Exam 1 Flashcards
(122 cards)
1
Q
Public Health
A
Goal is to organize community efforts that will use scientific and technical knowledge to prevent disease and promote health.
How do i keep the community healthy?
E.g., driving and there are plows and seatbelts
-mall portion of the health care budget in the U.S. that is used for this prevention and population-focused speciality. (Basically Their money is limited. You don’t get a lot of money. That’s usually the first place they cut. All our money is spent on chronic care. Very little spent on prevention)
2
Q
Benefits from Public Health
A
Dramatic increase in life expectancy
• Decreased number of deaths from stroke, coronary heart disease, and
cancer
• Declines in death rates of adults and children
• Population-focused PH approaches could help prevent up to 70% of
early deaths in America, compared to only 10% for medical treatment.
3
Q
What are the 3 Public Health Core Functions
A
Assessment
Policy Development
Assurance
describes public health in America. These functions provide a framework for defining the services to be provided by the public health system.
4
Q
Assessment
A
Collection data
systemic data collection on the population, monitoring the population’s health status and making information available about the health of the community
◦ Monitor health status to identify community health problems
◦ Diagnose and investigate health problems and health hazards in the community
5
Q
Characteristics of Public Health Nursing
A
- it is population-focused
-it is community-oriented - it is health and prevention focused
Interventions are performed at the community and/or population level - Concern for the health of all members of the population or
community, particularly vulnerable populations - The nurse often reaches out to those who might benefit from
a service or intervention
6
Q
Primary
A
Promote health and prevent disease from developing
E.g., immunizations, handwashing teaching, cover sneeze
7
Q
Secondary
A
Screening, early detection of disease
Screen before symptoms
8
Q
Tertiary
A
Treat
Attempt to limit the progression of the disease
“They already have it
9
Q
Quad Council
A
The Quad Council are made up of four public health nursing organizations and has established core competencies
These competencies reflect an agreement that the public health nurse requires preparation at the baccalaureate level.
10
Q
Healthy People 2030
A
Eliminate preventable disease, disability, injury, and premature death
Set healthy goals for the entire nation
Set up health objectives for the nation
11
Q
What are the Core Objectives?
A
Baseline only
Target met or exceeded
Improving
Little or no detectable change
Getting worse
12
Q
Baseline only
A
We dont yet have data beyond the initial baseline data, so we dont know if we’ve made progress
13
Q
Target met or exceeded
A
We’ve achieved the target we set aAt the beginning of the decade
14
Q
Improving
A
We’re making progress toward meeting our target
15
Q
Little or no detectable change
A
We haven’t made progress or lost ground
16
Q
Getting worse
A
We’re farther from meeting our target than we were at the beginning of the decade
17
Q
Developmental Objectives
A
Developmental Objectives represents high-priority public health issues that are associated with evidence-based interventions but dont yet have reliable baseline data.
/
Developmental Objectives: Developmental objectives are important public health issues that don’t have enough data yet to measure their impact, even though there are proven ways to address them. Whether or not they become main goals in Healthy People 2030 depends on if we can collect reliable data on them.
18
Q
Research Objective
A
Research objectives represent public health issues with a high or economic burden or significant disparities btwn population groups… but they aren’t yet associated with eveidence based interventions
/
Research objectives focus on public health issues that have a big impact on health or money, or show big differences between different groups of people, but don’t yet have proven ways to address them. These objectives may be added to Healthy People 2030 as we learn more about them and find effective interventions.
In simple terms, both developmental and research objectives are important public health issues, but the distinction lies in whether there is enough data and proven interventions to address them. Developmental objectives need more data, while research objectives need to find effective ways to tackle the issue before they can become core goals in Healthy People 2030.
19
Q
Social Determinants of health
A
Conditions in which people are born, grow, live, work, and age…influences their health status
Factors include education, economic status, social support, transportation, neighborhood, and physically environment and employment
Addressing social determinants of health is key to improving health of populations
20
Q
Challenges for Community and Public Health Nursing in the Twenty-first Century
A
• Helping eliminate health disparities in underserved populations
• Demonstrating cultural competence
• Planning for community change
• Contributing to a safe and healthy environment
• Responding to emergencies, disasters, and terrorism
• Responding to the global environment
21
Q
Florence Nightingale
A
Crimean War1854
•accepted an assignment to lead a group of nurses who
were sisters from various Catholic and Anglican orders to
the Crimea to work at the Barracks Hospital in Scutari
• Despite deplorable conditions, the army doctors at first refused her assistance.
• Eventually, the doctors, in desperation, called for her help.
• Purchased medical supplies, food, and linen; set up a kitchen; instituted laundry services; initiated social
services; spent up to 20 hours each day providing nursing care
/
She bought supplies and bought her own people; so The sheets were dirty, nobody cleaned anything. They weren’t going about nutrition, hand washing, sunlight. And she realized, hey, these are simple changes that we can make.And she actually went in and started making these changes. She actually has the roots of public health nursing. She sent the framework for current nursing.So while she was there, you think about, this was political activism. The first nursing school was established. She was honored as the foundation for professional nursing.She introduced principals of asepsis and infection control. She came up with a way to transcribe doctor’s orders, came up with a plan to have patient records.
- established 1st nursing school in England
Honored as the founder of professional nursing services,
- Introduced principles of asepsis and infection control, a
system for transcribing doctor’s orders, and a system to
maintain patient records
◦ Contributions to nursing research
◦ Kept careful statistics—documented a decrease in the death rate of soldiers from 42% to 2% as a result of health care reforms that emphasized sanitary conditions
22
Q
Who created the Frontier Nursing Services (FNS)
A
Mary Breckinridge
23
Q
Lilian Wald
A
In the 1880s, she developed a viable practice for public health nursing which is called The Henry Street Settlement, Lower East Side of NYC
- provide well baby care, health education, disease prevention, and treatment of minor illnesses
- nursing practice formed the basis for public health nursing in the U.S
- Developed the first nursing service fr occupational health ( Metropolitan Life insurance Company)
- Visting Nurse
- School nursing: • They didn’t have school nurses back then. And when somebody was sick, a child was sick, you went home. There was a lot of infectious diseases then.
• If I sent you home, I never checked that you didn’t come back. So she was like, what is going on? So they decided to set up school nurses.
- Occupational Health Nursing
24
Q
Metropolitan Life Insurance Company
A
Developed by Lilian Wald
Prevention of diseases in workers to promote productivity
Sliding scale fee
25
History of Lilian Wald
One of her assignments were to go out and walking in the tenements ; she used to do classes for the immigrants. They were very, very poor that lived in the tenements. And one day she was getting a class and one of her usual mommies didn't come. And she gave the class, and also the little girl comes running and crying, there's something wrong with my mother can you help? And she left and the mother delivered the baby, but she was still bleeding Nobody changed anything. And she just couldn't believe the horrible conditions. And she's looking around, how many people were in this little tenement? Nobody changed anything. And she just couldn't believe the deplorable conditions. And she's looking around, how many people were in this little tenement?The rats, the roaches, the bugs crawling up. And she just couldn't believe it and she realized, you know, we've got to start making changes. So she called that her baptism by fire. She couldn’t believe a family of 7 were in one tiny room… THAT WAS her START
• she started sending people to help the kids and to see what was going on with them
◦ Lead to babies being well,So she really was amazing. From her we have well baby care, health education, disease promotion. She was a champion for public health nurse.
She formed for housing reform,, world peace, rights of women, children, advocate for immaigrnts
◦ Fought for civil rights
◦ She has a place in the lower east side and it’s still there
◦ She came up with a playgraound
‣ They used to throw or empty their toilets on to the street where children play so she created a safe playground
26
Mary Breckinridge
Rural Nursing 1925
Established Frontier Nursing Service
• Rural nursing: There's no medical care. Who's delivering that baby? How many babies do you have? How many babies do you have? Oh, you've got the most. You're going to help me deliver. That's how they decided. So if I had the most babies, that was the person that would run around, to the whole town and help anybody else that was delivering.
• Yep. It sure is. Mary Breckenridge lost her own two children to different diseases as young children. And she said she wanted to help make a difference. So she brought about this royal frontier nursing where they can go out and actually help people. So the person that was training, it was much better to have a trained nurse than just somebody that happened to have four children delivering a baby, right?
27
Henry Street Settlement
Created by Lilian Wald
• Henry: buy this little house and decided hw to help these sick kids; nurses would spend the night with these kids; And the nurses would come back and say, it is so infested with rats and roaches. These kids sleep right through them, crawling on them, going in and out their ears, their nose.Like they came back so disgusted. We got to do something, right? So that's what she got so involved with making changes and reform.
Henry Street Settlement provided home visits, health education, and medical care to those in need.
Through her work at the Henry Street Settlement, Lillian Wald became a pioneering figure in public health nursing and social work. She advocated for social justice and healthcare reform, leaving a lasting impact on the field of public health and inspiring others to address the social determinants of health in underserved communities.
28
Diagnostic Related Groups (DRGs)
Are a classification system used by hospitals to group patients with similar diagnoses and medical needs together for the purpose of billing and reimbursement. Each DRG has a predetermined payment rate based on the average costs associated with treating patients in that group.
For example, if a patient is diagnosed with an inflamed appendix and the expected length of stay in the hospital is three hours, the hospital is reimbursed based on that predetermined time frame regardless of the actual length of stay. This means that the hospital receives the same payment whether the patient stays for three hours or longer.
If a patient can be discharged earlier than expected due to their good health and quick recovery, the hospital still receives the same payment for the anticipated duration of care. This can create incentives for hospitals to provide more efficient and effective care in order to optimize their financial outcomes within the constraints of the DRG payment system.
29
National Association of School Nurses (NASN)
Provides the general guidelines and support for all schoool nurses
- standards of professional practice
-Professional performance standards
So there are standards for home care nurses, standards for school nurses. No matter where you work, you're still following the nurse practice act, okay?
So don't let someone tell you, oh, it's okay. You can do that. If a nurse can't do that, a nurse can't do that, okay? So keep those things in mind.
30
Standards of Practice for School Nurses
The American Academy of Pediatrics (AAP) guidelines state that school nurses should ensure the following:
- tht children get the health care they need, including emergency care in the school
- that the nurse keeps track of the state-required vaccines
- that the nurse carries out the required screening of the children based on state law
- that children with health probs. Are able to Learn in the classrooms
31
What are the eleven criteria for school nurses?
1. Develop school health policies and procedures
2. Evaluate their own nursing practice
3. Keep up with nursing knowledge
4. Interact w/ the interdisciplinary healthcare team
5. Ensure confidentiality
6. Consult with other to give complete care
7. Use research findings in practice
8. Ensure the safety of children, including when delegating care to other school personnel
9. Have good communication skills
10. Manage a school health program efficiently
11. Teach others about wellness
Things don't need to be told. Guess what, if a child has HIV, the whole school does not need to know.….If the child is in fifth grade, do I need to tell the teacher? No, it's none of his or her business. If we're talking kindergartners and the kid is a biter, or the other kids are biting, that might be a conversation…..But other than that, all children, any bleed, anything universal precautions. Nobody's touching blood. So those are things to kind of, so confidentiality's a big deal.
32
What are the educational Credentials of School Nurses
The National Association of School Nurses (NASN) reccomend that school nurses have a bachelor’s degree in nursing and a special certification in school nursing
However, there is NO general law regarding the educational background of school nurse; some stated hire LPNs
33
What are the roles and functions of School Nurse?
Give care to children as:
- direct caregivers
-dispense meds
- educators
- counselors
Coordinate the health of many students in their schools with the health care that children receive from their own health care providers
34
School Nurses and Healthy People 2020
They wanna make sure children stay healthy and make sure they get their vaccinations , safety gear, nutritious foods, and decreasing the number of days absent (due to illness like asthma etc. )
35
1 nurse out every ____children is recommended
1 out of every 750 children
One nurse is really not enough.. who is that nurse responsible for in the school?—- EVREYONE IN THE BUILDING, t is not just the student,— also the faculty, and visitors (if a visitor gets a MI, you are responsible)
36
Primary Prevention in the School
Prevent childhood injuries
Substance abuse prevention education
Disease prevention education
Required vaccinations for schoolchildren
37
Secondary Prevention in the school
Emergency plan and emergency equipment
Giving medication in school
Assessing and screening
Indentification of child abuse or neglect
Communicating with/ health care providers
Efforts to prevent suicide
*Violence at school
38
Tertiary Prevention in the Schools
Children with asthma
Children with diabetes
Children who are autistic
Children with DNR orders
Homebound children
Pregnant teenagers and teen mothers
39
Scope of Occupational Health Nursing
Occupational Health Nursing is a speciality practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy work environment ; involves prevention of adverse health effects from occupational and environmental hazards
These nurses usually work in traditional manufacturing, industry, service, health care facilities, construction sites, and government settings
40
Occupational Safety and Health Act (1970)
OSHA
Safe work place
A federal agency improves worker health and safety by establishing standards and regulations and by educating workers.
Sets exposure standards and is responsible for enforcement of safety and health legislation.
41
Academic education is generally at the graduate level as a ____
Occupational Health Nurse
however, many nurses with an associate degree in
nursing or BSN work in occupational health
42
Role as a occupational nurse
Okay, so we do promotion help promotion at workplaces, which is important you should have a whole team that works there Injuries that can happen at work. We need to teach them about their workplace hazards and doing a natural walkthrough What are you seeing that somebody else isn't seeing? I like a better idea of challenges about
Go down to the warehouse and injure your back. What are they doing? What's happening now? So you want to decrease the risk of occupation from those who want to promote levels of prevention We want to prevent injuries It's preventing actual injury the nursery for their type of work they're doing
Optimally a team approach is used; core team members
include occupational health nurse, occupational physician, industrial hygienist, safety professional
• Services provided range from those focused only on work-
related health and safety problems to a wide scope of services that includes primary care
43
Worker Assesment
Occupational Nurses does worker assesment which do a traditional hxs and physical assessment, emphasizing exposure to occupational hazards
44
Workplace Assessment
Occupational nurses do worksite walk-through
45
Healthy People 2030 Occupational nursing
Identifies the national health objectives aimed at reducing the risk of occupational illnesses and promoting safety. Health education and health protection strategies are proposed to address the needs of large population groups such as the American workforce
46
Primary prevention Occupational Nurse
Promote health
Identify hazards
Immunizations
47
Secondary prevention occupational nurse
Screenings
Referral to counseling
48
Tertiary prevention occupational nurse
Restore health and assit to maximum level of functioning
49
National institute for Occupational Safety and Health (NIOSH)
The branch of the U.S. Public Health Service that is responsible for investigating workplace illnesses, accidents, and hazards.
50
Hazard Communication Standard
The “right to know” standard that requires all manufacturing firms to inventory toxic agents, label them, develop information sheets, and educate employees about these agents.
E.g., if job requires you to work with chemicals; you have the right to know
51
Disaster Planning and Management
Effective disaster plans are designed by those with knowledge of the work processors and materials, the workers and workplace, and the resources of the community.
Specific steps must be detailed for actions to be put in
place by specific individuals in the event of a disaster
52
Name the nursing process
Assessment
Analysis
Planning
Implementation
Evaluation
53
Assessment on Home health
Collecting data about home care clients
Establishing a database by gathering objective and subjective client data and confirming data. The nurse collects information relative to the client, verifies the data, and communicates the assessment data to relevant members of the health care team.
understand theri lifestyle . What do they live with? It's pretty different from what you're saying. Being a citizen. Judge Judy? Price is right. What else are they doing all day? Family might be away at work, wherever they might be. They might be alone all day. That's what they do. When you see a person coming in for their physical, a doctor's appointment, huge outing. What are they living? You might want to open that refrigerator to see what are their meals. So we'll talk more about those kinds of things. So when you're doing that assessment, you are going to be doing that physical assessment to look at the environment, their home, and it's safe.
54
Analysis : Home care
Diagnosis through the analysis of these data
Identify the client health care needs and/or problems based on an interpretation of assessment data. The nurse then formulates nursing diagnosis, and communicates the analysis findings to relevant members of the health care team.
55
Planning: Home Care
Setting goals for meeting client needs and designing strategies to achieve expected client outcomes. The nurse determines the expected client outcomes, develops and modifies the plan of care, formulates outcome criteria, and communicates the plan of care to relevant members of the health care team.
56
Implementation Home care
Initiating and/or completing actions in order to accomplish the defined goals of care. The nurse organizes, managed and provides care to accomplish expected client outcomes, and communicates nursing interventions to relevant members of the health care team.
57
Evaluation: home care
Determining whether or not the client outcomes have been achieved and interventions have been successful. The nurse compares the actual outcomes with expected expected outcomes of care and communicates the client responses to interventions and/or teaching.
58
Direct Care
ACTUAL care in the home ; refers to the actual physical
aspects of nursing care—anything requiring
physical contact and face-to-face
interactions:
• Assessment
• skilled intervention: IV
• teaching : maybe teach changing a dry dressing
Must consider 24hr needs
Client, family, caregiver— there is lots of teaching to families as well as home aids if they have one
You HAVE to document care DETAILED. Dont get lazy with it. E.g. Baby slept, baby ate. You have an ileostomy. What is something you really want to know? Thank you. What's the condition of the stoma? What else would an ileostomy and a two-month-old baby, what's important?
write your notes as if you work in the hospital
Performing a physical assessment on the client
• Changing a dressing on a wound
• Giving medication by injection
• Inserting an indwelling catheter
• Providing intravenous therapy
• Teaching clients and family caregivers how to performa certain procedure or task
59
Indirect Care
Indirect care activities are those that a nurse does on behalf of clients to improve or coordinate care:
-Consulting with other nurses and health providers in a multidisciplinary approach to care
- Organizing and participating in client care team conferences
-Advocating for clients with the health care system and insurers
-supervising home health aides
Obtains results of diagnostic tests
- documenting care
60
You have to be hombound to get ___
Medicare and get a home care nurse
61
When do we decide when home care or hospice happens?
While in the hospital
An interdisciplinary approach
Begins with the hospital discharge planner who identifies the client’s need for home health or hospice care; a client care conference is convened to discuss issues with the family, develop a consistent team approach, and clarify roles
62
Legal and ethical issues with Homecare
At risk for malpractice claims related to the complexity of care needed and actual or alleged negligence from rushed visits or failure to adhere to standards of practice
Get malpractice insurance!
63
Medicare and Medicaid are the principal funding sources
for ___
home health care , with private third-party health insurance providing another major source.
64
Hospice Care
Delivery of palliative care of the very ill and dying, offering both respite and comfort
Support and care for persons in the last phase of an incurable disease so that they may live as fully and comfortable as possible.
◦ you can get them help if they have to make difficult decisions. What do you do when someone has a loss of appetite or there's some things you can do to help them? What are you doing when the person is depressed, is scared? So this is the kind of help that you get. You make sure that they, you know, you talk to them about a living will, what are their goals for care, and you're providing emotional support.
◦ When somebody is getting worse and worse and now we're to the point that we start thinking what can we do for them, right? And when it gets to the point where death is imminent and talking about death coming in the next six months, at that point, we actually start to move them Into hospice care
when it's still all comfort care, the only thing is we move from here to hospice when there's, expect death within six months.
Suppose it's month seven, you're still alive. They don't kill you. They don't walk away from you. They just, they still support you. I know somebody whose grandmother was a hundred and one, she was on hospice care for two years.
65
Home Care of the dying Child
Knowledge of the child’s physical, cognitive, psychosocial, and spiritual development enables the nurse to provide appropriate pain management, assist the child and family to communicate with each other, advocate for their needs in the community, and refer to key players who can offer them assistance, such as voulenteers, counselors, or clergy
Most hospice nurses that work with children say their biggest problem is the family. They get, you know, the children get to the point where they understand, and their family doesn't.And that's one thing with hospice care, is the fact that you have somebody that you can talk to. Here at home you want to talk to your family, and you can't say what you want to say because you know they're going to cry, so you hold it in.
66
Nursing Care for Dying with Dignity
Attention to pain and symptom control*
Relief of psychosocial distress
Coordinated care in various settings, with high-quality communication btwn health care providers
Preparation of the client and family for death
Support of self-care, self-management , and independence
Clarification and communication of goals of treatment and values
Support and education during the decision-making process, including the benefits and burdens of treatment.
67
Cultural and Religious issues :Hospice care
Sensitivity and empathy are essential when caring
for a dying person from a different culture.
Each person is a unique individual with cultural
preferences that influence the specialized needs of
the client, the family, and their caregivers.
68
Palliative Care
• Interdisciplinary team-based care that is focused on
the relief of suffering for clients with serious illness.
• Best possible quality of life not only for clients but
for their families
• Acute, serious, life-threatening illness
• Progressive chronic illness
Palliative = not a cure, increase quality of life, provide comfort, controlling symptoms, coordinate care
69
Common fears and concerns of dying
Death itself
Thoughts of a long or painful death
Facing death alone
Dying in a nursing home, hospital or rest home
Loss of body control
Not able to make decisions concerning care
Loss of consciousness
Financial costs and becoming a burden on others
Dying before having a chance to put personal affairs in order
70
What kind of Environmental Assessments nurses do?
Community assessment
Windshield survey
Home assessment
71
SAFETY FACTORS
Let's think about the person's home. Is it safe? How's the neighborhood, you know? And do you need escort service? You need a plan. Somebody needs to know where you're going to be all day long, okay?Let somebody know your schedule, agency. The night before you go, you usually call your patients and say, okay, I'm coming in tomorrow with this time framework. So you let somebody know where you're going to be. You make sure you have a guest, and you have an extra key, and your car works. If not, you better know how to take the bus, and you better know all your agency numbers, emergency numbers, the neighborhood numbers. Not every neighborhood has a 911, and you might need to call the fire department for assistance. You shouldn't bring a purse. I come in, and I put my purse down over here.When I leave, I don't want any critters coming home with me, because I don't know how clean these homes might be.
Let someone know your schedule and where you are going to be for your safety
Make sure you have gas, an extra key, know the alternative routes of transportation
Know a phone number or local emergency numbers
72
Contents of Bag…what should you carry for home visits?
Soap/towels
Stethoscope/BP cuff
Penlight
Wound gauge
Disposables: apron, gloves, tape/dressings
OSHA: safety eyewear, masks
Map/drugbook
Airway/CPR
73
Faith Communities
Groups of people that gather in churches, cathedrals, synagogues, or mosques and acknowledge common faith traditions
74
Parish Nurses
respond to health and wellness needs of populations
of faith communities and are partners with the church in fulfilling the mission of health ministry
75
Health Ministries
Activities and programs in faith communities organized around health and healing to promote wholeness in health across the lifespan.
Services may include:
Visiting the homebound • Providing meals for families in crisis or when returning home after
hospitalization
• Participating in prayer circles
• Volunteering in community acquired immunodeficiency syndrome
(AIDS) care groups
• Serving “healthy heart” church suppers
• Holding regular grief support groups
76
Congregational Model
The nurse is usually autonomous
The development of a parish nurse/health ministry program arises from the individual community of faith
The nurse is accountable to the congregation and its governing body
77
Institutional Model
Includes greater collaboration and partnerships than the congregational model
The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions
78
Characteristics of the Parish Nursing Practice
The spiritual dimension is central to the practice of parish nursing
The roots of the role balance both knowledge and skills of nursing, the humanities, and theology
The focus of the specialty is the faith community and its ministry
Parish nurse services emphasizes strengths of individuals, families, and communities
Health, spiritual health, and healing are considered an ongoing, dynamic process
You have to have mutual faith to work with these pts
79
Scope and Standards of Parish Nursing Practice
Health promotion within the context of the client’s values,
beliefs, and faith practices
80
Educational Preparation for a Parish Nurse
Baccalaureate degree
• Valid nursing license in state practicing in
• Basic understanding of the concept of parish nursing
• 3 to 5 years’ experience in professional nursing
• Evidence of a mature faith
• Continuing education to stay current in practice
81
Healthy people 202: Faith communities
Encourages communities to cooperatively lend support to
individuals and families to attain an improved health status that can be passed on to future generations
82
Functions of the Parish Nurse
Personal health counseling
Health education
Liaison
Facilitator
Pastoral care
Services to vulnerable population
83
What are the fundamental assumptions in epidemiology?
Why does it happen and where does it happen?
Disease doesnt occur at random
Disease has causal and preventative factors
*Disease is not randomly distributed throughout a population
Epidemiology uses systemic approach to study the differences in disease distribution in subgroups
Allows for study of casual and preventive factors
84
Epidemiology
Study of determinants and distribution of health, disease, and injuries
85
Endemic
Continuing presence of disease or infectious agents in a given area
E.g., malaria is not in the US but its an endemic in other parts of the world; continuous, always around
86
Epidemic
Disease that exceeds the norm
E.g., more flue rates this year; exceeded the norm
87
Pandemic
Epidemic becomes world wide
E.g., covid started in china and then spread worldwide
88
Morbidity
State of poor health, severity of illness
89
Mortality
Susceptible to death
90
Why do we use epidemiology?
Epidemiology is the study of populations to determine the causes of health and disease in a population
Monitor the health of the populations
Identify the determinants of health and disease in communities
Investigate and evaluate interventions to prevent disease and maintain health
E.g., we started to see where people lived really did affect their health. We looked as covid and where it was more of an influence in the community, when people did not have access to vaccines and so on. (Social determinate of health)
91
More money goes to acute or chronic illnesses?
Chronic
92
Who is john snow?
Father of epidemiology
He went door to door, collecting information on a daily habits
Suspected water supply as source of epidemic
When broad street pump closed, epidemic stopped
Practical application of epidemiology—use epidemiological investigation to impact a health problem
So what was the big deal about John Snow? Well, at the time, they had the cholera, and they were trying to figure out where was it coming from.And people obtained the other scientists and doctors and so on, and cholera is one by bad care. It's something that people are breathing. And he wrote a whole essay saying, no way, show how, it's not that. So there was an outbreak of cholera, and he suspected it was the water supply. So what he did is he actually went out and did a plot map, and he started marking off every case of cholera.And then you look at the map and say, wow, look what's happening over here, the most cases. So he said something is happening here, so they shut the water pump on Broad Street. The cases went down. So he was able to make that formal link between water and cholera. So with him, he used some, a mode of investigation is called shoe leather.You actually go house to house to get information. We don't do that today. If there is an outbreak of some sort, they can go house to house trying to get information.
That’s why he is called the father of Epidemiology*
93
How nurses use Epidemiology?
Nurses study health and disease to track and monitor trends, find causes, and help prevent and treat sickness.
Nurses are involved in the surveillance and monitoring of disease trends
E.g., think about the school nurse who catches spread of illness
◦ E.g., documented that kids were ill in 2020… then figured out the disease; when was it happening where
94
Proportion
Ratio
95
Rate
Frequency
The primary measurement used to describe the occurrence of a state of health in a specific group of people in a given time period
Most commonly used in epidemiology because it
most clearly expresses probability or risk of
disease or other events in a defined population
over a specified period of time
So why do we have rates? To explain what's happening, I need to know how many people are getting sick, what are they getting sick with, right?What are the characteristics of those that are getting sick? So we want to know more about this disease, what's happening. And we calculate rates.
96
Risk
Probability
97
Incidence
New cases
There are, there were 2,000 cases of flu in 2023. December 15th through the 30th, there were 200 cases. What's my incidence? What number? (200)Because I'm talking about the new cases, right?
2,000=prevelance
98
Prevelance
All existing cases
99
Attack rate
Morbidity
100
Mortality rates
Deaths
101
What would have the biggest effects on prevalence numbers?
Chronic disease
Why? Because if a person is diagnosed with diabetes, they got it, it’s not going away ; they might have been diagnosed at 5 and when they are 55, they still have it.
Versus having the flu, they got it for 5 days and it’s gone; they left the pot; once you get better, you are out of the pot.
Which chronic, they stay in the pot
102
How would a chronic illed person get “get out of the pot”?
Dying, cured, or disabled
103
Incidence measure of the probability that ____ persons will develop the disease
Measure of the probability that UNAFFECTED
persons will develop the disease
• Used when examining an outbreak of a health
problem
104
Proportion of individuals in a population with
disease or condition at a specific point of time is called?
Prevalence
Provides estimate of the probability or risk that
one will be affected at a point in time • Provides an idea of how severe a problem may
be – measures overall extent
Useful for planning health services (facilities, staff)
105
How do you calculate prevalence?
Number of existing cases of disease / total population at risk
E.g., 25 students with asthma/ 100 students
= 25% students with asthma
106
Screening
Vital in secondary prevention interventions
Involves testing of groups of individuals who are at risk for a specific condition but DO NOT HAVE SYMPTOMS
The goal is to determine the likelihood that these
individuals will develop the disease.
Screening is NOT a diagnostic test
Effective screening programs must include referrals for
diagnostic evaluation for those who screen positive, to
determine if they actually have the disease and need
treatment.
Screening but not diagnosing —-nurses dont diagnose
107
What are the many characteristics that are used to described the affected population?
Age
Sex
Ethnic group or race
Social class
Occupation
Marital status
Family variables
Blood type
Environmental exposures
Personality traits
Among these characteristics the most commonly used are AGE, SEX and ETHIC GROUP or RACE
108
Place
Frequency of disease can also be described by place of occurrence, according to natural boundaries or political boundaries
To examine the distribution of disease even more specifically, it is common practice to plot individual cases by location (spot map).
Cases may be plotted by natural boundaries, political boundaries, census tract, facility location, etc.
109
Epidemiological Triangle
A triangle that links the agent, host and environment
So for a disease to progress, you have to have all three parts of that triangle. Our goal is to break the chain of transmission. So what can we do at any one point to break the transmission from it going from one to the other to the other?
So if you think of something, Lyme disease. Lyme disease would be our agent. Our host would be a person. The environment would be tall grass. So if you think about breaking the path, our intervention between host and agent, education, alter-exposure,
Our agent, you know, from obesity would be excess calories. Our environment could be the person that has low income, not able to afford proper food, right?So that's how you could see environment, that they are a person that sits more, they're not active. And that's just what I said. And then, again, looking at that host, why is one host more susceptible than the other?
110
Agent
The agent is a factor that must be present or
lacking for a disease or condition to develop.
5 types agents: biological, chemical, nutrient, physical,
psychological
111
What are the five types of agents?
Biological: bacteria, viruses arthropods
Chemical:pollutants, medications, drugs
Nutrient: absence and excess— vitamins, proteins
Physical: heat, trauma
Psychological: stress, isolation, social support
112
Host
The host is a living species capable of being infected or affected by an agent.
What affects this?
What is inherent resistance?
113
Environment
The environment is everything internal or external to a given host or agent and that is influenced and influences the host and/or agent.
114
What are the intrinsic factors of a host?
Lifestyle— excercise level, nutrition, health knowledge, motivation for achieving optimal wellness
115
What are the immutable factors of a host?
Age
Race
Genetic makeup
116
What is the wheel/web of causation
Biological environment
Social environment
Physical environment
Host
Genetic core
All o fthese factors are linked and each factor link in multiple chain of causation
Allows epidemiologists to map the interrelationships among factors contributing to the development (or prevention) of a particular health condition
Determine areas where efforts at control will be
most effective.
117
Secular trend
Means long term
A point in time
118
Cyclical time patterns
Seasonal fluctuation;; calendar events
119
Analytic epidemiology
You’re analyzing
I wanna know the how and why of observed patterns of health and disease
120
Examples of nursing positions that use
epidemiology:
Nurse epidemiologist
• School nurses
• Communicable disease nurse
• Environmental risk communicators
• Hospital infections control nurse
• All nursing documentation on patient charts and records is important source of data for epidemiological reviews
121
Community
A community is a social group determined by geographic boundaries and/or common values and interests. It members know and interact with one another. It functions within a particular social structure and exhibits and creates norms, values and social institutions
122
Types of communities
Community of place or geographic boundaries
Neighborhood or face-to-face
Special interest
Problem ecology
