Bsc Nursing 2nd year
Community Health Nursing - 2019
(Answers)
Answer. No. -1(a)
Healthy Life Style and its impact on the health of an individual:
A healthy lifestyle is a way of living that lowers the risk of being seriously ill or dying early.
Health is not only just about avoiding disease. It is also about physical, mental and social well being.
Problems like metabolic diseases, joint and skeletal problems, cardiovascular diseases, hypertension, over- weight can be caused by an unhealthy lifestyle.
Lifestyle has a significant impact on physical and mental health of human being some factors of lifestyle that influence on health are:
(1.) Diet and Body Mass Index (BMI): Diet is the greatest factor in lifestyle and has a direct and positive relation with health.
Poor diet and its consequences like obesity is the common health problem. Unhealthy life style can be measured by BMI.
(2.) Exercise: For treating general health problems, the exercise is included in life style.
The continuous exercise along with a healthy diet increases the health.
(3.) Sleep: One of the bases of healthy life is the sleep. Sleep cannot be apart from life. Sleep disorders have several social, psychological, economical and healthy consequences.
Lifestyle may have effect on sleep and sleep has a clear influence on mental and physical health.
(4.) Stress: Emotional Stress is chronic in nature. When an individual is struggling hard to meet his basic life demands, and living such, an irregular life, he is more susceptible to emotional stress due to failure or frustration.
(5.) Increased restlessness and fatigue: place or at home, sleep pattern of a person is disturbed and it leads to increased restlessness and fatigue.
Answer. No-1(b)
A community health nurse focuses on health of entire population or commu- nity CHN services are provided to individuals and families within the context of larger community.
CHN practice aims to improve the health of all people and minimize health problems among population by addressing determinants of health.
Role of CHN in helping adult population to adopt healthy life styles:
(1.) Health promotion:
(a.) Time to time health talks on various health problems or related topics.
(b.) Availability of resources for community.
(c.) Creating supportive environment.
(d.) Taking proper history and assessment of community.
(2.) Prevention:
(a.) Reproductive and family health and sexual health.
(b.) Prevention of chronic illness.
(c.) Nutrition/food security.
(d.) Mental health.
(3.) Health protection:
(a.) Prevention of communicable diseases.
(b.) Protection from injury.
(c.) Environmental health.
Other Roles of CHN:
(1.) Proper history and health assessment: A CHN should take complete history and proper health assessment to find out the cases of various health problems occuring in the community.
Head to toe assessment should also be done, e.g. A CHN should take proper history of workplace level of stress at job or at home.
(2.) Helping the community in reducing stress: A CHN should teach whole community in ways to reduce stress in life, e.g. yoga, meditation and to remain happy.
(3.) Advise the community to take proper rest and sleep: Atleast 6-8 hours sleep is necessary for an adult, so that his/her mind remains fresh and person should be able to carry out his/her day to day activities easily,
e.g. A CHN gives health education to minimize stress in life and to take 3. proper rest and sleep.
(4.) Advise the community to take a will balanced diet: A CHN should advise people to take healthy diet rich in proteins, fats, carbohydrates, vitamins and minerals,
e.g. health education with help of flash cards, charts to help people to take well balanced diet.
(5.) Advising the community to maintain good personal health and environment so that diseases can be prevented in future: Good personal and environmental hygiene is necessary to prevent from various air and water borne diseases, e.g. A nurse may help the community to wash hands before meals and after going to washroom.
Or
Answer. No-1(a)
Concept of Epidemiology
Epidemiology is defined as, "The study of the occurence and distribution of health related events, states and proceses in specified populations including the study of the determinants influencing such processes and the application of this knowledge to control relevant health problems".
Events: The health related events are all the conditions of the spectrum of health such as, disease, injury, disability and death.
Distribution: This refers to the pattern of occurance of disease in the community with reference to time, place and person.
This helps to study the trend of the disease over the years, geographical areas and over different population groups.
This study also helps to know the magnitude of the problem, gives a clue about the etiology, mode of transmission of the disease and also helps to formulate etiological hypothesis.
Determinants refers to risk factors related to particular disease. This study helps to test the etiological hypothesis formulated by descriptive study.
This aspect of epidemiology dealing with testing the hypothesis is known as 'Analytical epidemiology'.
Disease frequency means measuring the magnitude or extent of the health related event or health problem in the community, in terms of morbidity rates such as, incidence and prevalence and also in mortality rates.
(1.) The modern concept of epidemiology deals with measurements of occurence of heath related states or events which include diseases, disabilities, death, physiological conditions, health needs, demands and healthcare utilization.
(2.) Study of distribution of disease pattern, disabilities or death and other health related states or events in a community by place, person and time.
(3.) The study of determinants of health related states and events which can be done by testing of etiological hypothesis derived from descriptive epidemiological studies.
(4.) Planning of healthcare services based on the epidemiological studies, implementation and evaluation of health care services.
Answer. No.-1(b)
Definition of Epidemic:
Epidemic: (Epi = upon; demos = people).
(1.) An outbreak of disease in a community in excess of "normal expectation" and derived from a common or a propagated source.
(2.) The common epidemic diseases in India today are measles, chickenpox, viral hepatitis A, cholera, enteric fever, and cerebro-spinal meningitis.
Aids is a new epidemic disease world wide.
Definition or Investigation of an Epidemic:
(1.) Epidemic always signals some significant shift in the existing balance between the agent, host and environment.
(2.) Epidemiology has an important role to play in the investigation of epidemics.
The objectives of an epidemic investigation are:
(1.) To define the magnitude of the epidemic outbreak or involvement in terms of time, place and person.
(2.) To determine the particular condition and factors responsible for the occurence of the epidemic.
(3.) To identify the cause, source of infection and modes of transmission to determine measures necessary to control the epidemic; and
(4.) To make recommendation to prevent recurrence.
Investigation of an epidemic:
(1.) Verification of diagnosis:
(a.) Verification of diagnosis is the first step in an epidemic investigation, as it may happen sometimes that the report may be spurious, and arise from misinterpretation of signs and symptoms by the lay pubic.
(b.) It is therefore necessary to have the verification of diagnosis on the a. spot, as quickly as possible.
(2.) Confirmation of the existence of an epidemic:
(a.) This is done by comparing the disease frequencies during the same period of previous years.
(b.) An epidemic is said to exist when the number of cases is in excess of the expected frequency, for that population, based on past experience.
(c.) As in the case of common-source epidemics of cholera, food poisoning and hepatitis A, these epidemic are easily recognized.
(3.) Defining the population at risk:
(a.) Obtaining a map of the area:
(i.) Before beginning the investigation, it is necessary to have a detailed and current map of the area.
(ii.) If this is not available, it may be necessary to prepare such a map.
(iii.) It should contain information concerning natural landmarks, ii. roads and location of all dwelling units along each road or in isolated areas.
(iv.) The area may be divided into segments, using natural landmarks as boundaries. This may be divided into smaller sections.
(b.) Counting the population:
(I.) The denominator may be related to the entire population or sub-group of a population. It may also be related to total events.
For example: If the denominator is the entire population a complete census of the population by age and sex should be carried out in the defined area by house to house visits.
(ii.) For this purpose, lay health workers in sufficient number may be employed.
(iii.) Using this technique it is possible to establish the size of the population.
(4.) Rapid search for all cases and their characteristics:
(a.) Medical survey:
(i.) A medical survey should be carried out in the defined area to identify all cases including those who have not sought medical care, and those exposed to risk.
(ii.) Lay health worker may be trained to administer the "epidemiological case sheet" or questionnaire to collect the relevant data.
(b.) Epidemiological case sheet:
(i.) The epidemiologist should be armed with "epidemiological case sheet " for collecting data from cases and from person apparently exposed but unaffected.
(ii.) The epidemiological case sheet or case interview form should be carefully designated to collected relevant information.
(iii.) This includes age, name, sex, occupation, social class, travel, history of previous exposure, time of onset of disease, signs and symptoms of illness.
Personal contacts at home, work, school and other places; special events such as parties attended, food eaten and exposure to consumables such as water, food, milk, community visits, history of receiving injections or blood products, attendance at large gathering, etc.
For example: If the disease is food-borne, detailed food history is necessary.
(c.) Searching for more cases: The patient may be asked if he knew the other cases in the name, family, neighbourhood, school, work, place having onset within the incubation of the index cases.
The search for new cases shoud be carried out everyday, till the area is declared free of epidemic.
(5.) Data analysis: The data collected should be analyzed on ongoing basis, using the classical epidemiological parameters-time, place and person.
(a.) Time:
(i.) Prepare a chronological distribution of dates of onset and construct an "epidemic curve".
(ii.) Look for time clustering of cases
-A time relationship with exposure to a suspected source.
-Whether it is a common source or propagated epidemic.
- Whether it is a seasonal or cyclic pattern suggestive of a particular infection.
(b.) Place:
(i.) Prepare a "spot map" of cases, and if possible, their relation to possible source of infection,
e.g.: water supply, air pollution, food eaten, occupation, etc.
(ii.) Clustering of cases may indicate a common source of infection.
(c.) Person:
(i.) Analyze the data by age, sex, occupation and other possible risk factors.
(ii.) Determine the attack rates/cases, fertility rates, for those exposed and those not exposed and according to host factor.
For example: In most food borne outbreaks, food specific attack rates must be calculated for each food eaten to determine the source of infection.
(6.) Formulation of hypothesis: On the basis of time, place and person distribution of the agent-host-environment model, formulate hypothesis to explain the epidemic in terms of:
(a.) Possible source.
(b.) Causative agent.
(c.) Possible modes of spread.
(d.) The environment factor which enabled it to occur.
(7.) Testing of hypothesis:
(a.) All reasonable hypothesis need to be considered and weighed by comparing the attack rates in various groups for those exposed and those not exposed to each suspected factor.
(b.) This will enable the epidemiologist to exertion which hypothesis is consistent with all the known facts.
(8.) Evaluation of ecological factors:
(a.) An investigation of the circumstances involved should be carried out to undertake appropriate measures to prevent further transmission of the disease.
(b.) Ecological factors which have made the epidemic possible should be investigated such as sanitary status of eating establishments, water and milk supply, breakdown in the water supply system, movement of the human population, atmospheric changes such a temperature, humidity and air pollution, population dynamics of insects and animal reservoir.
(c.) The outbreak can be studied in a case of control fashion.
(9.) Further investigation of population at risk:
(a.) A study of the population at risk or a sample of it may be needed to obtain additional information.
(b.) This may involve medical examination, screening test, examination of suspected food, faeces or blood samples, biological studies, assessment of immunity status, etc.
For example:
(a.) Serological study may reveal clinically inapparent cases and throw a. light on the pathogenesis of the condition.
(b.) Healthy individuals from the same universe may be studied in a case of control fashion.
(c.) This will permit classification of all members as:
(i.) Exposure to specific potential vehicles.
(ii.) Whether ill or not.
(10.) Writing the report:
(a.) The report should be complete and convincing.
(b.) It may be necessary to implement temporary control measure at the commencement of an epidemic on the basis of known facts of disease.
(c.) These measures may be modified or replaced in light of new knowledge acquired by the epidemic investigation.
Answer.No.-2(A)
Common Risk Factors of NCDS
The risk factors are as follows:
(1.) Cigarette and other forms of tobacco smoking. Associated with lung cancer and chronic respiratory diseases.
(2.) Use of alcohol and poor nutrition: Associated with cancers and cardiovascular diseases.
(3.) Failure or inability to use preventive health care services for example, hypertension, cancer detection, management of diabetes, prenatal care and immunization.
(4.) Life style changes for example, sedentary life-style, excessive intake of fatty foods, lack of exercise and tension, are associated with obesity, cardiovascular diseases, hypertension and diabetes.
(5.) Environmental risk factors, i.e. air and water pollution, radiation exposure, exposure to occupational hazards.
(6.) Stress predisposes the person to hypertension.
(7.) Over weight and obesity: These are associated with heart disease stroke and diabetes mellitus.
(8.) Raised cholesterol is associated with heart disease and hypertension.
(9.) Cancer associated infection, e.g. hepatitis B and C virus.
(10.) Unhealthy diet: Many people consume high content of salt and high content of saturated fats and trans-fatty acids.
These are linked with high blood pressure and heart disease. Besides this there is low consumption of fruit and vegetables.
Risk of cardiovascular diseases, stomach cancer and colorectal cancer increases if diet does not contain adequate amount of vegetables and fruit.
(11.) Hypertension: It causes about 12.8% of all deaths and it is a risk factor for cardiovascular diseases.
(12.) Heredity and genetics.
Answer.No.-2(B)
Nurses role in the prevention of cardiovascular diseases:
(1.) Data collection: There should be basic reporting system of all cardiovascular diseases.
The nurse should collect the data regarding the cardio-vascular diseases.
(2.) Safety education: The nurse should provide safety education to people regarding cardiovascular diseases.
The nurse should educate the people regarding the risk factors regarding heart related problems and its safety measures.
(3.) Controlling cholesterol abnormalities: The nurse should educated the people avoid cholesterol rich diet.
Fatty foods are avoided in the meal. Serum cholesterol and LDL levels can usually be controlled by diet and physical activity.
(4.) Dietary measures: The nurse should provide education to adult people regarding diet. Soluble dietary fiber may also help lower cholesterol levels.
Soluble fibers, which are found in fresh fruits, cereal grains, vegetables and legumes, enhance the excretion of metabolised cholesterol.
(5.) Physical activity: The nurse should provide knowledge regarding physical activity. Nurse should encourage the people regarding physical activity.
Regular, moderate physical activity increases HDL levels and reduces triglyceride levels. The goal for the average person is a total of 30 minutes of exercise, 3 to 4 times/week.
The nurse helps patients set realistic goals for physical activity when the weather is hot and humid, the patient should be advised to exercise during the early morning or indoors and wear loose-fitting clothing, when the weather is cold, the patient should be instructed to layer clothing and to wear a hot.
The nurse can also advise the patient to avoid adverse weather conditions. The nurse should inform patient to stop any activity if they develop chest pain, unusual shortness of breath, dizziness, lightheaded- ness or nausea.
(6.) Medications: Medications are used in some instances to control cholesterol levels. If diet alone cannot normalize serum cholesterol levels, several medications have a synergistic effect with prescribed diet.
Lipid lowering medications can reduce CAD mortality in patients with elevated lipid levels and in those with normal lipid levels.
E.g. 3-hydroxy, 3-methylglutaryl coenzyme A, Nicotiric acids etc.
(7.) Promoting cessation of Tabacco use: The nurse should encourage the people avoid cigarette smoking.
Avoid tabacco because tobacco can effect the heart of the person and the person may suffer from the cardio- vascular disease.
(8.) Managing hypertension: The nurse should encourage avoid stressed environment.
Hypertension increases the work-load of the heart and this condition lead to cardiac failure.
Early detection of high blood pressure and adherence to a therapeutic regimen can prevent the serious consequences associated with untreated elevated blood pressure.
Answer.No.-(3)
The Concept and Scope of Demography
Concept of Demography: Demography is the branch of community medicine, which deals with the study of human population in a given area, usually during a given year, with reference to size, composition, behavior and distribution.
Size of population is described as the total number of persons residing in the country, it usually refers to the quantity of the population.
Composition is the distribution of population according to age, gender, literacy level, occupation, income, marital status, religion, so it describes the quality of the population.
Behavior of population means growth of the population over a period of decades. The trend of the population can be estimated through population projection.
Distribution of the population means density of the population per km²', rural-urban population ratio and location of the density of the population.
The Scope of Demography: There are broader and narrower and balanced views about its scope.
According to the broader view, the scope of demography is wide and it studies the causes of slow or rapid change in birth rate, death rate, population growth, sex ratio and health conditions.
Demographic studies are placed broadly under four categories.
(1.) Descriptive demography: Under which are studied census and registration statistics.
(2.) Analytical Demography: Which deals with analysis of the data collected and rates and ratios of population change.
(3.) Comparative demography: which covers study of different aspects of population and their determinants at two different places and at two different points of time.
(4.) Historical Demography: under which time series, and study of rates and ratios of population change are studied.
According to this view, in demography has many economic problems such as related to employment and income conditions of the masses, labour conditions and their living standard, information about production and consumption, rate of growth of population, population change and overall quality of life occurs.
According to the narrower view the scope of demography is restricted, under demography only births, death, migration, etc. is covered.
But urbanization, transportation, communication, rehabilitation, etc. all these subjects however, cannot be included under demography and it cannot be studied with the help of demography.
Balanced view presented that demography includes study of death, birth and rates of growth of population, information about female population, their education, health conditions, marital status, distribution of population and their classification according to their occupation and socioeconomic conditions.
Answer.No.- 3(B.)
The Methods of Collection of Demographic Data:
Data can be collected using the following methods:
(1.) Questioning: By asking questions, e.g. asking about benefits of immunization.
(a.) Questionnaire can be used as a tool:
A questionnaire is a set of questions related to a particular phenomena, answers to which are sought by the community health nurse.
It can be mailed or got filled in personal presence.
For example: A questionnaire can be mailed to a school authority, to get information about the physical facilities, number of students and teachers etc. in the school.
(b.) Interview schedule: It is a process of collecting data by face to face conversation.
It is of two types:
Structured and Non structured.
(i.) In structured interview, there are pre determined questions which are asked from the individual. For example: "How many members are there in the family?"
(ii.) In unstructured interview, questions are asked which are not predetermined.
(2.) Observation: Five senses are used in observation such as collecting environmental data.
It is of two types:
(a.) Direct observation: When subject knows that he/she is being observed and information is collected. Data may or may not be accurate.
(b.) Indirect observation: When subject does not know about the observation.
(i.) This type of data is always correct, because subject behaves normally without manipulating things.
(ii.) Observation promotes attention.
(ii.) It requires correct use of the senses of sight, hearing, touch, smell, movements, etc.
(iv.) A nurse should cultivate correct observation.
(v.) Observation checklist can be used as a tool for observation.
(3.) Record analysis:
(a.) Such as immunization records of under five year old children.
(b.) Eligible couple record.
(c.) MMR, IMR should be analysed.
(d.) Maternal and child health records, (including antenatal care, po natal care, child care and nutrition).
(4.) Survey: It is the method used to collect data about community health status.
It is less efficient than interview and observation.
(5.) Wind shield survey: It involves is recording observations about community sanitation, gathering places, geographic and geopolitical dimensions through an automobile wind shield.
Answer.No-4(a)
Determinants of Health: Health is multifactorial. The factors which influence health lie both within the individual and externally in the society in which he or she lives.
(1.) Biological determinants: The physical and mental traits of every human being are to some extent determined by the nature of his genes at the moment of conception.
The genetic make up is unique in that, it cannot be altered ter conception. A number of diseases are now known to be of genetic origin,
e.g. chromosomal anomalies, errors of metabolism, mental retardation, some types of diabetes, etc.
Now a days, medical genetics offers hope for prevention and treatment of a wide spectrum of diseases, thus the prospect of better medicine and longer, healthier life.
(2.) Behavioural and socio-cultural conditions: The term "lifestyle" is rather a diffused concept often used to denote "the way people live", reflecting a whole range of social values, attitudes and activities.
It is composed of cultural and behavioural patterns and lifelong personal habits that have developed through processes of socialization.
Life-styles are learnt through social interaction with parents, peer groups, friends and siblings and through school and mass media.
(3.) Environment: It was Hippocrates who first related disease to environmental factor as climate, water, air, etc.
Environment is classified as "internal" and "external".
-The internal environment of man pertains to "each and every component part, every tissue, organ, organ-system and their harmo- nious functioning" within the system.
-The external environment consists of those things to which man is exposed after conception.
It is defined "all that which is external to the individual human host".
It can be divided into physical, biological and psychosocial components, any or all of which can affect the health of man and his susceptibility to illness.
(4.) Socio-economic conditions: Socio-economic conditions have long been known to influence human health.
For the majority of the world's people, health status is determined primarily by their level of socio- economic development,
e.g. per capita GNP, education, nutrition,employment, housing, the political system of the country etc.
Those of major importance are:
(a.) Economic status
(b.) Education.
(c.) Occupation
(d.) Political system
(5.) Health services: The term health and family welfare services cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health.
The purpose of health services is to improve the health status of population,
e.g. Immunization of children can influence the incidence/prevalence of particular diseases.
Provision of safe water can prevent mortality and morbidity from water- borne diseases.
(6.) Gender: The commission drew up an agenda for action on women's health covering nutrition, reproductive health, the health consequences of violence, ageing, lifestyle related conditions and the occupational environment.
Answer.No.- 4(B)
The impact of Socio-cultural practices in determining health of an individual:
Cultural or religious dietary rules may affect food and nutrition security and health by affecting the quantities of food consumed dietary diversity and the intake of nutrient-rich foods.
Significant life events such as pregnancy ana childbirth are generally characterized by numerous cultural or religious beliefs and practices regarding food and health.
The examples of these beliefs and taboos are given below:
(1.) According to supernatural theory, Disease is a supernatural phenomenon governed by a hierarchy of vital powers.
These powers can interact, and they can reduce or enhance the power of a person. Disharmony in these vital powers can cause illness.
Numerous societies share the be- lief that evil spirits, witchcraft and the evil eye can cause illness or other problems.
(2.) Another example of these beliefs is observed differences in dietary patterns based on religions like following a vegetarian or non vegetarian dietary pattern is strongly influenced by religious beliefs.
(3.) There is substantial variation in the classification of foods as hot or cold and in the perceived consequences of eating such foods between countries, regions, communities and even individual.
In pregnancy commonly considered a hot state and the postpartum period a cold state.
-Hence, pregnant and postpartum women often face a large number of food proscriptions and prescriptions based on the hot-cold belief.
Often the consumption of certain foods is associated with a particular illness or health problem.
- In parts of India, it is believed that the consumption of papay that is a hot food may cause abortion.
- Rural women in Nepal believe that mango, a hot food, are good to eat during pregnancy in moderate quantities, but overconsumption of mangoes can cause abortion.
- Rural Bangladeshi women believe that "pregnant women should not eat during the evening or on a moonless night, because doing so upsets Rahu (a Hindu God).
(4.) In Sub-Saharan countries it is commonly believed that sexually trans- mitted diseases (STD's) or complications during childbirth are the result of the violation of (food) taboos and often interpret the occurrence or persistence of illness as a punishment for the violation of food taboos."
(5.) Another example is a direct causal link between the consumption of certain foods and the occurrence of diseases or other health problems, without reference to supernatural powers.
Associations between certain foods and diseases are often explained by categorizing foods as strong and weak or digestible and indigestible for example it is believed that eating pork will cause skin disease.
(6.) Cultural or religious dietary practices are frequently observed because of belief that non-observance will cause physical or mental illness, slow down recovery from iliness, lead to malformations or result in unfavorable characteristics such as stuttering or baldness.
These fears are especially prevalent during the reproduction cycle:
-In many societies mothers fear that non-observance of dietary and health practices during pregnancy will lead to miscarriage, malformation of the baby or illness of the mother or baby.
Answer.No.-5(a)
Demographic Transition:
Demographic transition is a model used to represent the movement of high birth and death rates to low birth and death rates as a country develops.
There are four stages to the demographic transition model:
Stage 1 (Pre-transition): Characterized by high birth rates and high fluctuating death rates.
Stage 2 (Early transition): During the early stages of transition, the death rate beings to fall. As birth rates remains high, the population starts to growth rapidly.
Stage 3 (Late transition): Birth rates start to decline Ine rate of population growth decelerates.
Stage 4 (Post-transition): Post-transitional societies are characterized by low birth and low death rates. Population growth is negligible or even enters a decline.
Answer.No.-5(b)
Communication:
The word communication is derived from Latin word "Communicare", which means to participate, to impart or inform.
Communication can be regarded as a "two-way process of exchanging or sharping ideas, feelings and information".
Broadly it refers, "to the countless ways/ methods that humans have of keeping in touch with one another".
Communication is more than mere exchange of information. It is a process necessary to pave way for desired changes in human behavior, and informed individual and community participation to achieve pre determined goals/objectives.
The individuals and groups can be motivated towards health protection by using communication skills in health education.
Health communication is an important area of communication. The term "health communication" is often used with health education, which itself suggests communication of knowledge.
Elements of Communication: Communication which is the basis of human interaction is a complex process.
The main components of communication are:
Sender
↓
Message
↓
Encoding
Channel
↓
Receiver/Recorder
↓
Decoding
↓
Feedback
(1.) Source/Sender: The sender (communicator) is the originator of the message.
To be an effective communicator, he must know:
(a.) his objectives, clearly defined.
(b.) his audience: interests and needs.
(c.) his message.
(d.) channels of communication.
(e.) his professional abilities and limitations.
The impact of message will depend on his own social status (authority), knowledge and prestige in the community.
(2.) Message (Content, Information or Ideas): A message is the information or content of communication which the communicator transmits to his audience to receive, understand, accept and act upon.
It may be in form of words, pictures or signs. Health education may fail in many cases, if its message is not adequate or clear.
A good message must be:
(a.) in line with the objectives.
(b.) meaningful.
(c.) based on felt needs.
(d.) clear and understandable.
(e.) specific and accurate.
(f.) according to audience.
(g.) interesting.
(h.) culturally and socially acceptable.
Transmitting or conveying the correct or right message to the right audience, at the right time is a crucial factor in successful communication.
(3.) Encoding: To convert content, information or ideas into codes (words, pictures, actions etc.) is known as encoding.
(4.) Channel (Medium): Channel is the media of communication between the sender and the receiver.
The whole communication effort is based on three media systems,
i.e. Interpersonal Communication, e.g. counseling,
traditional or folk media, e.g. puppet show, folk songs and nautanki, etc.
mass media, for example, radio, telephone, television, written message, posters, films and videos, etc. can be the mass media channels of communication.
Mass media is used to reach a very large population of a town, district, state or nation within a short time.
(5.) Receiver (Audience): All communications must have an audience, this may be a single person or a group of people.
Without audience, communication is nothing more than mere noise.
The audience may be of two types:
(a.) Controlled.
(b.) Uncontrolled.
A controlled audience is one which is held together by a common interest. It is a homogeneous group.
An uncontrolled or free audience is one which has gathered together from motives of curiosity. The more homogeneous the audience the greater are the chances of an effective communication.
(6.) Decoding: The opening of codes is called as decoding. It provides meaning to the received content.
(7.) Feedback: This is the flow of information from the receiver or audience It is the reaction of the audience to the message.
If the message is not clear or otherwise not acceptable the audience may reject it. The feedback thus provides an opportunity to the sender to modify or improve the message and render it acceptable.
In mass communication it takes some time to get feedback. Feedback is generally obtained through polls, attitude surveys and interviews.
Answer.No.-5(C)
Immunization Schedule
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.
Vaccines stimulate the body's own immune system to protect the person against subsequent infection or disease.
Objectives:
(1.) To reduce infant and maternal mortality and morbidity rates.
(2.) To control the infectious diseases and their carriers.
(3.) To increasing the health level and life expectancy of citizens by generating prophylaxis against diseases.
(4.) To develop sufficient capacity and technique to manufacture vaccines.
Answer.No.-5(D)
Healthful Housing
With broadening concept of housing, healthful housing concept has also being changed.
The following criteria are considered to be best for an appropriate healthful housing.
(1.) Site: The site should be elevated from its surrounding.
(2.) Set back: There should be proper lightening and ventilation and proper space all around.
(3.) Floor: The floor should be pucca and impermeable.
(4.) Walls: Walls should be reasonable strong and should have low heat capacity.
(5.) Roof: The height of roof should not be less than 10 feet.
(6.) Rooms: No. of living rooms should not be less than 2.
(7.) Floor area: Floor area of living room should not less than 120 sq ft.
(8.) Cubic space: Unless means are provided for mechanical replacement of air the height of rooms should be atleast 500 c. ft per capita.
(9.) Window: Should have at least 2 windows in room.
(10.) Lightening: The daylight factor should exceed 1% over half floor area.
(11.) Kitchen: Every dwelling house must have a separate kitchen. Kitchen must be protected against dust and smoke.
Answer.No.-5(E)
Role of Community Health Nurse in Prevention and Management of Malnutrition:
Primary Prevention
(1.) Health promotion:
(a.) Health education to mothers about good nutrition and food hygiene: Mothers should be educated regarding the importance of balanced diet and essential nutrients.
Health education should be provided regarding the functions of various components of food.
(b.) Distribution of supplements (distribution of iron, folic acid and vita- b. min A): Iron and folic acid supplements should be given to the antenatal mothers, adolescent girls to prevent anemia.
Vitamin A supplements should be given to the children to prevent the deficiency disorders.
(c.) Promotion of breastfeeding: Exclusive breastfeeding for six months should be encouraged.
(d.) Development of low cost weaning foods: Mother should be educated regarding the importance of weaning diet and how to introduce the various foods.
(e.) Measures to improve family diet: Advice should be given to eat plenty of fresh fruits and vegetables instead of fatty products.
Whole meal cereals and pulses should be consumed. Avoid fatty and sugary foods and alcoholic drinks.
(f.) Nutritional education: Education should be provided regarding the importance of getting enough food, making the meals hygienically and keeping food safe and clean.
(2.) Specific protection:
(a.) Consumption of specific protein diet, eggs, milk, fresh fruits should be encouraged.
(b.) Fortification of food with essential nutrients such as iodine.
Secondary Prevention:
(1.) Screening and active case-finding: Community health nurse should periodically screen the children for signs and symptoms of malnutrition like wasting and edema.
Height and weight of the children should be re- corded in growth charts. Head circumference, chest circumference and mid upper arm circumference should be measured.
Children identified as having mild/moderate edema or are wasted, but have a good appetite should be given therapeutic food (high calorie and high protein diet).
Only those who have poor appetite or ill should be referred for hospitalized care.
(2.) Community sensitization: Community health nurse should educate the people regarding impact of malnutrition.
They should be educated that malnutrition not only impacts growth in the short term, but can also limit total bone growth.
Malnutrition negatively effects brain development causing delays in motor and cognitive development.
(3.) Community mobilization to improve access to appropriate care and achieve high coverage.
(4.) Regular deworming of school and preschool children: Community health nurse should participate in Periodic deworming of all children to treat helminthic infections as they can interfere with the normal growth and development of children.
Health and hygiene education reduce trans- mission. Provision of adequate sanitation is also important in poor settings.
Tertiary Prevention:
(1.) Nutritional rehabilitation services: Community health nurse should educate the people about centers that provide rehabilitative services to the moderately wasted children and treat uncomplicated severe malnutrition.
The centers should be integrated into the child health services and could be attached to a clinic.
(2.) Hospital treatment.
(3.) Follow up of cases.
Community Health Nurse along with the team of Health Workers can play a very important role in prevention and control of Malnutrition among Under Five children.
(1.) Community Health Nurse should perform proper assessment of malnutrition among under five year children by appraisal of nutritional status
(it includes anthropometric assessment and clinical assessment),
appraisal of dietary intake and appraisal of ecological background
(it includes surveys related to health and disease profile, morbidity and mortality patterns, among under five, primary health care services, health and nutritional awareness, socio-economic and socio cultural aspects, nutrition intervention programmes).
(2.) Community Health Nurse should encourage the mothers and family members of under five year children to monitor growth and development of their children and to bring them to health centres for regular check up and record weight, MAC, height, etc.
(3.) Community Health Nurse should ensure 100% coverage of administration of vitamin A mega doses to children.
(4.) Community Health Nurse should help and guide health workers and mothers to detect early cases of malnutrition and other nutritional deficiencies such as vitamin A, iron and vitamin D and refer them to health centres as needed.
(5.) Community Health Nurse should guide and supervise health workers top conduct nutrition education on breastfeeding, weaning and supplementing of diet, selection of food items, storage, preservation of food, food hygiene, etc.
(6.) Community Health Nurse should guide and supervise health workers to participate in National Nutrition Programmes like Integrated Child Development Scheme, Mid day meal programme, and other nutrition supplementary programmes.
(7.) Community Health Nurse should encourage for increased production of processed food based on oil seed meals and their distribution through health centres.
(8.) Community Health Nurse should encourage the mothers of under five children to participate in Anganwadi day programmes to learn about preparation of healthy diet.
Answer.No.-5(F)
Analytical Epidemiology
Analytical studies are the second major type of epidemiological studies and is concerned with the search for causes and effects, or the why and the how. Epidemiologists use analytic epidemiology to quantify the association between exposures and outcomes and to test hypotheses about causal relationships.
It has been said that epidemiology by itself can never prove that a particular exposure caused a particular outcome. Often, however, epidemiology provides sufficient evidence to take appropriate control and prevention measures.
Analytical studies comprise two distinct types of observational studies:
(1.) Case control study: Case control studies has three distinct features:
(a.) Both exposure and outcome have occurred before the start of the study.
(b.) The study proceeds backwards from effect to cause.
(c.) It uses a control or comparison group to support or refute an inference.
A case control study involves two populations: cases and controls.
Case control studies are basically comparison studies.
Cases and controls must be comparable with respect to confounding factors such as age, sex, occupation, social status, etc.
For example, one can use as cases the immunized children and use as controls un-immunized children and look for factors of interest in their past histories.
Case control studies have been used effectively for studies of many cancers and other serious conditions such as cirrhosis of the liver, lupus erythematosus and congestive heart failure.
(2.) Cohort study: Cohort study is another type of analytical study which is usually undertaken to obtain additional evidence to refute or support the existence of an association between suspected cause and disease.
The distinguishing features of cohort studies are:
(a.) The cohorts are identified prior to the appearance of disease under investigation.
(b.) The study groups so defined are observed over a period of time to determine the frequency of disease among them.
(c.) The study proceeds forward from cause to effect.
Types of Cohort Studies:
Three types of cohort studies have been distinguished on the basis of time of occurrence disease in relation to the time at which the investigation is initiated and continued:
(a.) Prospective cohort studies: It is one in which the outcome has not yet occurred at the time investigation begins. Most prospective studies begin in the present and continue into the future.
(b.) Retrospective cohort studies: A retrospective cohort study is one in which the outcomes have all occurred before the start of the investigation.
The investigator goes back in time, sometimes 10 to 30 years, to select his study groups from existing records of past employment, medical or other records and traces then forward through time from a past date fixed on the records, usually upto the present.
(c.) combination of retrospective and prospective cohort studies: In this type of study, both the retrospective and prospective elements are combined.
The cohort is identified from the past records and is assessed of the date for the outcome.
The same cohort is followed up prospectively into future for further assessment of outcome.
Answer.No.-5(G)
Terminal Surgical Method for Planned Family: Once the family is complete, it is good to think and adopt a method which is terminal and provides permanent protection.
Sterilization is the only method gives permanent protection from conception.
Either husband or wife can under go sterilization by a simple surgical operation, i.e. vasectomy or tubectomy respectively.
(1.) Vasectomy: Vasectomy is sterilization of male. It is a very simple and minor operation which takes hardly 15-20 minutes.
The operation can be done is primary health center under local anaesthesia by a trained doctor. A strict aseptic technique is to be followed to prevent infection.
The operation involves a small cut on both sides of the scrotum, then a small portion of vas deferens (about 1 cm) on either side of the scrotum is cut and ligated, folded back and sutured. In this way coma the risk of recaualization is reduced.
This operation does not affect sexual characteristics and sex life in any form. The sperms are produced but are not ejaculated along with semen. Does not affect the maleness or masculine strength.
(2.) Tubectomy: Tubectomy is sterilization of female. This is done by resecting a small part of fallopian tubes and ligating the sected ends.
The closing of tubes can also be done by using others alternative methods like closing with hands, clips electro cautery. The operation can be done through abdominal or vaginal approach.
The most common abdominal procedures are laproscopy and mini laparotomy. Laproscopy is more popular in India.
Tubectomy may be done after delivery (postpartum), between deliveries (inter partum) and after abortion. The woman should not have any major illness.
Guidelines for sterilization:
Sterilization, both male and female can be done in primary health center in rural, hilly and tribal areas having facilities for such operations.
Some guidelines are provided by the government which need to be followed. These are:
(1.) Age of husband and wife: The age of husband should be between 25 to 50 years. The age of the wife should be between 20 years to 45 years.
(2.) No. of living children: The motivated couple should have 2 living children when undergoing sterilization.
(3.) Relaxation of age: The lower age limits of the husband may be relaxed if necessary when couple has 3 or more living children.
(4.) Motivation and consent: There is no coercion force/outside pressure.
(5.) Awareness of its implications.
END
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