Unit I

Introduction, Definition, Nature and Scope of Sociology and Anthropology

Sociology: -
Introduction: - The word Sociology is derived from Latin world Societus and Greek word logas. In
Latin word societus means society and logas means study or science, where as etymological
meaning of sociology is the study or science of society. Sociology is the science of society which studies
about society and social relationship. Sociology is the discipline which concern with the human relations.
Its subject matter is society rather than individual. In studying social relationship, it attempts to discover
the evolution of society its system and structure, the development of social institutions and their function,
the custom and rules and regulating, the group and communities formed by man throughout history, the
nature of interdependence of these groups like family, kinship, caste, class, religion, economic, political
institutions and the total ways of their life as a member of society in group. It also deals with families,
groups, business firms, computer networks, political parties, schools, religions, labors union etc. It is
concern with love, poverty, conformity, technology, discrimination, illness, alienation, population and
community.
French philosopher Auguste Comte introduced to sociology at first in 1838 AD. So he is known as father
of sociology. Similarly Emile Durkheim, Herbert Spencer and Max Weber also contributed a lot of to
develop this subject. Thus these four personalities are called four founding father of sociology. In this
respect Karl Marx is a additional name to develop the sociology.
Sociology came into existence as a separate discipline in teaching level very letter. The teaching of
sociology at first in USA, in 1876 AD, it started in France 1889 AD, in Britain 1907 AD, in India 1919
AD, in Mexico 1947 AD, and in Nepal very later in 1981 AD. In Summary: -
i. Sociology is the science of society.
ii. Sociology is the science of social relationship
iii. Sociology is the study of social life.
iv. Sociology is the study of human behaviour in group.
v. Sociology is the study of social action.
vi. Sociology is the study of forms of social relationship.
vii. Sociology is the study of social groups or social system.
Definitions: -
L.F. Ward Sociology is a science of society.
Emile Durkheim Sociology is the systematic description and explanation of society as a whole.
MacIver and page Sociology is about social relationship. The network of relationship, we call society.
Morris Ginsberg Sociology is the study of human interaction and interrelations, their condition and
consequence.
Gillin & Gillin Sociology in its broadest sense may be said to be the study of interactions arising from
the association of living beings.
W.F. Ogburn Sociology is a body of learning about society; it is a description of way to make society
better. It is social ethics a social philosophy. Generally however it is defined as science of society.
Nature of Sociology
In nature of sociology, we study about scientific nature of Sociology. At first what is science? In answer
to: -Science is the search of knowledge. In other world every effort to gain new knowledge is science or it
is always based on facts. It can prove, test and retest also possible. In broadest sense science is
classification in two these broad categories.

1
i. Natural science: - which studies about natural facts or evidences which are universal in nature
e.g. Physics, Chemistry, Biology, Zoology etc.
ii. Social science: - which facts or evidences are social in nature, which is dynamic or changeable
because nature of society is different or changeable e.g. Sociology, Anthropology, History,
Economics, Political science, Psychology etc.
Controversy about sociology is a science or not: -Sociology cannot be regarded as science or objection
views about scientific nature of sociology are: -
I. Lack of experiment (lab test) II. Lack of objectivity or exactivity
III. Lack of predictivity IV. Lack of clear terminology
Sociology as a science or clarifications about scientific nature of sociology. But the following arguments
we can point out that sociology is a science. All social sciences cannot hold observation in laboratory for
example Astronomy. This science cannot experiment with its material. Newton (law of gravity) did not
invent his laws in the laboratory.
In sociology every study or research is related to the sense of causality doesnt accept that social
phenomena are the cause of supernatural being. It doesnt define that logic is everything for
understanding social phenomena as previous people understood. In sociology scientific procedures are
always adapted from the beginning to the end of the study. Sociology is a science because it takes
scientific method to study every phenomenon. It tries to makes generations systematic. By general law the
social problem can be eliminated, Similar to Psychology, Economics, political science, History etc.
Those who criticize sociology argue that it cannot predict. Although the prediction of Meteorology isnt
always being right, it is science prediction alone isnt the criteria for any subject to be a science. Scientific
methods are sufficient for any subject. The social reality found by scientific research should be testable
anywhere. In sociology every conclusion and generalization can be observed and re-observed. As well as
the result of study can be tested so we can regard sociology as a science.
In The Social Order Robert Biersted has mentioned the following characteristics or the nature of
sociology;
i. Sociology is a social science or not a natural science.
ii. Sociology is a categorical or positive science not a normative science.
iii. Sociology is a pure or theoretical science not an applied science.
iv. Sociology is a abstract science not a concrete one.
v. Sociology is a generalizing science not a particularization science.
vi. Sociology is both a rational and empirical science.
Importance of Sociology
i. Sociology studies society in a scientific ways.
ii. Sociology studies the social nature of man.
iii. Sociology helps us to know not only our society but also other customs and culture.
iv. Sociology is important in solving social problems.
Social problems like poverty, unemployment, illiteracy, superstitions, disease, hungry, starvation,
epidemics, caste and gender discriminations, war, crime, violence, addictions etc all are related with
health problems of human.
Scope of Sociology
Every science has its own fixed or particular study area. But in scope of sociology about the fixed or
special area is still controversial. Different sociologists hove put forward their views with regarded to the
determination if the scope of sociology. Considering those various views we can categorize them into two
major schools of thought.

2
On the basis of definitions of sociology we can argue that scope of sociology is very broad. Trying to
limited the area of its study means not understanding it. Since sociology studies the process of
development of societies, its scope goes on expanding as time passes. Sociologists dont agree on whether
the studies of sociology should be general or particular. Thus there is no consensus among sociologists
regarding the scope of sociology. The variety of opinions can be presented as follows;
Formalistic or specialistic school of thought:- Sociologist like Max Weber, George Simmel and
Ferdinand Tonnies have argued that sociology should be developed as a particular science. Their views
are that like other social science sociology should also have a particular area of study. It means sociology
should deal with what is including in other social sciences. Basically that subject matter would turn out to
be human behaviour, action and interrelationship. This school focus is one from of subject matter not its
content. Max Webers view in this connection is that sociology should explain away those social
behaviours which are directed toward the fulfillment of certain goals. In this regard Tonnies put forward
the idea of pure sociology. According to him sociology should focus on the forms of relation that
differentiates society from a community. For Simmel, sociology should have a separate area of study like
other social science has. That specified field would be social relationship, behaviour and activities.
Criticism of Formalistic school of thought
This school of thought is regarded as a narrow concept in the field of sociology. The concept of this
school of thought to develop pure sociology is almost impossible. Objectively in the study of the society
and human behaviors is not possible.
i. This concept tries to study forms in isolation from content. It has not been adequately explained.
ii. Like in pure science it has difficult to make sociological study isolating from other social
sciences.
iii. Sociology should deal with the abstract aspects of its subject matter. From cannot be isolated
from the contents
iv. Issue like social relations, behaviours, activities as well as social, economic, political institutions,
language religions etc are also come under the scope of sociology. So sociology cannot be limited
so far as the question of studying society is concerned.
Synthetic school of thought: -The synthetic school of thought conceives of sociology as a synthesis of
the social science. It wants to make sociology a general social science and not a pure or special social
science. In fact this school has made sociology synoptic or encyclopedic in character. Durkheim, Hob
house, Ginsberg and Sorokin have been the chief exponents of this school. The main argument of this
school is that all part of social life is intimately inter-related. Hence the study of one aspect is not
sufficient to understand the entire phenomena and sociology should study social life as a whole. This
opinion has contributed to the creation of a general and synthetic sociology.
The view of Emile Durkheim: -Durkheim has claimed that sociology include three main fields of inquiry
or divisions as its subject matter they are:-
I. Social Morphology II. Social Psychology III. General Sociology
The views of Morris Ginsberg:- Another advocate of this school of thought Ginsberg has divided the
scope of sociology mainly into four part they are:-
I. Social Morphology II. Social control III. Social process IV. Social pathology
Ginsberg has summed up the chief functions of sociology as follows:-
i. Sociology seeks to provide a classification of types and forms of social relationships.
ii. It tries to determine the relation between different factors of social life for e.g. the economic and
political, the moral and the religious, the moral and the legal, the intellectual and the social
elements.

3
iii. It tries to disentangle the fundamental conditions of social change and persistence and to discover
sociological principles governing social life.
The scope of sociology is indeed very vast. It studies all the social aspects of society such as social
processes, social control, social change, social stratification, social system, social groups, social
pathology etc. Actually it is neither possible nor essential to delimit the scope of sociology.
ANTHROPOLOGY
In simple meaning Anthropology is a science which studies about man and their behaviour, culture and
activities. Man is superior among all the animals. He is superior because of his culture. Thus
anthropology is a science that studies physical cultural and social aspects of man from early history to till
now. No other any specific aspect of man but it studies the holistic aspects of man from the period of his
origination to till now. The discipline came in existence only in the mid 19 th century. It studies the
biological as well as cultural development of man. It also studies various social institutions of primitive
communities of the past as well as that of present.
The word Anthropology is derived from two Greek words Anthropos and Logas. In which
Anthropos means Man and Logas means Study or Science. Thus the etymological meaning of
Anthropology is science or study of man. It is about the development of human race and their culture. In
other word Anthropology is the science of mankind. It studies about not only of particular man but also of
groups, races, people and their happening and doings.
Definitions
A.L.Kroeber Anthropology is the science of man and his group and their behavior and production.
M.J.Herkowits Anthropology is the science of man and his works.
E.A.Hoebel Anthropology is the study of man and his works and race and customs of mankind.
Ralph Linton Anthropology is the science of the origin, development and nature of human species.
Oxford Dictionary of anthropology Anthropology is a broad scientific discipline which is dedicated to
the comparative study of mankind from its first appearance to its present stages of development.
D.N.Majumdar Anthropology studies the emergence and development of man from the physical,
cultural and social point of view.
By the above discussion and definitions we can say that Anthropology is the holistic study of man in
physical, cultural and social point of view.
Nature of Anthropology
The nature of anthropology refers to the quality and characteristics of Anthropology. Nature of
Anthropology is original and unique because it studies human being in two ways i.e. as a biological being
and as a cultural being. In other words we can say that it studies human being as socio-cultural methods.
So Anthropology is both natural and social science which is its real nature. To understand its nature more
clearly we can analysis more.
i. Anthropology is both natural and social science: - According to Kroeber and Hoebel it has
mainly two branches physical and cultural Anthropology. As a physical Anthropology it studies
about the origination of man, his growth and development, physical attributes and physical
characters. In this branch we study the origination of human descendents and their development
which includes human paleontology. Similarly in cultural Anthropology we study about origin of
human culture, development, variation and similarities in culture among the people living in
different places. These both are the subject matter of anthropology, so it is both the physical and
social science.

4
ii. Anthropology is only a science: - Anthropologists Radcliffe Brown, Malinowski etc are the
supporters of this view. They dont agree to say that anthropology is natural or social science.
They want to say that anthropology is only a science. Anthropology should study human and
society through direct observation.
iii. Anthropology is the science of the history: - It studies about human history. T.K.Panniman
takes anthropology as a natural science in one hand and on the other hand he has taken it as a
science of human history.
iv. Anthropology is a holistic study of man:- It studies about all aspects of human culture i.e.
economic, social, political, physical, material and non-material culture. It studies the all aspects
of human community from the early history to till now.
v. Comparative method is used in Anthropology: - It studies different human communities and
their culture so on and compare the cultures of different human communities. For this purpose
anthropology applies direct field observation.
Scope of Anthropology:- Generally scope refers to the limitation of the study. In this sense scope of
anthropology refers to the area or subject matter of Anthropology. Anthropology is the science which
studies about man, his behavior, culture and his activities. Also it studies the origination of races of
people, their development, physical appearance and structure as well as their material and non-material
culture. It also studies about why people of one place are differing to the people of another place? And
why they are similar? Why and how developed language? What difference can be found between ancient
and Modern man? Etc. In short it is the holistic study of man. From this, it is clear that the scope of
anthropology is very broad. To understand its scope we should know its branches. Mainly it has two
major fields which are explained bellow: -
A. Physical Anthropology: - In this field of anthropology it studied about the origin of man, his
development, different races of man, their physical structure, effects of environment to the body
structure of them and human fossils. In short human genetics and studies about the origination of man
and human paleontology are its subject matter.
B. Cultural Anthropology:- This field of anthropology studies about human customs, norms, values,
traditions, folkways, mores, religion, culture, art, science and technology, literature, language etc. It
also studies economic, political, and social institute. Apart from this it studies the social behaviors of
man, family, marriage, kinship and lineage etc in social anthropology which is the field of
anthropology.
Significance of Anthropology in Nursing
Anthropologys basic concern with, what defines human life and society, how are social relations among
humans organized, who are ancestors of modern man, what are humans physical traits, how do human
behave, how has evolutionary past of homo-sapiens influenced its social organization and culture and
soon this knowledge helps nurses on providing quality care to people as nurse become more familiar to
overall things related to human and also becomes easier to understand their needs, feelings, behaviours
etc.
Anthropology to the profession of nursing roots into health, disease, illness, sickness in human
individuals which would be undertaken from holistic and cross-cultural perspective.
Anthropology with an awareness of their biological, cultural, linguistic and historical uniformity and
variation helps to strengthen and boarder health care delivery system.
It also gives knowledge and skills relating to cultural, biological, historical uniformity and variations
which helps to implement culturally sensitive nursing care.
Anthropology makes us respect to people of different cultures.

5
 It provides forum for inquiring into how knowledge, meaning, livelihood, power and resource
distribution are shaped and how may go to shape patterns of disease experiences of health, illness and
organization of treatment.
Applying anthropology to nursing medical anthropology is dedicated to relationship between human
behaviour, social life and health in anthropological context.
2. Branches of Sociology/Anthropology including Health Sociology/Anthropology
Sociology: - It is fast growing and popular discipline. Sociologists are at work to bring into its range of
study almost all aspects of mans social life. Sociology has several specialized areas of inquiry. It has its
sub-divisions or branches they are as follows.
1. Historical Sociology: - Social history is history which deals with human relations, social patterns,
mores and customs and other various important institutions.
2. Social anthropology: - It is related branches of sociology and anthropology that studies how
contemporary living human beings behave in social groups.
3. Sociology of knowledge: - The sociology of knowledge is the study of the relationship between
human thought and the social context within which it arises and of the effects prevailing ideas have
on societies.
4. Environmental sociology: - It is the study of societal environmental interactions, typically placing
emphasis on the social factors that cause environmental problems, the impacts of these problems on
society and the efforts to resolve them. Attention is also paid to the processes by which environmental
conditions become defined and know to a society with sociology of disaster and human ecology.
5. Political sociology: - It is the study of power and the intersection of personality, social structure and
politics.
6. Economic sociology: - It is the study of the relationship between economic activity and social life.
7. Sociology of Education: - The sociology of education is the study of how educational institutions
determine social structures, experiences and other outcomes. It is particularly concerned with the
schooling systems of modern industrial societies.
8. Criminology: - It is the scientific study of the nature, extent, causes, and control of criminal
behaviour in both the individual and in society.
9. Family, gender and sexuality: - The sociology of the family, examines the family, as an institutions
and unit of socialization, with special concern for the comparatively modern historical emergence of
the nuclear family and its distinct gender roles.
10. Social Psychology: - Focuses on micro-scale social actions, examining whole societies through the
study of individual thoughts and emotions as well as behaviour of small groups, concern with how to
explain a variety of demographic, social and cultural facts in terms of human social interaction. This
fields includes, social inequality, group dynamics, prejudice, aggression, social perception, group
behavior, social change, nonverbal behavior, socialization, conformity, leadership and social identity.
11. Rural/Urban/Occupational/ Religion/Industrial/Law/Linguistics/Art and Literature/Theoretical
sociology are other important branches of sociology.
12. Medical sociology: - Human health and its impact on society. Traditional and modern technology
for remedy. Doctor-patient relationship with nursing care. Effects of urbanization,
industrialization and modernization in environment and public health. Tradition, culture, norms and
value, beliefs, superstition etc and their impacts on health sector. Clean environment and diet
system. Various problems in health sector e.g. medical facility is centered in urban area, medicine
facility are more expensive and non accessible to poor people etc. These all above social and health
related subject matter is studies in medical sociology. Similarly, it is especially focuses the doctor and
health professionals behaviors toward patients and interrelationship among them.

6
 Branches of Anthropology
Anthropology is the holistic study of mankind and it studies human as physical and cultural point of
view. Therefore anthropology has divided into two basic categories physical and cultural
anthropology and both branches has their own sub-branches according to their fields.
A. Physical anthropology: -It is such a branch of anthropology which studies about the human body
and its characteristics like gene, race, origin, development etc as a biological point of view.
E.A.Hoebel defines physical anthropology as Physical anthropology is the study of the physical
characteristics of the human race. Physical anthropology has some branches according to their
specialization fields they are: -
1. Human Genetics: - It studies the human physical characteristics that are transmitted through heredity
from generation to generation. According to E.C.Colin Genetics is that branch of biology which
deals with the laws or principles of heredity and variations as observed in plants in animals and in
man.
2. Human Paleontology:- Paleontology is the science of fossils which studies about evolution of man
especially primitive man through fossils. According to Websters International Dictionary Human
paleontology is the science deals with life of the past geographical periods. It is based on the study of
the fossils remains as organism.
3. Anthropometry: - Anthropometry is that branch of physical anthropology which deals of
measurement of various organs of man with its qualitative and quantitative nature. According to M.J.
Herkovits Anthropometry may be defined as measurement of man.
4. Biometry: - Biometry is the statistical study of biological characteristics. According to Charls Winik
Biometry is the statistical analysis of biological studies specially as applied to such area as disease,
birth, growth and death.
B. Cultural Anthropology: -It is another important branch of anthropology which studies about human
culture from its origin to present time. According to Beals and Hoizer Cultural anthropology studies
the origin and history of mans culture their evolution and development and the structure and
functioning of human culture in every place and time. Cultural anthropology is also classified into
sub-branches they are: -
1. Archaeology: -Etymologically the word archaeology is derived from two Greek words Archaios and
logas. Here Archaios means ancient, and logas means study or science, therefore archaeology is
the study or science of ancient things. The branch of anthropology that is concerned with the
historical reconstruction of culture. Archaeology works with objects used by mans of past societies
especially to their survive. It provides materials or prehistoric information when written records are
not available. It is concerned with all of mans material remains. The scientific study of material
remains (as fossils, relics, artifacts and monuments) of past human life and activities. It explores the
nature and process of origin of human culture, development and disappearance etc in a chronological
order. According to Nelsaon Archaeology may be define as the science devoted to the study of
entire body of tangible relics pertaining to the origin, the antiquity and the development of man and
his culture.
2. Linguistics: - Linguistics is a branch of cultural anthropology which studies about the language in a
scientific ways, while studying about human culture the language is one important part to study about
human culture. According to Varshney Linguistics is a study of origin, organization, nature and
development of language descriptively, historically, comparatively and explicitly and formulates the
general rules related to language. (prevalent more than 2700 language in world and 100 then more
only in Nepal)

7
3. Ethnology: - It is concerned with patterns of thought and behavior such as marriage and customs, kin
organization, political and economic system, religion, believes the way in which these patterns are
differ in contemporary society. Ethnology is the study of living community rather than past
community. According to S.C.Dubey Ethnology is a comparative study of the races and cultures of
mankind in their different aspect.
C. Social Anthropology: - In this branch we studies about the social system and process. The collective
behaviors, marriage system, religion, kinship system, socio-economic institutions, and in sum social
structure etc are comparatively studied here. What was the primitive social structure? What changes
are found in the structure of modern society? What are the reasons in similarities and differences in
the social structure of different age and different societies of same age? Are also comparatively
studied he in this branch of anthropology. According to S.C.Dubey Social Anthropology is that part
of cultural anthropology which devotes its primary attention to the study of social structure and
religion rather than material aspect of culture.
D. Medical Anthropology: - Medical anthropology investigates interaction among human health,
nutrition, social, environmental and cultural beliefs and practice. Medical anthropology is an
interdisciplinary field which studies human health and disease, health care system and bio-cultural
adaptation. It also focuses on different topic including cultural meaning of disease, the interface of
micro and macro environment that affect the health, the cultural ecology of responsibility as it relates
to gender and health.
The concept of illness, health and wellness are part of total cultural belief system. Cultural groups
often utilize traditional health care providers, identified and respected within the group.
Knowing that culture is one of organizing concept upon which health care in based and defined, it is
important forms to understand.
How cultural group understand life process.
How cultural group define health and illness.
What cultural groups do to maintain wellness.
How healer care and cure for member of cultural group.
What cultural groups believe to be the cause of illness and sickness.
How cultural background of health care workers influence the way in which care is delivered.
Anthropology shows that culture has powerful influence on ones interpretation and response to
health care.
To provide effective health care, it must reflect the unique understanding of value, beliefs, attitude,
life ways and world view of diverse population and individual acculturation.

History, present status and emergence of Medical sociology and Medical anthropology.
Medical sociology
Introduction: - Medical sociology is an important substantive area within the general field of sociology.
Sociology itself as an academic discipline that is concerned with the function, structure and roles of social
institutions and social processes. It is also concerned with the social behaviour of groups. It logically
follow to say that Medical sociology is concerned with the social aspects of health and illness, the social
functions of health institutions and organizations, as well as the relationship of system of health delivery

8
to other social systems, and the social behaviour of health personnel and all those who are consumers of
health.
Medical sociology is a relatively new especially in sociology in particular and behavioural science
generally. Some scholars define it as a new specially that is concerned with social as opposed to
biological factors in the causation of disease.
Definition: - Medical sociology is concerned with the relationship between social factor and health,
and with the application of sociological theory and research techniques to questions related to health and
health care system.
Medical sociology is the sociological analysis of medical organizations and institution: the production of
knowledge and selection of healthcare professionals and the social or cultural (rather than clinical or
bodily) effects of medical practice.
Sociology in medicine: - It is concerned with sociology collaborates directly with the role of the
physician and other health personnel in an attempt to study the social factors that are relevant to a
particular health problem. This aspect of medical sociology is intended to be directly applicable to patient
care or to the solving of a particular health problem. It is It has been concerned with two different areas:-
Ecology and Aetiology of disease:- An entire field of medicine deals with the correlation between
particular occupation and particular disease e.g. prostitution and HIV/AIDS
Variations in attitude and behavior regarding health and illness: - It deals with variations in attitude
and behaviors toward problems of health and illness.
3. The sociology of medicine: - The sociology of medicine on the other hand deals with such factor as
the organization, role, relationship, norms, value and beliefs of medical practice as a form of human
behaviour. The emphasis is upon the social processes that occur in the medical setting how those help our
understanding of medical sociology in particular and social life generally.
4. Historical Background
Study about health and sociology in different perspectives isnt new phenomena.
The systematic study of society come into existence only when Greece Plato (427-347 BC) and
Aristotle(348-322 BC).This made attempts to deal methodology with law, the state and society.
Darwin is one of the most important roots in this regard. His Origin of Species in 1859, the discovery of
cephalic index (the length and breaths of head) 1840, Lamarckian theory of human species and various
other works are bases of studying medical sociology and medical anthropology.
The beginning of Greek medicine had religious, magical and empirical attributes. During first several
centuries of Christian era various institutions were established and used for health care centers.
Established ethical codes for physicians and professionals.
Hippocrates pointed out that human being is influenced by the totality of environmental factors
climate and topography of land, quality of air, water and food. At that time there were a believed that
good health resulted that the equilibrium within the body of 4 humours (blood, phlegm, black bile and
white bile).
Greek humoral theory of disease is based on Hindu Ayuredic medicine or Mexican-Americans hot
and cold theory.
20th century is based entirely on Ayurvedic system and Hippocratic method.
Roman borrowed their medicine idea from the Greece. They established public and military hospital
for citizens. Developments of public health program and their base like roads for transportation,
adequate pure drinking water into the cities, sanitary condition and supply of food and gymnastics for
physical fitness.

9
 Later part on 20th century medical sociology regarded as a science to its involvement in the health
science field which is research based. It can develop an innovative application of fundamental
principles the art of practice such as medicine an individual etc. It determined and discovered the
strategies of investigations and also discovered principles and applied them.
S. Types of Means of Relations of Health system conditions Prospect situation Re
N. society production production ma
rks
1 Asiatic Forest Free labor Nature control Population Security and Exploitation C
(Forest) resource, increased hunger between h
hunting & and resource human and a
gathering limitation conflict n
between g
stronger and e
weaker
2 Slavery As above and Master Vs slave As above and As above As above As above
slave as magic and
property religion
3 Feudalistic Agriculture Landlords and As above, As above As above As above
and animal tenants Ayurvedic and
husbandry ethnomedicine
4 Semi- As above, As above and As above and As above As above As above
feudalistic petty Farmers, owners emergence of
industries Vs labors Allopathic
5 Capitalistic As above and Owner Vs labor As above and As above As above As above
industries landlords Vs emergence of
farmers public health
6 Imperialistic Colonial Imperialistic Vs Above all As above As above and As above and
countries colonies specialization with heavy nationality war
resources exploitation unity
7 Socialistic Social co- Society and All types Balance Elimination Development
operative social groups on of hunger
8 Proposed National co- National and Except More Development development En
communistic operative citizens shamanism balance ds
others as above

The Present Status of Medical Sociology

The social political and economic character of community determines the shape and direction of the
scientific and intellectual atmosphere including health science. Now rapid change in nature of social
science in delivery of the health service and the ideological and structure of larger social order.
H.F.Freeman et al suggested that health practitioners and researchers have long recognized the importance
of social dimension in the etiology of disease in the development of therapeutic interventions and the
delivery and use of health services and preventive efforts.
At the same time medical sociology could only have emerged as a special field of inquiry as part of the
growth and institutionalization of the present discipline of sociology since world war II.

10
MaCIntire(1894) used term medical sociology in bulletin of the American Academy of science article in
1894 general field of sociology become established during 1940-1950. Sociologist entered medical setting
and observed patient in their relation with care providers. Broad range of epidemiological outcome
studies were initiated that focus on these two areas:-
i. Social and social psychological properties as determinants of health and illness and as mediators
of treatment efforts.
ii. Hospitals (as a complex bureaucratic organization) and as employers of large number of health
professionals.
It must be granted that some of the early interest in medical sociology by sociologists and health
professionals was attributable to the relative availability of research and training funds. Sociological
researcher investigators become interested in a wide array of problems ranging from the correlates of
disease to the socialization of the health professionals (especially physicians and nurses)
At the end of1950s social science training program begin with the support from National Institute of
Mental Health. The medical sociology became one of the first and the largest section of American
Sociological Association (ASA).
In previous years a few sociologist had been involved in medical sociology. But only in the last more than
55 years wee large numbers of sociologists appointed to faculties of schools in the health professionals
and to research positions in health agencies. By any marker medical sociology is a very recent intellectual
and scientific field.
In their new roles sociologists participated in training of public health workers, medical students,
residents, nurses and other health practitioners.
Modern Medicine: - Medicine was revolutionized in the 19 th century and beyond by advance in chemistry
and laboratory techniques and equipment.
Old ideas of infectious disease epidemiology were replaced with bacteriology and virology.
Bacteria and microorganism were first observed with a microscope by Antoneie Van Leeuwenhoek in
1676 AD.
In 1847 dramatically reduced the death rate of new members.
Medical Anthropology
Since the end of World War II, anthropologist both biological and socio-cultural have turned in increasing
number to the cross-cultural studies of medical system and to the bio-ecological and socio-cultural factors
that influence the incidence of health and disease from human history to till now.
Anthropologist belief that Anthropological research, techniques, theories, and data can should to be used
in programs designed to improve health care in both developed and developing countries.
Today Anthropologists works in school of medicine, nursing, public health in hospital and health
department. They conduct research such an human evolution, anatomy, pediatrics epidemiology mental
health drug abuse, definition of health and disease, the training of medical personnel, medical
bureaucracies, hospital organizations and its operations, the doctor-patient relationship and the process of
bringing scientific medicine to communities that previously have known only traditional medicine.
Medical Anthropology is viewed by its practitioners as bio-cultural discipline.
i. Biological Pole: - Anthropologist whose dominant interests include human growth and
development, the role of disease in human evolution and paleopathology (the study of disease of
ancient man) with genetics anatomists, serologists, biochemists and like.
ii. Socio-cultural Pole:- Anthropologist whose dominant interests include traditional medical system
(ethnomedicine) medical personnel and their professional preparation, illness behaviour, the

11
 doctor-patient relationship and the dynamics of the introduction of western medical service into
traditional societies.
The bio-cultural nature of medical Anthropology is made clear in a series of review articles that have
appeared during last 6 decades. So called Roots of modern discipline. The roots of medical
Anthropology are more concerned to the discus about the origin of medical Anthropology.
German pathologist Rudolf Virchow (1849) suggested that In reality if medicine is the science is the
science of healthy as well as of the ill human being. What other science is better suited to purpose laws as
the basis of social structure in order to make effective those which are inherent in man himself.
The first major survey of merging anthropological interest in the health field published in 1953 was titled
Applied Anthropology in medicine.
The Roots of Medical anthropology
We trace contemporary medical anthropology to four rather different sources each of which developed in
relatives (not isolated from other)
Physical Anthropology: - Physical anthropologist interested in topics such as evolution, comparative
anatomy, racial types, genetics and serology. Physical anthropologist is medical anthropologist since their
concern with human biology parallel and overlaps many of the interest of medical doctors. A significance
numbers of physical anthropologists is medical doctors.
Hasan and Prasad (1959), J.H.Underwood (1975) list a number of these areas including nutrition
and growth and co-relation of body build and a wide variety of disease such as arthritis, ulcers, anemia,
and diabetes. Anthropological studies of human growth and development are as much medical as
anthropological. For many decades physical anthropologists have engaged in Forensic Medicine, an area
of medico- legal problems involving identification as to age, sex and race of human.
Ethnomedicine: - The sub-division of medical anthropology today called Ethnomedicine. Those belief
and practices relating to disease which are the products indigenous cultural development and are not
explicitly derived from the conceptual framework of modern medicine.
Cultural and personalities studies: -
Expect or ethnomedical studies done largely as a part of tribal studies most health related publications by
anthropologists prior to 1950 deal with psychological and psychiatric phenomena. During the 1980s and
onwards it appeared in different fields such as medical, nursing, public health, Ayurveda.
In the beginning of the mid 1930s anthropologists, psychiatrics and other behavioral scientists begun to
ask questions about adult personality or characters and the socio-cultural environment which this
character was displayed.
The inherent psychic constitution based on biological factor that plays a major role in determining the
culture and personality which raised the health care level.
International Public Health: -
After World War II U.S. technical aid extension the programs to Africa and Asia with founding of WHO
initiate major bilateral and multilateral public health programs in developing countries become a part of
world picture.
Those involved in clinical medicine that health and disease are as much social and cultural phenomena as
they are biological.
They quickly realized that the health needs of developing countries couldnt be met simply by
transplanting the health service of industrial countries.
The data of primitive and present medical beliefs and practices that had been gathered by cultural
anthropologists in earlier years. The information on cultural values and social forms and their knowledge

12
about the dynamics of social stability and change provided the needed key to many of the problems
encountered in these early public health programs.
How traditional beliefs and practices conflicted with western medical assumptions?
How social factors influence health care division and how health and disease are simply aspects of total
cultural patterns.
Beginnings in early 1950s anthropologists were able to demonstrate the practical utility of their
knowledge to international public health personnel. The anthropological approach was acceptable to
public health personnel too because it did not threaten then professionals. They saw that it is safe
approach. Anthropologists involved in cross cultural and international health programs.
Health Sociology or Sociology of health and illness
The Sociology of health and illness examines the interaction between society and health. The
objective of this topic is to see how social life has an impact on morbidity and mortality rate and vice
versa.
Covers sociological pathology (causes of disease and illness), reasons for seeking particular types of
medical aid, and patient compliance with medical regimes.
Health and lack of health, related to biological or natural condition.
The spread of disease influenced by the socioeconomic status of individuals, ethnic traditions or
beliefs and other cultural factors.
Medical research gather statics on a disease a sociological perspective on an illness would provide
insight on what external factors caused the demographics that contracted the disease to become ill.
Three areas: I, The conceptualization, ii, Study of measurement and social distribution and iii,
Justification of patterns, in health and illness.
By looking at these things researchers can look at different diseases through a sociological lens.
Prevalence and response to different disease various by culture.
By looking at bad health, researchers can see if health affects different social regulations or controls.
When measuring the distribution of health and illness, it is useful to look at official statics and
community surveys. Official statistics make it possible to look at people who have been treated, shed
light on the infected persons view of their illness.
Anthropology in relation to health and illness
Medical anthropologists investigate interaction among human health, nutrition, social, environmental
and cultural beliefs and practices.
Medical anthropology is an interdisciplinary field which studies human health and disease, health
care system and bio-cultural adaptation.
It also focuses on different topic including political ecology of disease, the interface of micro and
macro environmental that affect the health, the politics of responsibility as it relates to health, gender
and health policy.
The concept of illness health and wellness are part of total cultural belief system. Cultural groups
often utilize traditional health care providers identified by and respected within the group.
Knowing that culture is one of organizing concept upon which health care in based and defined, it is
important forms to understand;
i. How cultural group understand life process.
ii. How cultural group define health and illness.
iii. What cultural groups do to maintain wellness.
iv. How healer care and care for member of cultural group.
v. What cultural groups believe to be the cause of illness.

13
 vi. How cultural background of health care workers influence the way in which care is delivered.
Anthropology shows that culture has powerful influence on ones interpretation and responds to
health care.
To provide effective health care, it must reflect the unique understanding of values, beliefs, attitude,
lifeways and world view of diverse population and individual acculturation.

Unit II
Health and Disease in Different Stages of Human Evolution
Health and Sickness in Different Stages
Hunting and Food Gathering, Agricultural and Industrial Stages.
In development of society and culture various types of social systems are seen from past to present.
According to the mode of production determined the social and cultural system and socio-economic
structure. Stage of social developments refers to these modes of production or stages of society.
I. Hunting and food gathering society.
II. Agricultural society including pastoral society.
III. Industrial society.
Disease and sickness condition or cause and consequence of disease or sickness are also different
in different stages of society.
I. Hunting and Food Gathering Stages.
The available evidences such as atrophied arm, crushing eye, factures, blindness in eyes, arm and
foot factures, skull scars and various ribs injury were found on several of the adult male skeleton from the
Shanidar site Iraq suggest that Neanderthul man in lower Paleolithic age lived dangerously or with
violence. However those mans survived for a time or years having serious injuries suggesting that they
organized a social system for co-operation and care for sick and disable persons. A human fossils suffered
a crushing injury was discovered in same site. The injury may have been due to a rockfall which affect his
right arm clavicle scapula and lower right limb. The right arm was cut off at the elbow, based on this
evidence of deliberate human surgery in human history.
i. In ancient period (in prehistory) some diseases were species specific and other are affliction of all
animals.
ii. Extent of physiological responses to disease had developed throughout evolution.
iii. Life was unsecured, totally nomadic and depends on natural resources survive without the formal
production system. Result suffered from malnutrition, gastric, intestinal problems, water born
disease, environmental problem, air born problems and fractures.
iv. Wounds were common disease and medicated ingredients were natural products.
v. The discovery of past disease was based on fossils. The task of examining the fossils records for
evidence of health and disease in early human.
vi. Disease derived from pathogens: oral disease, measles, smallpox, poliomyelitis and mumps.
vii. Weiner (1971) infectious disease remains the overriding cause of high mortality rate at all ages.
viii. Men were infected by viruses responsible for respiratory disorders like influenza, common cold
and others.
ix. In primitive societies, females at their reproductive age because of limited food supplies
(deficiency of vitamins and minerals, calcium iron etc.) so maternal and infant mortality rate
become very high.
x. Lack of medical knowledge and technology birth and death rate both were very high.
2. Agricultural Stages: - The causes of origin of agriculture are: -
Post Pleistocene climate change.

14
 Growth of human population and dispersion.
Evolving technology etc.
Agriculture was started effecting so profound a change in human that it has been called appropriately the
Neolithic revolution. For the first time in more than five millions years of precarious existence many
generations would now live out their lives in one small area more or less assured of a food supply and in
intimate regular contacts with large numbers of human groups.
This stage is called the feudal stage. In this stage the disease and problems were created
by slavery society was found to be more complicated in addition to other acute and chronic disease were
born by the cause of poverty, insecurity, hard labor, exploitation of labor, psychiatric problems, religion
and culture born diseases which make more complicated and treatment were sought from religion,
ethnomedicine and new emerging modern medicine.
3. Industrial stages.
In evolutionary process human adaptation have changes in industrial system from full agricultural
livelihood. Now more people adapted in modern industrial economy which changes in socio-cultural
system and emerged new and complicated disease. Among the unfamiliar problems confronting newly
settled populations were the viruses and bacteria responsible for measles, smallpox, influenza, syphilis,
plague, tuberculosis and many other diseases that are dependents for steady transmission on the presence
large numbers of intimately people. More complicated disease such as heart disease, cancer, neurological
problems and industrial and development assets cause pollution and problems were the product of this
industrial society where sophisticated medical system were prevailed.
Definition of Health, Disease, Illness and Sickness
Generally health, disease, illness and sickness are defined by different cultures from their own
particular point of view. As culture is learned the ways people perceive define and respond to illness is
learned and varies difficult to define. There is no universal measuring to explain it to satisfaction and
there is no common definition of health understandable to all levels of people in all area.
Health
A bodily state in which all part are functioning properly. It refers to the normal functioning of a part
of a body. A state of normal functional equilibrium, homeostasis.
A condition of physical, mental and the absence of disease or symptoms and other abnormal
condition. It is not static condition, constant change and adaption to stress result in homeostasis.
Rene Dubos, often quoted in nursing education says The states of health or disease are the
expressions of the success or failure experienced by the organism in its efforts to respond adaptively
to environmental challenges.
Synonyms: - Fitness, healthiness, robustness, soundness, verdure, wellness, wholeness etc.
Antonyms: - Illness, sickness, unhealthiness, unsoundness etc.
Webster Dictionary The condition of being sound in body mind or spirit especially free from
physical disease or pain.
WHO (1948 ) Health is a state of complete physical mental and social wellbeing and not merely an
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.
The state of the organism when it functions optimally without evidence of disease or abnormality. A state
characterized by anatomical, physiological and psychological integrity to perform personally valued
family works and community roles, ability to deal with physical, biological, psychological and social
stress, a feeling of well being and freedom from any risk of disease and untimely death.

15
Disease
The term disease is formation by these two words Dis and Ease. Dis means reverse or opposite and
Ease means comfort or easiness. Therefore disease means not comfort or not easy or when something
is wrong with bodily function.
The simplest definition is of course that disease is just the reverse of health and it refers to organic
malfunctioning to objectively measurable disorder.
An interruption, cessation or disorder of body functions, systems or organs. A morbid entity
characterized usually by at least two of these criteria: recognized etiologic agents, identifiable group
of signs and symptoms or consistent anatomical alterations.
Synonyms: - affection, ailment, bug, disorder, distemper, infirmity, malady etc.
Antonyms: - health, wellness, soundness wholeness, fitness etc.
Webster Dictionary 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.
Oxford Dictionary A condition of the body or some part or organs of the body in which its
functions are disrupted or derange.
All societies have members that specialize to one degree or another in the diagnosis and treatment or
illness. People have always tried to cope with disease, whether the medical practice is primitive or
modern. It brings the following generalizations.
Disease is universal fact of human life, it occurs in all known time, places and societies.
All human groups develop method and allocate roles, congruent with their resources and structures,
for coping with are responding to disease.
All human groups develop some set of belier cognitions and perceptions consistent with their cultural
practices for defining disease.
Characteristics of Disease
i. Disease always has socially undesirable consequence. It is painful.
ii. It handicaps individual in the exercise of his faculties or performance of social work.
iii. It is characterized by a kind and degree of acuteness and chronically with a given degree of
threat to life.
iv. It is recognized by the medical institution of a society as requiring care under its direction.

Illness
Illness refers not only to the presence of a specific disease but also to the individual perceptions and
behaviour in response to the disease as well as the impacts of that disease on the psychological
environment. It is a subjective phenomenon in which individual feel unhealthy. Most to the time disease
produce illness, and illness it is increasingly thought can bring a disease.
Illness is a subjective phenomena in which individual perceive themselves as not feeling well and
therefore may not tend to modify their normal behaviour experience with pain, weakness, dizziness,
nausea or anxiety may fall in to this category. Illness is assumed to be caused by disease. A cancer patient
may not feel ill at until he/she is diagnosed as such by a physician. A person who have lost his/her job
when he/she feel him/her to ill.
Kleinman has tried to distinguish illness and disease. Disease is considered as a malfunctioning of
biologic and psycho logic process in the individual where as illness represents to personal, impersonal
and cultural reaction to disease and discomfort. Disease is the sickness defined by physicians and medical
professionals and illness is the sickness defined by patient or family. It is more or less shaped and
determined by cultural factors. So it is interwoven in the family and into the social and cultural factors.

16
A physician dingoes and perceives the disease not the illness. Illness and disease are not two separate
things; they are the branches of same tree. Where only disease is treated care will be less satisfactory to
the patient and less clinically effective then both are treated together. The case of Chinese patient (as
described by Kleinman ) and other support this view. When modern medicine and traditional Chinese
medicine were combined the patient was cured effectively. The patient and doctor have different realities.
The patients have cultural realities and the doctor have clinical realities. If the doctor understands
patients cultural realities the treatment will be more effective.
Sickness
When people are defined by other being unhealthy or they publicly define them self as unhealthy, a shift
in social identity takes place. The people carry new label such as sick, ill, diseased or sickly. Under those
conditions they are treated in a manner that differentiates them from that people defined as healthy and
hence social identity will be called sickness. The events that lead to the definition of sickness may either
be disease or illness or functioning in the social order. Sickness is a social phenomena. It is a social
designation or a kind of social status that can be occupied by people who are socially defined as having
disease or being ill the sick person is one who is treated as unhealthy by others. Such can occur whether
or not illness or diseases are present.
While a person is defined by other as being unhealthy his/her social identity shifted to that of a sick
person. The incumbent of sick role is exempt from normal social functioning but most confirm to the
norms associated with the sick role. The investigation of disease is the province of biology and medicine
and that of illness is the province of psychology and sickness is the unique province of sociology.
Sickness refers to a social identity distinguishable from disease which is a biological concept and from
illness which is socio-psychological concept. Disease then is the pathological process deviation from a
biological norm. Illness is the patients experience of ill health sometime disease cannot be found.
Sickness is the role negotiated with society.
Therefore, Disease: - physical concept Illness: - Psychological concept Sickness: - sociological
concept
The Social Role of Illness and Sickness
People who try to maintain their healths are considered as behaviours related to primary
prevention of disease is health related behaviours.
Secondary prevention of disease is more closely related to the control of a disease that an
individual has this types of prevention is most closely tied to illness behaviour.
Tertiary prevention is generally seen as directed toward reducing the impact and progression of
symptomatic disease in the individual.
This type of prevention is highly related to the concept of sick role behaviour. In general illness
and sickness role are viewed as characteristics of individual and as concepts derived from
sociological and psychological theories.
Illness is the night(dark) side of life, a more onerous(burden) citizenship. Everywhere who born
holds dual citizenship, in the kingdom of the well and sick. Although we all prefer to use good
passport. Susan Sontang
Disease involves not only the body, but also affects ones relationship, self image and behaviour.
The social aspects of disease may be related to the pathophisiologic changes.
A physician diagnose the mans condition as an illness he/she changes the mans behaviours.
The manners in which individuals monitor the structure and functions of their own bodies,
interpret symptoms take remedial action and make use of health care facilities.

17
 Any behaviour undertaken by an individual who feels ill to relieve that experience or to better
define the meaning of the illness experience.
Physical or mental symptoms turn to the medical care system for help (go to hospital), self-help
strategies (alternative medicine). While some may decide to dismiss the symptoms.
Illness behaviour may be a mixture of behavioural decisions.
Influences of illness behaviour and role
Many sociological psychological factors which determine the types of illness behaviour expressed in the
individual or illness behaviour is shaped by socio-cultural, socio-psychological factors;
Demographic status:-Married age, sex, ethnicity, education, family structure, social networks etc.
Culture of poverty:-Delay seeking professional health care even when presented with severe symptoms.
Post experience.
David Machanic, a pioneer in the study of illness behaviour. According to him illness behaviour arise
from complex causes, including biological predispositions, the nature of symptomatology, learned
patterns of response, attributional predispositions, situational influences, and the organization and
incentives characteristics of the health care system that affect access responsiveness and availability of
secondary benefits.
Sick-Role behaviour
i. American sociologist Talcott Parsons was a structural functionalist who argued that social
Practices should be seen in terms to their function in maintaining order or structure in society.
ii. He was concerned with understanding how the sick person related to the whole social system.
iii. Ultimately the sick role behaviour could be seen as the logical extension of illness behaviour
to complete integration into the medical care system.
Five major Sick-Role characteristics
i. First: - The sick person is exempt from carrying out normal social role. The more severe the
illness the more one is freed from normal social roles. A common cool allow one to be excused
from small obligations such as attending a social gathering. By contrast, major heart attacks
allow considerable time away from work and social obligations.
ii. Second : - People in the sick role are not directly responsible for their plight (unfortunate
conditions).
iii. Third: - The sick person needs to try to get well.
iv. Forth: - The sick role is regarded as a temporary stage of deviance that should not be prolonged
if at all possible.
v. Fifth: - The sick role person or patient must seek competent help and co-operate with medical
care to get well.
This conceptual scheme implies many reciprocal relations between the sick person (the patient), and the
healer (the physician). Thus the function of the physician is one of social control.
Importance of the sick role behaviour
Understanding this complicated relationship between patient and physician. It brings positive
behavioural change in both patient and practitioner that will lead to better health outcomes. Differential
power of participants in the relationship, superior power of the physician, in terms of technical expertise
and status, will more effectively include the patient toward a positive medical outcome.
3. Five stages in illnessSociologist and Anthropologist view about illness as marked by analytically
different stages. Suchman has divided to illness into five stages and the name he gives them are used as
basis for illustration the way in which sociologists and anthropologists view the sequence of illness.
I. The symptoms experience stages: - (The decisions that something is wrong): -

18
 The first step in medical drama. Occurs when physical discomforts, pain, change of appearance or
disability suggest to a person that something is wrong with his physical state. Suchman view in these
symptoms will be recognized and defined not in medically diagnostic but in terms of their
interference with normal social functioning.
After symptoms are recognized they must be interpret with their meaning and arose emotional
response of fear and anxiety.
Here it is found a qualitative difference between many western and non western people. Although
members of both groups assign priority to physical symptoms as evidence of illness.
Western people (patient) can also believe that in the absence of overt indicators, laboratory tests and
diagnosis is required. In contrast non western people tend to belief that unless pain and real
discomfort are present there can be no illness.
II. Assumption of sick role stages: - (The decision that one is sick and needs professional care)
Seeks advice and care initially is limited to home remedies and self doctoring and advice is sought
with in the lay referral system (i.e. through discussion of symptoms with relatives and friends).
Highly important at this stage is the provisional validation of friends and relatives to the claim of
illness. If family and friends generally are supportive of the suffered claims he/she is more apt to go
on to third stage than if they express skepticism.
Anthropologist tend to see stage two among the peoples they study as one in which stress is placed on
naming the illness. To name an illness is important for two reasons.
First the known named illness is less threatening than the unknown; it is easier to live with a named
than an unnamed illness.
Second naming and illness determines its etiology, its cause which in turns provides the doctor with
the information he/she needs to carryout treatment.
III. The medical care contact stages: - (The decision to seek professional care)
At this stage the person who suspected that he/she is ill is well on the road to becoming a patient.
Seek authorized confirmation of provisional validation of illness. If such conformation is forthcoming
he performs a medical diagnosis and purpose the course treatment designed to restore him to proper
health.
If doctor denied, turned to another physician, continue shopping around until he accepts himself as
without illness.
Good medical facilities in western world decision for consultant with physician are made by husband
and wife (not social but familial level).
In traditional and tribal medical society: Slow decision within large number of people.
IV. The dependent-patient role stage:-(Decision to transfer control to the physician and to
accept and follow prescribed treatment)
Nature of illness and treatment become an important matter.
Accept and follow prescribed treatment and follow treatment regime.
In which continuous patient role frequent physician visit, periodic hospitalization and expected loss of
physical confidence.
Patient expect to recover will be treated and will react to illness.
If acute-anticipated (expected) either death in near future or recover.
Chronic- person long term commitment to the implication of disability requires adjustment,
adaptation and transformation on number of social interpersonal and psychic level of functioning.
Change and alteration, more permanent character with more or less lasting re-arrangement in the
organization of life program.

19
 V. The recovery or rehabilitation stage: -(The decision to relinquish the patient role)
Relinquish (abandon) sick role. Resume normal role.
Good action in society tradition rituals symbolic action, e.g. in Mexico, an ill person said I have
bathed. It is sign of complete recovery (belief that bathing is to be highly dangerous during for the
sick.)
In Nigeria (if mental illness) symbolic recovery of illness, Patient taken to river where a dove is
sacrificed over his head and he is washed in its blood. Then his old clothing and carcass of the bird
are thrown in the stream and carried away while the priest chants: as the river can never flow
backward so may this illness never return.
The former patient dressed by best cloths meets his relatives who have assembled for a Feast in
respect to recovered health. Both patient and family presumably benefit from this ritual, the patient is
reassured that his relatives welcome him to back to his usual role with his normal activity.

Unit III
Nurse patient Relationship
Meaning and significance of interpersonal relationship:-
A relationship is normally viewed as a connection between two agencies such as individual and
individual, like child and parent, individual and group, like teacher and student or doctor and patient etc
group and group such as party and people or police and public etc. These relationships usually involve
some level of interdependence. People in an interpersonal relationship tend to influence each other, share
their thoughts and feelings, and engage in activities together. The study of interpersonal relationship
involves several branches of the social sciences, including such disciplines as sociology, psychology
anthropology and social work.
Interpersonal relationships are dynamic systems that change continuously during their existence. One of
the most influential models of interpersonal relationship was proposed by George Levinger. This model
was formulated to describe heterosexual, adult romantic relationships but it has been applied to other
kinds of interpersonal relations as well. According to the model, the natural development of a relationship
follows five stages;
Acquaintance:- Becoming acquainted depends on previous relationship, physical proximity, first
impressions and a variety of other factors. If two people begin to like each other, continued
interactions may lead to the next stages.
Buildup: - During this stage people begin to trust and care about each other.
Continuation:- This stages follows a mutual commitment to long term friendship.
Deterioration: - Not all relationship deteriorates, but those that do tend to show signs of trouble.
Boredom resentment and dissatisfaction may occur, and individual may less communicate and avoid
self-disclosure.
Termination: - The final stage marks the end of the relationship, either by death in the case of a
healthy relationship, or by separation.
Patient professional relation:-
The professional-patient relationship is a bond of trust between the patient and the medical professional
who is performing treatment. A role that of doctors, nurses, patients, social workers visitors and others has
duties or at least expectations of carrying out particular task and activities attached to it. There is
regularities in the way that most actors who occupy particular occupational or others role perform.

20
This viewed has offered some examples of theoretical reflection, practical issues and their inter relation in
the area of the professional patient relationship. The examples illustrate that the relationship between
theory and practice is a complex one; this means that the connections made here are by no means the only
possible ones, and some cases may be surprising or contentious. However, it has been argued that they are
plausible, and as such they illustrate the potential of ethical theory and practice in health care to
illuminate one another.
A. Talcott Parsons Model of the Doctor-Patient Relationship
The premises of the Parsonian model include the following.
i. The problem of health is intimately involved and the functional prerequisites of the social
system.
ii. Too low a general level of health too high an incident of illness in dysfunctional.
iii. As sickness and health care, because of their importance, parts of the culture.
iv. Health care is a social role relationship between a helping agent and a person needing help.
v. The social roles of the health care relationship are a patterned sector of culture, and this learned
sequences of behaviour.

Parsons Doctor-patient System Model

Status Patients (sick ) Role
Obligation To be motive to get well
Or duty
To sick technically competent help
To trust the doctor or to accept the
competence gap (asymmetry quality of
harmony balance of the relationship )
Doctors (Professional ) Role
Expected to act for the welfare of the
patient (orientation to collective Vs self)
Be guided by the rules of professional
behaviour (universalism Vs
particularism)
Apply high degree of achieved skill and
knowledge to problems of illness be
objective and emotionally detached
(affective neutrality). Professional self
regulation.

Privileges (benefit): Exemption:

Privileges Exemptions Status
Premise From performance of normal social Access to physical and personal intimacy.
obligations.
For responsibility for ones own Autonomy.
state.
Professional dominance
Modern medicine is organized about the application of scientific to the problems

21
 of illness and health and to the control of disease. (Functional Specificity).

Criticism: -
Modern medicine is organized about the application of specific knowledge to the problems of illness and
health and to the control of disease.
i. Lack of uniformity in illness response among various persona and social groups.
ii. Less applicability for chronic illness such as cancer, heart disease etc.
iii. It is based on traditional one to one interaction; It cannot be applied to a group of individuals.
iv. Middle class oriented- lay people do homework, they do not obey the suggestions of not doing
extra work.
v. Deficient with resent to mental illness which is not exempt from all his/her social responsibilities.
vi. Doctor-patient relationship is more complex and is reciprocal.

B. The Szasz- Hollender Model: Behavioural Implications of Organic symptoms.

Szasz and Hollender , both physicians saw more extensive behavioural implications of organic
symptoms which they incorporated in a mode of doctor-patient relationships based on a threefold
typology.
Model Physicians role Patients role Clinical Application of Prototype
Model (example)

Activity- Does something to Recipient (unable to Anesthesia, acute trauma, Parent- Infant
Passivity patient respond or inert) coma, delirium etc

Guidance Co- Tells patient what to do Co-operator (obeys) Acute infectious processes Parent child
operation etc (adolescent

Mutual Helps patient to help Participation in Most chronic illness Adult- adult
participation himself partnership (uses psychoanalysis etc
expert help)

Activity-Passivity:- Here the orientations is one in which the physician is active and the patient is
passive. The patient is more or less completely helpless and the physician does something to him or

22
everything to him. Treatment takes place regardless of the patients contribution. The relationship of the
doctor to the patient is similar to that of the parent and helpless infant.
Guidance Co-operation:-This model usually underlines the doctor-patient relationship when the
circumstances are less desperate than those describe above. Patient is capable of following direction and
the exercising some judgment. At this level the patient is expected to look up to his physician and to obey
him. In essence the patient says You know what is best for me. That is why I come to you. Tell me what
to do and I will follow your direction. This model has its prototype in the relationship parent and his
child.
Mutual participation:- This approach is often useful for the management of chronic illness in which the
treatment program is carried out by the patient with the only occasional consultation with a physician (i.e.
diabetes, mellitus, hypertension, myasthenia gravis, psoriasis etc). According to this model the physician
helps the patient to help himself. Since it requires a complex psychological and social organization on the
part of the patient, it is rarely appropriate for children or for people who are mentally deficient, very
poorly educated, or profoundly immature. Its prototype is the relationship of adult to adult with one
having specialized knowledge that other needs.
Criticism:-
This model also has the same criticism as of Talcott Parsons. Hospital base, one-to- one person relation,
mention of especially for acute illness, deficient with mental and chronic illness, middle class oriented,
curative aspect and lacks to explain community approach. Its model is minimized the role of other
professional such as nurse, hospitals, health workers, paramedics etc

Communication Pattern between professional and Indigenous Patient Care

Modern/Professional Care Pattern Indigenous Care Patterns
Registration system (outdoor) Personal contact
Institutional system Family-Individual system
Written documents Verbal fixation
Strict on date and time Flexibility on date and time
Lab/Supporting alternatives Sacrifice system
Technical methods of using instruments Approximation based on healers decisions
More responsible and easy predict No many responsibility and to haphazard
prediction
Routine for follow up No such system but frequent visit
Patient comes to hospital or professionals Healers goes to the patients house
Long and short term relationship Long term relationship with family system
Others Others

Barriers in effective professional-patient relationship

i. Lack of knowledge about the health and medical system.
ii. Illiteracy, in sufficient health resources.
iii. Egoism, professional centrist, superior inferior feeling.
iv. Lack of socio-cultural, economic knowledge and psychological barrier.

23
v. Heavy duty of the professional and misunderstanding.
vi. Socio-political and other pressures, violence, money oriented behaviour of the providers.
vii. Lack of budget in organizations, lack of beds, medicines, equipments.
viii. Environment such as infrastructural, physical and natural.
ix. Poverty of the user/patient and country.
x. Personality clash between professionals themselves and between providers-users, users-
administrator, providers-administrators, inter and extra environment.
xi. Others.
Nurse Patient Healthy Relationship
Some of the ways which nurse patient relationship can be improved are: Call the patient with name,
receive the patient with smile and listen to his/her complains with patience, never transmit your tension to
patient, talk to the patient with cheerful and smiling face, always honest with patient, always be talk with
soft kinds of words with patients, create confidence in mind of patient, assurance and explanation to the
patient is very essential. Never criticize other health professionals in front of the patient. Care is more
important than cure especially in incurable disease and terminally ill patients.
Unit IV
Culture and Health
Meaning and definitions of culture
In general speaking, culture is complex whole of material and non material things which are create by
people for solving their various needs. Material culture means house, temple, tools, weapons,
equipments, technological objects etc. Non material culture means norms value, customs, tradition,
language, religion, art, literature, festivals, rules and law etc.
Culture is powerful human tools for survival, but it is a fragile phenomena. It is constantly changing
and easily lost because it is the products of human minds.
Anthropologists and other behavioral scientists define to culture is the full range of learned human
behaviour patterns.
According to E.B.Tylor Culture is that complex whole which includes knowledge, belief, art,
moral, law, customs and any other capabilities and habits acquired by man as a member of society.
Anthropologist M.J.Herkovits define Culture is the man made part of the environment.
Culture is the integrated patterns of human behaviour that include thought, speech, action, and
artifacts and depends upon the human capacity for learning and transmitting knowledge to succeeding
generations the customary beliefs, social forms and material traits of a racial, religious or social
group.
Layers of Culture
There are three layers or levels of culture that are part of your learned behaviour pattern and perceptions.
First layers of culture: -If you talk about others culture, you are referring to the shared language,
traditions and beliefs that set each of these peoples apart from others. In most cases those who share your
culture do so because they acquired it as they were raised by parents and other family members who have
it.
Second layers of culture: -That may be part of your identity is a subculture. In complex and divers
societies in which people have come from many different parts of the world, they often retain much of
their original cultural traditions.
Third Layers of culture: - Consists of cultural universalities. These are learned behaviour patterns that
are shared by all of humanity collectively. No matter where people live in the world, they share these
universal traits.

24
 People even within the same culture carry several layers of mental programming.
The national level: nation is a whole.

Perceptions.
The regional level: associated with ethnic, linguistic or religious differences that exist within a nation.
The gender level: gender differences (male vs female).
The generation level: the difference between grandparents and parents, parents and children.
The social class level: economic, political, educational opportunities and differences in occupation.
The corporate level: particular culture of an organization. Applicable to those who are employed.
Examples of Human cultural traits
Communicating with a verbal language.
Using age and gender to classify.
Classifying people based on marriage and descent relationships and heaving kinship (e.g. wife mother
uncle cousin.)
Having a gender division of labor (e.g. mens work Vs women works)
Having a concept of privacy.
Having rules to regulate sexual behaviour.
Distinguishing between good and bad behaviour.
Having some sort of body orientation.
Having art.
Having some sort of leadership roles for the implementation of community decisions.

The Six Levels of Culture

National/societal: - each nation or society is known to have its unique culture. To be effective in
managing global talent and teams it is essential to understand this level of culture.
Social Identity Group: - each ethnic, religious, demographic or psychographic group has its own culture.
To leverage diversity it is critical to account for the cultures of each social group.
Organizational: - each organization is said to have its own culture making mergers and acquisitions and
global matrix teams difficult to manage effectively.
Functional: - within each organization functions have their own culture. For example the IT department
might have a different culture than the marketing department. To build cross-functional effectiveness and
collaboration addressing functional cultural is essential.
Team: - Building a team is not an easy task even if the teams are all in the same department or have the
same goals. Team effectiveness requires understanding the culture of the team members.
Individual: - each person has their own culture. Operating within any organization, employees must be
culturally developed for maximum individual and organizational growth.
Characteristics of Culture
1. Culture is learned or acquired: -This is fist essential characteristics of culture. Culture is learned by
any individual especially if he/she grows up with that particular culture. He/she can learn behavior
patterns including language and many other attributes. We can learn the culture of others especially if
we acquaint with them and get influence with their personality and lifestyle.
2. Culture is shared by group of people: - We can consider a thought or an action as a culture if it is
commonly shared and believed or practiced by a group of people then it can be considered as their
culture.

25
3. Culture is transmitted: - Culture can be passed from one generation to another generation
(vertically) and one society to another society (horizontally). More and more knowledge is added in
the particular culture as time passes. Each may work out solution to problems in life that passes from
one generation to another. This cycle remains as the particular culture goes with time.
4. Culture is dynamics or changeable: - It was considered that there is no culture remains on the
permanent form. Culture is changing constantly as new ideas and new techniques are added in time
modifying or changing the old ways. This is characteristics of culture that stems from the cultures
cumulative quality.
5. Culture is ideational: -Culture forms ideal pattern of behaviours that followed by individuals
expectedly. It serves as guidelines that must be followed by members to gain social acceptance from
the people with the same culture.
6. Culture is diverse: - It was considered that culture was formed by many separate cultures. It is a
system that has several mutually interdependent parts. Although these parts are separate, they are
interdependent with one another forming culture as a whole.
7. Culture gives us a range of permissible behaviour patterns: - Culture provides us with the norms
of appropriate behavioral patterns. It involves how an activity should be conducted, how an individual
should appropriately act, as husband, wife, parents, child, and others. It tells us how to dress based on
gender, occasions, status and many more.
8. Culture is continuous and cumulative: - Achievements of past and present, the social and cultural
heritage (tradition) of man.
9. Culture is determined by social life: - Not exist in isolation, not an individual phenomenon, product
of society, originated and developed through social interaction and shared by the member of society.
10. Culture is consistent and integrated: - Different parts of culture are interconnected e.g. the value
system of society is closely connected with its other aspects like morality, religion, customs,
traditions, beliefs, etc.
11. Culture varies from one society to another society: - Every society has own or unique culture, not
uniform, varies from time to time as well.
12. Culture is social not individual.
13. Culture fulfils some needs and desire of individuals.

Eight basic elements of culture

1. Religion 2. Daily life 3. History 4. Arts 5. Government 6. Economy 7. Social groups and
8. Language
Elements of Culture
Language, Norms, Value, Beliefs and Ideologies, Social collectives, Status and Roles, Cultural
integration etc.
Language: -
Language is a set of symbols used to assign and communicate meaning. It enables us to name or label
things in our world so we can think and communicate about them.
Language, as a social product.
Language, communicate and interaction.
Language, cognition and reality.
Language and culture
Norms: - Norms as humanly created rules for behaviour.

26
Types of norms: - Folkways, Mores, Customs, Taboo and totems, Rite and rituals, Religion, Law, Social
control etc.
Internal: - Socialization and the internalization of norm, ideologies, beliefs and values.
External: -
Informal sanction: (For small group and organization)
Physical and verbal reactions sanctions.
Embarrassment and stigma.
Avoidance/ostracization (exclude for society)
Formal sanction: (For large organizations):- Government, laws and police, courts hearing, trials and
punishments.
Values
Social values are behavioural standards for members of society about what is wrong and rights.
Values are anything members of a culture aspire to or hold in high esteem. Values are things to be
achieved, things considered of great worth or value.
Values are human creations. They are socio-cultural product.
Values can and do become reified
Values can be renegotiated and changed.
Beliefs and ideologies
Beliefs are the things members of a culture hold to be true. They are the facts accepted by all or most
members. Beliefs are not limited to religious sentiments, but include all the things a people know and
accept as true, including common sense everyday knowledge.
Like all other cultural elements, beliefs are humanly created and produced.
Beliefs can and do change, especially in modern industrial societies from traditional societies.
There is no absolute knowledge or absolute truth. All knowledge and truth is relative.
Ideologies are integrated and connected systems of beliefs. Sets of beliefs and assumptions connected
by a common theme or focus.
They are often are associated with specific social institutions or systems and serve to legitimize those
systems.
Social collectives: - Social collectives such as groups, organizations, communities, institutions, classes
and societies are also collectively produced symbolic social constructions. Social collectives are symbolic
entities.
Status and Role: - Status is the social identity and position of persons in society. Status provides certain
rights, duties, obligations, responsibilities, privileges to the individual, according to which performs roles
in society. A person has the multi status in a same time. Status and role is also determined by culture of
the society. Statues are of two types that a person can get in society.
Ascribed Status: - assigned by birth or without efforts.
Achieved Status: - Assigned by skills, abilities, capacities and qualifications of a man.
Cultural Integration: - Cultural integration refers to how interconnected, complimentary and mutually
supportive the varies elements of culture are:
Diversity, complexity and integration.
Variation within modern mass culture.
Diversity in historical and cultural traditions.
The relationship between beliefs, values, norms, and behaviour.
The traditional deterministic view.

27
 The culture as ecological and environmental view.
Ethnomedicine
Ethnomedicine is a sub-field of ethnobotany or medical anthropology that deals with
traditional medicine and healing systems. It is folk ideas and practices concerning the care and treatment
of illness available within particular (usually non-western) cultures that is outside the framework of
professionalized, regulated scientific medicine. They commonly involve empirically based natural
remedies, frequently from plants, and healing of rituals with a supernatural element. Often deemed
unscientific such methods of healing are increasingly shown to have some value. Some ethnomedicine
which are using for traditional or indigenous remedies are:
Ginger Root: - Ginger root used for many remedies in Chinese and Hindu cultures. This root is
believed to do many things such as cure colds, injury, nausea, anemia, rheumatism, piles, jaundice
and leprosy, reduce high blood pressure, and can increase sweating to help reduce fevers, regulate
menstruation and even stimulate sexual desire.
The African Ginger is a natural anti-inflammatory remedy, also used for many things such as
headaches, influenza, mild asthma, throat infections, menstrual cramps (pain) mood swings
(hang), colds, flu, and coughs, indigestion, nausea, gas, gastro-intestinal infections.
Coca Leafs: - In South America used as a remedy for overcoming altitude sickness, fatigue
(weakness), as well as other illness. This practice has been used by many tribes indigenous to Peru
and Bolivia and is still a common practice today.
Green Tea: - In the Western society used to prevent dark circles and wrinkles under eyes, cooled off
tea bags as compressors on each eye will reduce the risk of dark circles and wrinkles forming.
Garlic and Mustard Seed: - That is worn around ones neck as a means of preventing colds. Garlic
is also useful for gastric, ulcers, cancers etc.
Rhizome: - To treat asthma hysteria, colds, coughs, and the flu, the rhizomes and roots are chewed
fresh. Women may chew it to help ease women during menstruation. Used for nausea a single dose of
about 250 mg every 2 to 3 hrs or 1 gram per day may help.
Aloe Vera: - Its juice has healing properties for skin conditions such as burns, cuts, etc and also
useful for diabetes and high blood pressure. Aloes medicinal purpose have long been discovered and
re-discovered in various part of the world.
The first noted finding was in the Egypt and other parts of Africa, the plant most extensive.
The use of Aloe Vera is a very common in the Western society.
Evidence shows that ancient Greek doctors used the plant excessively for its soothing (relaxing)
properties.
Avocados: - This fruit is saturated by vitamins and minerals essential to healthy skin, teeth, and,
nails. It also contains fat, the good kind (as opposed to the heart-clogging kind), which provides
energy.
Similarly Banana, Caffeine, Chocolate, Citrus Fruits, Cucumbers, Honey, Grapes, Papaya etc are rich
of various vitamins and used to remedy for many disease.
Neem and Tulsi are also used for medicine in many societies.
Ethno Psychiatry
Ethno psychiatry is the study of mental illness in a cross-cultural perspective; including its definitions,
classification, causality and treatment of mentally ill persons in different cultural contexts.
Ethnopsychiatry is cross-cultural psychiatry or transcultural psychiatry.

28
 The new transcultural psychiatry demands special consideration of indigenous notions (ideas) of
causality and for explanatory models based on folk beliefs.
In the context of ethno psychiatry, as there is a disagreement over the boundaries of normal and
abnormal behaviour, difficult to define mental health.
Definitions of ethno-psychotherapy
Ethno-psychiatry is a psychotherapeutic that considers one after the other and not at the same time.
The disorders cultural dimension (emic-analyzing structural and functional elements)
The analysis of the psychic functions (etic-a system of moral standard)
George Devereux is the founder of the theory. According to him psychoanalysis and Anthropology
are necessary to approach the understanding and treatment of situations in which a family have
moved from one culture to another.
Ethno-psychotherapy requires de-centering culture.
It allows an analysis of the therapeutic resources of traditional societies.
Non-medical system, strength and weakness
The term non medical system refers to a body of therapeutic approaches that have also been referred to a
complementary, alternative, new age and integrative medicine. It is also known as the Traditional
Cultural medicine or Non- Western Medicine.
The term Non-medical system refers to ways of protecting and restoring health that existed before the
arrival of modern medicine which have been handed down from generation to generation.
History of Traditional Cultural Medicine (TCM)
Traditional systems in general have had to meet the needs of the local communities for many
centuries.
China and India, for example, have developed very sophisticated system such as acupuncture and
Ayurvedic medicine.
In practice, the term Traditional Cultural Medicine refers to the following components: acupuncture,
traditional birth attendants, mental healers and herbal medicine. Dhami/Jhankri (traditional healers),
Priest/Lama etc.
Over the years, the World Health Assembly has adopted a number of resolutions to the traditional
medicine for primary health care.
That the work force represents a potentially important resource for the delivery of health care and that
medicinal plants are of great importance to the health.
A genuine interest in various traditional practices now exists among practitioners of modern medicine and
growing numbers of practitioners of traditional, indigenous or alternative systems are beginning to accept
and use some of the modern technology. The reasons for the inclusion of traditional healers in primary
health care are manifold:
The healers know the socio-cultural background of the people.
They are highly respected and experienced in their work.
Economic considerations.
The distances to be covered in some countries.
The strength of traditional beliefs.
The shortage of health professionals, particularly in rural areas to name just a few.
Medicinal plants are the oldest known health care product. Their importance are:
It varies depending on the ecological, medical and historical background of each country.
For pharmacological research and drug development.

29
 For the synthesis of drugs or as models for pharmacologically active compounds.
WHO defines traditional medicine as The health practices, approaches, knowledge and beliefs
incorporating plant, animal and mineral- based medicines, spiritual therapies, manual techniques and
exercises, applied singularly or in combination to treat, diagnose and prevent illness or maintain well-
being.
Traditional medicines include herbal, Ayurveda, Siddha medicine, Unani, ancient Iranian medicine,
Islamic medicine, traditional Chinese, medicine, traditional Korean medicine, Acupuncture, Muti, Ifa,
traditional African medicine, and other pseudo medical knowledge and practices all over the world.
Up to 80% of the population relies on traditional medicine for their primary health care needs in
Asian and African countries.
In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60% of children with high fever
resulting from malaria is the use of herbal medicines at home. WHO estimates that in several African
countries traditional birth attendants assist in a majority of births.
Over one-third of the population in developing countries lack access to essential medicines. The
provision of safe and effective traditional medicine.
Ayurvedic scholars often recommended a regimen of relaxing and healthy yoga courses to keep the
body flexible and healthy while simultaneously aiiowing the mind a chance to unwind (relax). As
they say today: healthy body, healthy mind.
The internal medicine aspect of Ayurveda is called Kaaya-chikitsa, and there are also surgical (shalya-
chikitsa), pediatric (Kaumarabhrtyam),and toxicological (agadatantram) schools of Ayurvedic thought.
These different schools of medical thoughts have all been studied by modern physicians.
Ayurvedic/Alternative Medical Institutions
S.N. Hospitals Numbers
1 Ayurvedic Hospital 2
2 Vaidhyakhana 1
3 Anchal ayurveda Aushadhalaya 14
4 District Ayurveda swasthya Kendra 55
5 Ayurveda Ausadhalaya 216
6 Homopathy Hospital 1
7 Yunani Chikitsalaya 1
Source: MOHP
Strength of Traditional Cultural Medicine (TCM)
TCM being better in curing the root of the problem.
It is important for medical practitioners to be aware of the health attitudes of their patients from
different ethnic backgrounds.
Getting more popularity in non-western world like in China, Indio, Nepal etc.
The majority of the ethnic populations explains and understands their illnesses in their traditional
medical concepts.
No side effects.
TCM is considered to be good for some milder illnesses, for example, coughs and colds.
Chinese medicine is used only as an alternative.
TCM has been practiced in China for over 2000 years.
Weakness of Traditional Cultural Medicine (TCM)
Slow in action which may lead to delay of proper treatment or Worsening of the disease for example
flu virus may go to other parts of the body, causing more serious disease or death.

30
 No better patient-doctor relationship and better compliance of treatment.
Not applicable and popular in the Western world.
Significant side effect.
Not applicable in harder diseases like TB, cancer, leprosy etc.
It is less convenient than Western medicine.
The herbal medicine almost always bitter, which makes it unpopular with some patients.
On taking Chinese medicine, the patient has avoided certain food and this is difficult for some others.
Personalistic, Naturalistic Medical System
Personalistic Medical System
Illness is believed to be caused by the active, purposeful intervention of a sensate agent who may be a
supernatural being (a deity or a god).
A non- human being (a such as a ghost, ancestor, or evil spirit) or a human being (a witch or sorcerer)
causing of great harm, pain or upset.
The sick person literally is a victim, the object of aggression or punishment directed specifically
against him, for reasons that concern him alone.
A Personalistic disease causation belief is found among people who are relatively small, illiterate,
lacking contact or who are underdeveloped.
Naturalistic Medical system
Illness is explained in impersonal, systematic terms; Naturalistic systems conform above all to an
equilibrium model.
Health prevails when the insensate elements of the body, the heat, the cold, humors, are in balance
appropriate to the age and condition of the individual in his natural and social environment. When this
equilibrium is disturbed, illness resulted.
Disease is caused by supernatural or non-supernatural categories of power. Nurga discussing about
supernatural and natural causes of illness.
Disease is caused by supernatural forces, agents or act that cannot be directly observed e.g. witches,
sorcerers, spirit intrusion, evil eyes etc.
Non-supernatural (natural) explanations of disease are those which are based entirely on observable
cause and effect relationships. Like indigestible food, sudden change in temperature, strong winds
blood, air etc.
For Gartaula (1992) the contrast is between magical (witchcraft) and empirical aetiologies,
terms used to describe the folk medical beliefs of peoples in Nepalese and underdeveloped traditional
societies.
Cross-culture examples of culture in relation to behaviour and health problem in health care system
Cross-culture: - Having references to more than one culture or to comparative studies among several
cultures.
Tries to bring together such relatively unrelated areas and establish areas of communication. Its core is to
establish and understand how people from different cultures communicate with each other (shared values,
understandings, assumptions and goals) learned from earlier generations, imposed by the members of the
present days society and passed on to the succeeding generations.
Behaviour: - It refers to the action and mannerism made by organism, systems, or artificial entities in
conjunction with its environment, which includes the other systems or organisms around as well as the
physical environment. It is the response of the system or organism to various stimuli or inputs, whether
internal or external, conscious or subconscious, overt or convert, and voluntary or involuntary.

31
Biologically: -It human, behaviour is believed to be controlled primarily by the endocrine system and the
nervous system. It is most commonly believed that complexity in the behaviour of an organism is
correlated to the complexity of its nervous system. Generally, organisms with more complex nervous
system have a greater capacity to learn new response and thus adjust their behaviour.
Cross-cultural issues in relation to health
Culture, race and ethnic group play important roles in health role beliefs, behaviours and access to
optimal health care services.
The health of adolescents is affected by historic, political, economical and cultural factors.
Racial and ethnic minorities carry a disproportionate amount of health and economic inequality. Research
has shown that minority children with chronic disease have fewer visits to clinicians, fewer prescribed
medications and more visits to an emergency room compare to white children with the same degree of
illness. Similarly adolescents generally are at higher risk for poor access to health care service.
According to national survey of USA by the Centers for Disease Control and Prevention (CDCP) 39% of
white school boys engaged recently in binge drinking behaviours, which compares to 25% of African
Americans (Black) school boys engaged in same behaviour. Asian school boys drink less frequently than
white boys.
However according to same survey, 58% of African American (Black) teenagers having sexual
experienced compared to 32% of white teenagers.
Certain ethnic group may also have folk illnesses that are culturally constructed diagnoses that often
conflict with our biomedical understanding of disease.
Child with a seizure problem, the parents felt the seizures were due to a wandering of soul, physicians felt
that they were due to the biomedical model of disease, a misfiring (fail to operate properly) of his/her
neurons. This misunderstanding between the childs family and the physicians led to a bad outcome for
the child who suffered severe seizure and brain damage.
Health care system
Aim to meet the health care needs of target populations.
WHO, 2000 are good health, responsiveness to the expectations of the population, and fair financial
contribution.
Duckett 2004, purposed a two dimensional approach to evaluation of health care; quality, efficiency
and acceptability on one dimension and equity on one another.
There are a wide variety of health care systems around the world.
In some countries the health care system planning is distributed among market participants, whereas
in other planning is made more centrally among governments, trade unions, charities, religious or
other co-ordinate bodies to deliver planned health care services targeted to the populations they serve.
Modern providers of health care system
Doctors and nurses, paramedics, dentists, medical laboratory staffs, specialist therapists, psychologists,
pharmacists, chiropractors, optometrists etc.
Special health Care System
Occupational safety and health.
School health services.
Military medicine.
Vaccination: - Vaccination policy refers to the policy a government adopts in relation to vaccination.
Vaccinations are voluntary in some countries and mandatory in some countries. Some governments
pay all or part of the costs of vaccinations for vaccines in a national vaccination schedule.

32
Indigenous healers
The traditional healer or indigenous healer is define as someone who is recognized by the community in
which he lives as competent to provide health care by using vegetable, animal and mineral substances and
certain other methods based on the socio-cultural and religious backgrounds as well as the prevailing
knowledge, attitudes and beliefs regarding physical, mental and social well being and the causation of
disease and disability in the community.
Each of them has their own field of expertise. Even the techniques employed differ considerably.
They have their own methods of diagnosis and their own particular medicine.
Most of the medicines used by traditional practitioners have not been validated scientifically. Many
people suffer because of the serious complications that arise due to the use of traditional medicine.
Different Indigenous Healers
Diviners (having godlike nature) analyze the cause of specific events and interpret the messages of
the ancestors.
Herbalists (herb specialists) have good healing practice and empirical knowledge about reaction of
herbs which plays important role and they are able to diagnose certain illness with certainty. In
Nepalese context Baidhya, Kabiraj, jadibutiwala etc.
Faith Healers use their prayers or chants to healing method like in Nepal they are known as Dhami,
Jhankri, Jharfukey, Lama, pandit, Jyotisi etc.
Traditional Birth Attendants (TBAs)
They often serve the communities located in isolated and remote areas.
However they also provide their services in urban/semi-urban communities, which despite their
exposure to western health care services may still prefer TBAs. May still now TBAs are changed in
Midwives.
This category of health provider continues to play an important role in health care system.
Why Indigenous Healers? These practices are primary and have emerged due to the following
reasons: -
Lack of modern medical experts/doctors in comparison to the population in the societies.
Lack of health institutions.
Lack of alternative resources.
Lack of planning and policies formulated by the organization.
Lack of health education to the people.
Lack of economic opportunities.
Lack of subsisting means of economy along with the subsidiary means to manage and fulfill the daily
basic needs and health expenditure.
Unavailability of medicine and if available high cost which is not tolerable to the people due to their
poverty.
Availability of the traditional providers which is lower cost, easy to meet, culturally attached and
accepted.
These (so called traditional by the westerns) medications are acceptable due to the culture and social
life of the people.
Roles of indigenous healers in primary health care (PHC)
Primary health care (PHC) is the ideal model of health care was adopted Alma-Ata conference in
1978 and became a core concept of the WHOs goal of health for all.

33
 The Alma-Ata Conference mobilized a PHC movement of professionals and institutions,
governments and civil society organizations, researchers and grassroots organizations that undertook
to tackle the politically, socially and economically unacceptable health inequalities in all countries.
In developing countries, where the needs are great and the resources scarce, traditional healers can
play a significant role in helping the rural community to improve its health & quality of life.
Various kinds of traditional medicine are: Ayurvedic medicines, the Chinese yin/yang system and
homeopathic medicine- complex system of medicine with registration procedures for recognition.
Traditional healers treat a number of conditions with herbal extracts acting on the body metabolism.
In east and south Asian countries, over 80% 0f the people living in rural areas and 80% of trained
health workers are centered in urban areas, hardly 10 to15% of the people have access to officially
provided health care facilities.
The present scenario of health indicators in Nepal indicates a high death rate (9/1000 population), a
high infant mortality rate (33/1000 live births) and a low contraceptive prevalence rate only 43.7%.
The doctor- population ratio is far from accepted norms.
Main objective of the national health policy is to upgrade the health of the rural people through the PHC
approach. To reach the target, health facilities at the different levels have been constituted as follows: -
Proposed health Population ratio Level of infrastructures.
units

Sub health post 1:4000 Village level

Health post 1:20000 Ilaka level

District health center 1:100000 Electoral constituency level

District health office 1:200000 District level

Traditional healers were willing to work in primary health care centers.

There is increase use of oral rehydration solution.
There is rational use of treatment procedures for diarrhea.
Latrines have been constructed and are used in homes.
Increasing numbers of cases are referred to the health centers.
There is increased attendance at the health post.
Traditional healers are able to act as a link between the local population and health workers.
Problems
Lack of clear recognition by the government about their role and value for the health system.
Lack of government commitment about their participation in the national health care system and
program which discourages their participation.
Lack of dialogue between them and the government system which makes their role insignificant.
Lack of trust between them and health workers trained in the allopathic system, which produce many
conflicts, ultimately leading to counter-productive results.

Recommendations

34
 There should be a government policy for training and using traditional healers.
Traditional healers should be fully incorporated into the health system based on the need of the
community.
There should be an atmosphere of understanding, trust and respect between them and health workers.
Their role in PHC must be defined and identified. The roles may vary according to responsibility,
status and culture practices of the healers.
The planning, implementation and evaluation of programmes for training and using traditional healers
in PHC should be done jointly by representatives from health and other related sectors of the
government and NGOs, Traditional healers and the community they serve.
The training course should contain all the principles and elements of primary health care.

Self-medication and other prevailing health care practice in Nepal

Self-medication is a term used to describe the use of drugs (including alcohol) or other self-soothing
form of behaviour to treat untreated and often undiagnosed mental distress, stress and anxiety
including mental illness or psychological trauma. Self-medication is often seen as gaining personal
independence from established medicine.
As different drugs have different effects, they may be used for different reasons. According to the
self-medication hypothesis (SMH), the individuals choice of a particular drug is not accidental or
coincidental, but instead, a result of the individuals psychological condition, as the drug of choice
provides relief to the user specific his/her condition. Specifically addiction is hypothesized to function
as a compensatory means to modulate effects and treat distressful psychological states, whereby
individuals choose the drug that will most appropriately manage their specific type of psychiatric
distress and help them achieve emotional stability.
The self-medication hypothesis (SMH) originated in prepares by Edward Khantzian, Mack and
Schatzberg, Devid F. Duncan and a response to Khantzian by Duncan. The SMH initially focused on
heroin use, but follow-up paper added cocaine. The SMH was later expanded to include alcohol and
finally all drugs of addiction.
Self medication is use of medicine or other kinds of traditional methods by self decision or without
doctors prescription.
Use of a drug with therapeutic intent but without professional advice or prescription.
There are legal constraints on self-medication; however there is a psychiatric hypothesis by which it
is linked to drug abuse and addiction. Some medicine, including aspirin, paracetamol, some anti-cold
or painkillers etc, are licensed for sale for self medication; products sold over countries.
Also, legal use may be made of drugs such as alcohol and tobacco which are not covered by drug
control laws.
Specific mechanisms of self medication
Depression is often self medicated with alcohol, tobacco, cannabis or other mind altering drug use. This
may immediate relief of some symptoms such as anxiety, it may stimulate some symptoms of several
kinds of mental illnesses that are already latently present, and may lead to addiction, among other side
effects of long-term use of drug.
1. CNS Depressants:-Alcohol and sedative/hypnotic drugs are central nervous system (CNS)
depressants which produce feeling of relaxation, and sedation (restfulness) while relieving feelings of
depression and anxiety.

35
2. Psycho- stimulants: -Cocaine, amphetamines, caffeine and nicotine, produce improvements in
physical and mental functioning, including increased energy and feelings of euphoria (joy), stimulants
tend to be used by individuals who experience depression to reduce anhedonia (without pleasure) and
increase self esteem.
3. Opiates (sleeping drug):-Heroin and morphine function as an analgesic by binding to opine
receptors in the brain and gastrointestinal tract. This binding reduces the perception of and reaction to
pain while also increasing pain tolerance.
4. Cannabis:- Cannabis is a psychoactive that is considered to have both Stimulating and sedating
properties. Depressants properties more obvious in occasional users and stimulating properties more
common in chronic users.
Effectiveness
Self medicating excessively for prolonged periods of time with alcohol often makes the symptoms of
anxiety or depression worse.
This is believed to occur as a result of the changes in brain chemistry from long-term use.
Self-medication and non-doctor prescribing of drugs is common in developing countries.
Complementary and alternative medications, especially herbs are also commonly used.
The common reasons given for self medication were mild illness previous experience of treating a
similar illness and non availability of health personnel.
The compounder and health assistant were common sources of medicines.
Paracetamol and antimicrobial were the drug most commonly prescribed.
A significantly higher proportion of over 40 years male had used self-medication comparison than
other groups.
Urban youths were more involves in self-medication of drugs addictions.
Herbs were also used for self medication. Fever and headache were the most common reasons for
non-doctor prescription.
Self-medication of common illness by lay people is common in economically deprived countries.
Common reasons cited for self-medication are inaccessibility of health care facilities, economic
constraints and previous experience of illness. Since drug-use studies in the community and factors
influencing the drug use patterns.
The more common ethnic groups self-medications tools were followed by other ethnic groups e.g. in
Nepal self-medications method of Brahmin and Kshetris followed by other ethnic groups.
Perceptions of illness,
Early research has been identified five dimensions within the cognitive representation of illness.
i. Identity: - The label the person uses to describe the illness and the symptoms they views as being
part of the disease.
ii. Consequences: - The expected effects and outcome of the illness.
iii. Cause: - Personal ideas about the cause of the illness.
iv. Timeline: - How long the patient believes the illness will last.
v. Cure and control: - The extent to which the patient believes that they can recover from or
control the illness.
Perceptions of illness by different people:-
Different people perceive and respond to illness in their own way. There are so many factors; some of
them are as follows: -
i. Age: - Different people of different age groups perceive health problem in different way for e.g.
Elderly people seek attention more in even in minor illness than younger people.

36
ii. Sex: -There is more emphasis on male in comparison to female, due to our social structure e.g. If
the man is chief earning person in the family he may get health more quickly rather than female.
iii. Occupation: -Occupation may also interfere with perception and response to illness. If anything
gets wrong in health personnel, they may be more sensitive towards their health. On the other
hand some people will be busy with their occupation so they may not care about their health.
iv. Education: -The educated person has more consciousness to their health; if anything interferes
with their health go for health check-up. But uneducated people may not be conscious to their
health problem or ignore it, or may go to traditional healers.
v. Marital status: -Sometime married women cannot get the facilities for health check-up due to
their extra family burden but it is quite different in married man. They might get more attention
and timely treatment.
vi. Socio-culture structure: -In some culture disease is preserved as a result of god coarse or evil
spirit. In other culture disease is preserved formal sin and receive treat from traditional healers.
vii. Geographical or Environmental condition: -In certain circumstances people neglect their
illness due to inaccessibility of health service or facilities because of lack in transportation.
viii. Family status: -The role or position of the person in family may reflect the perception of the
health problem or illness e.g. If ones role is greater in his family or one is beloved in family,
he/she get more attention.
ix. Economic background: -Rich person can focus more for fulfilling their daily needs and can
spend more money for the treatment of minor health problem in timely or quickly but poor or low
status people are unable to pay more attention on their illness or health problem.
x. Past experience: -
xi. Personality factor:-

Hierarchy and food habits in Nepal

Food is the just a source of nutrition.
It is found up in social relations, cultural ideas, the human body and the meaning of health.
Cultural groups differ from one another in many of other beliefs and practices related to food.
Food stuffs which are eaten in one group can be forbidden in another group.
There are variations among cultures as to how food is prepared, Served and eaten.
Stages of food consumption are patterned by cultural values and are parts of the accepted way of life
of that community.
Different categories of food
i. Food Vs non-food:-
Each culture defines which food can be eaten and which cannot be eaten.
All cultural groups utilize nutritional foods as the purpose of subsistence.
ii. Sacred (holy) Vs profane (impurity): -
Sacred is assumption purity; eat and used with respect. Profane is the assumption about impurity and
couldnt be touch.
iii. Caste Vs food:-
Higher caste avoids polluting foods to retain their caste status there are 3 categories of food: -
i. Satavic food: - Satavic (sakahari) foods are vegetarian food including milk, curd, butter etc.
ii. Rajasi food: - Rajasi (royal) foods are hot including fish, meat, eggs, onion and garlic. These
foods are to be beliefs that produce egoism, selfishness, violence, jealousy, ambitious etc.
iii. Tamasi food: -Tamasi foods are recognized as spoiled food (alcohol, heavy amount of meat,
stale etc), which generates to laziness or bad behaviour.

37
 In Nepalese context according to cultural beliefs foods are divided in hot and cold, into two basic
categories.
In Nepal food intake is influence by various elements like geographical area, availability and
accessibility of resources, age, gender, education, occupation, fashion, habit, technology, economic
condition, culture, tradition etc.
Food patterns: -
Traditional food patterns:- Foods are preparation by traditional methods refers traditional food
patterns which is based on agricultural societies.
Modern food patterns: -Foods are preparation by modern mechanized technology refers modern food
patterns; basically based on technological or industrial societies.
If food preparation of breads from floor of wheats is known as traditional food patters and if made
off noodles is refers to modern food patterns.
Anthropological Research Methodology
Research is an attempt to gain new knowledge, facts, information etc in a systematic and scientific
manner. It is the systematic and organized effort to investigate a specific problem that needs a solution.
Such process of investigations includes gathering and recording the facts, analyzing and interpreting the
data to find out the answer of the problem.
The word research has been derived from two words Re and Search. In here Re means again and
Search means to investigate. Thus, etymological meaning of research is to investigate again and again
to any phenomena. Research is important in every field but in Anthropology, it is primary needs.
Anthropological research is highly interesting and existing. In anthropology is really a kind of systematic
study of society and culture. It gives the answer of innumerable puzzles and suspicions, withstands
disappointment and discouragements, challenges, superstitions and unravels the mystery that clouds the
truth.
Steps of Anthropological research
Identification of problem (Selection of the topics)
Statement of the problem
Determination of objectives
Formulation of hypothesis
Review of literature
Research design
Research method
Data collection
Interpreting and presentation of data
Summary, conclusion and recommendation
Purpose of Research
We should think of the purpose of research in health science as providing clues for our search for
knowledge and understanding. Turning from our own need, consider the use of research as follows.
Discover new facts about known phenomenon.
Find answers to problems which are only partially solved by existing methods and information.
Improve existing techniques and develop new instruments or products.
Discover previously unrecognized substances or elements.
Discover pathway of action of known substances and elements.

38
 Schlot feldt says The ultimate aim of research in the ordering of related valid generalizations into
systematized science. Our research benefits us personally and results in a contribution to other and to
the health profession.
According to Seaman and Verhonic, the purpose of health research may be summarized as to observe
in order to know, to predict, to control, to practice and prescribe in a professional manner.
Health Research involving human subjects including
Studies of psychological, biochemical or pathological process or of the response to a specific intervention
whether-physical, chemical or psychological or social in healthy subject or patients.
Controlled trails of diagnostic, preventive or therapeutic measures in larger groups of persons, designed to
demonstrate a specific generalisable response to these measures against a background of individual
biological variations;
Studies concerning human health related behaviour in a variety of circumstance and environment;
Studies in which environmental factors are manipulated in a way that could affect incidentally exposed
individuals. E.g. exposure includes toxic chemicals and pathogenic organism or agents or absence of
these. Psycho-social challenge or deprivations, and implementation of health policy or management
options influencing the environment of the subjects.
Research is designed to obtain new information about drug or other therapeutics, diagnostics, preventive
measure, knowledge, practice or behaviour of community or individual human subjects.
Epidemiological research is to explore the distribution and determinants of risk factors of health related
events or problems in specified population and geographic area in order to prevent, control and manage
health problems and promotes healthy and environment friendly behaviour.

Types of Anthropological Research

i. Basic or pure research
ii. Applied research
iii. Experimental research
iv. Action research
v. Non-experimental research
vi. Descriptive/Analytical research
vii. Quantitative/Qualitative research
Qualitative research:- The specified objectives in a small but in depth study is considered in this
research. Features are not shows in no. of defined units such as experience, knowledge believes, faith,
pride etc.
Quantitative research:- Variables which have a certain no. of defined units such as age, income,
qualification etc.
Research Design
Research methodology
Sources of data
Sampling methods: - Probability sampling i)Simple random ii)Systematic iii)Stratified iv)Cluster
and Non-probability sampling i)Convenience ii)Purposive iii)Quota iv)Snowball
Data collection techniques
Reliability and validity of data
Data processing and analysis
Limitation of the study
Techniques of data collection

39
i. Observation: - Participant and Non-participant Observations
ii. Questionnaire:- Close end and open end questionnaire
iii. Interview: - Structured and non-structured interview
iv. Case study: -
v. Scaling: -Measuring instruments are commonly referred to as scale. Social behaviours and
personality scale, moral scale, character texts scale, social participation scale etc.

Unit V
Socio cultural change, Social problem and Control
Social and cultural change
Social: - Every aspects of society like behaviour, relation, institution, organization, system, structure,
process etc.
Change:- The word change denotes a difference in anything observed over a period of time. Change
mentioned those three aspects i) Objects ii) Time iii) Variation.
Social change is a term used to describe variations or modification of any aspect of social process,
behavior, relation, institution, organization, system, structure etc.
Cultural change: - Every manmade part in environment is culture, which is invented by man for fulfill
their various needs. Culture is basically divided into material and non-material culture, Therefore the
change in all material and non-material culture refers to cultural change.

Definitions
Jones -social change is a term used to describe variation or modification of any aspect of social
process, social patterns, social interaction or social organizations.
Anderson and Parker -Social change involves alteration in the structure or functioning of social
form or processes themselves.
M.D.Johnson -Social change may be define as modification in way of doing and thinking of
people.

Nature or characteristics
Social change is a universal phenomenon: - It occurs in all societies but the speed and extent of
change may differ from society to society.
Social change is community change: - It doesn't refer to the change in life pattern of any or some
individuals. It is a change which occurs in the life of the entire community.
Speed of social change is not uniform: -social change in urban is faster than in rural areas or modern
societies than traditional societies.
Social change occurs as an essential law: - It may occur either in the spontaneous or as a planned
effort.
Definite prediction is not possible: - It is difficult to make any prediction about exact forms of social
change.
Social change shows chain run sequence: - A societys pattern of living is a dynamic system of
interrelated parts. Therefore change is one of part usually reacts on the other parts of the society.

Factors of social and cultural change

A. Biological factors:- It includes living beings that is

I. Plants and animals in the area: Many plants are used for medical treatment

40
 II. The change in population both in number and composition.
B. Technological factors:- Development of science or technology
C. Geographical or ecological factors:- Land, climate, natural resources
D. Cultural factors:-
E. Economic factors:-
F. Political factors:-
G. Educational factors:-
H. Psychological factors:-
I. Ideological factors:-
Direction or theories of social and cultural change
A. Unilinear or evolutionary theory: -According to this theories society is gradually moves to an even
higher state of civilization and that is advanced in other stage and in the direction of improvement.
B. Cyclic theories:- Human society goes through certain cycles or society has predetermined life cycle
(birth, growth, maturity and decline) history repeats itself, society after passing through all the stages
returns to the original stages then the cycle is repeated.
C. Fluctuating or up-down patterns of social change: - According to this theory changes often goes in
forward or progress or positive ways and sometime in backward or destroy or negative ways.
Effects of social and cultural change
Changes in socio-cultural life of people.
Changes in economic life and livelihood patterns of people.
Changes in political system.
Changes in agricultural and other production system.
Changes in social institution.
Changes in norms, values and ideologies.
Industrialization and modernization through technological development.
Consequence of social and cultural change
It has narrowed the gap of caste system or discrimination and marriage is no longer religious band.
It has promotes a higher standard of living.
Birth rate has been control because of the invention of birth control device.
Participate or employment of women in office and various economic sectors.
Superstition and pseudo beliefs are reduced.
Social desolation or disorganization.
Barriers of social change (Obstacles)
1. Psychological:-
Perceived needs:- Sometimes people dont excited to change.
Communication patterns:- communication gap between social groups.
Attitude: -Feelings of superior and inferior in caste, class, gender, ethnic or racial system
Personal influence: - Selfishness of any persons or a certain groups.
2. Cultural:-
High and low context
Cultural integration
Other barriers to change fatalism
Superstitions or pseudo beliefs
Orthodox cultural beliefs
Lack of education or awareness
Lack of modern scientific technology

41
3. Social:-
Desire for prestige.
Less chances to contact with other societies.
Authority or power concentration in one or few persons.
Lack of participation in planning, policy making or decision making process.
Lack of group or social mobilization.
5. Economic:-
Economic advantage of upper classes or power holders
Vested interests:-People who feel that social change endangers their interest.
Limited natural or environmental resources
Lack of financial institutions and industrialized production system
Social Problem
Social problem is to be range of conditions and aberrant behaviors which are held to be
manifestations of social disorganization and to warrant society.
Typically these problems include many forms of deviant behaviour (such as crime, juvenile
delinquency, prostitution, mental illness, drug addiction, suicide) and of social conflict (sectarism,
domestic violence, industrial strife, etc)
A social problem is a condition that at least some people in a community view as being undesirable.
Other social problems may be undesirable as such by certain group of people not by all. Smoking in
public place is undesirable to some peoples but some people considered it easily.
Every newspaper is filled with stories about undesirable social conditions e.g. crime, violence, drug
abuse and environmental problems can be found at the local, state, national and international levels.
Social problems involve problems that effect real life. E.g.
Prostitution
Sexual abuse
Alcohol abuse
Drug abuse
Crime
Poverty
Anti social behaviors
Economic deprivation
Unemployment. Etc

A. Prostitution
The provision of sexual act or practice for financial purpose has probably been institutionalized in the
form of prostitution in every society.
It has nearly always involved the prostitution of women to man is more common, though male
prostitution especially to female clients is not uncommon.
Prostitution is one of the branches of the sex industry. Estimates place the annual revenue generated
from the global prostitution industry to be over $100 billion.
In Britain and some other countries prostitution itself is legal but in many countries with Nepal
prostitution is illegal.

42
 Sociological studies of prostitution shows that their motivation is mainly economic and it seems
likely that the number of prostitutes increases when there are fewer other job opportunities for
women.
International movements of prostitutes are nearly always from poor countries to richer ones.
Effects
Relation to crime: - One of the most serious problems associated with prostitution is the fact that the
sex trade is illegal, abusive and dangerous activities.
One view is that such situation occurs because prostitution is kept illegal and the industry operates on
the black market.
Another legalized or regulated prostitution could not improve the situation, but instead makes it
worse.
Human trafficking and sexual slavery:- Today human trafficking is primarily for prostituting women
and children.
It has been suggested that human trafficking is the fastest growing form of the existing slavery and is
the third largest and fastest growing criminal industry in the world.
Use of children:- Apply a child on prostitution as well as those on sex.
Thailands Health system research instituted reported that children in prostitution make up 40% of
prostitutes in Thailand.
Some adults travel to other countries to have access to sex with children, which is unavailable in their
country.
In illegal immigration:- A difficulty facing migrant prostitutes in many developed countries is the
illegal residence status of some of these women.
There are brothels that may not adhere to the usual legal standards planned to safeguard public health
and the safety of the workers.
HIV/AIDS:- A main cause of the increasing numbers HIV positives is unsafely prostitution.
B. Alcoholism
Alcoholism was coined as a term to denote a special medically diagnosable condition of serious
dependence upon or addiction to alcohol.
Alcoholism has been described in term of disease, a genetic disorder, a psychological problem, and as
the product of the dysfunctional family.
Undoubtedly, drink and its heavy consumption are related to the incidence of petty and serious crime
(especially violence, and motor accident) health problems and workplace injuries.
Social problems
Alcoholism is a cause to loss of employment which leads to financial crisis and loss of properties
Drinking at inappropriate times and behaviour caused by reduced judgment, can lead to legal
consequences such as criminal charges for drunk driving (mapase) public disorder, or civil penalties.
Rejection from family and friends, this can lead to family and marital conflict. Similarly its bad
impacts on childrens educations and in their future.
Alcoholism can lead to various crime e.g. burglary, violence, murder, rape etc.
Health or physical problems
Long term alcohol abuse can cause a number of physical symptoms, including cirrhosis of liver,
pancreatitis, epilepsy, polyneuropathy, heart disease, nutritional deficiencies and sexual dysfunction
and can eventually be fatal.

43
 Increased risk of developing cardiovascular disease, mal absorption, alcoholic liver disease and
cancer.
Damage to the central nervous system and peripheral nervous system can occur from regularly
alcohol consumption.
Heavy drinking over time has been found to have a negative effect on reproductive functioning in
women
Prevention
WHO, EU and other national governments have formed alcohol policies in order to reduce the harm
of alcoholism?
Targeting adolescents and young adults is regarded as an important step to reduce the harm of
alcohol abuse.
The banning or restricting advertising of alcohol has been recommended as additional ways of
reducing the harm of alcohol dependence and abuse.
Guidelines for parents to prevent alcohol abuse amongst adolescents and for helping young people
with mental health problem have also been suggested.

C. Sexual abuse
Sexual abuse also referred to as molestation (to force unwanted sex) is the forcing of undesired sexual
behaviour by one person upon another, when that force is immediate, short duration or infrequent, it
is called sexual abuse.
The term also covers any behavior by any adult toward a child to stimulate either the adult or child
sexuality.
When the victim is younger than the age of consent (the minimum age at which a person to legally
competent in sexual course), it is referred to as child sexual abuse.

Types of sexual abuse

Non consensual, forced physical sexual behavior (rape)
Unwanted touching, either of a child or an adult.
Sexual kissing fondling (touch in stimulate way) exposure of genitalia, exhibitionism.
Exposing a child to pornography (sexual image or film)
Saying sexually suggestive statements toward a child (child molestation)
Incest (any sexual intercourse between close relatives)
Spousal sexual abuse: - It is a form of domestic violence when involves forced sex to wife.
Power misuse:-
Sexual misconduct can occur where one person uses a position of authority to compel to another
person to engage in an otherwise unwanted sexual activity. E.g. sexual harassment in the workplace
might involve an employee being forced into a sexual situation out of fear of being dismissed.
Sexual harassment in education might involve a university student submitting to a professors sexual
advances in fear of being given a failing grade or marks
Child sexual abuse
This is a form of child abuse in which a child is abused for the sexual satisfaction of an adult.
In addition to direct sexual contact, child sexual abuse also occurs when an adult exposes their
genitalia to a child asks or pressures a child to engage in sexual activities.

44
 Effects of child sexual abuse include guilt and fear, sexual dysfunction, chronic pain, addiction, self
injury, suicidal ideation, depression, anxiety, mental illness, personality disorder.
Sexual abuse by a family members can result in more serious and long term trauma.
Research show that approximately 25% to 40% of women and 10% to 15% of man were sexually
abused when they were children.
Most sexual abuse offenders are; approximately 30% are relatives of the child, most often fathers,
uncles or cousins; around 60% are other acquaintances such as friends of family members, teacher
hostel keeper or neighbors.
Most of the child abuse cases are not reported by the fear or social insults about victims.
D. Crime
A crime is held to be an offence which goes beyond the personal and into the public sphere, breaking
prohibitory rules or law, to which legitimate punishments or sanctions are attached, and which
requires the intervention of a public authority.
Crime is the breach (break) of rules or laws for which some governing authority can ultimately
prescribe a conviction.
According to human society may each define crime and criminal behavior differently.

E. Child labour
Refers to the employment of children at regular and sustained labour.
This practice is considered exploitative by many international organizations and is illegal in many
countries.
In many developed countries, it is considered inappropriate or exploitative if a child below a certain
age and nature of works.
An employer is usually not permitted to hire a child below a certain minimum age.
The minimum age depends on the country and the type of work involved. States ratifying the
minimum age under the rules of ILO in1973, have adapted minimum ages verifying from 14 to 16
years.
The incidence of child labour in the world decreased from 25 to 10 percent between 1960 and 2003,
according to the World Bank.
Child labour is still common in some parts of the world; it can be factory work, mining, prostitution,
quarrying, agriculture, helping in the parents business, having ones own small business.
Some children work as guides for tourists, sometime combined with bringing in business for shops
and restaurant.
According to UNICEF, there are estimated 158 million children aged 5 to 14 in child labours
worldwide, excluding child domestic labour.
Causes of child labour in Nepal
Poverty:- It is a vital cause of child labour. Family send to children as a workers to others home return
to some wages.
Social structure:- Rigid behaviour under children, e.g. step father and mother etc.
Rural poverty, large no. of children in family, rural to urban migration in hopes to find employment.
Great disparity of wealth in Nepal poor families are often in great debt and in turn must become
bonded laborers.
Their debts are passed to their children, who then become bonded laborers themselves.
Worst Data about Child labors

45
 About 7 million children between 5-14 years old working in Nepal, about 3 millions are found to be
regularly working and 1.7 million children are found to be economically active.
The number of child laborers at around 2,060,000 where about 94.7% are involved in agriculture and
household work and the remaining 5% are service and manufacturing industries. For every 100
children in the 6-14 years age group 4-5 are engaged in paid work. (ILO-IPEC Country Paper Nepal
1999)
Of 2.59 million working children 278000 or4.5%of all Nepali children are in paid work and 1.38
million or 22.2%of children are in unpaid work (ILO-IPEC Child labours condition in Nepal 1998)
F. Drug Abuse
Drug abuse generally refers to illegal drugs, although the social significance of alcohol, tobacco and
tranquillizers should be noted (e.g. regarding health).
The diverse origins of illegal drugs include natural plants and manufactured synthetics.
Research shows that patterns of use, behavior and subjective experience will be influenced by
particular properties of drugs but also by social factors such as culture and expectation.
Most commonly used is cannabis, but greatest social concern is aroused by heroin and more recently
cocaine and opiates generates amphetamine and ecstasy.
Prohibitions on drug use are relatively recent; use of opiates as remedies and intoxicants was common
during the 19th century.
The concept of drug abuse is always harmful; it suggests a dependency with grave consequences nor
do such consequences inevitably follow; the term problem drug users is therefore increasingly
favored.
Regarding crime is the dominant factors of regular drug use, coupled with the illegality of supply
forces users to commit crime to pay for drugs. However drugs use leads to involvement in crime or
involvement in delinquent life styles introduces a person to drug use is debated.
HIV transmission via shared syringes has encouraged the aim of minimizing harm associated with
use., challenging the traditional pursuit of abstinence.
Resulted drug uses are impressed by family and friends but legislative provision is inadequate to
prevent it.
G. Suicide
Latin word suicidium to kill own self, is the term used for the deliberate self-destruction of a human
being by causing their body to cease life function.
Such action are typically characterized as being made out of despair or attributed to some underlying
mental disorder which includes depression bipolar disorder, schizophrenia (mental disorder),
alcoholisms and drug abuse.
Financial difficulties, interpersonal relationship and other undesirable situations play a significant
role.
Over one million people commit suicide every year, making it the 10 th leading cause of death
worldwide.
It is a leading cause of death among teenagers and adults under 35. There are an estimated 10 to 20
million non-fatal attempted suicides every year worldwide.
Views on suicide have been influenced by broader cultural views on existential themes such as
religion, honor, the meaning of life.
The Abrahamic religions consider suicide an offense toward God due to religious belief.
Sati is a Hindu funeral practice in which the widow would immolate herself on her husbands funeral
pyre, either willingly, or under pressure from the family in-laws.

46
 Medically assisted suicide (the right to die) is currently a controversial ethical issue involving people
who are terminally ill, in extreme pain, or have minimal quality of life through injury or illness.
Self- sacrifice for others is not usually considered suicide, as the goal is not to kill oneself but to save
another.
Causes/Risk factors of suicide
Psychiatric, disorders, drug misuse, psychological states, cultural, family and social situations and
genetics.
Mental illness and substance misuse frequently co-exist.
Other risk factors include having previously attempted suicide, the ready availability of a means to
commit the act, a family history of suicide, or the presence of traumatic brain injury.
Socio-economic factors such as unemployment, poverty homeless, and discrimination may trigger
suicidal thoughts.
Impact of suicide on health and society
Isolated from society.
Bad impression in children, family or society.
Serious injury or death.

Social Control
Social control refers to the system of devices where by society bring its member in to conformity with
the accepted standard of behavior.
Social control is a system of measures, suggestion, persuasion, restraints, cohesion and physical codes
by which the society origins into conformity to the approached behaviors. The person is influenced
through in the interest of others rather than in accordance with his individual interests.
The techniques and strategies for preventing deviant human behavior in any society The deliberate
institutional means of making individuals and groups in a society observed and conform to the
avowed social norms.
Definitions
MacIver and Page -Social control is the way in which entire social order coheres and maintains
itself how it operates as a whole as a changing equilibrium.
R.Robert - The term social control refers to the techniques and strategies for regulating human
behavior in any society.
M.Lane - Social control is a social process by which the individual makes group responsive and by
which social organization in built and maintains.
Types of Social Control
Kral Mennheim:-
I. Direct: -From law, police, military etc.
II. Indirect: -From family, norms and value etc.
Kimbal Young: -
I. Positive: - Via reward
II. Negative: -Via punishment
Gurvich and Moore: -
I. Traditional: -By religion, customs, norms and value etc.
II. Institutional: -By state, government, police, military etc.
Means of Social Control

47
 A. Informal means of social control.
B. Formal means of social control.
A. Informal means of social control: -
I. Belief: - It is the conviction that a particular thing is true e.g. human belief in the existence of an
unseen power, belief in the heaven and hell, belief in the goodness, belief in the immortality of
soul etc. Belief may be true or false, but also it influences humans behaviors in society.
II. Social Suggestion: -Social suggestions are also powerful means of social control. It is the indirect
communication of ideas and feeling. Such communication may be made through various
methods. The first method is putting life examples of great persons e.g. Mahatma Gandhi.
III. Ideologies: -Ideology is a theory of social life which interprets social realities from the ideas
deals to prove the correctness of the analysis and to justify these ideals. Leninism has influenced
the social life of the Russians. Gandhism has influenced the social life in India. Ideologies
stimulate action and provide a set of values for social action. They make life meaningful. The
success of any ideology as effect means of social control depends on many factors.
IV. Folkways: - The term (Folkways and mores) was first introduced by W.G.Summner. Folkways
are group habits and commonly accepted ways of behaving in society. They are foundation by
group culture. They are socially approved and become a habit and followed unconsciously. E.g.
dressing, fooding, respect, hospitality system of every society. These are social in nature and are
of implanned origin. Since folkways become a matter of habit, these are followed unconsciously
and exercise powerful influence over humans behaviour in society.
V. Mores: - Is a term used to denote behavior patterns which are not only accepted and traditional
but are prescribed. Costumes or conventions of the community. These are the norms that are
considered to be very important by group and vital for its welfare. Violation of the more evokes
an emotional response and instead of the mere raising of eyebrows or ridicule a strong group
action follow. Thus mores are norms of a higher order than folkways. Death rituals (kajkriya,
sraddha),wearing of necklace and vermilion by married women, Burka to muslim women are
some examples of mores.
VI. Customs:- Customs are long established habits and usages of the people. In other words custom
are developed form of usages. They are these folkways and mores existed in society for very long
time and passed on from generation to generation. They arise spontaneously and gradually and
regulated social life to a great extend. They are so powerful that no one can escape their ranges.
The primitive customs are main agencies of social control but in modern times their force has
loosened.
VII. Religion: - Religion is the beliefs in spiritual beings. It is an attitude toward super human power.
It expresses itself in several forms like superstition, animism, totemism, magic, ritualism and
fetishism. It is a powerful agency in society and influenced human behaviour. It makes children
obey their parents; make people tolerant, charitable and truth table.
VIII. Art and Literature: - Arts is in its simplest sense includes painting, sculpture, architecture,
music and dance; similarly literature includes poetry, drama and fiction. Both are and literature
influence the imagination and exert control on human behaviour. The martial music of the
military band arouses feeling of determination and strength. The statue of Mahatma Gandhi
teaches us simple living and high thinking. A painting may arouse in us a feeling of sympathy,
affection and hatred. Similarly Ramayan, Mahabharat, Bhagawat Geeta are some of the classical
works of great social value.

48
IX. Humor and Satires: -Humor is also means of social control. It has seems various forms
depending on the situation and purpose. Satire employs with and scorn as indirect criticism of
harmful behavior of people and cause the give up victious and harmful stress.
X. Public opinion: - The influence of public opinion as a means of social control of is greater in
simple situation for fear of public opinion and criticism people avoid immoral and anti social
activities. Every individual want to win public praise recognition and avoid public ridicule or
criticism.
B. Formal means of Social control
i. Law: - Law is the most important formal means of social control. Law is a body of rules farmed
by legally authorized bodies and enforced by authorized agencies law prescribed uniform rules
and penalties for breaking those rules. A number of laws have been made to promote social
welfare. Law exercises a powerful influence upon the behavior of people in modern societies.
ii. Education: - Education is a process of socialization. It prepares the child for social living. It
teaches him the value of discipline, instills in him the qualities of honesty, helpful, truthfulness,
fair play a sense of right and wrong. Though the family makes the child superstitious and
education will correct his beliefs and remove prejudices.
iii. Coercion: - It is use of force to enforce social control. It may be physical or non-violent. It is the
ultimate means of social when all other means fails. The physical coercion may take the form of
bodily injury imprisonment and death penalty.
Needs for Social control (Importance)
For social order: - It is necessary for every society of group to maintain its social order and this is
possible only when its members behave in accordance with that social order.
To establish Social unity: - Without social control, social unity would be a more dream. Social
control regulates behaviors in accordance with established norms which bring uniformity of behavior
and lead to unity among the individual.
To regulate or control individual behavior: - Peoples are difference in their attitudes, ideas,
interests and habits and interests. There is so much difference in the ways of living of people that at
every moment there is possibly of clash between them. Social control is necessary to protect social
interests and satisfy common needs. If social control is removed and every individual is left to behave
freely then society would be reduced to a state of lawlessness.
To provide social sanction: - Social control provides social function to the social ways of behavior.
There numerous folkways of modes and customs prevalent in society. Every individual violet the
social norms he is compelled through social control to observe them. Thus social control provides
function to social norms.
To check cultural mal adjustment: - Society is subject to change. New inventions, new discoveries
and new philosophies continue to take birth in society. The individual has to adjust his behavior to the
changes taking in the society.
To provide social sanction: - Social control provides social function to the social ways of behavior.
There numerous folkways of modes and customs prevalent in society. Every individual violet the
social norms he is compelled through social control to observe them. Thus social control provides
function to social norms.
To check cultural mal adjustment: - Society is subject to change. New inventions, new discoveries
and new philosophies continue to take birth in society. The individual has to adjust his behavior to the
changes taking in the society.

49
 Unit VI
Cultural Groups of Nepal
Nutritional beliefs and child barring and rearing practices of major cultural groups like
Brahmin, Magar, Sherpa, Tamang, Thakali, Tharu.
A. Brahmin : -
Brahmin, the priestly close of Indo-Aryan origin, occupies the highest position in Hindu hierarchy.
They are said to have came to Nepal from Different parts of India. Today they are found in every part
of Nepal and have kept different occupations. This ethnicity encourages the women to see pleasant
scenes in this ethnicity, the pregnant women are not allowed in the kitchen in the last trimester. She is
not allowed to watch animal slaughter and touch small babies. In this group the antenatal mothers are
allowed to eat sour fruits as much as she likes. Birth and menstruation forbidden customs are more
rigid in this group, and it bad impacts in mothers and Childs health. Brahmin had similar food habits
both vegetarianism and non-vegetarianism was very popular. First rice feeding ceremony is done for
girls to 5 and boy to 6 months. Male Childs is preferred by Hindu parents for performing their
religious rites. According to CBS 2011 the population of Brahmin hills is 3226903.

B. Magar: -
The Magar having Mangolian origin and lived in Kali Gandaki regions, Rapti and southern part of
Dhulagiri zone. This ethnic group has good physical fitness; in habits they are very straight and more
laborious. Hindu and Buddhist both religions are found in this community. Mostly Magar youths are
found in any force therefore Childs are rearing by mothers. According to CBS 2011 the population of
Magars is 1887733.
Hindu Magar observe birth pollution for 11 days and in Buddhist Magar it observed just 5 days
and name is given to child in last day by priests or lama.
The ceremony for saving the head of the boys is done at the age of 6-8 years.
Alcoholism, cirrhosis of liver, respiratory infection, lung cancers, worm infection, water born disease,
STDs, environmental pollution, constipation, mental retardation, deprivation, wound etc are more
common health problems in this community.
C. Sherpa
Sherpa in literal terms means people of east in the Tibetans. Sherpas major occupations include
agriculture, animal husbandry, and trade, are famous for trekking and mountaineering. Today they are
known worldwide for their skills and hardiness. They follow Buddhism as their major religion and culture
for polyandry. Their ancestral place of these famous mountaineers is northern side of Solukumbu districts,
also in the valley between Dhudhkoshi and sunkoshi river. According to CBS 2011 the population of
Sherpa is 112946.
They feed ghee of chauri to baby after birth and then feed breast milk.
Delivery conducts at home by the helps of their relatives or experienced women.
Observed by presenting the new born child to the Lama. He calculated the childs name according to
his astronomy.
Pasni (first rice feeding ceremony) is done at the age of 5 to 6 months.
Health problem: common STDs, scabies, TB, constipation, cirrhosis of liver, lung cancer etc.
D. Tamang
In Tibetian language Tamang means horse traders. It is believed that they originally came from Northern
parts. The majority of Tamangs live in the hill surrounding Kathmandu valley. Their social practices and
costumes or base on Buddhism and they have their own separate language. Tamang as their occupation

50
mainly farmers, labor and as porter and some are in trade. According to CBS 2011 the population of
Tamang is 1539830.
Child rearing and bearing practice in Tamang
In pregnancy period, they give nutrition food for the pregnant women.
Early marriage and non-matured pregnancy are also found in this community, non-marital pregnancy
is also acceptable in their community.
In the time of delivery mother in law help to her and after delivery she should cut off the cord by
herself and then she care to postnatal mother.
Breast feeding and other milk is given till 5-6 months.
They give Chhang, meat and rice to the postnatal mother and it is restriction to give green vegetables.
Nutritional beliefs: - Milk products, meat, egg etc are the major nutritional foods of this community.
They consume heavy alcohol during the festival, Lhosar, Dashain are the major festivals of Tamang.
During the festival they sacrificed goat, chicken buffalo etc.
E. Thakali
The origin of Thakali is Thakkhola, a high valley in Muktinath region of Mustang district. They have
Mangolian features, a fair complexion and narrow eyes. Thakali are divided into four major groups,
Gauchan, Tulachan, Sherchan and Bhattachan. These four groups are equal status in socially and ritually.
Their religion is a mixture of Hinduism, Buddhism and natural deitys. They get more reputation in hotel
business for their good hospitality, salesmanship, testy and cleanliness food etc. They are also known for
economic successful ethnic group and Dhikur is their traditional economic trust. According to CBS 2011
population of Thakali is 13215.

Child rearing and bearing practice in Thakali

In early time, they werent aware of health practice.
In nowadays, they take regular medical checkup due to their higher economic condition.
Due to their improved economic and educational status they are conscious to hygiene and nutritional
foods.
Delivery usually in home and conducted by aged women.
F. Tharus
Tharus are the only people living in east to west of the Terai regions along the Southern base of Shivalik
hills. They are dark in complexion and have smart, trim bodies. They follow Hindu religion and their
practices are depending on many typical practices. Farming, fishing and business are their main
occupation and they are more laborious ethnic group. Danuwars, Dhimal, Majhis and Daraies are very
similar to Tharus physically and culturally. Nevertheless they speak their own Tharu languages but it is
different in western and eastern region. According to CBS 2011 population of Tharu is 1737 470.
Normally delivery is conducted in home by mother in law and other aged women. Used clean home
delivery kit (CHDK) and a few had used knife to cut the cord.
Rice, milk, meat, fish, egg, vegetable etc are the main sources of nutritions. Oil massage and kept to
child in sunlight is also done by this community.
The influence of modernization and practices of others cultural groups also seen in Tharu community
but in this process eastern Tharus are more forward than western Tharus.
Nowadays medical checkup and consciousness about health practices are increased in this community
but some Tharu community of western region are very backward and rest with low social and
economic conditions.

51
 Most health problems faced by Tharu communities are STDs, Typhoid, Measles, Ringworm,
Diarrhea, Scabies, Influenza Kala-azar Dysentery etc.
Part B. Applied Psychology
Unit I
Introduction to behaviroual Science
Definition and significance of behavioral science in nursing profession.
Behavioral Science: - The science which deals with the exploration of different activities of living
organism and the interactions that takes places between them is termed as behavioral science.
A branch of science (as psychology, sociology and anthropology) that deals primarily with human action
and often seeks to generalize about human behaviour in society.
A scientific discipline which is concerned with the development of a body of principles that will
contribute to the understanding of human behaviour.
It usually included among the behaviroual science and have been psychology, sociology, cultural
anthropology and some aspects of economic and political science.
Significance of Behaviroual Science
The importance of Behaviroual Science in each discipline is increasing with the development of the
society and its complexity.
In health science:-
Biological perspective
Cultural perspective
Social perspective
Socio-psychological perspective:- Relationship between health and social institutions.
Education, business, mgmt & industry, criminology, politics, guidance and counseling military,
adjustment and mental health and self development.
Psychology
Introduction and Definition:- Psychology is the behavior and mental processes. It is the science of
human experience, human behavior and personality which is formed by social and cultural experiences.
Shortly psychology means:-
The science of mind and behavior
The mental or behavioral characteristics of an individual or group
The study of mind and behavior in relation to a particular field of knowledge or activity.
The word psychology is the derived from two Greek words Psyche and Logas, here Psyche
means soul and loges means study or science. Therefore the etymological meaning of psychology
is science of soul.
Hence the earliest definition of psychology was that it is the study of soul and spirit.
The word soul was used rather vaguely and there were many interpretations that could be given to it.
Hence later on the term mind replace to soul.
Psychology as a science deals systematically with human behavior with the motives, feelings,
emotions, thought and action of man and women.
It discovers and explains the underlying laws and principles of behaviour.
It tells us why and how we behave at different stages of growth.
It describes the laws of learning thinking and feeling and many others.
It collects the subject matter or facts of behaviors by means of objective method such as observation
and experiment.

52
 Nurses are always working with people. It is therefore useful for them to understand people. In a
hospital there are patients, in the home there are people who need care: in the public health nursing
field, there are people of all ages who need to be educated.
They also interact with other members of health sectors such as doctors, other nurses,
psychotherapists, hospital technicians, medical social workers and others.
The nurse who takes the trouble to study, understand and use psychology in her work becomes a
better team member.
Health Psychology
It concerned with understanding how biological, psychological, environmental, and cultural factors
are involved in physical health and illness.
Health psychologists work alongside other medical professionals in clinical settings, work on
behaviour change in public health promotion, teach at universities, and conduct research.
Field of Health Psychology
There are four divisions and one allied field within health psychology;
1. Clinical health psychology(CIPH)
2. Public health psychology(PHP)
3. Community health psychology(CoHP)
4. Critical health psychology(CrHP)
Occupational health psychology (OHP) is allied.
1. Clinical Health Psychology(CIHP)
In a term that refers to the application of scientific knowledge, derived from the field of health
psychology, to clinical questions that may arise across the spectrum of health care.
CIHP is one of many specialty practice area for clinical psychologists.
It is also a major contributor to the prevention focused field of behavioral health and the treatment
oriented field of behavioral medicine.
Clinical practice includes education, the techniques of behavior change and psychotherapy.
In some countries, a clinical health psychologist, with additional training can become a medical
psychologist and thereby obtain prescription privileges.
1. Public health psychology (PHP)
PHP is population oriented. A major aim of PHP is to investigate potential causal links between
psychological factors and health at the population level.
Public health psychologists present research results to educators, policy makers and health care
providers in order to promote better public health.
PHP is allied to other public health disciplines including epidemiology, nutrition, genetics and
biostatistics.
Some PHP interventions are targeted are toward at-risk population group e.g. all pregnant women,
undereducated married women etc.
2. Community Health Psychology (CoHP)
Investigates community factors that contribute to the health and well-being of individuals who live in
communities.
CoHP also develops community level interventions that are designed to combat disease and promote
physical and mental health.
The community often serves as the level of analysis and is frequently sought as a partner in health-
related interventions.
3. Critical Health Psychology (CrHP)

53
 It is concerned with the distribution of power and the impact of power differentials on health
experience and behavior, health care systems, and health policy.
CrHP prioritizes social justice and the universal right to health for people of all races, genders, ages,
and socio-economic positions.
A major concern is health inequalities. The critical health psychologists an agent of change, not
simply an analyst or cataloger.
A leading organization in this area is the international society of Critical Health Psychology.
Occupational Health Psychology(OHP)
A separate but related discipline (OHP) is a relatively new field that emerged out of the confluence
(together) of health psychology, industrial/organizational psychology, and occupational health.
The field is concerned with identifying psychological characteristics of workplaces that affect the
health and well-being of them.
OHP is also concerned with developing strategies to effect change at workplace in order to improve
the health.
The study of occupational health psychology deals with psychological causative agent or factors
associated with the workplaces and which are responsible for various health related problems of
working people.

Objectives of Health Psychology

Understanding behavioural and contextual factors: conduct research to identify behaviors and
experiences that promote health and recommended ways to improve health care and health-care
policy.
Preventing illness: work towards promoting health through behavioral change.
The effects of disease: how disease affects individuals psychological well-being, concerns itself
with bettering the lives of individuals with terminal illness, when there is little hope of recovery.
Critical analysis of health policy: how health policy can influence inequities, inequalities, and social
injustice.
Important Contributions of Psychology to Health
It has provided techniques useful in changing behaviors that affect health and illness.
It committed to keeping people healthy rather than waiting to only treat them when they become ill.
Long history of developing reliable and valid measures for assessing health related factors.
It has contributed a solid foundation of scientific methods for studying such behaviors.
Psychology and Nursing
It will enable her to understand herself.
It will enable her to understanding other people.
To appreciate the necessity of changing the environment or surroundings and guide herself how to
mention this situation.
Interdependence of body, mind and spirit in each individual.
The nursing student has to make a number of adjustments in order to work effectively and efficiently
with other people. These adjustments are:-
A. Adjustment to her new environment which is so different from her situation.
B. Adjustment to her patient suffering from various illnesses and of different age groups.
Adjustment to her work routine along with study. Besides, she needs to develop a Professional
Personality. In all these areas, psychology will stand her in good stead, possessed with a better
understanding of herself and a keener insight in to others behavior.

54
 Significance of Psychology in Nursing
The knowledge of psychology helps nurse for making herself a number of adjustments likes:-
A. Adjustment in new environment.
B. Adjustment to work routine and profession.
C. Adjustment to patients, doctors and other health professionals.
Adjustment to other peoples and society.
Knowledge of Psychology can help to nurse are:-
A. The patients motive, mind and desire.
B. Every individual reacts to illness in a particular way according to their physical, social, cultural or
intellectual condition.
C. Differences in patients reaction to illness can also be due to their age, nature of illness and the type of
their personality.
D. Patients symptoms of the particular illness as well as his/her intellectual, emotional and cultural
factors need to be taken into account.
Thus, knowledge of psychology can enable a nurse to use the principle of nursing during whole
process of caring of the patient.
Relationships among Sociology, Anthropology with Psychology
Psychology has relationship with anthropology or the science of man. Anthropology studies the
history of human race, the physical evolution of mankind and the development of human civilization.
It is concerned with the social problems of primitive man and their culture, tradition, customs and
manners.
Psychology studies how these cultural factors influence the human behavior. Particularly, the cross-
cultural psychologists draw from the knowledge base of the anthropologists to understand the unique
features and influences of a culture.
They use the methods of the anthropologists. So the study of the anthropology facilitates the study of
psychology.
Similarly, the knowledge of abnormal and social psychology helps the anthropologists in explaining
the man, his culture and behaviour.
Moreover, psychological techniques are applied for the comparative study of culture.
Thus there is a close relationship between anthropology and psychology, sociology and psychology
are so close that they are classified under the discipline of Behavioral Science.
Psychology and sociology are also close related to each other but only difference is that psychology
give emphasizes to individual but sociology gives more emphasizes to group.
Difference between Psychology and Anthropology
Psychology Anthropology

Studies the reactions and responses; heredity is and The main subject of study is human as a physical
important part. and cultural point of view.

It studies the motive which guides the person; It studies the development of human.
generally these motives are common to all.

It studies the human behavior as equal form. It studies the civilized culture in scientific manner.

It emphasize the tendency of man then the culture It studies the history, the past culture and

55
and civilization civilization of man studies on basis of the past
culture and civilization.

Difference between Psychology and Sociology

Psychology Sociology

The study of an individual mind and creates the It is study of the group and treats the society as a
individual as a complete unit unit.
It studied the personality, behavior, thinking and t studied the tradition and problems of the groups
experiences of an individual. of individual or society.

It studied the contribution of an individual toward It studied the formation of society and nation.
society and nation.

Unit II
MOTIVATION
Meaning And Concept Of Motivation
Internal and external factor that stimulate desire and energy in people to be continually interested in
and committed to a role, or subject, and to bring president effort in attending a goal
Motivation result from the interactions among conscious and unconscious factors such as the
Intensity of desire or need,
Incentive or reward value of the goal, and
Expectations of the individual and of his or her significant others.
An individual has not eaten, he or she feels hungry, as a response he or she eats and decrease feelings
of hunger. According to various theories, it may be rooted in a basic need to minimize physical pain
and maximum pleasure,
Types of motivation
Intrinsic motivation: motivational stimuli are coming from within. An individual has the desire
to perform a specific task, its results are in accordance with his belief system of fulfills a desire
and therefore importance is attached to it.
Acceptance (decisions, are accepted by others)
Curiosity
Honor (respect the rules and to be ethical)
Order (need to be organized)
Power (influence)
Social contact (social interactions)
Social Status (important)
Extrinsic motivation: motivational stimuli are coming from outside. In other words, our desires
to perform a task are controlled by an outside source. Extrinsic motivation is external in nature.
The most well-known and the most debated motivation is money.
Employee of the month awarded
Benefit package
Bonuses

56
 Organized activities
Conflict of motives
When two states of feeling, viewed merely as emotions, come together, if they are of the same nature, we
have a sum total as when the occurrence of two pleasure gives a greater pleasure. When a pain concurs
with a pleasure, we find as a matter of fact that the one can neutralize the other. All through life we apply
the grateful to submerge the disagreeable. This is one phase of the opposition of the two cardinal states of
our consciousness. Each of them has a distinct substantive existence, like black and white. There are
opposites that have merely a formal existence, as plus and minus in algebra, but the state of pain would be
a genuine fact, although there were no state of pleasure at all; in which case the opposition would simply
be suffering and the absence of suffering It is true, but only as a matter of observation, and not as a matter
of foregone necessity, that the remission or cessation of a pained condition yields a pleasure, which we
can accept as an element of our happiness no less than when affected with an impression of a pleasurable
origin. In the same manner when we r under delight, a check or suspension operates up[on the mind like
positive infliction from the beginning, so that out of pleasure springs pain, and the contrary. Nevertheless
we must regard the two modes of mind as each of positive and independent character, although possessing
those relationships[s of mutual opposition. In the conflict of the two, therefore, one will be lost and the
other lowered in its efficacy; the first being pronounced the weaker and the second the stronger

Frustration
Frustration refers to the blocking behavior directed towards a goal. An individual displays some short of
disturbed behavior when he/she is prevented from fulfilling the desired goals. If motives are frustrated or
blocked, the person may feel anxious depressed or angry. If you want to go to a party during the class
time and your teacher is not agreed your proposal you may show some kind of disturbed behavior such as
anger and shouting. Frustration often leads to aggression directed towards to source of frustration.
Three Main sources of Frustration
1. Environmental Forces:-The environmental factors can frustrate the satisfaction of motives. The
obstacle may be physical such as lack of money or road block. They may be social. For instance, your
parents, teachers or classmates may prevent you from doing something what you want to do
2. Personal factors or Limitations:-They make goals unattainable and produce frustration. The personal
inadequacy may be either physical or psychological. The personal characteristics of individual like
personality or intelligence affect performance. The limitation of ability frustrates individuals because they
do not let him or her to achieve very high goals. At times we have conflicting goals which create
frustration.
3. Conflict: - A conflict is a situation in which an individual is required to act in two or more
incompatible ways to achieve goals. It occurs when an individual is unable to choose between two or
more goals.
Motivation the heart of self improvement A Z Motivational tips
With the countless negatives the words brings about, how do we keep motivated? Try out the tips we
prepared from A to Z:
A. Avoid negative people, things and place.
B. Believe in yourself and what you can do.
C. Consider things on every angle and aspect. Motivation comes from determination. To be able to
understand life, you should feel the sun from both sides.

57
D. Dont give up and dont give in. Thomas Edison failed once, twice more than thrice before he come
up with his invention and perfected the incandescent light bulb. Make motivation as your steering
wheel.
E. Enjoy. Work as if you dont need money. Dance as if no bodys watching. Love as if you never cried.
Learn as if youll live forever. Motivation takes place when people are happy.
F. Family and Friends are lifes greatest treasures. Dont loose sight of them.
G. Give more than what is enough. Where does motivation and self improvement take place at work?
At home? At school? When you exert extra effort in doing things.
H. Hang on to your dream. They may dangle in there for a moment, but these little stars will be your
driving force.
I. Ignore those who try to destroy you. Dont let other people to get the best of you. Stay out of toxic
people the kind of friends who hates to hear about your success.
J. Just be yourself. The key to success is to be yourself. And the key to failure is to try to please
everyone.
K. Keep trying no matter how hard life may seem. When a person is motivated, eventually he sees a
harsh life finally clearing out, paving the way to self improvement.
L. Learn and love yourself. Now isnt that easy?
M. Make things happen. Motivation is when your dreams are put into work clothes.
N. Never lie, cheat or steal. Always play a fair game.
O. Open your eyes. People should learn the horse attitude and horse sense. They see things in two ways
how they want things to be and how they should be.
P. Practice makes perfect. Practice is about motivation. It lets us learn repertoire3 and ways on how we
can recover from your mistake.
Q. Quitters never win. And winners never quit. So choose your fate. Are you going to be a quitter or a
winner?
R. Ready yourself. Motivation is also about preparation. We must hear the little voice within us telling
us to get started before others will get on their feet and try to push us around. Remember, it wasnt
raining when Noah build the ark.
S. Stop procrastinating. Nothing kills motivation more than procrastination. Choose to spend your
time accomplish more than the average person lacking motivation.
T. Take control of your life. Discipline or self control jives synonymously with motivation. Both are
key factors in self improvement.
U. Understand others. If you know very well how to talk, you should also learn how to listen. Yearn to
understand first and to be understood second.
V. Visualize it. Motivation without vision is like a boat on a dry land.
W. Want it more than anything. Dreaming means believing. And to believing is something that is
rooted out from the roots of motivation and self improvement.
X. X-factors if what will make you different from other. When you are motivated, you tend to put on
extras on your life like extra time for family, extra help at work extra care for friends and so on.
Y. You are unique. No one in this world looks, acts or talks like you. Value your life and existence,
because youre just going to spend it once.
Z. Zero in on your dreams and go for it.
Seven rules of motivation.
1. Set a major goal but follows a path.
2. Finish what you start.
3. Socialize with others of similar interest.
4. Learn how to learn.
5. Harmonize natural talent with interest that motivates.

58
6. Increase knowledge of subjects that inspires.
7. Take risk.
Theories of Motivation
Incentive Theory: - A reward point of view motive is done by positive meaning to the behavior.
Reinforces and reinforcement principles of behavior differ from the hypothetical construct of reward. A
reinforce is any stimulus change following a response that increase the future frequency or magnitude of
that response. Incentive theory in psychology treats motivation and behavior of the individual as they are
influenced by beliefs such as engaging in activities that are expected to be profitable. Incentive theory is
promoted by behavioral psychologists such as B.F.Skinner . Skinner in his Philosophy of Radical
behaviorism to mean that a persons actions always have social ramifications and if action are positively
received people are more likely to act in this manner or if negatively received people are less likely to act
in this manner. Incentive theorists tend to distinguish between wanting and liking adds an active process
attracting the person towards the stimulus.
Incentive theory distinguishes itself from other motivation theories such as drive theory in direction of the
motivation. In incentive theory stimuli attract to use the term above a person toward them. As opposed
to the body seeking to reestablish homeostasis pushing it towards the stimuli. In term of behaviorism
incentive theory involve s positive reinforcement the stimuli has been condition to make the person
happier. For instance a person knows that eating food drinking water or gaining social capital will make
them happier. As opposed to in drive theory which involves negative reinforcement a stimuli has been
associated with the removal of the punishment the lack of homeostasis in the body. For example a person
has come to know that if they eat when hungry, it will eliminate that negative feeling of hunger or if they
drink when thirsty, it will eliminate that negative feeling of thirsty.
Drive theories: - There are a number of drive theories. The Drive-Reduction theory grows out of the
concept that we have certain biological drives, such as hunger. As time passes the strength of the drive
increases if it is not satisfied (in this case by eating). Upon satisfying a drive the drives strength is
reduced. The theory is based on diverse idea from the theories of Freud to the ideas of feedback control
systems such as a thermostat.
Drive theory has some Intuitive or folk validity. For instance when preparing food the drive model
appears to be compatible with sensations of rising hunger as the food is prepared and after the food has
been consumed a decreased in subjective hunger. There are several problems however that leaves the
validity of drive reduction open for debate. The First problem that it doesnt explain how secondary rein
forcers reduce drive. For example money satisfies no biological or psychological needs, but a pay check
appears to reduce drive through second-order conditioning. Secondly a drive such as hunger is viewed as
having a desire to eat making the drive a human being- a feature criticized as simply moving the
fundamental problem behind this small man and his desire.
In addition it is clear that drive reduction theory cannot be a complete theory of behavior or a hungry
human could not prepare a meal without eating the food before he finished cooking it. The ability of drive
theory to cope with all kinds of behavior from not satisfying a drive (by adding on other traits such as
restraint) or adding additional drives for for tasty food which combine with drive for food in order to
explain cooking render it hard to test.
Maslow hierarchy of needs.
Abrahum Maslow(1908-1970)is regarded as a humanistic psychologists in the field of learning
psychology. He proposed five stages of human needs.

59
 ntueyfSLovbsP-Ehczidmr/agl
1. Physiological need: -breathing, food, water, sex, sleep, homeostasis, excretion Self actualization

II.
III.
IV.
V.

60
Needs.
2. Safety/security needs:-security of body, employment, resources, morality, the family, health, property.
3. Love belonging need:-Friendship, family, sexual intimacy.
4. Self-Esteem/Prestige needs:- Self-esteem, confidence, achievement, respect of others, respected by
others.
5. Self actualization Needs:- morality creativity spontaneity, problem solving, lack of prejudice,
acceptance of facts.

Causes of human behaviors

Primary cause
Predisposing cause
Precipitatory cause

I.
Cause of abnormal behaviour
The cause of abnormal behavior are categorized under three main headings.
A. Biological Factors:-

I.
II.
III.

I.
Genetics factors
Constitutional factors
Physical handicap
Physical deprivation
Disruptive emotional process
B. Physical-social Factors
Mental deprivation
Pathogenic family patterns
Stress
C. Socio-cultural factors
War and violence
 II. Group prejudice
III. Economic and employment problem
IV. Technological and social change
Unit III
Perception
Meaning and Definition of attention, perception and sensation
Attention:- Attention means the focusing of consciousness on a particular object or idea at a
particular time to the exclusion of all other object or ideas.
It is the highest and clearest consciousness of an object or stimulus.
Definitions given by some specialist;
Dumvidle Attention is the concentration of consciousness upon one object rather than upon
another[1938]
Ross Attention is the process of getting an object or thought clearly before the mind[1951]
Synonyms:- awareness, consciousness, watchfulness, alertness, mindfulness,
Factors of Attention
1. External factors:- 2. Internal factors
A. Nature of stimulus A. Interest
B. Intensity and size of the stimulus B. Motives
C. Size C. Mental set
D. Contrast
E. Repetition
F. Movement of stimulus
Types of Attention: - According to Ross (1951)
I. Non-volitional or involuntary attention:- It is the arrousal without the will. It is of two types:
A. Enforced involuntary attention:- Arroused by the instincts.
B. Spontaneous involuntary attention:-Arroused by sentiments
II. Volitional or voluntary attention:-It is arroused by own will. It is of two types:-
A. Implicit volition attention:-obtained by single act of will.
B. Explicit volition attention:- obtained by a respected act of will.
III. Habitual attention:- In habitual attention there is no conscious effort or sensation which are
striking to attract our involuntary attention. We attend to them because of our attitude, habits or interests.
Clinical model of attention:-
A. Focused attention
B. Sustained attention
C. Selective attention
D. Alternating attention
E. Divided attention
Attention and the nurse:- Correct attention is necessary.
A. To examine the blood pressure
B. To fell the pulse
C. To read temperature
D. To note change in the patient
E. To make report to doctors
F. To administer correct dose of medicine etc.
SENSATION
Sensation is derived from Latin word sensatio which means understanding, idea.
Function of the senses, perception or awareness of stimuli through the senses.

61
 A mental condition or physical feeling resulting from stimulation of a sense organ or internal
bodily changes.
The faculty of perception of stimuli.
A general feeling not directly attribute to any stimuli as discomfort, anxiety.
A mental feeling.
Feeling in ones body, awareness, impression, intense, shock.
Definitions
Sensation is a mental process caused by physical stimuli through our sense organs. It is a process of
which we are aware about our characteristics and environment through the functioning of sense
organs.
Sensation is the result of physical stimuli operating on our nervous system. Various physical energies
in the environment act on the sense organs. The receptors in them are stimulated from which nerve
impulses are transmitted to the brain. Perception of the objects and events are produced when these
nerve impulses are processed.
Examples of sensation
I experienced a stinging sensation in my arm.
She felt a burning sensation in her throat.
She had the strange sensation that someone was watching her.
I couldn't quite shake the sensation that Id been fooled
Her injury left her with no sensation in her leg.
Characteristics of sensation
Sensation is meaningful.
Accompanied by interpretation.
It is objectified. There is always some apprehension of the of the object or stimulus which has
stimulated the sense organ.
Sensations precede perception but pure sensation can be experienced only by infants or those
with severe mental retardation.
It is the initial response of an organism to a stimulus or objects.
Types of sensation
S.N. Sense Organ involved Sense experience

1 Audition Ear bacillary membrane Sounds

2 Vision Eye Light, color, shape, size

3 Taste Tongue test buds Sweet, sour, bitter, spicy

4 Olfaction Receptors in nasal passage Sweet, fragrant, pungent

5 Cutaneous The skin Heat, cold, pain, pressure

6 Kinesthetic Receptors in the muscles Pull, push and strength

7 Organic Receptors and muscles of internal Hunger, thrust, nausea

organs.

62
8 Static or posture Ear semicircular canal Sense of equilibrium, dizziness,
recining

Sensory process or Nurse

Sensory processes are applied in the environmental theory.
A. Lighting:- Provide subdued light to the patient who needs rest and provide bright light to those
who needs stimulation and encouragement.
B. Noise:-Reduce loud noise as far as possible in the ward.
C. Smells and odors:- Avoid disagreeable smells and odors as far as possible by opening the door
and using air freshener.
D. Taste:- Help patient to rinse the mouth or brush the teeth regularly to avoid bitter taste.
E. Food:- Supply warm , fresh, clean tasty and nutritional food.
F. Kinesthetic sense:-Move patient slowly, not using jerky.
G. Temperature:- Provide warm environment to the patient in cold days.
Perception
Perception can be define as whatever is experienced by the person through various sensory organs
of the body resulting enable to recognize meaningful objects or events in response to external
stimuli or events, depends upon ones personal interpretation.
Perception (Latin-Perceptio) is the process of attaining awareness or understanding of the
environment by organizing and interpreting sensory information.
All perceptions involves signals in the nervous system, which in tern result from physical
stimulation of the sense organs. (vision involves light striking the retina of the eyes).
Seeing, hearing, touching, smelling, tasting and perceiving the world.
Perception can be shaped by learning, memory and expectation. It depends on complex functions
of the nervous system.
A persons proceeding memory, knowledge and these resources can turn direct the use of the
sense.
It is also the reflex action, stimulates, response and others.
Perception pyramid

63
hWaeHowtdvpsynkcri
Factors affecting Perception
A. Factors in the perceiver:-

Emotion
Interest
Expectation
Mental sets
Acquired interest
Needs and desires
Past experience
Foundation

Attitude (positive rather than negative)

Motivation (Strong motivation involve good perception)

A person who collects stamps as a hobby will notice quickly any unusual stamp in the letter.
B. Factors in the situation:- i. Time work setting ii. Social setting, iii. Mental setting
C. Factors in the target: - i. Novelty (newer objects), ii. Movement or motion iii. Sounds, iv. Size,
v. Background, vi. Proximity, vii. Similarity
Principle of Perception
An individual have tendency to perceive sensory patterns as well organized wholes rather than as
separate, isolated parts.
Principle of figure and ground relationship: - According to this principle, a figure is perceived in
relationship to its background. A tree is a figure that appears against a background of the sky.
Similarly the words are figures that appear on the background of a page.
Principle of closure: - Another important principle of perceptual organization is that of closure.

64
According to this principle, while confronting an incomplete pattern one tends to complete or close
the pattern or fill in sensory gaps and perceives it as a meaningful whole.
 This type of organization is extremely helpful in making valuable interpretation of various
incomplete objects, pattern or stimuli present in our environment.
Principle of grouping: - It refers to the tendency to perceive stimuli in some organized meaningful
patterns by grouping them on some solid basis like similarity, proximity and continuity.
I. On the basis of similarities:- The law of similarity suggests that things tends to appear grouped
together. Grouping can occur in visual and auditory stimuli. For example, people of same age
group and people of same ethnic group, same behavior patterns and students with similar
intelligence level and so on.
II. On the basis of proximity: - According to the law of proximity, things that are near each other
seem to be grouped together. That mean objects or stimuli that appear closer to one another are
likely to be perceived as belonging to the same group.
III. On the basis of continuity: - The law of continuity explains that the objects or stimuli are
perceived as a unit or group on the basis of continuity. It explains that our attention is being held
more by continuous patterns rather than discontinuous ones.
Principle of context: - Perceptual organization is also governed by the principle of context i.e. the
setting in which a perceived stimulus or objects appears. A change in its context is likely to bring a
great change in its perception. For example an examiner may award higher marks to the same answer
book in a pleasant context than in an unpleasant one.
Principle of adaptability: - According to this principle, the perceptual organization for some stimuli
depend upon the adaptability of the perceiver to perceive the similar stimuli. An individual who
adapts himself to work before an intense bright light will perceive normal sunlight as quite dim while
for a person who adapts himself to work in a dimly light dark room, the normal sunlight is likely to be
perceived as very bright.
Unit IV
Emotion
The affective aspect of consciousness or a state of feeling.
The word emotion comes from the Latin word Movere which means to move
It is a conscious mental reaction (as anger or fear) subjectively experienced as strong feeling
usually directed toward a specific object and typically accompanied by physical and behavioral
changes in the body.
You often feel joy and happiness when you reach a goal and feel angry and frustrated when you
cannot reach to goal. These all experiences are emotions so emotions is a strong feeling and the
active mental forces which agitate and excite us.
Cycle of our emotions

65
 H
E
T
S
A
a
x
e
c
n
a
p
c
n
a
g
d
p
i
d
r
y
t
e
y
e
r
d
d
Definition
Emotion is the complex psycho physiological experience of an individuals state of mind as
interacting with biochemical (internal) and environmental (external) influence.
Emotion is associated with mood, temperament, personality and disposition and motivation.
Cognitive Vs Non-cognitive emotions.
Categorization based on duration, some emotions occur over a period of seconds (for example
surprise) whereas others can more time (for example love)
James Drever- Emotion is a complex state of the organism involving bodily changes of a
widespread character in breathing, pulse gland etc and on the mental side a state of excitement or
perturbation marked by a strong feeling and usually an impulse toward a definite from of
behavior.
P. V. Young- Emotion is an acute disturbance of the individual as a whole psychological in
origin involving behavior, conscious experience and visceral functioning.
Woodworth- Emotion is moved or stirred up state of the organism. It is a stirred up state of
feeling. That is the way it appears to the individual himself.
Types of Emotion
A. Negative emotion:- like fear, anger, jealousy, etc
B. Positive emotion:- like love, curiosity, joy and happiness etc
Variations factors of emotion
The frequency and intensity of emotional experiences.
The situation occasion and the nature of the stimulus which arouses the emotions
Characteristics of emotion
1. Emotion acts as a motive. It implies a goal.
2. Emotional reactions tend to be violent.
3. Emotion is usually transitory.
4. Emotional experience alters thought processes often by directing attention toward some things
and away from other.

66
 5. Emotional experience elicits an action tendency.
6. Emotional experience usually happens without willful intent.
7. Emotions are accompanied by both physical and cognitive changes.
8. Whenever an organism is experiencing an emotion, a lot of energy is released.
9. Emotions in general are the product of perception.
10. Emotional expressions are intense in childhood.
11. Emotions are found in every organism and present at all stages of development.
12. Emotions differ from person to person.
13. Emotions rise suddenly but die slowly.
14. . One emotion may give rise to number of likewise emotions.
15. Emotion is subject to displacement.
16. The emotional reactions tend to be violent in the beginning.
17. Emotion serves as a means of communication.
18. Emotions are source of social and self evaluation.
19. Environmental factors affect an individuals emotion.
20. Emotion affects ones social relationship and reasoning capacity.

Importance of Emotion
Here are a few of the reasons for why our emotions are important in our lives.
1. Survival
2. Decision making
3. Boundary setting
4. Communication
5. Happiness
6. Unity
Purpose of emotion
1. Can work as motive.
2. Can work as effective means of communication.
3. Help to draw others attention.
4. Can give color to life.
5. Can reduce tensions as laughing with others and laughing at you.
6. Can resume equilibrium through expression of negative emotion
Emotional Intelligence
It includes ability to perceive, assess and manage emotions of ones self of others and of groups
in which one is working. Emotional intelligence is composed of five dimensions:-
1. Self awareness:-
2. Self management:-
3. Self motivation:-
4. Empathy:-
5. Social skills:-
Measures to expressing emotion
A. External changes that accompany emotional reactions:-
1. Facial expression:-
2. The fore-head and eye brow:-
3. Eye:-
4. Vocal expression:-
5. Posture:-
6. Bodily movement:-
B. Internal changes that accompany emotional reactions:-

67
 1. Changes in breathing:-
2. Changes in heart rate:-
3. Change in blood pressure:-
4. Changes in glandular function:-
5. Changes in digestive system.
Emotional development throughout life cycle
Infancy
Toddler
Pre-school age
School age
Adolescence
Young adulthood
Middle adulthood
Older adulthood
Importance of child emotions
It is necessary for physical, mental and intellectual development.
It is necessary for maintaining proper relationship with family, friends and society.
It is helpful for socialization.
It is important for personality development.
Controlling of childs emotion
Imitation by peer group.
Teaching and training.
Guidance and proper supervision.
Channeling into proper creative activities.
Positive reinforcement.
Showing their own willing to control their emotions.
Punishment and disapproval.
Emotional Deprivation
Causes of emotional deprivation
Death of one or both of the parents.
Separation.
Neglected or reject child.
Spoil of freedom of the child.
Inability to meet the basic needs of the child.
Results of emotional deprivation.
Delayed normal physical, mental and intellectual development.
Child may be uncooperative, negative and of hostile attitude.
May develop the rebellious feeling towards the authority.
May develop the aggressiveness, disobedience and other forms of anti-social behaviour
Way of controlling emotion
A. Developing problem-solving approach. B. Developing positive philosophy of life. C. Time
management. D. Relaxation. E. Meditation. F. Recreation. H. Diversification. I. Exercise etc
Expression and control of emotion in Health personnel
A. By themselves(control of emotion in health personnel)

68
 Try to understand themselves, their conflicts and your physical and emotional limits.
Learn as much as you can about the course and physical reaction to emotion.
Greater knowledge helps to control over emotions.
Plan work to avoid emergencies.
Control stress.
Balance work with recreation, exercise and social activities.
Practice relaxation by meditation listening to music, involving themselves into their hobbies etc.
Use sense of humor.
Try to control unreasonable and excessive external expression of emotion.
They can excite other people and cause further emotionality.
A desirable philosophy of life will enable you to avoid mental conflicts and emotional tensions.
B. In others (control of emotion in the patients)
1. Remember the importance of tone of the voice and body language.
2. Create welcome and ease atmosphere.
3. Understand his/her negative emotions.
4. Promote positive feelings.
5. Develop empathy.
Emotion and its impacts on Health
Emotion plays an important role in our health condition. Our body functions well when we are
happy. There is a saying that joy is the best medicine.
Heart attack may arouse by suddenly emotions.
Persistent emotional disturbance caused by anger, fear, and worries have been found to be one of
the causative factors in peptic ulcers, heart disease and epilepsy and tuberculosis and diabetes are
made worse.
Other illnesses in which emotions play a vital role are bronchial asthma, high B.P, insomnia,
chronic constipation and other.
A. Positive emotion can have positive impact on health.
Love:- it has a great healing potential, this quality brings good health.
Laughter:-
i. Increase muscular and respiratory activity,
ii. Stimulates cardio muscular and nervous system.
iii. Increase antibodies, bodys first line of defense.
iv. Increase pain tolerance.
B. Negative emotion can have negative impact on health.
Anger, high B.P, heart attack, stroke stomach ulcers, mental illness etc

Unit V
Application of Psychology in Hospital and Community Setting
Psychology is a science because it gives a lot of emphasis on search for truth. It adopts the method of
scientific enquiry and approach to the study of behavior.
It deals with the related facts and it formulates laws. Like a science, it collects the subject matter of
facts of behavior by means of objective methods like observation, experiment.
Like a science it can predict behavior. It is considered a positive science and not a normative science
like ethics. It is concerned with what is and not what ought to be.
Application of psychology with different clients of different age groups/ illness/status

69
 Status of patients: - The application of psychology is differ as per status of patients as per the
description of Odlum, he thinks that patients can be roughly classified into main two types; one types
is tough and other types is tender.
The tough patients are realistic; they accept and understand their illness. They are not sensitive to
pain and discomfort. They remain calm.
The tender patients are over conscientious, highly sensitive to pain and discomfort, do not accept
their illness easily. They are anxiety prone, obsessional sympathy seeking, histrionic, self-
dramatizing and inadequate.
Their reactions to illness or hospitalization are more or less childish and immature. They have
inadequate personality. Those who have such personalities seem to be over protected by their parents
and relatives.
Sometimes some of them take advantage of their illness to be way from reality and show little desire
to get well.
It must be noted that all the tender patients do not show all the above mentioned characteristics.
Even among the tender patients some may be extremely self-dramatizing, other may be extremely
obsessive.
It must be noted that most of the patients have a little of these ingredients in their reactions towards
illness.
To deal with each of these types of patients, a nurse should be very understanding and sympathetic.
She should note their individual differences and treat them accordingly
Age groups: -We have been discussing from time to time about the individual differences among
the patients and their reactions toward illness.
One of the factors that explain individual differences among the patients is their age variations.
To provide an effective nursing care to the patients a nurse should be familiar with the psychological
needs of the various age groups.
The child, the adolescent, the adult and the aged.
Children: - The kind of care a baby receives in infancy is more important than other stages. The
nurse who wants to develop a good understanding of a sick child must first know a great deal about
healthy children.
She needs to learn what to expect of a child and when to expect it. If her expectations are very high
the child will become frustrated and develop feelings of inferiority. Low expectations are also
equality dangerous if she does not make expectations will lack the stimulation to develop.
A nurse should be familiar with the childs interest. Children under care are very responsive to nurses
moods. Anything which upsets her will also upset them.
Personalized care is essential for the childs happiness. When the child is not with his family a nurse
must be able to act as a mother or sister. She should make an effort to understand the child in the
context of his/her family.
The hospitalized child is always much happier when he knows that his family and his friends are
going to visit him regularly.
So the nurse should encourage such visits by to family members or the visitors in the visiting hours.
The children may have their own weakness and limitations. Some children may be frightened by
darkness or animals. If they not share feelings and surprise them it can be very dangerous. She should
encourage the child to talk about his fear and should provide psychological support to him.

70
 Some children are very inquisitive. They arise the various questions and a nurse should be try to
answering these questions, I dont know If she does not know the answer rather than providing false
information. This helps her in gaining more respect.
Since grown up children want to be more independent, nurse should allow them to make their
independent decisions in certain issues.
It will help their emotional development. All these are essential for establishing good interpersonal
relationship between the children and the nurses.
Elderly people: - In order to provide effective nursing care to the elderly people a nurse should first
of all be familiar with the problem of the elderly people. Age brings many physical, intellectual and
emotional changes. All these changes produce changes in personality. An elderly person wants to
share their experience or own problems with another and sometimes elderly people find in difficult
to express their feelings.
Another reason for exaggerating pain could be to gain attention and sympathy from others. An
efficient nurse should have understanding towards such patients.
She should provide some activity to distract the patient from their worries and given a new interest.
Most old people resist change. So any changes which are required in the patients lifelong habits need
to be carefully interpreted to them. The old people also need health teaching.
They should be familiarized with basic rules of personal hygiene and basic rules of well balanced
diet. In the Nepalese context when discussing the patients diet with him, his economic background
should also be taken into account.
The principles of good nutrition need to be explained in terms of inexpensive food
The nurse will have to establish a good relationship with the patient before she attempts to do any
health teaching.
Most of the elderly people think that they are experienced enough to know what is good and what is
bad, what should be followed and what should be avoided.
Because there is a fear of old people being offended, the nurse needs to be very tactful and
considerate to make her teaching effective.

Part C: - Unit I
Health Politics
Introduction to Health politics
Health:- In the past, health of a person was only viewed with the persons closeness to normal values of
biomedical parameters (biomedical concept).later, concept of health was expanded to embrace mental
and social dimensions. WHO defines health in terms of bodily, psychological and environmental
determinism The WHO definition is comprehensive but can often be confusing particularly in assessing
social aspect of health.
So far, we have been talking of good health. But health may not always be optimal. In fact no one is
healthy when put on WHO scale. An overwhelming majority of world people falls below the acceptable
level of good health and that is why health is a subject of major concern among people of all walks of life.
Not to run after the definitions, need to understand human health in its totality with correct knowledge of
its different dimensions and a scientific vigilance on its determinants.
Politics: - Human health is shaped by numerous forces that originate from within the individuals body
and from the interaction of people among themselves and with their living and non-living environment
and large columns of social determinants of health has a lot to do with the politics of the particular

71
community, society or whatever. But what does that exactly mean? What exactly is politics? Alike health
politics may be defined in a hundred and one ways. Whatever the definitions be politics isnt just flags
and slogans and it shall not be equated to partisan politics. Politics come from within the people, all kinds
of people proletariat to capitalists, and landlords to peasant farmers. By politics we should think of the
way of running human society progressively shaping it through all turns of Asiatic stage to the 21 st
century, human society has experienced numerous forces (of human origin) acting on it. The culmination
of these forces is politics.
Health Politics
In modern time good health of peoples is the major responsibility of country and it is established
in fundamental human right.
Human health is shaped by numerous forces that originate from within the individuals body and
from the interaction of people among themselves within their living environment.
Health politics is a means of process and mechanism of making system in the country in all
sectors.
Health politics includes most of the influences that have something to do with the organism and
management of health care, the distribution of resources and authority in any community of
people, livelihood etc.
The politics of health
1. Creating the situations in which people can sustain their health and fulfilling lives is one of the
most important political responsibilities.
2. Politicians, planners and policy makers must place at heart of their work in the development of
policy that improves health and narrows the health gap between rich and poor.
Why health politics?
Everyone have rights to healthful living, this is depends upon the individuals access to education, health
and other basic needs. The amount of such an access is determined by the kind of prevailing government,
which in turn is a result of the dynamics political forces.
Policy
Plan of action, statement of ideas etc proposed or adopted by government, political parties, private sectors
etc. Which includes: -
1. Political affairs or life or party politics.
2. Political views, beliefs and practices.
3. Competition between political parties and revolutionaries.
Political instability, war and conflict affect the public and health services. If there is conflict or war the
resources allocated in the health sector is decreased to compensating the war which is detrimental for the
health of people.
Definition of health politics
1. Politics: - politics is the art of influencing other to accept a specific course of actions,, political
activities used to develop various activities e.g. policy, formulation of law, rules and regulations.
2. Law: - Law is a system of rules and regulation established by authority by which easy to solve the
problems. Society is governed in a formal way and legally bind, it is a social order supported by
society and system through judicial process and legal way. Law has major affects on nursing practices
e.g. prevention and protection of work place, occupational hazards, maintain clients rights.
Relationship between health and politics
1. There is a strong relationship between health and politics, politics and law.
2. Policies play a great role in development and implementation of health actions.

72
3. All types of health practices are affected by political system at all level of promote the quality health
care services.
4. Health personnel need to involve in policies for the benefit of the country.

Role and responsibility of nurse in health politics

1. Understand the concept of law, policies and politics to promote quality nursing services and
professional development.
2. Take part in professional lobbies through NAN, legislative committee by various methods and
Medias.
3. Take part in revision and development of nursing policies, rule and regulations.
4. Participation in political committee.
5. Involve with national and international nursing organizations and take parts in nursing research
activities.
6. Involve and take part in revising developing, nursing job description, nursing standards, nursing
manuals etc.
7. Involve in examination and educational board.
8. Prevent professional negligence.
Impact on health politics
A. Positive impacts: - Participate in policies of health service at all level.
1. Environmental sanitation program.
2. Communicable disease prevention.
3. Reproductive health service, disable and safety at work.
4. Medical nursing, vocational and other health related educational program.
5. Disaster management-at hospital, at community.
6. Formation of health acts.
7. Application of concerned act on different sectors.
B. Negative Impacts: - Bias among parties and people.
1. Misuse of budget and other resources.
2. Lack of monitoring and supervision.
3. Increasing malpractice in health field.
4. Interference by national and local leaders.
Political commitment on health services
Prevention, promotive, curative, reproductive health care and service up to grassroots level,
increase productivity of human power, supervision, monitoring, evaluation etc.
Legal basis of health care: General welfare services
1. Occupational safety at work place.
2. Maintaining clients rights.
3. Compulsory immunization of Iodine salt.
4. Developments of protocols and health standards.
5. Service for aging and disable people.
6. Pharmaceuticals law, rules and policies.
7. Licensing board- NMC, NNC, NPC
Trends in policy Development
The national health policy was adopted in FY 2048-49BS to bring about improvement in the health
conditions of the people of Nepal with emphasis on: -
i. Preventive health service.
ii. Promotive health service.
iii. Curative health service.

73
 iv. Basic primary health services with one health post each in the entire 205 electoral
constituencies to be converted into primary health care center.
v. Ayurvedic and other traditional health service.
vi. Community participation.
vii. Human resources for health development.
viii. Resources mobilization.
ix. Decentralization and regionalization.
x. Drug supply.
xi. Health research

Long Term Health Plan (LTHP)

The LTHP (1975-1990) with the calendar of 5th 6th and 7th five year plan.
Motto: - Integrated community health development through primary health care.
Major aim compressive basic primary health services to the rural poor people.
The second long term health plan (SLTHP 2054-74 BS.) aims at guiding health sector
development for improving the health of the inhabitants, particularly those whose health needs
are not often met. The main objectives of SLTHP are: -
1. To improve the health status of the most vulnerable groups particularly those whose health needs
often are not met- women and children, the rural population, the poor, the underprivileged, and
the marginalized population.
2. To extend to all districts cost-effective public health measures and essential curative services for
the appropriate treatment of common diseases and injuries.
3. To provide technically competent and socially responsible health personnel in appropriate
numbers for quality health care throughout the country, particularly in under-served areas.
4. To improve the management and organized of the public health sector and to increase the
efficiency and effectiveness of the health care system.
5. To develop appropriate roles for NGOs and the public and private sectors in providing health
services.
6. To improve inter and intra-sectoral coordination and to provide the necessary support for effective
decentralization of health care services with full community participation.
7. To increase total health expenditure to 10% of total government expenditure. (MOH Annual
report 2002-2003)
8. The national health policy aims at improvement in the health conditions of the people of the
Nepal through extension of primary health care system (PHC) to the rural population with a view
to provide the benefits of modern medical facilities through trained health care providers.
9. The strategic analysis of health sector in 1999 resulted in the development of the medium term
strategic plan for the 10th fifth year health plan (2002-07) which included: -
a. Essential, affordable and accessible health care services.
b. Promote a public-private NGO partnership.
c. Decentralized the health system and execute particular approaches at all levels.
d. Improve quality of health care through the public private NGO partnership by total quality
management of human, financial and physical resources.
Target of the Second Long Term Health Plan (SLTHP)
1. To reduce the infant mortality rate to 34.4 per thousand live births.
2. To reduce the under-five mortality rate to 62.5 per thousand.
3. To reduce the total fertility rate to 3.05.
4. To increase life expectancy to 68.7 years.

74
 5. To reduce the CBR to 26.6 per thousand.
6. To reduce the CDR to 6 per thousand.
7. To reduce the maternal mortality rate to 250 per hundred thousand births.
8. To increase the contraceptive prevalence rate to 58.5%.
9. To increase the percentage of deliveries attended by trained personeel to 95%.
10. To increase the percentage of pregnant women attending a minimum of four antenatal visits to
80%.
11. To reduce the percentage of iron-deficiency anemia among pregnant women to 15%.
12. To increase the percentage of women of child bearing age(15-44 years) who receive tetanus
toxoid to 90%.
13. To decrease the percentage of newborns weighting less than 2500 grams to 12%.
14. To have essential healthcare service in the districts available to 90% of the population living
within 30 minutes travel time of facilities.
15. To have essential drugs available at cent percent of facilities.
16. To equip cent percent of facilities with full staff to deliver essential health care services.
17. To increase total health expenditure to 10% of total government expenditure.
18. More resources will be mobilized at the local level to ensure financial sustainability by
considering the Local Self Government Act 2055 and the decentralized health management of the
Health Sector Reform Strategy (HSRS).
19. Nepal government is committed to bring about tangible changes in the health-sector development
process.
th
10 five-year plan (2002-2007): - It aims at providing an equitable, high quality health care system for
all the Nepalese.
11th three-year plan (2007- 2010): - Aims at more active participation of private sector in health care
delivery.
12th five year plan (2011- 2017): - Aims at increased participation of private sector and NGOs sectors
health care delivery and health insurance system.
The proportion of the government budget allocated to health will increase from 5% to 6.5% in
2006and 7% in 2009 and aims will be 10% by 2017.
World trends of health politics
1. Policies are general statements based on human aspiration, set of values, commitments, assessment of
current situations.
2. National health policy is an expression of goals for improving the health situation.
3. Each country will have to develop a policy of its own aimed at defined goals for improving the
peoples health within its own problems, circumstances, social and economic structure, political and
administrative mechanism.
4. A landmark in the development of health policy was the worldwide adoption of the goal of HFA by
2000 AD.
5. Further landmark was the Alma-Ata Declaration 1978(Russia) calling on all governments to develop
and implement primary health care strategies to attain the target of HFA by 2000 AD.
Alma-Ata Declaration
1. The world health assembly, May 1977, decided the main social goal of government and WHO in the
coming years should be the attainment by all the people of the world by the year 2000 AD of a level
of health that will be permit them to lead a socially and economically productive life.
2. This goal has come to be properly known as health for all by the year 2000AD.

75
3. Growing concern about the unacceptably low levels of health status of the majority of the worlds
population especially the rural poor and the gross disparities in health between rich and poor, urban
and rural population, both between and within the countries.
4. The essential principle of HFA is the concept of quality in health i.e. all people should have an
opportunity to enjoy good health.
5. It is mean that there will be an even distribution among the population-people will use the available
approaches for better health.
6. HFA implies wide ranging improvements in access health service, socio-economic development.
PHC was accepted by the member countries of WHO to achieving the goal of HFA by the year 2000 AD.
The declaration of Alma-Ata PHC includes: -
1. Education about prevailing health problems and methods of prevailing and controlling them.
2. Promotion of food supply and nutrition.
3. An adequate supply of safe water and basic sanitation.
4. Mental and child health care, including family planning.
5. Immunization against infectious disease.
6. Prevention and control of appropriate disease.
7. Appropriate treatment of common disease and injuries.
8. Provision of essential drugs.
The conference call for urgent and effective actions to develop and implement PHC in all over the
world with special focus is in developing countries.
Call support from all world community for financial and technical support particularly in developing
countries.

Legislative aspects of health

76
 Role of health advocacy and lobbying in health policy formulation
Health and Advocacy on: - Policy formulation on: -

77
 Child health and child rights Immunization, control of ARI, reduces child labor,
safety of disable child.

Women empowerment FP, safe motherhood, MCH, age at marriage, abortation

etc

Occupation health and safety Work place environment, working hours, insurance,
workman compensation and rehabilitation.

Environmental protection Environmental acts, environmental impact assessment

(EIA)

Prevention and control of HIV/AIDs and Education, service center(VCT, screening of blood, etc)
STDs mass education through media, free condom
distributing, mass campaign

Smoking, Alcoholism and abuses Band in advertisement on electronic media or tax on

these items.
Welfare of the disabled people Vocational training, no discrimination on employment,
policy in rehabilitation

Accessibility of health service Establishment of health outlets

Abuse, security and health protection of Resource mobilization in health services

citizens

Advocacy for human resources for health Policy on training of health workers strengthening.
development

Advocacy for integration through Policy to upgrade PHC and integration of basic health
international convention like Alma-Ata services.

78
 Unit III
Executive Aspects of health
Health related role and function of executive
1. Administrative organ-council of ministers.
2. Ministry of health- executive for related to health.
3. Health minister- appointed by PM.
4. Carry out the rule and act.
5. Executive power NG and cabinet.
6. Control and regulate health related administration.
7. Health issues- decision making authority.
8. Order and implement law.
9. Appointment, promotion, dismiss, transfer- regulate and control, public service commission.
10. Carryout- Treaty, convention and signatory forum.
11. Present budget- Health related

79
 Political commitment and health services
With the saying health is life, now the government is committed to provide preventive and
curative health services to the people of Nepal with top priority given to the rural population,
women, children and the marginalised group.
According to the political commitment, the health services in Nepal are:

80
1. Priority given to upgrade the health standard of the rural population through the PHC
approach.
2. Priority given to provide FP and MCH services in a more effective manner up to the village
level for population control
3. Priority given to provide the opportunity to the rural people so that they are access to modern
preventive and curative facilities by provision of outreach clinics.
Political commitment (Contd..)
The government has targeted to establish one SHP in each VDC to provide preventive,
promotive and curative services in an integrated way.
The government of Nepal is trying to fulfil basic objectives giving priority to formulate
policy guidelines for:
1. Preventive health services
2. Increase productivity of health manpower
3. Strengthen the services.
4. Expand curative services.
Criticism: Goals and strategy are urban oriented but neglecting the requirements of the rural
population.
Weakness:
1 Government is on linkage in organisational pattern, staffing pattern, training of health
personnel and implementation of plans of programme are poor.
2 Supervision, monitoring and evaluation of policies, programmes are not conducted in regular
and proper manner.
3 Parts of the plans are suddenly and periodically changed with change in ministries,
secretaries and individuals in the executive level.
4 Consequences of top down approach are the failure of the health services in the country.
5 Nepal government has left the part of the components and process of comprehensive PHC
approach and is applying selective PHC projects

Unit IV.
Health laws, nature, implementation strategies and challenges.
Nepal Medical Council act 2020.
Health practitioners council act 2053.
Nepal Nursing Council act 2052.
Nepal Ayurvedic council act 2045.
Nepal Pharmacy council act 2057.
Some other important health related act are:- Smallpox control act 2020,Infection disease act 2020,
Breast milk substitutes act 2029, Drug act 2035, Institute of national health science 2039, Pesticides
act 2048, Nepal health service act 2053, Environmental protection act 2053, Iodized salt act 2053,
Human organ transplantation act 2055 etc.
Control of health hazards through health laws & regulations
Black marketing and other social offences act, 2032 BS.
Drug abuse contract act, 2033.
Pesticide act, 2048.

81
 Breast milk substitute (marketing control) act 2049.
Environmental protection act, 2053.
Animal slaughter house and meat examinations act, 2044 BS
Infectious disease act 2020
Health related plans & policies
National health policy 1991
2nd long term health plan 1997-2017.
10th plan-poverty reduction strategy paper (PRSP) 2002-2007
Local Self Governance Act, 2055(LSGA 1997)
3 yrs interim plan approach paper 2064/2065-2066/2067
National Ayurbedic health policy 2052
National drug policy 1995
National medicines policy, 2007
Safe motherhood policy, 2003
National policy on (Safe Birth Attendance (SBA)
National safe abortion policy ,2003
Vital registration Act and regulation, 2033
National oral health policy
Mental health (treatment and protection act, 2006)
Policy on Quality assurance in Heath Care Services, 2064
Health care technology policy 2006
Water resources Act, 2049
Nepal national policy on sanitation
Rural water supply and sanitation national policy, 2004 & national strategy
Policy on participation of NGOs in water supply and sanitation program, 1996
Current status of food legislation
Natural disaster management
Natural calamity (Relief) Act 1982
National blood policy 2050 (1993)
National health research policy
The interim constitution asserts availability for Free basic health services to all.
Nature of Health Plan & Policy
21st century calls for a new health system-partnership oriented, population based &m productive
rather than reactive.
Health sector must serve as a guide to & be a partner in this action.
So-health concerns are represented appropriately at all stages of implementation.
Stronger partnership between health sector & other sector for reduction of health threats for
poor environment condition.
Resources apply both tangible: personal, facilities, equipments and infrastructure.
Intangible: valid knowledge, rooms & standards, legislation & rules operational communication
networks, systematized information, access to relevant decision making bodies, negotiated &
open agreement with participating organization, training ,capabilities, capacity building strategy.
Implementation strategies
Equity in access to health.

82
 Decentralized delivery of health care.
Community, private and NGOs sectors participation.
Greater socio-economic inclusion and improve the health of poor people.
Universal coverage of prioritized essential health care services.
Nepal health sector implementation plan 2003-2007.
Health sector strategy, an agenda for reform 2004.
In Nepal, in sprit of LSGA 1999, 1424 health facilities have been handed over to local bodies in
28 districts.
MDGs 1990-2015, Goal 4-reduce mortality rate & Goal 5- improve maternal health.
Challenges
Lack of skilled or trained health manpower and problems in their mobilization in rural and remote
health centers.
Centralized planning, policy making and administrative system.
Lack of economic resources due to the poverty of country and people.
Inadequate supply of equipments and drugs due to remote or difficult geographical structure.
Political instability and interference of political leaders in management.
Lack of good governance, strict rules, regulations and ethical codes, weak monitoring and supervision
of government mechanisms.
Lack of physical infrastructure and inadequate repair and maintenance of health.

Comprehensive and Selective PHC

Comprehensive Primary Health Care (CPHC)
Scientifically sound
Socially acceptable
Universally acceptable
Full participations (from lower to higher)
Affordable at every stage of development, self-reliance and self-determination.
All aspect of health and health care social, political and economic development as a programme.
Selective Primary Health Care (SPHC)
Health statistics (not health), we could improve statistics instead of life by SPHC.
Few and selected item (in only selected field) as a project
PHC unrealistic, too costly
Health is no big deal
Only selected field progress, then if there is good health.

Difference between CPHC and SPHC

Comprehensive Primary Health Care (CPHC Selective Primary Health Care(SPHC)

Based on socio economic status and political
stability or well being
Person's behaviour, KAP determines health
Outcomes visible only after long term expenses
because it utilises local resources rather than first
hand drugs
Popular People's Participation is essential
Data of health indicator should be good beside
other condition
The technology determines Health
Immediate, visible, recordable eg.ORS solution
instead of Nun-Chini-Pani (salt-sugar-water
solution), Profit Gain immediately
Community Participation not eessential but
involvement of Private sector.

83
Bottom-up approach
Local resource mobilisation
Health is the fundamental human right of people, it
should be free to people and government should
manage it
This is long term programme
Coverage is whole country
SPHC is one of the components/pillars of CPHC
Have better coordination with line ministries and
CBOs/I/NGOs/People at all level
Comprehensive is PHC because PHC is like the
term "People's Democracy" with multiple
programme
Top-down approach
Donor-agency provides resource.
Health is the facility to the people, those who could
afford cost only they get services, e.g. private and
government user fees
This is short term project
Project base
SPHC works alone
Coordination in theory only
Selective in real sense is not PHC, it is like
"Partyless" and for the world support Democracy
used to write (e.g. Partyless Panchayat Democracy
before 1990)

Health behavior modification through legal measures and challenges

Decline significantly; it is still at the higher spectrum compared to similar neighboring countries.
Reducing the high burden of unnecessary death due to pregnancy and child birth calls for a
combination of social, economic and health intervention as well as challenges in individual and
family behavior.
MCHW, ANM, SBAs promote at VDC level.
Nepal adopted SBA policy in 2005.
In Nepal, less than 19% of birth takes place with the assistance of SBA.
The targets for SBAs set for the country are 40% of all birth to be assisted by an SBA by 2005,
50% by 2010 and 60% by 2015.
Policy challenges: - Deficiencies in the production of ANMs, 22 skills out of 27 skills required
for competent SBA, ANMs has only 6-7 skills.
Curriculum need to be upgraded.
From Washington Consensus to Millennium Development Goals (MDGs)
MDGs developed out of the eight chapter of the UN millennium declaration signed on sep. 2ooo.
Goal 1:- Eradicate extreme poverty and hunger.
Target 1: - Halve the proportion of people living on less than $1 a day.
Target 2: - Achieve decent employment for women, men and young people.
Target 3: - Halve the proportion of people who suffer from hunger.
Goal 2: - Achieve universal primary education.
Target 1: - By 2015, all children can complete a full course of primary schooling girls and boys.
Goal 3: - Promote gender equality and empower women.
Target 1: - Eliminate gender disparity in primary and secondary education preferable by 2005 and
at all levels by 2015 AD.
Goal 4: - Reduce child mortality rate.
Target 1: - Reduce by two thirds between 1990 and 2015 the under five mortality rate.
Goal 5: - Improve maternal health.
Target 1: - Reduce by three quarter between 1990 and 2015 the maternal mortality rate.
Target 2: - Achieve by 2015 universal access to reproductive health.

84
 Goal 6: - Combat (fighting) HIV/AIDs, Malaria and other disease.
Target 1: - Halve halted (stopped) by 2015 and began to reverse the spread of HIV/AIDs.
Target 2: - Achieving by 2015 universal access to treatment for HIV/AIDs for all those who need
it.
Target 3: - Have halted (stopped) by 2015 and began to reverse the incidence of malaria and other
major
Goal 7: - Ensure environment sustainability.
Target 1: - Integrate the principles of sustainable development in to country policies and programs
reverse loss of environmental resources.
Target 2: - Reduce bio-diversity loss achieving by 2010 a significant reduction in the rate of loss.
Target 3: - Halve by 2015 the proportion of the population without sustainable access to safe
drinking water and basic sanitation.
Goal 8: - develop a global partnership for development.
Target 1: - Develop further an open rule based predictable non-discriminatory trading and
financial system.
Target 2: - Address the special needs to the least developed countries.
Target 3: - Address the special needs of landlocked developing countries and small island
developing states.
Target 4: - Dealing comprehensively with debt problems of developing countries through national
and international measures in order to make debt sustainable in long run.
Target 5:- In co-operation with the private sectors make available the benefits of new
technologies especially information and communication.
Making medicine accessible: -
The national drug policy publicized by government in 1995 to complement the national health
policy 1991.
National drug policy 2007 includes all the relevant elements of the 1995.
2007- To ensure the common people have access to safe, effective and quality medicine at an
affordable price for proper health care with social equity.
The country has a community drug program (CDP) aim to increase utilization and efficiency of
health facilities- in this program local bodies may also encourages and monitor the functioning of a
CDP management committee.
Critical challenges: - strength human resources and distribution of pharmacy outlets throughout
the country.
Quality of care in terms of rational use of drugs availability of right drug and trained health
workers, auditing mechanism need further strengthening.
Promoting prevention of non-communicable disease:
The risk factor of chronic and non-communicable disease is common in society.
Regular inspection of such factors in general population is necessary to track out the extent of
problems for control of non-communicable disease.
Extensive awareness and intervention program lunched.
On behavioral change intervention addressing the issue related to both smoking and use of
smokeless tobacco with a special focus on female youths and adults for quitting consumption as
well as demand reduce.

85
 Government should make strong commitment to implement existing policy initiative and take
new initiative to discourage the marketing and promotion of cigarettes and liquor.
Restrict buying/selling tobacco products and liquor so that the young people would be discourage
from consuming tobacco and liquor at an early age.
Challenges: - Lack of well-planned, need- based and effective programs for addressing the
lifestyle changes in the general population.
Legal protection against the threat in physical, mental and social health
Responding to crisis and disaster
Nepal is landlocked country, faces a verity of hazards, vulnerable to earthquake and flood.
According to global earthquake safety initiatives, Kathmandu is exposed to the greatest
earthquake risk among 21 megacities around the world.
Emergency preparedness and disaster risk management are relatively new concepts being applied
in the Nepalese context.
Institutional setup- Epidemiology and Disease Control Division (EDCD)/Dept of health services
of MOHP.
Challenges: -Human resources deficiency and training, ministry has no disaster management
unit or but a focal point with no program and budget.
Adapting to climate changes:
Raising temperature, heavy rain, droughts: - Diarrhea, dysentery, malaria, kala-azar,
encephalitis etc.
Air pollution: - ARI, chronic obstructive pulmonary disease and Tuberculosis etc.
Decrease production due to climate change: Rain, fed agriculture more severely affected
lead malnutrition, hunger, other nutrition related problems effects on physical, mental and
intellectual development of children, low productivity of adults, susceptible to infectious
disease.
Effective measures: - MOHP, ministry of Environment, Science and technology need to
record reliable and long term data on the potential impact on climate change.
The cleanliness of the area is the most important requirement for adaption.
Research and development of alternative approaches to cure and eliminate mosquitoes born
disease rather than DDT spray- have perceptive effects on soil-risk.
Surveillance program strengthened.
Health education promotion in preventive part.
Mental health (treatment and protection) act 2006.
For timely taking care of the mental disease.
Safeguarding the fundamental rights to person with mental disorders.

Consumers Rights
Generally accepted basic consumers rights are: -
1. Right to safety: Protection from hazardous goods.
2. Right to inform: Availability of information require for weighing, alternative and protection from
false and misleading claims in advertising and labeling practices.
3. Right to choose: Availability of competing goods service that offers alternative in terms of price
quality service.
4. Right to be heard assurance and will act with sympathy and dispatch through status and simple
and expeditious administrative procedure.

86
87