Historical developments, trends, issues, cultural and NATIONAL HEALTH POLICY ,SPECIAL LAWS RELATED TO OLDER PEOPLE

1. {
Historical developments, Trends,
Issues, Cultural or ethical issues in
Medical Surgical Nursing
Submitted to: Dr. Pallavi Pathania
(Assistant Professor of Medical
Surgical Nursing)
Submitted by: Priyanka Thakur
(MSc. Nursing 1st year)
NATIONAL HEALTH POLICY ,SPECIAL
LAWS RELATED TO OLDER PEOPLE

2.  Definition: Medical Surgical
Nursing is a specialized branch
of nursing that involve the
nursing care of adult patients,
whose disease condition are
treated medically, surgically
and pharmacologically.

3.  In ancient times, when
medical lore was associated
with good or evil spirits, the
sick were usually cared for
in temples and houses of
worship.

4.  These women had no real training by today’s
standards, but experience taught them
valuable skills, especially in the use of herbs
and drugs and some gained fame as the
physicians of their era.

5.  In the 17th cent., St. Vincent De Paul
began to encourage women to undertake
some form of training for their work, but
their was no real hospital training school
for nurse until one was established in
Kaiserwerth, Germany, in 1846.

6.  There, Florence Nightingale
received the training that later
enabled her to establish, at St.
Thomas’s hospital in London
the first school designed
primarily to train nurses rather
than to provide nursing
service for the hospital.

7.  Similar schools were established in 1873
in New York City, New Haven (Conn.),
and Boston.
 Nursing subsequently became one of the
most important professions open to
women until the social changes brought
by the revival of the feminist movement
that began in the 1960’s.

8.  During the late 19th and early 20th centuries
in the US, adult patients in many of the
larger hospitals were typically assigned to
separate medical, surgical and obstetrical
wards.
 Nursing education in hospital training
schools reflected these divisions to prepare
nurses for work on these units.

9.  Early National League of Nursing
Education (NLNE) curriculum guides
treated medical nursing, surgical nursing
and disease prevention (incorporating
personal hygiene and public sanitation)
as separate topics.

10.  By the 1930s, however , advocates
recommended that medical and surgical
nursing be taught in a single,
interdisciplinary course, because the
division of two was considered in an
artificial distinctions. Surgical nursing
came to be seen as the care of medical
patients who were being treated
surgically.

11.  The NLNE’s 1937 guide called for a
“Combined Course” of medical and
surgical nursing.
 Students were expected to learn not only
the theory and treatment of abnormal
physiological conditions, but also to
provide total care of the patient by
understanding the role of the health .

12.  In1960’s, nursing schools emphasized the
interdisciplinary study and the practice of
medical and surgical nursing.
 1960s and 1970s, standards were
developed for many nursing specialties,
including medical surgical nursing.

13.  Standards, Medical- Surgical Nursing
practices, written by committee of the
division on medical- surgical nursing of
the American Nurses Association (ANA),
was published in 1974.

14.  It focused on the collection of data,
development of nursing diagnoses and goals
for nursing, and development, implement of
nursing diagnoses and goals for nursing, and
development and evaluation of plans of care.
 A statement on the Scope of Medical-
Surgical Nursing Practice followed in 1980.

15.  In 1991, the Academy of Medical Surgical
Nurses (AMSN) was formed to provide an
independent specially professional
organization for medical- surgical and adult
health nurses.
 In 1996, the AMSN published its own Scope
and Standards of Medical- Surgical Nursing
Practice.

16.  The second edition appeared 2000. Both the
ANA and AMSN documents stated that while
only clinical nurse specialists were expected
to participate in research, all medical-surgical
nurses must incorporate research findings in
practice.

18.  A Trend is a change or development
towards something new or different.

19. 1. Education changes due to changes in
demographics.
2. Embracing of technology.
3. Advancements in communication and
technology.
4. Working with more educated consumers.
5. Increasing complexity of patient care.

20. 6. Increased cost of health care.
7. Changes in federal and state regulation.
8. Interdisciplinary skills.
9. Nurses working beyond retirement age.
10. Advances in nursing and science research.

21. Transitions taking place in health
care:
Curative
Specialized care
Medical diagnosis
Discipline
stovepipes
- Preventive approach
- Primary health care
- Patient emphasis
- Programme
stovepipes

22. Cont…
Professional identity
Trial and error
practice
Self-regulation
Focus on quality
- Team identity
- Evidence based
practice
- Questioning of
professions
- focus on costs

23.  High tech
 Competition
 Need to supervise
 Hierarchies

24.  Humanistic
 Cooperation
 Caching, mentoring
 Decentralized approach

25. • Continued competencies
• Hospital environment
• Quality as excellence
• Clear role
• Competencies a condition
• Community environment
• Quality as safe
• Blurring roles

27.  An issue is an important subject that
people are arguing about or discussing.

28. Confiden
-tiality
Family
organisation
Health
beliefs
Death
and
dying
Communi-
cation
cultural
Diet and
nutrition
Ethical Patient
care

29.  Related to diet
 Religion
 Rituals
 Refusal of medical procedures
Health belief issues
 Black magic

30.  Privacy
 Personal information
Family organization issues
 Communication on behalf of individual

31.  Wrong medication
 Malpractices
Diet And Nutrition Issues
 Poverty
 Cultural myths

32. Communication issues Cont…
 Culture value modesty
 Cared by female health providers
 Conflicts

33. Standards of
care
Incompetence
Negligence
Liability:
• Administrative
• Civil
• criminal

34.  Unexpected death
 Advance directives
 Organ and tissue donation
 Child abandonment

35.  Beauchamp and Childress(2009)
developed four principles:
1) Respect for Autonomy
2) Beneficence
3) Non-maleficence
4) Justice

36. RESPECT FOR AUTONOMY:
Autonomy can be defined as…”self-rule with
no control, undue influence or interference
from other”.
BENEFICENCE:
This can be defined as ”the principle of the
doing well and providing care to others”
Promotion of well being.

37.  Non –maleficence:
1. “Obligation not to inflict harm on others”
2. Goes hand in hand with beneficence.
Justice:
1. Simply defined as “equal treatment of equal
cases”
2. Treating everyone the same.

38.  Fairness
 Respect for autonomy
 Integrity
 Seeking the most beneficial and least
harmful consequences or results
 Fidelity
 Veracity

39. Nursing shortage
Health care
reforms
Low salaries Standard care

40. Informed
consent
Assault and
battery
Invasion of
privacy
Report it/Tort
it

42. compassionately
listen
communicate
identify
acknowledge
recognize

43. involve
document
Up to date
advice
Look after yourself

46. INTRODUCTION :
A health policy generally describes fundamental principles
regarding which health providers are expected to make value
decisions . “ Health policy provides a broad framework of
decisions for guiding health actions that are useful to its
community in improving their health, reducing the gap
between the health status of haves and have not and ultimately
contributes to the quality of life.

47.  The National Health Policy of 1983 and the National
Health Policy of 2002 have served well in guiding the
approach for the health sector in Five – Year Plans .
Now 14 years after the last health policy, a new is
introduced.
 The primary aim of the National Health Policy , 2017
is to inform, clarify ,strengthen the role of the
Government in shaping health systems in all its
dimensions .

48.  Health priorities are changing , there is growing burden
on account of non- communicable diseases and some
infectious diseases .
 A rising economic growth enables enhanced fiscal
capacity. Therefore , a new health policy responsive to
these contextual changes is required .

49.  The emergence of a robust health care
industry estimated to be growing at double
digit .
 Growing incidences of catastrophic
expenditure due to health care costs,
which are presently estimated to be one of
the major contributors to poverty .

50. Improve health status concerted policy actions in all
sectors and expand preventive, promotive, curative ,
palliative and rehabilitative services provided through
the public health sector with focus on quality.
Objectives are outlined under three broad
components :-

51.  Health status and Programme Impact
 Health systems Performance
 Health System Strengthening

52. Life expectancy and healthy life
a. Increase life Expectancy at birth from 67.5 to 70 by
2025
b. Establish regular tracking of Disability Adjusted Life
Years (DALY) Index as a measure of burden od
disease .

53. Mortality by age and/ or cause
a. Reduce infant mortality rate to 28 by 2019
b. Reduce Under Five Mortality to 23 by 2025 and
MMR from current levels to 100 by 2020 .

54. Coverage of Health Services
a. More than 90% of the new born are fully
immunized by one year of age by 2025
b. 80% of known hypertensive and diabetic
individuals at household level maintain
‘controlled disease status’ by 2025

55. Health finance
a. Increase State sector health spending to >8% of their
budget by 2020
b. Increase health expenditure by government as a
percentage of GDP from the existing 1.15% to 2.5 by
2025.

56. Health Management Information
a. Ensure district – level electronic database of
information on health system components by 2020
b. Strengthen the health surveillance system and
establish registers for diseases of public health
importance by 2020

57. Cross Sectional objectives related to Health
a. National/State level tracking of selected health
behaviour .
b. Access to safe water and sanitation to all by 2020(
Swatch Bharat Mission)

58. 1. Professionalism, Integrity and
Ethics
The health policy commits itself to the
highest professional standards, integrity and
ethics to be maintained in the entire system
of health care delivery in the country,
supported by a credible, transparent and
responsible regulatory environment .

59.  Reducing inequity would mean affirmative action to
reach the protest.
 It would mean minimizing disparity on account of
gender, poverty, caste , disability , other forms of
social exclusion and geographical barriers.
 It would imply greater investments and financial
protection for the poor who suffer the largest burden of
disease.

60. As costs of care increases, affordability, as
district from equity , requires emphasis.
Catastrophic household health care
expenditures exceeding defined as health
expenditure exceeding 10% of its total
monthly consumption expenditure or40% of
its monthly non- food consumption
expenditure ,are unacceptable .

61.  Prevention of exclusions on social,
economic or on grounds of current health
status. In this backdrop , systems and
services are envisaged to be designed to
cater to the entire population – including
special groups.

62. Financial and performance accountability ,
transparency in decision making , and
elimination of corruption in health care
systems , both in public and private .

63. Decentralization of decision making to a
level as is consistent with practical
considerations and institutional capacity .
Community participation in health planning
processes , to be promoted side by side .

64. Constantly improving dynamic organization of health
care based on new knowledge and evidence with
learning from the communities and from national and
international knowledge partners is designed .

65.  Increase Life Expectancy from 67.5 to 70 by 2025 .
 Establish regular tracking of Disability Adjusted Life
Years (DALY) Index as a measure of burden of
disease by 2022 .
 Reduction of TFR to 2.1 at national and sub- national
level by 2025 .
 Reduction Under Five Mortality to 23 by 2025 and
MMR from current levels to 100 by 2020 .

66.  Reduce infant mortality rate to 28 by 2019
.
 Reduce neo- natal mortality to 16 and still
birth rate to ‘single digit’ by 2025.
 Achieve and maintain elimination status of
Leprosy by 2018.
 Kala-Azar by 2017 and lymphatic
Filariasis in endemic pockets by 2017.

67.  Achieve global target of 2020 which is
also termed as target of 90:90:90, for HIV
AIDS.
 To achieve and maintain a cure rate of
>85% in new sputum positive patients for
TB and reduce incidence of new cases, to
reach elimination status by 2025.

68.  To reduce the prevalence of blindness to
0.251000 by 2025.
 To reduce premature mortality from
cardiovascular diseases, cancer, diabetes or
chronic respiratory diseases by 25% by
2025.
 Increase utilization of public health
facilities by 50% from current levels by
2025.

69.  Ante-natal care coverage to be sustained
above 90% and skilled attendance at birth
above 90% by 2025.
 More than 90% of the newborn are fully
immunized by 1 year of age by 2025.

70.  80% of known hypertensive and diabetic
individuals at household level maintain
‘controlled disease status by 2025.
 Meet need of family planning above 90%
at national and sub national level by 2025.

71.  Relative reduction in prevalence of current
tobacco use by 15% by 2020 and 30%
by2025.
 40% reduction in prevalence of stunting of
under-5 children by 2025.

72.  Safe water and sanitation to all by 2020
(Swachh Bharat Mission).
 Reduction of occupational injury by half
from current levels of 334 per lakh
agricultural workers by 2020.

73.  Increase health expenditure by
Government from the existing 1.15%
(GDP) to 2.5% (GDP) by 2025.
 Increase state sector health spending to
>8% of their budget by 2020.

74.  Decrease in proportion of household
facing catastrophic health expenditure
from the current levels by 25%, by 2025.
 Ensure availability of paramedics and
doctors as per IPHS norm in high priority
districts by 2020.

75.  Establish primary and secondary care
facility in high priority districts by 2025.
 Ensure district-level electronic database
of information on health system
components by 2020.

76.  Strengthen the health surveillance system
by 2020.
 Establish federated integrated health
information architecture, Health
Information Exchanges and National
Health Information Network by 2025.

77.  Establish federated integrated health
information architecture, Health
Information Exchanges and National
Health Information Network by 2025.

78. 1.The Swachh Bharat Abhiyan.
2.Balanced, healthy diets and regular
exercises.
3.Addressing tobacco, alcohol and substance
abuse.
4.Yatri Suraksha - preventing deaths due to
rail and road traffic accidents.

79. 5.Nirbhaya Nari action gender
violence.
6.Reduced stress and improved
safety in the work place.
7.Reducing indoor and outdoor air
pollution.

80. The 7 key policy shifts in organizing health care services
are:
1. In primary care from selective care to assured
comprehensive care with linkages to referral hospitals.
2. In secondary and tertiary care from an input oriented to
an output based strategic purchasing .

81. 3. In infrastructure and human resource from normative
approach to targeted approach to reach under-serviced
area.
4. In public hospitals from user fees at cost recovery to
assured free drugs , diagnostic and emergency
services to all.

82. 5. In urban health from token
interventions to on-scale assured
interventions, to organize Primary
Health Care delivery and referral
support for urban poor.
Collaboration with other sectors to
address wider determinants of
urban health is advocated.

83. 6. In national health programmes integration with health
systems for programme effectiveness and intern
contributing to strengthening of health systems for
efficiency .
7. In AYUSH services from stand alone to a 3
dimensional mainstreaming.

84. 1. RMNCH + A services
2. Child and Adolescent Health
3. Universal immunisation
4. Communicable diseases
5. Mental health
6. Non communicable diseases
7. Population stabilization

85.  This policy aspires to elicit developmental
action of all sectors to support Maternal and
Child survival. The policy strongly
recommends strengthening of general health
system to prevent and manage maternal
complications, to ensure continuity of care
and emergency services for maternal health.

86.  The policy endorses the national consensus
on accelerated achievement of neonatal
mortality targets and ‘ single digit ’ stillbirth
rates through improved home based and
facility based management of sick new borns
.
 School health programmes as a major focus
area , health and hygiene being a part of the
school curriculam

87.  It emphasis to the health challenges of adolescents and
long term potential of investing in their health care.

88.  Priority would be to improve
immunization coverage with quality and
safety, improve vaccine security as per
National Vaccine Policy 2011 and
introduction of newer vaccines based on
epidemiological considerations. The focus
will be to build upon the success of
Mission Indradhanush and strengthen it .

89.  The policy recognizes the
interrelationship between communicable
disease control programmes and public
health system strengthening .
 It advocates the need for districts to
respond to the communicable disease
priorities of their locality .

90.  The policy acknowledges HIV and TB co infection and
increased incidence of drug resistant tuberculosis as
key challenges in control of Tuberculosis .

92.  An integrated approach for screening
the most prevalent NCDs with
secondary prevention would make a
significant impact on reduction of
morbidity and preventable mortality
with incorporation into the
comprehensive primary health care
network with linkages to specialist
consultations and follow up at the
primary level .

93.  Screening for oral, breast and cervical cancer and
Chronic Obstructive Pulmonary Disease will be
focused in addition to hypertension and diabetes .

94. This policy will take action on the following
fronts :
 Increase creation of specialists through
public financing and develop special rules
to give preference to those willing to work
in public systems .

95.  Create network of community members to provide
psycho-social support to strengthen mental health
services at primary level facilities.

96.  Policy imperative is to move away from
camp based services to a situation where
these services are available on any day of
the week .
 And to increase the proportion of male
sterilization from less than 5% to at least
30% and if possible much higher .

97. While the public health initiates over the
years have contributed significantly to the
improvement of the health indicators, it to
be acknowledged that public health
indicators / disease burden statistics are the
outcome of several complementary
initiatives under the wider umbrella of the
development sector, covering rural
development, agriculture, food production ,
sanitation , drinking water supply, education
etc.

99.  Throughout the world , large number of
older people face challenges such as
discrimination , poverty and abuse that
severely restrict their human rights and
their contribution to society .
 Although concerns involving the
ageing population are not new, they
have traditionally been seen as
problems requiring solutions that are
functional and reactive .

100.  The rights of older people are the
entitlements claimed for senior
citizens . Elderly rights are one of
the fundamental rights of India .
 The International Day of older
persons is celebrated annually on
October 1 .
 The 2001 census of India
demonstrated that aged people in
India have crossed over 100
million .

101. The NPOP in India has been
formulated as a forward – looking
vision of the government for
improving quality of life of older
people in India through
i. Increased income security,
ii. Health and Nutrition ,

102. iii. Shelter,
iv. Education, empowerment and welfare .

103. 1. To encourage individuals to make various
provisions such as health and social
insurance for their own as well as their
spouse`s old age.
2. To encourage families to take care of their
older family members .

104. 3. To enable and support voluntary and
non-governmental organizations to
supplement the cate provided by the
family, with greater emphasis on non
institutional care .
4. To provide care and protection to the
vulnerable elder especially widows,
physically, challenged, abused and
destitute elderly .

105. 5. To provide health care facilities specially
suited to elderly .
6. To promote research and training to train
geriatric care givers and organisers of
services for the elderly.

106. 7. To facilitate and strengthen inter sectoral partnerships
in the field and
8. To create awareness regarding elder persons to
develop themselves into fully independent citizens .

107. 1.Financial Security :
 Pension scheme ( in public and private sector)
 Lower income tax rate and exemptions .

108. 2. Health care and Nutrition :
 Setting up Geriatric wards and training on Geriatric
Specialized care
 Expanding Mental Health Services for elderly .

109. 3. Shelter :
 Government and Private Housing
Schemes for elderly .
 Disposal of cases relating to property
transfer, mutation of property and tax .

110. 4. Education
 Information to elderly about Concept of wellness in
old age
 Evolving changes in lifestyle and living style .

111.  Identifying extremely vulnerable elderly
who are disabled, chronically sick and
destitute .
 Assistance to voluntary organisations to
construct and maintain old age homes, day
care centre , multi – services citizens
centres, supply of disability – related aids
and appliances .

112. 6. Research and Training :
 Encourage medical colleges, training institutions for
Nurses and Para medical institutes to introduce
COURSES ON GERIATRIC CARE.

113.  Research and Documentation in elderly care
 NGO supported specialized training in
Geriatric care.
7. Sensitizing the Media :
 Involvement of social medias and internet to
create awareness .

114. 1. Pradhan Mantri Suraksha Bima
Yogana :
2015 All savings bank account holders
18 – 70 years old can join the scheme. It
offers a coverage of rupees 200,000 for
death or total and irrevocable loss of
both eyes and rupees 100,000 coverage
for the loss of an eye .

116.  The government started the
Swavalamban Scheme in 2010/11 which
was replaced by the Atal Pension Yojana
(APY) in June 2015 for those persons
engaged in the unorganized sector , who
are not members of any statutory social
security scheme .

118.  Low premium life insurance (Pradhan
Mantri Jeevan Jyoti Bima Yojana)
 General insurance (Pradhan Mantri
Suraksha Bima Yojana) .
 The pension plan (Atal Pension Yojana).
It is proposed to link this to the accounts .

120.  This scheme is a part of the
government`s commitment to
financial inclusion and social
security during old age and to
protect those aged 60 years and
above against a future fall in their
interest income due to uncertain
market conditions. The scheme will
be implemented through LIC .

124. How the Money is Used

125. A regional body South Asia Senior Citizens`s Working
Group aims to work closely with the respective
governments, NGOs and civil society members of the
region in order to improve the well –being of the ageing
population .

129.  The policy should emphasise
the need for expansion of
social and community services
for older persons , particularly
vulnerable women group to get
accessible to the user friendly
client oriented services.

130.  Special efforts will be made to implement the
policy at the rural populations and
unorganised sectors where most of the older
population lives .