Some terminology

 Some Terminology Related to B.P.P.N

1. Dyspepsia

Indigestion , feeling of fullness, discomfort, nausea and anorexia.

2. Dysphagia

Difficulty in swallowing / painful in swallowing.

3. Nausea

Sensation to vomit.

4. Nutrients

Constituents of food. e.g,  carbohydrates, protein, fat, minerals vitamins and water.

5. Regurgitation

It refers to back flow.

e.g, backflow of parcely digested food into the mouth from the stomach.

6. Vomiting

Expulsion of stomach contain through oesophagus and mouth.

7. Anorexia

Lack of appetite.

8. Anosmia

Loss of sense of smell.

9. Appetite

Psychological stimulus to eat that may be connected with and triggered by emotion stimuli.

10. Asphyxia

Lack of oxygen in the tissue.

11. Body Mass Index

A figure derived from a person height and weight that indicate whether that weight is acceptable.

12. Bulimia Nervosa

It is an eating disorder in which excessively eating is followed by depression and guilt , self induced vomiting and burging .

 

13. Malabsorption

Inadequate or disorder absorption of nutrients from the intestinal canal.

14. Halitosis

Bad breath smell

15. Turgor 

Resistance of skin to  deformation when pinch.

16. Anorexia Nervosa

Psychiatric disorder characterized by intense fear of becoming overweight even when emaciated.

17. Bradycardia

Heart rate less than 60 beats per minute in  adult.

18. Tachycardia

Heart rate more than 100 beats per minute in adult.

19. Eupnea 

It refers to easy respiration with normal breath rate per minute that is age specific.

20.  Bradypnea

Respiratory rate become 10 or fewer breath per minute.

21. Tachypnea

Respiratory rate greater than 24 breath per minute.

22. Hypoventilation

Refers to shallow respiration.

23. Hyperventilation

Refers to deep and rapid respiration.

24.  Cheyne stock respiration

 Respiratory rhythm is irregular , characterized by alternating period of Apnea and hyperventilation.

25. Kussmaul respiration

Respiration are abnormal deep but regular, similar to hyperventilation.

26. Orthopnea

Respiratory condition in which a person must sit or stand in order to breathe deeply or comfortably.

27. Platypnea

Opposite of orthopnea.

Difficult respiration on upright position , a person can laying down and breath comfortably.

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Hospital admission and discharge

 Part 3

Points to remember___

Ensure that no dues certificate is taken before handing over the step to patient.

Inform relatives about  discharge in audience.

Change the dressing when the patient is ready for discharge.

 

Provide clear instruction regarding use of drugs, diet.

Keep the patients record in safe custody.

Discharge Procedure

* The physician should write the patient name who is being discharged on chart.

* Patient personal belongings should be returned.

* The articles in patient units should be checked and ensure that they are completed.

* Check the payment of hospital bills.

* Arrange wheelchair , if patient is not able to 

walk.

* Complete all records of the patients.

Nurses Responsibility In Discharging Patient

* Inform the patient and relatives a day before discharge.

* Get the discharge slip prepared after checking the vital signs.

* The nurses should be that the patient personal hygiene is maintained.

* Hand over patient belongings.

* Complete the admission unit and discharge register sheet.

* Hand over case sheet and other records to medical record department.

* Hand over the discharge sleep to the patient or relatives.

* Ensure that the patient receive old medicine as for discharge slip.

* Place the patient on wheelchair as per patients condition.

* Immediately after the patient leaves, reorganize the patient's.

Transferring the patients

It refers to the patient may require transfer either from the unit to another or to  other health Care institution according to condition of patient.

 Transferring procedure

* Check the order of transfer to another unit.

* Assess the unit where patient is to be shifted.

* Explain the procedure of transfer to patient.

* Review the checklist of patient belonging so that all things are transferred with patient.

* Transfer patient by using wheelchair.

Assess and gather equipment that will be transferred with patient

E.g. infusion pump

* Document time of transfer and patient condition medications.

Transfer to extended care facility

1. Make sure that physician has written the transfer order on patient chart and transfer form.

2. Complete the nursing summary.

3. Attach a copy of transfer form and nursing notes with patient chair.

Care of unit after discharge

1. After the patient is discharged and before admitting another patient,  the room is cleaned windows and doors are opened.

2. Disposable things are discarded and linens are send to laundry.

3. Hatters pellows, blanket are posed to sunlight .

4. In case of communicable disease fumigation of room and articles is done.

5. Sanititation of bed, cabinet and the general area of the patient care unit with germicidal agent after patient is discharged.

Purpose of cleaning

1. Prevention of spread from microorganism.

 

2. Removal of body waste from mattress .

3. Deodrizing the bed tray mattress and pillows.

Guideline for cleaning

1. Review ward policies.

2. Use only authorised detergent or solution for cleaning.

3. Check bedside cabinet is cleared from any valuable of patient.

 4. Check bed linens for personal cleams ( money, contact lense).

5. Replace torn mattress or pillow.

6. Allowed the mattress and pillow to dry thoroughly before making bed.

7. Prevent spread of microorganism by carefully removing linen from bed.

Medico legal case (MLC)

Medico legal case are the cases requiring medical statement , by the same time involve information to law enforcing authorities is called medico legal case.

Types of MLC_____

* All road traffic accident

 * Bomb blast

* Poisoning

* Sexual offence

* Domestic violence

* Criminal abortion

* Attempts suicide

* Bullet injuries

Hospital admission and discharge

 Part 2

Nurses responsibility during admission of patient

In outpatient department

When patient comes receive with kindness and courtesy and offer a chair , if very ill patient come for the examination.

Fill the particulars form name, age ,sex, religion, address, husband or father's name date of admission.

Check vital sign and observe general conditions to determine patient condition.

Get the patient examined and admission slip completed by doctor.

Educate patient or relatives and assess the assess the patients body.

Take the patient along with case sheet to the ward.

In wards

When patient come take the case sheet and receive the patient in the admission bade

 

If patient is ill inform the doctor incharge immediately.

 

Complete admission register 

Makes general observation from here to toe.

Give bath to the patient .

Dress the patient in clear hospital  clothes .

Hand over patient belonging to relatives or ward incharge.

 

If patient is admitted for operation or any treatment take the consent.

 

Proper orientation should be done .

 If patient mentally upset , give psychological support.

Discharge The Patients

Discharge is the process when the patient is shifted from the hospital to home.

                  Or

"Discharge means permitting the patient to let go from hospital to his home"

Objectives of Discharge

To ensure medical care after discharge .

To motivate patient and relative .

To promote good public relation.

Types of discharge________

Cured and discharge

This discharge is initiated by physician who advice the patient that he is well enough to leave the hospital, patient is satisfied and leaves.

Discharge to another hospital or another unit (Referral)

In this physician refer the patient to other hospital for better treatment.

When they do not have appropriate staff and equipments.

This is done to just save life of patients.

Discharge against medical advice (DAMA) (LAMA)

In this case the patient leaves the hospital against medical officer advice.

 

When a patient is kept from hospital without knowledge of hospital staff he is treated as absconded in hospital records

Absconded

When patient leaves hospital without any prior information on to staff , and without clearing dues.

DOR (Discharge on Request)

Discharge is given on personal request of client when he/ she is not willing to take treatment from hospital.

Death

When the patient does not recovered from the health problems and dies in hospital the doctors handover body to relatives.

Discharge planning

An effective discharge requires careful planning and continuous assessment of patient needs during hospitalization.

IDEAL discharge planning

I : Include patient and family members as partners in discharge process.

D : Discuss key areas to prevent problems

* Management of disease

* Explain test results

* Medication

* Follow up

E : Educate family and patient about discharge process.

A : Assess whether patient is able to understand the process.

L : Listen to patient and family members respect their difference.

Hospital admission and discharge

  Part 1

        Unit 3

HOSPITAL ADMISSION AND DISCHARGE

Admission to the hospital

The entrance of the patient into the health care agency such as hospital eastern as admission.

Admission

It means allowing a client to stay in the hospital for observation investigation and treatment of disease he is suffering from.

Indication

A patient admitted to hospital with following reason such as diagnostic procedure , surgical  intervention ,condition requiring expert care,  therapeutic  aspect for treatment , etc.,

Types of admission_____

Emergency admission

Client are admitted in acute conditions requiring immediate care .

e.g Client with heart attack

Routine admission

Client admitted for investigation and plant treatment and surgeries.

e.g. Patient with hypertension or pregnant lady 

Purpose of admission

1. To provide immediate care safety and comfort.

 2. To observe and report sign and symptoms of disease condition.

3. To improve general condition of patient.

 4. To reduce fear and anxiety .

Unit and its preparation

It is a place where the patient is kept during hospital stay.

The admission department notify the unit prior to the patient arrival . So that room /bed can be prepared.

Preparations

1. Prepare the treatment table

2. Ensure all the equipments are completed.

3. Check  ventilation properly.

4. Ensure patient airway.

Admitting the patient

The procedure for admitting a client to a health Care facility is very important.

Data required for admission of patient includes____

# Name of patients 

# Age 

# Gender / sex 

# Marital status

 # Occupation 

# Income

# Mobile number

Articles

Admission bed

 Temperature

 Weighing machine

 Kidney tray

 Documentation sheet

 Articles for physical examination

 BP apparatus

Admission Procedure

* Meet and receive the patient 

* Verify the patient data , by checking records sheet.

 

* Introduce personal 

* Assist to treatment care.

 

* Ask the patient to change clothes into hospital gown if necessary .

* Perform examination and evaluation procedure established baseline values like vital signs.

For Routine Admission

OPD ------ Doctor office ----- Admission office --- Ward

For Emergency Admission

In this patient is directly admitted emergency.

 

Bed and emergency equipment should be ready.

 When patient is out of danger , then he is shifted to other wards

Observation of Patient

Nurses should check all vital sign of the patient. 

Patients general facial expression will denote not only his emotions but also presence of pain.   

Any discolouration of skin like jaundice, cyanosis.

Special Consideration

1. Isolate the patient is suffering from communicable diseases.

 

2. Make proper observation of the patients condition record and report.

 

3. Orient the patient and his relatives to hospitals.

 

4. Be kind to patient and family members .

5. Collect information about patient from relatives.

 

6. Never leave the patient alone in  casualty.

Documentation and reporting

 Part 3

              Methods of recording

Records and report must be accurate, factual complete , current and confidential . There are many method used for recording such as______

1. Narrative charting

This is traditional method of recording nursing care is a story format that describe that client status.

2. Problem oriented charting 

This is a method of the human documentation that places emphasis on clients problems.

3. Sources oriented charting 

This is a descriptive recording done by each member of healthcare team or separate records.

4. PIE charting

SOP format is developed on medical models PIE(problem , intervention , evolution) chatting has a nursing origin.

5. Focus charting 

Focus charting is a method of identifying and organising the narrator documentation of clients concerns.

6. Charting by exception (CBE)

Patient is charting method that requires nurse to record only deviations from pre - established norms.

Flow sheets

Highlight important findings and define assessment parameters and findings.

Reference documentation:- Is related to standard of nursing practice.

Bed side accessibility :-Is related to documentation forms.

Patient have four components of problem oriented charting

Database

It contains information recording assessment. E.g. history , physical examination , nurses assessment , laboratory findings.

Problem list

Best of on the database list of problem planning (physiological , social , spiritual , cultural, environmental, etc)

Initial plan

Based upon the identified problems , care is developed with clients active participation is setting goals , outcomes and interventions.

Progress notes

Health team members will evaluate and record the progress of  client's problems information can be expressed in various formats such as SOAPIE or SOAP.

Computerized documentation

Nurse use computer to store the client database , add new data , created and revise care plans and documents client progress.

Advantages

1. Legibility of information 

2. Increased time efficiency , consistency and accuracy in records keeping .

3. Provide database for research.

4. Patient link various sources.

5. Client information , request and result are sent and received quickly.

6. Standard terminology improve communication.

Disadvantages

1. Clients may not have privacy is security measures are not used.

2. System failure can cause an availability of information.

3. System is expensive.

4. Extended training may be required whenever an updated system is installed.

Documentation and reporting

 Part 2

          Types of records___

1. Patient clinical records 

2. Medical /Nursing records

 3. Ward records

 4. Administrative records

Patient  clinical record

It is the knowledge of involved in the patients illness progress in his recovery and the type of care provided by the hospital personnel. All records basically contain the following information ______

1. Client's identification and demography data.

2. The present complaints 

3. Informed content for treatment and procedures 

4. Admission nursing history

 5. Family history

6. Physical examination findings

 7.Nursing diagnosis and problems

 8. Nursing care plan 

9. Medical history 

10. Tentative diagnosis 

11. Medical diagnosis

 12. Therapeutic orders

13. Treatment given

 14. Reports of diagnostic studies

 15. Final diagnosis

 16. Client education

 17. Summary of operative procedures

 18. Discharge plan and summary 

19. Any specific special instruction

Medical records

Medical record is a legal document providing information of a patient medical history and data by physician , nurse practitioner and other members of the health care.

 Some  information contained in the medical records____

Identification information of the patient .

Patient health is information on a patient tell the health care providers about their past and present health status.

Medical examination findings.

Nursing records

Progress notes :- it should be written at least once every 24 hours and for each of the following events.

a) Admission 

b) Transfer

c) Discharge

d) Treatment or procedure 

e) Charge in patients condition.

 f) Patient incident note.

 g) Patient or parent /caregiver education.

Worksheet and kardexes :- nurse use worksheet to organise the care they provide and to manage their time and multiply priorities. Kardexes are used to communicate current orders , upcoming test or surgery is special clients for the use of aids  for independent.

Flow sheets :-  A new flow sheet  is to be initiated for each 24 hours period , by signing and initiating the flow sheets  the RN indicate.

A safety check has been performed the presence of correct ID band 

The presence of an accurate allergy band.

The documentation of the monitor control number and assessment of appropriate alarm limits.

Intake/output section

Hourly IV site/ rate check.

Cumulative IV volume infused hourly. 

Complete description of all IV solutions.

 All medication given.

Vital signs section

Document vital signs in the space provided. Graph by the vital sign using the graph legend symbol and assessment legend.

Client care plan

Care plan outlines of the care for individual clients and make a part of the permanent health records.

Care plan written in ink ,  up-to-date and clearly identify the needs and wishes of the client

E - Health records

There is no doubt that the computerization of the health care records has  many benefits .  The same principle apply whether documentation is completed in the paper health care records or electronically.

Wards records

Ward records include ;-

Admission and discharge record

Line in record

Record of production or increasing beds.

Index books

Round book , attendance book and record book 

Treatment records

Administration records

It includes record of______

Treatment

Admission

Equipment losses and replacement .

Personal performance

Organiszational records

Documentation and reporting

 Part 1

                                 Unit - 6

DOCUMENTATION and REPORTING

Documentation is any written electric electronically generated information about a client that describe the care or service provided to that clients .

It may be record in the form of paper documents or electronic medical records , faxes, emails, audio or video tapes and images.

By the process of documentation a nurse can communicate easily with other health team members and clients and understand their problems or need.

Nursing documentation clearly described

An assessment of the client health status nursing intervention carried out the impact of thus intervention on clients outcomes.

A care plan or health plan reflecting the needs and goals of the clients.

Information reported to a physician or other health team member.

Advocacy undertaken by the nurse on behalf of the client.

Record

It is defined as a clinical , scientific, administrative and permanent legal documentation of information related to the clients healthcare.

Purpose of recording

Communication :- with the help of the record health team member can communicate easily regarding to the status of the  patients.

Quality of care:- record help to identify the health needs of the patient , various interventions carried out on patient and their outcomes.

Legal documentation:- legal documentation help in legal worked . It helps police and health care team during accident or any criminal work .

Planning patient care:- review of patient record is done to assess the health condition of the clients  and to plan further care.

Audit :- An audit is done to assess the standard and quality of care provided in institution by reviewing the patients records.

Research :- the information in a patient records can be used as a source for nursing and health research projects.

Importance of records

For family and individual

Record serve as a detailed description of client history .

 Assist in continuity of care.

 Evidence to support legal issues.

For Physician

Serve of guide for diagnosis and treatment.

 Self evolution of medical practice .

Teaching and research.

For Nurses

Document nursing service in hospital .

Guide for professional growth.

 Act as  communication tool.

For Authority

Record provide satisfied information .

 Provide future it reference. 

Evaluation of care in terms of quality and adequacy.

Health unit 1

 Part 13

                                 ELEMENTS

1) Intensive care or critical care

Patients who require close monitoring and intensive care.

E.g patient with myocardial infection, burns, renal transplant.

2) Immediate care

Critically ill patients are shifted to immediate care where vital signs are taken.

E.g. Cardiac care wards

3) long term care

These care are assigned to patients with chronic illness.

Nurses help patients by providing therapy like physical and occupational therapy.

4) home care

Home care for those who do not need hospitalization.

5) Ambulatory care

Patients visit hospital for follow up, rehabilitation and preventive services.

6) Convalescent and self care

Patients in these areas active participate to acheive  complete self care status.

Advantages

Patient receives specialized care.

Nursing personnel can make use of special skills.

Continuity care maintained

Disadvantages

There may be discomfort to client or patients.

Greater emphasis on written care plan.

Primary Nursing

It is good for long term care, rehabilitation units.

It is a system in which nurse is responsible for total care of number of client is 24 hours a day.

Advantages 

There is an opportunity to see the client and family one system.

Nurse use wide range of skills, knowledge.

Primary nurse is first line manager.

Disadvantages

More nurses are required for this method.

More expensive than other method.

Nurses may find difficulty in following plans made up by other nursing staff.

Primary Nursing care system is good for long term care, clinic.

Primary health care ( P.H.C )

It is assential health care based on practical, socially acceptable method made universally accessible to individuals.

Definition

"PHC is essential health care made universally accessible to individuals to them through their full participation and at a cost of community and country can afford."

Basic Requirements (7A's and 3C's )

1. Appropriate

2. Availability

3. Adequacy

4. Accessibility

5. Acceptability

6. Affordability

7. Accountability

1. Completeness

2. Contenuity

3. Comprehensive

Function

Medical care

MCH including family planning

Safe water supply

Prevention and control from endemic disease

Health education

Collection and reporting of vital statistics

Refferal of health workers local dias

Principles of PHC

1. Equitable distribution

PHC must shared equally by all people irrespected of their colour,sex, and religion.

2. Community participation

It needs to participate in the health care so there should be active participation of individuals.

3. Appropriate use of technology

It involves health care there should be proper equipment and their supplies throughout community.

4. Manpower development

Human resources are important factor for success of PHC.

5. Inter sectoral coordination

Health community cannot be improved by only health sectors.

Role of nurse in PHC

Work as a care provider, manager, advocate for clients or patients, coordinator, advisor, team leader, supervisor , etc.

Health unit 1

 Part 12

Approaches for Primary Prevention

Population

High Risk

Secondary prevention

In this level of prevention activities are done to stop the progress of disease in primary stage.

Specific intervention are ___

# early diagnosis

# treatment

Early diagnosis and treatment

The earlier a diseases is diagnosed and treated the better is prognosis of the case.

Tertiary prevention

# the actions taken in later phase to reduce disability.

# It is used when disease process has advanced beyond its early stage.

# it is the stage in which all measures are taken to the conditions.

Intervention taken____

a) Rehabilitation

It is is combined and coordinate use of medical, social, educational measures for 

Nursing Care Delivery System

A nursing care delivery system organizes the work of caring for patients.

#  The decision of using this system is based on the needs of patients and availability of staff

# In planning for general staffing of ward, the head nurse must know the nursing needs of patients for 24 hours. She must balance, number and type of person available.

Methods

Several methods of assignment are used to plan for patient care in hospital.

Some methods are as follows____

Functional nursing

Case method

Team nursing

Case management

Progressive patient

Primary Nursing

Functional nursing

The nursing care is divided into task and each staff member is assigned to perform one or two task for all patients.

A particular job was assigned for the available staff like vital signs, treatment, medication.

The person who has complete responsibility of client is Head Nurse.

Advantages

Disadvantages

2. Case method

It is oldest mode of organizing patients care.

In this method , nurses assume total responsibility of assigned nurses.

Advantages

May client feel secure.

Family become better known by the nurse.

Disadvantages

Nurses may feel overworked.

Nurses may tensed.

3. Team nursing

# Team nursing care was introduced in 1950.

# It is the delivery of individualised nursing care to patient by a team of professional nurses.

4. Case management

# It involves responsibility of planning assisment, implementing and evaluating.

# It can be defined as a process that assess, plan implement and evaluate services to meet individuals health.

# The case manager is assigned responsibility of patients care from hospital and back to home care.

# he/she identify delay and discuss with doctors and patients.

Advantages

It ensures quality care.

In this method we can collaborate with other health professionals.

Disadvantages

Lack of coordination

5. Progressive patients care

It is defined as the organisation of hospital facilitate, services and staff as per medical and nursing needs.

It is a method in which different levels of care is provided.

UNIT - 4 COMMUNICATION AND NURSES PATIENT REALATIONSHIP

INTRODUCTION

.The word communication comes from the latin word 'communicare' which means to share, to import, to partake etc.

It means transmitting and sharing of ideas, opinions, facts and information between persons or groups in such a way that the meaning received is equivalent to those that is perceived and understood by the sender. 

DEFINITION OF COMMUNICATION-

1. "Communication is a process of mutual exchange of thoughts, feelings, ideas, facts and emotions."           -Merrihue

2. "Communication is sharing of ideas and feelings in a mood of mutuality."    -Edgar Dale 

3. "It is the process of sharing information ideas and attitude between individual"

LEVELS OF COMMUNICATION-

1. INTRAPERSIONAL COMMUNICATION-

*  It is powerful form communication that occurs in and individual.

* This level of communication is also called self -talks, self- verbalization and inner thought.

2. INTERPERSONAL COMMUNICATINON-

*  It is one to one interaction that occurs face to face.

*  This level of communication is frequently used in nursing situation.

*  Its results in expression of feeling, exchange of ideas, decision making, team building and problem solving  and personal growth when happen meaningfully.

3. TRANSPERSONAL COMMUNICATION-

*  It interaction that occurs with within a person's spiritual domain.

*  Nurses who value human spiritually use this  level for patients and for themselves.

4. SMALL GROUP COMMUNICATION-

*  It is interaction that take place with gathering of small number of persons. 

*  Its is usually goal-oriented and requires and understanding of group dynamics.

*  Nurses use this form for committee work, to lead client  support group, form research team and so on.

5. ORGANIZATION COMMUNICATION-

*  It is an interaction between an individual and groups within organization in order to achieve established goal.

6. PUBLIC COMMUNICATION-

*  it is interaction with an audience.

*  nurses use this form for group health education, classroom discussion with students or peers.

ELEMENTS OF COMMUNICATION PROCESS-

1.  SOURCES OF SENDER- the person objects which passes information or ideas to other person is known as sender or sources.

2.  IDEAS- this is the subject matter of communication. this might be opinions, attitudes, feeling, view, suggestion, order etc.

3.  ENCODING- conversion of subject matter into symbols(words, action, pictures etc.) is the process of encoding. Symbols are transmitted from sender to the receiver.

4. CHANNEL- the symbols are transmitted through  certain channels , e.g.. radio, telephone, speech, written message, gestures etc. depending upon the relative distance between the sender and receiver.

5.  RECEIVER- receiver the person to whom the message mental for.

6. DECODING- receiver converts the symbol received from the sender to give him the meaning of the message.

7. FEEDBACK- It is the response from the receiver. It is necessary to ensure that the receiver has received the message and understood it in the same sense as sender wants.

TYPES OF COMMUNICATION

1.  ON THE BASIS OF FLOW OF COMMUNICATION 

A. ONE-WAY COMMUNICATION- 

*  it is one way from the communicator to the audience. 

*  in this type of communication the sender will not get instant instant return or feedback from the receiver.    

B. TWO-WAY COMMUNICATION-

*  in this both the communicator and audience take parts. the process of communication is active and democratic it is more likely to influence behavior then one-way communication. people may rise questions and give their ideas, opinion and information to the subject.

2.  FORMAL AND INFORMAL COMMUNICATION-

A.  FORMAL COMMUNICATION-

*  it is mainly used in office or institution for communicating to the people. the medium of formal communication may be department meeting, interview, conference etc. 

B.  INFORMAL COMMUNICATION-

*  it is generally used in friends circle and family member for gossip. it is very fast and active process.

3.  VERBAL AND NON-VERBAL COMMUNICATION-

A.  VERBAL COMMUNICATION- it is traditional way of communication is the use of spoken and written word. language is the chief vehicle of communication through which we can interact with other and able to pass information.

B. NON-VERBAL COMMUNICATION- communication can occur even without work in which we can transfer or message with the help of  body-language without using words e.g. facial expression, body movement etc.

4. VISUAL COMMUNICATION- it include charts, graphs, tables, maps, posters etc.

5.  TELECOMMUNICATION- it is the process of communication over distance using electromagnetic instrument design for the purpose. e.g. T.V. , radio, internet, telephone etc.

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Health unit 1

 Part 11

     Health promotion model

The health promotion model (H.P.N) was proposed by Bola J. Pender .

It was designed to demonstrate "multidimensional nature of person as they interact with environment to pursue health".

The Model focuses on ___

Individual characteristics and experiences

Behaviour cognitions and affect 

Behaviour outcomes

Individual Characteristics And Experiences

Personal factors

a) Personal biological factor

It includes variables such as age ,gender, strength, balance, puberty.

b) Personal psychological factor

It Includes self esteem,self motivation

c) Personal soceio - cultural factor

Includes variables such as race , education

Behaviour (cognition, affect)

It is considered as a major motivational

1) Perceived benefits of action

Outcomes like physical fitness and stress reduction affects the persons plan to participate in health promotion.

2) Perceived barriers to action

A person's perception about time, inconvenience and difficulty in performing activity are the barriers.

3) Perceived self efficacy

Control on behaviour so higher the self efficacy results there are chances of lower perceptions of barriers.

4) Activity related affect

Subjective positive or negative feelings are based on behaviour.

The more the positive subjective feeling the more is self efficacy.

5) Interpersonal Influence

International influence are persons perception concerning behaviour,belief, attitudes.

6) Situational Influence

Behaviour includes available options, demand characteristic and features of environment.

Behaviour outcomes

Health promotion behaviour is the outcome of health promotion model, which helps I attaining positive health of client.

a) Commitments to plan of action

Concept of planned strategy leads to implementing the health behaviour.

b) Immediate Competing Demands and Preferences

Competing demands are alternative behaviour over which individual have low control because there are family care

Levels of Disease Prevention

Level of prevention are the actions aimed at elimination, minimising the impact of disease.

The goal of health care service are to promote health, prevent health and restore health.

Success of prevention depends upon_____

a) knowledge and causation

b) Dynamics of transmission

c) Identification of risk factors

Disease Prevention is described in terms of primary, premortal secondary and tertiary levels.

1. Primordial Prevention

It consists of action and measures.

It is the prevention of emergency or risk factor in population.

2. Primary Prevention

It is defined as action taken prior to the onset of diseases, which remove possibility that diseases will occur.

Types of primary prevention___

Health promotion

1. Health education

2. Environment modification

3. Nutrition

4. Lifestyle and behaviour changes

Specific protection

1. Immunization 

2. Specific nutrients

3. Protection

4. Control of hazard (air pollution)

IN HINDI:-

स्वास्थ्य संवर्धन मॉडल

स्वास्थ्य संवर्धन मॉडल (H.P.N) को बोला जे. पेंडर द्वारा प्रस्तावित किया गया था।

यह "व्यक्ति की बहुआयामी प्रकृति को प्रदर्शित करने के लिए डिज़ाइन किया गया था क्योंकि वे स्वास्थ्य को आगे बढ़ाने के लिए पर्यावरण के साथ बातचीत करते हैं"।

मॉडल ___ पर केंद्रित है-

व्यक्तिगत विशेषताएं और अनुभव

व्यवहार संज्ञान और प्रभाव

व्यवहार परिणाम

व्यक्तिगत विशेषताएं और अनुभव

व्यक्तिगत कारक

A) व्यक्तिगत जैविक कारक

इसमें आयु, लिंग, शक्ति, संतुलन, यौवन जैसे चर शामिल हैं।

B) व्यक्तिगत मनोवैज्ञानिक कारक

आत्म सम्मान, आत्म प्रेरणा शामिल है

C) व्यक्तिगत सामाजिक-सांस्कृतिक कारक

दौड़ , शिक्षा जैसे चर शामिल हैं

व्यवहार (अनुभूति, प्रभाव)

इसे एक प्रमुख प्रेरक माना जाता है

1) कार्रवाई के कथित लाभ

शारीरिक फिटनेस और तनाव में कमी जैसे परिणाम स्वास्थ्य संवर्धन में भाग लेने के लिए व्यक्तियों की योजना को प्रभावित करते हैं।

2) कार्रवाई के लिए कथित बाधाएं

समय, असुविधा और गतिविधि करने में कठिनाई के बारे में एक व्यक्ति की धारणा बाधाएं हैं।

3) कथित आत्म प्रभावकारिता

व्यवहार पर नियंत्रण इतना अधिक है कि आत्म-प्रभावकारिता का परिणाम बाधाओं की कम धारणा की संभावना है।

4) गतिविधि से संबंधित प्रभाव

व्यक्तिपरक सकारात्मक या नकारात्मक भावनाएं व्यवहार पर आधारित होती हैं।

सकारात्मक व्यक्तिपरक भावना जितनी अधिक होगी, आत्म-प्रभावकारिता उतनी ही अधिक होगी।

5) पारस्परिक प्रभाव

अंतर्राष्ट्रीय प्रभाव व्यवहार, विश्वास, दृष्टिकोण से संबंधित व्यक्तियों की धारणा है।

6) स्थितिजन्य प्रभाव In

व्यवहार में उपलब्ध विकल्प, मांग विशेषता और पर्यावरण की विशेषताएं शामिल हैं।

व्यवहार परिणाम

स्वास्थ्य संवर्धन व्यवहार स्वास्थ्य संवर्धन मॉडल का परिणाम है, जो मुझे ग्राहक के सकारात्मक स्वास्थ्य को प्राप्त करने में मदद करता है।

क) कार्य योजना के प्रति वचनबद्धता

नियोजित रणनीति की अवधारणा स्वास्थ्य व्यवहार को लागू करने की ओर ले जाती है।

ख) तत्काल प्रतिस्पर्धी मांगें और प्राथमिकताएं

प्रतिस्पर्धी मांग वैकल्पिक व्यवहार है जिस पर व्यक्ति का नियंत्रण कम होता है क्योंकि परिवार की देखभाल होती है

रोग की रोकथाम के स्तर

रोकथाम का स्तर बीमारी के प्रभाव को कम करने, उन्मूलन के उद्देश्य से की जाने वाली क्रियाएं हैं।

स्वास्थ्य देखभाल सेवा का लक्ष्य स्वास्थ्य को बढ़ावा देना, स्वास्थ्य को रोकना और स्वास्थ्य को बहाल करना है।

रोकथाम की सफलता _____ पर निर्भर करती है

A) ज्ञान और कारण

B) संचरण की गतिशीलता

C) जोखिम कारकों की पहचान

रोग की रोकथाम प्राथमिक, प्रसव पूर्व माध्यमिक और तृतीयक स्तरों के संदर्भ में वर्णित है।

1. प्राथमिक रोकथाम

प्राथमिक रोकथाम में कार्रवाई और उपाय शामिल हैं।

यह जनसंख्या में आपातकालीन या जोखिम कारक की रोकथाम है।

2. प्राथमिक रोकथाम

इसे रोगों की शुरुआत से पहले की गई कार्रवाई के रूप में परिभाषित किया गया है, जो इस संभावना को दूर करती है कि बीमारियां होंगी।

प्राथमिक रोकथाम के प्रकार___

स्वास्थ्य संवर्धन

1. स्वास्थ्य शिक्षा

2. पर्यावरण संशोधन

3. पोषण

4. जीवन शैली और व्यवहार में परिवर्तन

विशिष्ट सुरक्षा

1. टीकाकरण

2. विशिष्ट पोषक तत्व

3. सुरक्षा

4. खतरे का नियंत्रण (वायु प्रदूषण)

Health unit 1

  Part 10 

                                  Hospitals

Hospital is an integral part of a social and medical organisation, the function is to provide complete health care to patient.

"A hospital is an institution for health care and provide treatment by specialized staff and equipment."

Physical setup of hospital

1. Location of hospital

2. Provision for health factors

3. Construction of hospital building

Classification of hospitals

1. According to the size or bed capacity

100 or less bed capacity (small)

101-300 bed capacity (medium size)

301 to 1000 bed ( large hospital)

500 (teaching hospital)

200to 300 beds - district hospital

30 to 50 beds - community health center

6 to 10 beds - primary health care center

2. According to ownership

Government or public hospitals run by central state government.

Non-government hospitals run by clients fees, gifts.

3. According to objectives

Teaching hospital

Specialized hospital

Isolation hospital

Rural hospital

4. According to system of medicine

Long term care Hospitals

e.g cancer

Short term hospitals

5. According to management

Hospital run by union government (railway) Hospitals by state government

Hospitals run by autonomous bodies like AIIMS (New Delhi)

Voluntary hospitals ( CHC vellore)

Organization of hospital department

In hospitals various departments are maintained and organized.

Main objective of all departments is to provide quality services to patients.

Hospitals have following departments

Outpatient department

Outpatient department is the one where all patients except those who require emergency treatment.

Medical department

Patients admitted to different provide specialized care.

It includes pediatrics, cardiology, neurology, psychiatric, urology, obstetrics and gynaecology.

Nursing department

Nursing is one of the important department in hospitals.

Paramedical department

Laboratory services includes biochemistry, bacteriology, blood banking, etc.

Pharmacy department

Pharmacy is important factor in medical care.

It has responsibility of selection, storing, purchasing of drugs.

Radiology department

It includes facilities of---

X-ray

MRI(magnetic resonance image)

CT scan

Ultrasound

ECG (electrocardiogram)

Non-medical Department

Medical record department

This department includes records of patient who have been admitted, discharged or left against medical advice.

Central sterile department

This department supplies sterile equipments and these include sterile.

Dietary department 

This department is also plays crucial role for patients health.

This department provides proper balanced diet to patients.

House keeping department

This department responsibility for cleaning and furnishing of hospital including pre of infection.

Function of hospital

Diagnostic and therapeutic services

The chief function of hospital is to provide care to patient by early diagnosis.

Emergency and critical care

Hospitals provide care to the patients with acute illness in emergency condition and advanced care for life threatening disease.

Education and training

In order to improve the practice of health care professionals various education programs are conducted in hospitals.

Prevention of disease

There is immunization, outpatient services that will help in prevention of diseases.

Hospitals also prevent infection by using isolation wards.

Research

Hospital are providing opportunities for research to support clinical pradise and advancement in health care.

Rehabilitation

It is one of the important function of hospitals.

It is combined measure that help patients get back or improve the health conditions.

#novainstituteofnursingandparamedicalscience

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#rauniyar

#healthnotes

Health unit 1

 Part 9

Health promotions and preventions

Health promotion is a process of strengthen the individual or host and prevent the occurrence of the disease.

Health promotion involves the population as compared to focusing on people at risk.

The Principles

The focus of health promotion is an access to health services.

Development and improvement that is suitable to health.

Information and education are necessary component of health promotion.

Diagnostic Services

It facilitates the provision of timely,cost effective and highly quality diagnostic care in safe and secure environment.

These services function in the setting of ambulatory care, acute care, mental health, geriatric care and rehabilitation care.

Treatment Services

Treatment services are provided by various categories of health institutions.

* There are general hospitals, teaching hospital, region state hospital, district hospital.

* They also include public health services with available treatment Services.

* Emergency intervention and services should be integrated with primary care .

Rehabilitation

* Is a process used to give a healing touch to the patients who are suffering from physical or mental disorders.

* Rehabilitation program helps the patients to get back to his/her normal life.

Health Care Agency

Health Care Agency are established to India to provide health services to meet health needs, demand of individual.

Health Care services in India are delivered by both public and private sectors.

Public Agency

1. Public health Care centre

2. Hospitals

a) Rural hospitals

b) District hospitals

c) Teaching hospitals

3. Health insurance schemes

a) Employees State 

b) Central Government health schemes (CGHS)

4. Other agencies

 a)  Defensive services

b)  Railways

Private sectors

1) Hospitals

Acute in patients services

Intensive care

Emergency care

Surgical care 

Special care 

Special therapies

Councelling services

2. Long term care facilities

Intermediate and long term care for people with chronic illness.

Nurses provide care to the patients and support family members.

3. Outpatient setting

Treatment check up , follow up are the main services provided at outpatient setting.

These include clinics , mobile, treatment and diagnostic services.

4. Hospitals/institutions for illness

The main goal of the institution is to improve quality of the life until death.

Nurses provide pain control, comfort by using therapies.

E.g. yoga, massage, meditation

Unit 1

 Part 8

Delivery of health care services should

1. B we organise to meet the health needs of the entire population.

2. Cover full range of preventives , curative and rehabilitative services.

3. Based on policy objective of health for all.

Characteristics of Health care services

1. relevance

When the services provided in accordance with the needs is the priority for human population.

2. Adequacy

The services should adequate to the requirement.

3. Affordability

Cost of the services should be within the means of individual.

4. Integrated

Services should be combined and integrated and available at same place , and should be simple. 

5. Upto date

All the services based on latest technology.

6. Continuity

All the services once started should continue and must be available for money, resources.

7. Availability

Services must be available to the whole population.

# Principles of health care services

Services should make adequate provision for curative and preventive.

Health services should provide consultant, lab faciality.

The  health organisation should provide possible co operation.

Special provision is required for mother, children and mental children.

Health services should pay emphasis on creation and maintenance of healthy environment.

# Health promotion and prevention

It is a process of strengthen the individual or host and prevent the occurrence of disease. It involves the population as Compared to focussing on people at risk.

The principles of health promotion include

1. The focus of health promotion in an access to health services.

2. Development and improvement of environment that is suitable for health, includes specially the surrounding condition as work or home.

3. The promotion of healthy lifestyle and living conditions.

4. Information and education are accessary components of health promotion .

Health Care Team

It comprises the group of member to coordinate in order to provide comprehensive care to the patients.

Physician

Physician, dentist,surgen ,psychiatric and other professional health care specialist must past examination in their speciality to become certified and be permitted to in their area.

Physician Trend vin family medicine general medicine, general pediatry.

Common speciality include __

Cardiology

Neurology

Obstetrics and gynaecology

Pediatrics

Radiology etc

Health unit 1

 Part 7

Impact Illness on the client and and family

Illness is never isolated process. When an illness strike a person the family as the whole is affected by desease process.

The changes due to illness are as follows:-

Behaviour changes 

Patient or family experience behaviour changes such as anxiety,fear and shock .

Impact on family role

When illness occurre the role of the patient and family may changed.

This change may be for short term or long term.

During illness family members alter their lifestyle.

Impact on body image

The illness affects the physical appearance of the patients.

Impact on self concepts

Patient is living a restricted life and experiencing social isolation,show the individual feel frustrated and fear.

Impact on family dynamics

Illness individual affects the socio economic factors.

Factors causing stress in hospital

1. Unfamiliarity of surroundings.

2. Loss of independence

3. Separation from family

4. Financial problem

5. Lack of information

Health Care Services

Health has been declared as the fundamental human rights.

" The health care services are designed to meet the health need of community through hospital and community health care agency"

Health Care Services can be defined as "multitude of services rendered to individual families or community by agent of health care. Personal or professional for the purpose of promoting, maintening ,monitoring health."

Health unit 1

 Part 6

Classification of Illness

Acute Illness

Acute i generally develops suddenly and last a short period of time.

Some acute illness are serious and life threatening .

Chronic Illness

It is a long term health condition that may not have any cure.

eg. COPD(chronic obstructive pulmonary disease, Diabeties

Terminal Illness

Sometimes called as life threatening illness.

It is a disease that can not be cured or treated.

Age related Illness

Age associated illness means disease of elderly.

Illness behaviour

It is a complex process .

It involves the ways person monitor their bodies , define and interprete their symptoms, take remedial measures and use health care services.

Stages of Illness behaviour

The people generally pass through five stages of Illness.

Suchman (1979) described these stages

Symptoms Experience

It is a first stage in which a person comes to believe that something is wrong.

Patients can experience,pain, rashes,fever and cough.

At the end of this stage he is able to make decision that is symptom of Illness. It includes ABC

A     physical symptoms

B     Cognitive aspect

C    Emotional response

Assumption of sick role

The individual accept the sick role.

People do self treatment and delay to coming contact with health care professional.

It result in emotional changes such as depression.

Medical care Contact

At this stage the client acknowledges the illness and seeks to explain the causes symptom of disease.

After knowing some client seeks medical treatment,but other start denyed

 the diagnosis.

Assuming dependent rate

This stage  is characterized by the patients decision to accept the diagnosis and follow treatment plan.

Some people want to get information about the disease treatment, other prefer the physician.

After entering the dependent stage the client has to adjust disruption in daily activities which can effect the client.

Recovery or Rehabilitation

During this stage the individual or patient start gaining his/her original health status.

The changes vary dependent on the nature and duration of Illness.

Emotional Response to illness

 The patients who is suffering illness is under many emotional pressure.

The nurses must be able to recognise the sign and symptoms of stress an identity coping mechanisms.

Fear

Anxiety

Stress

Health unit 1

 Part 5

Immunization

Definition

Immunization is the most affective way of protecting the human body from infections disease.

                       OR

Immunization is the process of artificially inducing immunity or providing protection from disease.

                         OR

Immunization is define as a process by  which a person can be protected from disease by  giving immune biological substance which produce specific substance which produce specific protection against given disease, before it's occurance.

Important

The most important aspect in child care is to protect children against specific preventable disease like polio, pertusis, hepatitis B and tetanus.

Types of immunization

1. Live Vaccine

Prepared from live / weakened pathogens.

E.g.  BCG , Influenza, Yellow fever

2. Killed Vaccine

Prepared by killing the pathogens by heat or UV rays.

E.g. rabies

Site , complication, contra indication and after care 

BCG

It stand for bacillus calmate gurerin , given for protection from TB (tuberculosis)

Site

Middle of deltoid muscles over left arm.

After care

Follow BCG vaccination a papulle appeare in 2-3 weeks.

In 4-5 weaks papulle grows in size and then subside or break into shallow ulcer.

Ulcer heals in 8-12 weaks living a small scar.

Complection

Deep ulceration

Keloid formation ( scar tissue forms to protect the injury)

# Polio Vaccination

OPV is a cheaper easy to administered protects from poliomyelitis.

After care

After vaccination breast feeding can be given if child is Hungary,but hot drinks should be with held half an hours.

If child vomits give drop away.

# DPT Vaccination

It is combine Vaccine administered for the protection from three disease i.e., diphtheria, pertusis, tetanus.

Site

For children below one year the site should be lateral aspect of thigh (vastus laterails muscles), in older children. It may be given in upper and outer quadrants of geuteal muscles.

After care

Do not apply anything of infection site.

Croans syrup can be given in case of fever.

# Measles Vaccination

It protects the child from the measles.

Site

Given deltoid muscles of right arm .

After care

After vaccination, reaction may developed such as fever,rashes. Do not apply anything on site.

Hazards of immunization

Swelling

Redness

Tenderness

Reaction due to faulty techniques

Improve route

Site or dose

Faulty preparation

Reaction due to Hypersensitivity

Anaphylactic shock

Serum sickness

Health unit 1

 Part 4

Types of acquired immunity----

 There are two types of acquired immunity are as follows:-

1. Active immunity

2. Passive immunity

1. Active immunity (natural)

It is induced by natural exposure or by vaccination.

#  Humoral immunity

* it is defined as immunity mediated by antibodies, which are secreted by B lymphocytes.

* B lymphocytes secretes antibodies into blood and lymph.

* Blood and lymph are the body fluids. Since B lymphocytes provide immunity through hormones,so this immunity is called humoral immunity.

* Humural immunity is the measure defence mechanism against bacterial infection.

# Cell mediated immunity

* also called cellular immunity or T - cell immunity

* It is defined as the immunity develop by cell mediated response.

* It involves several types of cell's such as T lymphocytes, macrophages,nature killer cells, hence name cell mediated immunity

* Cell mediated immunity does not involve antibodies 

* cell mediated immunity is offered by T lymphocytes and it starts developing when T cells come in contact with antigen

∆  Live Vaccine

BCG for tuberculosis

MMR for measles ,mumps, rubella

Sabin vaccine for Polio mellitus

 ∆ Killed Vaccine

Inactivated polio vaccine

Pertusis (whooping cough)

2. Passive immunity 

It is the immunity that is transferred to recipient in redimate form.

Natural passive immunity

This immunity last for short period of time.

E.g. transport from mother to foetus through placenta.IgG ( immunoglobin), cross placenta to reach foetus.

Artificial passive immunity

Immunity transferred passively by administration of antibodies.

Difference between active immunity and passive immunity

 Active immunity                     Passive immunity

1. Produced by bodies      1.  received passively by  own immune system                                                                                               host,no                                                                                 involvement of                                              immune system.

2. Active immunity is         2. It is short lasting

long lasting

3. More affective              3. Less affective

4. Offer better protection   4. Inferior protection