CHN 312 Prelims Reviewer PDF

Property of: Alfie Velasco BSN 3-Y1-11 T - COMMUNITY HEALTH NURSING CONCEPTS: A - Learned practice discipline with the ultimate goal of contributing to the promotion of the client’s optimum le...

Property of: Alfie Velasco BSN 3-Y1-11 T - COMMUNITY HEALTH NURSING CONCEPTS: A - Learned practice discipline with the ultimate goal of contributing to the promotion of the client’s optimum level of functioning through teaching and delivery of care (Jacobson). - Special field of nursing that combines the skills of nursing public health and some phases of social assistance and functions for the promotion of health, improvement of social and physical conditions and rehabilitation of illness and disability (WHO) - The synthesis of nursing practice of Nursing practice and public health practice applied to promoting and preserving the health of population (AMA) B. Philosophy of Community Health Nursing: - Based on the worth and dignity of a man ~Margaret Shetland Mary S. Gardener and Cobb/Jone Leahy Principles of Community Health Nursing 1. Based on the recognized needs on of communities, families, groups and individuals 2. Nurses must fully understand the objectives and policies of the agencies they represent 3. The family is the unit of service 4. Community health nurse must be available to all 5. Health teaching is the primary responsibility of community health nurse 6. CH nurse works as a member of the health team 7. There must be periodic evaluation of the CH nurse services 8. Opportunities for continuing staff education programs for nurses must be provided by the agency 9. CH nurse makes use of available community health resources 10. CH nurse utilizes the already existing active organization in the community 11. There should be accurate recording and reporting of Community Health C. Features of CHN - Preventive approach to health - It is characterized by being population or aggregate-focused - It is developmental in nature - With existence of prepayment mechanism for consumers of community health nursing services - Care for different levels of clients E , Different Field in CHN - Public Health Nursing- subspecialty nursing practice generally delivered within official or government agencies - School Health Nursing- promote the health of school personnel and pupils Legal Mandate: Republic Act 124 mandates that school must provide clinics Eight Components of School Health Services Health Education Physical Education health services Nutrition services How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 Counseling Psychological and Social Services Healthy School Environment Health promotion of Staff Family and Community Involvement - Occupational Health Nursing- specialty focuses on promotion, prevention and restoration of health within the context of a safe and healthy environment - Community Mental Health Nursing- unique clinical process that includes concepts of nursing, mental health, social psychology and community networks including social sciences. Focus is on the mental health promotion D. Theoretical Models/Approaches in CHN: 1, - Health Belief Model- individuals must know what to do and how to do it before they can take action. It places burden of action exclusively on the individual Propositions/Framework Perceived Susceptibility- one’s belief regarding the chance of getting a given condition. Ex: A client believes he’s more likely to get HIV since he is sexually active individual Perceived Severity- one’s belief regarding the seriousness of given condition. Ex: A client is aware the different complications of malignancies/cancer Perceived Benefits- one’s belief in the ability of an advised action to reduce the health risk or seriousness of a given condition. Ex: A pregnant woman is taking Folic Acid supplements since she is aware of Folic Acid benefits in the development of her fetus especially in preventing neural tube defects Perceived Barriers- one’s belief regarding the tangible and psychological costs of an advised action. Ex: A patient refused to undergo chemotherapy due to financial constraints Cues to Action- strategies or conditions in one’s environment that activate readiness to take action Self-efficacy- one’s confidence in one’s ability to take action to reduce health risk 2 , - Millio’s Framework of Prevention- includes economic, political and environmental health determinants Propositions/Framework Population health deficits results from deprivation or excess of critical health resources Organizational dimension and policies dictate many of the option available and influence their choices Alterations in pattern of behavior resulting from decision making is significant number of people in a population can result in social change Behavior of population result from selection from limited choices; arise from actual and perceived options available as well as beliefs and expectations resulting from socialization, education and experiences How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 Individual choices relation to health promotion or health damaging behaviors are influence by effort to maximize valued resources Without concurrent availability of alternative health-promoting options, for investment of personal resources, health education will be largely ineffective on changing behavior patterns National level policy making was the best way to favorable impact the health of most people Health deficits results from an imbalance between a population's health needs and its health-sustaining resources Lifestyle are patterns of choices made from available alternatives according to people socioeconomic circumstances and how easily they are able to choose some over others 3 , - Nole Pender’s Health Promotion- explores many biophysical factors that influence individuals to pursue health promotion activities but does not include threat as a motivator Focuses on three categories: Individual characteristics and experience Prior related behavior- this influences subsequent behavior through perceived self-efficacy Personal factors- could be biological, Psychological and Sociocultural factors Behavior-specific cognition and effect Perceived benefit of action- strong motivators through intrinsic and extrinsic benefits Perceived barriers to action- unavailability, inconvenience, expense, difficulty regarding health behaviors Perceived self-efficacy- one’s belief of capability on carrying out behavior Activity related affect- feeling associated with behavior likely affect individual to repeat/maintain behavior Interpersonal influences- norms, support and model. These are feeling or thought regarding the beliefs or attitudes of others Situational influences- perceived options available, demand characteristics and aesthetics features of the environment where the behavior will take place Commitment to a plan of action- the initiate, a behavioral event Behavioral outcome Immediate competing demands (low controls) and preference (high control) - alternative behavior immediately prior to engaging in the intended or planned behavior Health promoting behavior - goal or the outcome. - 4 PRECEDE - PROCEED Model- developed by Dr. Lawrence Green and colleagues PRECEDE = Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation used for community diagnosis How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 PROCEED = Policy, Regulatory and Organizational Constructs in Educational and Environmental Development. Implementing and evaluating health programs based on PRECEDE - Predisposing factors- people’s characteristics that motivates them toward health-related behaviors. Includes attitudes, beliefs and values - Enabling factors- conditions in people and environment that facilitate or impede health related behavior. Includes skills, availability, accessibility and referrals - Reinforcing factors- feedback given by support person or groups resulting from the performance of health-related behaviors. Includes family, peers, teachers, employees and health care provider SD6/MD6 How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 I -- CONCEPTS OF COMMUNITY Community- group of people with common characteristics or interests living together within territory or geographical boundary. - Place where people under usual conditions are found A Types of Community: - Geopolitical- territorial; a spatial designation. Ex: Barangay - Phenomenological- functional; includes social groups, profession or religious groups B. Characteristics of a Healthy Community (Hunt 1997 and Duhl 2002) - Shared sense of being a community based on history and values - General feeling of empowerment and control over matter affecting the community as a whole - Existing structure that allows subgroups in the community Subgroups- smaller and regionalized group - Ability to cope with change, solve problems and manage conflicts within the community - Open channel of communication - Equitable and efficient use of community resources Di Factors affecting the health of community: * C. Components of A I' ~Population community - Population size and density - Population compositions: Age, Sex, Occupation and other variables - Growth and decline of population - Feeling of belongingness and participation (readily achieved in a cultural homogenous setting) 2 ~Location. - Occurrence of natural or man-made disaster - Geographic features: Land and Water form that influences food production - Community boundaries: clear demarcations in basis for determining catchment area Ex: increased population density = concentrated poverty and slum formation → greater exposure to health risk Informal settlements- unsafe and unhealthy homes, overcrowded, limited or no to access to basic service - Inequalities of economic opportunities, resources, and limit access to health facilities in rural areas 3 ~Social Systems. - An interdependent set of cultural and structural elements that can be thought of as a unit - Patterned serious of interrelationships existing forming coherent whole; includes family, economic, educational, communication, political, legal, religious, recreational and health system How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 E. Roles of CHN Nurse: 1. Care Provider/Clinician- promotion of health and prevention of illness 2. Educator- nurses seek to facilitate client learning 3. Advocates- helps clients find out what services are available, how to obtain the service, influence change and make system more responsive to client’s needs 4. Manager- supervise client care, ancillary staff and do case management. Run a clinic and conduct community health needs assessment. planning , leading and controlling evaluation 5. Collaborator- working jointly in a common endeavor to cooperate as partners 6. Leader- change agent. Direct and influence others to effect change 7. Researcher- systematic investigation, collection and analysis of data to enhance community health practice The Intervention Wheel - The Minnesota Intervention Wheel is a tool that illustrates what public health nurses do to improve health outcomes 1. Surveillance- describe and monitor health events 2. Disease and other health investigation- gather and analyze data regarding threats, ascertain source and how service can be obtain 3. Outreach- locate population and provide information 4. Screening- identifies unrecognized health risk factors 5. Case finding- locates identified risk factors and connects them with resources 6. Referral and follow-up- assist to identify and access necessary resources to prevent or resolve problems 7. Case management- optimizes self care abilities of individual and families 8. Delegated functions- direct health task that are carried out 9. Health teaching- communicates facts, ideas and skills 10. Counseling- establishes interpersonal relationships with an intention of increasing/enhancing capacity of self-care 11. Consultation- seeks information and generates optional solutions 12. Collaboration- commits two or more person to achieve common goal 13. Coalition building- promotes and develops alliance among organization or constituents for common purpose 14. Community organizing- helps community groups identify common problems, mobilizes resources and develop strategies How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 Philippine Health Situations: - As of 2017, urban migration in the Philippines, particularly towards the National Capital Region (NCR), which hosts 12.7% of the population. - The Philippines has a young population with about a third of its population younger than 15 years of age as of 2017. Median age is 24.3 - The aging index (Gavrilov LA et al., 2003) or the proportion of persons aged 65 years and over - The population growth rate has declined by almost half, from 2.7 to 1.5 during the same period. - The overall age dependency ratio declined by about a third (28.8) between 1980 (86.3) and 2017 (57.5) which is consistent with the decreasing trend of the child dependency ratio. However, the trend in the elderly dependency ratio is slowly increasing, reflecting the growing elderly population. - Of the estimated 71.6 million population aged 15 years and over, 44.6 million persons were in the labor force in 2017. Among them, 39.9% were women (World Bank, 2018b). - Number of households 22,975,630 ; Average household size 4.4 ; Literacy rate 98.3 Birth: - In 2017, registered live births were 1,700,618. This is equivalent to a crude birth rate (CBR) of 16.2 or 16 births per thousand population. - The total fertility rate declined steadily over time to 2.7 children per woman in 2017 How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 - More males (887,972 or 52.2%) were born than females (812,646 or 47.8%) which resulted in a sex ratio of 109 males per 100 females - n the total number of births in the - Philippines, 93.3 % birth deliveries were attended by health professionals such as physician, midwife or nurse - Median age at first birth among women 25-29 (Mother's mean age at first birth 22.8 years, 2017 est.) Mortality: - declined from 2015 to 2016 - 2017, an average of 1,587 persons died daily or to 66 deaths per hour or one per minute - In 2017, the number of deaths in males (332,517) was higher than deaths in females (246,720) - Higher proportions of female deaths observed in older age groups - Leading cause of morbidity in 2005 is Acute Lower Respiratory Tract Infection and Pneumonia. This is followed by bronchitis / bronchiolitis - Obesity - adult prevalence rate 6.4% (2016). Maternal mortality rate 121 deaths/100,000 live births (2017 est.). Children under the age of 5 years underweight 21.5% (2015) - Major infectious disease with degree of risk are (2016) : food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever (2016) ; vector borne diseases: dengue fever and malaria (2016) ; water contact diseases: leptospirosis (2016) - HIV/AIDS - adult prevalence rate 0.1% (2018 est.); HIV/AIDS - people living with HIV/AIDS 77,000 (2018 est.) ; HIV/AIDS – deaths 1,200 (2018 est.). There is a steady increase, though relatively slow, in the number of HIV seropositive cases in the country. One – third were OFW. 74% were males. Around 93% through sexual intercourse. There is also an increase of syphilis and gonorrhea (DOH, 2006). - Schistosomiasis continues to affect hundreds of barangays in 24 endemic provinces. - Polio outbreak in the Philippines ( Reported by WHO, 2019). irus isolated are both genetically linked to VDPV2 previously isolated from environmental samples in Manila and Davao caused by vaccine-derived poliovirus type 2 (VDPV2). Environmental samples taken from sewage in Manila on 13 August and a waterway Davao on 22 August have tested positive for VDPV2 How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 III. Health Statistics & Epidemiology A.Tools I DEMOGRAPHY. - “Description of People” study of the size, territorial distribution and composition of population, changes therein Population Composition- characteristics of population as to age, sex, occupation or educational level Population- group of individuals of the same species living and interbreeding within a given area; collection of person alive at a specified point in time who meet certain criteria Population projections- common demographic tool in determining projection of population growth or decline - Components of Population Growth: Birth, Death, Migration, Age Composition - Source of Demographic Data - Census- conducted by national government and attempts to enumerate every person in a country De Jure- “In Law”; usual household residents De Facto- “In Fact”; stayed in household last night - Sample Survey- data gathered from small number of people proportionate to the general population - Registration system- deals of recording of vital events - Population Size: - Natural Increase- defined as the difference between live births and deaths in a specified period of time: Number of births (specified year) - Number of deaths (specified year) = Natural Increase - Rate of Natural Increase- the difference between live births and deaths in a specified period of time Crude Birth Rate (specified year) - Crude Death Rate (specified year) = RNI - Absolute Increase per year- measures the number of people that are added to population per year Population size of latter time - population size of earlier time = Absolute increase/year - Relative Increase- population growth rate; measure the average yearly percentage change over the same time frame Population size of latter time - population size of earlier time = Relative Increase Population size of earlier time How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 - Population Composition: - Sex ratio/composition - ratio of males to females No. males / No. of females x 100 - Age composition- proportionate numbers of person in successive age categories in a given population Median age- single index that summarizes the age distribution of a population; two numerically equally sized groups that is half the people are younger than this age and half is older Age-Sex composition- universal characteristics of human population. Fundamental in understanding demographic processes of fertility, mortality and migration. Age-Sex composition is depicted in population pyramid Population pyramid- size of the population under investigation is depicted on the horizontal axis and age is aligned on the vertical axis Dependency ratio- measures the pressure on the productive population Total population of 0-14 y/o and 65 y/o above X 100 Total population of 15-64 y/o age group - Population Distribution: - Pattern of where people live. It denotes the spatial pattern due to dispersal of population, formation of agglomeration and linear spread of population Urban-Rural Distribution- illustrates the proportion of the people living in urban compared to the rural areas Crowding Index- measure of household crowding, as the number of usual residents in dwelling divide number of rooms in the dwelling Number of person in household Number of rooms used for sleeping Population Density- calculated as population divided by the total land area. It is the people per square kilometer land area. No. of People / Land Area in terms of square kilometers or meters How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 - 2 HEALTH INDICATORS AND VITAL STATISTICS Health Indicators- variable susceptible to direct measurement, it mirrors the state of health of a person in a community. Summary measures that capture relevant information on different attributes and dimensions of health status and performance of the health system. Quantitative measures in rates, ratios or proportion that describes various aspect of health status of population Use of Health Indicators - Identify public health problems and needs - Determine factors that contribute to causation and control of disease - Indicating priorities for resource allocation - Monitoring implementation of health programs - Evaluating outcomes of health programs Types of Health Indicators Health Status Indicators: Prevalence and Incidence Population Indicators: Age-Sex, Migration Indicators for the Provision of Healthcare: Access for health programs Risk Reduction Indicators: Case consulting a health provider (in %), Children that are fully vaccinated (in %) Social Economic Indicators: level and distribution of economic wealth, types and level of employment Environmental Indicators: Coliform counts, contamination and pollution level Vital Statistics- Conventionally numerical records of marriage, birth, sickness and death by which health and growth of community may be studied Source of Vital Statistics - Population census - Registration of vital statistics - Studies and researches Statistics on population is obtained from Philippines Statistics Authority (PSA) Births and Deaths are registered in office of local civil registrar of municipality or city Morbidity and mortality indicated state of health of community Common Vital Statistics Indicators - Crude Birth Rate- measure how fast people are added to the population through births/ annual number of live births per 1000 population Measures population growth Affected by: fertility, Age-Sex composition, Marriage Pattern and Practices, Birth registration practice How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 - General Fertility Rate- calculates the number of live births per 1000 women between the ages of 15 and 44 200/1000 = High GFR 60/1000 = Low GFR - Mortality Rate- measures of frequency of occurrence of death in defined population during a specified interval Crude Mortality Rate- the mortality rate from all causes of death for a population Specific Mortality Rate- show rates of dying in specific population groups Ex: TB cases among 20-24 y/o Cause of Death Rate- mortality rate from a specified cause for a population Infant Mortality Rate- death of infant before his/her first birthday - Good index of the general health condition of a community. Reflects changes in environment and medical condition. Important marker of the overall health Neonatal Mortality Rate- deaths among those under 28 days of age due to prenatal or genetic factors How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 No. of Deaths 28 days to less than 1 y/o same year x 1000 Number of Live Births same year Post Neonatal Mortality Rate- deaths among those 28 days to less than 1 year of age may be due to environmental, nutritional factor, infection No. of Deaths 28 days to less than 1 y/o same year x1000 Number of live births same year Maternal Mortality Rate- death of female from any cause related to/or aggravated by pregnancy or its management, during pregnancy and childbirth or within 42 days of termination of pregnancy irrespective of duration and site of pregnancy - Measures obstetrical risk - Affected by: Diagnostic ascertainment, completeness of registration of births Proportionate Mortality Rate- proportion of deaths assigned to a specific cause during a given time interval No. of deaths from particular cause x 1000 Total Deaths Swaroop’s Index- deaths above 50 y/o. It is said that the higher this rate the better is the health status of the population. Very good indicator in comparing health status of different countries No. deaths among those 50 y/o over x100 Total deaths Case Fatality Rate- proportion of cases that ends up in mortality. Risk of dying among person afflicted with a particular disease - Magnitude will depend: Nature of disease, diagnostic ascertainment, level of reporting in population No. of deaths from specified cause x100 No. of cases of the same disease - Morbidity Indicators- based on disease specific incidence and prevalence, measures total number of existing cases of disease at particular point in time divided by the number of people at that point in time How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 - Increased by: Longer duration of disease Prolongation of life of patient without care Increase in new cases (increase in incidence) In-migration of cases Out-migration of healthy people In-migration of susceptible people - Decreased by: Shorter duration of disease High case-fatality rate from disease Decrease in new cases In-migration of healthy people Out migration of case Improved cure rate of cases Incidence measures- measures number of new cases, episodes of event occuring over a specified period of time usually year within a specified population at risk - Indicators: Increasing, Decreasing or Static - Measures: evaluate effect of health intervention No. of new cases that developed during period = cumulative incidence No of person followed-up No. of new case that developed during the period = incidence density rate Sum of person time at risk Specific morbidity rates- shows disease rates in specific population groups Attack rate- an alternative form of the incidence rate that is used when the nature of disease or condition is such that a population is observed for a short period of time How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi  Property of: Alfie Velasco BSN 3-Y1-11 - IV EPIDEMIOLOGY - Study of occurrence and distribution of health circumstances such as disease, death and deformities; probable factors that influence development of health condition - Distribution determinants of health-related state/events in specified population - Application of the study to prevent and control health problems History of Epidemiology Hippocrates- Disease is associated with climate & physical environment John Snow- Investigation of Cholera epidemic in 1854 William Farr- Use of census & vital registration of data described pattern of mortality pattern in subgroups such as occupational group, prisoners & other age-group Framingham Heart Study- identified the risk factors for coronary heart disease Richard Doll and Bradford Hill- Doll and Hill's Study; Provided compelling evidence of the role of smoking in the incidence of lung cancer Jonas Salk- Developed and introduced in 1955 the Salk Vaccine. field trial showed protective effect of the vaccine against paralytic poliomyelitis. Key Terms: Study- Comprises of surveillance, observation, hypothesis testing, analytic research then experiments Distribution- frequency and pattern of health events; Denotes to an analysis by time, places and classes of people affected Determinants- risk factors and other definable identity that changes the health status of population Health related states/events- Denote to disease cause of death, behaviors such as the use of tobacco, positive health states, reactions to preventive regimens and provision and use of health services Specified population- collective health of people in a community or population. Contains identifiable characteristics such occupational group Application to Prevention and Control- aim to promote, protect and restore the health of the public PRACTICAL APPLICATIONS OF EPIDEMIOLOGY 1. Assessment of the health status of the community or community diagnosis. 2. Elucidation of the natural history of disease. 3. Determination of disease causation. 4. Prevention and control of disease 5. Monitoring and evaluation of health intervention 6. Provision of evidence for policy formulation Sporadic disease- occurs frequently and irregularly Endemic disease- usual prevalence of disease in specific geographic data Hyperendemic- persistent high level of diseases occurrence How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 Epidemic- increase and sudden rise of cases above the normal occurrence Outbreak- increase and sudden rise of cases but in limited geographical data Cluster- an aggregation of disease group in place and time that is greater than expected Pandemic- epidemic that has affected several countries/continent Latent period- period between exposure and infection Incubation period- period between exposure and onset of the clinical symptoms (host may become infectious) Infection period- period where infected host can infect susceptible host Practical Application in Nursing Practice: - Aids in ranking health problems - Identify risk factors - Design targeted specific intervention - Monitor and evaluate interventions Natural History of Disease- its course overtime starting from pre-pathogenesis stage to termination - Pre-pathogenesis- pathologic changes begun but asymptomatic - Discernable lesions- early signs and symptoms occurs; discernable by diagnostic tests - Advance disease- anatomical and structural changes produced. Identifiable clinical manifestation occurs Prospective Cohort Study- observing cohort from the time members are disease-free to the time they develop the disease through its termination Prevention- refers to identification of potential problems to minimize or eradicate possible disease - Levels of Prevention: Primary- health promotion and addressing risk factors to a well population Secondary- screening of at risk individual, control of risk factors and early intervention Tertiary- rehabilitation and prevention of complication Models of Disease Causation: - Wheel Model Inner Core- emphasis on the role of genetic make up Outer Core- host characteristics Outer Edge- Biologic, Physical and Chemical factors - Web Model- shows complex interrelatedness of risk factors of disease. Applicable for non-communicable disease - Ecological Triad- AKA epidemiologic triangle or triangle model a multiple theory of disease causation External agent- factors that precipitate the disease. Ex: Virus Susceptible host- actual/potential recipient of the disease How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 Environment- all external factors; where agent and host freely interacts Elements of Environment Physical- geology and climate Biologic- vectors of diseases Socio-economic- crowding, sanitation etc. Epidemiological approach- The practice of epidemiology relies on a systematic approach In simple terms, a nurse epidemiologist: Counts cases or health events, and describes them in terms of time, place, and person; Divides the number of cases by an appropriate denominator to calculate rates; and Compare these rates over time or for different groups of people. Phases of Epidemiological Approach Descriptive Epidemiology- Consist of disease distribution and frequency Analytical Epidemiology- Attempts to analyze the cause or determinants of disease through hypothesis testing Intervention or Experimental Epidemiology- Answers questions about the effect of new methods for controlling diseases or for improving underlying conditions Evaluation Epidemiology- Attempts to measure the effects of different health services and program Time Variation of Epidemic: 1. CYCLICAL VARIATION- FLUCTUATION in incidence. For a short period of time. May be seasonal 2. SECULAR VARIATION- Changes in the TREND of disease occurrence over a long period of time. 3. SHORT TIME FLUCTUATIONS a) COMMON SOURCE EPIDEMIC. Simultaneous exposure of a large number of people to a common infectious agent. b) PROPAGATED EPIDEMIC. Person-to-person transmission STEPS OF EPIDEMIOLOGICAL INVESTIGATION 1. Operationally define what constitute a “case” 2. Based on the operational definition, identify the cases 3. Based on the number of cases identified, verity the existence of an outbreak 4. Establish the descriptive epidemiologic features of the cases 5. Record the clinical manifestation of cases 6. Based on the clinical manifestations, incubation period, available laboratory findings & other information gathered, formulate a hypothesis regarding the probable etiologic agent, the sources of infection, the mode of transmission & the best approach for controlling an outbreak 7. Test the hypotheses by collecting relevant specimens from the patients and from the environment How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 8. Based on the results of the investigation, implement prevention and control measures to prevent recurrence of a similar outbreak. 9. Disseminate the findings of the investigation through media and other forms to inform the public MONITORING AND EVALUATION OF HEALTH INTERVENTIONS: Monitoring Is an ongoing activity during program implementation to assess the current status of its implementation. Evaluation describe as systematically and objectively assesses compliance to the design of the program, performance, relevance and success of project - Outcome Evaluation- Evaluates the extent to which a project accomplishes its intended results. - Impact Evaluation- assesses in interval the program effectiveness in achieving its ultimate goals. The essence of impact evaluation is for comparison How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi Property of: Alfie Velasco BSN 3-Y1-11 References: Famorca, Z. 2013. Nursing Care of the Community, a comprehensive text on community and public health nursing in the Philippines, 2013 DO NOT RELY SOLELY ON THIS REVIEWER KINDLY READ OTHER LEARNING MATERIAL AS WELL THIS WILL ONLY SERVE AS YOUR STUDY GUIDE Selling of this reviewer is strictly prohibited! Thi is t e la ti I’m as g yo w yo b e m he in t e b i k of an ey ~St. Tay Swi How ca yo sa t a yo lo so e yo ca ’t te is d i g? ~St. Tay Swi