NCM 113: Community Health Nursing 2 PDF

NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS Community-based nursing focuses on an individual COMMUNITY HEALTH and is family- centered in orientatio...

NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS Community-based nursing focuses on an individual COMMUNITY HEALTH and is family- centered in orientation NURSING CONCEPTS PHILOSOPHY 1. The practice of community and public health COMMUNITY HEALTH NURSING nursing is anchored on the primary of worth and “Service rendered by a professional nurse to dignity of man. communities, groups, families and individuals at 2. Respect for people’s inherent value regardless of home, in health centers, in clinics, in schools, and in their background and beliefs are edified in the places of work for the promotion of health, universal bioethical principles. prevention of illness, care of the sick at home, and 3. Responsibility for health rests primarily on people rehabilitation.” - Ruth B. Freeman and not on agencies or professionals “Nursing practice in a wide variety of community 4. The need for the attainment of independence and services and consumer advocare areas, and in a self- reliance in health variety of roles, at times including independent 5. Health is shared responsibility and therefore practice… community nursing is certainly not requires collective efforts from all sectors. Working confined to public health nursing agencies.” - with communities requires active participation of the Jacobson, 1975 people. “The utilization of the nursing process in the 6. A fundamental commitment of community and different levels of clientele individuals, population public health nurses is to adhere to the tenets of groups and communities, concerned with the social justice. This principle speaks of promoting promotion of health, prevention of disease and common good and not merely to be fair to all disability and rehabilitation.”- Maglaya, et at 7. One hallmark of the profession is having its own code of ethics 3 BASIC CONCEPTS OF COMMUNITY AND PUBLIC HEALTH NURSING PRINCIPLES OF CHN The community is the patient in CHN, The Family is 1. THE COMMUNITY AS A CLIENT the unit of care and there are four levels of clientele: Community is a collection of people who interacts individual, family, population group (those who with one another and whose common interests or share common characteristics, developmental characteristics form the basis for a sense of unity or stages, and common exposure to health problems- belonging (Alexander et al.,2009) e.g. children, elderly, and the community. In CHN, the client is considered as an active partner 2. HEALTH AS A GOAL not passive recipient of care. Health is a state of complete physical, mental, and CHN Practice is affected by developments in health social well-being and not merely the absence of technology, in particular, changes in society, in disease or infirmity (WHO, 2010). Health is more general. than a state of well-being. It is a multidimensional The Goal of CHN is achieved through multi sectoral reality that includes socioeconomic, environmental efforts. and even political factors. Healthcare needs to be CHN is a part of health care system and the larger holistic. The nurse in the community foster human services system. multidisciplinary efforts to address various core determinants of health. PRINCIPLES OF COMMUNITY AND PUBLIC HEALTH NURSING 3. NURSING AS THE VEHICLE OR MEANS TO 1. Focus on the community as the unit of care. ACHIEVE ITS AIMS 2. Give priority to community needs. Nursing is the art and science of caring. According 3. Work with the community as a equal partner of the to Florence Nightingale (1973), Nursing is a means health team. of ensuring that people are placed in a optimum 4. In selecting appropriate activities, Focus of the condition where nature can contribute to healing health team. and wellness. 5. Promote a healthful physical and psychosocial environment. PHILOSOPHY AND PRINCIPLES 6. Reach out to all who may benefit from a specific service. 7. Promote optimum use of resources. PHILOSOPHY OF CHN 8. Collaborate with others working in the community. Community health nursing is a philosophy of care that is characterized by collaboration, continuity of care, client and family responsibility for self-care, FEATURE OF CHN preventive health care (Hunt, 2005). It is a specialty field of nursing. Its practice combines public health with nursing. 1 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS It is population based. PENDER’S HEALTH PROMOTION MODEL It emphasizes on wellness and other than disease Similar to health belief model. or illness. Does not consider health risk as a factor that It includes inter-disciplinary collaboration. provokes change. It amplifies client’s responsibility and self-care Examines factors that affect individual actions to promote and protect health. CHARACTERISTICS AND FEATURES OF ○ Personal factors (Biological,Psychological, COMMUNITY AND PUBLIC HEALTH NURSING Sociocultural behaviors, Abilities, 1. Developmental Self-efficacy 2. Multidisciplinary ○ Feelings, Benefits, Barriers, and 3. Ecology Oriented characteristics associated with the action 4. Promotes social justice ○ Attitudes of other, and competing demands 5. Values consumer involvement and preferences ESSENTIAL OF 6. Uses prepayment mechanism COMMUNITY NURSING 7. Focuses on preventive service 8. Offers comprehensive care DETERMINANTS OF HEALTH are factors that influence the client’s health. These A COMMUNITY HAS THREE FEATURES can include nutrition, stress, education, the (ALLENDER ET AL., 2009; HUNT, 2009) environment, finances and social status/stigma 1. People (prejudice). 2. Location 3. Social system HEALTH INDICATORS (mortality rates, disease prevalence, levels of THEORETICAL MODEL/ APPROACH physical activity, obesity, tobacco or other substance use) describe the health status of a COMMUNITY HEALTH NURSING THEORIES community and serve as targets for the Nursing theory provides the basis for care of the improvement of a community’s health. community and family Theorists have developed sound principles to guide HEALTH PROMOTION MODEL VARIABLES nurses in providing high-quality care 1. Individual characteristics and experiences 2. Prior related behavior Nursing theories appropriate for community health include 3. Personal factors the following. 4. Behavior- specific cognitions and affect 5. Perceived benefits of action HEALTH BELIEF MODEL 6. Perceived barriers to action Purpose is to predict or explain health behaviors. 7. Perceived self- efficacy Assumes that preventive health behaviors are taken 8. Activity- related affect primarily for the purpose of avoiding disease. 9. Interpersonal influences Emphasizes changes at the individual level. 10. Situational influences Describe the likelihood of taking an action to avoid 11. Commitment to a plan of action disease based on the following. 12. Immediate competing demands and preferences ○ Perceived susceptibility, seriousness, and 13. Health- promoting behavior threat of a disease ○ Modifying factors (e.g., demographics, LAWRENCE GREEN’S PRECEDE-PROCEED knowledge level) MODEL ○ Cues to action (e.g., media campaigns, A comprehensive structure for assessing health diseases effect on family/ friends, needs for designing, implementing and evaluating recommendation from health care health promotion and other public health programs professionals) to meet those needs. ○ Perceived benefits minus perceived barriers to taking action. PRECEDE Provides the structure for planning a targeted and MILIO’S FRAMEWORK FOR PREVENTION focused public health program. Complements the health belief model Stands for predisposing, reinforcing, and enabling Emphasizes change at the community level constructs in educational diagnosis and evaluation. Identifies relationship between health deficits and It involves assessing the following community availability of health-promoting resources. factors: Theorizes that behavior changes within a large ○ Social assessment: Determine the social number of people can ultimately lead to social problems and needs of a given population change and identify results. 2 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS ○ Epidemiological assessment: Identify 8. Facilitate service with visiting psychiatrist the health determinants of the identified 9. Home Health Care - helps in providing nursing care problems and set priorities and goals. to the individuals and families in their own place of ○ Ecological assessment: Analyze residence mainly to minimize the effects of illness behavioral and environmental and disability. determinants that predispose, reinforce 10. Hospice home care - specifically renders to and enable the behaviors and lifestyles are terminally ill, intended to provide comfort to improve identified. quality of life provide support to the patient and ○ Identify administrative and policy factors family. that influence implementation and match 11. Faith community nursing - or parish nursing is the appropriate interventions that encourage practice of art and science and nursing combine desired and expected changes. with spiritual care. ○ Implementation of interventions CONCEPTS OF A COMMUNITY PROCEED A community is a group of people sharing common Provides the structure for implementing and geographic boundaries and or common values and evaluating the public health program. interest within specific social system Stands for policy, Regulatory, Organizational Communities also vary in terms of community Constructs in Educational and Environmental dynamics- citizen participation, power and decision Development. It involves the Identification of making structures and community collaboration desired outcomes and programs implementation: effort ○ Implementation: Design intervention, Webs of people shaped by relationships, assess availability of resources, and Interdependence, mutual interests and patterns of implement program interaction (Behringer and Richards) ○ Process Evaluation: Determine if “ a collection of people who interact with one program is reaching the targeted another and whose common interest or population and achieving desired goals characteristics form the basis for a sense of unity or ○ Impact Evaluation: Evaluate the change belonging”(Allender et al., 2009); in behavior “A group of people who share something in ○ Outcome Evaluation: Identify if there is a common and interact with one another, who may decrease in the incidence or prevalence of exhibit a commitment with one another and shade a the identified negative behavior or an geographic boundary.” (Lundy & Janes, 2009) increase in identified positive behavior. “A group of people who share common interests, who interact with each other, and who function in DIFFERENT FIELDS collectively within a defined social structure to address common concerns” (Clark,2008); 1.SCHOOL HEALTH NURSING “A locality-based entity, composed of systems of formal organizations reflecting society’s institutions, Promotes the health of school personnel and informal groups and aggregates”(Shuster & students. It aims to prevent health problems that Goeppinger, 2008). would hinder students learning and performance of Maurer and Smith (2009) further addressed the their developmental task concept of community and identified four defining attributes:(1) people,(2) place,(3) interaction, and 2. OCCUPATIONAL HEALTH NURSING (4) common characteristics, interest, or goals. Aimed in assisting workers in all occupation to cope Combining ideas and concepts in this text, with actual and potential stresses in relation to their community is seen as group or collection of work and work environment. locality-based individuals, interacting in social units and sharing common interest, characteristics, 3. COMMUNITY MENTAL HEALTH NURSING values, and/or goals. Promotion of mental Health and prevention of mental illness across the lifespan and across TYPES OF COMMUNITIES sectors. INTEREST THE SERVICES MAY INCLUDE Communities of people who share the same interest 1. Treatment planning or passion 2. Medication management 3. Assessment 4. Counseling ACTION 5. Family Support Communities of people trying to bring about change 6. Education 7. Group Support 3 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS PLACE Open channels of communication and cooperation Communities of people brought together by among the members of the community. geographic boundaries Equitable and efficient use of community resources within the view towards sustaining natural sources. PRACTICE Communities of people in the same profession or A healthy city is one that is continually creating and undertake the same activities improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of TYPES OF COMMUNITIES life and developing to their maximum potential. It aims to: (MAURER & SMITH, 2009) a. Achieve a good quality of life b. Create a health- supportive environment 1. GEO-POLITICAL COMMUNITIES c. Provide basic sanitation and hygiene needs Geopolitical communities are most traditionally d. Supply access to health care recognized or imagined when considering the term community COMPONENTS OF COMMUNITY Geopolitical communities are defined or formed by A community can be described as a complex whole both natural and man-made boundaries and include resulting from the combination of barangays, municipalities, cities, provinces, regions, ○ The People and nations ○ The Environment Other commonly recognized geopolitical ○ The Economy communities are congressional districts and ○ Culture neighborhoods ○ Health Geopolitical communities may also be called ○ Quality of life territorial communities PEOPLE AS COMPONENTS OF COMMUNITY 2. PHENOMENOLOGICAL COMMUNITIES A group of people is the most fundamental or Phenomenological communities in the other hand, essential component of community. When a group refer to relational, interactive groups, in which the of people live together and share a common life and place or setting is more abstract, and people share bind by a strong sense of community a group perspective or identity based in culture, consciousness at that moment a community is values, history, interest, and goals formed. Hence a group of people is the first Examples: if phenomenological communities prerequisite of community. includes school, colleges, and universities; churches, and mosques; and various groups or THE ENVIRONMENT AS COMPONENT OF organizations COMMUNITY The Environment as a component, influences CHARACTERISTICS OF A HEALTHY COMMUNITY lifestyle in any community setting and it is an A healthy community is one in which all residents indispensable component it cannot be overlooked. have access to a quality education, safe and healthy homes, adequate employment, transportation, physical activity, and nutrition, in THE ECONOMY/ ECONOMIC SYSTEM AS A addition to quality health care. COMPONENT OF THE COMMUNITY A healthy community is, in fact, the context of health Since communities are made of people who promotion defined in the Ottawa Charter ultimately interact with their physical and social (WHO,1986) as “The process of enabling people to environment, thus making the community good for increase control over and to improve their health” business and employment. Many businesses stabilize the economy and improve the social CHARACTERISTICS OF A HEALTHY COMMUNITY conditions. (HUNT, 1997; DUHL, 2002) Shared sense of being a community based on HEALTH AS A COMPONENT OF COMMUNITY history and values. As humans it is the ability of individuals or General feeling of empowerment and control over communities to adapt and self manage when facing matters that affect the community as whole. physical, mental and psychological and social Existing structures that allow subgroups within the changes with the environment. Health is an community to participate in decision making in important component of a community. community matters. The health of the community is a function of their Ability to cope with change, solve problems, and environment, and the people. manage conflicts within the community through A community cannot be described completely acceptable means. without due reference to the health of its members. 4 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS QUALITY OF LIFE AS A COMPONENT OF SOCIAL SYSTEMS WITHIN THE COMMUNITY COMMUNITY Health system Quality of life is the general well being of individuals Family system and societies, outlining negative and positive Economic system features of life. It observes life satisfaction, Educational system Including everything from physical health, family, Religious system education, employment, wealth, religious beliefs, Welfare system finance and the environment. Political system A community is not just a geographical location, but Recreational system it rather implies physical closeness, and Legal system relationships at a particular location which in turn, Communication system adversely or positively improve the quality of life of its members. The other factors that influences health as identified by the charter are rapid and often adverse social economic and CULTURE AS COMPONENT OF THE COMMUNITY demographic changes that affect the working conditions, Culture is defined as the social behavior and norms learning environments, family patterns, and the culture and found in human societies and communities. Some social fabric of the communities. aspects of human behavior, social practices such as culture, such as technology, architecture and art, POVERTY whereas their material aspects of culture such as Poverty is the indication of the continuing social principles of social organization- including practices injustice and failures of a country’s development of political organization of social institutions. efforts. The poor have poor health because they do A community is a small or large social unit a group not have the resources to afford the basic requisites of people who have something in common such as of health; They do not covered by health insurance; norms, religions values or identities and they do not have the capacity to effectively A community is a social unity made of people, transact or negotiate with the health care system cultural traits, described by health and quality of life, which seems to be more responsive to the need of located in a defined geographical location and those with the necessary financial resources. environment, and maintains a relatively consistent economic system. CULTURE Culture has a positive effect on health. An example FACTORS AFFECTING HEALTH OF THE is the value that we Filipinos placed on close family COMMUNITY ties and social relationships. Families, relatives and 1. Characteristics of population friends are a major source of financial, emotional, 2. Location of the community instrumental and social support especially during 3. Social system within the community crisis situations. These relationships contribute to our sense of DETERMINANTS OF HEALTH AND DISEASE emotional well-being and mental health. Some The health status of a community is associated with people have beliefs and practices that adversely several factors: affect health. ○ Health care ○ Access ENVIRONMENT ○ Economic conditions The environment plays a direct influence on the ○ Social health of the people. The state of the world’s ○ Environmental issues environment is the direct result of the interaction of ○ Cultural Practices a number of factors such as industrialization, government policies, poverty and an uncaring CHARACTERISTICS OF THE POPULATION attitude towards the environment which contributes Population is a group of people who share to the factors that affect the health of the people in common characteristics, developmental stage or the communities. common exposure to particular environmental factors, and consequently common health POLITICS problems, issues, and concerns. Policies reflects the priorities of the government and Population “aggregates” with developmental needs the value systems of policy makers. The health and those that are vulnerable (rural clients, the budget is the most concrete expression of the poor, minority populations experiencing health government’s political will. disparities, those with mental health issues) The severely limited health budget is also the Population groups are the usual targets or biggest hindrance to the full implementation of well beneficiaries of social services and health meaning policies such as health insurance. programs. Allender and Spradley 5 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS ROLES AND ACTIVITIES OF COMMUNITY HEALTH efficiently. Budgeting, Inventories, scheduling and NURSE staffing, conducting training sessions are likewise The complex nature of the health needs of communities calls included under this role. for a holistic response from public health nurses. This in effect demands not only collaborative interventions but at the RESEARCHER/EPIDEMIOLOGIST same time the nurse working with communities is expected The nurse is regarded as the health monitor of the to demonstrate competencies demanded by different settings community. Together with the rural health midwife, and situations of his/her clientele. they keep track of illnesses encountered in their areas of jurisdiction and submits report to health ROLES AND ACTIVITIES OF COMMUNITY HEALTH authorities as required by law. In the event of an NURSE outbreak, authorities as required by law. In the event of an outbreak, community/public HEALTHCARE PROVIDER health nurses with other professionals and agencies in conducting investigation to identify etiology of Caring is the essence of nursing and has been epidemic and ultimately identify potential solutions widely accepted in all settings. The use of the to halt the progress of the problem. nursing process applied in the natural environment Apart from collecting actual data for research the of the client pertains to this role. nurse utilizes research findings to provide evidence Examples include the occupational health nurse to convince decision-makers to enact policies for conducting a physical examination of an employee, health. a school nurse providing first-aid to student who sustained a cut, and a nurse taking the history of a pageant woman in the village clinic. CLIENT ADVOCATE The community/ public health nurse takes a HEALTH EDUCATOR proactive stand in ensuring that the right to health of the population he/she works with is realized and Communicating information to help patients make protected. an informed choice regarding their health is a key To do this, he/she engages stakeholders in activity in public health works. It is hoped that clamoring and lobbying for policies that impact the awareness will impact people’s behavior to achieve health of communities. The nurse in the field also health in their own hands. initiates organizing activities to form coalitions and Instructing patients how to take their prescribed linkages to foster awareness of people to various medicine or sharing information about the benefits health-related issues. of a healthy lifestyle illustrate this role. END OF MODULE 1 PROGRAM IMPLEMENTER Nurses working under local government units deliver healthcare to the grassroots. This also HEALTH STATISTICS & requires that programs initiated by the national government thru the Philippine Department of EPIDEMIOLOGY Health(DOH) are executed at all levels. This includes immunization which offers protection A. TOOLS against infectious disease. The nurse works with Tools in measuring and analyzing community health the rural health midwife in conducting routine problems were applied to form part of our vaccination in communities to achieve herd assessment tools in diagnosis of community health immunity and contribute to the overall goal of nursing problems. reducing child mortality. Likewise, submitting reports per standards of documentation on targets reached and missed is part of this role of the nurse in DEMOGRAPHY community/public health. Is the science which deals with the study of the human population’s size, composition and distribution in space. COMMUNITY ORGANIZER Working with people in communities and providing SOURCES OF DATA them ownership of their healthcare needs and to act collectively on their issues is best captured by this role of the nurse in public health. CENSUS Is defined as an official and periodic enumeration of MANAGER/LEADER population. Demographic economic social data are collected from specified population groups. Community and public health work deal with competing claims specifically on utilization of limited resources. Hence, the nurse employs principles of management to maximize resources effectively and 6 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS SAMPLE SURVEY instead of census , demographic information collected from a sample of a given population. REGISTRATION SYSTEM MATERNAL MORTALITY RATE are those that collected by the civil registrar’s office Measures the risk of dying from causes related to deal with recording of vital events in the community. pregnancy, childbirth and puerperium. It is an index Vital events refer to births, deaths, marriages, of the obstetrical care needed and received by divorce and the like. Other registration systems can women in a community also be used to describe specific characteristics of the population. POPULATION SIZE SPECIFIC RATE OF MORTALITY Refers to the number of people in a given place or Describes more accurately the risk of exposure of area at a given time. certain classes or groups to particular diseases. To understand the forces of mortality, the rates should COMPOSITION be made specific provided the data are available for When the population is characterized in relation to both population and the event in their specification. certain variables such as age, sex, occupation or educational level. LEADING CAUSES OF MORBIDITY Cause Specific Death Rate DISTRIBUTION It shows how people are distributed in a specific geographic location. B. PHILIPPINE HEALTH SITUATION LIFE EXPECTANCY 1. Demographic Profile is calculated by constructing a life table. A life table 2. Health Profile incorporates data on age-specific death rates for the population in question, which requires HEALTH INDICATORS enumeration data for the number of people, and the number of deaths at each age for that population. The commonly used measures of health status reflect disease and mortality, rather than health itself. LIFE EXPECTANCY AT BIRTH Mortality rate data are widely used to describe the is the total person-years lived beyond exact age 0 health status of the population. (newborns - column 5 - Tx) divided by the number Typically period life tables are constructed applying of newborns (100,000) age-specific death rates of a given population for a given year to a hypothetical cohort of 100,000 SWAROOP'S INDEX newborns is the percentage of the deaths aged 50 years or older. Its inverse represents the percentage of CRUDE BIRTH RATE untimely deaths (those who died younger than 50 A measure of one characteristic of the natural years). growth or increase of a population C. EPIDEMIOLOGY AND THE NURSE EPIDEMIOLOGY the study of the occurrence and distribution of CRUDE DEATH RATE health conditions such as disease, death, A measure of one mortality from all causes which deformities, or disability on human population. may result in a decreased population. It is also concerned with the study of probable factors that influence the development of these health conditions. INFANT MORTALITY RATE USES OF EPIDEMIOLOGY Measures the risk of dying during the 1st year of life. Study the history population and the rise and fall of It is a good index of the general health condition of diseases and changes in their character a community since it reflects the changes in the Diagnose the health of the community and the environment and medical condition of a community. condition of people to measure the distribution and dimension of illness in terms of incidence, 7 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS prevalence, disability and mortality, to set health ○ B. Discernible lesions problems in perspective and to define their relative changes maybe detectable importance and to identify groups needing special through sophisticated laboratory attention. test, during this period the early Study the work of health services with a view of signs and symptoms of disease improving them. Operational research shows how are developing. community expectations can result in the actual ○ C. Advanced disease provisions of service. anatomical and functional Estimate the risk of disease, accident, defects, and changes have produced the chances of avoiding them.identify syndrome by recognizable signs and symptoms describing the distribution and association of clinical These stages have relevance to the concept of levels of phenomena in the population. disease prevention. Complete the clinical picture of chronic disease and describe their natural history. LEVELS OF PREVENTION OF HEALTH PROBLEMS Search for causes of health and disease by comparing the experience of groups that are clearly 1. PRIMARY PREVENTION defined by their composition, inheritance, It is directed to the healthy population , focusing on experiences, behavior and environments. prevention of emergence of risk factors and removal of the risk factors or reduction of their levels FUNCTION OF THE EPIDEMIOLOGY NURSE (specific protection) Implement public health surveillance 2. SECONDARY PREVENTION Monitor local health personnel conducting disease Aims to identify and treat existing health problems surveillance at the earliest possible time. Conduct and/or assist other health personnel in outbreak investigation 3. TERTIARY PREVENTION Assist in the conduct of rapid surveys, and Limits disability progression. Rehabilitation and surveillance during disaster maintenance of health. Assist in the conduct of surveys, program evaluations, and other epidemiology studies. Assist in the conduct of training course in EPIDEMIOLOGICAL TRIANGLE epidemiology Assist the epidemiologist in preparing the annual COMPONENTS OF EPIDEMIOLOGICAL TRIANGLE report and financial plan Agent Responsible for inventory and maintenance of ○ is the intrinsic property of microorganism to epidemiology and surveillance unit (ESU) survive and multiply in the environment to equipment. produce disease. ○ Causative agent is the infectious agent or NATURAL LIFE HISTORY OF DISEASE its toxic component that is transmitted from Describing the natural history of the disease seeks the source of infection to the susceptible to identify factors related to the course of a disease body once established in order to determine its duration Host and the probability of the various possible outcomes ○ is any organism that harbors and provides such as recovery, death or specific complications. nourishment for another organism. Understanding the natural history of disease will Environment help institute measures to prevent pathologic ○ is the sum total of all external conditions processes from further evolving. and influences that affects the development of an organism which can be biological, social and physical. It affects STAGES OF NATURAL HISTORY OF DISEASE both the agent and the host. For example, the temperature in a PREPATHOGENESIS OR SUSCEPTIBILITY given location might affect an in this stage, disease has not developed but factors agent’s ability to thrive, as might that favors its occurrence are present the quality of drinking water or the accessibility of adequate medical PATHOGENESIS facilities. disease has developed and has 3 sub- stages: ○ THREE COMPONENTS OF THE ○ A. Pre- symptomatic disease or early ENVIRONMENT pathogenesis Physical environment is an individual has no symptoms composed of the inanimate that indicate the presence of surroundings such as the illness. 8 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS geophysical conditions of the the exposure is associated with the climate. disease. Biological environment makes Cross-sectional studies up the living things around us ○ measure exposure and disease status at such as plants and animal life. the same time, and are better suited to Socio-economic environment descriptive epidemiology than causation. which may be in the form of level of economic development of the APPROACH TO DISEASE AND DETERMINANTS community. The present epidemiology approach is based on the interaction of the causative agent and the EPIDEMIOLOGICAL PROCESS AND environment. Essentially , epidemiology patterns INVESTIGATION depend upon these factors which influence the probability of contact between an infectious agent 2 MAIN AREAS OF INVESTIGATION and susceptible host. The study of the distribution of diseases The search for determinants (causes) of disease DISEASE DISTRIBUTION and it's observed distributions The method and technique of epidemiology are desired to detect the cause of a disease in relation DISTRIBUTION to the characteristic of the person who has it or to a Describes the distribution of health status in terms factor present in his environment. Since neither of gender, race, geography, time and so on might population and environment of different times or be considered in an expansion of the discipline of places are similar, these characteristics and factors demography to health and disease. are called epidemiologic variables. these variables are studied since they determine DETERMINANTS the individuals and populations at greatest risks of acquiring particular disease, and knowledge of Involves explanation of the patterns of disease these association may have predictive value. distribution in terms of causal factors. For the purpose of analyzing epidemiology data , it has been found helpful to organize that data EPIDEMIOLOGICAL STUDIES according to the valuables of: The purpose of an analytic study in epidemiology is ○ TIME to identify and quantify the relationship between an refers both to the period during exposure and a health outcome. The hallmark of which the cases of disease being such a study is the presence of at least two groups, studied were exposed to the one of which serves as a comparison group. source of infection and the period during which the illness occurred. CATEGORIES PERSON refer to the EXPERIMENTAL STUDIES characteristics of the In an experimental study, the investigator individual who were determines the exposure for the study subjects; exposed and who contacted the infection OBSERVATIONAL STUDIES of the disease in In an observational study, the subjects are exposed question. under more natural conditions. PLACE OBSERVATIONAL COHORT STUDY refers to the features, ○ subjects are enrolled or grouped on the factors or conditions basis of their exposure, then are followed which existed in or to document occurrence of disease. described the Differences in disease rates between the environment in which the exposed and unexposed groups lead diseases occurred. investigators to conclude that exposure is Urban/ Rural associated with disease Differences: diseases OBSERVATIONAL CASE-CONTROL STUDY, spread more rapid in ○ subjects are enrolled according to whether urban areas than in rural they have the disease or not, then are areas primarily because questioned or tested to determine their of the greater prior exposure. Differences in exposure population. prevalence between the case and control groups allow investigators to conclude that 9 | NEW JEANS & PERFECT FERSONS NCM 113: COMMUNITY HEALTH NURSING 2 BSN 3F: 1ST SEMESTER - PRELIMS PATTERNS OF OCCURRENCES AND DISTRIBUTION The variables of disease as to person, time and place are reflected in distinct patterns of occurrence and distribution in given community. The following are the characteristic of patterns of disease occurrence; SPORADIC OCCURRENCE Intermittent occurrence of a few isolated and unrelated cases in a given locality. The cases are few and scattered, not related, occur on and off, intermittently Rabies occurs sporadically in the Philippines, the cases are scattered throughout the country, so that the cases are not related at all to the cases in other areas. ENDEMIC OCCURRENCE is the continuous occurrence throughout a period of time, of the usual number of cases in a given locality. Tuberculosis is endemic in all specific areas of the country. EPIDEMIC OCCURRENCE is an unusually large number of cases in a relatively short period of time. Bird’s flu, there has been no case in any area of the country. The occurrence of few cases in a given area in a given time would constitute a bird’s flu epidemic. PANDEMIC OCCURRENCE is the simultaneous occurrence of an epidemic of the same disease in several countries. It is another pattern of occurrence from an international perspective. Corona Virus has been existed and with different pattern of occurrence in the present as we call it now COVID-19 10 | NEW JEANS & PERFECT FERSONS