advanced nursing practice first year MSc nursing

1. PRIMARY HEALTH CARE
Ms ARIFA T N
FIRST YEAR M.Sc NURSING, MIMS CON

2. PRIMARY HEALTH CARE
 The concept of primary health care was introduced
at international level jointly by WHO and UNICEF at
the Alma Atta conference in 1978 to achieve the goal
of HFA (health for all) by the year 2000A.D

3. DEFINITION
 “Primary Health Care is essential health care
made universally accessible to individuals &
acceptable to them, through their full
participation & at a cost the community &
country can afford”

4. PRIMARY HEALTH CARE
 This is the first level of contact between the recipient
of care and the health care delivery system. Majority
of the problems at this level are solved by the people
with some assistance and guidance of health
workers

5.  In rural area these services are given by the means
of sub centres, PHC and CHC
 In urban areas these services are given by maternal
child health and family welfare centres and
dispensaries

6. ELEMENTS OF PRIMARY HEALTH CARE

7. ELEMENTS OF PRIMARY HEALTH CARE
 Education concerning prevailing health problem &
the methods of preventing & controlling them
 Promotion of food supply & proper nutrition
 An adequate supply of safe water & basic sanitation
 Maternal & child health care, including family
planning
 Immunization against major infectious diseases
 Prevention & control of locally endemic diseases
 Appropriate treatment of common diseases &
injuries.
 Provision of essential drugs

8. CHARACTERISTICS
 It is essential health care which is based on practical,
scientifically sound and socially acceptable methods and
technology.
 It should be rendered universally, acceptable to
individuals and the families in the community through
their full participation.
 Its availability should be at a cost which the community
and country can afford to maintain at every stage of their
development in a spirit of self reliance and self-
development.
 It requires joint efforts of the health sector and other
health-related factors, via., education, food and
agriculture, social welfare, animal husbandry, housing,
rural reconstruction, etc.

9. PRINCIPLES OF PRIMARY HEALTH CARE
1. Equitable distribution.
2. Community participation.
3. Intersectoral coordination.
4. Appropriate technology.
5. Prevention

10. EQUITABLE DISTRIBUTION
 Health services must be shared equally by all people
irrespective of their ability to pay
 Rich or poor / rural or urban must have access to
health services
 80% percentage of people live in rural areas & only
20% live in the urban areas, but the proportion of the
health services is grossly inversely Propotionate.ie,
80% of people are catered by only 20% & 20% are
catered by 80% of health services

11. EQUITABLE DISTRIBUTION
 This has been termed as social injustice
 Primary Health Care aims to readdress this
imbalance by shifting the centre of gravity of the
health care system from cities to the rural areas, &
bring these services as near people’s home as
possible

12. COMMUNITY PARTICIPATION
 Involvement of the individuals & community in
promotion of their own health & welfare, is an
essential ingredient of primary health care
 There must be a continuing effort to secure
meaningful involvement of the community in
planning, implementing & maintenance of health
services, besides maximum reliance on local
resources such as manpower, money & materials

13. COMMUNITY PARTICIPATION
 One approach – the VHG (village health guides) &
Trained Dais has been successfully tried in India.
 They are selected by the local community & trained
locally in the delivery of primary health care to the
community they belong
 By overcoming cultural & communication barriers,
they provide primary health care in ways that are
acceptable to the community

14. COMMUNITY PARTICIPATION
 It is now considered that “Health Guides” & “Trained
Dais” are an essential feature of primary health care
in India
 These concepts are revolutionary. They have been
greatly influenced by the experience in China where
community participation in the from of “bare foot
doctors” took place on an unprecedented scale.

15. INTERSECTORAL COORDINATION
 There is an increasing realization that HFA cannot be
provided by the health sector alone
 The declaration of Alma Ata states that primary
health care involves in addition to health sector, all
related sectors and aspects of national and
community development, in particular agriculture,
animal husbandry, food, industry, education,
housing, public works, communication & other
sectors

16. INTERSECTORAL COORDINATION
 To achieve such cooperation, countries may have to
review their administrative system, reallocate their
resources and introduce suitable legislation to
ensure that coordination can take place
 This requires a strong political will to translate values
into action
 An important approach is the inter sectoral
approach.

17. APPROPRIATE TECHNOLOGY.
 Appropriate technology has been defined as
“technology that is scientifically sound, adaptable to
local needs, & acceptable to those who apply it & for
those whom it is used & that cab be maintained by
the people themselves in keeping with the principles
of self reliance with the resources the community &
country can afford

18. APPROPRIATE TECHNOLOGY.
 The term appropriate is emphasized because in
some countries luxurious hospitals that are totally
inappropriate to the local needs, are built, which
absorb a major part of the national health budget,
effectively blocking many improvement in general
health services
 This also implies use of costly equipments,
procedures and techniques when cheaper,
scientifically valid and acceptable ones are
available. (ORS packets over house to houses and
pipe connections)

19. SERVICES IN PRIMARY HEALTH CARE
 Education concerning prevailing health problems
and the methods of preventing and controlling them.
 Promotion of food supply and proper nutrition
 An adequate supply of safe water and basic
sanitation
 Maternal and child health care, including family
planning
 Immunization against major infectious diseases
 Prevention and control of locally endemic diseases.
 Appropriate treatment of common diseases and
injuries
 Provision of essential drugs

20. NURSES ROLE

21. NURSES ROLE
 The role of a nurse to deal health needs and health
problems of people at community level was realized
by WHO in 1970s
 The same was recognized in 1977 during 30th WHO
Assembly and also during International Conference
on Primary Health care in 1978 at Alma Ata.
 The participants at the meeting suggested to
change/ modify basic, post basic and continuing
education so that nurses are prepared to fit into
national health care system and meet health care
needs of people in the context of primary health
care.

22. NURSES ROLE
 In 1970, the International Council of Nurses affirmed
its commitment to primary health care.
 It felt since nurses provide and continue to provide
large part of health care in most countries, their
training should and role in health care must be
enlarged and enriched to fit into the changing health
care approach
 It suggested changes in nursing curriculum,
nursing practice and nursing administration so
that nurses can participate from decision making
level to grass root level and contribute to primary
health care approach effectively

23. NURSES ROLE
 The Trained Nurses Association of India (TNAI)
affirmed its commitment to HFA through primary
Health Care in its conference on Nursing education
in 1979.
 It recommended to prepare nurses to work in the
community, to re-orient nurses to primary health
care, to have nurses at decision making position at
the centre and state level and have more nurses in
the district and primary health centres.
 The Indian Nursing Council (INC) revised and
modified the curriculum for ANM and BSc., Nursing (
to prepare nurses to perform primary health care
roles and functions)

24.  WHO study group in 1985 highlighted the
following roles and functions of nurses in
primary health care
 Direct care provider
 Health educator and teacher
 Planner and care manager
 Guide and supervisor

25. Direct care provider

26. Direct care provider
 The nurse provide direct care to individual, families
and community with reference to 8 elements of
primary health care.
 Eg: For MCH care the nurse has to identify pregnant
mothers, register them, conduct complete physical
and obstetrical examination, identify high risk factors,
give TT injection, IFA tablets, and health educate
them about diet, rest and sleep, exercise etc.

27. Health educator and teacher
 In order to promote health, prevent disease, regain
and maintain health, the nurse educates individuals,
families and community at large about healthful
behavior, sanitary environment, prevention of
diseases etc

28. Health educator and teacher
 Whatever she does, even the care of the sick at
home, she educates family members to take are of
the sick in her absence and also other preventive
measures
 As a teacher, she trains other health workers such
as ANMs, health Guides, Village Dais

29. Planner and care manager
 The nurse working for primary health care makes
assessment of health needs, health problems of
individuals, families and community
 The nurse plans care accordingly for them and
implements the planned care
 The nurses involves individuals, families and
community in planning and implementing of the care
 The nurses makes use of the community resources
and guides them in giving care

30. Planner and care manager
 The nurse listens to and communicates with them
and advise them accordingly
 She makes referrals when required.
 She maintains the record of care given and
evaluates the effectiveness of the same

31. Guide and supervisor
 As a nurse engaged in providing primary health care,
she is expected to supervise, guide and help other
personnel in providing care, planning health services
for families and for the community.

32. Specified functions
 Assessment of health needs and health problems of
individuals and community.
 Provide integrated comprehensive primary health
care service related to 8 essential elements.
 Mobilize involvement of individuals, families and
community in providing primary health care
 Surveillance of locally endemic diseases

33. Specified functions
 Training and supervision of health workers
 Working in collaboration with other socioeconomic
sectors.
 Maintenance of accurate, complete and up-to-date
records of health care services rendered
 Monitoring and analysis of health condition to
determine the progress in primary health care

34. HEALTH PROMOTION

35. INTRODUCTION
 Health promotion is an important component of
nursing practice.
 It is a way of thinking that revolves around a
philosophy of wholeness ,wellness and well-being.
 The concept of health promotion is positive, dynamic
and empowering which makes it rhetorically useful
and politically attractive

36. DEFINITION
 Health promotion as a “behavior motivated by the
desire to increase wellbeing and actualize human
health potential”
(Pender ,Murdaugh and Parsons, 2006)
 Health promotion is a process of enabling people to
increase control over the determinants of health and
their by improve their health

37. DEFINITION
 “The process of enabling people to increase control
over and improve their health”
(World Health Organisation
1986)
 Health Promotion = health education x healthy public
policy. (Tones and Tilford,
1994)

38. The WHO’s 5 key concepts for health
promotion
 ‘Healthy public policy’ is the process of trying to
ensure that all areas of policy (not just health
services) are favourable to health
 ‘Supportive environments for health’ is where action
to improve health is directed at the settings of
people’s everyday lives - homes, neighbourhoods,
workplaces.
 ‘Community action for health’ is where local people
come together to share their health concerns, and
support each other in improving their own
circumstances.

39. The WHO’s 5 key concepts for health
promotion
 ‘Personal skills for health’ focuses on what it takes
for individuals to deal with the changes and
challenges of their lives, to manage stress and
emotions in creative and adaptive ways
 ‘Reorienting health services’ is about achieving
services that bring practitioners together with a focus
on the needs of the whole population and an
emphasis on positive health gain.

40. PRINCIPLES OF HEALTH PROMOTION
 The five key principles of health promotion as
determined by WHO are as follows:
1. Health promotion involves the population as a
whole in the context of their everyday life, rather
than focusing on people at risk from specific
diseases.
2. Health promotion is directed towards action on the
determinants or causes of health therefore,
requires a close co-operation of sectors beyond
health services, reflecting the diversity of
conditions which influence health

41. PRINCIPLES OF HEALTH PROMOTION
3. Health promotion combines diverse, but
complementary methods or approaches including
communication, education, legislation, fiscal
measures, organizational change, community
change, community development and spontaneous
local activities against health hazards.
4. Health promotion aims particularly at effective and
concrete public participation. This requires the
further development of problem-defining and
decision-making life skills, both individually and
collectively, and the promotion of effective
participation mechanisms.

42. PRINCIPLES OF HEALTH PROMOTION
5. Health promotion is primarily a societal and political
venture and not medical service, although health
professionals have an important role in advocating
and enabling health promotion.

43. PROCESS OF HEALTH PROMOTION

44. Models of health promotion
 Frameworks and Models are tools that help explain
phenomena.
 Many tools developed to explain the scope of health
promotion.
 Beattie’s (1991) model of health promotion
 Tones and Tilford’s (1994) empowerment model of
health promotion
 Caplan and Holland’s (1990) Four perspectives on
health promotion
 Naidoo and Wills (2000) typology of health promotion

45.  Models of health promotion may help to:
 Conceptualize or map the field of health promotion
 Interrogate and analyze existing practice
 Plan and chart the possibilities for interventions

46. Beattie’s model of Health Promotion

47. Beattie’s model applied
 Key features
Examines 2 axis
 Type of approach used top down (authoritarian) or bottom
up (negotiated or owned by clients)
 size of approach
Categorises 4 types of activities
 Personal Counseling : Eg working with dietician on food
and physical individual personal plans and goals
 Health persuasion :Eg Campaign of eating 5 fruit and
vegetables a day on TV
 Legislative action : Eg laws that subsidise the price of
healthy food stuff
 Community development : Eg communities producing and
distributing food themselves

48. Tones and Tilford’s (1994) model of
health promotion
Key features
i. States interaction between two main sets of processes
for health improvement
ii. Development and implementation of healthy public
policy
iii. health education in which people are empowered to
take control of their life.
Example :attempts of Jamie’s School Diners campaign
where school meals was brought into public
consciousness and lead to standards for meals and an
increase in the budgets for school meals.
 Only when these two approaches work in parallel can the
conditions for living and individuals behavioral aspects of
health be addressed

49. Caplan and Holland’s model of health
promotion (1990)
Key features
 More complex and theoretically driven
 Attempts to unpick what determines health and ill-
health and therefore what activities can be used to
address health issues.
 One axis refers to a theory of knowledge and how
knowledge is generated in relation to health
 The other axis refers to how society is constructed
and how thisimpacts on health

50. Tannahill’s model of health promotion

51. Tannahill’s model of health promotion
 Preventive services, e.g.. immunization, cervical
screening, hypertension case finding, developmental
surveillance, use of nicotine chewing gum to aid
smoking cessation
 Preventive health education, e.g.. smoking
cessation advice and information.
 Preventive health protection, e.g..fluoridation of
water.
 Health education for preventive health
protection, e.g.. lobbying for seat belt legislation.
 Positive health education, e.g. life skills with young
people

52. TANNAHILL’S MODEL OF HEALTH
PROMOTION
 Positive health protection, e.g.. workplace smoking
policy.
 Health education aimed at positive health
protection, e.g.. Pushing for a ban on tobacco
advertising
 TANNAHILL’S MODEL
 Shows how these different approaches relate to each
other in an all-inclusive process termed health promotion.
 Health education- communication to enhance well being
and prevent ill health through influencing knowledge and
attitudes.
 Prevention- reducing or avoiding the risk of diseases and
ill health primary through medical interventions.
 Health protection safeguarding population health

53. A FRAMEWORK FOR HEALTH
PROMOTION ACTIVITIES

54. A FRAMEWORK FOR HEALTH
PROMOTION ACTIVITIES

55. Main approaches to health promotion
 Medical or preventative
 Behavioral change
 Educational
 Empowerment
 Social change

56. These approaches have different objectives
 To prevent disease
 To insure that people are well informed and are able
to make health choices
 To help people acquire the skills and confidence to
take greater control over their health
 To change polices and environments in order to
facilitate healthy choices

57. The medical or preventative approach
 Aims
 Reduce morbidity and premature mortality
 Target: whole populations or high risk groups
 Promotion of medical intervention to prevent ill-health

58. Behavior change approach
 Aims
 Encourages individuals to adopt healthy behaviors which
improve health
 Views health as a property of individuals
 People can make real improvements to their health by
choosing to change lifestyle
 It is people’s responsibility to take action to look after
themselves
 Involves a change in attitude followed by a change in
behavior

59. The educational approach
 Aims
 To enable people to make an informed choice about their
health behavior by
 providing knowledge and information
 developing the necessary skills
 Not similar the behavioral approach, it does NOT try to
persuade or motivate change in a particular direction
 OUTCOME is client’s voluntary choice which may be
different from the one preferred by health promoter

60. Empowerment approach
WHO defined health promotion as “enabling people to
gain control over their lives” (empowerment)
 Aims
 Helps people identify their own concerns and gain the
skills and confidence necessary to act upon them
 This is the only approach to use a ‘bottom-up’ (rather than
‘top-down’) approach
 Empowerment may involve both self-empowerment and
community empowerment

61. Empowerment approach
 Self-empowerment:
 Based on counseling
 Uses non-directive ways
 Increase person’s control over his/her own live
 For people to be empowered they need to:
 Recognize and understand their powerlessness
 Feel strongly enough about their situation to
want to change it
 Feel capable of changing the situation by
having information, support and life skills

62. Social change approach
 Aims
 Radical approach which aims to change society not
individual behavior
 Aims to bring changes in the physical, economic and
social environment
 Healthy choice to become the easier choice in terms of
cost, availability and accessibility
 Targeted towards groups and populations

63. Basic Strategies for Health Promotion
 Advocate
 Enable
 Mediate

64. Advocate
Good health is a major resource for social,
economic and personal development and an
important dimension of quality of life. Political,
economic, social, cultural, environmental, behavioral
and biological factors can all favor health or be
harmful to it. Health promotion action aims at making
these conditions favorable through advocacy for
health.

65. Enable
 Health promotion focuses on achieving equity in
health.
 Health promotion action aims at reducing differences
incurrent health status and ensuring equal
opportunities and resources to enable all people to
achieve their fullest health potential.
 This includes a secure foundation in a supportive
environment, access to information, life skills and
opportunities for making healthy choices.
 People cannot achieve their fullest health potential
unless they are able to take control of those things
which determine their health. This must apply equally
to women and men.

66. Mediate
 The prerequisites and prospects for health cannot be
ensured by the health sector alone. More
importantly, health promotion demands coordinated
action by all concerned: by governments, by health
and other social and economic sectors, by
nongovernmental and voluntary organization, by
local authorities, by industry and by the media.
 People in all walks of life are involved as individuals,
families and communities.

67. Mediate
 Professional and social groups and health personnel
have a major responsibility to mediate between
differing interests in society for the pursuit of health.
 Health promotion strategies and programmes
should be adapted to the local needs and
possibilities of individual countries and regions to
take into account differing social, cultural and
economic systems.

68. 6 Major Elements
 Better Health policy.
 Physical environment.
 Social environment.
 Community relationships.
 Personal health skills.
 Health services

69. HEALTH PROMOTION TOPICS
 INFANTS
 Infant parent
attachment/bonding
 Breast feeding
 Sleep patterns
 Playful activity to
stimulate development
 Immunization
 Safety promotion and
injury control

70.  CHILDREN
Health promotion topics..
 Nutrition
 Dental checkup
 Rest and exercise
 Immunizations
 Safety promotion and
injury control

71.  ADOLECENTS
 Communicating with the
teen
 Hormonal changes
 Nutrition
 Exercise and rest
 Peer group influences
 Self concept and body
image
 Sexuality
 Safety promotion and
accidental prevention.
 Health promotion topics

72. Health promotion topics..
 Adequate sleep
 Appropriate use of
alcohol
 Dental/oral health
 Drug management
 Exercise
 Foot health
 Health screening
 Hearing aid use
 Safety precautions
 Weight control etc.
 ELDERS

73. NURSES ROLE IN HEALTH PROMOTION
 Model healthy life style behaviors and attitudes.
 Facilitate client involvement in the assessment ,
implementation an
 Teach client health care strategies to enhance
fitness improve nutrition ,manage stress and
enhance relationships.
 Assist individuals, families and communities to
increase their levels of health.
 Educate client to be effective health care consumers
.
 Assist clients ,families ,and communities to
develop and
choose health promoting options and evaluation of
health

74. NURSES ROLE IN HEALTH PROMOTION
 Guide clients development in effective problem
solving and decision making
 Reinforce clients personal and family health
promoting behaviors.
 Advocate in the community for changes that promote
a healthy environment

75. Conclusion
 Primary health care
 Health promotion

76. Thank you