Comprehensive Textbook of Foundation of Nursing Rebecca Nissanka
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Introduction: Concept of HealthCHAPTER 1

 
DEFINITION OF HEALTH
 
The World Health Organization (WHO) Defines
Health as a “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (WHO 1947). Many other aspects of health need to be considered. Health is a state of being what people define in relation to their own values, personality, and lifestyle. Each person has a personal concept of health.
Pender, Murdaugh and Parsons (2002) define health as the actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others, while adjustments are made as needed to maintain structural integrity and harmony with the environment.
Individual's views of health can vary among different age-groups, gender, race and culture. All people free of disease are not equally healthy. Views of health have broadened to include mental, social, and spiritual well-being as we focus on health at the family and community levels.
To help clients identify and reach health goals, the nurse must discover and use information about their concepts of health. Pender “for many people conditions of life rather than pathological states are what define health.” Life conditions can have positive or negative effects on health before an illness is evident. Life conditions may include socioeconomic variables such as environment, diet and lifestyle practices or choices, as well as many other physiological and psychological variables.
Health and illness must be defined in terms of the individual, health can include conditions previously considered to be illness. For example, a person with epilepsy who has learned to control seizures with medication and who functions at home and at work may no longer consider himself or herself ill. Nurse's attitudes toward health and illness should consider the total person, as well as the environment in which the person lives, to individualize nursing care and enhance meaningfulness of the client's future health status.
To the layman, health implies a sound mind, in sound body, in a sound family, and in a sound environment.
Health is the absence of disease. Being at peace with self, the community, God and cosmos.
Nursing as a profession aims at promoting health, preventing disease and providing holistic nursing care to patients where their physical, social and spiritual needs are to be taken into consideration.
The widely accepted definition of health as given by the World Health Organization (WHO) in 1948, states.
Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity.
Health is being well and using to the fullest extent every power we have.
Florence Nightingale
Health is a condition of being sound in body, mind and spirit especially freedom from physical disease or pain.
Webster's Dictionary
Health is the soundness of body on mind, that condition in which its functions are duty and efficiently discharged.
Oxford English Dictionary
Health is that state of moral, mental and physical well-being which enables a person to face any crisis in life with the almost grace (of God) and facility.
Pericles
Health in its broadest sense is a dynamic state in which the individual adapts to changes in internal and external environment to maintain a state of well-being.
Internal environment includes many factors that influence on health, including psychological variables, intellectual and spiritual dimensions and disease processes.
External environment include factors outside the person that may influences on health, including physical environment, social relationship and economic variables.
 
Changing Concepts
  • Biomedical concepts: Traditionally, health has been worded as an absence of disease and if one was free from disease, then the person was considered healthy this concept is known as ‘Biomedical concept’. The medical 2profession viewed the human body as a machine, disease as a consequence of the breakdown of the machine and one of the doctor's task as repair of the machine.
  • Ecological concept: The ecological concept raised two issues, imperfect man and imperfect environment. History argues strongly that improvement in human adaptation to natural environment can lead to longer life expectancies and a better quality of life.
  • Psychosocial concept: Health is not only a biomedical phenomenon, but one which is influenced by social, psychological, cultural, economical and political factors of the people concerned that factors must be taken into consideration in defining and measuring health. Thus health is both biological and social phenomenon.
  • Holistic concept: The holistic model is a synthesis of all the abacus concepts. If reorganize the strength of social, economic, political and environmental influences on health.
 
DETERMINANTS OF HEALTH
Health is multifactorial. Important determinates of health include:
  • Heredity
  • Environment
  • Lifestyle
  • Socioeconomic condition
  • Health and family welfare services
  • Other factors.
 
Model of Health and Illness
A model is a theoretical way of understanding a concept or idea. Models represent different ways of approaching complex issues, because health and illness are complex concepts, models are used to understand the relationships between these concepts and client's attitudes toward health and health behaviors.
Health beliefs are person's ideas, convictions, and attitudes about health and illness. They may be based on factual information or misinformation, common sense or myths, or reality or false expectations. Because health beliefs usually influence health behavior, they can positively or negatively affect a client's level of health. Positive health behaviors are activities related to maintaining, attaining or regaining good health and preventing illness. Common positive health behaviors include immunization, proper sleep patterns, adequate exercise, and nutrition. Negative health behaviors include practices actually or potentially harmful to health such as smoking drug or alcohol abuse, poor diet and refusal to take necessary medications.
Nurses have developed the following health models to understand client's attitudes and values about health and nursing models allow nurses to understand and predict client's health behavior including how they use health services and adhere to recommended therapy.
 
HEALTH-ILLNESS CONTINUUM MODEL
According to the health-illness continuum model as given by Betty Neuman. Health is a dynamic state that fluctuates 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 (Fig. 1.1).
Illness is a process in which the functioning of a person is diminished and impaired in one a more dimensions when compared with the person's previous conditions.
Because health and illness are relative qualities, existing in varying degrees, it may be more useful to consider health and illness in terms of a point on a scale or a continuum rather than as an absolute state.
High level wellness and severe illness (premature death) are at opposite ends of the continuum.
According to Neuman (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 represent total energy depletion.”
A nurse can determine a client's level of health at any point on the health illness continuum.
Central to the health-illness continuum model are risk factors which are important in identifying the level of health. Risk factors include genetic and physiological variables such as age, lifestyle and environment. As a person progresses through the developmental stages certain risk factors are more common than others.
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Fig. 1.1: Health-illness continuum model
3
The way the clients view their level of health depend on their attitudes towards health, values, beliefs and perceptions of their physical, emotional, intellectual, social, developmental and spiritual well-being.
 
Advantages
The health illness continuum is most effective when used to compare a client's present level of health with the client's own previous level of health.
Subsequently, it is useful as the nurse helps the client set goals to attain a future level of health.
 
Disadvantages
It is not always easy to describe a client's level of health in terms of one point between two extremes. For example, a man with a broken leg but who has adapted to limited mobility is more as less healthy than a physically healthy man experiencing severe depression after the death of a spouse.
 
FACTORS INFLUENCING HEALTH (FIG. 1.2)
  • Physiological factors and genetic factors: Physiological changes, e.g. pregnancy and certain genetic factors cause increased susceptibility to illness.
  • Age: As age increases, there is increased susceptibility to certain illnesses.
  • Environment: The physical environment in which a person works or lives can increase the likelihood of certain illness.
  • Lifestyle factors: Lifestyle practices, habits, activities, behaviors have a positive or negative effect on health.
 
Dimensions of Health
Health is multidimensional. The factors that influence health and illness related to the person in terms of the human dimension are as follows:
Though the WHO definition envisages three specific dimensions physical, mental and social, but every person is composite of physical dimension, emotional dimension environmental dimension, intellectual dimension, socio-cultural dimension and spiritual dimension and each dimension influence the behavior of the person receiving care (Fig. 1.2).
zoom view
Fig. 1.2: Factors influencing health
 
Factors Affecting Health and Illness (Fig. 1.2)
  • Physical dimension: The state of physical health implies the notion of perfect functioning of the body. It conceptualizes health biologically as a state in which every cell and organ is functioning at optimum capacity and in perfect harmony with the rest with body. It includes genetic make up age developmental level, race and sex. All are parts of individuals which strongly influence health status and health practices.
  • Mental/intellectual dimension: Mental health has been defined as a state of balance between the individual and the surrounding world, a state of harmony between oneself and that of other people and that of the environment.
  • Sociocultural dimension: It is defined as quality and quantity of an individuals interpersonal lives and the extent of involvement with the community. The social dimension of health includes the level of social skills one possesses, social functioning and the ability to set oneself as a member of a larger society. It includes individuals economic level, educational status, lifestyle, family and culture. These are all which influence on the health and illness of people.
  • Environmental dimension: It has many influences on health and illness. Housing, sanitation, climate and pollution of air, food and water are aspects of the environment, which cause illness.
  • Emotional dimension: It express that how the mind and body interact to effect body function and to respond to body. Emotions also influences health, long-term stress effects the body system and anxiety effects health habits. Calm acceptance and relaxation can actually change the body responses to illness. Historically mental and emotional health dimensions were considered same but mental health can be seen as knowing or cognition and emotional health relates to feeling.
  • Spiritual dimension: Spiritual and religious beliefs and values are the important component of how a person behaves in the health and illness. It is important that nurse respects these values and understand their importance to the individual's spirituality.
  • Practical skills as a dimension: When work is fully adapted to human goals, capacities and limitations, it often plays a role in promoting both physical and mental health. Goal achievement and self-realization in work is a source of satisfaction and enhanced self-esteem.4
  • Other dimensions:
    • Philosophical
    • Educational
    • Nutritional
    • Curative
    • Preventive.
 
CAUSES AND RISK FACTORS FOR DEVELOPING ILLNESS
A risk factor is any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increase the vulnerability of an individual or group to an illness or accident.
The presence of risk factors does not mean that a disease will develop, but risk factor increase the chances that the individual will experience a particular disease or dysfunction.
 
Risk Factors
It can be placed in the following interrelated categories: genetic and physiological factors, age, physical environment, and lifestyle.
 
Genetic and Physiological Factors
Physiological risk factors involve the physical functioning of the body. Certain physical conditions, such as being pregnant or overweight, place increased stress on physiological systems (e.g. the circulatory system), increasing susceptibility to illness in these areas. Heredity, or genetic predisposition to specific illness, is a major physical risk factor. For example, a person with a family history of diabetes mellitus is at risk for developing the disease later in life. Other documented genetic risk factors include family history of cancer, heart disease, kidney disease, or mental illness.
 
Age
Age increases or decreases susceptibility to certain illness. Age risk factors are often closely associated with other risk factors such as family history and personal habits. Nurses need to educate their clients about the importance of regularly scheduled check-ups for their age group.
 
Environment
Where we live and the condition of that area (its air, water, and soil) determine how we live, what we eat, the disease agents to which we are exposed, our state of health, and our ability to adapt. The physical environment in which a person works or lives can increase the likelihood that certain illness will occur. Nursing assessments extend from the individual to the family and the community in which they live.
 
Lifestyle
Many activities, habits, and practices involve risk factors. Lifestyle practices and behaviors can have positive or negative effects on health. Practices with potential negative effects are risk factors; these include sedentary lifestyle, overeating or poor nutrition, insufficient rest and sleep, and poor personal hygiene. Other habits that put a person at risk for illness include tobacco use, alcohol or drug abuse, unsafe sex, multiple sex partner, and activities involving a threat of injury, such as sky diving or mountain climbing. Some habits are risk factors for specific diseases. Nurses can educate their clients and the public on wellness-promoting lifestyle behaviors. Care must be taken however, not to blame clients for their illness. Stress can be a lifestyle risk factor if it is severe or prolonged, or if the person is unable to cope with life events adequately. Stress can threaten mental health (emotional stress), as well as physical well-being (physiological stress). Stress may also interfere with health promotion activities and the ability to implement needed lifestyle modifications. Emotional stressors may result from life event such as divorce, pregnancy, death of a spouse or family members, and financial instabilities. Job-related stressors, for example, may overtax a person's cognitive skills and decision-making ability, leading to ‘mental overload’ or ‘burnout’.
The goal of risk factor identification is to merely assist clients in visualizing those areas in their life that can be modified or even eliminated to promote wellness and prevent illness.
 
BODY DEFENSES— IMMUNITY AND IMMUNIZATION
The term ‘immunity’ refers to the resistance exhibited by the host towards injury caused by micro-organisms and their products. Protection against infectious diseases is only one of the consequences of the immune response, which entirely is concerned with the reaction of the body against any foreign antigen.
 
Types of Immunity against Infectious Diseases
Innate or native immunity is the resistance to infections which an individual possesses by virtue of his genetic and constitutional make up. It is not affected by prior contact with microorganisms or immunization. It may be nonspecific, when it indicates a degree of resistance to infections in general, or specific where resistance to a particular pathogen is concerned.5
Innate immunity may be considered at the level of the species, race or individual. Species immunity refers to the total or relative refractoriness to a pathogen, shown by all members of a species. For instance, all human beings are totally unsusceptible to plant pathogens and to many animal pathogens. This immunity is something a person obtains by virtue of being a part of the human species. The mechanisms of species immunity are not clearly understood.
Within a species, different races may show differences in susceptibility to infections. This is known as racial immunity, the classic example of which is the high resistance of Algerian sheep to anthrax. Such racial differences are known to be genetic in origin, and by selection and in breeding, it is possible to develop, at will, races that possess high degrees of resistance or susceptibility to various pathogens.
The differences in innate immunity exhibited by different individuals in a race is known as individual immunity. The genetic basis of individual immunity is evident from studies on the incidence of infectious diseases in twins. It is well-documented that homozygous twins exhibit similar degrees of resistance or susceptibility to lepromatous leprosy and tuberculosis. Such correlation is not seen in heterozygous twins.
Several factors influence the level of innate immunity in an individual.
Age: The two extremes of life carry higher susceptibility to infectious diseases as compared with adults. The fetus in utero is normally protected from maternal infection by the placental barrier.
Hormonal influences: Endocrine disorders such as diabetes mellitus, hypothyroidism and adrenal dysfunction are associated with an enhanced susceptibility to infections. The high incidence of staphylococcal sepsis in diabetes may be related to the increased level of carbohydrates in tissues. Corticosteroids exert an important influence on the response to infection.
The elevated steroid level during pregnancy may be related to the heightened susceptibility of pregnant women to many infections.
Nutrition: The interaction between malnutrition and immunity is complex but, in general, both humeral and cell-mediated immune processes are reduced when there is malnutrition. Cell-mediated immune responses such as the Mantoux test become negative in severe protein deficiency, as in kwashiorkor. Because of its wide prevalence, malnutrition may well be the most common cause of immunodeficiency.
 
Acquired Immunity
The resistance that an individual acquires during life is known as acquired immunity as distinct from inborn innate immunity. Acquired immunity is of two types, active and passive. Active immunity is the resistance developed by an individual as a result of an antigenic stimulus. It is also known as adaptive immunity as it represents an adaptive response of the host to a specific pathogen or other antigen. This involves the active functioning of the host's immune apparatus leading to the synthesis of antibodies and/or the production of immunologically active cells. Active immunity set in only after a latent period which is required for the immunological machinery to be set in motion.
The resistance that is transmitted to a recipient in a ‘ready-made’ form is known as passive immunity. Here the recipient's immune system plays no active role. There is no antigenic stimulus; instead, preformed antibodies are administered. There is no latent period in passive immunity, protection being effective immediately after passive immunization. There is no negative phase. The immunity is transient, usually lasting for days or weeks, only till the passively transmitted antibodies are metabolized and eliminated. No secondary type response occurs in passive immunity. In fact, passive immunity diminishes in effect with repetition. When a foreign antibody is administered a second time, it is eliminated more rapidly than initially. Following the first injection of an antibody such as immune horse serum, the elimination is only by metabolic breakdown but during subsequent injection of horse serum, elimination is much quicker as it combines with antibodies to horse serum that would have been produced following its initial injection.
Passive immunization is less effective and provides an immunity inferior to that provided by active immunization. The main advantage of passive immunization is that it acts immediately and, therefore can be employed when ‘instant’ immunity is desired.
Active immunity may be natural or artificial:
Natural active immunity results from either a clinical or an unapparent infection by a parasite. A person who has recovered from an attack of measles develops natural active immunity.
Artificial active immunity is the resistance induced by vaccines. Vaccines are preparations of live or killed microorganisms or their products used for immunization.
Examples of vaccines are as follow:
  • Bacterial vaccines
    • Live (BCG vaccine for tuberculosis)
    • Killed (Cholera vaccine)
    • Subunit (Typhoid Vi antigen)
    • Bacterial products (Tetanus toxoid)
  • Viral vaccines
    • Live (Oral polio vaccine—Sabin)
    • Killed (Injectable polio vaccine—Salk)
    • Subunit (Hepatitis B vaccine).
Natural passive immunity is the resistance passively transferred from mother to baby. In human infants, maternal antibodies are transmitted predominantly through the placenta. The human colostrums, which is also rich in IgA antibodies resistant to intestinal digestion, gives protection6 to the neonate. The human fetus acquires some ability to synthesize antibodies (IgM) from about the twentieth week of life but its immunological capacity is still inadequate at birth. It is only by about the age of three months that the infant acquires a satisfactory level of immunological independence.
Artificial passive immunity is the resistance passively transferred to a recipient by the administration of antibodies. The agents used for this purpose are hyperimmune sera of animal or human origin, convalescent sera and pooled human gamma-globulin. These are used for prophylaxis and therapy. Equine hyperimmune sera such as anti-tetanus serum and ATS prepared from hyperimmunized horses used to be extensively employed. They gave temporary protection but carried the disadvantages of hypersensitivity and immune elimination. Human hyperimmunoglobulin (for example, tetanus immunoglobulin, TIG is free from those complications and also gives more lasting protection. Antisera of animal origin are now recommended only where human preparations are not available (antigas gangrene and antibotulinum sera; antivenous.
Convalescent sera (sera of patients recovering from infectious diseases) contain high levels of specific antibody. Pooled human gamma-globulin (gamma-globulin from pooled sera of healthy adults) contains antibodies against all common pathogens prevalent in the region. Convalescent sera and pooled human gamma-globulin are used for passive immunization against some virus infections (like viral hepatitis A). Human gammaglobulin is also used in the treatment of patients with some immunodeficiency.
Passive immunization is indicated for immediate and temporary protection in a no immune host faced with the threat of an infection, when there is insufficient time for active immunization to take effect. It is also indicated for the treatment of some infections. Passive immunization may also be employed for the suppression of active immunity, when the latter may be injurious. An example is the use of Rh immunoglobulin during delivery to prevent immune response to the Rhesus factor in Rh-negative women with Rh-positive babies.
Sometimes a combination of active and passive methods of immunization is employed. This is known as combined immunization is employed for immediate protection, combined immunization is to be preferred, as in the protection of a no immune individual with a tetanus-prone wound.
A special type of immunization is the injection of immunologically competent lymphocyte. This is known as adaptive immunity and does not have general application. Instead of whole lymphocytes, and extract of immunologically competent lymphocytes, known as the ‘transfer factor’, can be used. This has been attempted in the treatment of certain types of diseases (for example, lepromatous leprosy).
 
Measurement of Immunity
A simple method of testing immunity is to relate its level to some convenient indicator, such as demonstration of the specific antibody. The antibodies may be demonstrated by a variety of techniques such as agglutination, precipitation, complement fixation, hemagglutination inhibition, neutralization ELISA and others. In the absence of exact information as to which antigen of the pathogen constitutes the ‘protective antigen’, serological attempts to measure immunity are at best only approximation.
 
Local Immunity
The concept of local immunity, proposed by Besredka (1919–24), has gained importance in the treatment of infections which are localized or where it is operative in combating infection at the site of primary entry of the pathogen. This is achieved by the local intestinal immunity acquired either as a result of natural infection or immunization with the live oral vaccine.
 
Herd Immunity
This refers to the overall level of immunity in a community and is relevant in the control of epidemic diseases. When a large proportion of individuals in a community (herd) are immune to a pathogen, the herd immunity to pathogen is satisfactory. When herd immunity is low, epidemics are likely to occur on the introduction of a suitable pathogen, due to the presence of large numbers of susceptible individuals in the community.
 
ILLNESS AND ILLNESS BEHAVIOR
 
Introduction
Disease is a medical term meaning that there is a pathological change in the structure or function of the body or mind. It is a condition that has specific symptoms and boundaries.
An illness is the response, the person has, to a disease, it is an abnormal process in which the person's level of functioning is changed compared with a previous level. The response is different for each person, and is influenced by self-perception, the effects of changes in body, structure and functions, the effects of those changes on roles and relationships and cultural and spiritual values and beliefs.
 
Definitions
  • By Patrica a Potter: An abnormal process in which aspects of social, emotional or intellectual condition and function of a person are diminished or impaired.
  • Medical dictionary: Illness is a state in which a person's physical, emotional, intellectual, social, developmental or7 spiritual functioning is diminished or impaired compared with previous experience.
  • Nursing dictionary: Disease, sickness or the condition of being in poor health, either physically or mentally.
 
Classification
  • Acute illness
  • Chronic illness.
Acute illness: These are usually having a short duration, and is severe. The symptoms appeal abruptly, are intense and often subside after a relatively short period.
Chronic illness: Persists usually longer than 6 months and can also affect functioning in any dimension.
 
Factors Affecting Health and Illness
  • Physiological factors and genetic factors: Physiological changes, e.g. pregnancy and certain genetic factors–cause increased susceptibility to illness.
  • Age: As age increases, there is increased susceptibility to certain illnesses.
  • Environment: The physical environment in which a person works or lives can increase the likelihood of certain illness.
  • Lifestyle factors: Lifestyle practices, habits, activities, behaviors have a positive or negative effect on health.
 
Determinants of Illness Behavior
  • The visibility and recognizability of the illness symptoms.
  • The extent to which the person perceives the symptoms as serious (the person's estimate of the present and future roles).
  • The person's information, knowledge and cultural assumption and understanding realized to the perceived symptoms.
  • The extent to which symptoms disrupt family, work and social activities.
  • The frequency of the appearance of the symptoms and persistence.
  • The extent to which others exposed to the persons tolerate, the symptoms.
  • The extent to which basic needs are denied because of illness.
  • The extent to which meeting others limits with illness responses.
  • The extent to which the person gives other possible interpretation to the symptoms.
  • The availability and physical proximity of treatment resources and psychologically and monetary costs of taking action (including costs in time and effort, as well as costs such as stigma, social distance, and feelings of humiliation).
 
Stages of Illness Behavior
  • Symptom experience
  • Assumption of the sick role
  • Medical care contact
  • Dependent client role
  • Recovery and rehabilitation.
 
Symptoms Experience
During initial stage, a person is aware that something is wrong. A person usually recognizes a physical sensation or limitation in functioning but does not suspect specific diagnosis. The person's perception of a symptom include awareness of a physical change much as pain, rash or a lump evaluation of this change and decision that it is a symptoms of an illness and emotional response. For example, a 38-year-old woman detects a lump during monthly breast examination—due to hormonal changes, not cancer.
 
Assumption of the Sick Role
If symptoms persists and become severe, client assumes the sick role. At this point the illness become social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they should be excused from normal duties and role expectations. The social group recognizes the illness and may also support continued medication.
The assumption of the sick role results in emotional changes such as withdrawal or depression and physical changes. Emotional changes may be simple or complex, depending on the severity of the illness, the degree of disability, and anticipated length of the illness.
 
Medical Care Contact
If symptoms persist despite the home remedies become serve, or require emergency care, the person is motivated to seek professional health services.
 
Dependent Client Role
After accepting the illness and seeking treatment, the client enters this stage. Here the client depends on health care professional, for the relief of symptoms. The client accepts care, sympathy, and protection from the demands and stresses of life. A client adopts the dependent role in a health care institution, at home or in a community settings.8
The client also adjusts to the disruption of a daily schedule occupation family, and community.
 
Recovery and Rehabilitation
A client is said to be recovering from his illness when his symptoms of his disease are diminishing and his general condition is improving. On the health-illness continuum he/she is moving towards the side of high level of wellness.
 
Rehabilitation
It is a dynamic, health oriented process that assists an ill or disabled individual to achieve the greatest possible level of physical, mental, spiritual, social and economic functioning.
  • The rehabilitation process helps the person to achieve and acceptable quality of life with dignity, self-respect and independence.
  • Rehabilitation is an integral part of nursing.
  • The emphasis of rehabilitation is to restore the patient to independence or to the pre-illness or preinjury level of function in as short time as possible.
  • Realistic goals based on individual patient assessment are established with the patient to guide the rehabilitation program.
  • Every patient regardless of age, socioeconomic status, or diagnosis, has a right to rehabilitative services.
  • Economic advantage is that instead of being unemployed, the person is rehabilitated into employment. Instead of being dependent on society the person contributes to it.
 
ILLNESS
Illness is a state in which a person is physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience.
Illness is not synonymous with disease. Although nurses must be familiar with different kinds of diseases and their treatments, they are concerned more with illness, which may include disease but also includes the effects on functioning and well-being in all dimensions.
 
Types of Illness
Acute illness and chronic illness are two general classifications of illness. Both acute and chronic illness have the potential to be life-threatening.
  • Acute illness: Usually has a short duration and is severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. An acute illness may affect functioning in any dimension.
  • Chronic illness: Persists, usually longer than 6 months, and can affect functioning in any dimension. The client may fluctuate between maximal functioning and serious health relapses that may be life-threatening. A person with a chronic illness is similar to a person with a disability in that both have limitations (of varying degrees) in function resulting from either a pathological processes or an injury. Chronic illness and disabilities remain a leading health problem. A major role for nursing is to provide client education aimed at helping clients manage their illness or disability. The goal managing a chronic illness is to reduce the occurrence of symptoms or to improve the tolerance of symptoms. By enhancing wellness, nurses may help improve the quality of life for clients living with chronic illnesses or disabilities.
It is important to understand that clients with chronic disease and families of children with chronic diseases are phased with a process called normalization, in which they adapt to the diseases. There is a relationship between family members believes about their illness experiences and their illness management behaviors that affects the process of normalization.
 
ILLNESS BEHAVIOR
People who are ill generally act in a way that medical sociologist call illness behavior. It involves how people monitor their bodies, define and interpret their symptoms, take remedial action, and used the health care system. Personal history, social situation, social norms, and the opportunities and constraints of community institution can all affect illness behavior. Although there is a large variability in the way people react to an illness, illness behavior displayed in sickness can be used to manage life adversities. In other words, if people perceived themselves to be ill, illness behavior can be coping mechanisms.
 
Variable Influencing Illness and Illness Behavior
Just as health and health behavior are affected by internal and external variables, so are illness and illness behavior. Based on an understanding of these variable and behavior, nurses can plan individualized care to assist clients in coping with their illness at various stages of illness. The goal of nursing is to promote optimal functioning in all dimensions throughout an illness.
 
Internal Variables
  • Client's perception of symptoms: If clients believe that the systems of their illness disturb their normal routine, they are more likely to seek health care assistance than if they9 do not perceive the symptoms to disruptive. If clients believe that the symptoms are serious or perhaps life-threatening, they are also more likely to seek assistance however, such a perception can also have the opposite effects. Individual may fear serious illness, react by denying it, and not seek medical assistance.
  • The nature of illness: The nature of illness, either acute or chronic, can also affect a client's illness behavior. Clients with acute illness are likely to seek health care and comply readily with therapy on the other hand, a client with a chronic illness, in which the symptoms may be cured, but only partially relieved, may be motivated to comply with the therapy plan. Chronically ill clients may become less actively involved in their care, may experience greater frustration, and may comply less readily with care. Because nurses generally spend more time than other health care professionals with chronically ill clients, they are in the unique position of being able to assist these clients in overcoming problems related to illness behavior. Clients coping skills as well as his or her focus of control, are other external variables that affect the way the client behaves when ill.
 
External Variables
External variables influencing a client's illness behavior include:
  • Visibility of symptoms
  • Social group
  • Cultural background
  • Economic variables
  • Accessibility of the health care system
  • Social support.
The visibility of the symptoms of an illness can affect body image and illness behavior. A client with a visible symptom may be more likely to seek assistance than a client without such a visible symptom.
Client's social groups may assist them in recognizing the threat of illness or support the denial of potential illness. Families, friends, and coworkers all may influence client's illness behavior. Client's often react positively to social support while practicing positive health behaviors. A person's culture and ethnic background teaches the person how to be healthy, how to recognize illness, and how to be ill. The effects of disease and its interpretation vary according to cultural circumstances. Ethnic differences can influence decisions about health care and the use of diagnostic and health care services. Dietary practice among ethnic groups, occupations help by the certain cultural groups, and cultural beliefs are other factors that contribute to illness and the distribution of disease.
Economic variables influence the way a client reacts to illness. Because of economic constraints, a client may delay treatment and in many cases may continue to carry out daily activities. Client's access to the health care systems is a socioeconomic system that client's, entry into the system is complex or confusing, and some client's may seek no emergency medical care in an emergency department because they do not know how otherwise to obtain health care agency often influences how soon they enter the system after deciding to seek care.
 
IMPACT OF ILLNESS ON THE PATIENT AND FAMILY
Illness is never an isolated life event. The client and family must deal with changes resulting from illness and treatment. Each client responds uniquely to illness, and therefore nursing intervention must be individual.
 
Behavior and Emotional Changes
People react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness, the client's attitude towards it, the reaction of others to it, and the variables of illness behavior.
Short-term, nonlife-threatening illness evokes few behavioral changes in the functioning of the client or family.
Severe illness, particularly one that is life-threatening, can lead to more extensive emotional and behavioral changes, such as anxiety, shock, denial, anger, and withdrawal. These are common responses to the stress of illness. The nurse can develop interventions to assist the client and the family in coping with and adapting to this stress because the stressor itself cannot usually be changed.
 
Impact on Body Image
Body image is the subjective concept of physical appearance. Some illness result in changes in physical appearance, and client's and families react differently to these changes. Reactions of clients and families to changes in body image depend on the type of changes, their adaptive capacity the rate at which changes takes place, and the support services available.
When a change in body image occurs, such as results from a leg amputation, the clients generally adjust in the following phases: shock, withdrawal, acknowledgment, acceptance, and rehabilitation.
 
Impact on Self-concept
Self-concept is a mental self-image of strength and weakness in all aspects of personality. Self-concept depends in part on body image and roles but also includes other aspects of psychology and spirituality. The impact of illness on the self-concepts of10 clients and family members may be more complex and less readily observed than role changes.
Self-concept is important in relationship with other family members. A client whose self-concept changes because of illness may no longer meet family expectations, leading to tension or conflict. As a result, family members may change their interactions with the client. In the course of providing care, a nurse is able to observe changes in the client's self-concept (or in the self-concepts of family members) and develop a care plan to help them adjust to the changes resulting from the illness.
 
Impact on Family Roles
People have many roles in life, such as wage earner, decision maker, professional, child, sibling, or parent. When an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness. Role reversal is common. If a parent of an adult becomes ill and cannot carry out usual activities, the adult child often assumes many of the parent's responsibilities and in essence becomes a parent to the parent. Such a reversal of the usual situation can lead to stress, conflicting responsibilities for the adult child, or direct conflict over decision-making.
Such a change may be subtle and short-term or drastic and long-term. An individual and family generally adjust more easily to subtle, short-term changes. In most cases, they know that the role change is only temporary and will not require prolonged adjustment process similar to the grief process. The client and family often require specific counseling and guidance to assist them coping with the role changes.
 
Impact on Family Dynamics
Because of the effects of illness on the client and family, family dynamics often change. Family dynamics is the process by which the family functions, makes decisions, gives support to individual members, and copes with everyday changes and challenges. If a parent in a family becomes ill, family activities and decision-making often come to a halt as the other family members wait for the illness to pass, or they delay action because they are reluctant to assume the ill person's roles or responsibilities. Because of the effects of illness, family dynamics often change. The nurse must view the whole family as a client under stress, planning care to help the family regain the maximal level of functioning and well-being.
 
HEALTH CARE SERVICES
The term health care services cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion and health. The purpose of health services is to improve the health states of population. For example: Immunization of children can influence the incidence/prevalence of particular diseases. Provisions of safe water can prevent mortality and morbidity from water borne diseases. To be effective the health services must reach the social periphery, equitably, distributed, accessible at a cost the country and community can afford and socially acceptable.
 
HEALTH CARE DELIVERY SYSTEM
 
Levels of Care
  • Preventive Care
    • Education
    • Prevention
  • Primary Care
    • Early detection
    • Routine care
  • Secondary Care (Acute care)
    • Emergency treatment
    • Critical care (intense and elaborate diagnosis and treatment)
  • Tertiary Care (Special care)
    • Special care: Highly technical services for clients in a large geographical area.
  • Restorative Care
    • Intermediate follow-up care—Surgical, postoperative, routine care, routine medical care
    • Rehabilitation
    • Home care
  • Continuing Care
    • Long-term care
    • Chronic care
    • Personal care
    • Hospice care.
 
HEALTH PROMOTION, WELLNESS AND ILLNESS PREVENTION
 
Introduction
Health care has become increasingly focused on health promotion, wellness and illness prevention. The rapid use of health care cost has motivated people to seek ways of decreasing the incidence and minimizing the results of illness or disability.
 
Definition
By American Journal of Health Promotion.
“Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal11 health.”
Health and illness as affected by choices made by individuals. An individual takes responsibility for health and wellness that they affect a person's quality of life. Positive lifestyle choices and the avoidance of negative lifestyle choices may also pay a role in the prevention of illness. Prevention of illness has an economic impact in that it decreases health care costs.
 
Goals
The concept of health promotion, wellness and illness prevention are closely related and in practice overlap to some extent. All are focused on the future, the difference between them involves motivations and goals.
  • Health promotion activities such as routine exercise and good nutrition, help clients maintain or enhance their present levels of health. Health promotion activities motivate people to act positively to reach more stable levels of health.
  • Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management and self-responsibility. Wellness strategies are designated to help persons achieve new understanding and control of their lives.
  • Illness prevention activities such as immunization programs protect clients from actual and potential threats of health. Illness prevention activities and potential to health illness prevention activities motivate people to avoid decline in health or functional levels.
 
IMPORTANT OF NURSES
  • Nurses emphasize health promotion, wellness enhancing strategies and illness prevention activities as important forms of health.
  • The goal of total health program is to improve a client's level of well-being in all dimensions, not just physical health.
  • Total health program are based on the belief that many factors can affect a person's level of health.
  • Tobacco use, nutrition, alcohol use, habituating drug use, driving, exercise, sexuality and contraceptive use, family relationships, risk factors, modification, coping and adaptation.
 
Factors Influencing Health
  • Individual practices: Poor eating habits and little and no exercise.
  • Physical stressors: Poor living environment, exposures to air pollutions and an unsafe environment.
  • Hereditary and psychological stresses: Emotional, intellectual, social, development and spiritual factors.
    • Total health programs are directed at individuals changing their lifestyle by developing habits that can improve their level of health.
 
Specific Program for the Health Promotion
  • Programs for specific health care problems
  • Support groups for HIV infected persons
  • Exercise program for persons with heart disease
  • Stress reduction program for persons under stress.
Operation of health promotion, wellness education, illness prevention program:
  1. By health care agency.
  2. Independent operation.
  3. Corporation for health promotion of employees.
  4. Community health centers.
 
ROLE OF NURSES
  • Consultant
  • Referral service.
 
Goal
Improve client's level of health through preventive health services, environment protection and health education.
 
Types of Health Promotion Activities
  • Active strategies: Individuals are motivated to adopt specific health programs, e.g. weight reduction and smoking cessation requires client to be actively involved in measures to improve their present and future level of wellness and decrease risk for disease.
  • Passive strategies: Individuals gain from the activities of others without acting themselves, e.g. fluoridation of municipal drinking water, fortification of common salts with iodine.
 
LEVELS OF PREVENTION OR LEVELS OF PREVENTIVE CARE
 
Introduction
Nursing oriented to health promotion, wellness and illness prevention can be understood in terms of health activities on primary, secondary and tertiary levels (Tables 1.1 and 1.2).12
Table 1.1   The primary level of preventions by Leavell and Clark
Primary prevention
Specific prevention
  • Health education
  • Use of specific immunization.
  • Attention to personal hygiene.
  • Good standard of nursing adjusted to developmental phases of life.
  • Use of environmental sanitation.
  • Attention of personality development.
  • Protection against occupation hazards.
  • Provision of adequate housing and recreation as well as agreeable working conditions
  • Protection from accidents.
  • Marriage counseling and sore education.
  • Use of specific nutrients.
  • Genetic screening.
  • Protection from carcinogens.
Table 1.2   Leavell and Clark's secondary and tertiary levels of preventions
Secondary prevention
Tertiary prevention
  • Early diagnosis and prompt treatment.
  • Restoration and rehabilitation.
  • Case finding measures individuals and mass screening surveys.
  • Provision of hospital community facilities for training and education to maximize use of remaining capacities.
  • Selective examination to:
    • Cure and prevent disease process.
    • Prevent spread of communicable disease.
    • Prevent complications.
    • Shorten period of disability.
  • Education of public and industry to use rehabilitated persons to fullest possible extent.
  • Disability limitations
  • Selective placement.
  • Treatment to arrest disease process and prevent further complications.
  • Work therapy in hospitals.
  • Provision of facilities to limit disability and prevent death.
 
Primary Prevention
  • It is true preventions.
  • It precedes disease or dysfunction and is applied to client consider physically and emotionally healthy.
  • Primary prevention aimed at health promotion, includes health education programs, immunization and physical and nutritional fitness activities. It can be provided to an individual or to a general population. Or it can focus or individuals risk for developing specific diseases.
  • Wellness activities are synonymous with the activities identified for primary prevention (by Level l+ Clark 1965).
  • Primary prevention includes all health promotion efforts, as well as wellness activities that focus on maintaining or improving the general health of individuals, families and communities.
 
Secondary Prevention
  • Secondary prevention focuses on individuals who are experiencing health problems or illness and who are at risk for developing complications or worsening conditions.
  • A large position of nursing care related to secondary prevention is delivered in homes, hospitals by skilled nursing facilities.
  • Activities are directed at diagnosis and prompt intervention thereby reducing severity and enabling the client to return to a normal level of health as early as possible.
  • It includes screening techniques and treating early stages of disease to limit disability and averting or delaying the consequences of advanced disease.
    Tertiary prevention refer to Table 1.2.
 
PRIMARY CARE
 
Definition
“Primary care is defined as provision of integrated, accessible health care services by clinicians, who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and community.”
The emphasis is on personal health care services.
 
Theoretical Views on Caring
Caring is universal phenomenon that influences the ways in which people think, feel, and behaves in relation to one another. Caring in nursing has been studied from a variety of philosophical and ethical perspectives since the time of Florence Nightingale. A number of nursing scholars have developed theories on caring because of its importance to the practice of nursing as well as the existence of human kind.
 
Primary Care Benner and Wrubel
The works of Patricia Benner (1984) and Benner and Wrubel (1989) offers nurses a rich, holistic understanding of nursing practice and caring through the interpretation of expert nurses’ stories.13
  • The essence of excellent nursing practice is caring.
  • The nurses’ behaviors and decisions that express caring.
  • Caring means that persons, events, projects, and things matter no people.
  • It is a word for being connected. Because caring determines what matters to a person, it describes a wide range of involvements, from parental love of friendship, from caring for one's clients.
  • “Caring creates possibility.”
  • Personal concern for another person, an event, or thing provides to care.
  • Caring is an inherent feature of nursing practice, whereby nurses help clients to recover in the face of illness, to give meaning to that illness, and to maintain or re-establish connection.
  • Caring makes nurses notice which interventions are successful, and this concern then guides future care giving.
  • Clients are not all the same. Each individual brings a different background of experiences, values, and cultural perspectives to a health care encounter. Caring is always specific and relational for each nurse-client encounter.
  • Caring facilitates, a nurse's ability to know a client allowing the nurse to recognize a client's problems and to find and implement individualized solutions.
Because illness is the human experience of loss or dysfunction, any treatment or intervention given without consideration of its meaning to an individual is likely to be worthless. Expert nurses understand the difference between health, illness, and disease. Through caring relationship, nurses learn to listen to clients’ stories about their illness so that an understanding, therapeutic, client-centered care can be provided.
 
REHABILITATION
Rehabilitations mean the restoration of ones physician, mental, social, vocational and economic capacity to the fullest extent to which one is capable.
Rehabilitation is a treatment process designed to help physically handicapped individual to make maximum use of residual capacities and to enable them to obtain optimal satisfaction and usefulness in terms of themselves, their families and their communities.
Helen J Fasner
Rehabilitation is a program designed to unable the individual who is physically disable, chronically ill convulsing to live and to work to the at most of his capacity. It is an integral part of climax non-institutional and community responsibility in meeting the problem of chronic illness.
Dr Haward Rusk
Rehabilitation is creative process that begins with immediate preventive cure in the first degree of accident or illness. It is continue through the reparative phase of care and inventive a classification after whole being to a new life.
Rehabilitation is the process of maximizing and individual's abilities and resources to promote optimum growth and focusing on the individuals decision-making ability. This begin with preventive care in initial stage of accident and/or illness, it continues through the restorative phase and it involve adaptations to new life.
 
PHILOSOPHY OF REHABILITATION
Rehabilitation is a dynamic, health-oriented process that assets an ill or disable individual to achieve the greatest possible level of physical, mental, spiritual, social and economic functioning the rehabilitation process help the person to achieve an expectable quality of life with dignity, self-respect and independent.
Rehabilitation programs are designed for individual with physical mental and emotional disabilities. During rehabilitation, the individuals is assisted to adjust the disability by learning low power use resources and to focus existing abilities are emphasized.
 
Rehabilitation Team
Rehabilitation is a creative and dynamic process that require a team of professional working together with patient and family. Each health professional are assessed the patient's needs within the discipline domain. Team members meet in group lesson at frequency intervals and collaborate, to evaluate process, and to modify goals as needed to facilitate rehabilitation.
The patient is the key member of the rehabilitation team. Patient is the focus of the team effort and that one whom determines the final cautions of the process.
The patient family is incorporated into the team. Only by incorporating the family into the rehabilitation process can make the family adapt to the change in one of its members.
The family provides organized support; participate in problem solving in learning to provide necessary organized care.
In rehabilitation nurse develops therapeutic and supportive relationship with the patient and the family the nurse always emphasizes the patient's assess and stronger. During nurse patient interception, the nurse actively listen, and encourage and shares the patient's triumph. The patient is praised for efforts to improve self-concepts and self-care abilities.
The nurse assumes role of care-provider, teacher, councilor, patients advocate and consultant. Frequently the14 nurse if the care manager responsible for coordinating the total rehabilitative plan. The nurse collaborates with and coordinate the service provided by all members of the health care team including the some health nurse who is responsible for directing the patients care after return to the home.
The rehabilitation team also must include a physician, surgeon, psychiatrist, physical therapist, occupation therapist, speech and language therapist, pathologist, psychologist, social worker, vocational council or orthologist and rehabilitation engineer.
 
Basic Aim of Rehabilitation
Three basic aim of rehabilitation considered in the care given by all the members of the health team.
  • Prevent further impairment example of preventive measures are: When there is an automobile accident the ambulance driver is probable the person to handle the injured person. The worker moves the persons from the street into the ambulance may prevent further injury, in emergency room nurse also prevent further impairment by her knowledge of body mechanic, body alignment and first aid. If we visit the patient throughout his hospital stay we will see necessary actions taken to prevent contracture, foot drop, pressure low, dependent and so on.
  • Maintaining existing ability: Maintaining existing ability actually entails preventing additional injury or deterioration of unevaluated parts. For example, there is a need to be emphasis on the maintenance of the ability of noninjured part. Why should someone with a fractured leg develop hypostatic pneumonia? Why should be a young child develop a press ache from wearing leg brace? Nurses can make some additional treatment of tough hospitalization if required because of a lack of knowledge on the part of their caring for the patient.
  • Restore as much function as possible: The third aim of rehabilitation is to restore as much function as possible in injured or disease part. The nurse works with the health team to help the patient to regain strength to restore speech, to walk to relearn activities of daily living and to gain new ways to handle bowel and bladder problems. While prevention of further impairment and maintenance of existing ability continue throughout patient's rehabilitations programs.
 
Role of the Rehabilitation Nurse
At least some rehabilitation knowledge is required by the nurses while working with patients. We often forget about the physical disabilities threat accompany mental disease. If a person with schizophrenia is allowed to sit in a chair throughout the day he can struck live fusion contractures. We frequently do not use appropriate psychiatrist knowledge in care of patients with psychiatrist problem. It is up to the nurse to apply the appropriate comment and techniques to the patients under her care.
Knowledge skill and attitude—Certain knowledge skills and attitudes, while pertinent to many area of nursing, care required in fretted depth by the nurse who works with patient having a chronic illness or in a rehabilitation program.
 
Continuing Care
Client's across the lifespan that have long-term health care needs are the chronically ill and disabled. Continuing care describes a collection of health, personal, and social services provide over a prolonged period to persons who are disabled, who never were functionally independent or who suffer a terminal disease. Continuing care is available within institutional settings (e.g. nursing centers of nursing homes, group homes, and retirement communities) or the home (e.g. homecare, home-delivered meals, and hospice).
 
HEALTH CARE TEAM
 
Introduction
In most practice settings, the nurse work with other members of the team. The involvement of many different persons in the client's health care have the risk of fragmenting care. Nurses have the other professionals in the health care team they coordinate and integrate various services within the care plan.
 
Definition
Team: “A team means a set of specially prepared persons working together for a common goal”.
CP Thresyamma
Health team: “Health team consists of particular group of health care professionals to provide total care for clients”.
CP Thresyamma
 
The Health Care Team Members
  • Physician: A physician is a professional who has earned a degree of Doctor of Medicine and has passed a licensing examination. Most physicians specializes their practice in medicine. Nurses work closely with physician under supervision or as coworkers.
  • Assistant physician: Assistant physicians are junior doctors and they work under the direction of chief physicians in the hospital and clinic. Nurses work with them as they do with physician.
  • Therapists: They are licensed to assist in the examination and treatments of clients in special ways such as physical,15 occupational, etc. Nurses collaborate with them and evaluate the work.
  • Pharmacists: They are licensed to formulate and dispense drugs. They provide valuable information to nurse about drugs, their uses and effects.
    Paramedical staff like technologist in laboratory, X-ray, etc. are members of the team to perform their words.
  • Dietician: He is a member of the health team prescribes and manages to provide the nutritional needs of the client in consultation with the physician.
  • Social workers: They are trained to counsel and refer clients to appropriate agencies. Nurses work with them to identify the best resources for the client.
  • Chaplain: Chaplains offer spiritual support and guidance to clients and their families. The client may request to chaplain about his spiritual need or the nurse many refer the client chaplain.
  • Nurses: In the hospital there is a nursing team for the care of patients. The team leader will be the nursing superintendent. She will delegate her responsibilities to the head nurses who are the team leaders of each ward. She is responsible for assigning duties to the other members of the team in the ward for the care of patients there.
  • Nonprofessional workers: These are also required to be considered such as clerks, attendees, cleaners, etc. To meet the needs of the clients and family in the hospital.
 
Types of Health Care Agencies
The health care system of India may be defined as the industry which provides health services (health activities) so as to meet the health needs and demands of individuals and community. It operates in context of the socioeconomic and political system of the country. It is represented by the five major sectors or health agencies which differ from each other by the health technology applied and by the source of funds for operation.
These five major sectors or health agencies are the following:
  • Public agencies
    • Public health centers
    • Hospitals
      1. Rural hospitals
      2. District hospitals
      3. Specialist hospitals
      4. Teaching hospitals
    • Health Insurance Schemes
      1. Employees State Insurance
      2. Central Government Health Schemes
    • Other Agencies
      1. Defense service
      2. Railways
  • Private agencies
    • Private hospitals, polyclinics, nursing homes and dispensaries
    • General practitioners and clinics
  • Indigenous systems of medicine
    • Ayurveda and Siddha
    • Unani and Tibhi
    • Homeopathy
    • Unregistered practitioners
  • Voluntary health agencies
  • Vertical health program: Known as National Health Program such as WHO, UNICEF, Rockefeller Foundation, etc.
    The health agencies in the hospitals and community deal with the major health problems of India such as:
  • Communicable disease problems
  • Nutritional problems
  • Environmental sanitation problems
  • Medical care problems
  • Population problems.
    Health care services are rendered to the people by the professional staff, technical staff, auxiliary staff and unskilled staff of the hospital and community health agencies to meet the health problems and health needs. The general function of health agencies are:
  • Sanitation
  • Control of communicable diseases
  • Public health education
  • Individual's health protection promotion
  • Research on disease and protection.
 
Functions of the Hospital
 
Investigation, Diagnosis and Care of the Sick and Injured
According to the condition of the patient, they are examined or the necessary investigations are done in the outpatient department for the diagnosis. Then they are treated either as an outpatient or inpatient.
 
Health Supervision and Prevention of Disease
In the outpatient departments provisions are available for the routine health examinations and supervision of antenatal and postnatal mothers, health supervision and immunization of sick and healthy children and other services to persons in normal conditions. Hospitals prevent the spread of diseases by isolating the patients with communicable disease and help to raise the standard of health in the community by health education.16
 
Education of Medical Workers
Doctors, nurses, dietitians, social workers, physical therapists, technicians, hospital administrators and other medical and paramedical people are taught within the hospital and much of what they must learn in order to practice their professions.
 
Medical Research
Hospital offer medical workers opportunities for investigations by laboratory facilities, trained personals, patients and accumulation of records which are not available elsewhere. This research is thought to be such an important factor in the successful practice of medicine and the advancement of medical science.
 
Rehabilitation
Rehabilitation is an essential aspect of all health care and it is one of the functions of hospital.
Special units have been established in hospitals to help persons with physical disabilities that keep them moving freely in their environment. They admit both inpatients and outpatients in the unit. Initially rehabilitation focuses on preventing complications and later, services begin towards maximizing the functioning and increasing the level of independence of the client. Such an effective rehabilitation involves the client, family and the whole health care team which is only possible in a hospital.
 
PRIMARY HEALTH CARE AND ITS DELIVERY
 
Definition
Primary health care is essential health care made universally accessible to individuals and acceptable to them through the full participation and at the cost the community and country can afford”. By WHO.
 
Elements of Primary Health Care
  • Education concerning prevailing health problems and the methods of preventing and controlling them
  • Promotion of food and proper nutrition
  • An adequate supply of safe water and basic sanitation
  • Maternal and child health care including family planning
  • Immunization against major infectious disease
  • Prevention and control of locally endemic disease
  • Appropriate treatment of common disease and injuries
  • Provision of essential drugs.
 
Principles of Primary Health Care
  • Accessible: Covering both rural and urban populations.
  • Affordable: To be maintained and sustained, thus, promoting self-reliance.
  • Appropriate technology: This does not mean primitive technology. Oral rehydration therapy (ORT) for prevention of dehydration is an example of advanced technology, simpler, cheaper and more effective than the intravenous approach.
  • Involvement/participation of the individual and the community.
  • Intersect: Oral action for health and overall social development.
  • Emphasis on promotive and preventive aspect in addition to curative aspects.
The realization of health goals and objectives, requires that the primary health care as defined above needs to be translated into action. Health service infrastructure at the primary level needs to reoriented to take new roles in line with primary health care approach.
 
Organization of Health Care System according to Primary Health Care Concept
The primary health care approach is a way (strategy) for planning, organizing and providing of health care to achieve the maximum possible improvement in health and welfare of the community with the available resources.
As primary health care approach is community oriented approach, the organization of health care starts with the people, individuals and families, and communities. These need to be connected with the health facilities at primary level, secondary level, and tertiary level with effective system of referral.
 
Primary Level
This level starts with individuals/families, to the first health facility. Health personnel work closely with other sectorial personnel and with the community to support provision of essential health care for all the community.
This is the most important level of the health system being the firstline of action.
 
Secondary Level
This level cares for people requiring services, not available at the primary health care level. It serves as referral for the primary health level. It should also provide support for the primary level.17
 
Tertiary Level
This level is more specialized, with more trained personnel and more sophisticated diagnostic and therapeutic technology. It is usually located at medical college hospital, regional and national medical centers.
 
The Cost-Benefit of Primary Health Center
Only through a health care system based on PHC, it is expected to make major gains in terms of reduction of morality, morbidity and improving the quality of life.
Countries committed to PHC and eager to bring of the majority of their populations will direct their policies and efforts more in favor of primary health care.
 
Health Care Services
The term health care services comes a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health. The purpose of health services is to improve the health status of population. For example, immunization of children can influence the incidence/prevalence of particular diseases. Provision of safe water can prevent mortality and morbidity from water borne diseases. To be effective the health services must reach the social periphery, equitably, distributed accessible at a cost the country and community can afford and socially acceptable.
 
Primary Health Center
Primary health center is the first contact point between people and doctor. Primary health center is established to cover 30,000 populations in plain and 20,000 population in rural/tribal areas. Establishment and maintenance of the center are done under the minimum basic need program of the state governments. The work of PHC is looked after by a medical officer. There are 4 to 6 beds for patients and some diagnostic facilities for patients are also available at PHC.
 
Personal/Staffing
The following staff/personal should be employed in PHC:
Medical Officer
1
Nurse
1
Female Health Worker/ANM
1
Pharmacist
1
Block Extension Educator
1
Health Assistant Male
1
Health Assistant Female/LAV
1
Lower Division Clerk
1
Upper Division Clerk
1
Lab Technician
1
Driver (If vehicle available)
1
Fourth Class Servant
4
Total
15
 
Functions of PHC
  • Medical Care
  • Basic Sanitation and Clean Supply
  • Treatment and Prevention of Endemic Disease
  • Reproductive and Child Health, Collection of Vital Statistic, Family Planning Program/Services
  • Health Education
  • Referral Services
  • Basic Laboratory Tests/Services
  • National Health Program
  • Training of Village Health Guide, Local daises, Health Worker and Health Assistance.
 
Responsibilities of Nurses in Primary Health Care
In 1984 following responsibilities were based in best trained/nurses by the expert committee of World Health Organization for taking care of primary health. Assessing the health level of individual and community. Activating the participation of the community and encouraging the individuals to participate. Providing treatment in emergencies and taking care of the general health. Referring the patients to specialists (Following the referral systems). Keeping an eye on the epidemics. Training and surprising of health workers. Coordinating with other health program. Observing the progress of primary health care. Major responsibilities of primary health care lies with community health nursing. Therefore, it is essential that community health nursing system is further developed and strengthened, soon the nurses can after duty discharge there responsibilities related to primary health.