RNB30704

COMMUNITY HEALTH NURSING

INTRODUCTION TO
COMMUNITY HEALTH NURSING
 Learning Outcomes
At the end of this lesson, students should be able to:
• define community, health and community health;
• state the philosophy, concepts and principles of community health nursing;
• describe the roles of community health nurse;
• identify the activities of community health nursing;
• outline the historical development of health system and community health
nursing in Malaysia;
• state the categories of health care services in Malaysia and roles of world
health agency in health for all.

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 Introduction
• Nursing practice developed to accommodate the needs of changing
society.
• Community health nursing aims to improve population health
promotion, disease prevention and risk reduction.
• The community health nurses focus on few health delivery activities:
– Health Promotion
– Health Maintenance
– Health Prevention (primary, secondary & tertiary level)
– Health Balance

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 Definition of Community
• Traditionally, a community has been defined as a group of people
interacting and living in a common location.
• People or a group of individuals and families living together in a
defined geographical area, usually comprising a village, town or
city.
• Is a social group determined by geographical boundaries and/or
common values and interests, where its members know and
interact with each other. (WHO)

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 Definition of Health & Community Health
Health
• A state of complete physical, mental, and social well-being,
and not merely the absence of disease or infirmity (WHO).

Community Health
• Focuses on the maintenance, protection and the improvement
of population health and communities as opposed to health of
individual patients.

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 Community Health Nursing
• Publichealth nursing is a specialized field of registered nursing
that combines nursing and public health principles.
• In
Malaysia, the terms “public health nursing” and
“community health nursing” are used interchangeably

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 Community Health Nursing
• Community health nursing combines nursing science, arts and
public health practices, systematically using the nursing process
and other health models to promote health and prevent illnesses of
the population.
• Community health nursing focuses on the well-being of individual,
family, groups and community.
• Thepractice expands into the areas of disease prevention, health
enhancement, empowerment, advocacy, community development
and research.

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 PHILOSOPHIES, CONCEPTS &
PRINCIPLES OF
COMMUNITY HEALTH NURSING

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 Philosophy of Community Health Nursing
The community health nurses are responsible to improve health of the
community by upholding their professional philosophy, that states:
 It is essential to respect the dignity, freedom and right of every
individual, communities need to be empowered to attain their high
level of wellness.
 All individuals have potential to manage their own life and health
needs. Different cultures, norms and standards of living have made
individuals belief and perceive differently the concept and value of
health.

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 Philosophy of Community Health Nursing
 Right of the individual to obtain basic necessities in fulfilling their life
needs and to seek help when the need arises regardless of gender,
race and ethnicity.
 Realize that health and disease are part of the component in
human life cycle, having different levels of priority at different ages.
 Human being is dynamic and flexible, able to change and upgrade
knowledge and technology to meet contemporary health needs.
 Community health nurses are ever ready to assist community to
attain, maintain and promote their high level of wellness.
-Adopted from Clemen-Stone, McGuire & Eigsti, 2002 and B.T. Basavanthappa, 2008, cited by Yadav, Chan & See (2011)-

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 Concepts of Community Health Nursing
Community Health Nurse works within a primary health care setting.
There are a number of core concepts that are inherent and valued
within the practice of community health nursing:
 Promotion and understanding of health as a complete state of
physical, social and emotional well-being, and not merely the
absence of disease.
 Contribution to identifying and meeting the main health needs of
the community.
 Accessible, available and affordable services based on principles
of social justice and equity.

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 Concepts of Community Health Nursing
 Comprehensive service delivery and program.
 Content that includes treatment, early identification, and
intervention and health promotion.
 The participation and consultation of people and communities
about health issues and their own health care.
 Multi-disciplinary approaches in carrying out the cost effective
health care practices.
 Promoting health through working in collaboration with other
sectors in order to address the social and environmental factors
that inhibit health and well-being.
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 Concepts of Community Health Nursing
Public health is for:
• The sanitation of environment
• The control of communicable infections
• The education of the individual in personal hygiene
• The organization of medical and nursing services for the early
diagnosis and preventive treatment of disease
• The development of the social machinery to insure everyone a
standard of living adequate for the maintenance of health

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 Principles of Community Health Nursing
i. Health care program should be integral with national health system
and services, and involve the community to promote and maintain
their own related family health and well-being.
ii. Health care activities should be in line with community needs, their
priority, and resources available to implement them effectively.
iii. Health care program should focus on empowerment of families and
community, finding ways for them to acquire skills and knowledge
to participate in their family’s and own health care issues.

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 Principles of Community Health Nursing
iv. Health care activities should be a continuous integral approach;
encompassing preventive, promoting, curative and rehabilitative
measures.
v. Health care intervention should be undertaken by trained staffs
according to their skills and credibility, to ensure the public gains
the most benefit from it.
vi. Health care should be provided equally to those who are in need,
despite their gender, age, ethnicity and economic status.
-Adopted from Clemen-Stone, McGuire & Eigsti and B.T. Basavanthappa (2008), cited by Yadav, Chan & See (2011)-

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COMMUNITY HEALTH NURSE &
ACTIVITIES OF
COMMUNITY HEALTH NURSING
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 Characteristics of
Community Health Nursing Practice
• Health needs of an entire population
• Assessment of population using a comprehensive systematic
process
• Attention to broad determinant of health
• Emphasis on primary prevention
• Applying intervention at all levels (individuals, families, communities)

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 Community Health Nurse
• All
nurses who work outside institutional settings such as hospitals
(Lewenson, 2013).
• Specialty encompassed by the term “community health nurse”.
• A registerednurse who works in the community setting, whether or
not he/she is educationally prepared for public health nursing.
• A public
health nurse is a nurse with advanced education at a master
or doctoral level that is based on public health science (Levin et al.,
2007)

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Case finders
Coalition builders
Leaders

Researchers
Change agents

Community Advocacy
developers

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 Basic Components of
Community Health Nursing Practice
Health
promotion, Illness
primary health prevention
care

Community Community
participation development

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Activities of Community Health Nursing

Health
assessment
Family
planning Health
education

Home
nursing Activities of
Community disease
Community prevention
Health Nurse assessment

Community
rehabilitation
School health
services
Other health related
services
(with other agencies)

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 HISTORICAL BACKGROUND &
DEVELOPMENT OF
COMMUNITY HEALTH NURSING
IN MALAYSIA

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Historical Background and Development of
Community Health Nursing in Malaysia
• Malaysia was formerly a British colony, therefore many Malaysian
systems, including health care delivery systems are based on the
British system.
• The history of nursing in Malaysia began from about the year 1800
with the formation of the East India Company, when hospitals for
the sick were established in Penang and Singapore.
• Nursing orientation during pre-independence period in Malaya was
in the form of “on-the-job training”, e.g. training given by European
sisters, matrons, nuns and doctors.

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Historical Background and Development of
Community Health Nursing in Malaysia
Pre-independence
• Local nurses were recruited and trained oversea.
• Besides the oversea basic nursing program, many qualified nurses
were sent to various post-graduate courses in Great Britain,
Australia and New Zealand to enriched their knowledge and skills.
• Malaysia’snursing program kept expanding rapidly, with the help of
UNICEF and WHO which supplied qualified tutors to assist in
teaching nurses.

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 Historical Background and Development of
Community Health Nursing in Malaysia
Pre-independence
• In
1949, the first two local tutors entered the Royal College of
Nursing, England and became tutors two years later.
• In 1950, the Nurses Board Federation of Malaya came into force.
• The health services were not organized and services were poor.
• The British opened the first hospital in Taiping in 1878 because the
tin mining activities were at their peak in that area.

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 Historical Background and Development of
Community Health Nursing in Malaysia
Pre-independence
• In
1880, the Chinese settlers built a hospital in Kuala Lumpur for
their workers
• In 1883 -1910, general hospitals were opened in all the states.
• In 1900, the Institute of Medical research (IMR) was set up.

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First hospital in Taiping

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 Historical Background and Development of
Community Health Nursing in Malaysia

Post-independence
• Since 1957, more nurses returned from postgraduate studies
overseas; including public health programs, psychiatry nursing,
tuberculosis nursing, public health nursing and midwifery.
• In 1973, the Family Planning Service in Rural Health was
integrated with the National Rural Health Development Program.
• After independence, health care services became a federal
government responsibility.

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 Historical Background and Development of
Community Health Nursing in Malaysia
Post-independence
• After
1957, there was rapid growth of the medical services in the
country.
• The 3-tier system was introduced
– main health center (to serve a population of 50,000)
– healthsub-center (10,000)
– a midwife clinic-cum-quarters (2,000)

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 Historical Background and Development of
Community Health Nursing in Malaysia
Post-independence
• WHO then proposed a 2-tier system, converting the 3-tier to serve
the people better.
• The2-tier now means the health center serves a population of
15,000 - 20,000 and the community clinic serves a population of
2,000 - 4,000.
• The upgrading of the health sub-center to health center meant
better facilities for the health sub-centers and the midwife clinic-
cum-quarters is now upgraded to a community health.

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Historical Background and Development of
Community Health Nursing in Malaysia
The three tier a
system
• Serving 50,000 population

Main Health Centre a

a

a Health Sub-centre

Midwife clinics

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Historical Background and Development of
Community Health Nursing in Malaysia
• The two tier system
‒ Health
centre
‒ Community clinics

Health
center
• Serving15,000-
20,000 population

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Community Health Services
Development in Malaysia

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 Historical Background and Development of
Community Health Nursing in Malaysia
Post-independence
• The proposal to increase the number of health centers and
community clinics over the 5-year development plan has improved
the coverage of the health care.
• Thisalso improved the accessibility, availability and affordability of
health care to the rural area.
• To
meet the needs of the health centers more nursing schools,
medical assistant schools and health inspectors schools were
opened to serve the need of the people.
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 Historical Background and Development of
Community Health Nursing in Malaysia
Post-independence
• Theintroduction of the rural health infrastructure managed to
improve the health status of the people tremendously.
• The services in Sarawak and Sabah also followed the rural health
infrastructure.

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 Community Health Nursing in Malaysia
• Community Nursing activities began major milestones in 1951
‒ Maternal and child
health (MCH) services became an essential
component of National Rural Health Development programme
• Introduction
of legislation for the control of the practice of midwifery
and midwifery training in 1923.
• Extensivedevelopment of health infrastructure facilities was initiated
under the National Rural Health Development programme
‒ MCH remain major service
‒ 106 health centres and 447 community centres were set up in 1955
‒ Sabah and Sarawak were included

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 Community Health Nursing in Malaysia
• 1960-1970 more change and activities and training implemented
Training for rural health workers increased
Family Planning Acts established with National Family Planning
Board
School health services
National Health Institutes was set up
Training of traditional birth attendance (TBA) in 1967

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 Community Health Nursing in Malaysia
• More development and improvements for each Malaysia Plan up to
10th Malaysia Plan  11th Malaysia Plan (2015 – 2020)

• Comprehensive health coverage

• Universal access to affordable high quality health care

‒ Cover health promotion, health prevention, curative and
rehabilitative

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Categories of Health Care Services In Malaysia

Tertiary
health care

Secondary
health care

Primary
health care

Communities
health care
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Levels of Health Care Delivery in Malaysia
National

State

District

Health Center

Community Clinic

Mobile teams/ subsidiary clinics

Community
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 DISTRICT HEALTH SERVICES

Outpatient Family Health Disease Administration

Services Health Education Control &
Environmental
Health

Community Clinics
Clinical support services including Pharmacy, Lab, Imaging..

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 Medical Officer of Health

Administration Health Center Service

Human resources MCH: Nutrition

Environmental Health:
Financial Food & Water quality
management

Disease Control
Health management
information system
Support service
(Lab & Pharmacy)
Quality assurance

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Organisation chart of the district health office
 Public Health System in Malaysia
• Toachieve “Malaysia is to be nation of healthy individuals,
families and communities through a health care system that is
equitable, affordable, efficient, technologically appropriate,
environmentally adoptable and consumer friendly with
emphasize on quality, innovation, health promotion, and
respect for human dignity and which promotes individual
responsibility and community participation towards enhanced
quality of life” (MOH, 2004)

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Public Health System in Malaysia

The divisions of Department of Public Health under MOH

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FAMILY HEALTH DEVELOPMENT DIVISION
(FHDD)
• The heart of public health service are primary level parked under Public
Health Department

• FHDD services
‒ Maternal health
‒ Perinatal, neonatal and child health
‒ Adolescent health
‒ Women and men Health
‒ Elderly health
‒ Rehabilitation services

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 The Role of World Health Agencies
• World Health Organization (WHO)
‒ Social goals of WHO and its member states is to achieve “Health For all by
the year 2000”
 Today it is still relevant and has been extended based on the current needs
‒ The Declaration of Alma –Ata (Health for All)
‒ Nursing through ICN declared commitment to the goal through primary health
care
‒ Major initiatives are Safe Motherhood and Millennium Development Goal
(MDG)

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 Summary
• Public health is a scientific discipline that includes epidemiology, statistics and
assessments; which focus on behavioural, cultural and economic factors.
• A community health nurse is any registered nurse who works in the community
setting.
• British ruled the longest, thus, Malaysia inherited the British system of health
care delivery.
• Nurses practice in the pre-war era in Malaya was carried out by nurses without
structured training.
• A well-thought out initiative to improve health of the population was seen in the
policy set up by the First Malaysian Plan.

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 Summary
• The role of WHO are mainly on world policies for improvement of health of the
world population.
• The Malaysian health care system is largely government-led and funded by
public services, under Ministry of Health.
• The Department of Public Health (DPH) is one of the main department in MOH.
• The Family Health Development Division (FHDD) is the heart of the public
health service at the primary level.

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 Self Directed Learning Activity
• Search and read more on the following:
1. 11th Malaysia Plan (2016 – 2020) – focus on healthcare
2. The upcoming 12th Malaysia Plan (2021 – 20205)
3. Millennium Development Goals (MDG) in Malaysia from
http://www.un.org.my/0912010346%C2%BBMDGs_In_Malaysia.aspx
4. Sustainable Development Goals (WHO & Malaysia)
https://sustainabledevelopment.un.org/
https://sustainabledevelopment.un.org/sdgs
https://sustainabledevelopment.un.org/memberstates/malaysia
5. Integrating SDG in the Malaysia Plan
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