LECTURE NOTES

For Nursing Students

Daniel Mengistu

Equlinet Misganaw

University of Gondar

In collaboration with the Ethiopia Public Health Training Initiative, The Carter

Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of

Education

Community Health

Nursing 

2006

Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00.

Produced in collaboration with the Ethiopia Public Health Training Initiative,

The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry

of Education.

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©2006 by Daniel Mengistu and Equlinet Misganaw

All rights reserved. Except as expressly provided above, no part of this

publication may be reproduced or transmitted in any form or by any means,

electronic or mechanical, including photocopying, recording, or by any

information storage and retrieval system, without written permission of the

author or authors. 

This material is intended for educational use only by practicing health care workers or

students and faculty in a health care field. 

PREFACE

Community health Nursing is the synthesis of nursing and

public health practice applied to promote and protect the

health of population. It combines all the basic elements of

professional, clinical nursing with public health and community

practice.

Community health nursing is essential particularly at this point

in time because it maximizes the health status of individuals,

families, groups and the community through direct approach

with them. Today community participation and involvement is

getting a due attention before the occurrence of illnesses as

life-style changes to continue to play a significant role in

morbidity and mortality. Chronis illnesses, tobacco smoking,

road traffic accident (RTA) …etc, and environmental changes

that affect health are steadily becoming the major concerns

influencing human health in our country. As nurses of 21st

century we have duties and responsibilities to keep a dynamic

balance with the ever changing needs of the health of our

society. To maintain abreast with this societal needs we

professional nurses must understand concepts and models of

the community health nursing, the importance of health

i

promotion and disease prevention and health care planning,

implementation and evaluation of health care efforts for the

advantage of the community.

The purpose for preparing this lecture note is to upgrade the

previously prepared lecture note and to present the subject in

a relatively simplified and organized way.

ii

The teaching material is based on the existing curriculum of

community health nursing and consists of 14 units. Each unit

has its own objectives, body and reviewing question at the

end.

Finally a lot of effort has gone in preparing this material within

short period of time, valuable and constructive comments

have welcome for the improving of this lecture note. 

ACKNOWLEDGEMENT

We would like to acknowledge The Carter Center initiative for

supporting the preparation of these lecture notes.

We are very grateful to the Nursing and Community Health

Department staffs for their valuable comments and ideas in

revising the first draft.

We also owe special gratitude to Mr. Mesfin Negussie, and S/r

Hanna Alebachew who have produced the first ever lecture

note on Public Health Nursing in this country.

We would also like to extend our special regards to Mr. Akililu

Mulugeta, Technical Manager, TCC for his support during the

entire preparation of this lecture note.

iii

Finally, we wish to extend our thanks to W/ro Serkalem

Teshome for writing the draft of these lecture notes.

TABLE OF CONTENTS

Preface ...............................................................................

I Acknowledgment ..............................................................

III Table of

content................................................................IV List of

figures .....................................................................X List of

tables ....................................................................XI

Abbreviations ..................................................................XII

Unit one: Introduction to concepts of Community Health

Nursing................................................................ 1

1.1. Introduction ..................................................... 1

1.2. Health ...................................................... 3

1.3. Health and wellness......................................... 5

1.4. Health and illness .......................................... 13

1.5. Health- illness continuum............................... 14

iv

1.6. Communing health practice ........................... 17

1.7. Community health nursing ............................. 18

1.8. Public health nursing...................................... 22

 Review Questions...................................... 23

Unit two: Historical Development of Community Health

Nursing ............................................................. 24

2.1. Introduction ................................................. 24

2.2. Factor influencing the growth of community

health nursing ............................................. 32

2.3. Role of Community Health Nursing ............ 34 2.4.

Setting of Community Nursing Practice ..... 39

 Review questions ....................................... 40

Unit three: Health care Delivery System and Primary Health

Care ............................................................ 41

3.1. Introduction ................................................. 41

3.2. Factors affecting health care delivery system.46

3.3. Health care delivery system in Ethiopia ..... 48

3.4. Primary Health Care ................................... 62

3.5. Organization of health care delivery system in

Ethiopia ................................................... 84

Review questions........................................ 89

Unit Four: Nursing Process in the Community.............. 90

4.1 Introduction.................................................... 90

v

4.2 Phases of nursing process in the community 96

 Review questions.............................................. 108

Unit Five: Maternal and Child Health (MCH) ............... 109

5.1 Introduction ................................................ 109

5.2 Historical development of MCH service....... 111

5.3 Reason for priority given to MCH service .... 115

5.4 Major target of MCH service ....................... 117

5.5 Major component of MCH service............... 117

5.6 Child Health ................................................ 118

5.7 Common indicator of MCH Service.............. 119

Review questions......................................... 123

Unit Six: Adolescent Reproductive Health (ARH) ....... 124

6.1 Introduction ............................................... 124

6.2 Rationale why concern to ARH ................ 126

6.3 Components of ARH................................. 126

6.4 Problem of Adolescent Fertility ................ 127

6.5 Strategies of ARH .................................... 129

Review questions...................................... 134

Unit Seven: Street “On” and “Off” Children .................. 135

7.1. Introduction ............................................... 135

7.2. Reason (factors contributing) for being

 street......................................................... 136

7.3. Problem of Street Children........................ 136