7. Powell, M. (1999). Presenting in English.

London: Language
Teaching Publication.
8. Ruetten, M. K. (2004). Focus on writing: Developing composition
skills through instruction and practice 1. Singapore: Learners
Publishing.
9. Smaley, R. L., Ruetten, M. K., & Kozyrer, J. R. (2004). Focus on
Writing: Refining composition skills through instruction and practice
2. Singapore: Learners Publishing
10. Stevens, M. (1998). How to be better at giving presentations. New
Delhi : Kogan Page.
11. Wallace, M. J. (2004). Study skills in English: A course in reading
skills for academic purposes (2nd ed.). Cambridge: Cambridge
University Press.
12. Wong, S. (1991). Summary writing: Techniques and practice
Singapore: Manhattan Press.

YEAR-3
SEMESTER-VI

Total
S# Semester VI Theory Clinical Skills/Lab Credit
Course Title
1 Mental Health Nursing 3.00 3.00 6.00
Introduction to
2 Biostatics 2.5 0.5 3.00
Behavioral
3 Psychology 2.00 2.00
4 Epidemiology 2.00 2.00
Culture Health and
5 society 2.00 2.00
English VI(Academic
6 Writing) 2.00 2.00
Total 17.00

1. Mental Health Nursing 6 CH

Course Description:
This course introduces the learners to the concepts of mental health and
mental illness, the various concepts of psychiatric nursing and its
development in general and in Pakistan in particular. It further develops
understanding of holistic approach to mental health nursing by applying the
nursing process for patients and families in hospital settings. The course is
also intended to explore personal and cultural perceptions, values, and

1
beliefs about mental health problems and the need and relevance of
community mental health care in Pakistan.
Course Objectives:
On completion of this course, the learners will be able to:

1. Demonstrate an awareness and acceptance of mental health and

illness as legitimate health issues
2. Describe the nursing process as applied to mental health nursing
3. Utilize knowledge base to actively participate in therapeutic milieu for
clients with mental health problems
4. Explore factors affecting mental health especially in the Pakistani
culture
5. Demonstrate care of a client suffering from different mental health
illnesses
6. Identify need and relevance of community mental health in Pakistan
and the resources available to manage it

Teaching/Learning Strategies:
Lecture with discussion, work in small group setting, review of articles,
presentation, role-play, field visit and clinical.

Evaluation Criteria:
Group Presentation 20%
Mid-term exam 15%
Scholarly paper 30%
Clinical portfolio 10%
Final Exam 25%
Clinical Pass/Fail

UNIT OBJECTIVES:

Unit I: Mental Health & Mental Illness

1. Analyse own perceptions, values, beliefs and feelings towards mental
health and mental illness
2. Analyse cultural perceptions to mental health, mental illness and mental
health nursing.
3. Discuss about the history of psychiatry and psychiatric nursing in
Pakistan
4. Demonstrate understanding about laws governing admissions and
discharge of clients in mental health settings
5. Analyze the common personal and civic rights retained by patients in
mental health settings and ethical issues related to it

2
Unit II: Tools of Psychiatric Nursing

A: Therapeutic Communication and therapeutic relationship:

1. Discuss significance of communication skills in mental health settings

2. Describe techniques that facilitate or impede therapeutic
communication in mental health settings
3. Demonstrate „use of therapeutic self‟ while dealing with clients with
mental health problems in selected settings.
B: Mental health assessment:
1. Discuss nature, purpose and process of mental health assessment
2. Begin to analyze clinical findings that indicate mental health problems in
selected clients.

C: Self Awareness:
1. Define self awareness
2. Establish relationship between self-awareness and development of
therapeutic relationship in mental health setting.

Unit III: Factors Affecting Mental Health and Mental Illness

1. Describe biological, sociocultural and interpersonal factors and their
impact on mental health and mental illness
2. Discuss stress and adaptation, and its relationship with mental health
and mental illness
Unit IV: Bio-Psychosocial Interventions (to be taught in
different classes and during clinical conferences as
appropriate)
1. Discuss effective ways of managing anger
2. Discuss cognitive behavioral therapy
3. Discuss psychopharmacological interventions
4. Describe the mechanism of action, clinical use, and side effects
related to drugs used in mental health settings
5. Identify role of the nurse in psychopharmacological treatments
6. Analyze relevance and appropriateness of these therapies in the field
of mental health

Unit V: Psychopharmaco dynamaic

(needs to develop objectives)
Unit VI: Personality Disorders
1. Discuss the development of personality disorders.
2. Discuss some common features exhibited by individuals with
antisocial and borderline personality disorder.
3
3. Explore causative factors of personality disorders
4. Utilize nursing process based on an understanding of the
psychodynamics‟ of clients exhibiting various maladaptive behaviors
in selected situations.

Unit VII: Mental health Problems & Therapeutic Interventions

A: Anxiety and dysfunctional anxiety responses
1. Discuss the concept of anxiety
2. Discuss physiological, perceptual, cognitive, and behavioural effects
of anxiety
3. Discuss various dysfunctional anxiety responses [Generalized anxiety
disorder, Post traumatic stress disorder, Phobia, Obsessive
Compulsive disorder, Conversion reaction] and their basis in etiology
4. Demonstrate understanding of the principles of nursing and
psychosocial care, while caring for clients with dysfunctional anxiety
responses.

B: Altered mood states:

1. Describe the continuum of adaptive and maladaptive emotional
response
2. Discuss phenomenon of „depression‟ Analyse the prevailing
psychological, biological, and social theories that serves as basis for
caring for clients with altered mood statesAnalyse the human
responses to mood alterations Discuss effective nursing and
psychosocial interventions for clients with Altered mood states

C: Deliberate self-harm and suicidal behaviour:

1. Describe the continuum of adaptive and maladaptive self- protective
responses
2. Discuss prevalence of self harm and suicidal behaviour in Pakistani
population.
3. Explore predisposing factors, precipitating stressors, and appraisal of
stressors related to self-protective responses
4. Discuss effect to nursing interventions related to self-protective
responses.
D: Altered thoughts and perceptions:

1. Describe „schizophrenia‟ in light of altered thoughts and perceptions

2. Distinguish key positive and negative symptoms found in clients with
thought disorder
3. Analyze human response to schizophrenia with emphasis on
perception, thought, activity, and consciousness, affect, and
interpersonal relationship
4. Analyze predisposing factors, precipitating stressors and appraisal of
stressors related to schizophrenia

4
5. Discuss principles of care for helping client suffering from altered
thoughts and perceptions and their families.

E: Substance abuse and dealing with aggressive clients:

1. Define the terms related to substance abuse

2. Discuss predisposing factors related to substance abuse
3. Describe different categories of drugs of abuse and their specific
effects
4. Discuss principle of care for client who abuses the drug.
5. Define violence, its possible causes and characteristics
6. Describe theories contributing to the development of aggressive
behaviour
7. Identify factors useful in predicting aggressive behaviour among
clients
8. Discuss strategies to assess patients with aggressive behaviors
9. Relate behaviors and values of nurses related to violence and
substance abuse
10. Discuss primary and secondary prevention of aggression in hospital
setting.
Unit VIII: Childhood Mental Disorders
(needs to develop objectives)

Unit-IX: Geriatric Mental Health problems:

1. Identify and describe the elements of a comprehensive psychiatric
assessment of elderly clients with compromised cognition.
2. Discuss Dementia and delirium in relation to mental health of elderly
3. Analyze nursing care needs for elderly clients with mental health
problems.

Unit X: Community Mental Health Nursing

1. Discuss various models of community mental health nursing and its

relevance to Pakistan
2. Analyze functions of mental health nurse in community setting of
Pakistan
3. Demonstrate understanding of faith healing practices as local
resource for community mental health in Pakistan.

Unit XI: Rehabilitation and Recovery:

1. Define tertiary prevention and rehabilitation
2. Discuss the behaviors and rehabilitative needs of people with serious
mental health problems
3. Discuss response of families and communities towards rehabilitative
needs of clients.

5
 Clinical Objectives:
At the end of the clinical experience, learners will be able to:

1. Apply theoretical knowledge to psychiatric-mental health nursing

practice in hospital settings
2. Demonstrate enhanced self-awareness and self-understanding in
clinical practice
3. Apply therapeutic communication skills while caring for clients
4. Demonstrate use of nursing process (assessment, diagnosis,
planning, implementation, and evaluation) in the care of clients with
mental health problems
5. Explore and analyze issues that contributes in promoting mental
health and preventing mental illness
6. Recognize nurses' role as health educator and once patient's needs
are identified, plan/conduct health education session(s)
7. Perform all required skills, maintaining clients safety
8. Identify and evaluate the mental health care services available in
community.
COURSE SCHEDULE
Day/Date Topics Faculty

Unit 1: Mental Health and Mental Illness

 History of Psychiatry and Psychiatric
Nursing
 Mental Health Ordinance 2001 Pakistan
Unit 2: Tools of Psychiatric Nursing
 Therapeutic communication and
therapeutic relationships
 Mental health assessment
 Self awareness
Unit 3: Factors Affecting Mental Health
and Illness
 Biological factors
 Socio cultural factor
 Psychological factors
Unit 4 Biopsychosocial Interventions
 Cognitive behavioural therapy
 Anger management

Unit 5: Psycho-Pharmacodynamics

Unit 6: Personality Disorders

 Anti-social personality
 Borderline Personality
 Maladaptive behaviours
6
 Unit 7: Mental Health Problems and
Therapeutic Interventions
Anxiety responses
 Dysfunctional anxiety responses
 Generalized anxiety disorder
 Post traumatic stress disorder
 Phobia
 Panic disorder
 Obsessive compulsive disorder
 Conversion disorder

Altered mood states

 Bipolar disorder
 Major depressive disorder

Deliberate self-harm and suicidal

behaviors

Altered thoughts and perceptions

 Schizophrenia

Substance abuse and dealing with

aggressive behaviours
Unit 8: Childhood mental disorders

Unit 9: Geriatric Mental Health Problems

 Dementia
 Delirium
Unit 10: Community Mental Health Nursing
 Models of community mental health
nursing
 Faith healing
 Crisis intervention
Unit 11: Rehabilitation and recovery of
the clients with Mental Health problem

GROUP PRESENTATION ON NURSING PROCESS IN MENTAL

HEALTH SETTING 20%

The presentation would be conducted in groups consist of 4-6 learners.

Each group would choose a presentation topic from the given list. The
group members will carry out relevant search and develop outline for the
presentation. The outlines must be approved by the assigned faculty
members at least one week before the presentation is due. The group
leaders will keep record of all the meetings and activities and submit it to
the assigned faculty before the presentation along with a printed copy of
7
the presentation. Each group will be given a total of 20 minutes for
presentation and 10 minutes for discussion.
The list of topics is as follow:
1. Powerlessness
2. Altered thought process
3. Self esteem disturbance
4. Adjustment, impaired
5. Caregiver role strain
6. Altered Sensory perception
7. Defensive coping
8. Risk for violence directed to self and others
9. Guilt
10. Loss & grief
11. Hope-Hopelessness
12. Flexibility-Rigidity
13. Boredom
14. Manipulation
15. Loneliness
16. Trust-Mistrust
17. Dependence –Independence
18. Adaptation
19. Self concept
20. Transference/ Counter transference
21. Genuineness and empathy
22. Professional boundaries
23. Self management skills and mental health
24. Emotions and mental health
25. Environment and mental health
26. Social inclusion and mental health
27. Faith healing
28. Cultural diversity and mental health
29. Resilience
30. Nursing complementary therapies
31. Family intervention
32. Crisis interventions
33. Occupational therapy
Topics can also be selected from world mental health day themes.

Presentation Guidelines
1. Define the selected topic
2. Discuss the topic with literature support in relation to mental health /
mental illness
3. Identify a case scenario from your clinical experience at psychiatric
unit and relate it with the topic.

8
4. Analyze the topic with the help of chosen scenario and clinical
experience
5. Develop an integrated nursing care plan highlighting the nursing
process of the chosen topic
6. Conclude and summarize the presentation
7. Share your personal experience regarding process of the
presentations.
Note: Refer appendix A for evaluation tool to be used for
presentation.

Scholarly Paper: Ethical and legal issues Related to Mental

Health 30%
The purpose of this scholarly paper is to build critical understanding and to
bring insight about few common, yet very important mental health related
ethical and legal issues. This paper will also help learners to contribute
positively towards the mental health of clients.
 Define the issue from varying point of view
 Describe significance of the chosen issue within socio-cultural context
 Identify clinical scenario related to the chosen issue
 Analyze the issue in the light of Eastern and Western
literature/integration of ethical/legal based model, theory or framework.
 Establish the relationship of the issue with mental health and illness , by
describing its application to the clinical scenario
 Propose strategies to promote mental health of the client within the
context of the issue
 Conclude and summarize the paper
 APA formatting & language

 The length of your assignment should be between 1600-2000 words,

excluding title and reference page. The title page should include word
count.
 Discuss your assignment outlines with the faculty member and submit it
at least one week before the paper submission.
 A copy of all the literature used and all drafts/edited copies of
assignment should be submitted along with the final paper

Clinical Portfolio 10%

 Each learner is expected to submit a portfolio to their respective

faculty members.
 The learners will be responsible for developing and maintaining
evidences of activities performed during the clinical practice.
 Ensure that your assignments/evidences are signed by the
respective clinical faculty members on timely basis.

9
  Add a summary sheet as first page before submitting your mid term
and final clinical portfolio. Table of contents and paragraph of
preface and acknowledgement should be added.

Portfolio Evaluation

1. Professional development
Evidence would consist of:
Improved performance based on feedback by faculty and
peers
2. Communication
Evidence would consist of:
Process recording [verbatim]
Nurses notes
3. Nursing process
Evidence would consist of:
Complete psychosocial assessment
List of nursing care priorities
A nursing care plan choosing relevant and appropriate
goals/outcomes and interventions.
Evaluation for the nursing care implemented
4. Teaching learning activities
Evidence would consist of:
Teaching learning plans with resources explored and
utilized
Articles/literature used in clinical conferences or patient
care
5. Weekly reflective log
Evidence would consists of:
Written reflection on clinical experience during the clinical
rotation
Note: Refer appendix B for the guidelines of reflective
log.

RELATED JOURNALS:
 American Journal of Psychiatry.
 British Journal of Psychiatry
 Indian Journal of Psychiatry
 Issues in Mental Health Nursing
 Journal of Psychiatric and Mental Health Nursing
 Psychosocial Nursing & Mental Health Service.
 Journal of Pakistan Medical Association
 Journal of Pakistan Psychiatric Society

10
References:
1. Boyd, M. A. (2002). Psychiatric nursing: Contemporary practice (2nd
ed). Philadelphia: Lippincott.
2. Burgess, A. W. (1998). Advanced practice of psychiatric nursing.
London: Prentice Hall.
3. Fortinash, K. M., & Holoday-Worret, P. A. (2004). Psychiatric mental
health nursing (5th ed). St. Louis: Mosby.
4. Frisch, N. C., & Frisch, L. E. (2002). Psychiatric mental health nursing
(2nd ed). Albany: Delmar Publishers.
5. Gadit, A., & Khalid, N. (2002). State of mental health: Service,
education & research. (4th ed). Karachi: Hamdard Foundation.
6. Gamble, C., & Brennan, G. (Eds.). (2000). Working with serious
mental illness: A manual for clinical practice: London: Bailliere Tindall.
7. Keltner, N. L., Schwecke, L. H., & Bostrom, C. E. (2003). Psychiatric
nursing (4th ed). St. Louis: Mosby.
8. Neeb, K. (2001). Fundamentals of mental health nursing.
Philadelphia: F.A.Davis Company.
9. O‟ Brien, P. G., Kennedy, W. Z., & Ballard, K. A. (1999). Psychiatric
nursing: An integration of theory and practice. New York: McGraw Hill.
10. O‟Brien, A. J. (2001). The therapeutic relationship: Historical
development and contemporary significance. Journal of Psychiatric
and Mental Health Nursing, 8, 129-137.
11. Shives, L. R. (2002). Basic concepts of psychiatric mental health
nursing (5th ed). Philadelphia: F. A Davis.
12. Stuart, G. W., & Laraia, M. T. (2001). Psychiatric nursing: Principles
and practice of psychiatric nursing (7th ed.). St. Louis: Mosby.
13. Thompson, T., & Mathias, P. (2000). Lyttle’s mental health and
disorder (3rd ed). London: Bailliere Tindall.
14. Townsend, M. C. (2003). Psychiatric mental health nursing: Concepts
of care (4th ed). Philadelphia: Lippincott.
15. Varcarolis, E. M. (2002). Foundation of psychiatric mental health
nursing (4th ed). Philadelphia: Saunders.
16. Videbeck, S. L. (2004). Psychiatric mental health nursing.
Philadelphia: Lippincott.

2. Introduction to Biostatistics 3 CH

Course Description:
This course provides the learners preamble knowledge to basic statistical
principles and their application to qualitative and quantitative research
studies in health sciences. It is aimed to develop understanding of rules
governing use of descriptive and inferential statistics to enhance learners‟
knowledge and skills to analyze, synthesize, infer and present given data.

11
Course Objectives:
By the end of this course the learners will be able to:
1. Define various statistical terms.
2. Explain the various statistical methods used in health sciences.
3. Analyze the use of statistics in some selected research studies.
4. Calculate statistical results for selected measures.

Teaching/Learning Strategies:
Interactive lectures, problem solving exercises, small group sessions and
tutorials.

Evaluation Criteria:
Home assignments 20%
quizzes 40%
Midterm Examination 20%
Final examination 20%

COURSE SCHEDULE

TOPIC

Unit 1
 Introduction to Biostatistics
 Identification of variable types and variable scales
(nominal, ordinal, continuous).
Unit 2
 Organizing and displaying data: tables; frequency
distributions: bar graphs, histograms, frequency
polygon; cumulative frequency.
Unit 3
 Measures of central tendency (mean, median,
mode) and measures of dispersion (range,
variance, standard deviation).
Unit 4
 The Normal distribution.
Unit 5
 The sampling distribution and the Central Limit
Theorem.
Unit 6
 Estimation.
Unit 7
 Hypothesis testing: null & alternative hypotheses;
significance level
Unit 8
 Type I and Type II errors and Power of the test.

12
 Unit 9
 T-test – one sample
Unit 10
 T-test - two independent samples.
Unit 11
 Paired T- test
Unit 12
 Regression.
Unit 13
 Correlation
Unit 14
 Chi square and contingency tables
Unit 15
 Analysis of variance (ANOVA).

References:
1. Gillings, D. B., & Douglas, C. W. (1985). Biostats: A primer for health
care professionals. CAVCO: Chapel Hill.
2. Kuzma, J. W. (2001). Basic statistics for the health sciences (4th ed.).
California: Mayfield.

3. Behavioural Psychology 2 CH

Course Description:
This course will help the learner understand human behavior and provide
insight into one‟s personal attitudes, responses to everyday situation and
interactions. It will further assist learners to understand the way psychology
can address issues concerning various spheres of life.
Course Objectives:
On completion of this course, learners will be able to:
1. Discuss key concepts, approaches, methods and interventions of
modern day psychology.
2. Demonstrate understanding of theories of personality and behavior.
3. Develop understanding of the concepts of health psychology.
4. Discuss social relationships and group behavior.
5. Orient themselves with the concepts of abnormal psychology.
6. Demonstrate an understanding of applying concepts of behavioral
psychology to the practice of nursing profession.
Teaching/Learning Strategies:
Interactive lectures, discussions, readings, presentations, quizzes, and
field trips.

13
Evaluation Criteria:
1. Scholarly Paper 30%
2. Quiz 40%
3. Group Presentations 30%
Total 100%

UNIT OBJECTIVES:
Unit I: Introduction:
This unit orients learners to behavioral psychology and various perspective
of psychology.
At the end of this unit learners will be able to:

1. Define Behavioural Psychology.

2. Outline the major perspectives which developed into modern
psychology.

Unit II: Biology & Behaviour

This unit outlines the brain/behaviour relationships and how heredity
influences behavior. At the end of this unit learners will be able to:
1. Discuss biological influences on behaviour
2. Discuss how heredity and environment interact to produce the
development of behaviour.
3. Discuss research methods used in behaviour genetic research.

Unit III: Person Perception: How we see ourselves and others

This unit helps learners to identify and describe influence of social
perception on behaviour.
At the end of this unit learners will be able to:

1. Understand basic principles of social perception.

2. Understand the process of self and other perception and sources of
errors involved in formulating such perceptions.
3. Discuss perceptual inaccuracy with reference to prejudice.
4. Identify ways to approach self and others positively.

Unit IV: Interpersonal Communication

This unit helps learners develop understanding about the constructive role
of self- disclosure and how communication skills can be used effectively in
order to do so.

14
At the end of this unit learners will be able to:
1. Demonstrate the understanding of the ways involved in achieving
effective communication.
2. Demonstrate understanding of using effective communication in
complex situations.
3. Identify circumstances leading to self-disclosure.
4. Develop understanding of the role of self-closure in psychological
health and its use in interpersonal conflicts.

Unit V: Gender & Behaviour

This unit helps learners to establish gender/behaviour relationships and
how it influences adjustment.
At the end of this unit learners will be able to:

1. Demonstrate understanding about stereotypes attached to gender

differences.
2. Discuss impacts of adhering to traditional gender roles on behaviour.
3. Discuss changing gender roles.

Unit VI: Overview of Adult Development

This unit outlines major milestones of adult personality and impact of
emotional intelligence on adult relationship.
At the end of this unit learners will be able to:

1. Discuss Adult developmental transitions in martial and intimate

relationship.
2. Discuss age roles and social clocks and its influences on behavior.
3. Discuss issues in marriage, leading to divorce.
4. Discuss adjustment to divorce and its impact on individual and family
behavior.
5. Develop understanding about significance of “Emotional Intelligence”
in intimate interpersonal and work situations.

Unit VII: Health Psychology

This unit outlines concepts of health psychology and how it contributes to
psychological health.
At the end of this unit learners will be able to:

1. Identify determinants of peoples‟ health related behavior.

2. Develop understanding about the role of locus of control and
attribution styles in serving as protective measures for psychological
health.

15
Unit VIII: Stress & its Effects
This unit identifies and describes the role of stress in an individual life and
how self-modification principles can be used to moderate its effects.
At the end of this unit learners will be able to:
1. Identify major sources of psychological stress.
2. Identify factors influencing stress intolerance.
3. Develop understanding about achieving self-control through self-
modification.

Unit IX: Theories of Personality and Behaviour

This unit outlines major theories of personality & behaviour and then role in
the development of personality.

At the end of this unit learners will be able to:

1. Demonstrate understanding of theories of personality and behaviour.
2. Discuss the relevance of these theories to the development of healthy
personality.
3. Identify various ways of assessing personality.

Unit X: Counseling
This unit outlines and describes the process of counseling and how it can
be effectively utilized in professional relationships.
At the end of this unit learners will be able to:

1. Demonstrate understanding of the counseling process.

2. Demonstrate understanding of applying counseling techniques in
various scenarios.

OURSE SCHEDULE
Day/Date Topics Faculty
Unit 1
 Introduction to Behavioural Psychology
 Various perspectives
 Significance of Behavioral Psychology in
various spheres of life.
Unit 2
 Neurobiology and developmental
psychology.
 Genetic and environmental influences on
behaviour.

16
 Unit 3
Person perception: How we see ourselves and
others.
Unit 4
Interpersonal communication
 Psychological processes in interpersonal
communication.
 Achieving effective communication in
complex situation (crises)
Unit 5
Gender and behavior
Stereotype traditional gender role
Unit 6
Overview of Adult Development
Unit 7
Health Psychology
Unit 8
Stress and its effects
Unit 9
Theories of personality and behavior
Unit 12
Counseling.

Behavioural Psychology
Marking Criteria for Scholarly Papers (30%)

1. Introduction: Clear concise rationale for choosing the topic, interesting

beginning 1500-2000 words.
2. Body: Discussion as per above topics, and relevance to Pakistan.
3. Logical flow and progression of ideas those are easy to follow.
4. Use of personal opinions and evidence of critical thinking
5. Integration of experiences/observations and literature review to
support or refute discussions, balance between opinions and facts
6. Conclusion: Clear, concise review of only the major points and the
point of view of the writer up to 15 sentences.
7. References: Appropriate to the topic
8. Appropriately used throughout the paper (Helps build on and support
the topic).
9. Correct use of standard writing style in body of paper and inclusion of
all reference cited in the paper
10. Paper should be written neatly and readable

17
 Presentation Guideline 30%
1. Describe the present situation of your topic in Pakistan-from your
observations, experiences and readings. Where applicable describe
the root causes of the problem.
2. Describe the impact on psychological (mental) health of your topic.
(Who is impacted and how?)
3. How do people deal/cope with this and how effective are these.
4. Suggest ideas for change, or if something is working how can it be
maintained?
5. As a nurse, what is your role in this, and/or the role of the nursing
profession?

Note: Refer appendix A for evaluation tool to be used for

presentation.

References:
1. Atkinson, R. L., Atkinson, R. C., Smith, E. E., Bem, D. J., & Nolen-
Hoeksema, S. (1996). Hilgard’s introduction to psychology (12th ed ).
Fort Worth, TX: Harcourt Brace & Company.
2. Aronson, Elliot (2006) Social Psychology, edition 6th Prentice Hall
Publication
3. Charles, G (2005). Understanding Psychology .Amazon series
4. Gerrig, Zimbardo (2006) Psychology and Life, edition 17th Academic
International
5. Hewstone, M (2005).Psychology. Published by Blackwell, UK
ISBN.0631206787
6. John, W (2004). Health Psychology. Published by Blackwell, UK
1SBN.0631214429
7. Lynda, l. (2004). Explore the human psyche and understand why we
do the things we do. New York: Worth publishers. Everything series.
8. Myers, G. (2003). Psychology. New York 10010: Worth Publishers,
41, Madison Avenue
9. Nairne, J (2005) Psychology. Amazon series.
10. Nevid, J. (2000). Abnormal psychology in a changing world. London :
Prentice Hall.
11. Publication Manual of the American Psychology Association (5th ed.).
(2001). Washington, DC: American Psychological Association.
12. Sarafino, E. (1994). Health psychology: Bio psychosocial interaction.
USA : John Wiley and Sons.
13. Walker, Jan (2006) Psychology for Nurses and Caring Professionals,
Open University Press.

18
4. Epidemiology 2 CH

Course Description:
This course is designed to provide the knowledge and skills to the learners
for using epidemiological concepts in assessing the contributing factors,
diagnosing the problems, planning intervention and evaluating the results
in the community. In addition the learners will be able to make inferences
the impact on population demographics, social and health status in
Pakistan. Learners will also be able to correlate Epidemiological research
findings to community health nursing practice.
Course Objectives:
By the end of the course the learners will be able to:
1. Illustrate the general use of Epidemiology
2. Illustrate the use of a model of the natural history of a disease as a
base for community intervention
3. Describe the common epidemiological methods
4. Describe the steps of an epidemiological investigation
5. Interpret the relevance of epidemiological research findings to
community health nursing practice
6. Discuss the impact of population growth on the socioeconomic and
health status in Pakistan.
Teaching/Learning strategies:
Interactive lecture, discussion, self study, brain storming and paper writing

Course Expectation:
Pre-reading and preparation for class and participation in class discussion
Evaluation Criteria:
Assignment
Group Presentation 35%
Mid Term Examination 25%
Final Examination 40%
Total 100%

UNIT OBJECTIVES:

Unit I: Introduction of Epidemiology

In this unit learners will be introduce to the basic concepts of Epidemiology
and learners will be able to the uses and scope of Epidemiology

19
At the completion of this unit learners will be able to:

1. Introduce of Epidemiology
2. Define Epidemiology
3. Discuss the uses of Epidemiology
4. Explain the scope of Epidemiology

Unit: II: Concept of Health & Disease

In this unit learners will be introduce to the basic concepts of Health,
Disease, and Well-being and learners will be able to know the concept of
causation in Epidemiology
At the completion of this unit learners will be able to:

1. Discuss the terms of Health, Disease, Well-being.

2. Describe the concept of causation.
3. Understand the Health indicator.

Unit III: Natural History of Disease

In this unit learners will be introducing to the basic concepts of Host, Agent
and Environment will also briefly discuss. Moreover, Learners will discuss
the Epidemiological approach in community setting.
At the completion of this unit learners will be able to:

1. Define the term:

1.1 Host,
1.2 Agent,
1.3 Environment.
2. Identify the concept of epidemiology and diseases with the help of
Epidemiological Trait.
3. Identify Epidemiological approach in community setting.

Unit IV: Concept of Prevention

In this unit learners will be introduce to the basic concept of prevention.
Moreover, Learners will discuss the how the preventive measures apply in
community setting.
At the completion of this unit learners will be able to:
1. Discuss the level of prevention
2. Define Primary level of prevention
3. Discuss Secondary and Tertiary level of prevention

20
Unit V: Basic Measurement of epidemiology
In this unit learners will be introduce to the basic concept of Mortality,
Morbidity. Additionally, learners will discuss the how measures apply in
community setting and whole population.
At the completion of this unit learners will be able to:
1. Understand the concept Mortality, Morbidity
2. Discuss the Rate, Ratio, Incidence, and Prevalence
3. Identify the Maternal and Infant rates in the specific community

Unit VI: Epidemiological transitions in disease patterns

In this unit learners will be introduce to the basic concept of Population
changes. Learners will also discuss the Changes in life expectancy of
whole population.
At the completion of this unit learners will be able to:
1. Define Population changes and population pyramid
2. Illustrate Factors affecting population change (dependency ratio, sex
ratio)
3. Discuss Changes in life expectancy and changes in age / sex
distribution
4. Discuss Changes in major causes of death Changes in age / sex
distribution

Unit VII: Epidemiological Methods

In this unit learners will be introduce to the basic concept of epidemiological
studies. Moreover, Learners will discuss the application of the studies in
community setting and whole population.

At the completion of this unit learners will be able to:

1. Discuss the Descriptive in term of Time, place and Person.
2. Discuss the Analytical and basic Concepts of Cross Sectional
3. Describe the Intervention / Experimental study

Unit VIII: Surveillance and Notification of Communicable Diseases

In this unit learners will discuss about the surveillance and notification of
communicable diseases. Learners will also discuss the various modes of
disease transmission.
At the completion of this unit learners will be able to:
1. Define the term surveillance.
1. Discuss the principles of surveillance and notification of
communicable diseases.
2. Describe different methods of surveillance and notification of
communicable diseases.
3. Identify nurses‟ role in surveillance and control of communicable
21
 diseases.
4. Discuss health indicators.
5. Define the term:
5.1 Health indicators.
6. Discuss health indicators including:
6.1 Crude Birth Rate,
6.2 Crude Death Rate,
6.3 Infant Mortality Rate,
6.4 Morbidity Rate,
6.5 Perinatal Mortality Rate,
6.6 Neonatal Mortality Rate,
6.7 Maternal Mortality Rate,
6.8 Incidence Rate,
6.9 Prevalence Rate,
6.10 Life Expectancy,
6.11 General Fertility Rate.
Unit X: Screening
In this unit learners will discuss about the screening and its importance.
Learners will also discuss the various types of screening
At the completion of this unit learners will be able to
1. Define the concept of screening
2. Discuss the importance of screening
3. Explain the Types of screening.

Unit XI: Data management and presentation

In this unit learners will discuss about the data management and
presentation.
1. Define the term data
2. Discuss the types of data and various methods of data collection.
3. Discuss the different means and interpretation of data presentation
through:
 Graphs,
 Tables,
 Charts.
Course Schedule
Day/date Topics Faculty
Unit 1: Introduction of Epidemiology
Use of epidemiology
Scope of Epidemiology
Unit 2: Concept of Health & Disease
 Health
 Health indicator
 Disease
22
  Concept of causation
 Illness
 Well being
 Determinants of disease in individuals
and community
Unit 3: Epidemiological Models
 Natural History of Disease
 Web of causation
 Triad
Unit 4: Concept of Prevention
 Primary
 Secondary
 Tertiary
Unit 5: Basic Measurement
 Mortality, Morbidity, Rate, Ratio,
Incidence, Prevalence
 Maternal and Infant rates
Unit 6: Epidemiological transitions in
disease patterns
 Health and demographic transition
 Population changes (population pyramid)
 Factors affecting population change
(dependency ratio, sex ratio)
 Changes in life expectancy
 Changes in major causes of death
Unit 7: Epidemiological Methods
 Description – Person, place and Time
 Analytical: Basic Concepts of Cross
Sectional Prospective & Retrospective
 Intervention / Experimental study
Unit 8: Surveillance and notification
 Define the term surveillance.
 Discuss the principles of surveillance and
notification
 Describe different methods.
 Identify nurses‟ role in surveillance
 Health indicators
Unit 9: Screening
 Definition
 Types
Unit X: Data management and presentation

23
Note: Group presentation will be in pairs or trio would be presented
by students in every class for 20 minutes with 10 minutes
discussion.
References:
1. Aderson, E. T. & McFarlane, J. M. (1996). Community as Partner
(2nd ed.). Philadelphia: Lippincott.
2. Ahmed N., & Iliyas, M. (1993). Community Medicine. Karachi: Time
Traders.
3. Ansari. I. M. (2003). Community Medicine and Public Health (6th ed.)
Karachi: Urdu Bazaar.
4. Bahn, M. (1995). Epidemiology: An Introductory Text. Philadelphia:
Saunders Company.
5. Basavanthappa, B. T. (1998). Community Health Nursing). New
Delhi: Jaypee Brothers.
6. Illyas, M. (2003). Community Medicine and Public Health. (6th ed.)
Pakistan: Time Traders.
7. Ilyas, M. & Kahlid, R. (2000). Community Health: For Lady Health
Visitors, Nurses and Allied Health Profession. Pakistan: Time
Publisher.
8. Munro, B. (2001). Statistical Methods for Health Care Research (4th
ed.) New York: Lippincott.
9. Nice, M. A., & McEwen, M. (2001). Community Health Nursing:
Promoting the Health of Population. Toronto: Saunders Company.
10. Smith, C. M., & Maurer, F. A. (2000). Community Health Nursing
Theory and Practice (2nd ed.) Toronto: Saunders Company.
11. Valanis, B. (1992). Epidemiology in nursing and Health Care 2nd. Ed.
New Delhi: Prentice Hall
12. Standhope, M. & Lancaster, J. (1992). Community Health Nursing.
London: C. V. Mosby
13. Vanghan, J. P. & Morrow, R. H. (1989). Manual of Epidemiology for
District Health Management. Geneva: WHO
14. Mausner, J. S. & A. K. Bahn (1974). Epidemiology: An Introductory
Text. London: W. B. Saunders
15. Lilienfeld, P. K & Stolley P. D (1994). Foundation Epidemiology 3rd
Ed. London
Source: http://www.cdc.gov/nccdphp/drh/epi_gloss2.htm#M

Culture, Health & Society 2 CH

Course Description:
This course introduces learners to human interaction and its impact on
individual and group behavior. It also introduces learners to the field of
socio-cultural anthropology. It focuses on the exploration of values, beliefs
and practices related to health and illness in general and among specific
groups of people in Pakistan. The focus is on analysis of the inter
24
relatedness of culture, society and health care delivery in Pakistan. The
course promotes the exploration of trans-cultural nursing concepts, which
will be promoted in the clinical setting.
Course Objectives:
By the end of this course learners will be able to:

1. Identify the units of social structure and their function.

2. Describe the structure and patterns of groups.
3. Discuss the role of members of a society.
4. Explain the social development of Pakistan.
5. Explore the relationship between culture, society and health
6. Analyze health-related knowledge, beliefs, attitudes and practices of
various socio- cultural groups in Pakistan
7. Appreciate the role of society and culture in recognizing health system
utilization
8. Discuss the application of trans-cultural nursing concepts when
providing nursing care to clients.
9. Discuss relevant social issues and suggest methods to facilitate
change where necessary

Teaching/Learning Strategies:
Lectures, group discussions, self-directed learning activities, small group
activity, book presentations, role-play and paper writing.
Evaluation Criteria:
Group Presentation on Pakistani Culture of a particular province including
Health beliefs and practices (Home Remedies) 30 %
Paper on Current Issue 30 %
Final Exam 40 %

UNIT OBJECTIVES:

Unit I: Introduction to Socio Cultural and Anthropological

Concepts
At the end of this unit learners will be able to:

1. Discuss Sociology as a science, its knowledge and methods.

2. Discuss the importance of socio cultural anthropology and its relation
to health
3. Explain the concept of culture
4. Explain the concept of society at micro and macro levels

25
Unit II: Social Institutions and Groups/ Socialization
At the end of this unit learners will be able to:

1. Delineate the difference among Social Institutions e.g.

o Family-types function, marriage, caste, family relationship,
divorce etc.;
o Religious – beliefs, superstitious etc;
o Political system - autocratic, democratic, dictatorship;
o Legal system: Recreation, Educational system.
2. Describe Group: In-group, Out-group, primary group, and secondary
group.
o Reference group, caste, ethnic group, pressure group, vested
interest group etc.

Unit III: Culture and Health Behaviour/Socialization

At the end of this unit learners will be able to:

1. Explain the effects of culture on illness, cultural shock, and

maladjustment.
2. Describe Sickness and sick role, Birth and Death.
3. Discuss the Cultural variations in symptoms. How do the sick
behave?
4. Review the concept of Compliance in different cultures
5. Describe the Food taboos in different cultures.
6. Define Behavior in-groups: status, deviance, alienation, and
socialization.

Unit IV: Pakistani Society/Pakistan A Cultural Perspective/

Briefing on Group

At the end of this unit learners will be able to:

1. Discuss the origin and development of Pakistani Society.
2. Describe the structural changes taking place.
3. Discuss the characteristics of Primary units of social life in Pakistan.
4. Explain the Social norms and mores.
5. Describe the Culture in Pakistan.
6. Review Traits, norms, mores, and folkways of the following regions of
Pakistan.
o Northern areas.
o N.W.F.P
o Punjab
o Sindh
o Balochistan

26
Unit V: Concepts and Perceptions of Health, Illness, and
Disease/Healing System
At the end of this unit learners will be able to:
1. Describe the concepts of health, illness and disease
2. Discuss perceptions of health and illness in different societies and
cultures
3. Discuss health and disease as a product of social behaviour
4. Differentiate between the different healing systems and practitioners
5. Describe basic principles of Eastern and Western medicine
6. Identify issues of integration of traditional healing practices and
modern medicine

Unit VI: Population and Demography

At the end of this unit learners will be able to:

1. Describe the Demography - study the population of Pakistan.

2. Discuss the Population pyramid
3. Analyze the phenomena of Urbanization and migration.

Unit VII: Trans Cultural Nursing Concepts and Assessment

At the end of this unit learners will be able to:

1. Describe concept of trans-cultural nursing

o Explain key concepts related to trans-cultural nursing
o Identify the components of cultural assessment
2. Integrate concepts of trans-cultural nursing care throughout the life
span
3. Identify nursing frameworks and theories applicable to trans- cultural
nursing
o Examine culturally related issues across the life span
o Explore the role of family and cultural practices related to the
developmental stages

Unit VIII: Special Issues in the Delivery of Trans Cultural

Nursing Care
At the end of this unit learners will be able to:

1. Assess cultural specific aspects of pain experience

o Discuss various treatments for pain (home remedies)
2. Explore dietary beliefs and practices of clients from different cultures
o Identify strategies to facilitate dietary change
3. Demonstrate an understanding of health maintenance and disease
prevention models
27
 o Utilize health belief model in client care
o Identify reasons for non adherence to treatment
o Explore religious beliefs and practices related to prevention
and healing in illness
4. Demonstrate an understanding regarding attitudes of society
towards stigmatized diseases
o Discuss societal knowledge regarding infectious diseases
o Discuss societal attitudes towards infectious diseases
o Share ways of enhancing acceptance of individuals with
stigmatized diseases
5. Describe spirituality and its relationship with health and illness
o Differentiate between healing and cure
o Identify different methods of spiritual healing

Unit IX: Societal Perceptions towards Gender/Domestic

Violence
At the end of this unit learners will be able to:

1. Describe gender as a sociological construct

2. Analyze personal and cultural perceptions towards gender
3. Discuss societal perceptions and status regarding men and women
4. Discuss the role and status of women in Pakistani society
5. Evaluate societal attitudes towards factors enhancing women‟s status

Unit X: Human Rights

At the end of the unit learners will be able to:

1. Recognize basic human rights

2. Define human rights
3. Appreciate the importance of human rights
4. Conceptualize a rights based approach to health
5. Identify nurses role in client centered health care approach
6. Discuss the concept of poverty
7. Describe poverty and related theories
8. Discuss poverty distribution
9. Identify the impact of poverty in Pakistani society
10. Explore the relationship between poverty and health.

Unit XI: Migrating Families and Health

At the end of the unit learners will be able to:

1. Describe cultural change and process of change

o Determine factors influencing immigration and emigration (in
society)
o Analyze stages of cultural shock

28
 o Discuss challenges of immigrant populations
o Discuss current world affairs and their influence on human
rights and health in particular
o Discuss the local health system frameworks and its efficiency
in meeting the needs of the population

Unit XII: Social Issue after Disasters:

At the end of the unit learners will be able to:

1. Discuss the general impact of disasters

2. Analysis psychological and social implication of disasters

COURSE SCHEDULE

Day/Date Topics Faculty

Unit 1: Introduction to Socio cultural and
Anthropological Concepts
 Socio cultural anthropology
 Concept of culture
 Society at micro and macro level
Unit 2: Social Institutions and Groups
Socialization
Unit 3: Culture and Health Behaviour/
Socialization
Unit 4: Pakistani Society/Pakistan-A cultural
perspective
Unit 5: Concepts and perceptions of Health,
illness, and disease; and healing system
Unit 6: Trans cultural Nursing Concepts and
Assessment
Unit 7: Special issues in the delivery of Trans
cultural Nursing Care
Unit 8: Societal Perceptions towards Gender /
Domestic Violence
Unit 9: Human Rights
Unit 10: Migrating Families and Health

Guidelines for Paper Writing

1. During the first few weeks of the course identify an unresolved health
or social issue that you may become aware of through any source
(news papers, discussion, TV program, clinical and community setting
etc).
2. The topic must be current (of last one year) and have a significant
effect on human health & society as a whole.
3. You must inform your faculty about your topic of interest prior to the
due date
29
4. The paper should be limited to 1250-1500 words
5. Refer the attached guidelines for paper writing

Paper Writing Criteria

Name: Topic:

Total marks obtained: % Obtained: /30%

Remarks Marks

Learners develops outline, shares

and gets

feedback from peer (title, 3

topic sentences and 3
supporting points) and submits
to faculty
Introduction

Interesting beginning leading to

thesis statement

Thesis statement and plan of

development mentioned

Background information

Socio-cultural significance of
paper, place

and priority in health care/ social

system

Relation to health and role as a

nurse or

member of society

Body

Description of issue

Implications of issue discussed

with reference

to health care/ social system

30
 Details supported by relevant, carefully

selected resources

Existing knowledge or practice challenged for

accuracy and applicability

Rationale for long term effects on health /

society mentioned

Point of view / stand summarized

Ideas expressed are original and innovative

Conclusion

Key ideas summarized

Author‟s views and recommendations expressed

Overall Organization

All paragraphs support thesis

Spelling, punctuation and capitalization

Sentence structure

Proof reading evident

Note: Refer appendix A for evaluation tool to be used for

presentation.

References:
1. Acello, B. (2001). Controlling pain: Breaking down cultural barriers.
Nursing, 31 (2), 26.
2. Ameling, A. (2000). Prayer: An ancient health practice becomes new
again. Holistic Nurse Practitioner, 14(3), 40-48.
3. Andrews, M. M. (1999). Transcultural concepts in nursing care (2nd
ed.). Philadelphia: Lippincott.
4. Broad, L. M., & Allison, D. M. (2002). Nurse practitioners and
traditional healers: An alliance of mutual respect in the art and
science of health practices. Holistic Nurse Practitioners, 16(12), 50-
57.
5. Chatarjee, M. (2004). Feminism & women’s human rights. Jaipur:
Avaiskkar Publisher.
31
6. Chaudhry, M. I. (2004). General sociology. Lahore: Aziz Publisher.
7. Farooq, Z. S. A. (2005). The art of sociological. London: Mc-Graw
Hill.
8. Hughes, M. (2002). Sociology the core. New York: McGraw Hill.
9. Horton, P. B., & Hunt. C. L. (1984). Sociology. (6th ed.). New York:
McGraw- Hill.
10. Leininger, M. (1984). Transcultural Nursing: An overview. Nursing
Outlook, 32 (2), 72-73.
11. Magill, F. N. (2003). International encyclopedia of sociology. New
Dehli: Bhavan Books.
12. McGee, P. (2000). Health, illness and culture. Nursing Standard, 14
(45), 33-34.
13. Merrell, J. (2001). Social support for victims of domestic violence.
Journal of Psychosocial Nursing, 39(11), 30-35.
14. Miller, M. A. (1995). Culture, spirituality and women‟s health. Journal
of Obstetrics and Gynecological Neonatal Nursing, 24 (3), 257-263.
15. Montbriand, M. M. (2000). Alternative therapies: Health
professionals‟ attitudes. Canadian Nurse, March 22-26.
16. Narayanasamy, A. (2003). Transcultural nursing: How do nurses
respond to cultural needs? British Journal of Nursing, 12 (3), 185-
194.
17. Perry, P. (2006). Contemporary society: An introduction to society.
New Delhi: Academic Publishers.
18. Pfeffer, N. (1998). Theories of race, ethnicity and culture. British
Medical Journal, 317 (14), 1381-1384.
19. Prasad, B. K. (2004). Ngo's and development. New Delhi: Anmol
Publications.
20. Zoucha, R. (2000). Understanding the significance of culture in
nursing. American Journal of Nursing, 100 (2), 124GG-124JJ.

Web Sites for National/Local Literature Search:

http://faridi.net/news/links/
http://dawn.com
http://pakiztan.8m.com/pak.html
http://pakvalley.com
http://www.dailypakistan.com/
http://www.geocities.com/citpakistan/geninfo.html
http://www.jang.com.pk/thenews/index.html

English VII (Academic Writing) 2 CH

ANNEXURE-A

32
Unit Objectives:

Unit I Academic Writing

Unit Descriptions:
This unit would assist the learners to improve upon their academic writing,
with special focus on language used in comparison and contrast, and
cause and effect.

Unit Objectives:
By the end of this unit, students will be able to:

1. develop unity within ideas presented

2. support ideas with evidence
3. organize ideas coherently
4. use appropriate sentence structure
5. use specific transitional words / phrase effectively
6. write essays presenting effective arguments

Unit II Incident Reports

Unit Description:
The aim of this unit is to enhance the learners language skills to be able to
detect problems, determine their causes and resolve the issues while
writing incident reports.
Unit Objectives:
By the end of this unit the students will be able to:

1. Identify the purpose for writing incident report

2. Exploit guidelines for incident reports
3. Write organized incident report
4. Use appropriate language for writing incident reports.

Unit III Proof reading & Editing Skills

Unit Description:
The unit will guide students to realize that academic writing is a process
that involves drafting and re-drafting to craft your paper into its final form.
The students will review and re-work on texts keeping in mind the purpose
of writing and the audience it is being written for.
Unit Objectives:
By the end of this unit, students will be able to:

33
1. Understand what is involved in editing
2. Edit for structure-organization
3. Edit for style-tone
4. Proof read for spellings, punctuation, grammar

Unit IV References & Citations in APA Style

Unit Description:
The course is designed to enhance the scientific information of the
learners. In addition the course will also improve the scholarly and
technical information of the learners.
Unit Objectives:
By the end of this unit, students will be able to:

1. Understand what plagiarism involves

2. Cite sources (quotations and paraphrasing)
3. Compile a reference list
4. Use levels of headings
5. Use APA style in written assignments.
References:
1. American Psychological Association. (2001). Publication manual of
the American psychological association. (5th ed.). Washington, DC
2. American Psychological Association. Retrieved April 08, 2006, from
http://apa.org/
3. Axelrod, R. B., & Coper, C. R. (1990). Reading critically, writing well:
A reader and guide (2nd ed.) New York: St Martin‟s Press.
4. Crawford, P., Brown, B., & Nolan, P. (1998). Communicating care:
The language of nursing. Cheltenham: Stanely Thornes.
5. Davidson, W. (2001) Business writing: What works, what won’t (Rev.
ed.). New York: St. Martin‟s Griffin.
6. Emmerson, P. (2004). Email English. Oxford: Macmillan.
7. Fisher, A. (2004). Critical thinking: An introduction. Cambridge:
Cambridge University Press.
8. Glendinning, E. H., & Holmstrom, B. (2004). Study teaching: A
course in reading skills for academic purposes (2nd ed.). Cambridge:
Cambridge University Press.
9. Gelfand, H., Charles J., & Walker, J. C. (Eds.). (2001). Mastering
APA style: Instructor’s resource guide (5th ed.). Washington:
American Psychological Association.
10. Hacker, D. (1998). A writer’s reference. (3rd ed.). Boston: Bedford
books.
11. Langan, J. (2005). College writing skills (6th ed.). New York:
McGraw-Hill.

34
35