Unit 1 ( Health ), Nursing
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UNIT 1: Concept of Health
Ms.Vinay Kumari
Introduction
The primary roles of the nurse as caregiver are to: Promote health Prevent illness Restore health Facilitate coping Health is more than just the absence of illness; it is an active process in which an individual moves toward wellness by reaching his or her maximum potential. 08/22/09
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Introduction
(cont..)
To give holistic care, the nurse must understand and respect each person’s individual definition of health and response to illness and should be familiar with models of health and illness. Finally, the nurse needs to understand how to provide nursing care to promote health and prevent illness.
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Health Traditionally health was defined in terms of the presence or absence of disease. Individually defined Each person defines health in terms of his or her own values and beliefs. Acc. to WHO (World Health Organisation, 1946) Health is a state of complete physical, mental,and social well being, and not merely the absence of disease or infirmity.
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Definitions of Health
American Nurses Association (1980)
’’A dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible.’’
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Wellness and Well-Being
Wellness is a state of well being. 7 components of wellness (Anspaugh, Hamrick, and Rosato, 2006)
Physical (ability to carry out daily tasks, achieve fitness, maintain adequate nutrition & proper body fat, and generally positive lifestyle habits)
Social (ability to interact successfully with people & within the environment)
Emotional (ability to manage stress & to express emotions appropriately.) 08/22/09 6
Wellness and Well-Being 7 components of wellness (Anspaugh, Hamrick, and Rosato, 2006)
Intellectual (ability to learn & use information effectively for development)
Spiritual ( belief in some force that serves to unite human beings
Occupational (ability to achieve a balance between work & leisure time)
Environmental (ability to promote health measures that improve the standard of living & quality of life in the community)
Wellness and Well-Being
Well being is a subjective perception of vitality and feeling well. It is a component of health.
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Models of health and illness
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Agent- host- environment model Health-illness continuum High level wellness model Health promotion model Health belief model
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Agent- host- environment model
Developed by Leavell and Clark(1965) Useful for examining the causes of disease in an individual. An agent is an environmental factor or stressor that must be present or absent for an illness to occur. A host is a living organism capable of being infected or affected by an agent. The environment includes all the factors external to the host that may or may not predispose the person to the development of disease. 08/22/09
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Health-illness continuum
The health illness continuum is one way to measure a person’s level of health. This model views health as a constantly changing state, with high level wellness and death being on opposite ends of a graduated scale, or continuum. This continuum illustrates the dynamic(ever changing) state of health, as a person adapts to changes in the internal and external environments to maintain as state of wellbeing. 08/22/09
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Health illness continuum
Illness area DEATH
ILLNESS
Death
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Well area NORMAL HEALTH
GOOD HEALTH
HIGH LEVEL WELLNESS
Well being
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Health illness continuum
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People move back and forth within this continuum day by day A person with a chronic illness may view himself or herself at different points on the continuum at any given time, depending upon how well the patient believes he or she is functioning with the illness.
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Factors/Variables affecting Health and Illness
People can usually control their health behavior and choose healthy or unhealthy activities. Internal variables
External variables
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Biologic dimension Psychologic dimension Cognitive dimension
Physical environment Standard of living Family and cultural beliefs Social support networks
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Internal Variables Often described as non modifiable variable
Biologic dimension 1. Genetic makeup (influences biologic characteristic, innate
temperament, activity level, and intellectual potential) E.g: Diabetes, breast cancer; Africans (Hypertension , Sickle cell anemia)
2. Gender (influences the distribution of disease )
E.g: Females ( osteoporosis, Rheumatoid arthritis) ; Males (Stomach cancers, abd hernias) 3. Age (distribution of disease varies with age. ) E.g: Heart disease (middle aged men) ;Communicable diseases (children) 4. Developmental level (major impact on health status) E.g : Toddlers learning to walk are more prone to falls 08/22/09
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Internal Variables
(Cont…)
Psychologic dimension
Mind body interaction can affect health status +vely or –vely.Emotional responses to stress affect body functions. E.g : student anxious before test may experience diarrhea.
Self concept is how a person feels about self (self esteem) and perceives the physical self (body image), needs , roles and abilities. It affects how people view and handle situationts. Such attitudes can affect health practices, response to stress, illness etc.
E.g: Anorexia nervosa
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Internal Variables
(Cont..)
Cognitive dimension
Life style refers to a person’s general way of living
( living conditions and individual patterns of behavior). Lifestyle is often considered as behavior and activities over which people have control. E.g: Overeating, Insufficient exercises are related to incidence of Heart disease ; Excessive tobacco use linked with lung cancer
Spiritual and religious believes can significantly affect health behaviour.
E.g: Some religious gp are strict vegetarian; serious illness as God’s punishment 08/22/09
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External variables
(Cont….)
Family and cultural beliefs
Family passes on patterns of daily living and lifestyle to offspring. E.g A man who was abused as a child may physically abuse his childern Each culture has ideas about health, and these are often transmitted to children. E.g Asians prefer herbal remedies and acupunture than analgesics
Social support network ( family, friends) and
job satisfaction helps people avoids illness. Support people help the person that illness exists and provide stimulus to become well again.
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External variables
Environment
Geographic location determines climate and climate effects health (malaria more in tropical than temperate climate) : pollution;radiation
Standards of living (reflecting ocupation,
income, and education) is related to health, morbidity and mortality. Hygiene, food habits, propensity to seek health care advise vary among high and low income gps. 08/22/09
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Illness And Disease
Illness is the highly personal state in which the persons physical ,emotional ,intellectual, social, developmental or spiritual functioning is thought to be diminished. Not synonymous with disease. For e.g An ind. could have a disease ( growth in stomach), and not feel ill.
Illness is highly subjective; only the individual can say he or she is ill.
Disease can be described as an alteration in body functions resulting in reduction of capacities or a shortening of normal life span. Causation of disease is ETIOLOGY
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Types Of Illness
Acute illness is characterized by severe symptoms of relatively short duration. Symptoms often appear abruptly and subside quickly. Depending on the cause, may or may not require interventions by health professionals. Following an attack, most people return to their normal level of wellness . E.g: Appendicitis, colds Chronic illness is one that last for an extended period, usually six months or longer and often for the person’s life. Slow onset. Often have peroids of Remission( when symptoms disappear) and exacerbation ( symptoms reappear). E.g : Diabetes, heart disease. 08/22/09
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Causes and risk factors for developing illness
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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 increases the vulnerability of an individual or group to an illness or accident
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Causes and risk factors for developing illness The presence of risk factors doesn't mean that a disease will develop, but the risk factors increase the chances that the individual will experience a particular disease or dysfunction. 2. Genetic and Physiological factors Heredity or genetic predisposition to specific illness, is a major physical risk factor. Certain physical conditions, such as being pregnant or overweight, place increased stress on physiological systems, increasing susceptibility to illness.
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Causes and risk factors for developing illness (Cont…) 2. Age Age increase or decreases susceptibility to certain illnesses. 3. Environment The physical environment in which a person work or lives can increase the likelihood that certain illnesses will occur. 4. Lifestyle Lifestyle practices with potential negative effects are risk factors; these include sedentary lifestyle, overeating or poor nutrition, insufficient rest and sleep, and poor personal hygiene etc.
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Illness Behaviours
When people become ill, they behave in certain ways that sociologist refer to as illness behavior Illness behavior, a coping mechanism, involves ways individual describe, monitor and interpret their symptoms, take remedial actions, and use the health care system Variables affecting illness behavior are: age, sex, occupation, socio economic status, ethnic origin, personality, education, and modes of coping. 08/22/09
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Illness behaviour
(cont…)
5 stages of illness ( Suchman, 1979) Stage 1: Symptom experiences
At this stage, the person comes to believe something is wrong. 3 aspects of this stage: Physical experience of symptoms Cognitive aspect (interpretation of symptoms in terms that have some meaning to person) Emotional aspect ( fear or anxiety) During this stage, the unwell person usually consults others about symptoms; try home remedies . If self management is ineffective, the individual enters the next stage.
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Illness behaviour
(cont…)
Stage 2: Assumption of the sick role Individual accepts sick role & seeks confirmation; continue self treatment and delay contact with health care professionals as long as possible. May be excused from normal duties &role expectations Emotional responses such as withdrawal, anxiety, fear and depression are not uncommon When symptoms persist, the person is motivated to seek professional help 08/22/09
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Illness behaviour
(cont…)
Stage 3: Medical care contact Sick people seek the advise of a health professional either on their own initiative or at the urging of significant others. 3. Validation of real illness 4. Explanation of symptoms in understandable terms 5. Reassurance that they will be all right or prediction of what the outcome will be. Client may accept or deny the diagnosis
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Illness behaviour
(cont…)
Stage 4: Dependent Client Role
After accepting the illness & seeking treatment, the client becomes dependent on the professional for help.
Stage 5: Recovery or Rehabilitation
The client is expected to resume former roles and responsibilities. For Acute illness (illness duration is less; rapid recovery); Chronic illness ( adjustments in life; find recovery more difficult) 08/22/09
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Impact of illness
Illness is never an isolated life event. The client and family must deal with changes resulting from illness & treatment. The changes vary depending on the nature, severity, and duration of illness, attitudes associated with the illness by the client and the others, and the financial demands, the lifestyle changes incurred, adjustment to usual roles, and so on.
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Impact of illness on the client
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Ill clients may experience behavioral and emotional changes, changes in self concept and body image and life style changes. Behavioral and emotional changes associated with short term illness are generally mild and short lived Certain illnesses can also change the clients body image Clients self esteem and self concept may also be affected Ill individuals are also vulnerable to loss of autonomy Illness also often necessitates change in life style 31
Impact on the family
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A persons, illness affects not only the person who is ill but also the family or significant others Role changes Task reassignments and increase demands on time Increase stress due to anxiety about the outcome of the illness Financial problem Loneliness Change in social customs 32
Health Care Services
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A health care system is the totality of services offered by all health disciplines. The services provided by health care system are commonly categorized according to type and level.
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Types of health care services
Health care services are often described in a way correlated with levels of disease prevention
A) Primary prevention (Health promotion and illness prevention) B) Secondary prevention (Diagnosis and treatment) C) Tertiary prevention (Rehabilitation, health restoration, palliative care )
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Types of health care services ( Cont..) PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION Health promotion was slow to develop until the 1980s. Since that time more and more people are recognizing the advantages of staying healthy and avoiding illness.
Primary prevention programs address areas such as adequate and proper nutrition, weight control and exercise, and stress reduction. Health promotion activities emphasize the important role clients play in maintaining their own health and encourage them to maintain the highest level of wellness they can achieve. 08/22/09
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Types of health care services ( Cont..)
PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION (Cont..) Illness prevention programs may be directed at the client or the community and involve such practices as providing immunization, identifying risk factors for illnesses, and helping people take measures to prevent these illnesses from occurring. Illness prevention also includes environmental programs that can reduce the incidence of illness or disability
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Types of health care services ( Cont..) SECONDARY PREVENTION: DIAGNOSIS AND
TREATMENT In the past, the largest segment of health care services has been dedicated to the diagnosis and treatment of illness. Hospitals and physician’s offices have been the major agencies offering these complex secondary prevention services Freestanding diagnostic and treatment facilities have also evolved and serve ever growing number of clients. Also included as health promotion service is early detection of disease. This is accomplished through routine screening of the population and focused screening of those at increased risk of developing 08/22/09 certain conditions. E.g: Regular dental examination; 37
Types of health care services ( Cont..)
TERTIARY PREVENTION: REHABILITATION, HEALTH RESTORATION AND PALLIATIVE CARE The goal of tertiary prevention is to help people move their previous level of health (i.e to previous capabilities) or to the highest level they are capable of given their current health status. Rehabilitation care emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives. If injury is temporary, rehabilitation can assist in return to former function. If the injury is permanent, rehabilitation assists the client in adjusting how to perform activities in order to achieve maximum abilities. Sometimes, people cannot be returned to health. A growing field of nursing and tertiary prevention services is that of palliative care – providing comfort and treatment of symptoms 08/22/09 38
Health Promotion, Wellness, & Illness Prevention
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Health care has become increasingly focused on health promotion, wellness, and illness prevention. Concept of health promotion, wellness, and illness prevention are closely related & in practice overlap to some extent. All are focused in future Health promotion activities such as routine exercise and good nutrition, help clients maintain or enhance their present levels of health. Motivate people to act positively to reach more stable levels of health. 39
Health Promotion, Wellness, & Illness Prevention
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. Help persons achieve new understanding and control of their lives. Illness prevention activities such as immunization prog protect clients from actual or potential threats to health. Illness prevention motivates people to avoid declines in health or functional levels.
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Health Promotion
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Science and art of helping people change their lifestyles to move toward a state of optimal health. Health promotion activities: Active and Passive Passive (individuals gain from activities of others without acting themselves e.g fluoridation of municipal water) Active ( individuals are motivated to adopt specific health prog e.g weight reduction) 41
Levels of preventive care Nursing care oriented to health promotion, wellness, and illness prevention can be understood in terms of health activities on primary, secondary and tertiary level. Primary prevention True prevention; preceds disease or dysfunction and applied to clients considered physically or emotionally healthy. Aimed at health promotion includes health education programs, immunisation, physical and nutritional fitness activities. Focus on maintaining or improving the general health of individuals, families, and communities.
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Levels of preventive care
Secondary Prevention
Focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions.
Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to normal level of health as early as possible.
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Levels of preventive care
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Tertiary Prevention Occurs when a defect or disability is permanent and irreversible. Involves minimizing the effects of long term disease or disability by interventions directed at preventing complications and deterioration Activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness. Prevents further disability or reduced functioning.
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Health Care Agencies
Health care organizations( agencies) may be defined as structural and functional units of personnel who provide health services to individuals, families, groups, and society.
Classification Acc to focus of service
Exist mainly to provide health care (hospitals, ambulatory care centers, home health agencies) Exist for another purpose but also include the provision of some health care as part of their services ( occupational health services, schools that provide student health services and prisons that provide dispensaries)
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Health Care Agencies
Classification (Cont..) Acc to population served Age
gp: (pediatric, adult health or geriatric client) Stage of illness: ( primary, secondary, tertiary) Specific health problems : ( communicable diseases, drug addiction etc)
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Health Care Agencies
Classification (Cont..) Acc to type of services Specific
services (diagnostic studies, counseling, formal instruction, surgery, non surgical treatment) General services (hospitals provide a more comprehensive array of services)
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Health Care Agencies
Classification (Cont..) Acc to source of fund Profit
institutions (proprietary): (receive payment from those who use their services) Nonprofit (not-for-profit): voluntary agencies (financed by private charitable or religious org.) public( govt. operated) agencies (funding from local, state govt)
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Hospital
The word hospital is derived from the Latin word hospitalis- for a guest in French “hospes- a host , a guest.” In olden days, the hospitals were guest houses for the shelter of homeless and for the treatment of travellers.In the modern times, the chief function of the hospital has been the care and treatment of sick. A hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays.
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Definition of Hospital
The 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 out patient services reach out to the family and its environment; the hospital is also a centre for the training of health workers and for bio- social research
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(WHO)50
Hospital
(Cont..)
The Changing role of hospitals Hospitals in India have come of age in the past 50 years or so. The old idea of hospital was that it is a place for the treatment of sick. Now , with the emphasis on physical, mental, social well being, reaching out to community and training of health workers, the health care services have undergone a steady metamorphosis and the role of the hospitals has changed, with emphasis shifting from:
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Hospital
(Cont..)
The Changing role of hospitals ( cont…)
Curative to preventive In patient care to out patient and home care Acute to chronic illness Tertiary and secondary to primary health care
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Hospital
(Cont..)
Functions
Primary function: provision of medical care to community INTRA-MURAL FUNCTIONS These functions are within the hospital, namely: A)Therapeutic
Diagnostic : diagnosis of illness
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Hospital
(Cont..)
INTRA-MURAL FUNCTIONS ( Cont..) A) Therapeutic ( Cont…)
2) Curative : Treatment of an illness 3) Rehabilitative : Physical, mental, social and vocational rehabilitation 4) Care of emergencies : Accident trauma and acute life threatening conditions
B) Preventive 1. 2. 3. 4. 5.
Antenatal and postnatal services Well baby clinics and immunization schedule Family welfare services Control of communicable diseases Health education
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Hospital
(Cont..)
INTRA-MURAL FUNCTIONS ( Cont..)
c) Education
Medical : Undergraduate, post graduate and post doctoral Nursing education: Undergraduate, post graduate and post doctoral Specialty Paramedical Community health
D) Research
Clinical medicine Hospital administration
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Hospital
(Cont..)
EXTRA MURAL FUNCTIONS
Those functions which are outside the hospital, namely: 1) Outpatient services 2) Home care/ out reach/ domiciliary services
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Classification of Hospitals Can be classified in many ways
According to ownership/ Control
B)
Public hospitals
Run by central/ state Govt or Municipal bodies on non commercial basis. May be general or specialized hospitals or both. General hospitals are those which provide treatment for common diseases, whereas specialized hospitals provide treatment for specific diseases, specific group of people like infectious diseases, cancer, eye, ENT, cardiac diseases
Voluntary ( Charitable ) hospitals
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Established and incorporated under the Societies Registration Act. A board of trustees usually manages such hospitals. The main source of revenue are publics and private donations and grants aid from the Central govt./ State govt. and from philanthropic organizations, both national and international
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Classification of Hospitals A)
According to ownership/ Control Private hospitals
Corporate hospitals
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Generally owned by individuals or groups of people and are run on a commercial basis Run by limited companies, formed under the companies Act.They can be general, specialized or both.
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Classification of Hospitals ( Cont..)
B) According to clinical specialities In these hospitals, patients are treated for those diseases for which that hospital has been set up, such as tuberculosis, cancer, cardiac diseases etc. These hospitals may be according to ownership/ control basis.
C) Acc. to length of stay In these hospitals, patients may stay for a long term or a short term. Day care hospitals are those where parents stay from morning to evening, as members of the family may not be at home to take care of the sick.
Acute care / short term stay (with mean length of stay 730 days) Long term stay ( average of length of stay over 30 days)
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Classification of Hospitals ( Cont..)
E) Acc to bed strength
Small (<100 beds) Medium sized (100-300 beds) Large (> 300 beds)
F) Acc. to teaching and non teaching A teaching hospital has a medical college attached to it. A hospital without a medical college is termed as a non teaching hospital . 08/22/09
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Physical Plan of the hospital SELECTION OF SITE
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Place should not be densely populated Site of the hospital should be elevated from the surroundings Should have an independent access to a street Must be away from nuisance such as dust, smoke, bad odor, excessive noise and traffic Open space all around will help in proper lighting (natural), and ventilations will provide a pleasing surrounding
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Physical Plan of the hospital
PROVISION OF Safe
drinking water Adequate lighting and ventilation Control of noise Collection and safe disposal of refuse and excreta Control of arthropods, vermin and animal pests
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Physical Plan of the hospital
Important points to be considered while constructing a hospital
Walls and floor should be, as far as possible, non absorbent, non porous, shock absorbing, attractive, fire resistant, durable, easy to clean, and damp proof, free of cracks (prevent breeding of insects)
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Physical Plan of the hospital (Cont..)
Important points to be considered while constructing a hospital
Floor area should be adequate acc. to the no. of beds, so there is sufficient space between the beds (6 feet) Windows and doors should be placed in such a way that natural lighting is available in the room with cross ventilation Latrines are placed in such a way that it does not cause bad odor and unpleasant scenes. Should be placed where direct sunlight enters in. Reception counter and the OPD should be near to the main entrance of the hospital. IPD can be towards the back of the building.
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Physical Plan of the hospital (Cont..)
Important points to be considered while constructing a hospital
The kitchen and the dining rooms should be fly proof and away from the hospital wards. There should be central corridor connecting the different departments and wards. There should be provision for the isolation of patients having infectious diseases or who are suspected to be infectious. There should be railings along the open corridors and staircases to prevent accidents by falling Staircases, ramps and elevators should be centrally placed
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Organization of hospital Organization varies from hospital to hospital. Some feature are common to all. Line of authority differs acc. to the ownership and administration.
The governing body of a hospital, usually called the board of trustees or directors is responsible for the policies of the institution. Directly under the governing body is the head of the hospital, the administrator or director, to whom authority and responsibility for management is delegated.
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Organization of hospital (Cont..) The administrator/ director directs two divisions of the hospital work- the business management and the professional care of the patients. The business management includes administration, accounting, maintenance, engineering, housekeeping and purchasing.
Under the professional care of the patients are found the medical, nursing, paramedical and other special department.
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS Medical department (Medical superintendent is a
doctor who has control over all the medical dept.) Nursing department Paramedical department Pathology dept ( Bacteriology lab, biochemistry lab, hematology lab, parasitology lab, serology lab, Blood Bank, Histopathology dept ) Pharmacy dept (selecting, purchasing, compounding, storing and dispensing all drugs ) Physical medicine and rehabilitation Radiology dept Dietary dept
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS NON PROFESSIONAL SERVICES (BUSINESS MX)
Admitting dept Administration Personnel dept ( recruitment, interview, promotion, transfer, inservice training, safety, health prog, recreation) Purchasing dept Medical records Accounts (Business office) Housekeeping (to keep hospital clean) Laundry Mechanical dept (electricity, water supply,heat.) Maintenance dept (carpenter, painters, welders, gardners Central supply dept Social services 69 08/22/09
Primary Health care
Originally conceptualized in 1978 by the WHO and the United Nations International Children’s Emergency Relief Fund (UNICEF)
Concept was developed based on decreases in illness and death in member countries that were achieved by simple, local, inexpensive solutions to health problems, especially when combined with economic and social development.
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Primary Health care
Defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford “Primary health care is essential health care, made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.” (Alma Ata conference) 08/22/09
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Primary Health care (Cont…)
Not to be confused with primary care. Primary care is the delivery of healthcare services, including the initial contact and ongoing care. Included in primary care is the responsibility for referral to other providers based on patient needs. Both physicians and nurse practitioners provide primary care, which focuses on individual patient and is directed by the provider. In contrast, primary health care has a community based philosophic base that emphasizes universal access and affordability of health care, health of whole population, and consumer involvement. 08/22/09
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Primary Health care (Cont…)
Principles of primary health care
1.Equitable distribution Health services must be shared equally by all people irrespective of their ability to pay and all (rich or poor, urban or rural) must have access to health services. Primary health care aims to address the current imbalance in health care by shifting the centre of gravity from cities where a majority of the health budget is spent to rural areas where a majority of people live in most countries.
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Primary Health care (Cont…)
Principles of primary health care
2. Community participation There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, beside maximum reliance on local resources such as manpower, money and materials.
3. Intersectoral coordination Primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors.
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Primary Health care (Cont…) Principles of primary health care 4. Appropriate technology “Technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford.”
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Primary Health care (Cont…) n
n n n
n n n
n
8 Essential elements of primary health care Education- concerning prevailing health problems and the methods of preventing and controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation Maternal and child health care, including family planning Immunisation against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Provision of essential drugs 08/22/09
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Primary Health care (Cont…)
Role of Nurse
Assessing the health status of individuals and community. Promoting community involvement Providing integrated health care including the treatment of emergencies and making referrals. Making epidemiological surveillance. Training and supervising health workers. Collaborating with other developmental sectors Monitoring progress in primary health care
Body defenses: Immunity and Immunization
Introduction
Individuals normally have defenses that protect the body from infection. These defenses can be categorized as specific and non specific. Non specific defenses protect the person against all microorganisms, regardless of prior exposure. Specific immune) defenses, by contrast, are directed against identifiable bacteria, viruses, fungi, or other infectious agents.
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Non Specific Defenses
Nonspecific body defenses include anatomic and physiologic barriers, and the inflammatory responses.
Anatomic and Physiologic Barriers
Intact skin and mucous membrane : first line of defense against micro-organisms. Normal secretions make the skin slightly acidic; acidity also inhibits bacterial growth. Nasal passages have a defensive function. Moist mucus membranes and cilia trap microorganisms, dust, foreign materials. Lungs have alveolar macrophages (large phagocytes) that ingest microorganisms, other cells, and foreign particles.
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Non Specific Defenses (Cont…)
Anatomic and Physiologic Barriers (Cont…)
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Each body orifice also has protective mechanisms. The oral cavity regularly sheds mucosal epithelium to rid the colonizers. Saliva contains microbial inhibitors such as lactoferrin, lysozyme and secretory IgA. Eye is proteced from infection by tears, which continually wash microorganisms away and contain inhibiting lysozyme. High acidity of stomach normally prevents microbial growth.
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Non Specific Defenses (Cont…)
Inflammatory Responses Inflammation
is a local and nonspecific defensive response of tissues to an injurious or infectious agent. It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents further spread of injury, and promotes the repair of damaged tissue.
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Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) It is characterized by 5 signs: 1. 2. 3. 4. 5.
Pain Swelling Redness Heat Impaired function of the part, if the injury is severe.
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Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) A series of dynamic events commonly referred to as the 3 stages of inflammatory response
First Stage: Vascular and cellular Responses At the start of 1st stage, blood vessels at the site of injury constrict. This is rapidly followed by dilation of small blood vessels (occurring as a result of histamine released by injured tissues). Thus, more blood flows to the injured area( hyperemia) and is responsible for the characteristic signs of redness and heat. Vascular permeability increases at the site with dilation of the vessels in response to cell death, the release of chemical mediators (e.g bradykinin, serotonin, prostaglandins) and histamine. 08/22/09
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Non Specific Defenses (Cont…) 2.
Inflammatory Responses (Cont..)
First Stage: Vascular and cellular Responses
Fluid, proteins and leukocytes leak into interstitial spaces, and the signs of inflammation swelling (edema) and pain appear. Pain is caused by pressure of accumulating fluid on nerve endings and the irritating chemical mediators. Leukocytosis (large no of leukocytes produced by bone marrow and released into blood stream). Leukocytes move through the blood wall into the affected tissue spaces.
Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) Second Stage : Exudate production The inflammatory exudate is produced, consisting of fluid that escaped from the blood vessels, dead phagocytic cells, and dead tissue cells and products that they release. The plasma protein fibrinogen ( which is converted into fibrin when it is released into the tissues), thromboplastin (released by injured tissue cells), and platelets together form an interlacing network to wall off the area, and prevent spread of injurious agent. During this stage, the injurious agent is overcome, and the exudate is cleared by lymphatic drainage. 08/22/09
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Non Specific Defenses (Cont…) 2)
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Inflammatory Responses (Cont..) Third Stage : Reparative Phase Involves the repair of injured tissues by regeneration or replacement with fibrous tissue( scar) formation. Regeneration is the replacement of destroyed tissue cells by cells that are identical in structure and function. When regeneration is not possible, repair occurs by fibrous (scar) tissue formation. Damaged tissues are replaced with the connective tissue elements of collagen, blood capillaries, lymphatics.
87
Non Specific Defenses (Cont…) Inflammatory Responses (Cont..) 2) Third Stage : Reparative Phase In the early stages of this process, the tissue is called granulation tissue (fragile, gelatinous, pink or red) Later, the tissue shrinks, capillaries constrict and collagen fibers contract, so that a firmer fibrous tissue remains. This is called as cicatrix or scar.
Specific defenses
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Specific defenses of the body involve the immune system.
89
Immunity
Immunity is a material term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. An antigen is a substance that induces a state of sensitivity or immune responsiveness (immunity).
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90
Types of Immunity IMMUNITY
NATURAL
ACTIVE
(INFECTION) 08/22/09
PASSIVE (MATERNAL)
ACQUIRED
ACTIVE
PASSIVE
(IMMUNISATION)(ANTIBODY TRANSFER) 91
Active and passive immunity
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Passive immunity is acquired through transfer of antibody or activated T-cells from an immune host, and is short lived, usually lasts only a few months, whereas active immunity is induced in the host itself by antigen, and lasts much longer, sometimes life-long.
92
Components of immune response
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Immune response has two components: Antibody mediated defenses and cell mediated defenses. These two systems provide distinct but overlapping protection.
93
Components of immune response (Cont…)
Antibody mediated defenses ( Humoral or circulating immunity)
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These defenses reside ultimately in the B lymphocytes and are mediated by antibodies (immunoglobulin) produced by B cells. The antibody mediated responses defend primarily against the extra cellular phases of bacterial and viral infections.
94
Components of immune response (Cont…) Antibody mediated defenses ( Humoral or circulating immunity) Active immunity (host produces antibodies in response to natural antigens (e.g infectious microorganisms) or artificial antigens (e.g. vaccines). B cells are activated when they recognize antigen. Bcells may produce antibody molecules of 5 classes of immunoglobulins (IgM, IgG, IgA, IgD, and IgE.)
Passive immunity the host receives natural (e.g from nursing mother) or artificial(from an injection of immune serum) antibodies produced by another source.
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Components of immune response (Cont…) Cell mediated defenses ( Cellular immunity)
The cell mediated defenses or cellular immunity, occur through the T cell system. On exposure to an antigen, the lymphoid tissues release large numbers of activated T cells into the lymph system. These T cells pass into general circulation. There are 3 main gps of T cells
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helper T cells, which help in the functions of immune system cytotoxic T cells, which attack and kill microorganisms and sometimes the body's own cells suppressor Tcells which can suppress the functions of the helper T cells and cytotoxic T cells
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Immunisation
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Immunisation
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Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).
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Passive and active immunization
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Immunisation can be achieved in an active or passive fashion: vaccination is an active form of immunization.
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Active immunization
Active immunisation entails the introduction of a foreign molecule into the body, which causes the body itself to generate immunity against the target. This immunity comes from the T cells and the B cells with their antibodies.
ACTIVE IMMUNISATION
NATURAL
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ARTIFICIAL
100
Active immunization
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Active immunization can occur naturally when a person comes in contact with, for example, a microbe. If the person has not yet come into contact with the microbe and has no pre-made antibodies for defense (like in passive immunization), the person can become immunized. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune
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Active immunization
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Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated, so that they will not harm the injected person as the naturally occurring microbe would. Depending on the type of disease, this technique also works with dead microbes, parts of the microbe, or treated toxins from the microbe.
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Passive immunization
Passive immunization is where pre-made elements of the immune system are transferred to a person, and the body doesn't have to create these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear
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Passive immunization
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Passive immunization can be naturally acquired when antibodies are being transferred from mother to fetus during pregnancy , to help protect the fetus before and shortly after birth.
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Passive immunization
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Artificial passive immunization is normally given by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment to poisons (for example, for tetanus).
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National Immunization Schedule AGE BIRTH 6 WEEKS 10 WEEKS 14 WEEKS
VACCINE BCG OPV OPV DPT
DOSE 1 0 1 1
ROUTE ID ORAL ORAL IM
OPV
2
ORAL
DPT
2
IM
OPV DPT
3 3
ORAL IM
National Immunization Schedule AGE
9 MONTHS
VACCINE
DOSE
ROUTE
MEASLES
1
SC
18 MONTHS DPT
1 BOOSTER IM
OPV
1 BOOSTER ORAL
5 YEARS
DT
1
IM
10 YEARS
TT
1
IM
16 YEARS
TT
1
IM
Optional Vaccines AGE
AGE
DOSE ROUTE
HEPATITIS B
BIRTH
1
IM
10 WEEKS
2
IM
9 MONTHS
3
IM
1 YEAR
1
IM
1 AND ½ YEAR 2
IM
06 MONTHS
1
IM
14 MONTHS
2
IM
18 MONTHS
3
IM
MMR
15 MONTHS
1
IM
CHIKENPOX
24 MONTHS
1
IM
TYPHOID
5 YEARS
2
IM
HEPATITIS A H. INFLUENZA-B (HIB)
UNIT TEST ON THIS UNIT COMPULSORY FOR ALL DURATION : 1 HR MM: 35 (28/11/08 : FRIDAY) Time: 1.45 to 2.30 PM
Ms.Vinay Kumari
Introduction
The primary roles of the nurse as caregiver are to: Promote health Prevent illness Restore health Facilitate coping Health is more than just the absence of illness; it is an active process in which an individual moves toward wellness by reaching his or her maximum potential. 08/22/09
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Introduction
(cont..)
To give holistic care, the nurse must understand and respect each person’s individual definition of health and response to illness and should be familiar with models of health and illness. Finally, the nurse needs to understand how to provide nursing care to promote health and prevent illness.
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3
Health Traditionally health was defined in terms of the presence or absence of disease. Individually defined Each person defines health in terms of his or her own values and beliefs. Acc. to WHO (World Health Organisation, 1946) Health is a state of complete physical, mental,and social well being, and not merely the absence of disease or infirmity.
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4
Definitions of Health
American Nurses Association (1980)
’’A dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible.’’
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5
Wellness and Well-Being
Wellness is a state of well being. 7 components of wellness (Anspaugh, Hamrick, and Rosato, 2006)
Physical (ability to carry out daily tasks, achieve fitness, maintain adequate nutrition & proper body fat, and generally positive lifestyle habits)
Social (ability to interact successfully with people & within the environment)
Emotional (ability to manage stress & to express emotions appropriately.) 08/22/09 6
Wellness and Well-Being 7 components of wellness (Anspaugh, Hamrick, and Rosato, 2006)
Intellectual (ability to learn & use information effectively for development)
Spiritual ( belief in some force that serves to unite human beings
Occupational (ability to achieve a balance between work & leisure time)
Environmental (ability to promote health measures that improve the standard of living & quality of life in the community)
Wellness and Well-Being
Well being is a subjective perception of vitality and feeling well. It is a component of health.
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8
Models of health and illness
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Agent- host- environment model Health-illness continuum High level wellness model Health promotion model Health belief model
9
Agent- host- environment model
Developed by Leavell and Clark(1965) Useful for examining the causes of disease in an individual. An agent is an environmental factor or stressor that must be present or absent for an illness to occur. A host is a living organism capable of being infected or affected by an agent. The environment includes all the factors external to the host that may or may not predispose the person to the development of disease. 08/22/09
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Health-illness continuum
The health illness continuum is one way to measure a person’s level of health. This model views health as a constantly changing state, with high level wellness and death being on opposite ends of a graduated scale, or continuum. This continuum illustrates the dynamic(ever changing) state of health, as a person adapts to changes in the internal and external environments to maintain as state of wellbeing. 08/22/09
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Health illness continuum
Illness area DEATH
ILLNESS
Death
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Well area NORMAL HEALTH
GOOD HEALTH
HIGH LEVEL WELLNESS
Well being
12
Health illness continuum
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People move back and forth within this continuum day by day A person with a chronic illness may view himself or herself at different points on the continuum at any given time, depending upon how well the patient believes he or she is functioning with the illness.
13
Factors/Variables affecting Health and Illness
People can usually control their health behavior and choose healthy or unhealthy activities. Internal variables
External variables
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Biologic dimension Psychologic dimension Cognitive dimension
Physical environment Standard of living Family and cultural beliefs Social support networks
14
Internal Variables Often described as non modifiable variable
Biologic dimension 1. Genetic makeup (influences biologic characteristic, innate
temperament, activity level, and intellectual potential) E.g: Diabetes, breast cancer; Africans (Hypertension , Sickle cell anemia)
2. Gender (influences the distribution of disease )
E.g: Females ( osteoporosis, Rheumatoid arthritis) ; Males (Stomach cancers, abd hernias) 3. Age (distribution of disease varies with age. ) E.g: Heart disease (middle aged men) ;Communicable diseases (children) 4. Developmental level (major impact on health status) E.g : Toddlers learning to walk are more prone to falls 08/22/09
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Internal Variables
(Cont…)
Psychologic dimension
Mind body interaction can affect health status +vely or –vely.Emotional responses to stress affect body functions. E.g : student anxious before test may experience diarrhea.
Self concept is how a person feels about self (self esteem) and perceives the physical self (body image), needs , roles and abilities. It affects how people view and handle situationts. Such attitudes can affect health practices, response to stress, illness etc.
E.g: Anorexia nervosa
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Internal Variables
(Cont..)
Cognitive dimension
Life style refers to a person’s general way of living
( living conditions and individual patterns of behavior). Lifestyle is often considered as behavior and activities over which people have control. E.g: Overeating, Insufficient exercises are related to incidence of Heart disease ; Excessive tobacco use linked with lung cancer
Spiritual and religious believes can significantly affect health behaviour.
E.g: Some religious gp are strict vegetarian; serious illness as God’s punishment 08/22/09
17
External variables
(Cont….)
Family and cultural beliefs
Family passes on patterns of daily living and lifestyle to offspring. E.g A man who was abused as a child may physically abuse his childern Each culture has ideas about health, and these are often transmitted to children. E.g Asians prefer herbal remedies and acupunture than analgesics
Social support network ( family, friends) and
job satisfaction helps people avoids illness. Support people help the person that illness exists and provide stimulus to become well again.
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External variables
Environment
Geographic location determines climate and climate effects health (malaria more in tropical than temperate climate) : pollution;radiation
Standards of living (reflecting ocupation,
income, and education) is related to health, morbidity and mortality. Hygiene, food habits, propensity to seek health care advise vary among high and low income gps. 08/22/09
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Illness And Disease
Illness is the highly personal state in which the persons physical ,emotional ,intellectual, social, developmental or spiritual functioning is thought to be diminished. Not synonymous with disease. For e.g An ind. could have a disease ( growth in stomach), and not feel ill.
Illness is highly subjective; only the individual can say he or she is ill.
Disease can be described as an alteration in body functions resulting in reduction of capacities or a shortening of normal life span. Causation of disease is ETIOLOGY
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20
Types Of Illness
Acute illness is characterized by severe symptoms of relatively short duration. Symptoms often appear abruptly and subside quickly. Depending on the cause, may or may not require interventions by health professionals. Following an attack, most people return to their normal level of wellness . E.g: Appendicitis, colds Chronic illness is one that last for an extended period, usually six months or longer and often for the person’s life. Slow onset. Often have peroids of Remission( when symptoms disappear) and exacerbation ( symptoms reappear). E.g : Diabetes, heart disease. 08/22/09
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Causes and risk factors for developing illness
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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 increases the vulnerability of an individual or group to an illness or accident
22
Causes and risk factors for developing illness The presence of risk factors doesn't mean that a disease will develop, but the risk factors increase the chances that the individual will experience a particular disease or dysfunction. 2. Genetic and Physiological factors Heredity or genetic predisposition to specific illness, is a major physical risk factor. Certain physical conditions, such as being pregnant or overweight, place increased stress on physiological systems, increasing susceptibility to illness.
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23
Causes and risk factors for developing illness (Cont…) 2. Age Age increase or decreases susceptibility to certain illnesses. 3. Environment The physical environment in which a person work or lives can increase the likelihood that certain illnesses will occur. 4. Lifestyle Lifestyle practices with potential negative effects are risk factors; these include sedentary lifestyle, overeating or poor nutrition, insufficient rest and sleep, and poor personal hygiene etc.
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Illness Behaviours
When people become ill, they behave in certain ways that sociologist refer to as illness behavior Illness behavior, a coping mechanism, involves ways individual describe, monitor and interpret their symptoms, take remedial actions, and use the health care system Variables affecting illness behavior are: age, sex, occupation, socio economic status, ethnic origin, personality, education, and modes of coping. 08/22/09
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Illness behaviour
(cont…)
5 stages of illness ( Suchman, 1979) Stage 1: Symptom experiences
At this stage, the person comes to believe something is wrong. 3 aspects of this stage: Physical experience of symptoms Cognitive aspect (interpretation of symptoms in terms that have some meaning to person) Emotional aspect ( fear or anxiety) During this stage, the unwell person usually consults others about symptoms; try home remedies . If self management is ineffective, the individual enters the next stage.
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Illness behaviour
(cont…)
Stage 2: Assumption of the sick role Individual accepts sick role & seeks confirmation; continue self treatment and delay contact with health care professionals as long as possible. May be excused from normal duties &role expectations Emotional responses such as withdrawal, anxiety, fear and depression are not uncommon When symptoms persist, the person is motivated to seek professional help 08/22/09
27
Illness behaviour
(cont…)
Stage 3: Medical care contact Sick people seek the advise of a health professional either on their own initiative or at the urging of significant others. 3. Validation of real illness 4. Explanation of symptoms in understandable terms 5. Reassurance that they will be all right or prediction of what the outcome will be. Client may accept or deny the diagnosis
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28
Illness behaviour
(cont…)
Stage 4: Dependent Client Role
After accepting the illness & seeking treatment, the client becomes dependent on the professional for help.
Stage 5: Recovery or Rehabilitation
The client is expected to resume former roles and responsibilities. For Acute illness (illness duration is less; rapid recovery); Chronic illness ( adjustments in life; find recovery more difficult) 08/22/09
29
Impact of illness
Illness is never an isolated life event. The client and family must deal with changes resulting from illness & treatment. The changes vary depending on the nature, severity, and duration of illness, attitudes associated with the illness by the client and the others, and the financial demands, the lifestyle changes incurred, adjustment to usual roles, and so on.
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30
Impact of illness on the client
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Ill clients may experience behavioral and emotional changes, changes in self concept and body image and life style changes. Behavioral and emotional changes associated with short term illness are generally mild and short lived Certain illnesses can also change the clients body image Clients self esteem and self concept may also be affected Ill individuals are also vulnerable to loss of autonomy Illness also often necessitates change in life style 31
Impact on the family
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A persons, illness affects not only the person who is ill but also the family or significant others Role changes Task reassignments and increase demands on time Increase stress due to anxiety about the outcome of the illness Financial problem Loneliness Change in social customs 32
Health Care Services
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A health care system is the totality of services offered by all health disciplines. The services provided by health care system are commonly categorized according to type and level.
33
Types of health care services
Health care services are often described in a way correlated with levels of disease prevention
A) Primary prevention (Health promotion and illness prevention) B) Secondary prevention (Diagnosis and treatment) C) Tertiary prevention (Rehabilitation, health restoration, palliative care )
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34
Types of health care services ( Cont..) PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION Health promotion was slow to develop until the 1980s. Since that time more and more people are recognizing the advantages of staying healthy and avoiding illness.
Primary prevention programs address areas such as adequate and proper nutrition, weight control and exercise, and stress reduction. Health promotion activities emphasize the important role clients play in maintaining their own health and encourage them to maintain the highest level of wellness they can achieve. 08/22/09
35
Types of health care services ( Cont..)
PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION (Cont..) Illness prevention programs may be directed at the client or the community and involve such practices as providing immunization, identifying risk factors for illnesses, and helping people take measures to prevent these illnesses from occurring. Illness prevention also includes environmental programs that can reduce the incidence of illness or disability
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36
Types of health care services ( Cont..) SECONDARY PREVENTION: DIAGNOSIS AND
TREATMENT In the past, the largest segment of health care services has been dedicated to the diagnosis and treatment of illness. Hospitals and physician’s offices have been the major agencies offering these complex secondary prevention services Freestanding diagnostic and treatment facilities have also evolved and serve ever growing number of clients. Also included as health promotion service is early detection of disease. This is accomplished through routine screening of the population and focused screening of those at increased risk of developing 08/22/09 certain conditions. E.g: Regular dental examination; 37
Types of health care services ( Cont..)
TERTIARY PREVENTION: REHABILITATION, HEALTH RESTORATION AND PALLIATIVE CARE The goal of tertiary prevention is to help people move their previous level of health (i.e to previous capabilities) or to the highest level they are capable of given their current health status. Rehabilitation care emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives. If injury is temporary, rehabilitation can assist in return to former function. If the injury is permanent, rehabilitation assists the client in adjusting how to perform activities in order to achieve maximum abilities. Sometimes, people cannot be returned to health. A growing field of nursing and tertiary prevention services is that of palliative care – providing comfort and treatment of symptoms 08/22/09 38
Health Promotion, Wellness, & Illness Prevention
08/22/09
Health care has become increasingly focused on health promotion, wellness, and illness prevention. Concept of health promotion, wellness, and illness prevention are closely related & in practice overlap to some extent. All are focused in future Health promotion activities such as routine exercise and good nutrition, help clients maintain or enhance their present levels of health. Motivate people to act positively to reach more stable levels of health. 39
Health Promotion, Wellness, & Illness Prevention
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. Help persons achieve new understanding and control of their lives. Illness prevention activities such as immunization prog protect clients from actual or potential threats to health. Illness prevention motivates people to avoid declines in health or functional levels.
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40
Health Promotion
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Science and art of helping people change their lifestyles to move toward a state of optimal health. Health promotion activities: Active and Passive Passive (individuals gain from activities of others without acting themselves e.g fluoridation of municipal water) Active ( individuals are motivated to adopt specific health prog e.g weight reduction) 41
Levels of preventive care Nursing care oriented to health promotion, wellness, and illness prevention can be understood in terms of health activities on primary, secondary and tertiary level. Primary prevention True prevention; preceds disease or dysfunction and applied to clients considered physically or emotionally healthy. Aimed at health promotion includes health education programs, immunisation, physical and nutritional fitness activities. Focus on maintaining or improving the general health of individuals, families, and communities.
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42
Levels of preventive care
Secondary Prevention
Focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions.
Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to normal level of health as early as possible.
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43
Levels of preventive care
08/22/09
Tertiary Prevention Occurs when a defect or disability is permanent and irreversible. Involves minimizing the effects of long term disease or disability by interventions directed at preventing complications and deterioration Activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness. Prevents further disability or reduced functioning.
44
Health Care Agencies
Health care organizations( agencies) may be defined as structural and functional units of personnel who provide health services to individuals, families, groups, and society.
Classification Acc to focus of service
Exist mainly to provide health care (hospitals, ambulatory care centers, home health agencies) Exist for another purpose but also include the provision of some health care as part of their services ( occupational health services, schools that provide student health services and prisons that provide dispensaries)
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Health Care Agencies
Classification (Cont..) Acc to population served Age
gp: (pediatric, adult health or geriatric client) Stage of illness: ( primary, secondary, tertiary) Specific health problems : ( communicable diseases, drug addiction etc)
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Health Care Agencies
Classification (Cont..) Acc to type of services Specific
services (diagnostic studies, counseling, formal instruction, surgery, non surgical treatment) General services (hospitals provide a more comprehensive array of services)
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Health Care Agencies
Classification (Cont..) Acc to source of fund Profit
institutions (proprietary): (receive payment from those who use their services) Nonprofit (not-for-profit): voluntary agencies (financed by private charitable or religious org.) public( govt. operated) agencies (funding from local, state govt)
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Hospital
The word hospital is derived from the Latin word hospitalis- for a guest in French “hospes- a host , a guest.” In olden days, the hospitals were guest houses for the shelter of homeless and for the treatment of travellers.In the modern times, the chief function of the hospital has been the care and treatment of sick. A hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays.
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Definition of Hospital
The 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 out patient services reach out to the family and its environment; the hospital is also a centre for the training of health workers and for bio- social research
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(WHO)50
Hospital
(Cont..)
The Changing role of hospitals Hospitals in India have come of age in the past 50 years or so. The old idea of hospital was that it is a place for the treatment of sick. Now , with the emphasis on physical, mental, social well being, reaching out to community and training of health workers, the health care services have undergone a steady metamorphosis and the role of the hospitals has changed, with emphasis shifting from:
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51
Hospital
(Cont..)
The Changing role of hospitals ( cont…)
Curative to preventive In patient care to out patient and home care Acute to chronic illness Tertiary and secondary to primary health care
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Hospital
(Cont..)
Functions
Primary function: provision of medical care to community INTRA-MURAL FUNCTIONS These functions are within the hospital, namely: A)Therapeutic
Diagnostic : diagnosis of illness
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Hospital
(Cont..)
INTRA-MURAL FUNCTIONS ( Cont..) A) Therapeutic ( Cont…)
2) Curative : Treatment of an illness 3) Rehabilitative : Physical, mental, social and vocational rehabilitation 4) Care of emergencies : Accident trauma and acute life threatening conditions
B) Preventive 1. 2. 3. 4. 5.
Antenatal and postnatal services Well baby clinics and immunization schedule Family welfare services Control of communicable diseases Health education
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Hospital
(Cont..)
INTRA-MURAL FUNCTIONS ( Cont..)
c) Education
Medical : Undergraduate, post graduate and post doctoral Nursing education: Undergraduate, post graduate and post doctoral Specialty Paramedical Community health
D) Research
Clinical medicine Hospital administration
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55
Hospital
(Cont..)
EXTRA MURAL FUNCTIONS
Those functions which are outside the hospital, namely: 1) Outpatient services 2) Home care/ out reach/ domiciliary services
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56
Classification of Hospitals Can be classified in many ways
According to ownership/ Control
B)
Public hospitals
Run by central/ state Govt or Municipal bodies on non commercial basis. May be general or specialized hospitals or both. General hospitals are those which provide treatment for common diseases, whereas specialized hospitals provide treatment for specific diseases, specific group of people like infectious diseases, cancer, eye, ENT, cardiac diseases
Voluntary ( Charitable ) hospitals
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Established and incorporated under the Societies Registration Act. A board of trustees usually manages such hospitals. The main source of revenue are publics and private donations and grants aid from the Central govt./ State govt. and from philanthropic organizations, both national and international
57
Classification of Hospitals A)
According to ownership/ Control Private hospitals
Corporate hospitals
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Generally owned by individuals or groups of people and are run on a commercial basis Run by limited companies, formed under the companies Act.They can be general, specialized or both.
58
Classification of Hospitals ( Cont..)
B) According to clinical specialities In these hospitals, patients are treated for those diseases for which that hospital has been set up, such as tuberculosis, cancer, cardiac diseases etc. These hospitals may be according to ownership/ control basis.
C) Acc. to length of stay In these hospitals, patients may stay for a long term or a short term. Day care hospitals are those where parents stay from morning to evening, as members of the family may not be at home to take care of the sick.
Acute care / short term stay (with mean length of stay 730 days) Long term stay ( average of length of stay over 30 days)
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Classification of Hospitals ( Cont..)
E) Acc to bed strength
Small (<100 beds) Medium sized (100-300 beds) Large (> 300 beds)
F) Acc. to teaching and non teaching A teaching hospital has a medical college attached to it. A hospital without a medical college is termed as a non teaching hospital . 08/22/09
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Physical Plan of the hospital SELECTION OF SITE
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Place should not be densely populated Site of the hospital should be elevated from the surroundings Should have an independent access to a street Must be away from nuisance such as dust, smoke, bad odor, excessive noise and traffic Open space all around will help in proper lighting (natural), and ventilations will provide a pleasing surrounding
61
Physical Plan of the hospital
PROVISION OF Safe
drinking water Adequate lighting and ventilation Control of noise Collection and safe disposal of refuse and excreta Control of arthropods, vermin and animal pests
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62
Physical Plan of the hospital
Important points to be considered while constructing a hospital
Walls and floor should be, as far as possible, non absorbent, non porous, shock absorbing, attractive, fire resistant, durable, easy to clean, and damp proof, free of cracks (prevent breeding of insects)
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Physical Plan of the hospital (Cont..)
Important points to be considered while constructing a hospital
Floor area should be adequate acc. to the no. of beds, so there is sufficient space between the beds (6 feet) Windows and doors should be placed in such a way that natural lighting is available in the room with cross ventilation Latrines are placed in such a way that it does not cause bad odor and unpleasant scenes. Should be placed where direct sunlight enters in. Reception counter and the OPD should be near to the main entrance of the hospital. IPD can be towards the back of the building.
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Physical Plan of the hospital (Cont..)
Important points to be considered while constructing a hospital
The kitchen and the dining rooms should be fly proof and away from the hospital wards. There should be central corridor connecting the different departments and wards. There should be provision for the isolation of patients having infectious diseases or who are suspected to be infectious. There should be railings along the open corridors and staircases to prevent accidents by falling Staircases, ramps and elevators should be centrally placed
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Organization of hospital Organization varies from hospital to hospital. Some feature are common to all. Line of authority differs acc. to the ownership and administration.
The governing body of a hospital, usually called the board of trustees or directors is responsible for the policies of the institution. Directly under the governing body is the head of the hospital, the administrator or director, to whom authority and responsibility for management is delegated.
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Organization of hospital (Cont..) The administrator/ director directs two divisions of the hospital work- the business management and the professional care of the patients. The business management includes administration, accounting, maintenance, engineering, housekeeping and purchasing.
Under the professional care of the patients are found the medical, nursing, paramedical and other special department.
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS Medical department (Medical superintendent is a
doctor who has control over all the medical dept.) Nursing department Paramedical department Pathology dept ( Bacteriology lab, biochemistry lab, hematology lab, parasitology lab, serology lab, Blood Bank, Histopathology dept ) Pharmacy dept (selecting, purchasing, compounding, storing and dispensing all drugs ) Physical medicine and rehabilitation Radiology dept Dietary dept
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Organization of hospital (Cont..)
MAJOR DEPARTMENTS NON PROFESSIONAL SERVICES (BUSINESS MX)
Admitting dept Administration Personnel dept ( recruitment, interview, promotion, transfer, inservice training, safety, health prog, recreation) Purchasing dept Medical records Accounts (Business office) Housekeeping (to keep hospital clean) Laundry Mechanical dept (electricity, water supply,heat.) Maintenance dept (carpenter, painters, welders, gardners Central supply dept Social services 69 08/22/09
Primary Health care
Originally conceptualized in 1978 by the WHO and the United Nations International Children’s Emergency Relief Fund (UNICEF)
Concept was developed based on decreases in illness and death in member countries that were achieved by simple, local, inexpensive solutions to health problems, especially when combined with economic and social development.
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Primary Health care
Defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford “Primary health care is essential health care, made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.” (Alma Ata conference) 08/22/09
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Primary Health care (Cont…)
Not to be confused with primary care. Primary care is the delivery of healthcare services, including the initial contact and ongoing care. Included in primary care is the responsibility for referral to other providers based on patient needs. Both physicians and nurse practitioners provide primary care, which focuses on individual patient and is directed by the provider. In contrast, primary health care has a community based philosophic base that emphasizes universal access and affordability of health care, health of whole population, and consumer involvement. 08/22/09
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Primary Health care (Cont…)
Principles of primary health care
1.Equitable distribution Health services must be shared equally by all people irrespective of their ability to pay and all (rich or poor, urban or rural) must have access to health services. Primary health care aims to address the current imbalance in health care by shifting the centre of gravity from cities where a majority of the health budget is spent to rural areas where a majority of people live in most countries.
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Primary Health care (Cont…)
Principles of primary health care
2. Community participation There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, beside maximum reliance on local resources such as manpower, money and materials.
3. Intersectoral coordination Primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors.
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Primary Health care (Cont…) Principles of primary health care 4. Appropriate technology “Technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford.”
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Primary Health care (Cont…) n
n n n
n n n
n
8 Essential elements of primary health care Education- concerning prevailing health problems and the methods of preventing and controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation Maternal and child health care, including family planning Immunisation against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Provision of essential drugs 08/22/09
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Primary Health care (Cont…)
Role of Nurse
Assessing the health status of individuals and community. Promoting community involvement Providing integrated health care including the treatment of emergencies and making referrals. Making epidemiological surveillance. Training and supervising health workers. Collaborating with other developmental sectors Monitoring progress in primary health care
Body defenses: Immunity and Immunization
Introduction
Individuals normally have defenses that protect the body from infection. These defenses can be categorized as specific and non specific. Non specific defenses protect the person against all microorganisms, regardless of prior exposure. Specific immune) defenses, by contrast, are directed against identifiable bacteria, viruses, fungi, or other infectious agents.
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Non Specific Defenses
Nonspecific body defenses include anatomic and physiologic barriers, and the inflammatory responses.
Anatomic and Physiologic Barriers
Intact skin and mucous membrane : first line of defense against micro-organisms. Normal secretions make the skin slightly acidic; acidity also inhibits bacterial growth. Nasal passages have a defensive function. Moist mucus membranes and cilia trap microorganisms, dust, foreign materials. Lungs have alveolar macrophages (large phagocytes) that ingest microorganisms, other cells, and foreign particles.
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Non Specific Defenses (Cont…)
Anatomic and Physiologic Barriers (Cont…)
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Each body orifice also has protective mechanisms. The oral cavity regularly sheds mucosal epithelium to rid the colonizers. Saliva contains microbial inhibitors such as lactoferrin, lysozyme and secretory IgA. Eye is proteced from infection by tears, which continually wash microorganisms away and contain inhibiting lysozyme. High acidity of stomach normally prevents microbial growth.
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Non Specific Defenses (Cont…)
Inflammatory Responses Inflammation
is a local and nonspecific defensive response of tissues to an injurious or infectious agent. It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents further spread of injury, and promotes the repair of damaged tissue.
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Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) It is characterized by 5 signs: 1. 2. 3. 4. 5.
Pain Swelling Redness Heat Impaired function of the part, if the injury is severe.
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Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) A series of dynamic events commonly referred to as the 3 stages of inflammatory response
First Stage: Vascular and cellular Responses At the start of 1st stage, blood vessels at the site of injury constrict. This is rapidly followed by dilation of small blood vessels (occurring as a result of histamine released by injured tissues). Thus, more blood flows to the injured area( hyperemia) and is responsible for the characteristic signs of redness and heat. Vascular permeability increases at the site with dilation of the vessels in response to cell death, the release of chemical mediators (e.g bradykinin, serotonin, prostaglandins) and histamine. 08/22/09
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Non Specific Defenses (Cont…) 2.
Inflammatory Responses (Cont..)
First Stage: Vascular and cellular Responses
Fluid, proteins and leukocytes leak into interstitial spaces, and the signs of inflammation swelling (edema) and pain appear. Pain is caused by pressure of accumulating fluid on nerve endings and the irritating chemical mediators. Leukocytosis (large no of leukocytes produced by bone marrow and released into blood stream). Leukocytes move through the blood wall into the affected tissue spaces.
Non Specific Defenses (Cont…)
Inflammatory Responses (Cont..) Second Stage : Exudate production The inflammatory exudate is produced, consisting of fluid that escaped from the blood vessels, dead phagocytic cells, and dead tissue cells and products that they release. The plasma protein fibrinogen ( which is converted into fibrin when it is released into the tissues), thromboplastin (released by injured tissue cells), and platelets together form an interlacing network to wall off the area, and prevent spread of injurious agent. During this stage, the injurious agent is overcome, and the exudate is cleared by lymphatic drainage. 08/22/09
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Non Specific Defenses (Cont…) 2)
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Inflammatory Responses (Cont..) Third Stage : Reparative Phase Involves the repair of injured tissues by regeneration or replacement with fibrous tissue( scar) formation. Regeneration is the replacement of destroyed tissue cells by cells that are identical in structure and function. When regeneration is not possible, repair occurs by fibrous (scar) tissue formation. Damaged tissues are replaced with the connective tissue elements of collagen, blood capillaries, lymphatics.
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Non Specific Defenses (Cont…) Inflammatory Responses (Cont..) 2) Third Stage : Reparative Phase In the early stages of this process, the tissue is called granulation tissue (fragile, gelatinous, pink or red) Later, the tissue shrinks, capillaries constrict and collagen fibers contract, so that a firmer fibrous tissue remains. This is called as cicatrix or scar.
Specific defenses
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Specific defenses of the body involve the immune system.
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Immunity
Immunity is a material term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. An antigen is a substance that induces a state of sensitivity or immune responsiveness (immunity).
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Types of Immunity IMMUNITY
NATURAL
ACTIVE
(INFECTION) 08/22/09
PASSIVE (MATERNAL)
ACQUIRED
ACTIVE
PASSIVE
(IMMUNISATION)(ANTIBODY TRANSFER) 91
Active and passive immunity
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Passive immunity is acquired through transfer of antibody or activated T-cells from an immune host, and is short lived, usually lasts only a few months, whereas active immunity is induced in the host itself by antigen, and lasts much longer, sometimes life-long.
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Components of immune response
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Immune response has two components: Antibody mediated defenses and cell mediated defenses. These two systems provide distinct but overlapping protection.
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Components of immune response (Cont…)
Antibody mediated defenses ( Humoral or circulating immunity)
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These defenses reside ultimately in the B lymphocytes and are mediated by antibodies (immunoglobulin) produced by B cells. The antibody mediated responses defend primarily against the extra cellular phases of bacterial and viral infections.
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Components of immune response (Cont…) Antibody mediated defenses ( Humoral or circulating immunity) Active immunity (host produces antibodies in response to natural antigens (e.g infectious microorganisms) or artificial antigens (e.g. vaccines). B cells are activated when they recognize antigen. Bcells may produce antibody molecules of 5 classes of immunoglobulins (IgM, IgG, IgA, IgD, and IgE.)
Passive immunity the host receives natural (e.g from nursing mother) or artificial(from an injection of immune serum) antibodies produced by another source.
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Components of immune response (Cont…) Cell mediated defenses ( Cellular immunity)
The cell mediated defenses or cellular immunity, occur through the T cell system. On exposure to an antigen, the lymphoid tissues release large numbers of activated T cells into the lymph system. These T cells pass into general circulation. There are 3 main gps of T cells
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helper T cells, which help in the functions of immune system cytotoxic T cells, which attack and kill microorganisms and sometimes the body's own cells suppressor Tcells which can suppress the functions of the helper T cells and cytotoxic T cells
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Immunisation
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Immunisation
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Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).
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Passive and active immunization
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Immunisation can be achieved in an active or passive fashion: vaccination is an active form of immunization.
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Active immunization
Active immunisation entails the introduction of a foreign molecule into the body, which causes the body itself to generate immunity against the target. This immunity comes from the T cells and the B cells with their antibodies.
ACTIVE IMMUNISATION
NATURAL
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ARTIFICIAL
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Active immunization
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Active immunization can occur naturally when a person comes in contact with, for example, a microbe. If the person has not yet come into contact with the microbe and has no pre-made antibodies for defense (like in passive immunization), the person can become immunized. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune
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Active immunization
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Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated, so that they will not harm the injected person as the naturally occurring microbe would. Depending on the type of disease, this technique also works with dead microbes, parts of the microbe, or treated toxins from the microbe.
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Passive immunization
Passive immunization is where pre-made elements of the immune system are transferred to a person, and the body doesn't have to create these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear
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Passive immunization
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Passive immunization can be naturally acquired when antibodies are being transferred from mother to fetus during pregnancy , to help protect the fetus before and shortly after birth.
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Passive immunization
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Artificial passive immunization is normally given by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment to poisons (for example, for tetanus).
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National Immunization Schedule AGE BIRTH 6 WEEKS 10 WEEKS 14 WEEKS
VACCINE BCG OPV OPV DPT
DOSE 1 0 1 1
ROUTE ID ORAL ORAL IM
OPV
2
ORAL
DPT
2
IM
OPV DPT
3 3
ORAL IM
National Immunization Schedule AGE
9 MONTHS
VACCINE
DOSE
ROUTE
MEASLES
1
SC
18 MONTHS DPT
1 BOOSTER IM
OPV
1 BOOSTER ORAL
5 YEARS
DT
1
IM
10 YEARS
TT
1
IM
16 YEARS
TT
1
IM
Optional Vaccines AGE
AGE
DOSE ROUTE
HEPATITIS B
BIRTH
1
IM
10 WEEKS
2
IM
9 MONTHS
3
IM
1 YEAR
1
IM
1 AND ½ YEAR 2
IM
06 MONTHS
1
IM
14 MONTHS
2
IM
18 MONTHS
3
IM
MMR
15 MONTHS
1
IM
CHIKENPOX
24 MONTHS
1
IM
TYPHOID
5 YEARS
2
IM
HEPATITIS A H. INFLUENZA-B (HIB)
UNIT TEST ON THIS UNIT COMPULSORY FOR ALL DURATION : 1 HR MM: 35 (28/11/08 : FRIDAY) Time: 1.45 to 2.30 PM
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