Community Health Nursing
Community health nursing tests epidemiology, levels of prevention, national health programmes and the organisation of primary care in India. Questions blend definitions with calculations and programme-specific details such as which worker delivers which service.
Prevention framework
- Primordial: preventing risk factors in the whole population (tobacco control policy).
- Primary: before disease occurs (immunisation, safe water, condom promotion).
- Secondary: early detection and prompt treatment (screening, PAP smear, case finding).
- Tertiary: disability limitation and rehabilitation (physiotherapy after stroke).
Epidemiology measures
- Incidence = new cases in a period ÷ population at risk × 1000. It measures risk.
- Prevalence = all existing cases ÷ total population × 1000. It measures burden and rises when survival improves.
- IMR = infant deaths under 1 year ÷ live births × 1000; MMR = maternal deaths ÷ live births × 100,000.
Worked example
A block of 50,000 people records 150 new tuberculosis cases in a year and already has 400 patients on treatment. Incidence = 150 ÷ 50,000 × 1000 = 3 per 1000 per year. Prevalence = 550 ÷ 50,000 × 1000 = 11 per 1000. Reasoning: only new cases enter the numerator of incidence, while prevalence counts everyone who has the disease at that point.
Programme specifics
- ASHA: one per 1000 population, trained community health worker on performance-based incentives; she does not prescribe or conduct deliveries.
- Primary Health Centre: covers 30,000 rural people (20,000 in hilly or tribal areas).
- NTEP: sputum microscopy and CBNAAT for diagnosis, with treatment adherence support.
Traps
Using prevalence as a risk measure, calling screening primary prevention, and confusing UNICEF (New York) with WHO (Geneva).