CHNN312 PRELIM.pdf

CHNN312: Exam Week 06 BSN 3RD YEAR 1ST SEMESTER PRELIM 2022...

CHNN312: Exam Week 06 BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Bachelor of Science in Nursing 3YA Professor: Adelynne Joie B. San Diego, RN, MAN Prelim Topics: 10) The Community Health Nurse utilizes the already existing Community Health Nursing Concepts active organization in the community Concepts of the Community and Philippine Health 11) There should be accurate recording and reporting in Situation Community Health Nursing Concepts of Demography To Watch Health Indicators - View and understand the concept of community Epidemiology and the Nurse health and health promotion on link provided: https://www.youtube.com/watch?v=G2quVLcJVBk COMMUNITY HEALTH NURSING CONCEPTS according to Jacobson: Features of CHN - It is a learned practice discipline with the ultimate Preventive Approach to health. goal of contributing to the promotion of the client’s It is characterized by being population or aggregate – OLOF (Optimum Level of Functioning) through focused. teaching and delivery of care It is developmental in nature According to WHO: With existence of prepayment mechanism for consumers - It is a special field of nursing that combines the skills of community health nursing services of nursing, public health and some phases of social Care for different levels of clientele assistance and functions for the promotion of health, Different Fields of CHN improvement of social and physical conditions and - Community Health Nursing is considered broader and rehabilitation of illness and disability more general specialty area that encompasses by American Nurses Association (ANA). subspecialties which includes: - “The synthesis of nursing practice and public health 1. Public Health Nursing practice applied to promoting and preserving the - Seen as a subspecialty nursing practice generally health of the populations.” delivered within “official” or government agencies. 2. School Health Nursing Philosophy of Community Health Nursing - Aims to promote the health of school personnel and Philosophy pupil / students. It aims to prevent health problems - is defined as “a system of beliefs that provides a basis for that could hinder students learning and performance and guides action.” A Legal Basis: Republic Act 124 mandates that all - provides the direction and describes the whats, the whys schools are to provide school clinics for the treatment and the hows of activities within the profession. of minor ailments and emergency cases - According to Margaret Shetland, the philosophy of CHN is Eight Components of School Health Services are: based on the worth and dignity of a man Health Education, Physical Education Health Services, Principles of Community Health Nursing by Mary S. Nutrition Services, Counselling, psychological and Gardner and Cobb/Jones Leahy social services Healthy School Environment, Health 1) Community Health Nursing is based on the recognized Promotion for Staff. Lastly, the Family & Community needs on recognized needs of communities, families, Involvement groups and individuals. Health Appraisal Activities To Be Performed By The 2) The Community Health Nurse must fully understand the School Nurse: objectives and policies of the agencies she represents. o I. Health Assessment - Done once a year. Priority 3) In Community Health Nursing, the family is the unit of should be given to Grade I enrollee; service. o II. Rapid Classroom Inspection - It should be done 4) Community Health Nurse must be available to all. after a long vacation, between health examination, 5) Health teaching is the PRIMARY responsibility of the or when there is an impending or actual epidemic; I Community Health Nurse o II. Vision Testing - Test for visual acuity should be 6) The Community Health Nurse works as a member of the done once a yr, preferably at the beginning of health team school year; 7) There must be provision for periodic evaluation of o IV. Height and Weight Measurement - a) Community Health Nurse services Measurement of height, weight is done at 8) Opportunities for continuing staff education programs for beginning & end of school year. b) Pupils who are nurses must be provided by the agency. recipients of rehabilitative supplementary feeding 9) The Community Health Nurse makes use of available program should be weighted every quarter. community health resources J.A.K.E 1 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Health Status Of Public School Pupils In Public available as well as beliefs & expectations, resulting Schools: infectious diseases (respiratory tract from socialization, education and experience. infections and diarrhea), worm infestations and 5) Individual choices related to health promotion or Dental caries health damaging behaviors are influenced by efforts 3. Occupational Health Nursing to maximize - valued resources - As defined by American Association of Occupational 6) Without concurrent availability of alternative health- Health Nurses (AACHN) as a specialty practice that promoting options, for investment of personal focuses on promotion, prevention and restoration of resources, health education will be largely ineffective health within the context of a safe and healthy on changing behavior patterns environment. It includes the prevention of adverse - It stated that diseases associated with excess (e.g. health effects from environmental hazards. It provides obesity and alcoholism) afflict affluent societies, and the for and delivers occupational health and safety diseases that result from inadequate or unsafe food, programs and services to clients. shelter and water afflict the poor. 4. Community Mental Health Nursing - The range of available health choices is critical in shaping - Unique clinical process that includes concepts of a society’s overall health status. nursing, mental health, social psychology and - National level policy making was the best way to community networks including social sciences. Focus favorably impact the health of most people rather that is on the Mental Health Promotion. concentrating efforts on imparting information in an effort to change individual patterns of behavior. Theoretical Models / Approaches - Health – promoting choices must be readily available and Health Belief Model (HBM) less costly than health-damaging options - Developed in the 1958 by group of U.S. Public Health - Health Deficits results from an imbalance between a Service social psychologists. Believed that individual must population’s health needs and its health sustaining know what to do and how to do it before they can take resources. action. Major limitation of HBM is that it places burden of - Compared to HBM, Milio’s framework includes economic, action exclusively on the client. political and environmental health determinants. - Key Concept and Definitions of HBM - Lifestyle are patterns of choices made from available Perceived Susceptibility - One's belief regarding the alternatives according to people socioeconomic chance of getting a given condition circumstances and how easily they are able to choose Perceived Severity - One's belief regarding the some over others. seriousness of a given condition Nole Pender’s Health Promotion (HPM) Perceived Benefits - One's belief in the ability of an - Developed in 1980’s and revised in 1996. Explores many advised action to reduce the health risk or biophysical factors that influence individuals to pursue seriousness of a given condition health promotion activities but does not includes threat as Perceived Barriers - One's belief regarding the a motivator. tangible and psychological costs of an advised - Pender's model focuses on three categories: individual Action characteristics and experiences, behavior-specific Cues to Action - Strategies or conditions in one's cognitions and affect, and behavioral outcomes. Details environment that activate readiness to take action are as follow: Self-efficacy - One's confidence in one's ability to take Individual characteristics and experiences action to reduce health risks o Prior related behavior - This influence subsequent To Watch - View and understand the Health Belief Model in behavior through perceived self-efficacy the link provided: For HBM : o Personal Factors - This are Biological, https://www.youtube.com/watch?v=c0-wVqTG2no Psychological, Sociocultural in Nature Milio’s Framework for Prevention Behavior-specific cognition and affect - Nancy Milio (1976) provides complement to the HBMs. o Perceived Benefits of Action- These are strong - 6 Propositions of this framework are related to the motivators through intrinsic and extrinsic benefits. following: o Perceived Barriers to Action- Are perceived 1) Population health deficits results from deprivation unavailability, inconvenience, expense, difficulty or &/or excess of critical health resources time regarding health behaviors 2) Organizational Dimension & policies dictate many of o Perceived Self-efficacy - Is one’s belief that he or the options available and influence their choices she is capable of carrying out behavior 3) Alterations in pattern of behavior resulting from o Activity-related affect - Feeling associated with decision – making of significant number of people in a behavior likely affect individual to repeat/maintain population can result in social change. behavior. 4) Behavior of population result from selection from o Interpersonal Influences (family, peers, provident), limited choices; arise from actual & perceived options Norms, Support, Model - These are feelings or thoughts regarding the beliefs or attitudes of others. J.A.K.E 2 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 o Situational influences (Options, Demand health-related behavior. This includes Support from family, characteristics, Aesthetics) - These are perceived peers, teachers, employers, health care providers. options available, demand characteristics and - To Watch: View and understand the PRECEDE – PROCEED aesthetics features of the environment where the Model in other resources. Proceed in the following links: behavior will take place. https://www.youtube.com/watch?v=YmD4Ju0TGS0 o Commitment to a plan of action - This initiates a https://www.youtube.com/watch?v=ZlVnGcRNY_s behavioral event Behavioral Outcome Terminologies o Immediate competing demands (low controls) & Aggregate - is literally defined as the sum or the whole. preferences (high control) - These are alternative Community - is a part of that whole. behavior Immediately prior to engaging in the Geopolitical Community – is a community with defined intended, planned behavior geographical and jurisdictional boundaries, such as rural o Health promoting behavior - Goal/ outcome municipalities, towns or city communities. A is the o To Watch - View and understand the Pender’s procedure of systematically acquiring and recording Theory in the link provided: For Pender’s Theory : information about the members of a given population. https://www.youtube.com/watch?v=PahdzR9YfVg Phenomenological Community - A phenomenological community is said to be a group of people who are defined by sharing values, customs, interests, religion or academic interests. It is a phenomenological community because members share common beliefs and interests allocates them to the place where enumerated—normally where they spend the night of the day enumerated. RLE IDEAL COPAR AGAINST PRACTICED COPAR IDEAL COPAR PRACTICED COPAR - 3 to 6 wks. Immersion - Sometimes 8 to 16 and mode of Time frame - 3 to 6 wks. duty, 8 hrs. a week, for 2-4 exposure hrs. a day, 5-6 days a weeks depending on wk. the time allotted by the school or institution. - The survey form will - Use of ready-made Methodology and survey vary to the needs of survey form from the community school, books, or (custom made) and from the institution the methodology is they are working for. form surveying the - Some use survey but participants others just collect PRECEDE – PROCEED Model data from previous - Developed by Dr. Lawrence Green and colleagues. studies ex. Health - PRECEDE which stands for Predisposing, Reinforcing and situation from the Enabling Constructs in Educational Diagnosis and barangay. Evaluation, is used for community diagnosis. - 30%, 60% or 100% - 25 – 50 families or - PROCEED, an acronym for Policy, Regulatory, and depending on the depending on the Organizational Constructs in Educational and Number of Recipients number of population required number of Environmental Development, is a model for implementing and situation of the families by the and evaluating health programs based on PRECEDE. community. school or - Predisposing factors refer to people’s characteristics that - With allotted 10-15 institution. motivate them toward health-related behavior. This data or tally sheet for includes attitudes, beliefs and values dead files. - Enabling factors refer to conditions in people and the environment that facilitate or impede health related behavior. This includes skills, availability, accessibility & referrals. - Reinforcing factors refer to feedback given by support persons or groups resulting from the performance of the J.A.K.E 3 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 -A primary and - No organizations - The “fish rod effect” - The “fish effect” secondary built or sometimes should be done programs that are organization should the organizations “teach the man to not meant to last be built and it should are not properly fish and he shall - 1 day programs are be strengthened or never be hungry, give the often done, this strengthened by set registered, no by the man fish and he programs also of officers, bylaws, laws are present. will ask for more”. diminishes after the building stage Organization registrations to the Therefore the The programs that health worker leave. proper institution functions are not will be implemented (SEC, DTI)) clear, the should stand and - The primary and responsibilities are remain feasible even Implementation secondary leaders not well stated. after the Phase-out are committed and or even after the the members are all HCW leave the coming from the community. community and not - The program should from the healthcare not be a 1day affair worker. (ex. mother’s class, - The problem will only - Misjudging 1day feeding, or be stated after the complex problems nutrition program) survey has been as simple ones but should be done, tallied and - Not considering program that analyzed. the result of the program that will last - The problem will be survey form but the even after the phase- coming from the say of the few. Ex. out. It should be survey form and not Barangay officials. something that you from the judgement will leave with of the healthcare community. worker, because of - The HCW should - Some results are Statement Problem the simple reason learn to accept manipulated just to that any problem not reality that not all say that the goals Evaluation perceived is not a programs will are me problem. prosper and not all - No - Any problem too big their goals will be reimplementation or too complicated to met the health worker to - After evaluation manage should not there should be a be prioritized. The reimplementation. principle within is that we should not CONCEPTS OF THE COMMUNITY AND PHILIPPINE HEALTH prioritize something SITUATION that we can do Concept of the Community nothing about. Community - a group of people with common characteristics or interests living together within territory or geographical boundary - It is a place where people under usual conditions are found. - Types of Community Geopolitical community – territorial ex. School Phenomenological community – functional ex. Barangay Characteristic of Healthy Community - Adapted from Hunt, 1997 and Duhl, 2002 Shared sense of being a community based on history and values General feeling of empowerment and control over matters affecting the community as a whole J.A.K.E 4 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Existing structures that allow subgroups in the community Manager Ability to cope with change, solve problems & manage Collaborator conflicts within the community To watch: View and relate the roles and responsibilities of Open channel of communication Community Health Nurse in the video. Equitable and efficient use of community resources https://www.youtube.com/watch?v=1rjtdz3Qxyk The intervention Wheel Factors Affecting Health of the Community - The Minnesota Intervention Wheel is a tool that illustrates - Community has 3 features. It includes population, what public health nurses do to improve health outcomes. location and social systems. Descriptions are as follow: Characteristics of the People / Population Surveillance: Describes and monitor health events - Population size and density influences the number and Disease & other health investigation: Systematically size of health care institutions gathers & analyzes data regarding threats, ascertain - Health needs of community varies because of differences source, what to do & how services can be obtained. in population composition by age, sex, occupation, level Outreach: Locates populations & provides of education and other variables information about the nature of concern, what can be - Other factors are rapid growth or decline of a population, done & how services can be obtained the feeling of belonging and participation in community Screening: Identifies unrecognized health risk factors action including level of education and social class. or asymptomatic disease conditions Location of the Community Case finding; Locates those with identified risk factors - Health of community is affected by both natural and man- & connects them with resources made variables related to location. Referral and follow – up: Assist to identify & access - Geographic features consist of land and water forms that necessary resources to prevent or resolve problems influence food sources and prevalent occupations. Case Management: Optimizes self-care capabilities of - Geography plays an important role in disasters individuals & families & capacity of community - Effects of climate change on human health are evidenced Delegated functions: Direct health task that are by seasonal diseases. carried out - Geographic location of the Philippines makes it vulnerable Health teaching: Communicates facts, ideas and to natural hazards. The country in the so called “Ring of skills that change knowledge, attitudes, values, Fire,” in which volcanic eruptions and earthquakes are beliefs, behaviors & practices frequent Counselling: Establishes an interpersonal relationship - Other factors that affects health of community are plants with an intention of increasing / enhancing capacity and fauna. It also includes community boundaries, air for self – care. water and soil pollution. Consultation: Seeks information & generates optional - Factors that contribute to health problem in urban are: solution higher population density while factors that contribute to Collaboration: Commits two or more persons to health problem in rural are: inequalities of resources and achieve a common goal economic opportunities, Social Systems within the community Coalition building: Promotes & develops alliances - Social system is the patterned series of interrelationships among organizations or constituencies for common existing between individuals, groups and institutions and purpose forming a coherent whole. Community organizing: Helps community groups - This includes the following: family economic, educational, identify common problems, mobilize resources & communication, political, legal, religious, recreational and develop/ implement strategies to realize goal health system. collectively - To Read: Read and comprehend how health is affected by Image of intervention depicted below shows the individual – people, location & social services in: Famorca, Z. 2013. focused, community – focused, system – focused & Nursing Care of the Community, a comprehensive text on population – based approaches when intervening concerns community and public health nursing in the Philippines, related to public health. 2013, 4 – 7. Roles and Activities of Community Health Nurse Roles and activities of community health nurse and its sub- specialty are connected with following: Clinician / care provider Advocate Researcher Leader Educator J.A.K.E 5 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - The ageing index (Gavrilov LA et al., 2003) or the proportion of persons aged 65 years and over per 100 persons. Most countries are considered aging if they have at least 7% of the population over 65 years old," according - To watch: View and understand The Intervention to POPCOM. Wheel in the link provided below: - The population growth rate has declined by almost half, https://www.youtube.com/watch?v=5rKbqpWwFM8 from 2.7 to 1.5 during the same period. at 6:41 - The overall age dependency ratio declined by about a third (28.8) between 1980 (86.3) and 2017 (57.5) which is Philippine Health Situation consistent with the decreasing trend of the child - Information on the health status of the nation as a whole dependency ratio. However, the trend in the elderly gives us an idea of the health status in the communities dependency ratio is slowly increasing, reflecting the where we are assigned as community / public health growing elderly population. nurses. Here are the health profiles and demographics of - Consistent with the increasing population, the population the Philippines. density doubled from 159 persons per sq. km in 1980 to Demographics 352 persons per sq. km in 2017. In the same period, the - The population provides an understanding of the health proportion of the population residing in rural areas status of populations. decreased from 62.5% to 55.8%. - In terms of demographics, this module walks around only - Of the estimated 71.6 million population aged 15 years those key issues connected to the assessment of the and over, 44.6 million persons were in the labour force in health status that interface with the analysis of health. 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 - Major cities by population are 13.699 million MANILA (capital), 1.785 million Davao, 967,000 Cebu City, 905,000 Zamboanga, 859,000 Antipolo (2019) Total Population (2020)109, 947,900 Total population (2016) 103,320,000 Health Profile - Projected population of the Philippines is 104.9 Births million as of 2017, based on the 2015 Census of Population conducted by the Philippine Statistics Authority. The Philippines is the thirteenth most populous country in the world. - As of 2017, urban migration in the Philippines, particularly towards the National Capital Region (NCR), which hosts 12.7% of the population. This Births in the Philippines, 2017 (Based on PSO) creates problems in the area of housing, road traffic, - Sixteen births per thousand population pollution and crime. - Year 2017, registered live births were 1,700,618. This - The Philippines has a young population with about a is equivalent to a crude birth rate (CBR) of 16.2 or 16 third of its population younger than 15 years of age as births per thousand population. of 2017. Median age is 24.3 J.A.K.E 6 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - The number of registered live births showed a - The recorded highest number of illegitimate children decreasing trend, noticeably from 2012 to 2017. born in 2017 by usual residence of mother were - The decrease in the last five years was 5.0 percent, CALABARZON followed by NCR from 1,790,367 live births in 2012 to 1,700,618 More babies born to adolescent mothers recorded births in 2007 - Babies born to adolescent mothers (196,478) were - Several factors may contribute to the declining births, more than those babies sired by adolescent fathers such as social change or lifestyle choices associated (52,342). by economic affluence. - Babies sired by fathers aged 50 years old and over - In the National Demographic and Health Survey (27,068) were far more than babies born to mothers of (NDHS,2017), the total fertility rate declined steadily the same age group (328). over time to 2.7 children per woman in 2017. - Modal age group of childbearing in 2017 was at 20-24 years old. Highest frequency of live births belonged to mothers in this age group. On the other hand, fathers aged 25-29 were recorded to have e highest frequency of live births. - The median age of mothers giving birth was 26 and for fathers was 29 years old. Mortality - Mortality rates declined from 2015 to 2016. 2016 2015 2014 Deaths 579,262 582,183 560,605 More males born than females (Accdg to - More males (887,972 or 52.2%) were born than civil females (812,646 or 47.8%) which resulted in a sex registration) ratio of 109 males per 100 females. Male 332,529 334,678 321,624 - On the average, there were about 4,659 babies born Female 246,733 247,505 238,981 daily or about 194 babies born per hour or approximately three babies born per minute. - Highest occurrence of births in NCR. Of the total live births, 57.8 percent were born in Luzon, 19.1 percent in Visayas and 23.1 percent in Mindanao. - In the total number of births in the Philippines, 93.3 % birth deliveries were attended by health professionals such as physician, midwife or nurse. - ARMM showed very low proportion of medically attended births. More than half of births that occurred in the region were attended by Traditional Birth Attendant (hilot /unlicensed midwife).2017 FAMILY PLANNING 7/ (Source: PSA) Any modern method - 40.4 - In 2017, an average of 1,587 persons died daily or to Any traditional method - 13.9 66 deaths per hour or one per minute. Not currently using - 45.7 - Median age at first birth among women 25-29 (Mother's mean age at first birth 22.8 years, 2017 est.) More than half of babies born to unwed mothers - More than half (53.3%) of the total registered live births in 2017 were born out of wedlock. - In 2017, the number of deaths in males (332,517) was higher than deaths in females (246,720). J.A.K.E 7 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - The Age And Sex Pattern Of Death in 2017, reflects an Morbidity, Endemic and Outbreaks inverted pyramid, with fewer deaths at younger ages, - Leading cause of morbidity in 2005 is Acute Lower except for children under one, & progressively Respiratory Tract Infection and Pneumonia. This is - Higher proportions of female deaths observed in older age followed by bronchitis / bronchiolitis groups. - There were infectious diseases that have emerged each as - Out of 579,237 registered deaths, about half or 292,098 the severe acute respiratory syndrome (SARS). were not attended by medical doctor or any other allied - Obesity - adult prevalence rate 6.4% (2016). Maternal health care provider 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) ; vectorborne 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. From 1982 to 2006, cases is not just associated with homosexuality. One – third were OFW. 74% were males. Top three regions in terms of number of deaths by usual Around 93% through sexual intercourse. There is also an residence were found in Luzon: CALABARZON followed by increase of syphilis and gonorrhea (DOH, 2006). NCR then Central Luzon. On the other hand, the three regions which had the least number of deaths were ARMM, CAR and Caraga. Top 3 Leading Causes of Death (2016) 1. Ischemic heart diseases - 74,134 2. Malignant neoplasms (cancer) - 60,470 3. Pneumonia - 57,809 Rate of Malaria, TB and HIV from 2009 to 2019 in the Philippines released by WHO. The month of August recorded the highest number of deaths followed by January. February had the least number percent share of the total deaths. Schistosomiasis continues to affect hundreds of barangays in 24 endemic provinces. Mapping of Filariasis in the Philippines. Polio outbreak in the Philippines (Reported by WHO, 2019) - In September 2019, Philippines declared an outbreak of polio. Two cases were reported. First case was confirmed on 14 September. Case-patient is a 3-year-old girl from Lanao del Sur in the southern Philippines. The second case was confirmed on 19 September and is a 5-year-old J.A.K.E 8 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 boy from Laguna Province. Virus isolated are both Terminologies genetically linked to VDPV2 previously isolated from Aggregate - is literally defined as the sum or the whole. environmental samples in Manila and Davao caused by Community - is a part of that whole. vaccine-derived poliovirus type 2 (VDPV2). Environmental Department of Health - The Department of Health (DOH) samples taken from sewage in Manila on 13 August and a is the country's principal health agency. It is responsible waterway in Davao on 22 August have tested positive for for ensuring access to basic public health services VDPV2. through the provision of quality healthcare and the Measles Outbreak in the Philippines. (Reported by regulation of providers of health goods and services. UNICEF-WHO) Geopolitical Community – is a community with defined - Measles outbreak started late 2017 in Mindanao. In 2018, geographical and jurisdictional boundaries, such as rural 20,827 cases were reported with 199 deaths. With a Case municipalities, towns or city communities. A is the Fatality Rate (CFR) of 1,37% Outbreak & supplementary procedure of systematically acquiring and recording immunization activities in 2018 were ineffective due to information about the members of a given population. vaccine hesitancy. Weak routine immunization led to Phenomenological Community - A group of people who decrease in overall immunization coverage, a large are defined by sharing values, customs, interests, religion immunity gaps among younger children against vaccine or academic interests. It is a phenomenological preventable diseases including measles. community because members share common beliefs and interests allocates them to the place where enumerated— normally where they spend the night of the day enumerated. Philippine Statistics Authority - abbreviated as PSA, is the central statistical authority of the Philippine government that collects, compiles, analyzes and publishes statistical information on economic, social, demographic, political affairs and general affairs of the people of the Philippines and enforces the civil registration functions in the country. World Health Organization - The World Health Organization is a specialized agency of the United Nations Reported through Philippines Integrated Disease responsible for international public health. The WHO Surveillance & Response (PIDSR) system Constitution, which establishes the agency's governing - From January to June 2019, current dengue incidence is structure and principles, states its main objective as "the 85% higher than in 2018, in spite of a delayed rainy season. attainment by all peoples of the highest possible level of - DOH declared a National Dengue Alert in July 2019. health." - Regional DOH step up dengue surveillance, case management & outbreak response in primary health CONCEPTS OF DEMOGRAPHY facilities situations, vector control, and logistics support Demography for dengue control (insecticides, RDTs, medicine, etc). - Literally translated from the Greek, 'demography' means DOH Statement on Diphtheria (September 2019) 'description of the people’ - Cases of diphtheria and other infectious diseases are - “Demography is the study of the size, territorial monitored by the Epidemiology Bureau regularly. From distribution, and composition of population, changes January 2019 – September 2019, there have been 167 therein. (Duncan & Hauser 1972) cases and 40 deaths compared to 122 cases and 30 Population size deaths cases in the same period in 2018. The reasons for - Refers to the number of people in a given place at a given the trend are being investigated. The Department of time. Characteristics of population as to age, sex, Health (DOH) urges parents to ensure that their children occupation or educational level is Population receive the complete dose of all recommended vaccines Composition. Distribution is the specific geographic in their first year of life. Statement from WHO, May 2020 location. - A new virus and disease were unknown before the Population outbreak began in Wuhan, China, in December 2019. On - Demography uses a series of mathematical tools to 30 January 2020. investigate how populations respond to changes. - Philippine Department of Health reported the first case of - is a collection of persons alive at a specified point in time COVID-19 in the country with a 38- year-old female who meet certain criteria Example is the “population of Chinese national. Mindanao on April 2, 1999" and the "population of children - On 7 March, the first local transmission of COVID-19 was in Iloilo on July 8, 2000.” confirmed. - Population projections are a common demographic tool. They provide a basis for other statistical projections, helping governments in their decision making. J.A.K.E 9 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Components of Population growth during an earlier census. Also known as the population - The age and sex composition of a population affects its growth rate, it measures the average yearly percentage social life in many ways. Changes in age composition are change over the same time frame. due mainly to changes in birthrates and are presently increasing the proportion of aged and reducing the proportion of children in many countries. Sources of Demographic Data - Census is usually conducted by a national government and attempts to enumerate every person in a country. In Population Composition contrast to vital statistics data, which are typically Sex composition collected continuously and summarized on an annual - of the human population is one of the basic demographic basis, censuses typically occur only every 10 years or so, characteristics, which is extremely vital for any and thus are not usually the best source of data on births meaningful demographic analysis. Changes in sex and deaths. composition largely reflects the underlying socio- - Sample Survey is data gathered from small number of economic and cultural patterns of a society in different people proportionate to the general population ways. The sex ratio is the ratio of males to females in a - Registration System deals of recordings of vital events population. Age distribution - also called Age Composition, in population studies, the proportionate numbers of persons in successive age Population Size categories in a given population. A population with Natural increase persistently high fertility, for instance, has a large - defined as the difference between live births and deaths in proportion of children and a small proportion of aged a specified period of time. persons. Median age - is the age that divides a population into two numerically equally sized groups - that is, half the people are younger Rate of natural increase (RNI) than this age and half are older. It is a single index that - a statistic calculated by subtracting the crude death rate from the crude birth rate of a given region in a specified summarizes the age distribution of a population. period of time. This rate gives the public health nurse an Dependency ratio - is an age-population ratio of those typically not in the idea of how a certain country's population is growing. labor force (the dependent part ages 0 to 14 and 65+) and those typically in the labor force (the productive part ages 15 to 64). It is used to measure the pressure on the Developing countries typically have higher RNI values as they productive population. have limited infrastructure and access to healthcare which limits them to unregulated fertility levels. They have higher incidence of disease and poor health outcomes leading to more deaths on top of the already high fertility Absolute Increase per year Age and Sex Composition - measures the number of people that are added to the - The composition of population according to age and/or population per year sex is known as the age and sex structure. The universal characteristics of human populations are fundamental to understanding demographic processes of fertility, mortality and migration. Age composition may be summarized in terms of age groups (e.g., 0-15 years, 15- 64 years and 65 or above). The age and sex composition is depicted at the same time using a population pyramid. Relative Increase - is the actual differences between the two census counts expressed in percent relative to the population size made J.A.K.E 10 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Population pyramid HEALTH INDICATORS - the size of the population under investigation is depicted Vital Statistics on the horizontal axis, and age is aligned on the vertical - are conventionally numerical records of marriage, birth, axis. sickness and death by which the health and growth of community may be studied. It is a tool in estimating the extent or magnitude of health needs and problems in the community. - Through vital statistic indicators, the nurse is able to describe the health status of the people which serves as the basis for developing, implementing and evaluating programs and intervention strategies. - Statistics of disease (morbidity), and death (mortality) indicate the state of health of a community and the Population Distribution success of failure of health work. Statistic on population Population Distribution and the characteristics such as age, and sex, distribution - means the pattern of where people live. It denotes the are obtained from the Philippine Statistic Authority (PSA). spatial pattern due to dispersal of population, Birth and Deaths are registered in the Office of the Local formation of agglomeration and linear spread. Civil Registrar of the municipality or city. Urban – Rural Distribution Purpose of Vital Statistics - illustrates the proportion of the people living in urban To determine success or failure of specific health compared to the rural areas. problems. Crowding Index To promote health legislation at local and national level. - is an alternative measure of household crowding. It is To develop policies and procedure at state and center defined as the number of usual residents in a dwelling Sources of Data divided by the number of rooms in the dwelling. Population Census Registration of Vital Signs Health Survey Studies and researches Population density Common Vital Statistical Indicators - is calculated as population divided by total land area. Fertility Rates It is the people per sq. km of land area. - Crude birth rate (CBR) measures how fast people are added to the population through births - General Fertility Rate (GFR) Terminologies Census – A is the procedure of systematically acquiring Mortality Rates and recording information about the members of a given - Crude Death Rate (CDR) population. De Facto Census - allocates them to the place where enumerated—normally where they spend the night of the day enumerated. - Specific Morbidity Rates De Jure Census - tallies people according to their regular Show disease rates in specific population groups by or legal residence age, sex, occupation, education, exposure to risk factors, place of residence, or combinations of these factors. Example: TB morbidity rate for the age group 20 – 24 years - Cause-of-Death Rate J.A.K.E 11 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Infant Mortality Rate (IMR) - is the study of the distribution and determinants of health- related states or events in specified populations and the application of this study to the prevention and control of health problems. (Last, 1988) - Maternal Mortality Ratio (MMR) - In the process of epidemiological study, it uses variety of concepts from biology, sociology, demography, geography, environmental science, policy analysis and statistics. Morbidity Indicators Beginnings of Epidemiology - Incidence Density (ID) Rate Hippocrates - Disease is associated with climate & physical environment - Prevalence Rate John Snow - Investigation of Cholera epidemic in 1854 William Farr - Use of census & vital registration of data Terminologies - described pattern of mortality pattern in sdubgroups Vital Statistics - It is a tool in estimating the extent or such as occupational group, prisoners & other age- magnitude of health needs and problems in the group community. Framingham Heart Study Rates – Shows the relationship between the vital event - identified the risk factors for coronary heart disease and those persons exposed to the occurrence of the said Richard Doll and Bradford Hill events, within a given area and during a specified unit of - Doll and Hill's Study time. - Provided compelling evidence of the role of smoking Ratio - is used to describe the relationship between (2) in the incidence of lung cancer numerical qualities or measures of events without taking Jonas Salk particular considerations to the time or place. - Developed and introduced in 1955 the Salk Vaccine. field trial showed protective effect of the vaccine EPIDEMIOLOGY AND THE NURSE against paracytic poliomyelitis. Definitions And Related Terms Agents - Any element, substance or force, either animate Epidemiology is further described in the following terms: or inanimate which may serve as stimulus to initiate a Term Description disease process. Comprises of surveillance, observation, Case Definition - It is a set of standard criteria for Study hypothesis testing, analytic research then classifying whether a person has a particular disease, experiments syndrome, or other health condition. Denotes to an analysis by time, places Epidemiology - The study of the occurrence and Distribution and classes of people affected distribution of health condition such as disease, death, deformities on human population. It is a highly Contain all the biological, chemical, quantitative discipline based on principles of statistics physical, social, cultural, economic, and research methodologies. Determinants generic and behavioral factors that Environment - Sum total of all external conditions and influence health. influence that affect the life and development of an Denote to disease cause of organism. Health death, behaviors such as the use of related Herd Immunity - The probability of a group or community tobacco, positive health states, reactions states or developing an epidemic upon introduction of infectious to preventive regimens and provision and events agent. use of health services Host - is the actual or potential recipient or victim of the Comprise those with identifiable Specified disease. Hosts have characteristics that either predispose characteristics such as occupational populations them to or protect them from disease groups Risk - Probability of unfavorable event, disease, disability, Application The aim of public-health is to promote, defects or even death. to prevention protect, and restore good health and control Epidemiology - Originated from Greek words “epi” meaning “upon” and Practical Applications of Epidemiology “demos” meaning people. “Logos” means “study.” 1) Assessment of the health status of the community or - is the study of occurrence and distribution of health community diagnosis. circumstances such as disease, death, deformities on 2) Elucidation of the natural history of disease. people. Likewise, it studies probable factors that 3) Determination of disease causation. influence development of health conditions. 4) Prevention and control of disease J.A.K.E 12 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 5) Monitoring and evaluation of health intervention 6) Provision of evidence for policy formulation Practical applications of epidemiology for public health nurses are as follow: Stages in The Natural History of Disease & The Level of Prevention Models Of Disease Causation - Health events do not occur casually in a populace but are Natural Life History Of Disease more likely to happen in some members of the population - The natural history of a disease is its course over time, than others for the reason that risk factors may be highly starting from the pre-pathogenesis stage to its termination. distributed in a particular population than others. The stages are as follow: - To understand disease causation in epidemiology, there Stages of Natural History of Disease. are several models being utilized in epidemiological study, these are The Wheel, The Web and Epidemiological Triad. 1. Pre-pathogenesis 2. Pathogenesis Stage The Wheel Model of Disease Causation Stage - Susceptibility stage - Disease has already - Disease not started yet developed. - There are factors that - 3 sub – stages are: Pre- favor disease symptomatic, discernible occurrence. lesions and advance disease. Clinical data of patients with several stages of the disease are typically put together to determine the natural history of a specific disease. 1) Inner core of Wheel - This gives emphasis on the role of genetic makeup of the host 2) Outer Core of the Hub - Composed of the following: Host Characteristics – ex. Sex, age, socioeconomic status and behaviors 3) C. The Rim or the Outer Edge - Represents the biologic, physical & chemical environments - A prospective cohort study could plot it better because of The Web Model of Disease Causation the advantage of observing the cohort from the time that - The web is also applicable for non - communicable the members are disease- free to the time they develop disease the disease through its termination. - The Web Model shows complex interrelatedness of risk - Applicable level of prevention that is administered to the factors using the following: One Headed Arrow signifying patient is dependent on the stage of the disease when the the ancestors, Antecedent Factors at the tail of the arrow patient was diagnosed. & Intermediate factors at the head of the arrow J.A.K.E 13 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 characteristics may be biological (e.g., age, sex, and degree of immunity), behavioral (e.g., habits, culture, and lifestyle), or social (e.g., attitudes, norms, and values). - The agent is the factor that causes disease. - Agents are parasites, protozoans, bacteria, virus, nutritive factors, chemical agents, physical agents - Environment are either physical, biologic and socio- economic - Host is a susceptible human host - The environment includes all external factors, other than the host and agent, that influence health. It is categorized as: The ecological triad - Depicts the “Multiple Theory of Disease Causation” - The simplest of these is the epidemiologic triad or triangle. The triad consists of an external agent, a susceptible host, and an environment that brings the host and agent together. Agent can be divided in terms of the following: - In this model, disease results from the interaction Biological Such As Bacteria And Fungi between the agent and the susceptible host in an Chemical Such As Gases And Natural Or environment that supports transmission of the agent from Synthetic Compounds a source to that host. Nutritional Such As Food Additives Physical Such As Ionizing Radiation Epidemiological Triangle - Also known as epidemiologic triad or triangle model views the occurrence of disease as the balance of host, agent, and environment factors - Epidemiologic triad (or epidemiologic triangle) - The host is the actual or potential recipient or victim of the disease. Hosts have characteristics that either predispose them to or protect them from disease. Those J.A.K.E 14 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 Epidemiological Approaches 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 The Phases of epidemiological approach consist of: 6) Based on the clinical manifestations, incubation period, Descriptive Epidemiology - Consist of disease available laboratory findings & other information gathered, distribution and frequency. formulate a hypothesis regarding the probable etiologic Analytical Epidemiology - Attempts to analyze the cause agent, the sources of infection, the mode of transmission or determinants of disease through hypothesis testing & the best approach for controlling an outbreak Intervention or Experimental Epidemiology - Answers 7) Test the hypotheses by collecting relevant specimens questions about the effect of new methods for controlling from the patients and from the environment diseases or for improving underlying conditions 8) Based on the results of the investigation, implement Evaluation Epidemiology - Attempts to measure the prevention and control measures to prevent recurrence of effects of different health services and program a similar outbreak. Descriptive Epidemiology is concerned with describing 9) Disseminate the findings of the investigation through the frequency and distribution of disease in a given media and other forms to inform the public population. This is by observing & recording existing pattern of occurrence of disease. Describing disease as to Monitoring And Evaluation of Health Interventions: person, place and time characteristics. Host is described Monitoring in terms of herd immunity, exposure rate, chance. - an ongoing activity during program implementation to assess the current status of its implementation. Epidemic - is a situation when there is a marked upward fluctuation in disease incidence. Endemic - Is habitual presence of disease in given population. In sporadic, disease occurs every now and then affecting small number of populations. Pandemic - is a worldwide occurrence of disease. Evaluation - This is describe as systematically and objectively assesses compliance to the design of the program, performance, relevance and success of project J.A.K.E 15 of 16  COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022 - Outcome Evaluation - Evaluates the extent to which a project accomplishes its intended results. - It measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve - Impact Evaluation - Impact evaluation assesses in interval the program effectiveness in achieving its ultimate goals - The essence of impact evaluation is for comparison. - These comparisons are based on the observations of different groups at the same time or of the same group at different points over time. - This is done to measure and compare these differences and conclude whether or not observed differences may be attributes to the project. Terminologies Epidemiology - The study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems Fomites - articles that are easily contaminated by pathogens from the respiratory, intestinal tract and skin Inanimate (Non Living) Reservoirs - air, soil, food, milk, water, fomites GOOD LUCK!! NAWAY MAKAKUHA TAU NG MAGANDANG SCORE HEHE J.A.K.E 16 of 16