Community Health Nursing
Community Health Nursing asks how care is delivered outside hospital: prevention levels, epidemiology, national programmes, home visiting and the cold chain. Questions often use a village scenario and ask for the most appropriate public health action.
Levels of prevention
Primordial prevention removes risk factors from the environment. Primary prevention acts before disease (immunisation, health education, safe water). Secondary prevention detects and treats early disease (screening, case finding). Tertiary prevention limits disability and restores function (rehabilitation).
Epidemiology measures
Incidence = new cases in a period ÷ population at risk × 1000. Prevalence = all existing cases at a point ÷ total population × 1000. Incidence measures risk; prevalence reflects burden and duration.
Programme basics
Sub-centres serve about 3000–5000 people in the plains and 3000 in hilly or tribal areas; a primary health centre serves about 20,000–30,000. ASHAs link households to the health system. Cold chain: freeze-sensitive vaccines (DPT, hepatitis B, TT, pentavalent) must not freeze; OPV is stored frozen for long-term use. The vaccine vial monitor changes colour with heat exposure.
Worked example
A sub-centre population of 5000 records 25 new tuberculosis cases in a year. Incidence = 25 ÷ 5000 × 1000 = 5 per 1000 population per year. If 60 cases exist on 1 January, point prevalence that day is 60 ÷ 5000 × 1000 = 12 per 1000.
Traps
Do not report prevalence when the question asks for new cases. Do not freeze hepatitis B or DPT. Health education is primary prevention, not secondary. Screening is secondary prevention even when it feels like early diagnosis.