SlideShare a Scribd company logo
1 of 153
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”
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
CONCEPT OF
HEALTH
BIO MEDICAL
CONCEPT
ECOLOGICAL
CONCEPT
PSYCHOSOCIAL
CONCEPT
HOLISTIC
CONCEPT
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.
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
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
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 .
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,
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
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
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
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
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.
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:
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.
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
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
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.
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.
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.
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.
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.
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”
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.
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
Agent–Host–Environment
Model
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.
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.
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.
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
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
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
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
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.
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.
TRAVIS ILLNESS WELLNESS
CONTINNUM
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'.
MODEL OF HEALTH AND
ILLNESS
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 .
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.
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
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.
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
.
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
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.
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.
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.
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
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
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
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
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
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).
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.
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
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
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.
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
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.
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.
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.
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
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
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).
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.
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
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.
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.
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.
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
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
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
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.
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
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.
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
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.
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.
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.
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.
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.
• Vaccination
• Introduction of
Foreign molecules
in to the body
• Body generate imm.
Activ
e
• Presynthesised
elements of
immune system
• Antibodies
Passiv
e
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.
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.
• 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
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
Answer
keys:- 1.
(D)
2. (a)
3. (a)
4. (c)
5. (a)
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
•Answer
keys:- 1.
(d)
2. (a)
3. (b)
4. (a)
5. (d)
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.
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
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.
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
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
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
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.
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
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.
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
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.
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
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
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.
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:
• 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.
• 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.
Functions of Physiotherapist
are:
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.
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
• 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.
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.
• The Central Government
responsibility consists mainly
• of policy making , planning ,
guiding, assisting, evaluating
and
• coordinating the work of the
State Health Ministries.
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
DISTRICT
COLLECT
OR
SUBDIVISION 2-3
ASST./SUBCOLLEC
TOR
TALUKAS 200-600 VILLAGE
TEHSILD
AR
BLOCKDEV.OFFI
CER
COMMUNITY DEVELOPMENT
BLOCK
800000-120000 population
MUNICIPAL BOARDS MUNICIPAL
COMISSIONER
CORPORATION (ABOVE 200000)
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)
PANCHAYAT (AT THE VILLAGE
LEVEL):
The Panchayat Raj at the
village level consists of
The Gram Sabha
The Gram Panchayat
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.
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.
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.
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
(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
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
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.
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.
PRINCIPLES OF PRIMARY
HEALTH CARE
COMMUNIT
Y
PARTICIPATI
ON
EQUITABL
E
DISTRIBUTI
ON
PH
C
MULTI
SECTORI
AL
APPROA
CH
APPROPRI
ATE
HEALTH
TECHNOLO
GY
FOCUS
ON
PREVENTI
ON
• 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.
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
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.
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.
COMPONENTS OF PRIMARY
HEALTH CARE
PRIMA
RY
HEALTH
CARE
IMMUNIZATIO
N
HEALTH
EDUCATI
ON
MCH
CARE
SANITATI
ON
ADEQUA
TE
NUTRITI
ON
PRAMOTION
OF MENTAL
HEALTH
PREVENTI
ON OF
ILLNESS
PROVISION
OF
DRUGS
• 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
ROLE OF NURSE IN
PHC
Direct
care
provider
Teacher
&
Educato
r
Superviso
r &
Manager
Researche
r
Evaluator
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.
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
• 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
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,
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 .
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).
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
CLASSIFICATION
ACCORDING TO
SYSTEM
• Allopathic hospitals,
• Ayurveda hospitals
• Homeopathic hospitals,
• Unani hospitals,
• Hospitals of other systems
of medicine.
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,
• 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,
• 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.
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING
UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING

More Related Content

What's hot

Florence nightingale’s environment theory
Florence nightingale’s environment theoryFlorence nightingale’s environment theory
Florence nightingale’s environment theoryShrooti Shah
 
Community Health Nursing (complete)
Community Health Nursing (complete)Community Health Nursing (complete)
Community Health Nursing (complete)MarkFredderickAbejo
 
Concept of health and illness
Concept of health and illnessConcept of health and illness
Concept of health and illnessYoussef2000
 
Margaret Newman's Health As Expanding Consciousness
Margaret Newman's Health As Expanding ConsciousnessMargaret Newman's Health As Expanding Consciousness
Margaret Newman's Health As Expanding ConsciousnessJosephine Ann Necor
 
Application of theory to nursing practice
Application of theory to nursing practiceApplication of theory to nursing practice
Application of theory to nursing practiceArun Madanan
 
Health Care Programs
Health Care ProgramsHealth Care Programs
Health Care ProgramsPaolo Zabat
 
Virginia henderson's theory of nursing
Virginia henderson's theory of nursingVirginia henderson's theory of nursing
Virginia henderson's theory of nursingMandeep Gill
 
Concept of Health and Illness
Concept of Health and IllnessConcept of Health and Illness
Concept of Health and IllnessChanak Trikhatri
 
Nursing Theories in the context of ASSESSMENT (2)
Nursing Theories in the context of ASSESSMENT (2)Nursing Theories in the context of ASSESSMENT (2)
Nursing Theories in the context of ASSESSMENT (2)May Vallerie Sarmiento
 
Foundations of Nursing
Foundations of NursingFoundations of Nursing
Foundations of NursingTosca Torres
 
Factors affecting community health
Factors affecting community healthFactors affecting community health
Factors affecting community healthMiharbi Ignasm
 
Martha rogers theory
Martha rogers theoryMartha rogers theory
Martha rogers theoryankita Patel
 
Models of health and illness
Models of health and illnessModels of health and illness
Models of health and illnessSiva Nanda Reddy
 
Newman’s theory of health as expanding consciousness
Newman’s theory of health as expanding consciousnessNewman’s theory of health as expanding consciousness
Newman’s theory of health as expanding consciousnessحسين منصور
 

What's hot (20)

Florence nightingale’s environment theory
Florence nightingale’s environment theoryFlorence nightingale’s environment theory
Florence nightingale’s environment theory
 
Community Health Nursing (complete)
Community Health Nursing (complete)Community Health Nursing (complete)
Community Health Nursing (complete)
 
Health promotion model
Health promotion model Health promotion model
Health promotion model
 
Health promotion model
Health promotion modelHealth promotion model
Health promotion model
 
Concept of health and illness
Concept of health and illnessConcept of health and illness
Concept of health and illness
 
Nursing process assessing
Nursing process   assessingNursing process   assessing
Nursing process assessing
 
Margaret Newman's Health As Expanding Consciousness
Margaret Newman's Health As Expanding ConsciousnessMargaret Newman's Health As Expanding Consciousness
Margaret Newman's Health As Expanding Consciousness
 
Application of theory to nursing practice
Application of theory to nursing practiceApplication of theory to nursing practice
Application of theory to nursing practice
 
Nursing as a profession
Nursing as a professionNursing as a profession
Nursing as a profession
 
Health Care Programs
Health Care ProgramsHealth Care Programs
Health Care Programs
 
Virginia henderson's theory of nursing
Virginia henderson's theory of nursingVirginia henderson's theory of nursing
Virginia henderson's theory of nursing
 
Concept of Health and Illness
Concept of Health and IllnessConcept of Health and Illness
Concept of Health and Illness
 
Human becoming theory
Human becoming theoryHuman becoming theory
Human becoming theory
 
Nursing Theories in the context of ASSESSMENT (2)
Nursing Theories in the context of ASSESSMENT (2)Nursing Theories in the context of ASSESSMENT (2)
Nursing Theories in the context of ASSESSMENT (2)
 
Foundations of Nursing
Foundations of NursingFoundations of Nursing
Foundations of Nursing
 
Factors affecting community health
Factors affecting community healthFactors affecting community health
Factors affecting community health
 
NCM 100 *LECTURES*
NCM 100  *LECTURES*NCM 100  *LECTURES*
NCM 100 *LECTURES*
 
Martha rogers theory
Martha rogers theoryMartha rogers theory
Martha rogers theory
 
Models of health and illness
Models of health and illnessModels of health and illness
Models of health and illness
 
Newman’s theory of health as expanding consciousness
Newman’s theory of health as expanding consciousnessNewman’s theory of health as expanding consciousness
Newman’s theory of health as expanding consciousness
 

Similar to UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING

INTRODUCTORY CONCEPTS of fundamentals of nursing
INTRODUCTORY CONCEPTS of fundamentals of nursingINTRODUCTORY CONCEPTS of fundamentals of nursing
INTRODUCTORY CONCEPTS of fundamentals of nursingJRRolfNeuqelet
 
Overall Concept of health and disease.pdf
Overall Concept of health and disease.pdfOverall Concept of health and disease.pdf
Overall Concept of health and disease.pdfgrgodge
 
unit1-introdutiontohealth-160428103929.pdf
unit1-introdutiontohealth-160428103929.pdfunit1-introdutiontohealth-160428103929.pdf
unit1-introdutiontohealth-160428103929.pdfjesudiannath1
 
Unit 1 introdution to health
Unit 1   introdution to healthUnit 1   introdution to health
Unit 1 introdution to healthvruti patel
 
Concept of Health and Diseases- B.Pharm Semester 7
Concept of Health and Diseases- B.Pharm Semester 7Concept of Health and Diseases- B.Pharm Semester 7
Concept of Health and Diseases- B.Pharm Semester 7vedanshu malviya
 
concept of health and disease, public health.pptx
concept of health and disease, public health.pptxconcept of health and disease, public health.pptx
concept of health and disease, public health.pptxVarshaTambe6
 
Health and Changing concept of Health Lecture
Health and  Changing concept of Health LectureHealth and  Changing concept of Health Lecture
Health and Changing concept of Health LectureDr.Farhana Yasmin
 
Concepts of health and disease
Concepts of health and disease Concepts of health and disease
Concepts of health and disease Namita Batra
 
Concept of health and disease
Concept of health and disease  Concept of health and disease
Concept of health and disease Namdeo Shinde
 
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptx
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptxPARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptx
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptxHendriHeriyanto
 
Dimensions of health
Dimensions of healthDimensions of health
Dimensions of healthkunal770909
 
CONCEPTS OF HEALTH AND DISEASE
CONCEPTS OF HEALTH AND DISEASECONCEPTS OF HEALTH AND DISEASE
CONCEPTS OF HEALTH AND DISEASESuraj Dhara
 
concepts of health & health economics.pptx
concepts of health & health economics.pptxconcepts of health & health economics.pptx
concepts of health & health economics.pptxversha26
 
holistic health ppt.pptx
holistic health ppt.pptxholistic health ppt.pptx
holistic health ppt.pptxseeyarayamajhi
 

Similar to UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING (20)

INTRODUCTORY CONCEPTS of fundamentals of nursing
INTRODUCTORY CONCEPTS of fundamentals of nursingINTRODUCTORY CONCEPTS of fundamentals of nursing
INTRODUCTORY CONCEPTS of fundamentals of nursing
 
CHN Unit-I.docx
CHN Unit-I.docxCHN Unit-I.docx
CHN Unit-I.docx
 
Health disease and epidemiology
Health disease and epidemiologyHealth disease and epidemiology
Health disease and epidemiology
 
Introduction to Health.pptx
Introduction to Health.pptxIntroduction to Health.pptx
Introduction to Health.pptx
 
Overall Concept of health and disease.pdf
Overall Concept of health and disease.pdfOverall Concept of health and disease.pdf
Overall Concept of health and disease.pdf
 
unit1-introdutiontohealth-160428103929.pdf
unit1-introdutiontohealth-160428103929.pdfunit1-introdutiontohealth-160428103929.pdf
unit1-introdutiontohealth-160428103929.pdf
 
Unit 1 introdution to health
Unit 1   introdution to healthUnit 1   introdution to health
Unit 1 introdution to health
 
Concept of Health and Diseases- B.Pharm Semester 7
Concept of Health and Diseases- B.Pharm Semester 7Concept of Health and Diseases- B.Pharm Semester 7
Concept of Health and Diseases- B.Pharm Semester 7
 
Concept of health and disease
Concept of health and diseaseConcept of health and disease
Concept of health and disease
 
concept of health and disease, public health.pptx
concept of health and disease, public health.pptxconcept of health and disease, public health.pptx
concept of health and disease, public health.pptx
 
Concept and Dimensions of Health
Concept and Dimensions of HealthConcept and Dimensions of Health
Concept and Dimensions of Health
 
Health and Changing concept of Health Lecture
Health and  Changing concept of Health LectureHealth and  Changing concept of Health Lecture
Health and Changing concept of Health Lecture
 
Concepts of health,
Concepts of health,Concepts of health,
Concepts of health,
 
Concepts of health and disease
Concepts of health and disease Concepts of health and disease
Concepts of health and disease
 
Concept of health and disease
Concept of health and disease  Concept of health and disease
Concept of health and disease
 
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptx
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptxPARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptx
PARADIGMA KEPERAWATAN DALAM KONSEP PHILOSOPHYHENDRI PMB .pptx
 
Dimensions of health
Dimensions of healthDimensions of health
Dimensions of health
 
CONCEPTS OF HEALTH AND DISEASE
CONCEPTS OF HEALTH AND DISEASECONCEPTS OF HEALTH AND DISEASE
CONCEPTS OF HEALTH AND DISEASE
 
concepts of health & health economics.pptx
concepts of health & health economics.pptxconcepts of health & health economics.pptx
concepts of health & health economics.pptx
 
holistic health ppt.pptx
holistic health ppt.pptxholistic health ppt.pptx
holistic health ppt.pptx
 

More from VemuJhansi

FEMALE PELVIS.pptx
FEMALE PELVIS.pptxFEMALE PELVIS.pptx
FEMALE PELVIS.pptxVemuJhansi
 
UNIT -I NURSING EDUCATION.pptx
UNIT -I NURSING EDUCATION.pptxUNIT -I NURSING EDUCATION.pptx
UNIT -I NURSING EDUCATION.pptxVemuJhansi
 
Nursing as a profession detailed
Nursing as a profession detailedNursing as a profession detailed
Nursing as a profession detailedVemuJhansi
 
Documentation and reporting
Documentation and reportingDocumentation and reporting
Documentation and reportingVemuJhansi
 
Fluid and electrolytes, balance and disturbances ppt
Fluid and electrolytes, balance and disturbances pptFluid and electrolytes, balance and disturbances ppt
Fluid and electrolytes, balance and disturbances pptVemuJhansi
 
Isolation precautions
Isolation precautions Isolation precautions
Isolation precautions VemuJhansi
 

More from VemuJhansi (9)

FEMALE PELVIS.pptx
FEMALE PELVIS.pptxFEMALE PELVIS.pptx
FEMALE PELVIS.pptx
 
UNIT -I NURSING EDUCATION.pptx
UNIT -I NURSING EDUCATION.pptxUNIT -I NURSING EDUCATION.pptx
UNIT -I NURSING EDUCATION.pptx
 
Nursing as a profession detailed
Nursing as a profession detailedNursing as a profession detailed
Nursing as a profession detailed
 
Documentation and reporting
Documentation and reportingDocumentation and reporting
Documentation and reporting
 
Fluid and electrolytes, balance and disturbances ppt
Fluid and electrolytes, balance and disturbances pptFluid and electrolytes, balance and disturbances ppt
Fluid and electrolytes, balance and disturbances ppt
 
Isolation precautions
Isolation precautions Isolation precautions
Isolation precautions
 
Copd ppt (1)
Copd ppt (1)Copd ppt (1)
Copd ppt (1)
 
Emphysema ppt
Emphysema pptEmphysema ppt
Emphysema ppt
 
Hygiene
HygieneHygiene
Hygiene
 

Recently uploaded

Concept of Vouching. B.Com(Hons) /B.Compdf
Concept of Vouching. B.Com(Hons) /B.CompdfConcept of Vouching. B.Com(Hons) /B.Compdf
Concept of Vouching. B.Com(Hons) /B.CompdfUmakantAnnand
 
The basics of sentences session 2pptx copy.pptx
The basics of sentences session 2pptx copy.pptxThe basics of sentences session 2pptx copy.pptx
The basics of sentences session 2pptx copy.pptxheathfieldcps1
 
Science 7 - LAND and SEA BREEZE and its Characteristics
Science 7 - LAND and SEA BREEZE and its CharacteristicsScience 7 - LAND and SEA BREEZE and its Characteristics
Science 7 - LAND and SEA BREEZE and its CharacteristicsKarinaGenton
 
Accessible design: Minimum effort, maximum impact
Accessible design: Minimum effort, maximum impactAccessible design: Minimum effort, maximum impact
Accessible design: Minimum effort, maximum impactdawncurless
 
MENTAL STATUS EXAMINATION format.docx
MENTAL     STATUS EXAMINATION format.docxMENTAL     STATUS EXAMINATION format.docx
MENTAL STATUS EXAMINATION format.docxPoojaSen20
 
Separation of Lanthanides/ Lanthanides and Actinides
Separation of Lanthanides/ Lanthanides and ActinidesSeparation of Lanthanides/ Lanthanides and Actinides
Separation of Lanthanides/ Lanthanides and ActinidesFatimaKhan178732
 
Alper Gobel In Media Res Media Component
Alper Gobel In Media Res Media ComponentAlper Gobel In Media Res Media Component
Alper Gobel In Media Res Media ComponentInMediaRes1
 
Paris 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityParis 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityGeoBlogs
 
Hybridoma Technology ( Production , Purification , and Application )
Hybridoma Technology  ( Production , Purification , and Application  ) Hybridoma Technology  ( Production , Purification , and Application  )
Hybridoma Technology ( Production , Purification , and Application ) Sakshi Ghasle
 
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17Celine George
 
Introduction to AI in Higher Education_draft.pptx
Introduction to AI in Higher Education_draft.pptxIntroduction to AI in Higher Education_draft.pptx
Introduction to AI in Higher Education_draft.pptxpboyjonauth
 
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptx
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptxPOINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptx
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptxSayali Powar
 
BASLIQ CURRENT LOOKBOOK LOOKBOOK(1) (1).pdf
BASLIQ CURRENT LOOKBOOK  LOOKBOOK(1) (1).pdfBASLIQ CURRENT LOOKBOOK  LOOKBOOK(1) (1).pdf
BASLIQ CURRENT LOOKBOOK LOOKBOOK(1) (1).pdfSoniaTolstoy
 
Interactive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationInteractive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationnomboosow
 
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...M56BOOKSTORE PRODUCT/SERVICE
 
Employee wellbeing at the workplace.pptx
Employee wellbeing at the workplace.pptxEmployee wellbeing at the workplace.pptx
Employee wellbeing at the workplace.pptxNirmalaLoungPoorunde1
 
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...EduSkills OECD
 
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPT
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPTECONOMIC CONTEXT - LONG FORM TV DRAMA - PPT
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPTiammrhaywood
 

Recently uploaded (20)

Concept of Vouching. B.Com(Hons) /B.Compdf
Concept of Vouching. B.Com(Hons) /B.CompdfConcept of Vouching. B.Com(Hons) /B.Compdf
Concept of Vouching. B.Com(Hons) /B.Compdf
 
The basics of sentences session 2pptx copy.pptx
The basics of sentences session 2pptx copy.pptxThe basics of sentences session 2pptx copy.pptx
The basics of sentences session 2pptx copy.pptx
 
Science 7 - LAND and SEA BREEZE and its Characteristics
Science 7 - LAND and SEA BREEZE and its CharacteristicsScience 7 - LAND and SEA BREEZE and its Characteristics
Science 7 - LAND and SEA BREEZE and its Characteristics
 
Accessible design: Minimum effort, maximum impact
Accessible design: Minimum effort, maximum impactAccessible design: Minimum effort, maximum impact
Accessible design: Minimum effort, maximum impact
 
MENTAL STATUS EXAMINATION format.docx
MENTAL     STATUS EXAMINATION format.docxMENTAL     STATUS EXAMINATION format.docx
MENTAL STATUS EXAMINATION format.docx
 
TataKelola dan KamSiber Kecerdasan Buatan v022.pdf
TataKelola dan KamSiber Kecerdasan Buatan v022.pdfTataKelola dan KamSiber Kecerdasan Buatan v022.pdf
TataKelola dan KamSiber Kecerdasan Buatan v022.pdf
 
Separation of Lanthanides/ Lanthanides and Actinides
Separation of Lanthanides/ Lanthanides and ActinidesSeparation of Lanthanides/ Lanthanides and Actinides
Separation of Lanthanides/ Lanthanides and Actinides
 
Alper Gobel In Media Res Media Component
Alper Gobel In Media Res Media ComponentAlper Gobel In Media Res Media Component
Alper Gobel In Media Res Media Component
 
Paris 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activityParis 2024 Olympic Geographies - an activity
Paris 2024 Olympic Geographies - an activity
 
Hybridoma Technology ( Production , Purification , and Application )
Hybridoma Technology  ( Production , Purification , and Application  ) Hybridoma Technology  ( Production , Purification , and Application  )
Hybridoma Technology ( Production , Purification , and Application )
 
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
 
Introduction to AI in Higher Education_draft.pptx
Introduction to AI in Higher Education_draft.pptxIntroduction to AI in Higher Education_draft.pptx
Introduction to AI in Higher Education_draft.pptx
 
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptx
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptxPOINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptx
POINT- BIOCHEMISTRY SEM 2 ENZYMES UNIT 5.pptx
 
BASLIQ CURRENT LOOKBOOK LOOKBOOK(1) (1).pdf
BASLIQ CURRENT LOOKBOOK  LOOKBOOK(1) (1).pdfBASLIQ CURRENT LOOKBOOK  LOOKBOOK(1) (1).pdf
BASLIQ CURRENT LOOKBOOK LOOKBOOK(1) (1).pdf
 
Interactive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communicationInteractive Powerpoint_How to Master effective communication
Interactive Powerpoint_How to Master effective communication
 
Model Call Girl in Bikash Puri Delhi reach out to us at 🔝9953056974🔝
Model Call Girl in Bikash Puri  Delhi reach out to us at 🔝9953056974🔝Model Call Girl in Bikash Puri  Delhi reach out to us at 🔝9953056974🔝
Model Call Girl in Bikash Puri Delhi reach out to us at 🔝9953056974🔝
 
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...
KSHARA STURA .pptx---KSHARA KARMA THERAPY (CAUSTIC THERAPY)————IMP.OF KSHARA ...
 
Employee wellbeing at the workplace.pptx
Employee wellbeing at the workplace.pptxEmployee wellbeing at the workplace.pptx
Employee wellbeing at the workplace.pptx
 
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
Presentation by Andreas Schleicher Tackling the School Absenteeism Crisis 30 ...
 
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPT
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPTECONOMIC CONTEXT - LONG FORM TV DRAMA - PPT
ECONOMIC CONTEXT - LONG FORM TV DRAMA - PPT
 

UNIT 1 INTRODUCTION FUNDAMENTALS OF NURSING

  • 1.
  • 2. 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”
  • 3. 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
  • 5. 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.
  • 6. 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
  • 7. 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
  • 8. 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 .
  • 9. 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,
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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.
  • 15. 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:
  • 16. 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.
  • 17. 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
  • 18. 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
  • 19. 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.
  • 20. 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.
  • 21. 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.
  • 22. 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.
  • 23. 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.
  • 24. 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”
  • 25. 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.
  • 26. 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
  • 28. 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.
  • 29. 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.
  • 30. 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.
  • 31. 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
  • 32.
  • 33. 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
  • 34. 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
  • 35. 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
  • 36. 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.
  • 37. 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.
  • 39. 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'.
  • 40. MODEL OF HEALTH AND ILLNESS
  • 41. 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 .
  • 42. 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.
  • 43. 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
  • 44. 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.
  • 45. 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 .
  • 46. 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
  • 47. 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.
  • 48. 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.
  • 49. 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.
  • 50. 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
  • 51. 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
  • 52. 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
  • 53. 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
  • 54. 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
  • 55. 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).
  • 56. 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.
  • 57. 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
  • 58. 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
  • 59. 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.
  • 60. 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
  • 61. 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.
  • 62. 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.
  • 63. 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.
  • 64. 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
  • 65. 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
  • 66. 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).
  • 67. 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.
  • 68. 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
  • 69.
  • 70. 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.
  • 71. 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.
  • 72. 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.
  • 73. 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
  • 74. 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
  • 75. 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
  • 76. 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.
  • 77. 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
  • 78. 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.
  • 79. 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
  • 80. 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.
  • 81. 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.
  • 82. 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.
  • 83. 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.
  • 84. 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.
  • 85. • Vaccination • Introduction of Foreign molecules in to the body • Body generate imm. Activ e • Presynthesised elements of immune system • Antibodies Passiv e
  • 86. 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.
  • 87. 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.
  • 88. • 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
  • 89. 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
  • 90. Answer keys:- 1. (D) 2. (a) 3. (a) 4. (c) 5. (a)
  • 91. 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
  • 93.
  • 94. 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.
  • 95. 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
  • 96. 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.
  • 97. 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
  • 98. 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
  • 99. 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
  • 100. 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.
  • 101. 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
  • 102. 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.
  • 103. 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
  • 104. 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.
  • 105. 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
  • 106. 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
  • 107. 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.
  • 108. 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:
  • 109. • 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.
  • 110. • 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.
  • 112. 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.
  • 113. 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
  • 114. • 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.
  • 115. 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.
  • 116. • The Central Government responsibility consists mainly • of policy making , planning , guiding, assisting, evaluating and • coordinating the work of the State Health Ministries.
  • 117. 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
  • 118. DISTRICT COLLECT OR SUBDIVISION 2-3 ASST./SUBCOLLEC TOR TALUKAS 200-600 VILLAGE TEHSILD AR BLOCKDEV.OFFI CER COMMUNITY DEVELOPMENT BLOCK 800000-120000 population MUNICIPAL BOARDS MUNICIPAL COMISSIONER CORPORATION (ABOVE 200000)
  • 119. 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)
  • 120. PANCHAYAT (AT THE VILLAGE LEVEL): The Panchayat Raj at the village level consists of The Gram Sabha The Gram Panchayat
  • 121. 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.
  • 122. 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.
  • 123. 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.
  • 124. 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
  • 125. (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
  • 126. 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
  • 127. 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.
  • 128. 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.
  • 129. PRINCIPLES OF PRIMARY HEALTH CARE COMMUNIT Y PARTICIPATI ON EQUITABL E DISTRIBUTI ON PH C MULTI SECTORI AL APPROA CH APPROPRI ATE HEALTH TECHNOLO GY FOCUS ON PREVENTI ON
  • 130. • 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.
  • 131. 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
  • 132. 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.
  • 133. 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.
  • 134. COMPONENTS OF PRIMARY HEALTH CARE PRIMA RY HEALTH CARE IMMUNIZATIO N HEALTH EDUCATI ON MCH CARE SANITATI ON ADEQUA TE NUTRITI ON PRAMOTION OF MENTAL HEALTH PREVENTI ON OF ILLNESS PROVISION OF DRUGS
  • 135. • 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
  • 136. ROLE OF NURSE IN PHC Direct care provider Teacher & Educato r Superviso r & Manager Researche r Evaluator
  • 137. 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.
  • 138. 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
  • 139. • 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
  • 140. 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,
  • 141. 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 .
  • 142. 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).
  • 143. 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
  • 144. CLASSIFICATION ACCORDING TO SYSTEM • Allopathic hospitals, • Ayurveda hospitals • Homeopathic hospitals, • Unani hospitals, • Hospitals of other systems of medicine.
  • 145. 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,
  • 146. • 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,
  • 147. • 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.