4th Year B.Sc. Nursing Community Health Nursing

Fourth Basic B.Sc. Nursing Examination, Phase - II

Summer-2022

COMMUNITY HEALTH NURSING (II)

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) Explain briefly about Jungalwalla and Kartar Singh Committee.

b) Women Empowerment.

c) Temporary Contraception Methods.

d) National Health Policy.

c) Enumerate the types Occupational Hazards and explain it briefly.

f) Uses of Epidemiology.

a) Jungalwalla and Kartar Singh Committee

Jungalwalla Committee (1967):

Recommended integration of health services (curative + preventive).
Suggested one doctor – one health worker – one family approach.
Advocated for common seniority and unified cadre of medical services.
Proposed equal pay for equal work in health sector.
Emphasized team approach in healthcare delivery.

Kartar Singh Committee (1973):

Recommended Multipurpose Health Worker (MPHW) scheme.
Suggested two categories:
- Male MPHW (for malaria, TB, leprosy, etc.).
- Female MPHW (for MCH, family planning, immunization, etc.).
Proposed establishment of Sub-centres (1 per 5,000 population).
Strengthened primary health care structure.

b) Women Empowerment

Definition: Process of enabling women to have power and control over their lives.
Dimensions:
- Social Empowerment – education, awareness, freedom from social evils.
- Economic Empowerment – employment, equal wages, financial independence.
- Political Empowerment – participation in decision making, leadership roles.
- Legal Empowerment – rights, protection against discrimination and violence.
Government Schemes: Beti Bachao Beti Padhao, SHGs, Mahila Shakti Kendra, etc.

c) Temporary Contraception Methods

Barrier Methods:
- Condoms (male/female) – prevent pregnancy & STDs.
- Diaphragm, cervical cap.
Hormonal Methods:
- Oral contraceptive pills (combined & mini pills).
- Injectable contraceptives.
- Implants.
Intrauterine Device (IUD): Copper-T, Multiload.
Natural Methods:
- Safe period method.
- Coitus interruptus.
- Basal body temperature/ cervical mucus method.

d) National Health Policy

First (1983): Aim – “Health for All by 2000.” Focus on primary health care.
Second (2002): Emphasized private sector participation, reducing mortality, strengthening infrastructure.
Third (2017):
- Goal – Universal Health Coverage.
- Increase health expenditure to 2.5% of GDP.
- Provide free drugs, diagnostics, emergency services.
- Focus on NCDs, mental health, AYUSH integration.
- Strengthening health information systems.

e) Occupational Hazards (Types & Brief)

Physical Hazards: Noise, vibration, radiation, heat, cold.
Chemical Hazards: Dust, fumes, gases, solvents, pesticides.
Biological Hazards: Bacteria, viruses, fungi exposure.
Mechanical Hazards: Injuries from machinery, accidents.
Psychosocial Hazards: Stress, workload, night shifts, harassment.
Ergonomic Hazards: Poor posture, repetitive strain injuries.

f) Uses of Epidemiology

Study of disease distribution and determinants.
Helps in identifying risk factors for diseases.
Guides health planning and policy formulation.
Assists in evaluation of health programs and interventions.
Helps in outbreak investigation and control.
Predicts future health trends (forecasting).
Assists in research for preventive and therapeutic measures.

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

[1x15=15]

a) Discuss about Health System in India - at the Centre and State level.

b) Define immunization. Explain in detail about cold chain. Role of community health nurse in immunization.

a) Health System in India – at the Centre and State level

1. Health System in India – Overview

Federal structure – health is a state subject, but centre provides guidelines, funds, and national programs.
Aim: Universal, affordable, accessible, and equitable health care.
Delivered through 3-tier structure:
- Primary level: Sub-centres, PHCs, CHCs.
- Secondary level: District hospitals, sub-district hospitals.
- Tertiary level: Medical colleges, specialty hospitals.

2. At the Central Level

Ministry of Health and Family Welfare (MoHFW) is the nodal body.
Headed by Union Health Minister.
Departments under MoHFW:
1. Department of Health & Family Welfare.
2. Department of Health Research.
3. Department of AYUSH (Ayurveda, Yoga, Unani, Siddha, Homoeopathy).
Functions:
- Formulation of National Health Policies.
- Planning and implementation of National Health Programs (TB, Malaria, RNTCP, NRHM/NHM).
- Regulation of drugs (through CDSCO).
- Medical education (through NMC/NCISM).
- International health relations (WHO, UNICEF, etc.).
- Financial aid to states.

3. At the State Level

Each state has a State Health Department headed by State Health Minister.
Directorate of Health Services implements programs.
Functions:
- Implementation of national & state health programs.
- Recruitment & training of health staff.
- Administration of state hospitals, PHCs, CHCs.
- Regulation of private hospitals and nursing homes.
- Health education & promotion activities.
States vary in health infrastructure depending on resources.

4. District Level

District Medical Officer / Chief Medical Officer coordinates all health services.
District Hospital provides secondary care and supervises PHCs, CHCs.

b) Immunization, Cold Chain, Role of Community Health Nurse

1. Define Immunization

Process of making a person immune or resistant to an infectious disease, typically by administering a vaccine.
Provides active or passive immunity.
Example: BCG, OPV, DPT, Hepatitis-B, Measles vaccines.

2. Cold Chain (Detailed)

Definition: System of storing, transporting, and distributing vaccines in potent condition at recommended temperature (usually +2°C to +8°C).
Purpose: To maintain vaccine potency from manufacturer → user.

Components of Cold Chain:

Equipment:
- Walk-in coolers, deep freezers, Ice-lined refrigerators (ILR), cold boxes, vaccine carriers, ice packs.
Manpower:
- Trained health workers, supervisors, cold chain technicians.
Procedures:
- Proper vaccine handling, regular monitoring, maintenance of equipment.

Key Points:

BCG, OPV, Measles are freeze-sensitive.
DPT, TT, Hep-B are heat-sensitive.
Temperature must be monitored using vaccine vial monitor (VVM), thermometers.

3. Role of Community Health Nurse in Immunization

Educates community about importance of immunization.
Identifies eligible children and mothers for vaccination.
Ensures timely administration of vaccines as per schedule.
Maintains cold chain at sub-centre level (ILR, vaccine carriers).
Conducts immunization sessions and outreach services.
Keeps immunization records and reports.
Observes for adverse events following immunization (AEFI) and manages/report.
Motivates mothers, prevents myths and misconceptions.

Section - B

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

[4 x 5= 20]

a) Mention the various committees existing in India

b) Community health centre

c) Family welfare programme

d) Components of school health program

e) Indigenous system of medicine

a) Various Committees in India (Health Sector)

Bhore Committee (1946): Laid foundation of Indian health system, recommended 3-tier system (Primary, Secondary, Tertiary).
Mudaliar Committee (1962): Strengthening of district hospitals, more PHCs.
Chadha Committee (1963): Integration of malaria activities with general health services.
Mukherjee Committee (1966): Separate staff for family planning.
Jungalwalla Committee (1967): Integration of curative & preventive services.
Kartar Singh Committee (1973): Multipurpose health workers, sub-centres.
Shrivastav Committee (1975): Creation of village health guide & community health volunteers.

b) Community Health Centre (CHC)

Level: Secondary level of healthcare.
Coverage: One CHC for 80,000–1,20,000 population.
Staffing: 4 specialists – Physician, Surgeon, Gynecologist, Pediatrician + nurses & support staff.
Functions:
- Provides specialist OPD and inpatient services (30 beds).
- Emergency obstetric care.
- Referral centre for PHCs.
- Implements national health programs.
- Training and supervision of PHC staff.

c) Family Welfare Programme

Launched in 1951 as National Family Planning Programme (world’s first).
Objective: To stabilize population and improve maternal & child health.
Strategies:
- Contraceptive services: Temporary (condoms, OCPs, IUDs) & permanent (sterilization).
- Maternal health care: Antenatal, postnatal care.
- Child health: Immunization, nutrition, ORS.
- IEC activities: Awareness about small family norm.
Integrated with Reproductive and Child Health (RCH) Programme and National Health Mission.

d) Components of School Health Program

Health appraisal: Regular medical check-ups, screening.
Remedial services: Treatment & referral of sick children.
Preventive services: Immunization, deworming, first aid.
Healthful school environment: Clean water, sanitation, safe playground.
Health education: Personal hygiene, nutrition, physical exercise.
Mental health: Counseling, stress management.
Nutrition services: Midday meal program, nutrition education.
Record keeping & follow-up.

e) Indigenous System of Medicine (ISM)

AYUSH (Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homoeopathy).
Major systems practiced in India:
1. Ayurveda – holistic healing, herbal medicines.
2. Yoga & Naturopathy – lifestyle modification, natural therapy.
3. Unani – based on humoral theory.
4. Siddha – practiced in Tamil Nadu, herbal/mineral remedies.
5. Homoeopathy – “like cures like” principle.
Plays important role in preventive, promotive, and curative health care.

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

[1x5=15]

a) Explain about the three tier system of health care in India.

b) Mention the vital events and the uses of vital statistics. Role of village health Nurse in maintaining Perfect 👌 Here’s the exam-ready notes (15 marks format) for your Long Answer Question. I’ll give both options, so you can choose the one that’s easier for you in exam.

a) Three-tier system of health care in India

1. Introduction

India follows a 3-tier structure of health care delivery as recommended by the Bhore Committee (1946).
Aim: To provide universal, accessible, and affordable health care to all.
Levels: Primary, Secondary, Tertiary.

2. Primary Level

Sub-centres (SCs):
- First contact point for community.
- Population coverage: 5,000 (plain), 3,000 (hilly/tribal).
- Staff: 1 Female & 1 Male Health Worker.
- Services: MCH, family planning, immunization, health education, disease prevention.
Primary Health Centres (PHCs):
- Population coverage: 30,000 (plain), 20,000 (hilly).
- 1 PHC supervises 6 sub-centres.
- Staff: 1 Medical Officer, 14 paramedical staff.
- Functions: OPD, 6-bed IPD, immunization, antenatal care, minor ailments, referral.

3. Secondary Level

Community Health Centres (CHCs):
- Population coverage: 80,000–1,20,000.
- 30-bed hospital.
- Staff: 4 specialists (Surgeon, Physician, Gynecologist, Pediatrician) + paramedics.
- Functions: Referral unit for PHCs, emergency obstetric care, surgeries, lab services.
Sub-district/District Hospitals:
- Provide advanced care beyond CHC.
- Bed strength: 100–500 depending on district.

4. Tertiary Level

Medical College Hospitals & Apex Institutions (AIIMS, PGI Chandigarh, etc.).
Provide specialized, super-specialty care.
Training and research centres.
Referral for difficult/complex cases.

b) Vital Events, Vital Statistics & Role of Village Health Nurse

1. Vital Events

Refers to important events in human life recorded officially.
Includes:
1. Birth
2. Death
3. Stillbirth
4. Marriage
5. Divorce
6. Adoption
7. Foetal death

2. Vital Statistics – Uses

Measure population growth (birth & death rates).
Helps in planning health programs (immunization, MCH services).
Evaluates health services effectiveness.
Used in epidemiology (study of trends, causes of mortality).
Provides data for policy making and resource allocation.
Helps in international comparisons of health status.

3. Role of Village Health Nurse (VHN) at Sub-centre

Registers all births, deaths, marriages, stillbirths in her area.
Maintains vital event registers at the sub-centre.
Reports data regularly to PHC and higher authorities.
Educates community on importance of registration.
Assists in issuing birth/death certificates.
Ensures accuracy and timeliness of data collection.
Helps in population surveys and health program evaluation.