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  1. 1. DEFINITION OF HEALTH “ Health is a complete state of physical , mental, social and spiritual well being and not merely as an absence of a disease or infirmity”
  2. 2. CONCEPT OF HEALTH • Health is evolved over the centuries as a concept from individual concern to world wide social goal and encompasses the whole quality of life. Changing concept of health till now are: – Biomedical concept – Ecological concept – Psychosocial concept – Holistic concept 2
  4. 4. BIOMEDICAL CONCEPT 5 • Traditionally, health has been viewed as an “absence of disease”, and if one was free from disease, then the person was considered healthy. • This concept has the basis in the “germ theory of disease”. • The medical profession viewed the human body as a machine, disease consequenceof the breakdown as a of th e machine and one of the doctor’s task as repair of the machine.
  5. 5. ECOLOGICAL CONCEPT 6 • Form ecological point of view; health i s viewed as a dynamic equilibrium betwee n human being and environment, and disease a maladjustment of the human organism to environment. • According to Dubos “Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function.” • The ecological concept raises two issues, viz. imperfect man and imperfect
  6. 6. PSYCHOSOCIAL CONCEPT • According to psychosocial concept “health is not only biomedical phenomenon, but is influenced by social, psychological, cultural, economic and political factors of the people concerned.” 7
  7. 7. HOLISTIC CONCEPT 8 • This concept is the synthesis of all the above concepts. • It recognizes the strength of social, economic, political and environmental influences on health. • It described health as a unified or multi dimensional process involving the wellbeing of whole person in context of his environment .
  8. 8. DIMENSIONS OF HEALTH 9 • Health is multidimensional. • World Health Organization explained health in three dimensional perspectives: physical, mental, social and spiritual. • Besides these many more may be cited, e.g. emotional, vocational, political, philosophical, cultural, socioeconomic, environmental, educational, nutritional,
  9. 9. PHYSICAL DIMENSION • Physical dimension views health form physiological perspective. • It conceptualizes health that as biologically a state in which each and every organ even a cell is functioning at their optimum capacity and in perfect harmony with the rest of body. • Physical health can be assessed at community level by the measurement of morbidity and mortality 9
  10. 10. MENTAL DIMENSION • Ability to think clearly and coherently. This deals with sound socialization in communities. • Mental health is a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, coexistence between the relatives of the self and that of other people and that of the environment. • Mental health is not merely an absence of mental illness. 11
  11. 11. Features of mentally healthy person • Free from internal conflicts. • Well – adjusted in the external environment. • Searchesfor one’sidentity. • Strong sense of self-esteem. • Knows himself: his mind, problems and goal. • Have good self-controls-balances. • Faces problems and tries to solve 12
  12. 12. SOCIAL DIMENSION • It refers the ability to make and maintain relationships with other people or communities. • It states that harmony and integration within and between each individuals and other members of the society. • Social dimension of health includes the level of social skills one possesses, social functioning and the ability to see oneself as a 13
  13. 13. SPIRITUAL DIMENSION 14 • Spiritual health is connected with religious beliefs and practices. It also deals with personal creeds, principles of behavior and ways of achieving peace of mind and being at peace with oneself. • Itis intangible “something” that transcends physiology and psychology. • It includes integrity, principle and ethics, the purpose of life, commitment to some higher being, belief in the concepts that are not subject to “state of art” explanation.
  14. 14. WELLNESS Wellness is a state of well-being. Basic aspects of wellness include self-responsibility; an ultimate goal; a dynamic, growing process; daily decision making in the areas of nutrition, stress management, physical fitness, preventive health care, and emotional health; and, most importantly, the whole being of the individual. Anspaugh, Hamrick, and Rosato (2011) propose seven components of wellness To realize optimal health and wellness, people must deal with the factors within each component:
  15. 15. WELL BEING “Well-being is a subjective perception of vitality and feeling well . . .can be described objectively, experienced, and measured . . . and can be plotted on a continuum” It is a component of health.
  16. 16. CONCEPT OF WELLBEING • Wellbeing of an individual or group of individuals have several components and has been expressed in various ways, such as ‘standard of living’ or ‘level of living’ and ‘quality of live’. 17
  17. 17. STANDARD OF LIVING • Income and occupation, standards of housing, sanitation and nutrition, the level of educationa l, provision recreation al of health , and other services all be used individually as measures of socioeconomic status, and collectively as an index of the standard of living. 18
  18. 18. LEVEL OF LIVING 19 • It consists of nine components : health, food consumption, education, occupation and working conditions, housing, social security, clothing, recreation and leisure human rights. • These objective characteristics are believed to influence human wellbeing. It is considered that health is the most important component of the level of living because its impairment always means impairment of the level of living.
  19. 19. MODELS OF HEALTH AND WELLNESS Because health is such a complex concept, various researchers have developed models or paradigms to explain health and in some instances its relationship to illness or injury. Models can be helpful in assisting health professionals to meet the health and wellness needs of individuals. Models of health include the clinical model, the role performance model, the adaptive model, the eudaimonistic model, the agent–host–environment model, and health–illness continua.
  20. 20. Clinical Model The narrowest interpretation of health occurs in the clinical model. People are viewed as physiological systems with related functions, and health is identified by the absence of signs and symptoms of disease or injury. It is considered the state of not being “sick.” In this model, the opposite of health is disease or injury. Many medical practitioners have used the clinical model in their focus on the relief of signs and symptoms of disease and elimination of malfunction and pain. When these signs and symptoms are no longer present, the medical practitioner considers the individual’s health restored.
  21. 21. Role Performance Model Health is defined in terms of an individual’s ability to fulfill societal roles, that is, to perform his or her work. People usually fulfill several roles (e.g., mother, daughter, friend), and certain individuals may consider nonwork roles the most important ones in their lives. According to this model, people who can fulfill their roles are healthy even if they have clinical illness. For example, a man who works all day at his job as expected is healthy even though he is partially deaf. It is assumed in this model that sickness is the inability to perform one’s work role.
  22. 22. Adaptive Model In the adaptive model, health is a creative process; disease is a failure in adaptation, or maladaptation. The aim of treatment is to restore the ability of the person to adapt, that is, to cope. According to this model, extreme good health is flexible adaptation to the environment and interaction with the environment to maximum advantage. The famous Roy adaptation model of nursing (Roy, 2009) views the person as an adaptive system The focus of this model is stability, although there is also an element of growth and change.
  23. 23. Eudaimonistic Model The eudaimonistic model incorporates a comprehensive view of health. Health is seen as a condition of actualization or realization of a person’s potential. Actualization is the apex of the fully developed personality, described by Abraham Maslow .In this model the highest aspiration of people is fulfillment and complete development, which is actualization. Illness, in this model, is a condition that prevents self-actualization. Pender, Murdaugh, and Parsons (2011) include stabilizing and actualizing tendencies in their definition of health: “the realization of human potential through goal-directed behavior, competent selfcare, and satisfying relationships with others while adapting to maintain structural integrity and harmony with the social and physical environments”
  24. 24. Another model of this type is that of Margaret Newman (2008) who states that health is the expansion of consciousness. The basic assumptions of this model or theory are: Health is an evolving unitary pattern of the whole, including patterns of disease. Consciousness is the informational capacity of the whole and is revealed in the evolving pattern. Pattern identifies the human–environmental process and is characterized by meaning.
  25. 25. Agent–Host–Environment Model The agent–host–environment model of health and illness, also called the ecologic model, originated in the community health work of Leavell and Clark (1965) and has been expanded into a general theory of the multiple causes of disease. The model is used primarily in predicting illness rather than in promoting wellness, although identification of risk factors that result from the interactions of agent, host, and environment are helpful in promoting and maintaining health. The model has three dynamic interactive elements
  26. 26. Agent–Host–Environment Model
  27. 27. 1. Agent: Any environmental factor or stressor (biologic, chemical, mechanical, physical, or psychosocial) that by its presence or absence (e.g., lack of essential nutrients) can lead to illness or disease 2. Host: Person(s) who may or may not be at risk of acquiring a disease. Family 3. Environment: All factors external to the host that may or may not predispose the person to the development of disease. Physical environment includes climate, living conditions, sound (noise) levels, and economic level. Social environment includes interactions with others and life events, such as the death of a spouse.
  28. 28. Because each of the agent–host–environment factors constantly interacts with the others, health is an ever-changing state. When the variables are in balance, health is maintained; when the variables are not in balance, disease occurs.
  29. 29. Health–Illness Continua Health–illness continua (grids or graduated scales) can be used to measure a person’s perceived level of wellness. Health and illness or disease can be viewed as the opposite ends of a health continuum. From a high level of health a person’s condition can move through good health, normal health, poor health, and extremely poor health, eventually to death. People move back and forth within this continuum day by day. There is no distinct boundary across which people move from health to illness or from illness back to health. How people perceive themselves and how others see them in terms of health and illness will also affect their placement on the continuum. The ranges in which people can be thought of as healthy or ill are considerable.
  30. 30. DUNN’S HIGH-LEVEL WELLNESS GRID Dunn (1959) described a health grid in which a health axis and an environmental axis intersect. The grid demonstrates the interaction of the environment with the illness–wellness continuum. The health axis extends from peak wellness to death, and the environmental axis extends from very favorable to very unfavorable. The intersection of the two axes forms four quadrants of health and wellness
  31. 31. 1. High-level wellness in a favorable environment. An example is a person who implements healthy lifestyle behaviors and has the biopsychosocial, spiritual, and economic resources to support this lifestyle. 2. Emergent high-level wellness in an unfavorable environment. An example is a woman who has the knowledge to implement healthy lifestyle practices but does not implement adequate selfcare practices because of family responsibilities, job demands, or other factors. 3. Protected poor health in a favorable environment. An example is an ill person (e.g., one with multiple fractures or severe hypertension) whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction. 4. Poor health in an unfavorable environment. An example is a young child who is starving in a drought-stricken country
  32. 32. ILLNESS–WELLNESS CONTINUUM The illness–wellness continuum developed by Anspaugh, Hamrick, and Rosato (2011) ranges from optimal health to premature death. The model illustrates arrows pointing in opposite directions and joined at a neutral point. Movement to the right of the neutral point indicates increasing levels of health and wellness for an individual. This is achieved through health knowledge, disease prevention, health promotion, and positive attitude. In contrast, movement to the left of the neutral point indicates progressively decreasing levels of health. Some people believe that a health continuum is overly simplistic and linear when the real concepts are
  33. 33. John W. Travis is an American author and medical practitioner. He is a proponent of the alternative medicine concept of "wellness", originally proposed in 1961 by Halbert L. Dunn, and has written books on the subject. In the 1970s, Travis founded the first "wellness center" in California.He originated the Illness–Wellness Continuum
  34. 34. The Illness-Wellness Continuum is a graphical illustration of a wellbeing concept first proposed by Travis in 1972. It proposes that wellbeing includes mental and emotional health, as well as the presence or absence of illness Travis believed that a medical approach that relied on the presence or absence of symptoms of disease to demonstrate wellness was insufficient. As shown in the Continuum, the right side reflects degrees of wellness, while the left indicates degrees of illness.The model has been used to describe how, in the absence of physical disease, an individual can suffer from depression, anxiety or other conditions.
  35. 35. He contends that medicine typically treats injuries, disabilities, and symptoms, to bring the individual to a "neutral point" where there is no longer any visible illness. However, the Wellness Paradigm requires moving the state of wellbeing further along the continuum towards optimal emotional and mental states.The concept assumes that wellbeing is a dynamic rather than a static process. The Illness-Wellness Continuum proposes that individuals can move farther to the right, towards greater health and wellbeing, passing through the stages of awareness, education, and growth.Worsening states of health are reflected by signs, symptoms and disability.
  37. 37. HEALTH ILLNESS CONTINUUM • According to Newman (1990) "Health on a continuum is the degree of client wellness that exists at any point in time, ranging from an optimal wellness condition with available energy at its maximum to death, which represents total energy depletion.“ • According to Health-illness continuum model, 'Health is a dynamic state that continuously alters as a person adapts to changes in the internal and external environments to maintain a state of physical, emotional, intellectual, social, developmental and spiritual well-being. Illness is a process in which the functioning of a person is diminished or impaired in one or more dimensions when compared with the person's previous condition'.
  39. 39. HEALTH BELIEF MODELS Several theories or models of health beliefs and behaviors have been developed to help determine whether an individual is likely to participate in disease prevention and health promotion activities. These models can be useful tools in developing programs for helping people with healthier lifestyles and more positive attitudes toward preventive health measures .
  40. 40. Health Locus of Control Model Locus of control is a concept from social learning theory that nurses can use to determine whether clients are likely to take action regarding health, that is, whether clients believe that their health status is under their own or others’ control. People who believe that they have a major influence on their own health status—that health is largely self-determined—are called internals. People who exercise internal control are more likely than others to take the initiative on their own health care, be more knowledgeable about their health, make and keep appointments with primary care providers, maintain diets, and give up smoking. By contrast, people who believe their health is largely controlled by outside forces (e.g., chance or powerful others) are referred to as externals.
  41. 41. Rosenstock and Becker’s Health Belief Models Rosenstock and Becker’s health belief model (Rosenstock, Strecher, & Becker, 1988) is based on the assumption that health-related action depends on the simultaneous occurrence of three factors: (1) sufficient motivation to make health issues be viewed as important, (2) belief that one is vulnerable to a serious health problem or its consequences, and (3) belief that following a particular health recommendation would be beneficial. The model includes individual perceptions, modifying factors, and variables likely to affect initiating action
  42. 42. HEALTH CARE ADHERENCE Adherence is the extent to which an individual’s behavior (for example, taking medications, following diets, or making lifestyle changes) coincides with medical or health advice. Degree of adherence may range from disregarding every aspect of the recommendations to following the total therapeutic plan. There are many reasons why some people adhere and others do not. To enhance adherence, nurses need to ensure that the client is able to perform the activities, understands the necessary instructions, is a willing participant in establishing goals of therapy, and values the planned outcomes of behavior changes.
  43. 43. INDICATORS OF HEALTH 45 • A variable which helps to changes , directly or measur e indirectl y (WHO,1981). • The health indicators are defined as whic h those healt h variable s status measures the of an individual and community .
  44. 44. INDICATORS OF HEALTH • Morbidity Indicators: Incidence and prevalenc e rate, disease notification rate, • Mortality Indicators: Crude Death rate, Life Expectancy, Infant mortality rate, Child mortality rate, Under five mortality rate, Maternal mortality ratio, Disease specific mortality, proportional mortality rate etc. OPD attendance rate, Admission, readmission and discharge rate, duration of stay in hospital and spells of absence from work or 15
  45. 45. INDICATORS OF HEALTH 47 • Nutritional Status Indicators: Anthropometric measurement of preschool children, Prevalence of low birth weight etc. • Health Care Delivery Indicators: Doctor- population ratio, Bed-nurse ratio, Population- bed ration, Population per health facility etc. ANC coverage, % of Hospital • Utilization Rates: immunization coverage, Delivery, Contraceptives prevalence rate, Bed occupancy rate, average length of stay in hospital and bed turnover rate etc.
  46. 46. INDICATORS OF HEALTH 48 • Indicators of social and mental health: Rates of suicides, homicides, violence, crimes, RTAs, drug abuse, smoking and alcohol consumption etc. • Environmental indicators: proportion of population having access to safe drinking water and improved sanitation facility, level of air pollution, water pollution, noise pollution etc. • Socio Economic Indicators: rate of population increase, Per capita GNP, Dependency ratio, Level of unemployment, literacy rate, family size etc.
  47. 47. INDICATORS OF HEALTH 49 • Health policy Indicators: proportion of GNP spent on health services, proportion of GNP spent on health related activities including safe water supply, sanitation, housing, nutrition etc. and proportion of total health resources devoted to primary health care. • Indicators of Quality of Life: PQLI, IMR, Literacy rate, Life Expectancy at age one etc.
  48. 48. CONCEPT OF DISEASE • Ecological point of view disease is defined as “a maladjustment of the human organism to the environment.” • The simplest definition is that disease is just the opposite of health: i.e. any deviation from normal functioning or state of complete physical or mental well-being. 50
  49. 49. Distinction between Disease, Illness and Sickness • The term disease literally means “without ease” (uneasiness), when something is wrong with bodily function. • Illness refers to the presence of a specific disease, and also to the individual’s perceptions and behavior in response to the disease, as well as the impact of that disease on the psychosocial environment. • Sickness refers to a state of dysfunction. soci al
  50. 50. Distinction between Disease, Illness and Sickness • Disease is a physiological/psychological dysfunction. • Illness is a subjective state of the person who feels aware of not being well. • Sickness is a state of social dysfunction i.e. a role that the individual assumes when ill (sickness role). 24
  51. 51. Causes developing illness • hereditary problems or family history example diabetics mellitus hypertension cancer chromosomal problems • Environmental causes : air pollution noise pollution overcrowded area for sanitation • poor nutrition: malnutrition low weight vitamin deficiency anemia ,Poverty, obesity, smoking ,alcoholism, sedentary lifestyle, abusing drugs ,change in lifestyle: eating fast food items drinking beverages example Coca Cola Pepsi eating hot and spicy foods ,tobacco and narcotic use BD ,cigarette, Nut showing
  52. 52. Risk Factors for Illness or Injury A risk factor is something that increases a person’s chances for illness or injury. Like other components of health and illness, risk factors are often interrelated. Risk factors may be further defined as modifiable (able to be changed, such as quitting smoking) or nonmodifiable (unable to be changed, such as a family history of cancer). As the number of risk factors increases, so does the possibility of illness. For example, an overweight executive, under pressure to increase sales, smokes and drinks alcohol in excess. These factors, combined with a family history of heart disease, place this person at higher risk for illness. The six general types of risk
  53. 53. Classifications of Illness Illnesses are classified as either acute or chronic. A person may have an acute illness, a chronic illness, or both at the same time; for example, an adult with diabetes (a chronic illness) may also have appendicitis (an acute illness). Acute Illness and Illness Behaviors An acute illness usually has a rapid onset of symptoms and lasts only a relatively short time. Although some acute illnesses are life threatening, with self-treatment and use of over-the-counter medications simple acute illnesses, such as the common cold or diarrhea, do not usually require medical treatment. If medical care is required, a specific treatment with medications (e.g., antibiotics for pneumonia) or surgical procedures (e.g., an appendectomy for appendicitis) usually return the person to normal functioning. When a person becomes acutely ill, certain illness behaviors may occur in identifiable stages (Suchman, 1965).
  54. 54. ILLNESS BEHAVIOUR STAGE 1: EXPERIENCING SYMPTOMS How do people define themselves as “sick”? The first indication of an illness usually is recognizing one or more symptoms that are incompatible with one’s personal definition of health. Although pain is the most significant symptom indicating illness, other common symptoms include a rash, fever, bleeding, or a cough. If the symptoms last for a short time or are relieved by self-care, the person usually takes no further action. If the symptoms continue, however, the person enters the next stage.
  55. 55. STAGE 2: ASSUMING THE SICK ROLE The person now defines himself or herself as being sick, seeks validation of this experience from others, gives up normal activities, and assumes a “sick role.” At this stage, most people focus on their symptoms and bodily functions. Depending on individual health beliefs and practices, the person may choose to do nothing, may buy over-the- counter medications to relieve symptoms, or may seek out a healthcare provider for diagnosis and treatment. In our society, an illness becomes legitimate when a healthcare provider diagnoses it and prescribes treatment. When help from the healthcare provider is sought, the person becomes a patient and enters the next stage
  56. 56. STAGE 3: ASSUMING A DEPENDENT ROLE This stage is characterized by the patient’s decision to accept the diagnosis and follow the prescribed treatment plan. The person conforms to the opinions of others, often requires assistance in carrying out activities of daily living, and needs emotional support through acceptance, approval, physical closeness, and protection
  57. 57. STAGE 4: ACHIEVING RECOVERY AND REHABILITATION Recovery and rehabilitation might begin in the hospital and conclude at home, or may be totally concluded at a rehabilitation center or at home. Most patients complete this final stage of illness behavior at home. In this stage, the person gives up the dependent role and resumes normal activities and responsibilities. If the plan of care includes health education, the individual may return to health at a higher level of functioning and health than before the illness.
  58. 58. Chronic Illness Chronic illness is a broad term that encompasses many different physical and mental alterations in health, with one or more of the following characteristics: • It is a permanent change. • It causes, or is caused by, irreversible alterations in normal anatomy and physiology. • It requires special patient education for rehabilitation. • It requires a long period of care or support
  59. 59. Chronic illnesses usually have a slow onset and many have periods of remission (when the disease is present, but the person does not experience symptoms) and exacerbation (the symptoms of the disease reappear). Examples of common chronic illnesses are heart disease, diabetes mellitus, lung diseases, and arthritis.
  60. 60. Illness Behaviors When people become ill, they behave in certain ways that sociologists refer to as illness behavior. Illness behavior, a coping mechanism, involves ways individuals describe, monitor, and interpret their symptoms, take remedial actions, and use the health care system. How people behave when they are ill is highly individualized and affected by many variables, such as age, sex, occupation, socioeconomic status, religion, ethnic origin, psychological stability, personality, education, and modes of coping.
  61. 61. Parsons (1979) described four aspects of the sick role. Rights: 1. Clients are not held responsible for their condition. Even if the illness was partially caused by an individual’s behavior (e.g., lung cancer from smoking), the individual is not capable of reversing the condition on his or her own. 2. Clients are excused from certain social roles and tasks. For example, an ill parent would not be expected to prepare meals for the family.
  62. 62. Obligations: 3.Clients are obliged to try to get well as quickly as possible. The ill person should follow legitimate advice regarding a specialized diet or activity restrictions that could help with recovery. 4. Clients or their families are obliged to seek competent help. For example, the ill person should contact the primary care provider rather than relying solely on his or her own ideas of how to recove
  63. 63. Suchman (1979) described five stages of illness:  symptom experiences  assumption of the sick role  medical care contact  dependent client role  recovery or rehabilitation. Not all clients progress through each stage. For example, the client who experiences a sudden heart attack is taken to the emergency department and immediately enters stages 3 and 4, medical care contact and dependent client role. Other clients may progress through only the first two stages and then recover. Details of Suchman’s five stages follow
  64. 64. STAGE 1: SYMPTOM EXPERIENCES At this stage the person comes to believe something is wrong. Either someone significant mentions that the person looks unwell, or the person experiences some symptoms such as pain, rash, cough, fever, or bleeding. Stage 1 has three aspects: • The physical experience of symptoms • The cognitive aspect (the interpretation of the symptoms in terms that have some meaning to the person) • The emotional response (e.g., fear or anxiety).
  65. 65. During this stage, the unwell person usually consults others about the symptoms or feelings, validating with support people that the symptoms are real. At this stage the sick person may try home remedies. If self-management is ineffective, the individual enters the next stage.
  66. 66. STAGE 2: ASSUMPTION OF THE SICK ROLE The individual now accepts the sick role and seeks confirmation from family and friends. Often people continue with self-treatment and delay contact with health care professionals as long as possible. During this stage people may be excused from normal duties and role expectations . Emotional responses such as withdrawal, anxiety, fear, and depression are not uncommon depending on the severity of the illness, perceived degree of disability, and anticipated duration of the illness. When symptoms of illness persist or increase, the person is motivated to seek professional help
  67. 67. STAGE 3: MEDICAL CARE CONTACT Sick people seek the advice of a health professional either on their own initiative or at the urging of significant others. When people seek professional advice, they are really asking for three types of information: • Validation of real illness • Explanation of the symptoms in understandable terms • Reassurance that they will be all right or prediction of what the outcome will be.
  68. 68. The health professional may determine that the client does not have an illness or that an illness is present and may even be life threatening. The client may accept or deny the diagnosis. If the diagnosis is accepted, the client usually follows the prescribed treatment plan. If the diagnosis is not accepted, the client may seek the advice of other health care professionals or quasi-practitioners who will provide a diagnosis that fits the client’s perceptions.
  69. 69. STAGE 4: DEPENDENT CLIENT ROLE After accepting the illness and seeking treatment, the client becomes dependent on the professional for help. People vary greatly in the degree of ease with which they can give up their independence, particularly in relation to life and death. Role obligations—such as those of wage earner, parent, student, sports team member, or choir member— complicate the decision to give up independence.
  70. 70. Most people accept their dependence on the primary care provider, although they retain varying degrees of control over their own lives. For example, some people request precise information about their disease, their treatment, and the cost of treatment, and may delay the decision to accept treatment until they have all this information. Others prefer that the primary care provider proceed with treatment and do not request additional information. For some clients, illness may meet dependence needs that have never been met and thus provide satisfaction. Other people have minimal dependence needs and do everything possible to return to independent functioning. A few may even try to maintain independence to the detriment of their recover
  71. 71. STAGE 5: RECOVERY OR REHABILITATION During this stage the client is expected to relinquish the dependent role and resume former roles and responsibilities. For people with acute illness, the time as an ill person is generally short and recovery is usually rapid. Thus most find it relatively easy to return to their former lifestyles. People who have long-term illnesses and must adjust their lifestyles may find recovery more difficult. For clients with a permanent disability, this final stage may require therapy to learn how to make major adjustments in functioning
  72. 72. Effects of Illness Illness brings about changes in both the involved individual and in the family. The changes vary depending on the nature, severity, and duration of the illness, attitudes associated with the illness by the client and others, the financial demands, the lifestyle changes incurred, adjustments to usual roles, and so on
  73. 73. IMPACT ON THE CLIENT Ill clients may experience behavioral and emotional changes, changes in self-concept and body image, and lifestyle changes. Behavioral and emotional changes associated with short-term illness are generally mild and short lived. The individual, for example, may become irritable and lack the energy or desire to interact in the usual fashion with family members or friends. More acute responses are likely with severe, life-threatening, chronic, or disabling illness. Anxiety, fear, anger, withdrawal, denial, a sense of hopelessness, and feelings of powerlessness are all common responses to severe or disabling illness.
  74. 74. Nurses can help clients adjust their lifestyles by these means: • Provide explanations about necessary adjustments. • Make arrangements wherever possible to accommodate the client’s lifestyle. • Encourage other health professionals to become aware of the person’s lifestyle practices and to support healthy aspects of that lifestyle. • Reinforce desirable changes in practices with a view to making them a permanent part of the client’s lifestyle
  75. 75. IMPACT ON THE FAMILY A person’s illness affects not only the person who is ill but also the family or significant others. The kind of effect and its extent depend chiefly on three factors: (1) the member of the family who is ill, (2) the seriousness and length of the illness, and (3) the cultural and social customs the family follows.
  76. 76. The changes that can occur in the family include the following: • Role changes • Task reassignments and increased demands on time • Increased stress due to anxiety about the outcome of the illness for the client and conflict about unaccustomed responsibilities • Financial problems • Loneliness as a result of separation and pending loss • Change in social customs
  77. 77. BODY DEFENCE: IMMUNITY The Body Defence Against Infection  The first line of defense against infection to the body is the normal flora/non specific defense, which helps to keep harmful bacteria from invading the body.  Eg. Mechanical and Chemical Barriers:- It involves the skin and mucous membrane. In these membranes, there are densely packed cells that protect the internal environment from the invasion by foreign cells. Substances such as sebum, mucus, HCI in gastric mucosa act as non-specific defences.
  78. 78. BODY DEFENCE: IMMUNITY The Immune Response Involves nonspecific reactions in the body as it responds to an invading foreign protein such as bacteria, and in some cases, the body’s own bacteria.  A complex mechanism that swing into action as the body attempts to protect and defend its self. Antigen – the foreign body and the body responds to the antigen by producing an antibody.
  79. 79. BODY DEFENCE: IMMUNITY The inflammatory response The inflammatory response is a protective mechanism that eliminates the invading pathogen and allow tissue to repair by neutralising, controlling or eliminating the harmful agent and prepares the site for repair.
  80. 80. BODY DEFENCE: IMMUNITY Types of Immunity 1. Innate immunity : the natural defence against infectious agent. 2. Active immunity : Acquired naturally after exposure to infection or it could be artificially acquired immunity resulting from administration of vaccine. 3. Passive immunity : naturally transferred from mother to fetus orcould be by the artificial transfer of antibodies by parenteral administration.
  81. 81. BODY DEFENCE: IMMUNIZATION • Immunization is the process by which an individual immune system becomes fortified against an agent. • When the system is exposed to molecules that are foreign to the body, an immune response is set off, and the body develops the ability to quickly respond to a subsequent encounter because of immunological immunity that has been acquired. • T cells, B cells and antibodies are improved by immunisation.
  82. 82. • Vaccination • Introduction of Foreign molecules in to the body • Body generate imm. Activ e • Presynthesised elements of immune system • Antibodies Passiv e
  83. 83. IMMUNIZATIO N • BCG (TB) – At Birth • OPV - At Birth, 6 wks, 10 wks, 14 wks till 5 years • HBV – At birth, 6 wks, 10 wks, 14 wks • Pentovalent - 6 wks, 10 wks, 14 wks • Measles – 9 months • MMR – 15 months • Typhoid vaccine – 2 yrs. • TT – 10+ 15 Yrs.
  84. 84. Spectrum of Health: • -Positive Health, Better Health • -Unrecognized sickness, • -Mild sickness, • -Severe sickness, • -Death. • The spectrum indicates that health of a person is not a static condition, there arc always continuous changes that come in the health status and it is not possible to attain health once and for all.
  85. 85. • The literature supports the view that health and its attainment is a central concept and a goal of nursing practice. 1. A nurse can determine a client's level of health at any point on health illness continuum. A client's risk factors (variables) are important in identifying level of health. Risk factors include genetic and physiological variables. 2 As a person progresses through the developmental stages, certain risk factors are common than others, e.g. Body image changes and self-concept. 3. To help clients set goals to reach an optimal level of health, the nurse helps them identify their
  86. 86. d. 4 c. all of above d. none 1.How many concepts of health? a. 1 b. 2 c.3 2.What is bio-medical concept? a. germ theory b. environment of above 3.What are ecological concepts? a. environment b. air c. water d. all 4.What is psychological concept? a. germ theory b. environment c. psychology d. all c. diseases d. none 5.What is holistic concept? a. all of concept b. environment of above
  87. 87. Answer keys:- 1. (D) 2. (a) 3. (a) 4. (c) 5. (a)
  88. 88. 1. Howmany dimension are there? c. 5 d. 3 a. 1 b. 4 2. What is physical dimension? a. physical well-being c. air b. environment d. none of above c. air d. all of 3. What is mental dimension? a. healthy b. mental condition above 4. What is vocational dimension? a. related to air c. related to water b. related to job d. none of above 5. Other dimension include? a. cultural dimension c. socio-economic dimension b. educational dimension d. all of above
  89. 89. •Answer keys:- 1. (d) 2. (a) 3. (b) 4. (a) 5. (d)
  90. 90. LEVELS OF PREVENTI ON 94 Primordial Prevention : • Prevention from Risk Factors. • Prevention of emergence or development of Risk Factors. • Discouraging harmful life styles. • Encouraging or promoting healthy eating habits.
  91. 91. LEVELS OF PREVENTI ON 95 Primary Prevention: • Pre-pathogenesis Phase of a disease. • Action taken prior to the onset of the disease: • Immunization & Chemo-prophylaxis
  92. 92. LEVELS OF PREVENTI ON 96 Secondary Prevention: • Halt the progress of a disease at its incipient phase. • Early diagnosis & Adequate medical treatment. Tertiary Prevention: • Intervention in the late Pathogenesis Phase. • Reduce impairments, minimize disabilities & suffering.
  93. 93. MODES OF INTERVENTION 97 • Intervention is any attempt to intervene or interrupt the usual sequence in the development of disease. Five modes of intervention corresponding to the natural history of any disease are: –Health Promotion –Specific Protection –Early Diagnosis and Adquate Treatment –Disability Limitation –Rehabilitation
  94. 94. HEALTH PROMOTION 98 • It is the process of enabling people to increase control over diseases, and to improve their health. It is not directed against any particular disease but is intended to strengthen the host through a variety of approaches(interventions): –Health Education –Environmental Modifications –Nutritional Interventions –Lifestyle and Behavioral Change
  95. 95. SPECIFIC PROTECTION 99 • Some of the currently available interventions aimed at specific protection are: – Immunization – Use of specific Nutrients – Chemoprophylaxis – Protection against Occupational Hazards – Avoidance of Allergens – Control of specific hazards in general environment – Control of Consumer Product Quality & Safety
  96. 96. EARLY DIAGNOSIS & TREATMENT 10 0 • Though not aseffective and economical as‘Primary Prevention’, early detection and treatment are the main interventions of disease control, besides being critically important in reducing the high morbidity and mortality in certain diseases like hypertension, cancer cervix, and breast cancer. • The earlier the disease is diagnosed and treated the better it is from the point of view of prognosis and preventing the occurrence of further cases (secondary cases) or any long term disability.
  97. 97. DISABILITY LIMITATIONS 10 1 • The Objective is to prevent or halt the transition of the disease process from impairment to handicap. Sequence of events leading to disability & handicap: • Disease→Impairment →Disability→ Handicap
  98. 98. DISABILITY LIMITATIONS 10 2 • Impairment: Loss or abnormality of psychological, physiological/anatomical structure or function. • Disability: Any restriction or lack of ability to perform an activity in a manner considered normal for one’s age,sex,etc. • Handicap: Any disadvantage that prevents one from fulfilling his role considered normal.
  99. 99. REHABILITATI ON 10 3 • Rehabilitation has been defined as the ‘combined and coordinated useof medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functionalability” • Areas of concern in rehabilitation: – Medical Rehabilitation – Vocational Rehabilitation – Social Rehabilitation – Psychological Rehabilitation
  100. 100. CONCEPT OF CONTROL 10 4 • DISEASE CONTROL: The term disease control refers ongoing operation aimed at reducing: – The incidence of disease. – The duration of disease and the consequently the risk of transmission. – The effect of infection including physical and psychological complication. – The financial burden to the community.
  101. 101. CONCEPT OF CONTROL 10 5 • In disease control, the disease agent is permitted to persist in the community at a level where it ceases to be a public health problem according to the tolerance of local community. For example Malaria control programme. Disease control activities focus on primary prevention
  102. 102. CONCEPT OF CONTROL 10 6 ELIMINATION: Reduction of case transmission to a predetermined very low level or interruption in transmission. E.g. measles, polio, leprosy from the large geographic region or area. ERADICATION: Termination of all transmission of infection by extermination of the infectious agent through surveillance and containment. “All or none phenomenon”. E.g.Smallpox
  103. 103. CONCEPT OF CONTROL 10 7 • MONITORING: Defined as“the performance and analysis of routine measurement aimed at detecting changes in the environment or health status of population.” e.g. growth monitoringof child, Monitoring of air pollution, monitoring of water quality etc. • SURVEILLANCE: Defined as“the continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health.” E.g.Poliomyelitis surveillance programme of WHO.
  104. 104. HEALTH CARE TEAM :- • Definition:- The health team consists of a group of people who coordinate their particular skills in order to assist a patient or his family. The personnel, who comprise a particular team, will depend upon the needs of the patient. • The personnel commonly included In the health team are:
  105. 105. • 1. The Physician: - In hospital setting, the physician is responsible for the medical diagnosis and for determining the therapy required by a person who is ill or injured. A physician is a person who is legally authorized to practice medicine in particular jurisdiction. • 2. The Nurse: - A number of nursing personnel may be involved in health team and may have their own nursing team. A 'nursing team' composed of personnel who provide nursing services to a patient or his family. The team leader 'head nurse' is responsible for delegation of duties to members of her team and care given to the patients.
  106. 106. • 3. The Dietitian or Nutritionist: - When dietary and nutritional services are required, dietitian or' nutritionist may also be a member of health team. Dietitians design special duties and they supervise the preparation of meals according to doctor's prescription. The nutritionist in a community setting recommends healthy diets for people and is frequently involved in broad advisory services in regard to purchase and preparation of food. • 4. The Physiotherapist:-The physiotherapist provides assistance to a patient who has problem related to his musculoskeletal system.
  107. 107. Functions of Physiotherapist are:
  108. 108. 5. The Social Worker:- • The patient and his/her family are assisted by social worker with such problems as finances, rest home accommodation, counseling or marital problems, adoption of children. 6. The Occupational therapist:- • The occupational therapist assists patients with some impairment of function to gain skills as they are related to Activities of Daily Living (ADL) and help with a skill that is therapeutic. • It provides some satisfaction ego Teaching a man who has severe arroyos, in his arms and hands how to adjust kitchen utensils so that he can continue to cook.
  109. 109. 7. The Paramedical Technologist; -It includes laboratory technologists, radiologic technologists. • • Laboratory technologists:-Examine and study specimens such as urine, faeces, blood and discharges from wound. • • Radiologic technologist:-Assists with wide variety of x-ray procedures, from simple chest radiograph to more complex fluoroscopy. Through use of radioactive materials, nuclear medicine technologist can provide diagnostic information about functioning of a patient's liver etc. 8. The Pharmacist:-The pharmacist prepares and dispenses pharmaceuticals in hospital and community settings. The role of pharmacist in monitoring and evaluating the actions and effects of medications on patients is becoming increasingly
  110. 110. • 9. The Inhalation Therapist: - The inhalation therapist or respiratory technologist is skilled in therapeutic measures used in care of patients with respiratory problems. These therapists are knowledgeable about oxygen therapy devices, intermittent positive pressure breathing respirators, artificial mechanical ventilators, accessory devices used for inhalation therapy.
  111. 111. India is a union of 28 states and 7 union territories. States are largely independent in matters relating to the delivery of health care to the people. Each state has developed its own system of health care delivery, independent of the Central Government.
  112. 112. • The Central Government responsibility consists mainly • of policy making , planning , guiding, assisting, evaluating and • coordinating the work of the State Health Ministries.
  113. 113. The health system in India has 3 main links Central • 1. Ministry of Health and Family Welfare • 2. The Directorat e General of Health Services • 3. The Central Council of Health and Family State Local • 1.Sub –division • 2. Tehsils(Talukas ) • 3. Community Developmen t Blocks • 4. Municipalities and Corporations • 5. Villages and • 6. Panchayats
  115. 115. Panchayat Raj -The panchayat raj is a 3-tier structure of rural local self- government in India, linking the village to the district Ø Panchayat (at the village level) Ø Panchayat Samiti( at the block level) Ø Zila Parishad(at the district level)
  116. 116. PANCHAYAT (AT THE VILLAGE LEVEL): The Panchayat Raj at the village level consists of The Gram Sabha The Gram Panchayat
  117. 117. The Gram Sabha considers proposals for taxation,and elects members of The Gram Panchayat. The Gram Panchayat covers the civicl administration including sanitation and public health and work for the social and economic development of the village.
  118. 118. PANCHAYAT SAMITI (AT THE BLOCK LEVEL): Ø The Panchayat Samiti execute the community development programme in the block. The Block Development Officer and his staff give technical assistance and guidance in development work.
  119. 119. ZILA PARISHAD (AT THE DISTRICT LEVEL: Ø The Zila Parishad is the agency of rural local self government at the district level . Its functions and powers vary from state to state.
  120. 120. HEALTH CARE AGENCIES • The health care system is intended to deliver the health care services. It is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation. These are : 1) PUBLIC HEALTH SECTOR : • (a) Primary Health care Primary Health centers sub-centers
  121. 121. (b)Hospitals/Health centers community health centers Rural hospital District Hospitals Specialist Hospitals Teaching Hospital (c)Health Insurance Schemes Employees state Insurance Central Govt. Health Scheme (d)Other agencies Defense
  122. 122. 2) PRIVATE SECTOR (a) Private hospitals, polyclinics , Nursing homes ,and dispensaries (b) General practitioners and clinics 3) INDIGENOUS SYSTEMS OF MEDICINE Ayurveda and siddha Unani and Tibbi Homoeopathy Unregistered practitioners 4)VOLUNTARY HEALTH
  123. 123. PRIMARY HEALTH CARE • Definition: “Primary health care is essential health care based on practical, scientifically sound and socially acceptance method and technology made universally accessible to individual’s families in the community through their full participation and cost which the community and country can afford to maintain at every stage of their development.” - Alma ata declaration.
  124. 124. ELEMENTS OF PRIMARY HEALTH CARE 1. Education concerning prevailing health problems and the methods of preventing and controlling them. 2. Promotion of food supply and proper nutrition. 3. Maternal and child health care, including family planning. 4. Adequate safe water supply and basic sanitation. 5. Immunization against major infectious diseases. 6. Prevention and control of local endemic diseases.
  126. 126. • EQUITBLE DISTRIBUTION:- It means that health service must shared equally by all people irrespective of their ability to pay, and all the people rich or poor, rural or urban must have access to health services because the distribution of health & family welfare services, & also other related services, i.e. educative income.
  127. 127. COMMUNITY PARTICIPATIO N:-  It is the process by which individual, families & communities assume responsibilities in promoting their own health & welfare.  For the success of primary health care, community involvement & participation will be most vital. Community involvement concerned with the levels of community resident participation in health decision making.  To promote the development of the community & the community’s self reliance, resident themselves need to participate in decision about health of the community. Resident & health providers need to work together in partnership to seek solution to the complex problem facing community
  128. 128. APPROPRIATE HEALTH TECHNOLOGY:- • Appropriate technology refers to health care that is relevant to people’s needs & concerns as well as being acceptable to them. • It includes issues of costs & affordability of resources as the number & type of health professionals & other worker, equipment & their pattern of distribution throughout the community. • In other words “ appropriate technology means those which are decentralized, require low capital investment, conserve natural resources, are managed by their users, & are in harmony with the environment. • Thus appropriate technology is the technology which is scientifically or technically sound, adaptable to local needs, culturally acceptable & financially feasible.
  129. 129. MULTI SECTORIAL APPROACH:- • Health & family welfare programmes cannot stand on its own in an isolated manner. • it is recognized that health of a community cannot be improved by intervention within just health sector; other sectors are equally important in promoting the communities health & self reliance. • These are agriculture, irrigation, animal husbandry, housing, publi c co- operatives, works, industries , rura l an d education, developmen t, panchayats. • Therefore, these sectors need to work together in a multi sectorial approach to co-ordinate their goal, plans & activities to ensure conflicting or duplicating efforts.
  131. 131. • Population coverage of health centers HEALTH CENTERS Coverage of population living in plain area Coverage of population living in hilly/tribal area Sub centers 5000 3000 Primary health center 30000 20,000 Community health center 1,20,000 80,000
  132. 132. ROLE OF NURSE IN PHC Direct care provider Teacher & Educato r Superviso r & Manager Researche r Evaluator
  133. 133. HOSPIT AL According to WHO :- A hospital is an integral part of a social and medical organization, the function of which is to provide for the population, the complete health care, both curative and preventive and whose outpatient services reach out to the family and its home environment. The hospital is also a Centre for the training of health worker and for bio-social research.
  134. 134. Classification of Hospitals The most commonly accepted criteria for classification of modern hospital are according to:- • Length of stay of patient (Long term, Short term) • Clinical basis • Ownership/control basis • Objectives • Size • Management • System of medicine
  135. 135. • Classification according to length of stay of patient :- A patient stays for a short time in hospital for treatment of disease that is acute in nature, such as pneumonia, peptic ulcer etc. A patient may stay for a long term in a hospital for treatment of diseases that are chronic in nature such as TB, Leprosy, cancer etc. The hospitals according to long term and short term are also known as chronic care hospitals and acute care hospitals. • Classification according to Clinical Basis :- These are the licensed hospitals and are considered as general hospitals, treat all kinds of diseases, major focus on treating condition such
  136. 136. Classification according to ownership/ control • On the basis of ownership/Control, hospitals can be divided into four categories: • Public hospitals. • Voluntary hospitals. • Private!/charitable hospitals/ nursing houses, • Corporate hospitals,
  137. 137. CLASSIFICATION ACCORDING TO OBJECTIVES:- • TEACHING CUM REASEARCH HOSPITAL - It is a hospital to which a college is attached for medical/nursing/ dental/pharmacy education, the main objective of these hospitals is teaching based on research and the provision of health care is secondary. e.g.:- f IMS, PCIMER, Chandigarh. • GENERAL HOSPITAL ;-Are those which provide treatment for common diseases and conditions. The main objectives of these hospitals are to provide medical care to the people. e.g.:- All distinct and taluses or PHC or rural hospitals belong to this type. • SPCIALIZED HOSPITAL: are those that provide medical and nursing care primarily for only one discipline on a specific disease or condition of one system such as TB, ENT, Leprosy, STD's etc. • ISOLATION HOSPITAL:- are those hospitals in which the persons suffering from infectious/ communicable diseases require isolation. e.g.:- Epidemic disease hospital, Bangalore .
  138. 138. CLASSIFICATION ACCORDING TO SIZE 1. Teaching hospital - 500 (bed to be increased according to number of students). 2. District Hospital- 200 (bed to be increased upto 300 depending upon population). 3. Taluka Hospital - 50 (May be raised depending upon population to be served).
  139. 139. CLASSIFICATION ACCORDING TO MANAGEMENT • UNION GOVERNMENT/GOVERNMENT OF INDIA:- All hospitals administered by the government of India. e.g:- Hospitals run by Railways, military/ defense etc. • STATE GOVERNMENT: - Hospitals administered by state/ union territory including police, prison, irrigation department etc • LOCAL BODIES:- Hospitals are administered by local bodies i.e,muncipal corporation, zila prishad, panchayat etc. e.g:- co- operation maternity houses. • AUTONOMUS BODIES: - All hospitals established under special act of parliament or state legislation and founded by the central/ state government e.g. AIlMS, PCI etc. • PRIVATE:-All private hospitals are owned by an individual or by private Organization e.g.: MAHC Manipal, Hinduja Hospital. • Voluntary agency: - All hospitals are operated by a voluntary body/ a trust/charitable society etc. It includes hospitals run by missionary bodies and co-operations. e.g: CMC, Vellore
  140. 140. CLASSIFICATION ACCORDING TO SYSTEM • Allopathic hospitals, • Ayurveda hospitals • Homeopathic hospitals, • Unani hospitals, • Hospitals of other systems of medicine.
  141. 141. FUNCTIONS OF HOSPITAL • Care of sick and Injured:- Hospital is an medical institution where client suffering from some disease/health problem is getting treated and cared. Comprehensive care is provided to the sick/injured client by health care team. Clients are treated according to priority or needs. For example: Emergency care is provided to client with Heart attack than the client came with general weakness. • prevention of disease:-. Prevention of disease is accomplished by early screening, detection of risk prone cases. Maintaining aseptic technique, following the principles of medical care can prevent the occurrence of certain complications. For example: Immunization schedule for children, tetanus injection during pregnancy. • promotion of health:- A client who is maintaining his health can accomplish higher level of health. In hospital setting, various aspects of health promotion are taken. For example: Health education,
  142. 142. • Diagnosis and treatment of diseases:- As soon as client approaches the health care team, a complete assessment is done. Afterward medical diagnosis is made And treatment is started. • Scientific Application Of Mental Hygiene And Mental Therapy:-Mental health is an important aspect of a healthy person. Client suffering from stress, mental health 28 problems are getting treated if'. h0spitals. Counseling is also done in the hospital setting. • Rehabilitation: Rehabilitation is the process where an individual is reeducated, particularly where an individual has been ill/injured to enable them for becoming capable of useful activity. For example: Rehabilitation care is given to client who underwent for mastectomy,
  143. 143. • Medical Education: Hospital attached with medical colleges/nursing colleges are providing education to the students. They are taught how to care for a client. How to provide individualized medical care, how to tackle emergency cases. With this, they are gaining clinical skill as well as knowledge. • Research: incidence prevalence rate, mortality rate etc. are calculated from the hospital settings. Prevalence of disease is done by conducting research. Etc. in the hospital.