Community and Public Health Nursing
Domain 7 - Community and Public Health Nursing
This domain tests population-focused practice: primary health care principles, prevention levels, epidemiology, surveillance and outbreak response, immunisation programmes, home visiting, community assessment and health education - delivered through health centres, nursing stations and village health workers across Fiji's divisions.
Core rules
- Levels of prevention: primary (immunisation, clean water, health education), secondary (screening, early case detection, contact tracing), tertiary (rehabilitation, complication control).
- Incidence is new cases in a period; prevalence is all existing cases at a point in time. Attack rate is used in outbreaks.
- Notifiable diseases must be reported promptly through the national surveillance system; reporting triggers investigation, not just paperwork.
- Outbreak investigation steps: verify the diagnosis and confirm the outbreak, define and count cases (person, place, time), generate a hypothesis, investigate and take specimens, implement control measures, communicate, and evaluate.
- Cold chain: vaccine fridge between 2 and 8 °C, temperature logged twice daily, no food or specimens in the fridge, ice packs conditioned before transport, and a cold chain monitor in each carrier.
- Community assessment collects demography, water and sanitation, housing, vectors, food supply, health services and community priorities - with the community, not for it.
- Health education must be practical, culturally appropriate, in the local language, and built around what the learner already does.
Worked example
A nursing station reports five people from one settlement with fever, headache, muscle pain and rash within four days. Reasoning: this is a suspected dengue cluster. Actions: notify the subdivisional health office immediately, collect and send samples with the case definitions applied, search house-to-house for further cases, remove breeding sites and treat containers, give health education on source reduction and repellents, advise rest, fluids and paracetamol, with warning signs for severe disease, and monitor and report daily until the cluster closes.
Traps
- Confusing incidence with prevalence.
- Treating screening as diagnosis without confirmatory testing.
- Freezing vaccines or leaving them out of the fridge during a clinic.
- Delivering health education as a lecture instead of a two-way, problem-solving discussion.
- Reporting only the cases you can be bothered to write up.