Models of Prevention.pptx

IT INCLUDES CONTENT ON LEVELS OF PREVENTION AND MODELS OF HEALTH.

1. Models Of Prevention

2. Definition Health: WHO defines Health as “a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity”.

3. Views of Health: All people free of diseases are not equally healthy Health is condition of life rather than pathological state A complex concept, more than absence of disease

4. Prevention The goals of medicine are to promote health, to preserve health & to restore health when it is impaired. Depends on knowledge of causation, dynamics of transmission, identification of risk factors, availability of prophylaxis or early treatment

5. Nurses’ role in Health A healing presence , willing to learn from patients by listening, being attentive, recognizing & respecting others way of coping. Needs to have adequate knowledge Must understand & remember the concept of health promotion, wellness & illness & that they mean differently to different people.

6. Need for Prevention Iceberg of Disease: A disease in a community – Iceberg The floating tip- clinical cases (What the Physician sees) The vast submerged portion- hidden mass of disease, (latent, inappropriate, undiagnosed cases)

7. Detection & control of the submerged part- a challenge to modern technique in preventive medicine. Especially in diseases like hypertension, DM, anemia etc, where unknown morbidity far exceeds the known morbidity

8. Levels of Prevention Primordial prevention Primary prevention Secondary prevention Tertiary prevention

9. Primordial prevention Primary prevention in purest sense Prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared Eg : Discouraging children from smoking & other ill habits to prevent diseases like hypertension

10. Primary prevention An action taken prior to the onset of disease which removes the possibility that a disease will occur. Intervention in pathogenesis phase of the disease

11. Secondary prevention “A process which halts the progress of the disease at its incipient stage and prevents complications.” Specific interventions or early diagnosis & adequate treatment. Attempts to arrest the disease process An imperfect tool in the control of transmission of disease

12. Tertiary prevention Defined as “ All measures available to reduce or limit impairments & disabilities, minimize sufferings caused by existing departures from good health & to promote the patients adjustment to irremediable conditions.” Done when the disease process has advanced beyond its early stage.

13. Models of Health Model: A theoretical way of understanding a concept or an idea They represent various ways of approaching a complex issue. Models of Health & Illness contain a combination of biological characteristics, behavioral factors & social conditions.

14. Uses of Health models To help nurses understand patient’s attitudes & values about health & illness in order to provide effective care To help the nurses understand & predict patient’s health behavior, including how they use health services, participate in recommended therapy & care for themselves.

15. Health Belief model Rosenstoch’s Model Addresses the relationship between a person,s beliefs & behaviors Health Beliefs are ideas, convictions, & attitudes regarding health & illness.

16. Health Belief model contd As beliefs influence behavior, they positively or negatively affect patient’s level of health. Positive health behaviors Negative health behaviors

17. 3 components: Individual’s perception of illness Modifying Factors Variables affecting the likelihood of client’s preventive action

18. Health belief model

19. Health Promotion Model Pender’s Model Complement to Health Belief model Explains the likelihood of health promoting actions being taken.

20. Neuman system model Betty Neuman (1972) Health care system model Depicts an open system in which person and their environment are in dynamic interaction

21. Five interacting variables: Physiological Psychological Socio cultural Developmental Spiritual

22. 3 preventions as intervention modalities Primary Secondary Tertiary

23. Primary prevention Identify the community risk factor Plan for health education programs with community leaders Secondary prevention Identify the stressors and begins treatment Tertiary prevention Appropriate when the community becomes chronically dysfunctional.

24. Nightingale’s Environmental Theory Florence Nightingale - First Nurse Theorist Defined Nursing “The act of utilizing the environment of the patient to assist him in recovery”

25. Nightingale’s Assumptions Nursing is separate from medicine Nurses should be trained. The environment is important to the health of the patient. The disease process is not important to nursing Nursing should support the environment to assist the patient in healing

26. Nightingale’s Assumptions contd Research should be utilized through observation on empirics to define the nursing discipline. Nursing is both an empirical science & an art Nursing’s concern is with the person in the environment The person is interacting with the environment

27. Nightingale’s Assumptions contd Sick and well are governed with the same laws of health. The nurse should be observant and confidential.

28. Goal of Nursing Assisting the patient in his retention of his vital powers by meeting his needs & thus putting the patient in best possible environment for healing.

29. Three Types of Environments Physical Psychological Social

30. Physical environment Consists of physical elements like ventilation, warmth, cleanliness, light, noise and drainage where the patient is being treated Affects all other aspects of the environment.

31. Psychological environment Can be affected by a negative physical environment which then causes STRESS. Requires various activities like manual work, appealing food, a pleasing physical environment to keep the mind active & help the person survive psychologically.

32. Social environment Involves collecting data about illness and disease prevention. Includes components of the physical environment - clean air, clean water, proper drainage.

33. Perspective on Nightingale’s 13 canon Observation Personal Cleanliness Petty Management Light Health of Houses Cleanliness of rooms

34. Perspective on Nightingale’s 13 canon contd Ventilation & warming Bed & Bedding Taking food What food Noise Chattering Hopes & advices Variety

35. Regarded one’s senses, especially observation as reliable means of obtaining & verifying Knowledge Theory must be reformulated if inconsistent with empirical evidence Observation – important to all nursing functions

36. PRECEDE- PROCEED Model A comprehensive model for assessing health & quality of life and for designing, implementing & evaluating health promotion & other public health programs to meet those needs. PRECEDE- PROCEED are acronyms

37. How the Model works? Assesses the environment where the group lives, considering social factors that influence health behavior Examines both internal & external factors that predispose it to certain behaviors & health problems Identification of factors that help in adopting healthy actions

38. PRECEDE P - P redisposing R - r einforcing & E - e nabling C - c onstructs in E-e ducational D - d iagnosis

39. Phases of PRECEDE Has 4 phases Phase I: Identifying the ultimate desired result. Phase II: Identifying & setting priorities among health or community issues Phase III: Identifying the predisposing, enabling & reinforcing factors Phase IV: Identifying the administrative & policy factors

40. PROCEED P-Policy R- regulatory & O- organisational C-constructs in E-Educational & E- environmental D-development

41. Phases of PROCEED Phase V: Implementation Phase VI: Process Evaluation Phase V: Impact Evaluation Phase V: Outcome Evaluation

42. The OMAHA System A Nursing Process system. Comprises of Nursing Diagnosis Intervention Evaluation

43. Nursing Diagnosis Called “ The OMAHA Problem classification scheme” Organised at 4 discrete levels of abstraction All 4 levels consistent & parallel The four levels are Problems Domains Modifiers Signs & symptoms

44. The Four Domains Define the scope of community health nursing Environmental Psychosocial Psychological Health related behaviors There are 40 client problems in all under these domains The term ‘Other’ included under each domain

45. Intervention Scale A Systematic arrangement of nursing actions Organized under 3 levels of abstraction & specificity (Categories) Represents the essence of Community Health Nursing

46. Intervention Scale There are Four categories: Health teaching Treatments & Procedures Case Management Surveillance

47. Intervention Scale The second level of OMAHA intervention scheme is a list of 62 ‘Targets’ Used to delineate a problem specific intervention Eg : Anatomy/ Physiology Behavior modification Bronchial Hygiene Bonding ….

48. Intervention Scale contd The Third Level: Designed for client specific information Example: Income Low/no income Uninsured medical expenses Inadequate money management Able to buy only necessities Difficulty buying necessities Other

49. Problem Rating Scale for Outcomes For evaluation purpose A Five point Likert Rating scale Offers a systematic, recurring way of measuring client progress through out Initial rating established on admission Used as baseline

50. Problem Rating Scale for Outcomes contd Consists of likert scale for 3 concepts Knowledge Behavior Status Each has a continuum of 5 categories from very positive to negative

51. Milio’s framework for prevention Nancy Milio - nurse& leader in public health policy & education Includes concepts of community- oriented, population focused care Behavioural patterns of populations Main determinant of unhealthful choices is lack of knowledge

52. Neglected role of community nursing to examine determinants of community health through public policy

53. Milio’s proposition Health status of population is a function of lack or excess of health sustaining resources Behavior patterns of population are related to habits of choice from actual or perceived resources available Organisational decisions determine th erange of personal resources available.

54. Milio’s proposition contd Individual health related decisions are influenced by efforts to maximize valued resources in both personal & societal domains Social change reflects a change in population behavior pattern Health education impacts behavior patterns minimally without new health promoting options for investing personal resources

55. THANK YOU!!!!