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CHN-Unit 1.pptx

  2. Course Objective Aimed to provide • Basic knowledge in community health nursing regarding concept of health and spectrum of health, primary health care, community, nutrition, epidemiology, health statistics and indicators, family planning, immunization, pollution hazards, occupational hazards
  3. At the end of the sessions students will be able to • Define community • Describe community health • Describe community health nursing • Define health according to WHO • Define disease • Define illness • Describe spectrum of health and illness • Identify dimensions of health
  4. Community • A community is commonly defined as a group of people living together in the some geographic location and abiding by the laws • “ The people living in a particular place or region and usually linked by common interests”
  5. Cont’d… • A group of individuals and families living together in a defined geographical area, usually comprising a village, town or city • People living in the community may be socially and culturally similar to one another, or they could be quite different. • Those people have different occupations, religious values, economic status, education, etc.
  6. Community Health • The term community health has replace the term public health, preventive medicine and social medicine • According to WHO “ Community health refers to the health status of the members of the community, to the problems affecting their health and to the totality of health care provided for the community
  7. Cont’d… • Community health is a systematic way of studying the health and diseases present in a community and the patterns of delivery of care both of which influence the amount and nature of disease. • Also known as community medicine.s
  8. Community Health Nursing According to American Nursing Association (ANA), “community health nursing is a synthesis of nursing and public health practice applied to promoting and preserving the health of people. The practice is general and comprehensive. It is not limited to particular age group or diagnosis and is continuing, not episodic”
  9. Concept of Health • “Health” is perceived differently by members of the community. The concept of health is evolved over the centuries as a concept from individual concern to worldwide social goal and covers the whole quality of life.
  10. Changing Concept of Health a) Biomedical Concept b) Ecological Concept c) Psychological Concept d) Holistic Concept
  11. Cont’d… a) Biomedical Concept Traditionally health is viewed as “absence of disease”, if one is free from disease, the person was considered healthy. It is based on “germ theory of disease”. The medical profession viewed human body as a machine, disease as a consequence of the breakdown of the machine and one of the doctor’s task as repair of the machine
  12. Cont’d… b) Ecological Concept This concept raised because of deficiency in the biomedical concept. According to this concept, health is viewed as a dynamic equilibrium between human being and environment; disease as maladjustment of the human organism to environment. The ecological concept raises two issues such as imperfect man and imperfect environment.
  13. Cont’d… c) Psychological Concept According to this concept, health is not only biomedical phenomenon but one which is influenced by social, psychological, cultural, economic and political factors of the people concerned. Thus health is both a biological and social phenomenon.
  14. Cont’d… d) Holistic Concept It is synthesis of all the above concepts. It describes health as a unified or multi-dimensional process involving the well-being of whole person in context of his environment. This approach suggests that all sectors of society have an effect on health particularly in agriculture, animal husbandry, food, industry, education, housing, communication and other sectors
  15. Definition of Health • “Health” is one of the terms which is most people find it difficult to define although they are confident of its meaning • Webster: The conditions of being sound in body, mind and spirit specially freedom from physical disease or pain
  16. Cont’d… • The oldest definition is that health is the “absence of disease”. • According to WHO (1947), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” • In recent years, this statement has been amplified to include the ability to lead a “socially and economically productive life”
  17. Disease • Webster defines disease as “ a condition in which body health is impaired, a departure from a state of health, an alteration of the human body interrupting the performance of vital functions”. • According to Oxford dictionary, disease is defined as “ a condition of the body or some part or organ of the body in which its functions are disturbed or deranged.
  18. Cont’d… • From ecological concept, disease is considered as “a maladjustment of the human organism to the environment”. • From sociological concept, disease is considered as a social phenomenon, occurring in all societies and defined and fought in terms of the particular cultural forces prevalent in the society
  19. Cont’d… • The simplest definition is that disease is just the opposite of health i.e. any deviation from normal functioning or state of complete physical or mental well-being.
  20. Optimum health • Health is a continuum with optimum health on the one end and death on the other side. People fall somewhere on the continuum depending on their level of health or illness.
  21. Illness-Wellness Continuum
  22. Illness-Wellness Continuum The transaction from optimum level of health to illness is gradual in nature, where one state ends and the other begins in a matter of judgment. Health and disease lie along a continuum and there is no single cut off point.
  23. Cont’d… • The lowest point in the continuum is death and the highest point corresponds to the WHO definition of positive health. • Thus, a person who is physically, mentally, socially and spiritually healthy is said to be in a state of optimum health. It means people will have access to be born healthy, grow to adulthood and live productive life
  24. Spectrum of Disease • Spectrum of health refers to the range of manifestations and severities of illness associated wit ha given diseases, illness or injury. • The term “spectrum of disease” is a graphical representation of variations in the manifestations of disease
  25. Spectrum of Health and Sickness
  26. Cont’d… • Health and disease lie along a continuum, there is no single cut-off point • The health of an individual is not static; it is a dynamic phenomenon and a process of continuous change • There are degrees or "levels of health" as there are degrees or severity of illness. As long as we are alive there is some degree of health in us.
  27. Cont’d… • At one end of the spectrum are subclinical infections which are not ordinarily identified, and at the other end are fatal illness • In the middle of the spectrum lie illnesses ranging in severity from mild to severe.
  28. Cont’d… • These different manifestations are simply reflections of individual’s different states of immunity and receptivity • The sequence of events in the spectrum of disease can be interrupted by early diagnosis and treatment or by preventive measures
  29. Positive health Positive health means perfect functioning of the body and mind. It conceptualizes health biologically, as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body, psychologically, as a state in which the individual feels a sense of perfect well- being and of mastery over his environment and socially, as a state in which the individual’s capacities for participation in the social system are optimum
  30. Distinction between Disease, Illness and Sickness •Disease means “without ease” (uneasiness), when something is wrong with bodily function. Disease is a physiological/ psychological dysfunction.
  31. Cont’d… Illness means not only the presence of a specific disease, but also to the individual’s perception and behavior in response to the disease, as well as the impact of the disease on psychological environment.
  32. Sickness Sickness refers to a state of social dysfunction i.e. a role that the individual assumes when ill (sickness role). Sickness is related to different phenomenon, namely the social role a person with illness or sickness or is given in society, in different arenas of life.
  33. Disease Illness Sickness A condition that is diagnosed by a physician or other medical expert. → (Physician) Ill health that the person identifies themselves with, often based on self reported mental or physical symptoms. ● It can be Acute or Chronic → (Patient) Social & cultural conception of a person’s condition. "When it interferes with your life" → (Society) Flu diagnosed by a physician Flu reported by the patient Missed class or work due to Flu (Sick leave) Definitions: The trilogy of Disease, Illness, Sickness
  34. Dimensions of Health a) Physical Dimension b) Mental Dimension c) Social Dimension d) Spiritual Dimension e) Emotional Dimension f) Vocational Dimension Health is multidimensional. WHO defines 3 specific dimensions of health • Physical • Mental and • Social
  35. Cont’d… a) Physical Dimension • Physical health relates to the anatomical, physiological, and biochemical functioning of the human body. • The state of physical health implies the understanding of “perfect functioning” of the body
  36. Cont’d… The signs of physical health in an individual are” “ a good complexion, a clean skin, bright eyes, well clothed, not too fat, a sweet breath, a good appetite, sound sleep, regular activity of bowels and bladder and smooth, easy, coordinated bodily movements.
  37. Cont’d… All the organs of the body are of unexceptional size and function normally; all the special senses are intact, the resting pulse rate, blood pressure and exercise tolerance are all within the range of “normality” for the individual’s age and sex
  38. Cont’d… It conceptualizes health biologically as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body
  39. Cont’d… b) Mental Dimension • Mental health is not mere absence of mental illness. • Good mental health is the ability to respond to the many varied experiences of life with flexibility and a sense of purpose
  40. Cont’d… Mental health has been defined s “ a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment.
  41. Cont’d… c) Social Dimension • Social well-being implies harmony and integration with the individual, between each individual and other members, society and between individuals and the world in which they live • It can be defined as the “quantity and quality an individual’s interpersonal ties and the extent involvement with the community”
  42. Cont’d… • It includes the levels of social skills one possesses, social functioning and the ability to oneself as a member of a larger society. • Social health is rooted “ positive material environment” and “positive human environment” where is concerned with the social network of the individual
  43. Cont’d… d) Spiritual Dimension • Holistic approach of health believes that the time has come to give serious consideration to the spiritual dimension and to the role this plays in health and disease
  44. Cont’d… • It refers to that part of the individual which reaches out and strives for meaning and purpose in life. • It is intangible “something” that transcends physiology and psychology. • It includes integrity, principles and ethic the purpose in life, commitment to some higher being are belief in concepts that are not subject to state of the any explanation
  45. Cont’d… e) Emotional Dimension • The mental and emotional dimensions have been seen as one element or as two closely related elements • With greater numbers of research, a definite difference is emerging.
  46. Cont’d… • Mental health can be seen as “knowing” or “cognition” while emotional health relates to “feeling”. • Thus, the mental and emotional aspects of humanness may have to be viewed as two separate dimensions of human health
  47. Cont’d… f) Vocational Dimension • It is a new dimension to health • It is a part of human existence • When work is fully adapted to human goals, capacities and limitations, work often plays a role in promoting both physical and mental health.
  48. Cont’d… • Physical work is usually associated with an improvement in physical capacity, while goal achievement and self-realization in work are a source of satisfaction and enhanced self-esteem. • The importance of this dimension is exposed when individuals suddenly lose their jobs or faces with mandatory retirement.
  49. Cont’d… • For many people, the vocational dimension may be merely a source of income. • To others, this dimension represents the culmination of the efforts of other dimesions as they function together to produce what the individual considers life “success”
  50. Determinants/ Factors of Health • Factors which influence health lie both within the individual and externally in the society in which he or she lives. • A person can fall victim depending upon combination of his or her genetic factor and the environmental factors to which he is exposed.
  51. Determinants of Health 1) Biological Factors 3) Environment al Factor 2) Life style 4) Socio- economi c factor 5) Health Services 6) Aging of populatio n 7) Gender 8) Others
  52. Cont’d… • The health of an individual or the whole community may be considered as the result of the interaction between those factors.
  53. 1) Biological: •Genetic predisposition from the parents to the off- springs 2) Behavioral and socio-cultural (Life Style) •Cultural and behavior patterns, life long habits developed from socialization (eg: smoking, staying up late)
  54. 3) Environmental Factor •Can be internal environment that is every components in the body from the cell, tissue, organ, system and the harmonious relationship between the system •Can be external environment that is every thing outside the individual’s body which can be physical biological, and psychological components
  55. 4) Socio-economic factor •There is a strong impact on health. It includes race, income, level of education, occupation, gender, housing, and religion. 5) Health Services •The aim of health services is to enhance health status of population. Availability and quality of health services can affect health of individual and community
  56. 6) Aging population •Rapid aging of population increases burden of chronic disease 7) Gender •Women's health covering nutrition, reproductive health, the health consequences of violence, ageing, lifestyle related conditions and the occupational environment. •Road traffic accidents are more prone to man
  57. 8) Others •Information technology, health related systems like agriculture and food •Although technology is great, not everyone know how to use them
  58. Social Determinants of Health • Social determinants are the social and economic factors that influences people’s health. • These are obvious in the living and working conditions that people experience in daily life. • For example, income, social status, education, physical environment, social support networks, genetics, health services, etc
  59. Cont’d… According to WHO, social determinants of health are defined as “the conditions in which people are born, grow, live, work and age.”
  60. Dahlgren and Whitehead’s model of social determinants of health
  61. Cont’d… • The model proposed the layer of influence on health. • It describes the socio-ecological theory of health • It attempts to map the relationship between the individual, their environment, and disease
  62. Individual Lifestyle factors: Age, sex and hereditary factors • The core part of the model consists of inherited attributes relating to age, sex and hereditary factors • It suggests that health is partly determined by individual’s lifestyle, such as smoking, physical activity and diet that can promote or damage health and can be modified
  63. Social and Community Network • The second layer on the model is social and community network. • It draws attention to relationship with family, friends, and significant others within the local community.
  64. Cont’d… • This network contributes to the health by providing help, mutual support to members of the community in unfavorable conditions. • Sometimes, it may not support or may also have negative effect on health. For instance, broken family, divorce, conflict.
  65. General socio-economic, cultural and environmental conditions • It is the outermost layer of the model • It focuses on working and living conditions such as housing, health care services, water and sanitation, education, agriculture and food production and so on
  66. Cont’d… • This layer focus on broader socio-economic, cultural and environmental forces such as economic development, shift in welfare system, political change, social forces and structure
  67. Importance of Social Determinants of Health a) It directly affects health: For example, • Higher income and social status are linked to better health • Low level of education are linked with poor health, stress, etc. • Physical environment such as safe drinking water, clean air, healthy work places, safe houses, communities and roads all contributes to good health
  68. Cont’d… b) It predicts the greatest proportion of health status variance For example, • Poor social and economic conditions- poverty, social exclusion, unemployment and inadequate housing contribute to health inequalities
  69. Cont’d… It reflects an individual’s or population group’s position in society, security, resources, such as education, employment, housing as well as differential levels of participation in civic society and control over life
  70. Cont’d… c) Social determinants of health structure health behavior: Not only influence the overall health in positive and negative ways; it also determines the individual’s healthy behaviors and encourages in adopting healthy behavior • It depends on how much an individual is aware about staying fit and adopting healthy behaviors which helps to prolong life and stay away from disease and disability
  71. Cont’d… d) Social determinants interact with each other in order to produce healthy life. No single social determinants along can help individual obtain health. • For instance, cutbacks in welfare services might adversely affect people’s access to adequate housing and thus influence their health.
  72. Thank you !!!
  73. Community •A community is commonly defined as a group of people living together in the same geographic location and abiding by the laws. •“ A group of individuals and families living together in a defined geographic area, usually comprising a village, town, or city.”
  74. Cont’d… •According to WHO, community is a social group determined by geographical boundaries and/ or common values and interests with each other. It functions in a particular social structure and exhibits and creates certain norms, values, and social institutions. The individual belongs to the broader society through his family and community.”
  75. Community Health •According to WHO “ Community health refers to the health status of the members of the community, to the problems affecting their health and to the totality of health care provided for the community
  76. Community Health Nursing According to American Nursing Association (ANA), “community health nursing is a synthesis of nursing and public health practice applied to promoting and preserving the health of people. The practice is general and comprehensive. It is not limited to particular age group or diagnosis and is continuing, not episodic”
  77. Cont’d… An art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number. -WHO
  78. Goals of Community Health Nursing 1. Health promotion 2. Health maintenance 3. Prevention of illness 4. Restoration of health
  79. Cont’d… a) Meet the community First goal of CHN to meet the community in order to •Establish contact with community leaders, existing institutions •Obtain consent of the local leaders for a base-line survey of the health situation for identification of health problems and needs
  80. Cont’d… Various approaches for identification of community health problems and health needs are: •Base line survey •Scrutining the records of PHC and sub-centre •Specific questions regarding disease common in area •Questions regarding birth, deaths, disability, failure to work etc.
  81. Cont’d… b) Setting priorities among health problems Four criteria used for setting priorities among health problems: •Frequency with which the problems occurs •Seriousness of the problem for individuals and society •Urgency of the problem •Feasibility or susceptibility to control the problem within the financial resource limitation
  82. Cont’d… c) Planning and problem solving A community health nurse must decide what action should be taken by the health team and whether the health team will be capable of taking any action. Planning involving questions of setting objectives, and defining solutions to the problem
  83. Cont’d… d) Intervention or implementation The community health nurse caries out activities decided upon as being most effective, in order to fulfill the recognized need. This phase contains all the tasks, procedures and practices which are performed by nurses
  84. Cont’d… e) Evaluation Measurement of the extent to which the problem has been solved or the need met. It provides “feedback” that can lead to program more effectively
  85. Definition of Public Health Public Health is the field of health science that is concerned with safeguarding and improving the physical, mental, and social well-being of the community as a whole
  86. Cont’d… Mark Salman White (1982) describes a public health as an organized societal effort to protect, promote, and restore the health of people and public health nursing as focused on achieving and maintaining public health
  87. Public Health Nursing A branch of nursing concerned with providing nursing care and health guidance to individuals, families, and other population groups in settings such as the home, school, workplace, and other community settings such as medical and health centers
  88. Cont’d… American Public Health Association (2003) defines public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences
  89. Goals of Public Health Nursing 1. Improve the health outcomes of all population 2. Apply clinical knowledge and expertise in health care from an ecological standpoint 3. Acknowledge the public health problems and the relative nature of health including cultural, environmental, physical and social factors
  90. Cont’d… 4. Assess the potential or actual assets, needs, opportunities and inequities of individuals, families and populations and translate this assessment into action for public good 5. Focuses on advocacy, policy development and planning which addresses issues of social justice
  91. Population Health Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. -(Kindig and Stoddart, 2003)
  92. Components of population health •Health outcomes •Health determinants •Polices
  93. Level of Prevention
  94. Primordial Prevention •It is receiving of special attention in the prevention of chronic diseases. •It is primary prevention in its purest sense i.e. prevention of development of risk factors in population groups in which they have not yet appeared
  95. Cont’d… •Efforts of primordial prevention are directed towards discouraging children from adopting harmful lifestyles as many illness in adulthood have origins in childhood •Main intervention in primordial prevention is through individual and mass education
  96. Cont’d… •For example, many adults health problems (eg obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed (for example, smoking, eating patterns, physical exercise)
  97. Primary Prevention •It is defined as “action taken prior to the onset of disease which removes the possibility that a disease will ever occur”. •Primary prevention includes holistic approach. •It involves interventions in the pre-pathogenesis phase of a disease or health problem or other departure from health
  98. Health Promotion Health Education Environmental Modification Nutritional Intervention Life style and behavioral changes Specific Protection Immunization Chemoprophylaxis Use of specific Nutrients or supplementation Safety of drugs and foods Control of environmental hazards e.g. pollution
  99. Cont’d… •It includes measures both general health promotion and specific protection. •It includes the concept of “positive health”. •Positive health is a concept that encourages achievement and maintenance of “an acceptable level of health that will enable every individual to lead a socially and economically productive life.”
  100. Cont’d… For example: •It is now being applied to the prevention of chronic diseases such as coronary heart disease, hypertension and cancer based on elimination or modification of risk factors of disease
  101. Secondary Prevention •These are actions which halts the progress of a disease at its incipient stage and prevents complication. •The specific interventions arse early diagnosis and adequate treatment.
  102. Concept of disability •The sequence of events leading to disability and handicap have been stated as:
  103. Cont’d… Impairment: It is defined as “any loss or abnormality of psychological, physiological or anatomical structure or function” eg. Loss of foot, defective vision, etc
  104. Cont’d… Disability: It is defined as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being”
  105. Cont’d… Handicap: It is defined as “a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of role that is normal for that individual”.
  106. Cont’d… For example: Accident : Disease or disorder Loss of foot : Impairment Can’t walk : Disability Unemployed : Handicap
  107. Cont’d… •It aims to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes and reverse communicability of infectious diseases. •It is mainly associated with clinical medicine
  108. Cont’d… •Goal of secondary prevention is to cure disease at its earliest stage or when cure is impossible, to slow its progression as well as prevent complications and limit disability
  109. Tertiary Prevention •“All the measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing departures from good health and to promote the patient’s adjustment to irremediable conditions” •All the interventions are taken in late pathogenesis
  110. Cont’d… •When disease process has advanced beyond its early stages, it is still possible to accomplish prevention by tertiary prevention because tertiary prevention may limit disability •When disability are more or less stabilized, rehabilitation may play a preventable role.
  111. Level of Intervention 1. Individual Focused 2. Community Focused 3. System Focused
  112. Individual Focused •It is associated with interventions for promotion of personal health or individual health •Means these are applied at individual level For example •Modification of lifestyle and behavior by an individual for good health
  113. Community Focused •It is associated with interventions for promotion of health status of a group of people or sub-groups in the community For example •Health education activities, environmental modification, population strategies, screening test, case finding program, etc.
  114. System Focused •These are interventions targeted to an entire population, state or country. For example •National nutrition program, national immunization program, laws for protection against occupational hazards, laws for control of environmental hazards, treatment protocol for non-communicable diseases etc.