Subject: Nursing Foundation

Unit: 1- Introduction
By:
Ms. Dipal Patel.
Assi. Professor

Definition: Health
According

to WHO:
Health is a state of complete
physical, mental, and social well
being, not merely the absence of
diseases or infirmity.

Definition: Health

Health is a dynamic constantly

varying attribute rather than a
complete stated of any kind including
diseases Skrovan.

Health

is a state of physical, mental

and social well-being and the ability to
function and not merely the absence of
illness or infirmity.

Concept of Health:
Basic concept of Health:

Health was usually considered as absence of

disease.
Changing concept of Health:
1.
Bio-medical concept.
2.
Ecological concept.
3.
Psychological concept.
4.
Holistic concept.

Bio- medical concept:

Human

body and its functions, like

machine. When machine fail functioning,
need repairs.

Similarly

man likes machines, fails to

function causing disease and doctors treat
the disease to keep the body functioning.

Ecological concept:
According

to ecological concept, the health is

maintained in favorable environment and
disease is caused when there is any deviation
in the environment which is unfavorable.

It

is determined as the Dynamic

equilibrium between man and his
environment and disturbed equilibrium
between environment and man may cause
diseases.

Psychological concept:
Health

has been viewed not only by

absence of disease or environmental
influences, but various psychological/
economical and cultural factors
contribute towards health.

The

negative factors play important

role in causation of diseases.

Holistic concept:
Health

is considered as multi
dimensions and multi-determinants.

To keep

up the health, a person must

be free from sickness in healthy
environment and having positive
psychological, social and economical
factors.

Health

is a multi-sectorial.

Factor influencing health:

Habit,
environmental

condition,
Physiological condition or other variable
that increases the vulnerability of an
individual or group to an illness or accident.

Risk factors:
1.
2.
3.
4.

Genetic and physiological factors.

Age
Physical
Lifestyle.

Genetic and physiological factors:

Physiological risk factors involve the

physical functioning of the body,
Certain physical condition such as:
- being pregnant or overweight.
Place increased stress on psychological
system.
Increasing susceptibility to illness in these
areas.

Heredity or genetic predisposition to

specific illness.

Family histories of cancer, heart

diseases or kidney diseases.

Age:

Age

increases the susceptibility to certain

illnesses- eg.- the risk of heart diseases
increases with age for both genders.

The

risk of birth defects and complications

of pregnancy increases in women bearing
children after age 35.

Age:

Many

kinds of cancer pose a greater risk

for persons over age 45 than for younger
persons.

It

is closely associated with other risk

factors, such as family history and personal
habits.

Physical:

The physical environment in which a person

works or lives increases the likelihood that certain
illness will occur.

A persons home environment poor risks,

unclean, poorly heated or cooled, over crowded
dwellings.

Exposure to industrial area develop cancer,

diseases.

Life style:
Risk

factors include:

Poor nutrition.
Insufficient rest and sleep.
Poor personal hygiene.
Other habits like tobacco use alcohol or
drug abuse.

Life style:
Activities involving a threat of injury such as
skydiving or mountain climbing.
Excessive sun bathing Increase the risk of skin
cancer.
Over weight risk of cardiovascular diseases.

BODY DEFENSES:

BODY DEFENSES:

IMMUNITY.

IMMUNIZATION

IMMUNITY:

A person is said to be immune when

he possesses specific protection
antibodies or cellular immunity as a
result of previous infection or
immunization.

Classification of immunity:

Classification of immunity:
Innate( Natural) : Genetic constitution

1.

I.

Natural active: Attack of a diseases sub clinical

infection.
II. Natural passive: Mother to foetus via breast
milk or placenta

Acquired:

2.

I.

Artificial active: Administration of live, killed

vaccines and toxoids.
II. Artificial passive: Administration of
gamaglobulin and serum ATs etc.

1. Natural/ Innate:
Two types:
1. Active natural immunity.
2. Passive natural immunity.

Active natural immunity:

When

antibodies are prepared in ones own

body due to Attack of a diseases is known as
active natural immunity

This

immunity lasts for almost lifetime.

Passive natural immunity:

When antibodies are prepared in one body

[ human body or animal] are transferred to
another to induce protection against disease is
known as passive immunity

It transmitted from mother to foetus via placenta

and mother to new born via breast milk.

Protect the infant again communicable diseases.

2. Acquired immunity:

This is the immunity when a person develops during

the lifetime, which may be active or passive.

a] Active acquired immunity.

B] Passive acquired immunity.

i. active Artificial(acquired) immunity:

When antigens of specific diseases are introduced
into the body and antibodies are produced by the
retino-endothelial cells to produce immunity which
lasts for long time.
e.g. Administration of vaccines- toxoids, killed or live.
- It provide immunity for longer period or even
lifelong.

ii. passive Artificial (acquired) immunity:

When readymade antibodies are introduced into

the human body, it is called artificial passive
immunity. e.g. Antiserum
- Human gama globulin

Passive immunity is usually given against certain

diseases after exposure to infection and immediate
immunity is required.

IMMUNIZATION:

Immunization is the most effective

means of protecting the greatest
number of people, by reducing the
number of susceptible in the
community.

 Following

diseases control by the active

immunization: Tuberculosis
Poliomyelitis
Diphtheria
Measles
Whooping cough(Pertusis.)
Immunization against these diseases is given
as a routine program during infancy and
early childhood to maintain adequate level
of immunity.

ILLNESS & ILLNESS

BEHAVIOUR:
Illness

is a state in which a
persons physical, emotional,
intellectual, social,
developmental or spiritual
functioning is diminished or
impaired compared with
previous experience.

 Illness,

therefore, is not
synonymous with diseases.
Although nurse must be familiar
with different kinds of diseases
and their treatment, they are
concerned more with illness,
which may include disease but
also includes the effects on
functioning and well-being in all
dimensions.

Classification
Acute

illness

Chronic

illness

Acute illness
An

acute illness usually has a

short duration and is severe.

The

symptoms appear abruptly,

are intense and often sub-side
after a relatively short period.

An

acute illness may affect

functioning in any dimension.

Chronic illness
It

persist, usually longer than 6

months, and can also affect
functioning in any dimension.

The

goal of managing a chronic

illness is to reduce the
occurrence of symptoms or to
improve the tolerance of
symptoms.

Illness behavior:

People who are ill generally act

in a way that medical
sociologists call illness
behavior.

It

involves how people monitor

their bodies, define and interpret
their symptoms, take remedial
actions, and use the health care
symptoms.

Factor affecting on
behavior:
1.
2.
3.
4.
5.

Personal history
Social situations
Social norms
Opportunities
Community

Impact of illness on patient

and family:
Introduction:

-Each client responds uniquely to

illness, & therefore nursing
intervention must be individualized
-The client & family commonly
experience behavioral & emotional
changes, as well as changes in roles,
body image & self concept, & family
dynamics.

Impact of illness on patient

and family:
1.
2.
3.
4.
5.

Behavioral & emotional

changes.
Impact on body image
Impact on self concept
Impact on family roles
Impact on family dynamics.

1. Behavioral & emotional

changes.
It depend
on the nature of

illness.
The clients attitude towards it.
The reaction of others to it.
Variables of illness behavior:
-Short term, non-life threatening
illness evoke few behavioral
changes in the functioning of the
client or family.

1. Behavioral & emotional

Severe
changes.
illness specially

one that is life

threatening can lead to
more extensive emotional
& behavioral changes,
such as anxiety, shock,
denial, anger, and
withdrawal.

1. Behavioral & emotional

changes.
D -Denial

A -Anger
B -Bargaining
D -Depression
A-Acceptance

2. Impact on body image:

Some

illnesses result in changes

in physical appearance, & clients
& families react differently to
these changes.
Reactions of clients & families to
changes in body image depend
on the type of changes [e.g. loss
of limb, or an organ]
Their adaptive capacity, the rate
at which changes take place &
the support services available.

3. Impact on self concept:

Self

concept is a mental self

image of strengths & weakness
in all aspects of personality.

Self

concept depends in part on

body image & roles, but also
includes other aspects of
psychology & spirituality.

3. Impact on self
concept:
A

client whose self concept

changes because of illness may
not longer meet family
expectations, leading to tension
or conflict.

As

a result, family members may

change their interactions with
the clients.

4. Impact on family roles: People

have many roles in life,

such as wage earner, decision
maker, professional, child,
sibling or parent.

If

a patient of an adult becomes

ill & cannot carry out usual
activity, the adult child often
assumes many of the parents
responsibilities & in essence
becomes a parents to the

5. Impact on family
dynamics:
Family

dynamics is a process by
which the family functions,
makes, decisions give support to
individual members, & copes
with everyday changes &
challenges.

 If

5. Impact on family
dynamics:

a parents in a family becomes

ill, family activities & decision
making often come to a halt as
the other family members wait
for the illness to pass, or they
delay action because are
reluctant to assume the ill
persons roles or responsibilities.

Level of diseases
prevention:

Level of diseases prevention:

The word prevention is derived

from Latin prae venire, to come
before.

The prevention is anticipatory

medicine. It comes before the
diseases occurs.

Most of the preventive measures are

focused on Healthy people, to
ensure that they stay healthy & do
not contact or develop diseases or

Level of diseases prevention:

The goal of prevention is to achieve

health for all to ensure adequate
level of health which permits them to
lead a productive & socially useful
life.

Clearly, the concern & focus of

prevention is on Healthy people to
ensure that they stay healthy but the
concept of prevention can be applied
to unhealthy or sick also to restore
their health at the earliest & prevent
deaths & disability in sick persons.

Level of prevention in
Epidemiology:
1.

2.
3.

4.

Primordial: Focus on healthy

people
Primary:

Secondary: Focus on sick

people
Tertiary: Who have already
developed diseases.

Primordial prevention

Primordial prevention is a
strategy to reduce risks &
promotes healthy life style.

In developing countries with

high mortality 10 selected
leading risk factors have been
identified for appropriate actions
theses are:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Underweight/ Malnutrition.
Unsafe sex
Unsafe water, sanitation &
hygiene
Zinc deficiency
Indoor smoke from solid fuels.
Iron deficiency
Vita-A deficiency
Blood pressure
Tobacco use
Cholesterol.

Primary prevention:

The aim of primary prevention is

to limit the incidence of disease
by controlling causes & risk
factors.

Strategy of primary prevention:

1.
2.
3.
4.
5.

By health promotion.
Adequate nutrition.
Safe water and sanitation.
Periodic health check-up.
Specific prevention/Protection
against diseases, trauma &
accidents.

Secondary prevention:

This level of prevention is

directed in those individuals who
have developed diseases.

Aim of secondary prevention is

to reduce prevalence of disease
in the community.

Early detection method.

Tertiary prevention:

It is last level prevention.

It is the applied when the

individual has reached an
advance stage of disease.

Tertiary prevention:
Aim:

To reduce the progress and

development of complications of
established diseases.
To reduce impairment and
disability.
To provide rehabilitation
measures.
To prolong life.
To prevent deaths.

Rehabilitation:

It is the restoration of a person to the fullest

physical, mental, social, vocational & economic
usefulness possible.

It is a restorative medicine using the remaining

capacities of an individual & making him/her self
reliant & useful in the community.

Client require rehabilitation after a physical or

mental illness, injury or chemical addiction

Today specialized rehabilitation services, such as

cardiovascular & pulmonary rehabilitation
program help clients & families adjust to necessary
changes in lifestyle & learn to function with the
limitation of their diseases.

Rehabilitation services include physical, occupational

& speech therapy & social services.

Ideally rehabilitation begins the movement a client

enters a health care settings for treatment. E.g. some
orthopedic program now have clients undergo
physical therapy exercises before major joint repair.

Rehabilitation of paraplegic amputees, blind, deaf,

dam, mentally retired, leprosy cases etc.

CONTINUING CARE:
Who

needs?
- Client across the lifespan who have
long-term health care needs are the
chronically ill and disabled.

Continuing

care described a collection

of health, personal & social services
provided over a prolonged period to
persons who are disabled, who never
where functionally independent, or
who suffer a terminal diseases.

 Continuing

care available within

institutional settings [e.g.
Nursing centre or nursing
homes, group homes &
retirement communities.]

Communities

[e.g. home care,

home delivered meals and
hospice].

Assisted living
Assisted

living offers an
attractive long-term care setting
with a homier environment &
greater resident autonomy.

Clients

are generally in need of

some assistance with activities
of daily living but remain
relatively independent within a
partially protective setting.

group of residents live together,

but each resident has his or her own
room & shares dining & social
activities areas.
Usually people keep all personal
possessions in their residences.
Services within an assisted living
facility might include meals, social &
recreational program, personal
laundry & housekeeping,
transportation, 24hrs oversight, an
emergency call system & health
checks.

 Some

facilities provide
assistance with medication
administration.

Nursing

care services are not

directly provided, although a
home care nurse can visit an
assisted living facilities after a
client is discharged home.

Respite care:
Respite

care is a service that

provides short-term relief or
time off for persons providing
home care to the ill or disabled. [
e.g. children, psychiatric,
clients].
Adult day care is one form of
respite care. Respite care can
also be provided within the
home by health professionals &
trained volunteers.

 The

care giver is able to leave

the home for errands or for just
some social time while a
responsible person stays in the
home to care for the loved one.

Adult day care centers:

Services

offered during the day allow

family members to maintain their
lifestyle and employment & still
provide home care for their relatives.

Day

care centers may be associated

with a hospital or nursing facility or
exist as independent centers.

These

clients include older adults

needing daily physical rehabilitation,
individual with emotional illnesses
needing daily counseling or
supervisor & individual with chemical
dependence problem who are involve
in rehabilitation program.

 The

centers usually operate 5

days per week during typical
business hours.

Adult

day care centers allow

client to retain more
independence by living at home.

Hospice:
A

hospice is a system of family

centered care designed to allow
clients to live & remain at home
with comfort, independence &
dignity while alleviating the
strains caused by terminal
illness.

The

focus o hospice care is

palliative care not curative
treatment.

 Hospice

an benefit a client in the

terminal phases of any disease, such
as multiple sclerosis, AIDs, & cancer.

client entering a hospice has

reached the terminal phases of
illness [ Generally the final 6 months
or less], & the client, family &
physician have agreed that no
further treatment could reverse the
diseases process.

 The

client & family must accept

the fact that the hospice will not
use emergency measures such
as cardio-pulmonary
resuscitation to prolong life.

Instead

the hospice uses a

multidisciplinary approach to0
provide pain control & comfort
measures.

HOSPITAL

CONCEPT OF HOPSITAL:
- Hospitals are organized institution for the care of
the sick and injured.
- The word hospital comes from the word hospes
which means host.
- In olden days the hospitals were guesthouse for
the treatment of travelers. In the modern times,
however, the chief function of the hospital has been the
care & treatment of sick.

Definition: Hospital

According to WHO.

A hospital is an integral part of a social &

medical organization, the function of which is to
provide for the population the complete health care,
both curative & preventive & whose out-patient
services reach out to the family & its home
environment. The hospital also center for the
training of health workers & for bio-social
research.

Function of the hospital:

Care

of the sick & injured.

Prevention of disease & promotion of
health.
Diagnosis & treatment of diseases.
Rehabilitation & Vocational training.
Medical education.
Research.

Classification:

Hospital are classified according to the size or

bed capacity, ownership or control, purpose or
clinical facilities.

Size or bed capacity:

A bed capacity of 100 or less is considered as small

hospital.

A bed capacity of 100 or 300 is considered be a

medium size hospital.

A bed capacity of 300 or 1000 is considered as a

large hospital.

Ownership or control:

It can be classified into government or nongovernmental.

Hospitals controlled by government agencies are tax

supported.

Non-governmental institutions are supported by

patients fees; gifts & endowments etc.

Purpose or clinical facilities

Hospitals are classified into general hospitals & special
hospitals according to the type service they offer.
A general hospital has various clinical services
available to patient such as medical, surgical, obstetric,
pediatric, psychiatric, tuberculosis etc.
A special hospital limits its services to patient with a
particular diseases or condition e.g. tuberculosis,
maternity & pediatric hospitals etc.

Organization:

It varies from hospital to hospital.

The line of authority is differs according to the

ownership & 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 head of the
hospital, the administrator or director. To whom
authority & responsibility for management is
delegated.

The administrator/ director directs two division of

the hospital work-the business management & the
professional care of the patients.
The business management includes administration,
accounting, maintenance, engineering, house
keeping & purchasing.
Under the professional care of the patient area
found the medical, nursing, paramedical & other
special department.

Major department:

Medical department.
Nursing department.
Paramedical department: Pathology,
pharmacy, physical medicine, rehabilitation,
radiology, dietary department.

Non-professional services: Admitting department,

administration, purchasing, personal, accounts,
medical record, housekeeping, laundry, Mechanical
department, maintenance department, central
supply department, Social services.

HEALTH CARE TEAM:

The health team consist of
a group of a people who coordinate their particular skills
in order to assist a patient or
his family. The personnel who
comprises a particular team
will depend upon the needs of
the patient.

Personnel of health
team:

1.
2.
3.
4.
5.
6.

The physician:
Nursing personnel.
The dietitian or nutritionist.
Physiotherapist
Occupational therapist.
Paramedical technologist:
Laboratory technologist,
radiologist, Nuclear medicine
technologist.

7. The pharmacist.
8. The social worker.
9. Non-professional workers.

HEALATH CARE SYSTEM

1.
2.

Preventive care:
Education
Prevention
Primary care: Early detection &
routine care.
Secondary care: Acute care,
emergency treatment, Critical
care

1.

2.
3.

Tertiary care: [special care]:

Special care [highly technical
services for clients in a
geographical area].
Restorative care:
Intermediate follow-up care
[ surgical post-operative
routine care, routine medical
care.
Rehabilitation
Home care.


1.
2.
3.
4.

Continuing care:
Long term care
Chronic care
Personal care
Hospice care.

Examples of health care

services:
Health

promotion:
Prenatal care
Well baby care
Nutrition counseling
Exercise classes.
Family planning

 Illness

prevention:
- Blood pressure & cancer
screening.
- Immunization.
- Community legislation.[ seat
belt, air bags].
- Mental health counseling &
crisis prevention.

 Acute

& tertiary care:

- Radiological procedures.
- Serum testing
- Surgical out patient & in
patient services.
- Emergency care.

 Restorative

care:
- Cardio vascular & pulmonary
rehabilitation.
- Sports medicine.
- Spinal cord injury program.

Continuing

care:
- Assisted living
- Psychiatric day care.

HEALTH CARE AGENCIES:

1.
2.
3.

4.
5.
6.

FUNCTIONS:
Contribute funds for special
equipment.
Carries on research to explore ways
& means of doing new things.
Provides materials for health
education & carries on mass health
education work.
Exhibits demonstration &
experimental projects.
Guard the work of official agencies
by being good examples.
Advances health legislation.

Types:
National

health care agencies

International

agencies

health care

National health care

Indian
red cross society
agencies
The

Hindu Kusht Nivaran Sangh

Tuberculosis Association of India.
Bharat Sevak Samaj
The Central Social Welfare Board.
The Kasthurba Memorial Fund.
Family planning association of India.
All India Womens Conference
All India Blind Relief Society.
Indian Council for child Welfare.

International health care

agencies

The

World Health Organization

[W.H.O.]
United Nations International
Childrens Emergency Fund
[ UNICEF ]
International Red cross
Rockefeller Foundation
Ford Foundation
Care: [Co-operative for American
Relief Everywhere].

 FAO:

[Food and Agriculture

Organization]
ILO: [International Labor
Organization]
World Bank
USAID: [United States Agency for
International Development]
Colombo Plan.
SIDA: [ Swedish International
Development agency]
DANIDA: [Danish International

ANY QUERY???