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HOSPITAL SECTOR, BHILAI

SUBJECT: COMMUNITY HEALTH NURSING

UTAI RURAL COMMUNITY

SUBMITTED TO: SUBMITTED BY:


Mrs. Jaya Chakraborty Ms Rincy Mary
Reader CHN Department M.Sc. Nursing Previous
P.G. College of Nursing P.G. College of Nursing
INTRODUCTION:
As a part of our clinical experience of rural community health nursing, I along with two other classmates were
posted in Banjari Para, Utai village from_________ to ________ with the objective to provide comprehensive care to the
family.

DEFINITION:
Family health nursing is nursing aspects of organized family health care services which are directed or focused
on the family as the unit of care with health on the goal.

OBJECTIVE OF THE FAMILY HEALTH NURSING:


The broad objectives of family health nursing are as under:

To identify health and nursing needs and problems of family.


To ensure family’s understanding and acceptance of these needs and problems.
To plan and provide health.
To contribute to family’s performance of develop mental functions and tasks.
To help family make intelligent use of promotive, preventive and therapeutic and rehabilitative health and allied facilities
and services in the community.
To educate, counsel and guide family members to cultivate good personal health habits, practice self cultural practices
and maintain wholesome physical, psychosocial and spiritual environment.

COMMUNITY HEALTH PROGRAMMES:


The various community health programmes:
Pulse polio programme
Family welfare programme
National malaria control programme
National leprosy eradication programme
Vitamin A prophylaxis programme

INFLUENTIAL PERSONS:
The various influential persons in community:
Surpanch
Anganwadi worker
Private practitioners

FAMILY IDENTIFICATION DATA:


NAME OF HEAD OF FAMILY : Ajeet
RELIGION : HINDU
CASTE : SCHEDULE CASTE

FAMILY STRUCTURE AND CHARACTERSTICS:


FAMILY SIZE : 4
TYPE OF FAMILY : Nuclear Family
FAMILY COMPOSITION :
S.No NAME AGE/ RELATIONSHIP EDUC- OCCU- MARITAL IMMUNI- HEALTH REMARKS
SEX WITH THE ATION PATION STATUS ZATION STATUS
HEAD STATUS
OF THE FAMILY
1 Ajeet 23/M Head 7th class Laborer Married Unknown Good -

2 Shiv 25/F Wife 4th class Housewife Married Unknown Good -


Kumari
3 Neel 3/M Son - - - - Good -
Kamal
4 Anurag 1 and Son - - - - Good -
6mont
hs/M

FAMILY GENOME:

Ajeet 23/ M Shiv Kumari 25/ F

Mast. Neel Mast. Anurag


Kamal 3/ M 1 1/2/ M

ENVIRONMENTAL SANITATION:
DISPOAL OF REFUSE:
They disposed off the refuse by dumping in a common place or by burning.

DISPOSAL OF NIGHT SOIL:


They have no sanitary facility at home rather they go for open defecation.

DISPOSAL OF SEWAGE:
There is no proper disposal facility to drain sewage in the home.

DISPOSAL OF DEAD BODIES:


They dispose human dead bodies by cremation or burning as per cultural practices in a particular place and
animal dead bodies are disposed off by burying.

ENVIRONMENTAL FACTORS:
HOUSING:
Type of house : It is a semi- pucca house.

Ownership: It is their own house.

Adequacy of space: There is no adequate space at home.

Ventilation: Ventilation is not adequate since there is only one door & no window at the house.

Kitchen & hand washing facility: They have no separate kitchen and hand washing facility is available.
Presence of insect & rodents: Insects and rodents are present in the house.

Presence of domestic animals: They rear cows but no separate place for it.

General maintenance: General maintenance of house is not so good.

Toilet & bathroom: There is a bathroom but no toilet facility in house.

Sleeping arrangement: They have bed for sleeping.

Light: They have electricity as source of light.

Water: They have no hand pump in their house rather they have a common one in their locality.

NEIGHBOURHOOD:
Type of dwelling: There are pucca as well as kutcha houses in neighbourhood of my family.

Community facilities: Community facilities are available.

TRANSPORT & COMMUNICATION FACILITIES:


Road: They have road facility connecting them to nearby community health centre and other villages and community.

Own vehicle: The family is having one cycle.

Means of communication: They use mobile phone as means of communication.

Mass media: Radio is a means of mass media.

FAMILY SOURCE OF INCOME:


The head of family is Ajeet is working as a laborer.

DIETARY PRACTICES:
Type of diet: Family is non-vegetarian and consumes chicken twice in a month.
Number of meals: Family takes 3 meals per day i.e.- breakfast, lunch, dinner
General meal for each meal :
Breakfast - Roti/Poha , tea, subji
Lunch - Rice, dal , vegetable curry
Dinner - Rice/ roti dal , vegetable curry

Method of cooking: They cook food in chula and use methods of cooking such as boiling, steaming, frying etc.

Food storage: They store the food in a hygienic manner.

Special need: There are under-five children in family, which requires special attention towards good nutrition for proper
growth and development.

General knowledge and attitude towards diet: They do not have adequate knowledge about balanced diet.

Family meal timings: They consume 3 meals/day.


Breakfast – 7.30 am
Lunch - 1.30pm
Dinner - 8pm
Dietary advices: Advices regarding diet were given-
Take nutritious & balanced diet
Consume vegetables & seasonal fruits
Foods consumed should be clean and safe.

Educational needs of family regarding food:


Safe & adequate drinking water
Protection of food against flies
Hygienic kitchen practices
Thorough washing of uncooked fruits & vegetables.
Consume green leafy vegetables
Take more fruits

SLEEP, REST & EXERCISE PRACTICES:


Sleeping arrangement: They have four separate rooms and have adequate sleeping facilities
Timing & duration: They go to bed around 10.00pm & wake up by 6.00am
Exercise, yoga & meditation: They does not perform any exercise, yoga & meditation
Leisure time activities: In leisure time, they watch TV & have socializing talk with neighbours.

CULTURAL PRACTICES RELATED TO:


Marriage: They follow the cultural practices in marriage according to their Hindu religion
Sickness: If they fell sick, they go to private clinic and community health centre in utai.
Antenatal care: Proper care is provided to expectant mother were followed.
Natal care: They prefer institutional deliveries
Post natal care: They do not allow mother & baby to go outside the home after the delivery due to cultural practices.
Child care: They don’t have any cultural practice related to child care.

SOCIO-ECONOMIC ASPECTS:
Religion: The family believes in Hindu religion.
Income: 120/day or 3600/month
Earning members:
Mr.Ajeet
Place of work: Work as a laborer anywhere.
Monthly expenditure:
Food- 50% of income spent in food

ADEQUACY INCOME IN RELATION TO MEETING BASIC NECESSITIES:


They have less income to meet basic necessities.

FAMILY’S PERCEPTION OF THEIR INCOME:


Family members are not satisfied with their income.

HEALTH & MEDICAL HISTORY:


PRESENT HEALTH & ILLNESS STATUS: Anurag is having diarrhoe and Shiv Kumari
is having fever, rest all family members are healthy.

HISTORY OF PAST SIGNIFICANT ILLNESS & ACCIDENT: No significant history of illness.

FAMILY’S FERTILITY BEHAVIOUR:


Family welfare :
Number of eligible couple : Number of eligible couple in family is one
Age of Mr. Ajeet : 23yrs
Age of Mrs. Jyoti : 25yrs
Total no. of living children : 2
Age of youngest child : 18 months

FAMILY HEALTH NURSING CARE PLAN:

Family/ Head of family: Ajeet


Address : Banjari Para, Uttai
Setting for care : Family setting
Approach : Active family involvement
Aim : To develop abilities for performance of family’s health
task
Scheduling of contacts: As agreed upon by family and time upon agency policies
Frequency of contacts : Depending upon family needs & time available
Goals : After nursing interventions,

Mother will be able to provide care to child Anurag regarding diarrhea


Temperature of mother will be reduced
The family will be aware of regarding home accidents
The family will be aware of maintaining proper disposal of waste
The family will appreciate the importance of adopting family planning methods
The family will have knowledge regarding weaning

ASSESSMENT:
Child (Anurag) is having diarrhea- lethargic, weak, irritable.
Wife is having fever cold and cough
Child (Anurag) is climbing upstairs alone and risk of fall down
Improper collection and disposal of waste
Couples were not aware of family planning methods.
Wife is not aware of weaning foods

NURSING DIAGNOSIS:
Altered bowel movement related to diarrhoea
Altered thermoregulation related to respiratory infection
Potential for health injury related to home accidents
Poor environmental sanitation related to improper disposal of waste.
Knowledge deficit regarding small family norm.
Knowledge deficit regarding weaning foods.
ASSESSMENT NURSING GOAL & PLANNING INTERVENTION EVALUATION
DIAGNOSIS
Subjective data Altered bowel Goal: 1.Education of family on nature & Family was cooperative &
Mrs. Shiv Kumari movement related After nursing intervention the extent of the problem gained knowledge by the
verbalizes son Anurag is to diarrhoea mother will comprehend the Provide information on sign & advices given.
having diarrhoea. nature and extend of problem symptoms and compare with sign Could implement the care
Objective data and will be able to: and symptoms with present in child. as planned.
On physical examination Interpret signs & symptoms of Discuss modes of transmission of
& observation, it was diarrhoea disease and identify the contracting
found : Explain the mode of spread of cause/ mode in the child.
Lethargic disease Provide information on ORS therapy.
Irritable Appreciate the importance of # Take one litre of clean drinking
Mild dehydration ORS therapy water and boil it. Allow it cool.
Avail medical services from the # add 1 ORS packet & stir it well till it
concerned health agency dissolves
# Give a teaspoonful every 1-2 min.
and if child vomits wait for 10
minutes then give solution more
slowly.
# The solution should be used within
24 hours.
# also give home available fluids such
as dal water, rice water sikanji,
buttermilk, mashed ripe banana and
continue breast feeding
If condition persists, avail medical
services from health agency.
On observation, Anurag Potential for health Goal: Education of mother on home The family understands
tries to climb upstairs hazards or injury After nursing intervention, the accident understand the extent of about the home accidents
related to home mother will be able to problem and its prevention.
accidents understand the extent of home Provide information about the causes
accident as a problem: of home accident
Enumerate the causes of home Discuss measures prevent home
accidents accident:
Explain the preventive aspects Keep constant watch on child and
of home accident keep medicines, solutions out of
reach
Advise to keep the sharp objects
away from reach of child.
Ask to fix a wooden piece over the
staircase so that he will not climb
upstairs.
Always see child is away from animals
Subjective Data Altered Goal: 1. Education of client on fever, cold & They appreciated the
Mrs. Shiv Kumari is thermoregulation After nursing intervention , cough as problem. advices given.
having fever related to infection temperature will be reduce Provide information regarding the
Objective Data and will comprehend the care during illness
On touch, feverish nature and extend of problem Take rest
Temperature- 100of Interpret the sign & symptoms Advice to take plenty of fluids and
Pulse - 88/min Appreciate the importance of liquid diet.
Respiration - 22/min proper treatment Encouraged to take high calorie and
Avail medical services from the small frequent diet.
concerned agency Do cold sponging
Follow treatment as prescribed Provide information on medical
examination & diagnosis, medical
facilities
Discuss the importance and
continuous treatment
Help to avail medical services from
concerned health agency.
There is no proper Poor environmental Goal: Education of family on nature and Family accepted the advice
disposal of animal sanitation related to After nursing intervention they extent of problem. and decided to follow it
excreta improper disposal will understood the nature and Provide information on proper
of waste extend of problem and will be disposal of waste
able to: Proper disposal of animal excreta by
Enumerate about the proper compositing, burial or by manure
disposal of animal excreta. pits.
Explain the mode of diseases Proper cleaning of stable
spread by unhygienic condition Do not allow the water to stagnate
Appreciate the good over the place.
environment sanitation Provide knowledge about the
communicable disease such as
malaria & its preventive measures to
prevent it
She verbalized that she Knowledge deficit After nursing intervention, she Education of family on methods of They appreciated the
has not adopted any related to small will understood the importance family planning & importance of advices given & decided to
family planning family norm of small family norm small family norm. accept to follow it.
Recognize the advantages of Provide information about the
small family norm advantages of small family to mother,
father & child
Mother can maintain good health,
have less strain & worry due to
limited no. of children.
Children have conducive
environment for proper physical,
psychological growth & development.
Father can provide children better
education, comfort, food, clothing &
education.

She reported that his Knowledge deficit After nursing intervention, she Education on weaning helps her to They gained sufficient
son is not eating enough related to weaning will understand the weaning. provide the supplementary foods. knowledge and could
foods Provide knowledge regarding Give dal water, rice water& vegetable implement the advice
weaning soup within available resources.
Appreciate the importance of Advised to give tomato soup. Palak
weaning foods. dal, mango pulp or papaya pulp
Give khichdi, rice gruel.
Give cooked mashed potato, mashed
apple, banana & vegetables
Give soft cooked rice, boiled
vegetables, boiled egg(first start with
yolk, tolerates then give white of an
egg)
Offer one new food at a time interval
of over one week & start with small
quantity before breast feed & when
child tolerates, quantity should be
increased.
HEALTH EDUCATION:
As concerning the needs of family, the health education was imparted:
DIARRHOEA:
Wife was advised to:
To ensure safe drinking water
Maintain sanitation & hygienic conditions
Protecting food from contaminated flies.
Ensure hand washing while preparing and eating food.
Improving weaning practices by using nutritious & locally available foods will reduces the diarrhoeal
incidence.
To prevent dehydration, oral rehydration solution should be given.
Home made solution such as dal water, carrot juice, tender coconut water, kanji, fruit juice & banana can
be given but under strict hygienic conditions.
Breast feeding should be encouraged during diarrhoea.
Normal food intake should be promoted as soon as child is able to eat.
Low roughage food with small frequent meals can be encouraged

MALARIA:
Wife was advised to:
Malaria prevalence can be reduced by proper antimosquito and antilarval measures.
Mosquito breeding places can be removed by filling the pits and avoid stagnation of water
The antilarval measures e.g., putting kerosene oil on the collection of stagnated water.
Personal protection against mosquito bite by use of repellants, protective clothes, bed mosquito nets,
mosquito coils etc.
Household methods such as application of mustard oil and fumes of burning neem leaves also help in
control of mosquitoes.
Old types can store under a roof or cover to prevent collection of rain water.
The spraying of indoor surface of homes with residual insecticides is still most effective measure to kill
the adult mosquito.

BALANCED DIET:
A balanced diet is a diet that includes all the nutrients in adequate and appropriate amount.
All growing children should be given adequate diet for growth and development
Advised to take more green leafy vegetables in diet.
Take regular diet within resources.
Salts to be used in moderation
VISIT REPORTS

FIRST VISIT: at 9.00 am


Today, I along with my other classmates went to rural community utai, with our teacher to locate the
house where we will provide comprehensive care. Selection of house is made and met Mrs. Jyoti
daughter-in-law, had formal talk with introduction. I asked them about their daily routine so that I can
interact with her freely.

SECOND VISIT: at 9.00 am


Visited the family, obtained the information from Mrs. Jyoti and gave her information regarding
diarrhoea and its dietary management.

THIRD VISIT: at 9.00 am


While conversation I came to know about that his son tushar is not eating enough food. So I advised
her about the weaning and its principles which is to be followed.
FOURTH VISIT: at 9.00 am
I found that there is chance of fall from staircase as tushar is climbing up, so advised about the home
accidents and its prevention.

FIFTH VISIT: at 9.00 am


I found that that she had not adopted family planning methods so gave knowledge regarding about
importance of family planning methods.

SIXTH VISIT: at 9.00 am


I met the family members and summarized all advises and care given to them and gave assurance that
they will follow the advice & practice.

SUMMARY:
I selected a home in Banjari Para Uttai, rural community to provide comprehensive care to family. On
first day of visits, I introduced and established positive interpersonal relations with family members. On
subsequent visits, I had identified some health matters such as diarrhoea, home accidents, proper
disposal of waste, weaning and gave need based care regarding all the problems of family. Finally, family
members gained knowledge & appreciated for help in future.