Community Health, Public Health and Mental Health Nursing
Prevention and population measures
Public health items test levels of prevention: primary (immunisation, health education, safe water), secondary (screening, early diagnosis, contact tracing) and tertiary (rehabilitation, adherence support). Distinguish incidence (new cases over a period) from prevalence (all existing cases at a point in time). Know Ghana's structures - CHPS compounds, community health officers, district health directorates, the Ghana Health Service - plus the notifiable disease list, cold chain principles (vaccine vial monitors, +2 to +8 °C), outbreak investigation steps and the role of home visiting and health education.
Mental health nursing
Know the Mental Health Act, 2012 (Act 846), which protects the rights of people with mental illness and promotes community care. Differentiate hallucination (a false sensory perception) from delusion (a fixed false belief) and from illusion (misinterpretation of real stimuli). Screen for suicide risk directly and without judgement. Antipsychotics cause extrapyramidal effects, tardive dyskinesia and neuroleptic malignant syndrome (fever, rigidity, autonomic instability, raised creatine kinase); lithium requires serum monitoring and is toxic with tremor, vomiting and ataxia. Therapeutic communication is concrete, honest and non-confrontational.
Traps
Calling screening primary prevention; confusing incidence and prevalence; arguing with a delusion instead of acknowledging the feeling; and restricting a voluntary patient's liberty without legal grounds.
Worked example
During a community outreach, 40 new hypertension cases are found in one year in a district of 10 000 adults who already have 600 known cases. Incidence = 40 per 10 000 per year; prevalence = 640 per 10 000 (6.4%) at the end of the year.