Section - B

III. Short Answer Questions (any four out of five)

[4 x 5= 20]

a) Recommendations of Mudliar committee

b) NRHM

c) ASHA

d) School health services

e) National Immunization schedule

🟦 a) Recommendations of Mudaliar Committee (1962)

🔹 Purpose of Committee

To evaluate the progress of health services after the Bhore Committee and suggest improvements.

🟩 Key Recommendations:

Strengthening PHCs – Each PHC to serve 40,000 population with 2 doctors, nurses, and other staff.
Secondary Health Units – Upgradation of existing hospitals.
Integration of health services – Avoid duplication between rural & urban.
Improvement of medical education – Establish medical colleges with adequate staff and facilities.
Specialist services – District hospitals to have specialist units.
Public health laboratories – For disease detection and research.
Better transport & communication for emergency services.

🟪 b) NRHM – National Rural Health Mission (2005)

🔹 Aim:

Provide accessible, affordable, and quality health care to rural populations, especially vulnerable groups.

🟩 Objectives:

Reduce IMR & MMR.
Universal access to public health services.
Strengthen sub-centres, PHCs, CHCs.
Promote community participation.
Converge health programmes at the village level.

🟥 Key Components:

ASHA workers in every village.
Village Health & Sanitation Committees.
Mobile Medical Units.
Janani Suraksha Yojana (JSY) for safe motherhood.

🟩 c) ASHA – Accredited Social Health Activist

🔹 Definition:

A trained female community health volunteer selected from the village under NRHM.

🟪 Eligibility:

Female, preferably married/widow/divorced.
Age: 25–45 years.
Minimum education: 8th standard.
Resident of the village.

🟥 Roles & Responsibilities:

Health Education – Hygiene, nutrition, family planning.
Service Linkage – Guide people to PHCs/CHCs.
Immunization mobilization.
Distribution of medicines – ORS, IFA, contraceptives.
Accompany pregnant women to health facilities.
Maintain village health register.

🟦 d) School Health Services

🔹 Definition:

Health services provided to school children to maintain & promote their physical, mental, and social well-being.

🟩 Objectives:

Detect health problems early.
Promote healthy habits.
Provide treatment & follow-up.

🟥 Main Activities:

Medical check-ups & growth monitoring.
Immunization.
Health education – hygiene, nutrition.
Treatment of minor ailments.
Referral services for serious illnesses.
Nutrition programmes – mid-day meal.

🟪 e) National Immunization Schedule (NIS)

🔹 Aim:

Provide free vaccines to all children and pregnant women against preventable diseases.

🟩 Vaccines for Children:

At birth: BCG, OPV-0, Hep B-0.
6, 10, 14 weeks: OPV-1/2/3, Pentavalent-1/2/3, Rotavirus, FIPV.
9–12 months: Measles-Rubella (MR-1), JE (in endemic areas).
16–24 months: MR-2, DPT booster-1, OPV booster, JE booster.
5–6 years: DPT booster-2.
10 & 16 years: Tdap/Td.

🟥 Vaccines for Pregnant Women:

Early in pregnancy: Td-1.
1 month later: Td-2.
If vaccinated in previous pregnancy: Only Td booster.

IV. Long Answer Questions (any one out of two)

[1x5=15]

a) Define theory. Explain any two community theories in detail.

b) Define Home visit, Concept, Principles, Process and principles of Bag Technique..

a) Theory – Definition & Community Theories

Definition of Theory

A theory is a set of ideas and principles that explain or predict events by showing the relationship between concepts.
In nursing, theories give guidelines for practice and improve decision-making.

Two Community Theories

1️⃣ Orem’s Self-Care Deficit Theory

Focus: When people cannot meet their own self-care needs, nursing is needed.
Key Points:
- Self-care is necessary for health.
- Nursing supports, guides, and educates the patient/community.
Example: Caring for elderly or chronically ill people in the community.

2️⃣ Neuman’s Systems Model

Focus: The patient/community is a system affected by internal and external stressors.
Key Points:
- Prevention is the main goal (Primary, Secondary, Tertiary).
- Aim is to protect the system and maintain stability.
Example: Immunization drives to prevent disease outbreaks.

b) Home Visit – Concept, Principles, Process & Bag Technique

Definition

A home visit is a planned visit by a nurse to provide care, education, and follow-up at the patient’s home.

Concept

Takes health services to the family’s doorstep.
Builds trust and personal contact.

Principles

Planned & purposeful.
Based on family needs.
Involves family members.
Maintain privacy & confidentiality.

Process

Preparation – Identify purpose & collect materials.
Approach – Introduce & build rapport.
Care – Provide treatment, advice, and education.
Record – Document findings and actions.
Follow-up – Plan next visit or referral.

Bag Technique – Principles

Keep bag clean & organized.
Place on a clean surface.
Use aseptic techniques.
Sterilize and replace used items.