Health Promotion PDF

Health Promotion and Educational Technology 2024-2025 1 No List of content 1. Introduction to Health Promotion 3 2. Health Education and Health 13 Promotion 3. Health Promotion and Disease 23...

Health Promotion and Educational Technology 2024-2025 1 No List of content 1. Introduction to Health Promotion 3 2. Health Education and Health 13 Promotion 3. Health Promotion and Disease 23 Prevention 4. Immunization 29 5. Nutrition and Health Promotion 35 6. Maternity Nursing 45 7. Child Health Services 52 8. Family Health Promotion 60 9. Nurses Role in Health Promotion 68 10. Telenursing 74 2  Introduction to Health Promotion Learning objectives: At the end of the lecture; the student will be able to: 1. Define health promotion & Health. 2. Factors affecting Health. 3. Five Approaches to health promotion 4. List sites for health promotion activities. 5. Principle of health promotion program 6. Challenges of health promotion 3  Introduction to Health Promotion Introduction: Health promotion is an important component of nursing practice. It is a way of thinking that revolves around a philosophy of wholeness, wellness, and well-being. In the past two decades, the public has become increasingly aware of and interested in health promotion. Many people are aware of the relationship between lifestyle and illness and are developing health-promoting habits, such as getting adequate exercise, rest, and relaxation; maintaining good nutrition; and controlling the use of tobacco, alcohol, and other drugs. Definition of Health Promotion: The World Health Organization (WHO) defines health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health". This involves a wide range of social and environmental interventions designed to benefit and protect individual health and quality of life by addressing and preventing the root causes of ill health, rather than just focusing on treatment and cure. The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". This definition emphasizes that health is not just about being free from illness, but also about achieving a balanced state of overall well-being. 4 Factors affecting health: Five Approaches to health promotion: 1. Health Education Objective: To inform and educate individuals about health issues and healthy behaviors. Methods: Workshops, seminars, school programs, and public health campaigns. 2. Community Development Objective: To empower communities to take control of their health. Methods: Community-led initiatives, local health committees, and participatory action research. 5 3. Policy Advocacy Objective: To influence policy and create supportive environments for health. Methods: Lobbying for health-friendly policies, advocating for legislative changes, and working with policymakers. 4. Environmental Change Objective: To create physical and social environments that support health. Methods: Urban planning, improving access to parks and recreational facilities, and ensuring clean air and water. 5. Preventive Health Services Objective: To provide services that prevent illness and promote health. Methods: Vaccination programs, screening services, and health check-ups. These approaches work together to create a comprehensive strategy for improving public health and well-being. Sites for Health-Promotion Activities: Health promotion activities can take place in various settings, each offering unique opportunities to reach different populations. Here are some common sites for health-promotion activities: 1. Schools Schools are ideal for promoting health among children and adolescents. Programs can include physical education, nutrition education, mental health awareness, and substance abuse prevention1. 6 2. Workplaces Workplaces can implement wellness programs that encourage employees to adopt healthier lifestyles. These programs might include fitness challenges, health screenings, stress management workshops, and healthy eating initiatives. 3. Community Centers Community centers often host health fairs, vaccination drives, fitness classes, and educational workshops. These centers are accessible to a wide range of people and can address community-specific health needs2. 4. Hospitals and Clinics Hospitals and clinics provide a setting for health promotion through patient education, chronic disease management programs, and preventive care services. Healthcare professionals can offer personalized advice and support. 5. Online Platforms With the rise of digital health, online platforms have become crucial for health promotion. Websites, social media, and mobile apps can disseminate health information, offer virtual fitness classes, and provide support groups. 6. Public Spaces Public spaces like parks and recreational areas can host outdoor fitness activities, health campaigns, and community events. These activities promote physical activity and social interaction. 7 7. Religious Institutions Religious institutions can play a role in health promotion by organizing health screenings, educational sessions, and support groups. They often have strong community ties and can reach diverse populations. Principle of health promotion program: Health promotion programs are guided by several key principles to ensure they effectively improve public health. Here are some of the main principles: 1. Empowerment 8 Objective: To enable individuals and communities to gain control over their health. Methods: Providing education, resources, and opportunities for people to make informed health decisions. 2. Participation Objective: To involve individuals and communities in the planning and implementation of health promotion activities. Methods: Encouraging community engagement and collaboration in health initiatives. 3. Holistic Approach Objective: To address the multiple factors that influence health, including physical, mental, social, and environmental aspects. Methods: Integrating various health determinants into health promotion strategies. 4. Intersectoral Collaboration Objective: To work across different sectors and disciplines to address health determinants. Methods: Partnering with organizations, governments, and communities to create comprehensive health promotion programs. 5. Sustainability Objective: To ensure that health promotion efforts are maintained over the long term. 9 Methods: Developing policies and practices that support ongoing health promotion activities and outcomes. These principles help create effective and sustainable health promotion programs that can significantly improve public health outcomes Challenges of health promotion Health promotion faces several challenges that can hinder its effectiveness. Here are some of the key challenges: 1. Resource Limitations 11 Funding: Adequate funding is often lacking, which can limit the scope and sustainability of health promotion programs1. Human Resources: There may be a shortage of trained professionals to implement and manage health promotion activities1. 2. Measuring Outcomes Evaluation Difficulties: It can be challenging to measure the long-term impact of health promotion initiatives due to the complexity of health behaviors and outcomes1. Data Collection: Gathering accurate and comprehensive data to assess the effectiveness of programs can be difficult2. 3. Reaching Marginalized Populations Accessibility: Health promotion efforts may not reach marginalized or vulnerable groups effectively, leading to health disparities1. Cultural Sensitivity: Programs need to be culturally appropriate and sensitive to the needs of diverse populations3. 4. Intersectoral Collaboration Coordination: Effective health promotion requires collaboration across various sectors, which can be difficult to achieve due to differing priorities and agendas. Policy Integration: Integrating health promotion into policies across different sectors can be challenging4. 5. Behavioral Change 11 Motivation: Encouraging individuals to adopt and maintain healthy behaviors can be difficult, especially when faced with ingrained habits and lifestyle choices. Support Systems: Lack of social and environmental support can hinder individuals’ ability to make and sustain healthy changes2. Addressing these challenges requires a comprehensive and coordinated approach, involving adequate resources, effective evaluation methods, inclusive strategies, and strong intersectoral collaboration. 12  Health Education and Health Promotion Learning objectives: 1. Definition of Health 2. Physical health 3. Mental health 4. Social health 5. Definition of Health Education 6. Components of health promotion 7. Importance of health education in communities 8. Principles of Health Education 9. Health education settings 13  Health Education and Health Promotion Definition of Health: According to the World Health Education Organization "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity." Physical health: refers to anatomical integrity and physiological functioning of the body. To say a person is physically healthy: 1. All the body parts should be there. 2. All of them are in their natural place and position. 3. None of them has any pathology. 4. All of them are doing their physiological functions properly. 5. They work with each other harmoniously. Mental health: refers to ability to learn and think clearly. A person with good mental health is able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society. Social health: refers to ability to make and maintain acceptable interactions with other people. 14 Definition of Health Education: Health education is one of the most important components of health promotion. It is a means of promoting health. Health education is primarily focused at voluntary action people can undertake on their own to improve their own health, their families’ health and the community as a whole. “Any combination of learning experiences designed to facilitate voluntary action conducive to health” "The process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health". “A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health, and to seek help when needed.” Definition of Health Promotion To reach a state of complete physical, mental and social well-being it is beyond the activity of health education and even health sectors. In other words, health is not just the responsibility of health sector alone, but the responsibility of every sectors working for development. Thus, the concern for health outside to the healthcare sector is the call for health promotion. 15  Health promotion is the process of enabling people to increase control over, and to improve their health. It is a positive concept emphasizing personal, social, political and institutional resources, as well as physical capacities.  Health promotion aimed at the social and political actions that will facilitate the necessary organizational, economic, and other environmental supports for the conversion of individual actions into health enhancements. Components of health promotion: Health education Political environment Social environment Economic environment Organizational environment Importance of health education in communities: 1-HE improves the health status of individuals, families, and communities in general. 2- HE enhances the quality of life for all people. 3- HE reduces premature deaths. 16 4- HE reduces the health care cost by focusing in preventing measures. 5- HE teach about physical, mental, social and emotional health. 6- HE is concerned with helping people to help themselves. 7- A way of empowering people to understand their own problems, identifying its solution and take appropriate action. Principles of Health Education 1. All health education should be need based. 2. Health education aims at change of behavior. 3. It is necessary to have a free flow of communication 4. Health Education is based on scientific findings and current knowledge. 5. The health educators have to make them acceptable. 6. The health educator should use terms that can be immediately understood. Targets of health education Every stage of life, every person or social group and all occupations are appropriate targets of health education programs. Depending on the type of the problem there are three broadly classified targets of health education programs. Individuals: this includes clients of services, patients and healthy individuals. E.g. diabetic or hypertensive patients. 17  Groups: includes gatherings of two or more people who have a common interest. E.g. a family planning service for a couple a youth club about HIV/AIDS Community: include a collection of people who have common interests, a feeling of belongingness, and who usually share common values, culture, beliefs and interests. E.g. a village community about the dangers of FGM (Female genital mutilation) Health education settings Health education is delivered in almost every conceivable setting: Universities, schools, hospitals, pharmacies, grocery stores and shopping centers, recreation settings, community organizations, voluntary health agencies, worksites, churches, prisons, health maintenance organizations; it is delivered through mass media, over the Internet, in people’s homes, and in health departments at all levels of government. Ways to put across health messages: 1. Direct: Health Education Interpersonal (Individual and groups). 2. Indirect: Mass media and visual aids. 18  Health Educational Methods 1-Individual methods- (Counseling) 2- Group method 3- Mass method 1- Individual educational methods – Counseling: Counseling: is a person-to-person communication in which one person is helped by another to increase in understanding, ability and confidence to find solutions to own problems. a) Personal interviews b) Personal contact 19 c) Personal letter d) Health Counseling e) Home visits Purposes of counseling To help individuals increase knowledge of self. To encourage individuals or families to think about their problems and understand the causes. Help people commit themselves to take action on their own will to solve the problems. Help individuals to choose, but not forcing them to do so. Principles in counseling 1. Counseling requires establishing good relationship between the counselor and the client. 2. Counselors should assist people identify their own problems. 3. Counselors develop empathy. 4. Counselors should never try to persuade people to accept their advice. 2- Group method A group could be defined as a gathering of two or more people who have a common interest. 21 Example of groups often found in a community: 1. Family 2. Health committee 3. People working at the same factory, business, or agency 4. A class of school children 5. A farmers’ cooperative For Group Education, Common Methods Used: - Group discussions, lectures, workshops, seminars and role play Group discussions Discussion in a group allows people to say what is in their minds. They can talk about their problems, share ideas, support and encourage each other to solve problems and change their behavior. Size of a group: For sharing of ideas an ideal group is the one with 5-10 members. If the members are large every one may not have a chance to speak. There are two main types of group: 1. Formal groups Groups that are well organized with some rules and regulations E.g. Women’s Associations 21 2. Informal groups Groups that are not well organized E.g. People attending market on a particular day 3- Mass method For mass method Education, Common Methods Used: - Television, radio, newspaper, posters and internet 22  Health Promotion and Disease Prevention Learning objectives: At the end of the lecture; the student will be able to: 1. Definition of Prevention 2. Aim of Disease Prevention 3. Levels of prevention 23 Definition of Prevention The management of those factors that could lead to disease so as to prevent the occurrence of disease. Aim of Disease Prevention:- To maintain optimal health by preventing disease Levels of prevention 1-Primordial Prevention It is the prevention of emergence of risk factors in population, in which they have not get appeared. Interventions:- Individual and mass health education. 24 2-Primary prevention Primary prevention can be defined as action taken prior to the onset of disease, which removes the possibility that a disease will ever occur. Intervention:- A) General health promotion 1-Health education 2- Environmental modification 3- Nutritional interventions 4- Lifestyle and behavioral changes B) Specific protection 1-Immunization (BCG, DPT, MMR Vaccine) 2- Chemoprophylaxis (tetracycline for cholera, chloroquinine for malaria 3- Use of specific nutrients (vitamin A for children, iron and folic acid for pregnant mothers). 3- Protection against occupational hazards. 4- Avoidance of allergens 5- Protection from air pollution 3-Secondary Prevention 25 The action which halts the progress of a disease at its incipient stage and complications Intervention:-  Early detection  Prompt treatment 4-Tertiary Prevention All measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing departures from good health and to promote the patient adjustment irremediable conditions. Intervention:-  Disability limitation  Rehabilitation Types of Rehabilitation 1-Medical rehabilitation 2- Vocational rehabilitation 3- Social rehabilitation 4- Psychological rehabilitation 26 Health Education in Disease prevention Disease prevention means to interrupt or slow the progression of disease. The levels of health education in disease prevention there are three distinct levels of disease prevention in health education: Primary, Secondary, and Tertiary health education. 1. Primary health education Is encompass of those health education activities that aimed specifically at prevent the onset of illness or injury before the disease process begins Examples: Wearing safety belt, Immunization, Physical exercise, Brushing one’s teeth, Breast feeding. 2. Secondary health education 27 Once the disease occurred health education is important to slow down the disease progression to prevent the onset of disability. Example: Providing HE on adherence, educating ill person to seek treatment, breast-cancer screening, Blood pressure examination, Cholesterol level examination, treating malaria patients. 3. Tertiary health education Health education programs that specifically aimed at patients with irreversible, incurable, and chronic condition for social and psychological adjustment. It meant to avoid major disability, premature death. Example: educating after lung cancer surgery, working with the diabetes patients to ensure the daily Injections are taking. 28  Immunization Learning objectives: At the end of the lecture; the student will be able to: 1. Definition of Immunization 2. Types of vaccines: 3. Why are vaccines important? 4. Side effects of vaccination. 29 Definition of Immunization It is a way to protect people from infectious diseases. The process of inducing immune response in an individual by vaccination. Vaccine: A vaccine contains dead or weakened bacteria or viruses (they are not capable of causing a disease) that are administered to individuals to encourage the immune system to recognize them and to consequently produce antibodies that can identify the germ early on. This allows the individual to fight the germ if it encounters it again, therefore preventing disease. Target segments: 1-Infants 2- Children 3- Pregnant women 4- The elderly 5- People with weakened immune systems due to cancer treatments 6- People with chronic illnesses 7- Travelers heading to infected areas Types of vaccines: 31 There are several types of vaccines and each type helps the immune system fight a certain type of germs and the diseases they cause. They include: A) Live-attenuated vaccines: They use an attenuated (or weakened) form of the germ that causes a disease. These vaccines are very similar to the natural infection and therefore help protect against the infection by creating a strong and long-lasting immune response. Just 1 or 2 doses (of most live vaccines) can provide a lifetime of protection against a germ and the disease it causes. E.g.: MMR combined vaccine (measles, mumps, rubella), Rotavirus, Smallpox, Chickenpox, Yellow fever, Shingles, oral polio. B) Inactivated vaccines: They use the dead version of the germ that causes a disease. The immunity (protection) they provide is usually not as strong as that provided by live vaccines. Therefore, several doses may be needed over time to gain ongoing immunity against diseases. E.g.: Hepatitis A, Influenza, Polio, Rabies C) Subunit/conjugate vaccines: They use specific parts of the germ (e.g. protein, sugar, or the casing around the germ). 31 E.g.: Hib (Haemophilus influenzae type b) disease, Hepatitis B, HPV (Human papillomavirus), Whooping cough, Pneumococcal disease, Meningococcal disease. D) Toxoid vaccines: They use the harmful product (toxin) made by the germ that causes a disease so that the immune system can fight this toxin rather than the germ. E.g.: Diphtheria, Tetanus.  Why are vaccines important? 1-Give newborns a chance to grow healthily and to have a better life. 2- Eliminate infectious diseases that can cause severe complications or death. 3- Vaccines not only protect the vaccinated individuals but entire communities as well. 4- Help reduce mortality rates. 5- Help prevent infectious diseases. 6- Stop the development of antibiotic resistance by reducing the use of antibiotics. 7- Help you travel safely and comfortably. 8- Provide economic benefit by saving on the costs of treating diseases.  Side effects after vaccination: Most children feel fine after vaccination and may not exhibit any reaction at all. Some may exhibit some side effects based on the type of vaccine. Side effects include: 1-High temperature. 32 2- Pain, redness or swelling around the injection area 3- Sleeping more than usual 4- Itchiness around the injection area 5- Mild rash Headache 6- Nausea 7- In rare cases, a severe allergic reaction may occur within a few minutes after vaccination. N.B:- All of these reactions are considered normal and usually last 12 to 24 hours.  Nursing role of vaccination : - Before 1-Don't give antibiotic. 2- Don't give the vaccine in case :  The child suffer from fever.  The child suffer from gastroenteritis. 3- Ensure the child come in the appropriate time. 4- Ensure from follow sheet. 5- Ensure from bottle vaccine in the right place. 6- Know medical history from mother. During 1-Know the mother type of vaccine. 2- Know the mother side effect of vaccine. 3- Know the mother site of injection. 33 4- Antiseptic with alcohol swab for both bottle and site of injection. 5- Expire date of vaccine. After 1- Give antipyretic and warm compress if case of fever. 2- Give anti diarrheal if case of diarrhea. 3- Teach the mother don't feeding the child from 1/4 to 1/2 hour. 4- Teach the mother don't touch the site of vaccine. 5- Teach the mother BCG vaccine leave scar is effective and don't leave scar isn't effective and advice the mother to back to the vaccine office. 34  Nutrition and Health Promotion Food:- Can be defined as anything edible that can be solid, semisolid or liquid which when swallowed, digested and assimilated in the body, proves useful to it. These substances not only keep the person alive, but also provide energy used for growth and development, regulate the body processes and protect the body from diseases. Nutrition:- Is defined as the science of foods, nutrients and other substances they contain; and of their actions within the body including ingestion, digestion, absorption, metabolism and excretion. 35  Nutrients Are organic or inorganic substances present or contained in from which is required or necessary for growth and maintenance of function of body." E.g.: Proteins, Vitamins, etc. Or Nutrients have been defined as "chemical substances found in food that cannot be synthesized at all or in sufficient amounts in the body, and are necessary for life, growth and tissue repair." Or Nutrient "or "food factor" are organic and inorganic complexes contained in food, which are responsible for the functions of foods and protect the body from disorders. Balanced Diet:- A balanced diet is one which includes a variety of foods adequate amounts and correct proportions to meet the day's requirements of all essential nutrients such as proteins, fats, carbohydrates, vitamins, minerals, water, and fiber. 36  The Relationship Between Nutrition and Health:- 1-Food plays a vital role for human existence, essential for growth and maintenance of the tissue. 2- Healthy foods reduce risk of disease. 3- Good nutrition is critical in preventing not only deficiency diseases, but also chronic diseases. 37  Food classification: - Food can be classified in accordance to their chemical property, to their function, to their essentiality, to their concentration and to their nutritive value. A classification based on nutrients present will ensure that all nutrients are made available to the body and offer greater variety within the group. There are five basic food groups suggested by the Indian Council of Medical Research (ICMR). These include: 1-Cereals, grains and products 2-Pulses and legumes. 3- Milk and meat products 4- Fruits and vegetables. 5-Fats and sugars 38  Functions of Food:- 1-Physiological Function a-Energy yielding foods ( Carbohydrate, Fat) b- Body building foods (Protein) c- Protective and regulatory foods (Vitamins and minerals) 2- Social functions 39  3- Psychological functions Public Health Nutrition:- Promotion of good health through primary prevention of nutrition-related illness in the population: Public Health Nutrition deals with the following: Problems related to inadequate quantity and quality of the habitual diet Problems related to excessive intake of quantity of the habitual diet and food additives and supplements Food safety problems that affect the health and function of a large percent of the general population Identification of risk factors and early detection by screening when feasible, in contrast to only specific nutrient treatment Environmental and life style risk factors. Global warming, as well as natural disasters (flooding, droughts, civil strife, etc.) Principals of Public Health Nutrition:- 41  Three core responsibilities of public health have been identified: Assessment: Regularly and systematically assessing the nutrition-related problems and needs of the population, identifying problem areas and opportunities, monitoring the nutritional status of the population and high-risk subgroups. Assessment activities of public health nutritionist include: surveillance of nutrition status and risk factors; community needs assessment and resource identification; and evaluation of past efforts. Policy Development: Developing policies, programs and activities that address the highest priority nutritional problems and needs, promoting the use of scientific knowledge in nutrition decision making and policy development, and setting standards. Policy development activities of public health nutritionists in policy development include: setting priorities goals and objectives, writing standards, regulations and guidelines, developing and implementing program plans with attention to quality or performance standards, supervision, program management and fiscal management. Assurance: Assuring the implementation of effective nutrition strategies to meet agreed upon goals by encouraging and enabling provision by other entities, by requiring action through regulation, or providing services directly. 41 Assurance activities of public health nutritionists include: assuring access to programs by vulnerable population groups; fostering culturally-competent nutrition education; planning and providing nutrition services to high risk groups; coordinating nutrition programs; providing education and counseling to persons with nutrition-related conditions and disease, mobilizing nutrition resources, encouraging private and public sector involvement; and assuring adequate skills of nutrition personnel. Malnutrition: Adequate food and water are basic human needs. Sufficient energy (measured in calories), protein, fat, carbohydrates, water, vitamins, and minerals are necessary for preventing deficiencies, allowing proper growth, maintenance of body weight, and physiological function. Nutritional status is a significant determinant of health status. Malnutrition was the main nutrition concern worldwide. Recently, over nutrition, associated with obesity and chronic diseases, has now emerged as a significant and growing threat. Individual dietary behaviors vary greatly such as high consumption of added sugars, solid fats, and sodium, and low intakes of vegetables and whole grains. Decreased physical labor and physical activity in urban settings, accompanying cardiovascular diseases with obesity, causing high mortality and morbidity among adults. Over nutrition: - 42  Obesity Marked increase in obesity, particularly in urban and poor areas. Childhood obesity leads to adult obesity  Type II diabetes. o Complications: cardiac morbidity o Retinal with blindness o Gangrene- i.e. amputations  Elevated cholesterol and triglycerides  Risk factors for cardiovascular diseases Main Deficiency Syndromes and Conditions:- 1-Protein-Energy Malnutrition, from mild to severe 2-Kwashiorkor (protein deficiency: mainly seen in young children)  Low-serum albumin  Severe edema (hair discoloration and burn-like skin lesions)  Precipitated by measles or other severe infection  Abrupt weaning after birth of a new baby  Decreased cell-mediated immune function with high infection complications: return to normal with treatment  Rapid reversal of all signs and symptoms two weeks after with high protein diet. 43 3-Marasmus (total energy depletion).  Seen in both young children and adults.  Children alert, ravenous, and irritable.  Often seen with HIV/AIDS, tuberculosis, malignancies, etc.  High energy and protein diet required over many months for recovery.  Early weaning under 6 months with poor breast milk substitute major risk factor. 4-Stunting 5-Iodine deficiency 6- Iron deficiency 44  Maternity Nursing Definition of Maternity Nursing: Nursing care provided to women and their families during pregnancy and parturition and through the first days of the puerperium. Definition of Maternal-Child Nursing: The nursing specialty that deals with the care of women throughout their pregnancy and childbirth and the care of their new-born children. Definition of Safe Motherhood: Is the concept or initiatives to ensure that women receive high quality care in order to achieve the optimum level of health of mother and infant. Goals and objectives of safe motherhood:  To improving maternal and child health  To obtaining the desired outcome of pregnancy.  To reduce maternal and neonatal morbidity and mortality Important of safe motherhood  Promoting women’s health  improves not only individual health, but also the health and survival of women’s families 45  Improves well-being of communities and countries Essential Services for Safe Motherhood: Services for safe motherhood should be readily available through a network of linked community health care providers, clinics and hospitals. Integrated services include: 1. Community education on safe motherhood. 2. Prenatal care and counseling, including the promotion of maternal nutrition. 3. Skilled attendance during childbirth. 4. Care for obstetric complications, including emergencies. 5. Postpartum care. 6. Family planning counseling, information and services. 7. Reproductive health education and services for adolescents. Barriers to safe motherhood: 1- There are social/cultural norms related to gender that contribute to maternal mortality.  Poor nutrition Pregnant women: Poor maternal nutrition is very common in many countries. Women who are underweight are also less likely to have healthy pregnancies. 46  Early marriage Worldwide, more than 650 million women alive today were married as children. Every year, at least 12 million girls are married before they reach the age of 18.  Early first pregnancy: Improvements in maternal weight can be achieved by delaying age of first pregnancy, an issue linked closely to marital age. 2- Lack of education and information. 3- Restriction of women’s movement outside the home: in some societies, limits their access to services or ability to seek services. 4- Gender-based violence: which disproportionately affects girls/women, greatly contributes to maternal mortality 5- Lack of decision making power  Effect of family members  How many children to have?  Spacing between pregnancies Definition of Antenatal Care: Comprehensive health care provided during pregnancy. The Purposes of Antenatal Care: Enhance the pregnancy outcomes throughout: 47 1. Provide information about physical and psychological changes of pregnancy to the woman and her family. 2. Identify existing risk factors and other deviation from normal. 3. Motivate the pregnant woman to practice self-management and report unusual changes. Barriers to Obtain the Antenatal Care: 1. Lack of transportation. 2. Unpleasant clinic facilities or procedures. 3. Child care problems and personal attitudes. 4. Financial issues. Schedule of Antenatal Care 48 Most common complications of antenatal include:  High blood pressure  Gestational diabetes  Preeclampsia  Preterm labor  Loss of pregnancy, or miscarriage.  Still birth Definition of maternal mortality: The World Health Organization (WHO) defines maternal death as the death of a pregnant woman due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. Risk factors for maternal mortality: 1. Maternal Age: the safest age for childbearing is from 20 -24 Years, so pregnancy before 20 years or above 30 years is Associated with higher maternal mortality. 2. Lack of adequate spacing between pregnancies increase the Risk to the mother. 49 3. Mode of delivery: spontaneous vaginal delivery is safer compared to caesarian deliveries. 4. Place of delivery: home deliveries in developing country are associated with higher maternal mortality, high risk patient Should deliver at hospital. 5. Education of the mother: it has an influence on MM Causes of maternal mortality: Women die as a result of complications during and following pregnancy and childbirth as: 1. Heart disease & other diseases which become aggravated by pregnancy. Pregnancy can affect health problems such as heart disease, diabetes and anemia can develop or get worse. These issues account for approximately 28 percent of maternal deaths. 2. Hemorrhage: caused by abortion, disturbed ectopic pregnancy, vesicular mole, ante & postpartum hemorrhage. Postpartum hemorrhage is responsible for approximately 27% of all maternal deaths. 3. Hypertensive disorders of Pregnancy. Hypertensive disorders are responsible for anywhere from 13.3% to 15.9% of pregnancy related deaths. 4. Infection: septic abortion &puerperal sepsis. About 11% of maternal deaths are the result of an infection. 51 5. Thrombosis &pulmonary embolism. About 9.2% percent of maternal deaths are due to pulmonary embolism. Measures to reducing or avoiding maternal deaths: During premarital period:  Access to adolescent reproductive health education and services.  Stress on the importance of premarital counseling & premarital examination.  Arrangement of classes to educate population about the importance of preventing early marriage. During antenatal period:  Proper antenatal care with regular follow up of the mothers during pregnancy.  High risk women as diabetic & cardiac cases are seen more frequent.  Correction of anemia & malnutrition.  Hospitalization of cases of high risk.  Provide immunization. During post-natal period:  Maintain aseptic &antiseptic measures.  Antibiotics if indicated.  Health education about family planning information and services.  Access to postpartum care.  Early detection of postpartum hemorrhage and proper treatment 51  Child Health Services Introduction: Children health is the foundation of all growth development. Of course, your child's health includes more than physical growth. Some other important parts of your child's health include their cognitive (learning and thinking) development, social and emotional growth, and mental health Protecting and improving the health of children is of fundamental importance. More than half of child deaths are due to conditions that could be easily prevented or treated given access to health care and improvements to their quality of life. healthy children are more likely to become healthy adults. A child defined as: A child is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. Child health defined as: A state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity. Characteristics of a healthy child: 1. Active, alert and curious * During infancy period 52 They look into their mother's eyes and touch her hand. They can listen to their parent's voice. *During toddler and preschool period This is the state in which the child is ready to interact with the world. This is the time to play with other children. 2. Have clear skin, bright eye: A child with bright, clear eyes is likely to be the one who eats good food and is kept clean. 3. Their bowel movements are regular and normal: 53 Regular bowel movements are important to your child's health. The most common problems with bowel movements are constipation and diarrhea. 4. They sleep well: Sleep is an essential part of everyone's routine. Studies have shown that kids who regularly get an adequate amount of sleep have improved attention, behavior, learning, memory, and overall mental and physical health. 5. Healthy children trust others: Children learn and develop best when they have strong, loving, positive relationships with parents. 6. Generally feel good about themselves: Adults who spend time with children can positively impact how children feel about themselves by ensuring their words and actions reflect a positive, healthy. 54 Factors contributing to child's health 1- Maternal care: Throughout the entire maternity cycle is what prevents prenatal, neonatal and postnatal deaths, and ensures a healthy baby. 2- Periodic follow-up The child in the MCH center allows early detection of any minor problem. Growth monitoring is valuable for the prevention of malnutrition. 3- Breastfeeding and proper child nutrition: Promotes the child's health and builds up body resistance. 4- Immunization: Protects the child from childhood disease and prevents disability and under nutrition. 5- Early detection and proper treatment of any child health problem prevents serious squeal or complication 6- Health education of the mothers regards childcare, prevention of diarrhea and communicable diseases are of the most importance. 55 7- Nutrition education and Sanitary home environment. Child health services: Defined as promoting , preventing ,therapeutic or rehabilitation facility or care the child. Child health services: 1-New born care and breast feeding 2- Immunization 3- Monitoring growth and development care for the child 4- Child`s nutrition. 5- Early detection of health problem and treatment. Child Development:- A- Cognitive Development: Means how children think, explore and figure things out. It is the development of knowledge, skills, problem solving and dispositions. 56 B- Social and emotional Development: Social development refers to a child's ability to create and sustain meaningful relationships with adults and other children. Emotional development is a child's ability to express, recognize, and manage his or her emotions, as well as respond appropriately to others' emotions. C- Speech and language Development: The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others. 57 D- Fine motor skills Development: When a child uses the smaller muscles in their hands, wrists, fingers, feet and toes. Developing those muscles includes actions like grasping, holding, pressing, or using a pincer grip (holding something between the fore-finger and thumb). E- Gross motor skill Development: Involves the large muscles in the arms, legs and torso. Gross motor activities are important to everyday physical activities like walking, running, throwing, lifting, kicking. 58 Child nutrition  Importance of child nutrition Nutrition is important at every age. The children need proper nutrients 1. Stay healthy and strong. 2. Grow up healthy and strong. 3. Help establish a foundation for healthy eating habits and nutritional knowledge that the child can apply throughout life's.  Most common diseases from mal nutrition  Kwashiorkor. This is one of the most acute malnutrition of proteins in the world.  Marasmus. This disease is caused by the very severe lack of protein and calories.  Anemia. The most common illness which is caused by malnutrition.  Vitamin Deficiency. 59  Family Health Promotion Learning objectives: At the end of the lecture; the student will be able to: 1. Definition of family health promotion 2. Aim of family health promotion:- 3. Aspects of Family Health Promotion: 4.. Phases of family cycle of health &illness:- 5. Factors affecting family health promotion: 6. Some practical tips for family health promotion: 7. Role of Family in Health Promotion: 61  Definition of family health promotion Family health promotion involves activities and strategies that families use to improve or maintain the physical, emotional, and social well-being of all family members.  Aim of family health promotion:- 1. Improving the health of all family members 2. Changing behavior that may have a negative influence on health 3. Family health promotion increases family unity and quality of life  Aspects of Family Health Promotion: 1- Healthy Lifestyle Choices: Encouraging balanced diets, regular physical activity, and sufficient sleep. Families can plan meals together, engage in physical activities like walking or sports, and establish routines that promote good sleep hygiene. 2- Preventive Health Care: Regular medical check-ups, vaccinations, and screenings are essential. Families should keep track of medical appointments and ensure that all members receive necessary preventive care. 3- Mental Health Support: Promoting open communication about feelings and mental health. Families can support each other by listening, offering emotional support, and seeking professional help when needed. 61  4- Health Education: Educating family members about health risks and healthy behaviors. This can include discussions about the dangers of smoking, excessive alcohol consumption, and the importance of safe practices. 5- Creating a Supportive Environment: Building a home environment that supports health, such as having healthy food options available, creating spaces for physical activity, and reducing stressors. 6- Modeling Healthy Behaviors: Parents and caregivers can model healthy behaviors for children, such as eating nutritious foods, exercising regularly, and managing stress effectively. 7- Community Involvement: Engaging with community resources and programs that promote health, such as local fitness classes, health workshops, and support groups  Phases of family cycle of health &illness:- The family health and illness cycle is a model that outlines the different phases families go through in managing health and illness. Here are the six phases: 1- Health Promotion and Risk Reduction: Families engage in activities to maintain health and prevent illness, such as healthy eating, exercise, and regular medical check-ups. 62  2- Onset of Illness: This phase begins when a family member shows symptoms of illness. The family starts to seek medical advice and treatment. 3- Diagnosis: The family receives a diagnosis, which can be a stressful time. They need to understand the illness and its implications. 4- Acute Response: The family deals with the immediate impact of the illness, which may include hospitalization or intensive treatment. This phase requires significant emotional and practical support. 5- Adaptation to Illness: The family adjusts to the ongoing management of the illness. This may involve lifestyle changes, long-term treatment, and coping strategies. 6- End of Life and Bereavement: If the illness leads to the death of a family member, the family goes through the grieving process and adapts to life without their loved one1.  Factors affecting family health promotion: Family health promotion is influenced by a variety of factors that can be broadly categorized into several key areas: 1. Socioeconomic Status: Income, education, and occupation significantly impact access to healthcare, nutritious food, and safe living environments. 2. Physical Environment: The quality of housing, neighborhood safety, and access to recreational facilities play a crucial role in promoting healthy lifestyles. 63 3. Psychosocial Environment: Family dynamics, social support, and mental health are essential for fostering a supportive environment for health promotion. 4. Cultural Factors: Cultural beliefs and practices influence health behaviors, dietary habits, and attitudes towards healthcare. 5. Health Practices: Regular physical activity, balanced diet, and preventive healthcare measures are vital components of family health promotion. 6. Education: Health literacy and education about healthy behaviors empower families to make informed health decisions. 7. Gender Roles: Gender dynamics within the family can affect health promotion activities, with different expectations and responsibilities influencing health behaviors.  Some practical tips for family health promotion: Here are some practical tips to help promote health within your family: 1. Exercise Together: Make physical activity a family affair. Go for walks, bike rides, or play sports together. Even simple activities like dancing or playing tag can be fun and beneficial. 2. Healthy Eating: Encourage balanced meals with plenty of fruits, vegetables, whole grains, and lean proteins. Involve children in meal planning and preparation to teach them about nutrition. 64 3. Regular Health Check-ups: Stay on top of routine medical and dental check-ups for all family members. Preventive care is crucial for early detection and management of health issues. 4. Quality Sleep: Ensure everyone gets enough sleep. Establish a consistent bedtime routine and limit screen time before bed to improve sleep quality. 5. Stress Management: Practice stress-reducing activities like yoga, meditation, or deep breathing exercises. Encourage open communication to help family members express their feelings and concerns. 6. Limit Screen Time: Set boundaries for screen time and encourage other activities like reading, outdoor play, or hobbies. This helps reduce sedentary behavior and promotes more active lifestyles. 7. Hydration: Make sure everyone drinks enough water throughout the day. Limit sugary drinks and encourage water or milk as the primary beverages. 8. Positive Reinforcement: Celebrate healthy choices and achievements, no matter how small. Positive reinforcement can motivate everyone to continue making healthy decisions. 9. Family Time: Spend quality time together without distractions. Activities like family dinners, game nights, or outdoor adventures can strengthen bonds and promote emotional well-being. 65  10.Education: Teach children about the importance of health and wellness. Use age-appropriate resources to explain why healthy habits are essential.  Role of Family in Health Promotion: Families play a crucial role in health promotion by creating an environment that supports healthy behaviors and well-being. Here are some key roles families can take on: 1. Modeling Healthy Behaviors: Parents and caregivers can set examples by practicing healthy habits such as balanced eating, regular exercise, and stress management. Children often imitate these behaviors, leading to healthier lifestyles1. 2. Providing Emotional Support: Families can offer emotional support during stressful times, which is essential for mental health. Open communication and a supportive environment help family members cope with challenges2. 3. Encouraging Preventive Care: Families can ensure that all members receive regular medical check-ups, vaccinations, and screenings. This proactive approach helps in early detection and prevention of illnesses3. 4. Educating About Health: Sharing knowledge about health risks and healthy practices is vital. Families can discuss topics like nutrition, 66  physical activity, and the dangers of smoking and excessive alcohol consumption3. 5. Creating a Healthy Environment: Families can make their homes conducive to health by providing nutritious food, encouraging physical activity, and reducing stressors. This includes having healthy food options available and creating spaces for exercise3. 6. Supporting Mental Health: Promoting mental well-being through open discussions about feelings and seeking professional help when needed. Families can also engage in activities that reduce stress and promote relaxation. 7. Community Engagement: Families can participate in community health programs and activities, which can provide additional resources and support for maintaining a healthy lifestyle 67  Nurses Role in Health Promotion  Learning objectives: At the end of the lecture; the student will be able to:  Identify Nurses Role in Health Promotion.  The Importance of Health Assessment in Health Promotion.  Barriers/ Challenges to the implementation of nurse’s role in primary care settings: 68  Nurses Role in Health Promotion Nurses play a crucial role in health promotion, leveraging their unique position within healthcare settings to foster healthier communities. Here are some key aspects of their role: 1. Patient Education Nurses educate patients about healthy lifestyles, disease prevention, and management of chronic conditions. This includes advising on diet, exercise, smoking cessation, and the importance of regular health screenings1. 2. Advocacy Nurses advocate for patients’ health needs, ensuring they have access to necessary resources and support. They also work to influence health policies that promote public health2. 3. Community Involvement Nurses often participate in community health campaigns, school outreach programs, and workplace health initiatives. These efforts help raise public awareness about health issues and encourage preventive measures. 4. Routine Health Screenings By conducting routine health screenings, nurses help in early detection of diseases, which can lead to more effective treatment and better health outcomes. 69 5. Hygiene and Sanitation Nurses ensure that healthcare environments are clean and hygienic, reducing the risk of infections. They also educate patients and communities about proper hygiene practices. 6. Interprofessional Collaboration Nurses collaborate with other healthcare professionals to provide comprehensive care. This teamwork is essential for effective health promotion and disease prevention The Importance of Health Assessment in Health Promotion Comprehensive health assessments serve as the foundation for health promotion and wellness. These in-depth evaluations pinpoint aspects of your patient’s health that could present potential issues. Early identification of these factors enables swift action, heading off larger problems down the line. 1- Early Detection and Intervention Essentially, health assessments work as an early warning system. They can identify risks and early signs of diseases, providing the chance to intervene before conditions worsen. As an example, a health assessment might find elevated blood pressure, which, when addressed promptly, can prevent conditions like stroke or heart disease. 71  2- Disease Management If your patient is already dealing with a chronic disease, regular health assessments can help manage the condition. They track changes in your patient’s health status and guide adjustments to treatment plans. For instance, changes in blood sugar levels might suggest the need to adjust your patient’s diabetes medication. A comprehensive health assessment usually includes an exploration of your patient’s family history, lifestyle habits such as diet and exercise, and regular screenings for common conditions. As a nurse, you have a central role in communicating these findings and implementing healthcare plans based on them. 3- Promoting Health The ultimate goal of comprehensive health assessments is to promote overall health and wellness. By establishing a baseline understanding of your patient’s health status, you can recommend targeted health promotion strategies. These may range from lifestyle modifications, like healthier eating or increased physical activity, to mental health initiatives aimed at managing stress. Remember, the goal here is not only to identify and solve problems, but also to proactively enhance your patient’s overall well-being. Making recommendations for health screenings, regular exercise, a balanced diet, 71  and regular medical check-ups are all important parts of health promotion and disease prevention.  Barriers/ Challenges to the implementation of nurse’s role in primary care settings: Nurses face several challenges in health promotion, which can impact their ability to effectively support patients in maintaining and improving their health. Here are some of the key challenges: 1. Resource Limitations Staff Shortages: Many healthcare settings face a shortage of nursing staff, which can limit the time and resources available for health promotion activities. Financial Constraints: Limited funding for health promotion programs can restrict the availability of necessary materials and support. 2. Training and Education Lack of Specialized Training: Nurses may not receive adequate training in health promotion techniques, making it difficult to implement effective strategies. Continuous Education: Keeping up with the latest health promotion practices requires ongoing education, which can be challenging due to time constraints and workload. 72 3. Cultural and Organizational Barriers Cultural Sensitivity: Nurses must navigate cultural differences and tailor health promotion activities to meet the diverse needs of patients2. Organizational Support: Effective health promotion requires support from the entire healthcare organization, which may not always be present2. 4. Patient Engagement Autonomy and Preferences: Patients may have different levels of interest and willingness to engage in health promotion activities, which can affect outcomes. Communication: Establishing effective communication with patients to promote healthy behaviors can be challenging, especially in diverse populations. 5. Systemic Issues Policy and Regulation: Varying regulations and policies across regions can create inconsistencies in how health promotion is implemented. Integration with Primary Care: Ensuring that health promotion activities are well-integrated with primary care services can be complex and requires coordinated efforts 73  Telenursing  Learning objectives: At the end of the lecture; the student will be able to: 1. Define Tele-nursing 2. Benefits of Tele-nursing 3. Challenges of Tele-nursing 4. Tele-nursing impact on patient outcomes 74  Telenursing Telenursing, also known as telehealth nursing, involves using technology to provide nursing services remotely. This can include video calls, phone consultations, and remote monitoring of patients’ health data. Here are some key points about telenursing:  Definition Telenursing: is a subset of telehealth, focusing specifically on nursing care provided through telecommunications and information technology.  History: The practice began in the 1970s with nurses providing care over the phone. It has since expanded with advancements in technology  Benefits of Tele-nursing: 1. Accessibility: Patients can receive care from anywhere, which is especially beneficial for those in remote or underserved areas. 2. Efficiency: Nurses can monitor patients’ conditions continuously and provide timely interventions. 3. Cost-Effective: Reduces the need for in-person visits, saving time and resources for both patients and healthcare providers. 75   Challenges of Telenursing: 1. Technology Barriers: Both patients and nurses need access to reliable technology and internet connections. 2. Regulatory Issues: Different regions may have varying regulations regarding telehealth services. 3. Personal Interaction: Some aspects of care may be less effective without face-to-face interaction. Telenursing impact on patient outcomes: Telenursing has a significant positive impact on patient outcomes in several ways:  Remote Consultations: Patients in remote or underserved areas can receive timely care without the need to travel long distances.  Continuous Monitoring: Chronic conditions can be monitored more effectively, allowing for timely interventions and adjustments to treatment plans. B-Enhanced Patient Engagement  Proactive Health Management: Patients are more likely to engage in their health management when they have easy access to healthcare professionals.  Education and Support: Telenursing provides ongoing education and support, helping patients better understand and manage their conditions. 76  C- Better Health Outcomes  Reduced Hospital Admissions: Continuous monitoring and early interventions can prevent complications, reducing the need for hospital admissions.  Improved Chronic Disease Management: Regular virtual check-ins help in managing chronic diseases more effectively, leading to better overall health outcomes. D- Cost-Effectiveness  Lower Healthcare Costs: By reducing the need for in-person visits and hospital stays, telenursing can lower overall healthcare costs for patients and providers. Overall, telenursing enhances the quality of care, improves patient satisfaction, and leads to better health outcomes. 77