2. INTRODUCTION
Community health nurses face the challenge of continually assessing each population’s current health problems, as
well as determining available and needed services. Community health nursing interventions with maternal, infant,
toddler, and preschool, adults, women, elderly, physically and mentally challenged populations are focused on
health promotion and early intervention.
3. SPECIAL GROUPS
Special groups are the groups which would be vulnerable under any circumstances (e.g. where the adults are
unable to provide an adequate livelihood for the household for reasons of disability, illness, age or some other
characteristic), and groups whose resource endowment is inadequate to provide sufficient income from any
available source.
4. SPECIAL GROUPS INCLUDES
Children
Adolescents
Women
Elderly
Physically and mentally challenged
5. CHILDREN
A person between birth and full growth; a boy or girl.
Neonate
Under five age
6. GOVERNMENT INITIATIVES
PRIORITY INTERVENTIONS
Home-based newborn care and prompt referral.
Facility-based care of the sick newborn.
Integrated management of common childhood illnesses (diarrhea, pneumonia and malaria).
Child nutrition and essential micronutrients supplementation & ICDS.
Immunization.
Early detection and management of defects at birth, deficiencies, diseases and disability in children (0–18 years)
Other Schemes Include: – Balika Samriddhi Yojana (BSY)
Kishori Shakti Yojana (KSY)
Nutrition Programme for Adolescent Girls (NPAG)
Early Childhood Education for 3-6 Age Group Children Under the Programme of Universalization of Elementary
Scheme for welfare of Working Children in need of Care and
An Integrated Programme for Street children
7. Home-based newborn care and prompt referral.
Home-based newborn care scheme launched in 2011 provides immediate postnatal care and essential newborn
care to all newborns up to the age of 42 days.
ASHAs are trained and incentivized to provide special care to pre terms and newborns.
ASHA are also trained in identification of illnesses, appropriate care and referral through home visits
8. Facility-based care of the sick newborn.
Special Newborn Care Units (SNCU) have been established at District Hospitals and tertiary care hospitals.
The goal is to have one SNCU in each district of the country and in health facilities with more than 3,000
deliveries per year.
Newborn Stabilisation Unit (NBSU), which is a four- bedded unit providing basic level of sick newborn care, is
being established at Community Health Centres / First Referral Units.
Newborn Care Corners (NCC) at each delivery point
9. Integrated management of common childhood illnesses (diarrhea,
pneumonia and malaria).
Availability of ORS and Zinc.
Should be ensured at all sub-centres and with all frontline workers.
Timely and prompt referral of children with fast breathing and/or lower chest in- drawing should be made to
higher level of facilities.
Training of health service providers (doctors and nurses), especially those at FRUs and District Hospitals in F-
IMNCI
10. Child nutrition and essential micronutrients supplementation &
ICDS
Follow up of LBW baby by ASHA and ANM.
Bi-weekly iron and folic acid supplementation for preschool children of 6 months to 5 years as
part of the National Iron + initiative.
Administration of deworming tablets/syrup combined with Vitamin A supplementation during
biannual rounds.
11. Immunization
Second dose of measles has been introduced and Hepatitis B vaccine is now available in the entire country.
To strengthen routine immunization, newer initiatives include- provision for Auto Disable (AD) Syringes to ensure
injection safety.
Support for alternate vaccine delivery from PHC to sub-centres as well as outreach sessions.
Mobilization of children to immunization session sites by ASHA.
Coverage of vaccine beyond first year of life must be emphasised and monitored.
Investigation report of every serious ‘adverse event following immunisation’ (AEFI) case must be submitted
within 15 days of occurrence to district AEFI Committees.
12. Early detection and management of defects at birth, deficiencies,
diseases and disability in children (0–18 years)
Child Health Screening and Early Intervention Services (Rashtriya Bal Swasthya Karyakram)
This initiative aims to reach 27 crore children annually in the age group 0-18 years.
Child health screening and early interventions services will be provided by mobile health teams at block level.
These teams will include- at least 2 doctors (MBBS /AYUSH qualified)- 2 paramedics.
The health screening will be conducted to detect 4Ds: defects, deficiencies, diseases, development delays
including disabilities.
13. Balika Samriddhi Yojana (BSY)
It was introduced in 15th August 1997, under the policies for women and child development to facilitate the girl
child.
It is widely known as the key initiative to support the birth and education of the girl child.
Initially, under BSY there were incentives assimilated – a gift of rupees 500 presented to the mother on delivery
of the girl child also annual scholarship were provided for the childs’ education by the government.
14. Kishori Shakti Yojana (KSY)
It is a scheme initiated by ministry of women and child development in India, implemented by government of
ODISHA for juvenile girls age group 11-18 years under the ICDS programme.
Its aim is to empower adolescent girls, to motivate them to be self reliant, assist them in studies and vocation,
promote health care and gives them exposure to society for gaining knowledge so that they can grow into
responsible citizens.
It launched in 31st August 2007.
15. Nutrition Programme for Adolescent Girls (NPAG)
Introduced in the year 2002-2003 with 100% Central Assistance.
Aims:-
1. Improve Nutritional and health status adolescent girls.
2. Provide nutrition and health education to the beneficiaries.
3. Empower adolescent girls through increased awareness to take better care of their personal health and nutrition needs.
Beneficiaries:-
Adolescent girls <35 Kg Pregnant women <45 kg Services
6 Kg ration per month for three months consecutively.
Implemented through the A.W. Centres
Weighing four times in a year
on the basis of the body weight, issuance of live rice will continue for 3 months.
In Assam, Kokrajhar and Karbi-Anglong as pilot districts.
16. An Integrated Programme for Street children
OBJECTIVE-
Provisions for shelter, nutrition, health care, sanitation and hygiene, safe drinking water, education and
recreational facilities and protection against abuse and exploitation to destitute and neglected street children.
17. Child line Services
Central Adoption Resource Agency
Rajiv Gandhi National Crèche Scheme For the Children of Working Mother
Programme for Juvenile Justice
General Grant-in-Aid Scheme
Pilot Project to Combat the Trafficking of Women and Children for Commercial Sexual Exploitation in Destination
Area
Mid-day Meal Scheme
National Crèche Fund
18. Mid-day Meal Scheme
It is a school meal programme of government of INDIA, design to better the nutritional standing of school age
children nation wide.
Launched in 1995.
The programme supplies the free lunches on working days for children in primary and upper primary classes.
19. Child line Services
Child line is 1098 is a service of ministry of women and child development.
Child line India foundation is a non government organization in India that operates a daily phone helpline called
child line, for children in distress.
It was India’s first 24 hours call tollfree, phone outreach service for children.
Child line 1098 is available all over India.
20. Central Adoption Resource Authority
It is a statuary body of ministry of women and child development.
It functions as the nobal body for adoption of Indian children and mandated to monitor and regulate in country
and inter country adoptions.
CARA primarily deals with adoption of orphans, abundant and surrendered childrens through its associated/
recognized adoption agency.
21. Rajiv Gandhi National Crèche Scheme For the Children of
Working Mother
National crèche scheme (earlier name as Rajiv Gandhi National crèche scheme).
Is being implemented as a centrally sponsored scheme through states / UTs with effect from 1 January 2017 to
provide day care facility to children (age group of 6 months to 6 years) of working mothers.
22.
23.
24. Why pay attention to the health of an adolescent
To reduce death and disease in adolescents:
An estimated 1.7 million young people aged from 10 to 19 die each year due to accidents,
violence, pregnancy related problems or illnesses.
To reduce the burden of disease in later life:
Malnutrition in adolescence can lead to lifelong health problems.
Failure to care for the health needs of young pregnant women damage their own health and
that of their babies.
Some of the highest infection rates for sexually transmitted infections are in adolescents.
Diseases of late middle age, such as lung cancer, bronchitis and heart disease, are strongly
associated with smoking habit.
25. To invest in health today and tomorrow:
Healthy and unhealthy practices adopted today may last a lifetime.
Today’s adolescents are tomorrow’s parents, teachers and community leaders.
Adolescence is a period of curiosity, when young people are receptive to information about themselves and
their bodies, and when they begin to take an active part in decision making.
To protect human capital
In some societies two out of three adolescents are involved in productive work only due to injury, illness or
psychological damage where the cost is primarily a human one, but there is also a cost to society.
26. GOVT. INITIATIVES
Adolescent health programmes
RMNCH+A
Rashtriya Kishor Swasthya Karyakram (RKSK)
Kishori Shakti Yojana : To improve the health and nutritional status of girls
Nutrition Programme for Adolescent Girls (NPAG)
Balika Samridhi Yojana
WIFS (weekly iron folic acid supplementation)
National AIDS Control Programme
Adolescent Friendly Health Clinics(AFHCs)
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35.
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40.
41. WOMEN
Gender is one of many social determinants of health—which include
social, economic, and political factors—that play a major role in the
health outcomes of women in India. Therefore, the high level of gender
inequality in India negatively impacts the health of women.
42. STATUS OF HEALTH
The low status of—and subsequent discrimination against—women in India can be attributed to o cultural norms.
Societal forces of patriarchy,
Hierarchy
Multigenerational families
43. Highest rate of malnourishment.
50% of pregnant /non pregnant anaemic.
A 2012 study by Tarozzi have found the nutritional intake of early adolescents to be approximately equal.
However, the rate of malnutrition increases for women as they enter adulthood.
Furthermore, Jose et al. found that malnutrition increased for ever-married women compared to non-married
women.
44. Govt. Initiative
All the elements of RCH- II integrated in NHM
• Essential Obstetric Care
• Quality Ante Natal care
• Post natal care for mother and newborn
• Skilled Attendance at Birth
• Provision of Emergency Obstetric and Neonatal Care at FRUs
• Augmentation of skilled human resources for Maternal Health
Safe Abortion Services/ Medical termination of Pregnancy (MTP)
Supply of Nischay Pregnancy detection kits to sub centres
Maternal Death Review
MCTS
A Joint MCP Card
JSSK
Gender Based Violence (detection & support)
Setting up of Blood Storage Centre (BSC) at FRUs
Scheme for promotion of menstrual hygiene among adolescent girls in rural India
45. MCTS
Mother & Child Tracking System (MCTS), web based reporting software, under RCH-II programme for tracking of
health services delivered to pregnant mothers and children.
• Objectives:-
• Name Based Tracking of:
1. Pregnant women - for ANC, Delivery & PNC health services
2. Children - for immunization
To Facilitate:
1. Close monitoring of regular Checkups & service delivery to pregnant mothers with minimum essentials services
2. Full Immunization of Mother & Children
3. To follow up dropouts and track service delivery
4. To promote complete immunization and safe institutional deliveries
46. Tracking System
• New registration – 18 digit UNIQUE ID
• Service delivery record update
• Allotment of health provider –
• Overdue services for same beneficiary for every month are generated in health provider’s work plan.
• In rural area two health providers (one ANM & one ASHA) are allotted to each beneficiary.
• SMS alerts to beneficiary & health provider – For the information of registration status and services falling due
on the mobile number registered in MCTS.
47. Janani Shishu Suraksha Karyakaram
(JSSK)
Janani Shishu Suraksha Karyakaram (JSSK) Under this scheme services are provided to pregnant and deliverd
mothers and infants up to 1 year are getting benefitted in all government health facilities by all free health
services irrespective of poverty level, caste and parity.
1. Free drugs & Consumables
2. Free Referral Transport
3. Free Diagnostics
4. Free Diet To Delivered Mothers
5. Provision of Free Blood
6. Exemption from User Charges
48. A Joint MCP Card
MCP Card is the means of verification for conditionalities and service uptake.
Joint use of the same MCP card by AWW and ANM ensures better field level service convergence.
MCP Cards are supplied by Health, and issued by AWWs immediately on registration to all Pregnant Women
49. Nischay Pregnancy detection kits
Services for early detection of pregnancy.
Surveys indicate availability of pregnancy detection kits (NISHCHAY) with peripheral health functionaries.
ASHAs performed over 82 percent of tests themselves.
The Ministry of Health and Family Welfare (MOHFW), GOI, through National Rural Health Mission (NRHM) has
introduced rapid home pregnancy test kits (Nishchay).
Taking a holistic view of the concept, Nishchay is not a program for the promotion of the pregnancy test kit
alone, but is an entry point to RCH and family planning services for women seeking quality and assured RCH and
FP services.
50. ELDERLY
60-69 Old
70-79 Old - Older
80+ Oldest- Old
60-74 Young Old
75- 84 Middle old
85+ Old-Old
Source: National Policy on Older Person 1999 GOI
51. Community Geriatrics
Caring for older patients means not only understanding their diseases and
knowing who the support people are in their lives, but also creating a plan of
care that includes their social, financial and personal goals.
52. GENERAL PROBLEMS IN OLD AGE
Economic problems
Sociological changes
Spiritual changes
53. System wise changes
Cardiovascular changes
Respiratory system
Gastrointestinal system
Neurological system
Acidents
54. Various Levels of healthcare
Primary Level:
Good health habits like: Good sleep
Good and required nutrition
Curtailing smoking, alcohol and fatty foods.
Avoidance of overeating (Obesity control)
Avoiding risk factors like: |
Care at routine to avoid accident, fracture.
Diet restrictions.
Periodic health checkup
55. Secondary prevention
• Screening for hypertension, diabetes periodontal disease dental caries
• sensory impairment medication side effects
• colon-rectal cancer breast cancer, cervical cancer and prostatic cancer nutritionally-induced anaemias
depression, stress urinary incontinence podiatric problems fall risk
• Annual medical check-up
• Early detection ( Universal approach, Selective approach)• Treatment
56. Tertiary prevention
• Rehabilitation - physical deficits cognitive deficits functional deficits
• Caretaker support -Introduction of support necessary to prevent loss of autonomy.
• Counselling and Welfare activities ( Sanjay Niradhar Yojana, Vridhashrama )
• Improving quality of life
• Cultural programme
• Old age club
• Home help
• Old age home
57. How government help old age people
• Government announced a National Policy on older persons in January 1999.
• This policy identifies principal areas of intervention as security, healthcare, nutrition, welfare and protection
of life and property.
• A national council for older persons (NCOP) was constituted to operationalise this policy .
• 234oldage home,398 daycare centers and 40 mobile medical units are operational under this policy.
58. Under National Social Assistance Programme,
old age pension is being provided to more than 4 million aged people.
• Old Age Social and Income Security (OASIS) was launched to examine policy questions, connected with Old age
income security.
• Health care is provided to the older people under Bhavishya Arogya Mediclaim and Rural Group Life insurance
Schemes .
59. Help Age India is the largest voluntary organization working for the cause and care of the older people.
• Help Age India supports various programmes to make life easier for older people like
1. Free cataract operations
2.Mobile medical units
3.Old age homes and care centers.
4.Adopt a gran (grand parent).
5. Income generation and micro –credit.
60. NATIONAL PROGRAMME FOR THE HEALTH CARE OF THE
ELDERLY (NPHCE)
NPHCE is an articulation of the International and national commitments of the Government as envisaged under
the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP)
adopted by the Government of India in 1999.
NPHCE would operate through NCD cells under the programme constituted at State and District levels.
61. You do not heal old age. You protect it; you
promote it; you extent it. -Sir James Sterling
Ross
62. NURSES CARE IN PHYSICALLY AND MENTALLY
CHALLENGED PERSON
HANDICAPPED
Handicapped child is one who deviates from normal health status either
physically, mentally or socially and requires special care, treatment and
education.
DEFINITION
According to WHO, the sequence of events leading to disability and
handicapped conditions are as follows Injury or disease Impairment, Disability,
Handicap
65. PREVENTION OF BLINDNESS
Provide good antenatal care
Immunization – meseals, rubella
Genetic counseling and screening
Prevent infection
Prevent pre term birth and
Provide excellent neonatal care to pre
Vitamin A supplement
Health education about eye safety, personal hygiene and nutrition for health promotion
Treatment of causes of childhood blindness
Retinopathy of prematurity (ROP)
Cataract
Glaucoma
66. MANAGEMENT OF BLINDNESS
Physiotherapy
Orientation and mobility instructors
Mobility aid and guides
BRAIL technology
67. DEAFNESS
A person who is not able to hear as well as someone with normal hearing. It
can affect one ear or both ears, and leads to difficulty in hearing
conversational speech or loud sounds.
68. LEVELS OF HEARING IMPAIRMENT
Mild
deafness 25
to 39dB
Moderate
deafness 40
to 69dB
Severe
deafness -
70 to 89Db
Profound
deafness -
90dB <
69. MANAGEMENT
Sign language
Hearing devices - hearing aids, assistive listening devices and cochlear
implants.
Lip-reading skills
Speech therapy
Use of written or printed text
70. SPEECH HANDICAPPED
Means an impairment of speech or sound production, fluency, voice or
language which significantly affects a child’s educational performance or
their social, emotional or vocational development.
71. MANAGEMENT
Early identification of speech impairment
Elimination of hearing impairment
Medical and surgical intervention for underlying causes
Psychological counseling
Avoid making fun of their voice or speech
Voice or Speech therapy
Physical therapy
Cognitive rehabilitation
72. ORTHOPEDICALLY HANDICAPPED
Orthopedic disability occur when movements in over body are affected due to
disease, injury, any absence or deformities in the joints, bones, muscles or an
injury in nervous system Loco motor disability means disability of the
bones, joints or muscles leading to substantial restriction of the movement of
the limbs
73. MANAGEMENT
Correction of Deformities
Physical Therapy
Occupational Therapy
Massage Therapy
Prosthetics
devices for positioning and mobility
74. MENTAL HANDICAPPED
A mental handicap is an impairment in an individual's ability to function
cognitively, emotionally or physically due to the presence of a psychiatric
condition. This condition hinders someone's ability to perform a task or
prevents that person from engaging in an activity without assistance.
75. MENTAL RETARDATION
Mental retardation is defined as significantly sub average general intellectual
functioning, resulting in associated with concurrent impairment in adaptive
behavior, which manifests during the developmental period”. (American
Association on Mental Deficiency)
77. TREATMENT MODALITIES
Behavior management.
Environment supervision
Monitoring the child’s developmental needs and problems.
Programs that maximum speech, language, cognitive, psychomotor, social ,
self-care, and occupational skills.
Family therapy
Early intervention programs for children younger than age 3 with mental
retardation.
Provide day schools to train the child in basic skills, such as bathing and
feeding.
78. SOCIALLY CHALLENGED CHILDREN
A Socially handicapped children may be defined as a child
whose opportunity for a healthy personality development
and full unfolding of potentialities are hampered certain
elements in his social environment such as parental
inadequacy, environmental deprivation, (lack of learning
opportunity) and emotional disturbance.
79. CATEGORY OF SOCIALLY HANDICAPPED
CHILDREN
Orphan
Neglected children
Children of divorce or step parents
Delinquent children
80. Management
For Parents
Treatment for
Substance abuse.
Depression or other mental health problems.
Low self-esteem
Violent behavior
realize responsibility regarding child
educating and helping parents to correct their erroneous thinking and
behavior or parenting skills.
81. For Child
Child-centered interventions include
pediatric care, mentoring
Behavioral and mental health treatment.
Provide stimulation programme to emotionally neglected child
Develop timely and comprehensive assessments or placed in foster home
82. PREVENTION OF HANDICAPPED
CONDITION IN CHILDREN
PRIMARY PREVENTION
Genetic counseling
Genetic screening
Reduction of consanguineous marriage
Pregnancy planning
Rh incompablity
Immunization of mother and baby
Vitamin A prophylaxis
Improve nutritional status of mother and child
Prevention of iodine and folic acid deficiency
Provide essential care in prenatal, Intranatal, postnatal period
Prevent maternal and neonatal infection
Prevent birth injury, asphyxia, hyperbilurubinemia
Special care to high risk mother –abortion, premature birth
Encourage to kick bad habits such as smoking or alcohol abuse.
83. SECONDARY PREVENTION
Careful history
Regular medical supervision and developmental assessment
Treatment of particular handicap condition
Correction of deformity
Physiotherapy and exercise to improve physical condition
Occupational therapy
Speech therapy to improve communication ability
Prosthetics
Special care for mentally handicapped children with warmth , love , tolerance, discipline, avoid criticism
Counseling and guidance
Referral for welfare services
84. REHABILITATION OF HANDICAP
CHILDREN
Medical rehabilitation
Social rehabilitation
Educational rehabilitation
Psychological rehabilitation
Vocational rehabilitation
85. WELFARE OF HANDICAPPED CHILDREN
Persons with disabilities bill (equal opportunity, protection of right and full
participation)- 1995,introduced by ministry of welfare and Govt of India and it
deal with preventive and promotional aspect of rehabilitation
Children Act 1960- provide for the care protection, maintenance, welfare,
education, and rehabilitation of socially handicapped children.
86. Schemes for handicapped children
Deendhyal disabled rehabilitation scheme
Assistance to disabled person to purchase or fitting of aids and appliance
National handicapped finance and development cooperation
Scheme for implementation of person with disabilities act 1995(sipda)
Scheme for incentive to employees in the private sector for providing employment to person with disabilities
87. National institute for handicapped
National institute for orthopedically handicapped Calcutta
National institute for mentally handicapped Hyderabad
Ali yavar Jung National institute for hearing handicapped Mumbai
National institute for rehabilitation, training, and research Calcutta
National Institute for visually handicapped New Delhi and Dehradun
