The document discusses various definitions and models of health, prevention, and nursing's role in health promotion. It defines health according to WHO and describes views that health is more than just the absence of disease. It also summarizes levels of prevention from primordial to tertiary. Several health models are explained briefly, including Health Belief Model, Health Promotion Model, Neuman Systems Model, and Nightingale's Environmental Theory. Health promotion frameworks like PRECEDE-PROCEED and OMAHA System are also summarized. Milio's framework for prevention focusing on community-oriented care is described.

2. Definition
Health:
WHO defines Health as “a state of
complete physical, mental and
social wellbeing, not merely the
absence of disease or infirmity”.

3. Views of Health:
All people free of diseases are not
equally healthy
Health is condition of life rather
than pathological state
A complex concept, more than
absence of disease

4. Prevention
The goals of medicine are to promote
health, to preserve health & to restore
health when it is impaired.
Depends on knowledge of causation,
dynamics of transmission,
identification of risk factors,
availability of prophylaxis or early
treatment

5. Nurses’ role in Health
 A healing presence , willing to learn from
patients by listening, being attentive,
recognizing & respecting others way of
coping.
 Needs to have adequate knowledge
 Must understand & remember the concept
of health promotion, wellness & illness &
 that they mean differently to different
people.

6. Need for Prevention
Iceberg of Disease:
A disease in a community – Iceberg
The floating tip- clinical cases (What
the Physician sees)
The vast submerged portion- hidden
mass of disease, (latent, inappropriate,
undiagnosed cases)

7. •Detection & control of the
submerged part- a challenge to
modern technique in preventive
medicine.
•Especially in diseases like
hypertension, DM, anemia etc,
where unknown morbidity far
exceeds the known morbidity

8. Levels of Prevention
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention

9. Primordial prevention
Primary prevention in purest sense
Prevention of emergence or
development of risk factors in
countries or population groups in
which they have not yet appeared
Eg: Discouraging children from
smoking & other ill habits to
prevent diseases like hypertension

10. Primary prevention
An action taken prior to the onset
of disease which removes the
possibility that a disease will occur.
Intervention in pathogenesis phase
of the disease

11. Secondary prevention
“A process which halts the progress of
the disease at its incipient stage and
prevents complications.”
Specific interventions or early
diagnosis & adequate treatment.
Attempts to arrest the disease process
An imperfect tool in the control of
transmission of disease

12. Tertiary prevention
Defined as “ All measures available to
reduce or limit impairments &
disabilities, minimize sufferings caused
by existing departures from good
health & to promote the patients
adjustment to irremediable
conditions.”
Done when the disease process has
advanced beyond its early stage.

13. Models of Health
Model: A theoretical way of
understanding a concept or an idea
They represent various ways of
approaching a complex issue.
Models of Health & Illness contain a
combination of biological
characteristics, behavioral factors &
social conditions.

14. Uses of Health models
1. To help nurses understand patient’s
attitudes & values about health & illness
in order to provide effective care
2. To help the nurses understand & predict
patient’s health behavior, including how
they use health services, participate in
recommended therapy & care for
themselves.

15. Health Belief model
Rosenstoch’s Model
Addresses the relationship
between a person,s beliefs &
behaviors
Health Beliefs are ideas,
convictions, & attitudes regarding
health & illness.

16. Health Belief model contd
As beliefs influence behavior,
they positively or negatively
affect patient’s level of health.
Positive health behaviors
Negative health behaviors

17. 3 components:
Individual’s perception of illness
Modifying Factors
Variables affecting the likelihood of
client’s preventive action

18. Health belief model

19. Health Promotion Model
Pender’s Model
Complement to Health Belief
model
Explains the likelihood of health
promoting actions being taken.

20. Neuman system model
Betty Neuman (1972)
Health care system model
Depicts an open system in which
person and their environment are in
dynamic interaction

21. Five interacting variables:
Physiological
 Psychological
 Socio cultural
 Developmental
 Spiritual

22. 3
preventions as intervention
modalities
Primary
Secondary
Tertiary

23. Primary prevention
 Identify the community risk factor
 Plan for health education programs
with community leaders
Secondary prevention
 Identify the stressors and begins
treatment
Tertiary prevention
 Appropriate when the community
becomes chronically dysfunctional.

24. Tertiary
prevention
Secondary
prevention
Primary
prevention
core structure

25. Nightingale’s Environmental
Theory
Florence Nightingale - First Nurse
Theorist
Defined Nursing “The act of utilizing
the environment of the patient to assist
him in recovery”

26. Nightingale’s Assumptions
 Nursing is separate from medicine
 Nurses should be trained.
 The environment is important to the health
of the patient.
 The disease process is not important to
nursing
 Nursing should support the environment to
assist the patient in healing

27. Nightingale’s Assumptions
contd
 Research should be utilized through
observation on empirics to define the
nursing discipline.
 Nursing is both an empirical science & an
art
 Nursing’s concern is with the person in the
environment
 The person is interacting with the
environment

28. Nightingale’s Assumptions
contd
Sick and well are governed with
the same laws of health.
The nurse should be observant
and confidential.

29. Goal of Nursing
Assisting the patient in his
retention of his vital powers by
meeting his needs & thus putting
the patient in best possible
environment for healing.

30. Three Types of Environments
Physical
Psychological
Social

31. Physical environment
Consists of physical elements like
ventilation, warmth, cleanliness,
light, noise and drainage where the
patient is being treated
Affects all other aspects of the
environment.

32. Psychological environment
Can be affected by a negative physical
environment which then causes
STRESS.
Requires various activities like
manual work, appealing food, a
pleasing physical environment
to keep the mind active & help the
person survive psychologically.

33. Social environment
Involves collecting data about
illness and disease prevention.
Includes components of the
physical environment - clean air,
clean water, proper drainage.

34. Perspective on Nightingale’s
13 canon
Observation
Personal Cleanliness
Petty Management
Light
Health of Houses
Cleanliness of rooms

35. Perspective on Nightingale’s 13
canon contd
Ventilation & warming
Bed & Bedding
Taking food
What food
Noise
Chattering Hopes & advices
Variety

36. •Regarded one’s senses,
especially observation as
reliable means of obtaining &
verifying Knowledge
•Theory must be reformulated
if inconsistent with empirical
evidence
•Observation – important to
all nursing functions

37. PRECEDE- PROCEED Model
A comprehensive model for assessing
health & quality of life and for
designing, implementing & evaluating
health promotion & other public health
programs to meet those needs.
PRECEDE- PROCEED are acronyms

38. How the Model works?
Assesses the environment where the
group lives, considering social factors
that influence health behavior
Examines both internal & external
factors that predispose it to certain
behaviors & health problems
Identification of factors that help in
adopting healthy actions

39. PRECEDE
P- Predisposing
R-reinforcing &
E-enabling
C-constructs in
E-educational
D-diagnosis

40. Phases of PRECEDE
 Has 4 phases
Phase I: Identifying the ultimate desired
result.
Phase II: Identifying & setting priorities
among health or community issues
Phase III: Identifying the predisposing,
enabling & reinforcing factors
Phase IV: Identifying the administrative &
policy factors

41. PROCEED
P-Policy
R- regulatory &
O- organisational
C-constructs in
E-Educational &
E- environmental
D-development

42. Phases of PROCEED
Phase V: Implementation
Phase VI: Process Evaluation
Phase V: Impact Evaluation
Phase V: Outcome Evaluation

43. The OMAHA System
A Nursing Process system.
Comprises of
 Nursing Diagnosis
Intervention
Evaluation

44. Nursing Diagnosis
 Called “ The OMAHA Problem
classification scheme”
 Organised at 4 discrete levels of abstraction
 All 4 levels consistent & parallel
 The four levels are
Problems
 Domains
Modifiers
Signs & symptoms

45. The Four Domains
Define the scope of community health nursing
 Environmental
 Psychosocial
 Psychological
 Health related behaviors
There are 40 client problems in all under
these domains
The term ‘Other’ included under each domain

46. Intervention Scale
A Systematic arrangement of nursing
actions
Organized under 3 levels of abstraction
& specificity (Categories)
Represents the essence of Community
Health Nursing

47. Intervention Scale
There are Four categories:
 Health teaching
Treatments & Procedures
Case Management
Surveillance

48. Intervention Scale
The second level of OMAHA intervention
scheme is a list of 62 ‘Targets’
 Used to delineate a problem specific intervention
Eg:
 Anatomy/ Physiology
 Behavior modification
 Bronchial Hygiene
 Bonding ….

49. Intervention Scale contd
The Third Level:
Designed for client specific information
Example:
Income
 Low/no income
 Uninsured medical expenses
 Inadequate money management
 Able to buy only necessities
 Difficulty buying necessities
 Other

50. Problem Rating Scale for
Outcomes
For evaluation purpose
A Five point Likert Rating scale
 Offers a systematic, recurring way of
measuring client progress through out
Initial rating established on admission
Used as baseline

51. Problem Rating Scale for Outcomes
contd
Consists of likert scale for 3 concepts
Knowledge
Behavior
Status
Each has a continuum of 5 categories
from very positive to negative

52. Milio’s framework for
prevention
Nancy Milio- nurse& leader in
public health policy & education
Includes concepts of community-
oriented, population focused care
Behavioural patterns of
populations
Main determinant of unhealthful
choices is lack of knowledge

53. • Neglected role of community
nursing to examine determinants of
community health through public policy

54. Milio’s proposition
Health status of population is a
function of lack or excess of health
sustaining resources
Behavior patterns of population are
related to habits of choice from actual
or perceived resources available
Organisational decisions determine th
erange of personal resources available.

55. Milio’s proposition contd
Individual health related decisions are
influenced by efforts to maximize valued
resources in both personal & societal domains
Social change reflects a change in population
behavior pattern
Health education impacts behavior patterns
minimally without new health promoting
options for investing personal resources

56. THANK
YOU!!!!