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

Fourth Basic B.Sc. Nursing (Old) Examination, Winter - 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) Referral System.

b) Recommendations of Bhore Committee.

c) Goals of National Health Policy.

d) UNICEF.

e) Principles of home visiting.

f) Minimum need programme.

a) Referral System

A process of transferring patients from a lower-level health facility to a higher-level for better care.
Levels of referral:
1. Primary → Secondary (SC/PHC → CHC/District Hospital).
2. Secondary → Tertiary (District Hospital → Medical College/AIIMS).
Purpose: Ensure patient receives appropriate care at the right level.
Benefits: Optimum utilization of resources, timely treatment, reduced morbidity/mortality.

b) Recommendations of Bhore Committee (1946)

Laid the foundation of Indian health system.
Recommended integrated 3-tier health care system (Primary, Secondary, Tertiary).
PHC for 40,000 population, staffed with multidisciplinary team.
Secondary units (district level hospitals) with 650 beds.
Emphasis on preventive and curative services integration.
“Health for all based on primary health care.”
Development of medical and nursing education.

c) Goals of National Health Policy

(As per NHP 2017 – latest)

Universal Health Coverage with financial protection.
Increase health expenditure to 2.5% of GDP by 2025.
Reduce maternal mortality to < 100/1,00,000 live births.
Reduce infant mortality to < 25/1000 live births.
Reduce under-five mortality to < 23/1000 live births.
Achieve 90% immunization coverage.
Improve health infrastructure & human resources.
Promote AYUSH and digital health.

d) UNICEF (United Nations International Children’s Emergency Fund)

Established in 1946, HQ: New York.
Works in more than 190 countries.
Objectives: Improve health, nutrition, education, and welfare of children & women.
Activities:
- Provides vaccines, ORS, micronutrients.
- Supports child protection, early childhood care, and emergency relief.
- Collaborates in India for Universal Immunization Programme, Mid-day Meal, ICDS, Polio Eradication.
Present name: United Nations Children’s Fund.

e) Principles of Home Visiting

Planned and purposeful – visit must have a definite aim.
Convenient timing – suitable to family.
Flexibility – adjust as per family needs.
Respect and acceptance – maintain privacy, confidentiality, cultural sensitivity.
Participation – encourage involvement of family members.
Recording & reporting – maintain proper records.
Follow-up – ensure continuity of care.

f) Minimum Needs Programme (MNP)

Launched in Fifth Five Year Plan (1974).
Aim: To raise living standards of people and ensure social justice.
Components:
1. Rural health (SC, PHC, CHC establishment).
2. Rural water supply.
3. Elementary education.
4. Nutrition (mid-day meal, ICDS).
5. Rural roads & electrification.
6. Housing for landless laborers.
Integrated into National Rural Health Mission (NRHM) later.

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

[1x15=15]

a) Define Community Health Nursing. Discuss the goals of community Health Nursing. Describe the role of Nurse at PHC.

b) Describe Community Health Centre, its staffing pattern. Functions of Community Health Centre.

a) Community Health Nursing

1. Definition

Community Health Nursing is a specialized field of nursing which combines the skills of nursing, public health, and social sciences to promote, protect, and maintain the health of individuals, families, and communities in their natural environment.
Focus is on prevention, health promotion, and rehabilitation at community level.

2. Goals of Community Health Nursing

Health Promotion – creating awareness, encouraging healthy lifestyles.
Disease Prevention – immunization, health screening, health education.
Early Diagnosis & Treatment – detecting illness at early stages.
Rehabilitation – restoring individuals to maximum possible level of health.
Family-centered Care – considering family as a unit of care.
Equity & Accessibility – ensuring health care to vulnerable and underserved groups.
Community Participation – encouraging active involvement of people in health programs.

3. Role of Nurse at PHC

Direct Patient Care: Provides OPD care, minor treatments, antenatal & postnatal services.
Maternal and Child Health: Conducts deliveries, immunization, growth monitoring, family planning services.
Health Education: Educates on hygiene, nutrition, safe water, sanitation, lifestyle diseases.
Preventive Services: Organizes mass immunization, health camps, disease surveillance.
Administrative Role: Maintains records & reports (immunization, vital events, health registers).
Coordinator: Acts as a link between community and higher health centres.
Home Visits: Identifies high-risk families, provides counseling, follow-up care.
Training: Guides ASHA, ANM, MPHW in community-based activities.

b) Community Health Centre (CHC)

1. Introduction

CHC is the secondary level of health care in India.
Established as per Alma-Ata (1978) Primary Health Care concept and recommendations of Kartar Singh Committee (1973).
Acts as a referral unit for 4 PHCs.

2. Staffing Pattern (As per Indian Public Health Standards – IPHS)

Medical Specialists:
- 1 Surgeon
- 1 Physician
- 1 Gynecologist/Obstetrician
- 1 Pediatrician
Other Doctors: 7 Medical Officers (including AYUSH).
Nursing Staff: 19 (Staff nurses, Public Health Nurse).
Other Staff: Pharmacist, Lab technicians, Radiographer, Health educators, Ward boys, Clerks, Sweepers.
Total staff strength: Around 50–60 personnel depending on state norms.

3. Functions of CHC

Curative Services: OPD, 30-bed inpatient care, surgeries, emergency services.
Maternal & Child Health: Safe delivery, C-section facilities, newborn care, family planning.
Specialist Care: Medicine, Surgery, Pediatrics, Gynecology.
Diagnostic Services: Lab, X-ray, ECG, blood storage unit.
Referral Services: Functions as a referral unit for PHCs.
Implementation of National Health Programs: TB, Malaria, Leprosy, HIV/AIDS, RCH, etc.
Training & Supervision: Provides training to health workers, supervises PHCs.
Emergency Services: Accident, trauma, snakebite, poisoning, obstetric emergencies.
Public Health Role: Health education, outbreak investigation, epidemic control.

Section - B

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

[4 x 5= 20]

a) Importance of Vital Statistics.

b) Importance of health records.

c) Objectives of National Rural Health Mission.

d) Uses of Growth Chart.

e) Standing Orders in Community.

a) Importance of Vital Statistics

Measures population growth (birth, death, marriage, divorce rates).
Helps in planning and evaluating health programmes.
Identifies trends of morbidity and mortality.
Assists in resource allocation and policy-making.
Provides data for epidemiological research and comparison (national & international).

b) Importance of Health Records

Serves as a permanent record of patient’s illness and care.
Useful for continuity of care between health workers.
Provides legal evidence in medico-legal cases.
Helps in research and education of health personnel.
Facilitates evaluation of services and future planning.

c) Objectives of National Rural Health Mission (NRHM)

Launched in 2005, now part of National Health Mission (NHM).
Provide universal access to affordable and quality healthcare.
Strengthen health infrastructure in rural areas.
Reduce IMR and MMR through maternal and child health services.
Promote population stabilization and family welfare.
Encourage community participation (ASHA workers, Village Health Committees).
Main focus on 18 high-priority states.

d) Uses of Growth Chart

Monitors child’s growth (height, weight, nutrition status).
Helps in early detection of malnutrition and growth retardation.
Educates parents about child’s health and nutrition.
Motivates family to seek timely medical help.
Serves as a record for health workers in community follow-up.

e) Standing Orders in Community

Definition: Written instructions issued by higher health authorities allowing health workers/nurses to provide certain treatments or preventive care without direct doctor’s presence.
Examples:
- Giving ORS for diarrhea.
- Iron and folic acid distribution.
- Vitamin A supplementation.
- First aid for minor injuries, fever, malaria.
Importance: Ensures timely care, reduces delay in emergencies, strengthens primary health care delivery.

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

[1x5=15]

a) Discuss the scope of Employees State Insurance. Write in Brief on benefits of ESI. Scheme 1948. Discuss the role & function of an occupational health nurse.

b) Define Reproductive and Child health approach. Describe JSS Yojana. Explain the role and responsibilities of ASHA. Write in detail the points you will consider while organising Ante Natal Clinic.

a) Employees State Insurance (ESI)

1. Scope of ESI

ESI Act, 1948 – a social security scheme for workers in India.
Applies to:
- Factories & establishments with ≥10 employees.
- Workers earning up to ₹21,000/month (ceiling may be revised).
Covers employees + dependents.
Provides medical care, cash benefits, social security.
Financed by contributions from employer & employee + state support.

2. Benefits of ESI Scheme (1948)

Medical Benefit – free treatment for insured worker & family.
Sickness Benefit – 70% wages during certified illness (up to 91 days/year).
Maternity Benefit – 26 weeks leave with full wages, for confinement, miscarriage, or adoption.
Disablement Benefit – for temporary/permanent disability due to work injury.
Dependents Benefit – for family if worker dies due to employment injury.
Funeral Expenses – lump sum for funeral of insured person.
Rehabilitation Allowances – vocational training for disabled workers.

3. Role & Functions of Occupational Health Nurse

Health Promotion: Educates workers on hygiene, nutrition, safety.
Prevention: Conducts periodic health check-ups, immunization.
Curative Role: First aid, emergency care, referral for major illness/injury.
Rehabilitation: Assists in return-to-work programs, supports disabled workers.
Record Keeping: Maintains accident records, occupational disease reports.
Liaison Role: Acts as link between workers, management & health services.
Counseling: Stress management, substance abuse prevention.

b) Reproductive and Child Health (RCH)

1. Definition of RCH Approach

Launched in 1997, part of National Health Mission.
Aims at providing integrated services for reproductive health and child survival.
Includes: family planning, safe motherhood, child health, prevention of RTIs/STIs/HIV.
Focus on client-centered, need-based, gender-sensitive services.

2. Janani Suraksha Yojana (JSY)

Launched in 2005, under NHM.
Aim: Reduce maternal & neonatal mortality by promoting institutional deliveries.
Provides cash incentives for pregnant women (esp. BPL/SC/ST) to deliver in hospitals.
Encourages ASHA workers to motivate and accompany women to health facilities.
JSY has been a major contributor to increase in institutional delivery rate in India.

3. Role & Responsibilities of ASHA (Accredited Social Health Activist)

Acts as link between community & health system.
Mobilizes community for immunization, ANC, institutional delivery.
Identifies pregnant women, maintains health records.
Provides health education on nutrition, breastfeeding, family planning.
Accompanies mothers to health facility for safe delivery.
Provides first aid for minor illnesses, distributes ORS, IFA, contraceptives.
Assists in national health programs (TB, malaria, immunization campaigns).

4. Points to Consider while Organising Ante Natal Clinic

Planning: Select venue (PHC, CHC, outreach), prepare logistics.
Manpower: Doctors, nurses, ANMs, ASHA for mobilization.
Registration: All pregnant women recorded early in pregnancy.
Screening: Blood pressure, weight, urine test, hemoglobin, abdominal exam.
Immunization: TT injection.
Medication: Iron & folic acid tablets, calcium supplements, deworming.
Counseling: Nutrition, rest, hygiene, birth preparedness, danger signs.
Referral Services: Identify high-risk cases and refer to higher centers.
Record Keeping: Maintain ANC cards, reports, follow-up schedule.
Community Participation: Involve family & motivate for institutional delivery.