UNIT 1: Concept of Health

Ms.Vinay Kumari
 Introduction

 The primary roles of the nurse as caregiver are

to:
 Promote health

 Prevent illness

 Restore health

 Facilitate coping

 Health is more than just the absence of illness;

it is an active process in which an individual
moves toward wellness by reaching his or her
maximum potential.
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 Introduction (cont..)
 To give holistic care, the nurse must
understand and respect each person’s
individual definition of health and
response to illness and should be familiar
with models of health and illness.
 Finally, the nurse needs to understand
how to provide nursing care to promote
health and prevent illness.

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 Health

Traditionally health was defined in terms of
the presence or absence of disease.
 Individually defined
 Each person defines health in terms of
his or her own values and beliefs.
 Acc. to WHO (World Health Organisation,
1946)
 Health is a state of complete physical,
mental,and social well being, and not
merely the absence of disease or infirmity.
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 Definitions of Health
 American Nurses Association (1980)
’’A dynamic state of being in which
the developmental and behavioral
potential of an individual is
realized to the fullest extent
possible.’’

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 Wellness and Well-Being
 Wellness is a state of well being.
 7 components of wellness (Anspaugh,
Hamrick, and Rosato, 2006)
 Physical (ability to carry out daily tasks,
achieve fitness, maintain adequate
nutrition & proper body fat, and generally
positive lifestyle habits)
 Social (ability to interact successfully with
people & within the environment)
 Emotional (ability to manage stress & to
express emotions appropriately.)
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 Wellness and Well-Being
7 components of wellness (Anspaugh, Hamrick,
and Rosato, 2006)
 Intellectual (ability to learn & use information
effectively for development)
 Spiritual ( belief in some force that serves to
unite human beings
 Occupational (ability to achieve a balance
between work & leisure time)
 Environmental (ability to promote health
measures that improve the standard of living &
quality of life in the community)
 Wellness and Well-Being
 Well being is a subjective perception
of vitality and feeling well. It is a
component of health.

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 Models of health and illness
 Agent- host- environment model
 Health-illness continuum
 High level wellness model
 Health promotion model
 Health belief model

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 Agent- host- environment model

 Developed by Leavell and Clark(1965)

 Useful for examining the causes of disease in an
individual.
 An agent is an environmental factor or stressor
that must be present or absent for an illness to
occur.
 A host is a living organism capable of being
infected or affected by an agent.
 The environment includes all the factors
external to the host that may or may not
predispose the person to the development of
disease.

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 Health-illness continuum

 The health illness continuum is one way to

measure a person’s level of health.
 This model views health as a constantly
changing state, with high level wellness and
death being on opposite ends of a graduated
scale, or continuum.
 This continuum illustrates the dynamic(ever
changing) state of health, as a person adapts
to changes in the internal and external
environments to maintain as state of well-
being.
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 Health illness continuum

Illness area Well area

HIGH
NORMAL GOOD
DEATH ILLNESS LEVEL
HEALTH HEALTH
WELLNESS

Death Well being

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 Health illness continuum
 People move back and forth within
this continuum day by day
 A person with a chronic illness may
view himself or herself at different
points on the continuum at any
given time, depending upon how
well the patient believes he or she
is functioning with the illness.

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 Factors/Variables affecting Health and Illness
 People can usually control their health behavior
and choose healthy or unhealthy activities.
 Internal variables
 Biologic dimension
 Psychologic dimension
 Cognitive dimension
 External variables
 Physical environment
 Standard of living
 Family and cultural beliefs
 Social support networks

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 Internal Variables

Often described as non modifiable variable

 Biologic dimension
1. Genetic makeup (influences biologic characteristic, innate
temperament, activity level, and intellectual potential)
E.g: Diabetes, breast cancer; Africans (Hypertension , Sickle cell
anemia)
2. Gender (influences the distribution of disease )
E.g: Females ( osteoporosis, Rheumatoid arthritis) ; Males
(Stomach cancers, abd hernias)
3. Age (distribution of disease varies with age. )
E.g: Heart disease (middle aged men) ;Communicable diseases
(children)
4. Developmental level (major impact on health status)
E.g : Toddlers learning to walk are more prone to falls

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 Internal Variables (Cont…)

 Psychologic dimension
 Mind body interaction can affect health status +vely or
–vely.Emotional responses to stress affect body
functions. E.g : student anxious before test may experience
diarrhea.
 Self concept is how a person feels about self (self
esteem) and perceives the physical self (body image),
needs , roles and abilities. It affects how people view
and handle situationts. Such attitudes can affect health
practices, response to stress, illness etc.
 E.g: Anorexia nervosa

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 Internal Variables (Cont..)
 Cognitive dimension
 Life style refers to a person’s general way of living
( living conditions and individual patterns of behavior).
Lifestyle is often considered as behavior and activities
over which people have control.
E.g: Overeating, Insufficient exercises are related to incidence
of Heart disease ; Excessive tobacco use linked with lung
cancer
 Spiritual and religious believes can significantly
affect health behaviour.
E.g: Some religious gp are strict vegetarian; serious illness as
God’s punishment

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 External variables (Cont….)
 Family and cultural beliefs
Family passes on patterns of daily living and lifestyle
to offspring. E.g A man who was abused as a child
may physically abuse his childern
Each culture has ideas about health, and these are often
transmitted to children. E.g Asians prefer herbal
remedies and acupunture than analgesics
 Social support network ( family, friends) and
job satisfaction helps people avoids illness.
Support people help the person that illness exists
and provide stimulus to become well again.

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 External variables

 Environment
Geographic location determines climate and
climate effects health (malaria more in tropical
than temperate climate) : pollution;radiation
 Standards of living (reflecting ocupation,
income, and education) is related to health,
morbidity and mortality. Hygiene, food habits,
propensity to seek health care advise vary
among high and low income gps.

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 Illness And Disease

 Illness is the highly personal state in which the

persons physical ,emotional ,intellectual, social,
developmental or spiritual functioning is thought to be
diminished.
 Not synonymous with disease. For e.g An ind. could have
a disease ( growth in stomach), and not feel ill.
 Illness is highly subjective; only the individual can say
he or she is ill.

 Disease can be described as an alteration in body

functions resulting in reduction of capacities or a
shortening of normal life span. Causation of disease is
ETIOLOGY

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 Types Of Illness

 Acute illness is characterized by severe symptoms of

relatively short duration. Symptoms often appear
abruptly and subside quickly.
 Depending on the cause, may or may not require
interventions by health professionals. Following an
attack, most people return to their normal level of
wellness . E.g: Appendicitis, colds
 Chronic illness is one that last for an extended period,
usually six months or longer and often for the
person’s life. Slow onset. Often have peroids of
Remission( when symptoms disappear) and
exacerbation ( symptoms reappear). E.g : Diabetes,
heart disease.

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 Causes and risk factors for developing
illness

 A risk factor is any situation, habit,

social or environmental condition,
physiological or psychological
condition, developmental or
intellectual condition, or spiritual or
other variable that increases the
vulnerability of an individual or
group to an illness or accident

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 Causes and risk factors for developing
illness

 The presence of risk factors doesn't mean

that a disease will develop, but the risk
factors increase the chances that the
individual will experience a particular disease
or dysfunction.
2. Genetic and Physiological factors
Heredity or genetic predisposition to specific
illness, is a major physical risk factor.
Certain physical conditions, such as being
pregnant or overweight, place increased
stress on physiological systems, increasing
susceptibility to illness.
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 Causes and risk factors for developing
illness (Cont…)

2. Age
Age increase or decreases susceptibility to certain
illnesses.
3. Environment
The physical environment in which a person work or lives
can increase the likelihood that certain illnesses will occur.
4. Lifestyle
Lifestyle practices with potential negative effects are risk
factors; these include sedentary lifestyle, overeating or
poor nutrition, insufficient rest and sleep, and poor
personal hygiene etc.

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 Illness Behaviours

 When people become ill, they behave in certain

ways that sociologist refer to as illness behavior
 Illness behavior, a coping mechanism, involves
ways individual describe, monitor and interpret
their symptoms, take remedial actions, and use
the health care system
 Variables affecting illness behavior are: age,
sex, occupation, socio economic status, ethnic
origin, personality, education, and modes of
coping.

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 Illness behaviour (cont…)

 5 stages of illness ( Suchman, 1979)

Stage 1: Symptom experiences
At this stage, the person comes to believe something is
wrong.
3 aspects of this stage:
 Physical experience of symptoms
 Cognitive aspect (interpretation of symptoms in terms that
have some meaning to person)
 Emotional aspect ( fear or anxiety)
During this stage, the unwell person usually consults others
about symptoms; try home remedies .
If self management is ineffective, the individual enters the next
stage.
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 Illness behaviour (cont…)

 Stage 2: Assumption of the sick role

 Individual accepts sick role & seeks
confirmation; continue self treatment and delay
contact with health care professionals as long as
possible.
 May be excused from normal duties &role
expectations
 Emotional responses such as withdrawal,
anxiety, fear and depression are not uncommon
 When symptoms persist, the person is
motivated to seek professional help
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 Illness behaviour (cont…)

 Stage 3: Medical care contact

Sick people seek the advise of a health professional
either on their own initiative or at the urging of
significant others.
3. Validation of real illness
4. Explanation of symptoms in understandable
terms
5. Reassurance that they will be all right or
prediction of what the outcome will be.
 Client may accept or deny the diagnosis
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 Illness behaviour (cont…)

 Stage 4: Dependent Client Role

After accepting the illness & seeking treatment,
the client becomes dependent on the
professional for help.
 Stage 5: Recovery or Rehabilitation
The client is expected to resume former roles and
responsibilities.
For Acute illness (illness duration is less; rapid recovery);
Chronic illness ( adjustments in life; find recovery more
difficult)
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 Impact of illness

 Illness is never an isolated life event. The

client and family must deal with changes
resulting from illness & treatment.
 The changes vary depending on the nature,
severity, and duration of illness, attitudes
associated with the illness by the client and
the others, and the financial demands, the
lifestyle changes incurred, adjustment to usual
roles, and so on.

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 Impact of illness on the client
 Ill clients may experience behavioral and
emotional changes, changes in self concept
and body image and life style changes.
 Behavioral and emotional changes associated with
short term illness are generally mild and short
lived
 Certain illnesses can also change the clients body
image
 Clients self esteem and self concept may also be
affected
 Ill individuals are also vulnerable to loss of
autonomy
 Illness also often necessitates change in life style

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 Impact on the family

 A persons, illness affects not only the

person who is ill but also the family or
significant others
 Role changes
 Task reassignments and increase
demands on time
 Increase stress due to anxiety about the
outcome of the illness
 Financial problem
 Loneliness
 Change in social customs
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 Health Care Services
 A health care system is the totality
of services offered by all health
disciplines. The services provided by
health care system are commonly
categorized according to type and
level.

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 Types of health care services

 Health care services are often described in

a way correlated with levels of disease
prevention
 A) Primary prevention (Health promotion and
illness prevention)
 B) Secondary prevention (Diagnosis and
treatment)
 C) Tertiary prevention (Rehabilitation, health
restoration, palliative care )

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 Types of health care services ( Cont..)

 PRIMARY PREVENTION : HEALTH PROMOTION AND

ILLNESS PREVENTION
Health promotion was slow to develop until the 1980s.
Since that time more and more people are recognizing
the advantages of staying healthy and avoiding illness.
Primary prevention programs address areas such as
adequate and proper nutrition, weight control and
exercise, and stress reduction.
Health promotion activities emphasize the important role
clients play in maintaining their own health and
encourage them to maintain the highest level of
wellness they can achieve.
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 Types of health care services ( Cont..)

 PRIMARY PREVENTION : HEALTH PROMOTION AND

ILLNESS PREVENTION (Cont..)
 Illness prevention programs may be directed at the
client or the community and involve such practices as
providing immunization, identifying risk factors for
illnesses, and helping people take measures to prevent
these illnesses from occurring.
 Illness prevention also includes environmental
programs that can reduce the incidence of illness or
disability

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 Types of health care services ( Cont..)

 SECONDARY PREVENTION: DIAGNOSIS AND

TREATMENT
 In the past, the largest segment of health care services
has been dedicated to the diagnosis and treatment of
illness.
 Hospitals and physician’s offices have been the major
agencies offering these complex secondary prevention
services
 Freestanding diagnostic and treatment facilities have
also evolved and serve ever growing number of clients.
 Also included as health promotion service is early
detection of disease. This is accomplished through
routine screening of the population and focused
screening of those at increased risk of developing
certain conditions. E.g: Regular dental examination; 37
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 Types of health care services ( Cont..)
 TERTIARY PREVENTION: REHABILITATION, HEALTH
RESTORATION AND PALLIATIVE CARE
 The goal of tertiary prevention is to help people move
their previous level of health (i.e to previous capabilities)
or to the highest level they are capable of given their
current health status.
 Rehabilitation care emphasizes the importance of
assisting clients to function adequately in the physical,
mental, social, economic, and vocational areas of their
lives.
 If injury is temporary, rehabilitation can assist in return
to former function. If the injury is permanent,
rehabilitation assists the client in adjusting how to
perform activities in order to achieve maximum abilities.
 Sometimes, people cannot be returned to health. A
growing field of nursing and tertiary prevention services
is that of palliative care – providing comfort and
treatment
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 Health Promotion, Wellness, & Illness
Prevention
 Health care has become increasingly focused on
health promotion, wellness, and illness
prevention.
 Concept of health promotion, wellness, and
illness prevention are closely related & in practice
overlap to some extent. All are focused in future

 Health promotion activities such as routine

exercise and good nutrition, help clients maintain
or enhance their present levels of health. Motivate
people to act positively to reach more stable
levels of health.

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 Health Promotion, Wellness, & Illness
Prevention
 Wellness education teaches people how to
care for themselves in a healthy way and
includes topics such as physical
awareness, stress management, and self
responsibility. Help persons achieve new
understanding and control of their lives.
 Illness prevention activities such as
immunization prog protect clients from
actual or potential threats to health.
Illness prevention motivates people to
avoid declines in health or functional
levels.

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 Health Promotion
 Science and art of helping people change
their lifestyles to move toward a state of
optimal health.
 Health promotion activities: Active and
Passive
 Passive (individuals gain from activities
of others without acting themselves e.g
fluoridation of municipal water)
 Active ( individuals are motivated to
adopt specific health prog e.g weight
reduction)

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 Levels of preventive care
 Nursing care oriented to health promotion,
wellness, and illness prevention can be
understood in terms of health activities on
primary, secondary and tertiary level.
 Primary prevention

True prevention; preceds disease or dysfunction and

applied to clients considered physically or
emotionally healthy.
Aimed at health promotion includes health education
programs, immunisation, physical and nutritional
fitness activities.
Focus on maintaining or improving the general
health of individuals, families, and communities.

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 Levels of preventive care
 Secondary Prevention
Focuses on individuals who are experiencing health
problems or illnesses and who are at risk for
developing complications or worsening conditions.
Activities are directed at diagnosis and
prompt intervention, thereby reducing
severity and enabling the client to return
to normal level of health as early as
possible.

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 Levels of preventive care
 Tertiary Prevention
 Occurs when a defect or disability is permanent
and irreversible. Involves minimizing the effects
of long term disease or disability by interventions
directed at preventing complications and
deterioration
 Activities are directed at rehabilitation rather than
diagnosis and treatment.
 Care at this level aims to help clients achieve as
high a level of functioning as possible, despite
the limitations caused by illness.
 Prevents further disability or reduced functioning.

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 Health Care Agencies

 Health care organizations( agencies) may be

defined as structural and functional units of
personnel who provide health services to
individuals, families, groups, and society.
 Classification
 Acc to focus of service
 Exist mainly to provide health care (hospitals, ambulatory
care centers, home health agencies)
 Exist for another purpose but also include the provision of
some health care as part of their services ( occupational
health services, schools that provide student health services
and prisons that provide dispensaries)

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 Health Care Agencies

 Classification (Cont..)
 Acc to population served
 Age gp: (pediatric, adult health or geriatric
client)
 Stage of illness: ( primary, secondary,
tertiary)
 Specific health problems : ( communicable
diseases, drug addiction etc)

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 Health Care Agencies
 Classification (Cont..)
 Acc to type of services
 Specific
services (diagnostic studies,
counseling, formal instruction, surgery,
non surgical treatment)
 General services (hospitals provide a
more comprehensive array of services)

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 Health Care Agencies

 Classification (Cont..)
 Acc to source of fund
 Profit
institutions (proprietary): (receive
payment from those who use their services)
 Nonprofit (not-for-profit):
voluntary agencies (financed by private
charitable or religious org.)
 public( govt. operated) agencies (funding from

local, state govt)

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 Hospital

 The word hospital is derived from the Latin word

hospitalis- for a guest in French “hospes- a host , a
guest.”
 In olden days, the hospitals were guest houses for the
shelter of homeless and for the treatment of travellers.In
the modern times, the chief function of the hospital has
been the care and treatment of sick.
 A hospital is an institution for health care providing
treatment by specialized staff and equipment, and often
but not always providing for longer-term patient stays.

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 Definition of Hospital

 The hospital is an integral part of a

social and medical organization, the
function of which is to provide for the
population the complete health care,
both curative and preventive and
whose out patient services reach out to
the family and its environment; the
hospital is also a centre for the training
of health workers and for bio- social
research
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 Hospital (Cont..)

 The Changing role of hospitals

 Hospitals in India have come of age in the past 50
years or so. The old idea of hospital was that it is a
place for the treatment of sick. Now , with the
emphasis on physical, mental, social well being,
reaching out to community and training of health
workers, the health care services have undergone a
steady metamorphosis and the role of the hospitals has
changed, with emphasis shifting from:

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 Hospital (Cont..)

 The Changing role of hospitals ( cont…)

 Curative to preventive
 In patient care to out patient and home care
 Acute to chronic illness
 Tertiary and secondary to primary health
care

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 Hospital (Cont..)

 Functions
Primary function: provision of medical care
to community
 INTRA-MURAL FUNCTIONS
These functions are within the hospital,
namely:
A)Therapeutic
 Diagnostic : diagnosis of illness

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 Hospital (Cont..)

 INTRA-MURAL FUNCTIONS ( Cont..)

A) Therapeutic ( Cont…)
2) Curative : Treatment of an illness
3) Rehabilitative : Physical, mental, social and vocational
rehabilitation
4) Care of emergencies : Accident trauma and acute life
threatening conditions
B) Preventive
1. Antenatal and postnatal services
2. Well baby clinics and immunization schedule
3. Family welfare services
4. Control of communicable diseases
5. Health education

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 Hospital (Cont..)

 INTRA-MURAL FUNCTIONS ( Cont..)

c) Education
 Medical : Undergraduate, post graduate and post doctoral
 Nursing education: Undergraduate, post graduate and
post doctoral
 Specialty
 Paramedical
 Community health
D) Research
 Clinical medicine
 Hospital administration

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 Hospital (Cont..)
 EXTRA MURAL FUNCTIONS
Those functions which are outside the
hospital, namely:
1) Outpatient services
2) Home care/ out reach/ domiciliary services

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 Classification of Hospitals
 Can be classified in many ways
B) According to ownership/ Control
 Public hospitals
 Run by central/ state Govt or Municipal bodies on non commercial
basis. May be general or specialized hospitals or both. General
hospitals are those which provide treatment for common diseases,
whereas specialized hospitals provide treatment for specific diseases,
specific group of people like infectious diseases, cancer, eye, ENT,
cardiac diseases
 Voluntary ( Charitable ) hospitals
 Established and incorporated under the Societies Registration Act. A
board of trustees usually manages such hospitals. The main source of
revenue are publics and private donations and grants aid from the
Central govt./ State govt. and from philanthropic organizations, both
national and international

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 Classification of Hospitals
A) According to ownership/ Control
 Private hospitals
 Generally owned by individuals or groups of
people and are run on a commercial basis
 Corporate hospitals
 Run by limited companies, formed under
the companies Act.They can be general,
specialized or both.

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 Classification of Hospitals ( Cont..)

 B) According to clinical specialities

In these hospitals, patients are treated for those diseases
for which that hospital has been set up, such as
tuberculosis, cancer, cardiac diseases etc. These hospitals
may be according to ownership/ control basis.
 C) Acc. to length of stay
In these hospitals, patients may stay for a long term
or a short term. Day care hospitals are those where
parents stay from morning to evening, as members of
the family may not be at home to take care of the
sick.
 Acute care / short term stay (with mean length of stay 7-
30 days)
 Long term stay ( average of length of stay over 30 days)

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 Classification of Hospitals ( Cont..)

 E) Acc to bed strength

 Small (<100 beds)
 Medium sized (100-300 beds)
 Large (> 300 beds)
 F) Acc. to teaching and non teaching
A teaching hospital has a medical
college attached to it. A hospital without
a medical college is termed as a non
teaching hospital .
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 Physical Plan of the hospital
 SELECTION OF SITE
 Place should not be densely populated
 Site of the hospital should be elevated from the
surroundings
 Should have an independent access to a street
 Must be away from nuisance such as dust, smoke,
bad odor, excessive noise and traffic
 Open space all around will help in proper lighting
(natural), and ventilations will provide a pleasing
surrounding

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 Physical Plan of the hospital

 PROVISION OF
 Safe drinking water
 Adequate lighting and ventilation

 Control of noise

 Collection and safe disposal of refuse and

excreta
 Control of arthropods, vermin and animal
pests

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 Physical Plan of the hospital
 Important points to be considered
while constructing a hospital
 Walls and floor should be, as far as
possible, non absorbent, non porous,
shock absorbing, attractive, fire
resistant, durable, easy to clean, and
damp proof, free of cracks (prevent
breeding of insects)

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 Physical Plan of the hospital (Cont..)

 Important points to be considered

while constructing a hospital
 Floor area should be adequate acc. to the no. of beds, so
there is sufficient space between the beds (6 feet)
 Windows and doors should be placed in such a way that
natural lighting is available in the room with cross
ventilation
 Latrines are placed in such a way that it does not cause
bad odor and unpleasant scenes. Should be placed where
direct sunlight enters in.
 Reception counter and the OPD should be near to the
main entrance of the hospital. IPD can be towards the
back of the building.
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 Physical Plan of the hospital (Cont..)

 Important points to be considered while constructing a

hospital
 The kitchen and the dining rooms should be fly proof and
away from the hospital wards.
 There should be central corridor connecting the different
departments and wards.
 There should be provision for the isolation of patients
having infectious diseases or who are suspected to be
infectious.
 There should be railings along the open corridors and
staircases to prevent accidents by falling
 Staircases, ramps and elevators should be centrally placed

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 Organization of hospital

 Organization varies from hospital to hospital. Some

feature are common to all.
 Line of authority differs acc. to the ownership and
administration.
 The governing body of a hospital, usually called the
board of trustees or directors is responsible for the
policies of the institution. Directly under the governing
body is the head of the hospital, the administrator or
director, to whom authority and responsibility for
management is delegated.

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 Organization of hospital (Cont..)

 The administrator/ director directs two divisions of the

hospital work- the business management and the
professional care of the patients.
 The business management includes administration,
accounting, maintenance, engineering, housekeeping
and purchasing.
 Under the professional care of the patients are found
the medical, nursing, paramedical and other special
department.


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 Organization of hospital (Cont..)
 MAJOR DEPARTMENTS
 Medical department (Medical superintendent is a
doctor who has control over all the medical dept.)
 Nursing department
 Paramedical department
 Pathology dept ( Bacteriology lab, biochemistry lab,

hematology lab, parasitology lab, serology lab, Blood

Bank, Histopathology dept )
 Pharmacy dept (selecting, purchasing,

compounding, storing and dispensing all drugs )

 Physical medicine and rehabilitation

 Radiology dept

 Dietary dept
08/22/09 68
 Organization of hospital (Cont..)
MAJOR DEPARTMENTS
 NON PROFESSIONAL SERVICES (BUSINESS MX)
 Admitting dept
 Administration
 Personnel dept ( recruitment, interview, promotion, transfer, inservice
training, safety, health prog, recreation)
 Purchasing dept
 Medical records
 Accounts (Business office)
 Housekeeping (to keep hospital clean)
 Laundry
 Mechanical dept (electricity, water supply,heat.)
 Maintenance dept (carpenter, painters, welders, gardners
 Central supply dept
 Social services
69
08/22/09
 Primary Health care
 Originally conceptualized in 1978 by the WHO and
the United Nations International Children’s
Emergency Relief Fund (UNICEF)

 Concept was developed based on decreases in

illness and death in member countries that were
achieved by simple, local, inexpensive solutions to
health problems, especially when combined with
economic and social development.

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 Primary Health care

 Defined as essential health care based on

practical, scientifically sound, and socially
acceptable methods and technology, made
universally accessible to individuals and families
in the community through their full participation
and at a cost the community can afford
 “Primary health care is essential health care,
made universally accessible to individuals and
acceptable to them, through their full
participation and at a cost the community and
country can afford.” (Alma Ata conference)
08/22/09 71
 Primary Health care (Cont…)

 Not to be confused with primary care. Primary care

is the delivery of healthcare services, including the
initial contact and ongoing care.
 Included in primary care is the responsibility for
referral to other providers based on patient needs.
Both physicians and nurse practitioners provide
primary care, which focuses on individual patient
and is directed by the provider.
 In contrast, primary health care has a community
based philosophic base that emphasizes universal
access and affordability of health care, health of
whole population, and consumer involvement.

08/22/09 72
 Primary Health care (Cont…)
 Principles of primary health care

1.Equitable distribution
Health services must be shared equally by all people
irrespective of their ability to pay and all (rich or
poor, urban or rural) must have access to health
services. Primary health care aims to address the
current imbalance in health care by shifting the
centre of gravity from cities where a majority of the
health budget is spent to rural areas where a
majority of people live in most countries.

08/22/09 73
 Primary Health care (Cont…)

 Principles of primary health care

2. Community participation
There must be a continuing effort to secure meaningful
involvement of the community in the planning,
implementation and maintenance of health services, beside
maximum reliance on local resources such as manpower,
money and materials.
3. Intersectoral coordination
Primary health care involves in addition to the health sector, all
related sectors and aspects of national and community
development, in particular agriculture, animal husbandry,
food, industry, education, housing, public works,
communication and other sectors.

08/22/09 74
 Primary Health care (Cont…)

 Principles of primary health care

4. Appropriate technology
“Technology that is scientifically sound, adaptable
to local needs, and acceptable to those who apply
it and those for whom it is used, and that can be
maintained by the people themselves in keeping
with the principle of self reliance with the
resources the community and country can
afford.”

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 Primary Health care (Cont…)

 8 Essential elements of primary health care

n Education- concerning prevailing health problems and
the methods of preventing and controlling them
n Promotion of food supply and proper nutrition
n An adequate supply of safe water and basic sanitation
n Maternal and child health care, including family
planning
n Immunisation against major infectious diseases
n Prevention and control of locally endemic diseases
n Appropriate treatment of common diseases and
injuries
n Provision of essential drugs

08/22/09 76
 Primary Health care (Cont…)
 Role of Nurse
 Assessing the health status of individuals and
community.
 Promoting community involvement
 Providing integrated health care including the
treatment of emergencies and making referrals.
 Making epidemiological surveillance.
 Training and supervising health workers.
 Collaborating with other developmental sectors
 Monitoring progress in primary health care
Body defenses: Immunity and
Immunization
 Introduction

 Individuals normally have defenses that protect

the body from infection.
 These defenses can be categorized as specific
and non specific.
 Non specific defenses protect the person
against all microorganisms, regardless of prior
exposure.
 Specific immune) defenses, by contrast, are
directed against identifiable bacteria, viruses,
fungi, or other infectious agents.

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 Non Specific Defenses

 Nonspecific body defenses include anatomic and

physiologic barriers, and the inflammatory responses.
 Anatomic and Physiologic Barriers
 Intact skin and mucous membrane : first line of
defense against micro-organisms.
 Normal secretions make the skin slightly acidic; acidity
also inhibits bacterial growth.
 Nasal passages have a defensive function. Moist mucus
membranes and cilia trap microorganisms, dust, foreign
materials.
 Lungs have alveolar macrophages (large phagocytes)
that ingest microorganisms, other cells, and foreign
particles.
08/22/09 80
 Non Specific Defenses (Cont…)

 Anatomic and Physiologic Barriers

(Cont…)
 Each body orifice also has protective mechanisms.
The oral cavity regularly sheds mucosal epithelium
to rid the colonizers. Saliva contains microbial
inhibitors such as lactoferrin, lysozyme and
secretory IgA.
 Eye is proteced from infection by tears, which
continually wash microorganisms away and contain
inhibiting lysozyme.
 High acidity of stomach normally prevents
microbial growth.

08/22/09 81
 Non Specific Defenses (Cont…)

 Inflammatory Responses
 Inflammation is a local and nonspecific
defensive response of tissues to an
injurious or infectious agent.
 It is an adaptive mechanism that
destroys or dilutes the injurious agent,
prevents further spread of injury, and
promotes the repair of damaged tissue.

08/22/09 82
 Non Specific Defenses (Cont…)

 Inflammatory Responses (Cont..)

 It is characterized by 5 signs:
1. Pain
2. Swelling
3. Redness
4. Heat
5. Impaired function of the part, if the injury is severe.

08/22/09 83
 Non Specific Defenses (Cont…)

 Inflammatory Responses (Cont..)

 A series of dynamic events commonly referred to as
the 3 stages of inflammatory response
 First Stage: Vascular and cellular
Responses
At the start of 1st stage, blood vessels at the site of injury
constrict. This is rapidly followed by dilation of small blood
vessels (occurring as a result of histamine released by injured
tissues). Thus, more blood flows to the injured area( hyperemia)
and is responsible for the characteristic signs of redness and
heat.
Vascular permeability increases at the site with dilation of the
vessels in response to cell death, the release of chemical
mediators (e.g bradykinin, serotonin, prostaglandins) and
histamine.
08/22/09 84
 Non Specific Defenses (Cont…)
 Inflammatory Responses (Cont..)
2. First Stage: Vascular and cellular
Responses
Fluid, proteins and leukocytes leak into interstitial
spaces, and the signs of inflammation swelling (edema)
and pain appear.

Pain is caused by pressure of accumulating fluid on

nerve endings and the irritating chemical mediators.
Leukocytosis (large no of leukocytes produced by bone
marrow and released into blood stream). Leukocytes
move through the blood wall into the affected tissue
spaces.
 Non Specific Defenses (Cont…)

 Inflammatory Responses (Cont..)

 Second Stage : Exudate production
 The inflammatory exudate is produced, consisting of fluid
that escaped from the blood vessels, dead phagocytic
cells, and dead tissue cells and products that they
release.
 The plasma protein fibrinogen ( which is converted into
fibrin when it is released into the tissues),
thromboplastin (released by injured tissue cells), and
platelets together form an interlacing network to wall off
the area, and prevent spread of injurious agent.
 During this stage, the injurious agent is overcome,
and the exudate is cleared by lymphatic drainage.

08/22/09 86
 Non Specific Defenses (Cont…)
 Inflammatory Responses (Cont..)
2) Third Stage : Reparative Phase
Involves the repair of injured tissues by
regeneration or replacement with fibrous
tissue( scar) formation.
Regeneration is the replacement of destroyed
tissue cells by cells that are identical in structure
and function.
When regeneration is not possible, repair occurs
by fibrous (scar) tissue formation. Damaged
tissues are replaced with the connective tissue
elements of collagen, blood capillaries,
lymphatics.

08/22/09 87
 Non Specific Defenses (Cont…)

 Inflammatory Responses (Cont..)

2) Third Stage : Reparative Phase

In the early stages of this process, the

tissue is called granulation tissue (fragile,
gelatinous, pink or red)
Later, the tissue shrinks, capillaries
constrict and collagen fibers contract, so
that a firmer fibrous tissue remains. This is
called as cicatrix or scar.
 Specific defenses
 Specific defenses of the body
involve the immune system.

08/22/09 89
 Immunity
 Immunity is a material term that
describes a state of having sufficient
biological defenses to avoid infection,
disease, or other unwanted biological
invasion.
 An antigen is a substance that
induces a state of sensitivity or
immune responsiveness (immunity).

08/22/09 90
 Types of Immunity

IMMUNITY

NATURAL ACQUIRED

PASSIVE
ACTIVE PASSIVE ACTIVE
(INFECTION) (MATERNAL) (IMMUNISATION)(ANTIBODY TRANSFER)

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 Active and passive immunity
 Passive immunity is acquired
through transfer of antibody or
activated T-cells from an immune
host, and is short lived, usually lasts
only a few months, whereas active
immunity is induced in the host
itself by antigen, and lasts much
longer, sometimes life-long.

08/22/09 92
 Components of immune response
 Immune response has two
components: Antibody mediated
defenses and cell mediated
defenses. These two systems
provide distinct but overlapping
protection.

08/22/09 93
 Components of immune response
(Cont…)

 Antibody mediated defenses

( Humoral or circulating immunity)
 These defenses reside ultimately in the
B lymphocytes and are mediated by
antibodies (immunoglobulin) produced
by B cells. The antibody mediated
responses defend primarily against the
extra cellular phases of bacterial and
viral infections.

08/22/09 94
 Components of immune response
(Cont…)
 Antibody mediated defenses ( Humoral or circulating
immunity)
 Active immunity (host produces antibodies in response
to natural antigens (e.g infectious microorganisms) or
artificial antigens (e.g. vaccines). B cells are activated
when they recognize antigen. Bcells may produce
antibody molecules of 5 classes of immunoglobulins
(IgM, IgG, IgA, IgD, and IgE.)
 Passive immunity the host receives natural (e.g from
nursing mother) or artificial(from an injection of
immune serum) antibodies produced by another
source.

08/22/09 95
 Components of immune response
(Cont…)
 Cell mediated defenses ( Cellular immunity)
 The cell mediated defenses or cellular immunity, occur
through the T cell system. On exposure to an antigen,
the lymphoid tissues release large numbers of
activated T cells into the lymph system. These T cells
pass into general circulation. There are 3 main gps of T
cells
 helper T cells, which help in the functions of immune system
 cytotoxic T cells, which attack and kill microorganisms and
sometimes the body's own cells
 suppressor Tcells which can suppress the functions of the helper T
cells and cytotoxic T cells

08/22/09 96
 Immunisation

08/22/09 97
 Immunisation
 Immunization, or immunisation,
is the process by which an
individual's immune system
becomes fortified against an agent
(known as the immunogen).

08/22/09 98
 Passive and active immunization
 Immunisation can be achieved in an
active or passive fashion:
vaccination is an active form of
immunization.

08/22/09 99
 Active immunization
 Active immunisation entails the introduction of a foreign molecule
into the body, which causes the body itself to generate immunity
against the target. This immunity comes from the T cells and the
B cells with their antibodies.

ACTIVE IMMUNISATION

NATURAL ARTIFICIAL

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 Active immunization
 Active immunization can occur naturally when a
person comes in contact with, for example, a
microbe. If the person has not yet come into
contact with the microbe and has no pre-made
antibodies for defense (like in passive
immunization), the person can become
immunized. The immune system will eventually
create antibodies and other defenses against the
microbe. The next time, the immune response
against this microbe can be very efficient; this is
the case in many of the childhood infections that
a person only contracts once, but then is immune

08/22/09 101
 Active immunization
 Artificial active immunization is where the microbe,
or parts of it, are injected into the person before
they are able to take it in naturally. If whole
microbes are used, they are pre-treated, so that
they will not harm the injected person as the
naturally occurring microbe would. Depending on
the type of disease, this technique also works with
dead microbes, parts of the microbe, or treated
toxins from the microbe.

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 Passive immunization

 Passive immunization is where pre-made

elements of the immune system are
transferred to a person, and the body
doesn't have to create these elements itself.
Currently, antibodies can be used for
passive immunization. This method of
immunization begins to work very quickly,
but it is short lasting, because the
antibodies are naturally broken down, and if
there are no B cells to produce more
antibodies, they will disappear

08/22/09 103
 Passive immunization

 Passive immunization can be

naturally acquired when antibodies
are being transferred from mother
to fetus during pregnancy , to help
protect the fetus before and shortly
after birth.

08/22/09 104
 Passive immunization
 Artificial passive immunization is
normally given by injection and is
used if there has been a recent
outbreak of a particular disease or
as an emergency treatment to
poisons (for example, for tetanus).

08/22/09 105
 National Immunization Schedule
AGE  VACCINE DOSE ROUTE
BIRTH BCG 1 ID
OPV 0 ORAL
6 WEEKS OPV 1 ORAL
DPT 1 IM
10 WEEKS OPV 2 ORAL
DPT 2 IM
14 WEEKS OPV 3 ORAL
DPT 3 IM
 National Immunization Schedule
AGE 
VACCINE DOSE ROUTE
9 MONTHS MEASLES 1 SC
18 MONTHS DPT 1 BOOSTER IM
OPV 1 BOOSTER ORAL
5 YEARS DT 1 IM
10 YEARS TT 1 IM
16 YEARS TT 1 IM
 Optional Vaccines
AGE AGE DOSE ROUTE

HEPATITIS B BIRTH 1 IM
10 WEEKS 2 IM
9 MONTHS 3 IM
HEPATITIS A 1 YEAR 1 IM
1 AND ½ YEAR 2 IM
H. INFLUENZA-B 06 MONTHS 1 IM
(HIB) 14 MONTHS 2 IM
18 MONTHS 3 IM
MMR 15 MONTHS 1 IM
CHIKENPOX 24 MONTHS 1 IM
TYPHOID 5 YEARS 2 IM
UNIT TEST ON THIS UNIT
COMPULSORY FOR ALL
DURATION : 1 HR
MM: 35

(28/11/08 : FRIDAY)
Time: 1.45 to 2.30 PM