NURS 3036 Week 2 2025 PDF

NURS 3036 Week 2 Ch 5 - Evidence Informed Practice in Community Health Nursing Ch 8 - Epidemiological Applications Ch 9 - Working with the Community Ch 13 - Working with Groups, Teams & Partners *Doane & Varcoe – Ch 10 – How Does Nursing Contribute to Interprofessional Practice? Topics for Today ▪...

NURS 3036 Week 2 Ch 5 - Evidence Informed Practice in Community Health Nursing Ch 8 - Epidemiological Applications Ch 9 - Working with the Community Ch 13 - Working with Groups, Teams & Partners *Doane & Varcoe – Ch 10 – How Does Nursing Contribute to Interprofessional Practice? Topics for Today ▪ Discuss evidence-informed practice in Community Health Nursing ▪ Review important milestones in the history of epidemiology ▪ Define types of epidemiology ▪ Describe commonly used epidemiological measures ▪ Discuss usage of epidemiology in nursing practice ▪ Discuss working with the community & types of partnerships ▪ Examine community development as it relates to Community Health Nursing ▪ Discuss aspects of working in teams & navigating hard spots DiCasmirro_2025 Evidence-Informed Practice in Nursing DiCasmirro_2025 DiCasmirro_2025 Steps in Evidence-Informed Practice Develop clinical question based on client health status & situation PICO Example: P=population For new mothers (population), can I=Intervention e-health technology (intervention) C=Comparison be used to achieve a healthy O=Outcomes weight in the postpartum period (outcome)? DiCasmirro_2025 Steps in Evidence-Informed Practice Cont’d Use various sources of evidence: ▪ CHN’s professional knowledge & clinical experience ▪ Scientific knowledge of all types ▪ Client experiences, values, preferences & choices ▪ Consideration of the community, resources, accessibility & availability Any other sources of evidence CHNs might draw on? DiCasmirro_2025 Based on: DiCenso, A, Bayley, L, Haynes, B. (2009). "Accessing preappraised evidence: fine-tuning the 5S model into a 6S model." ACP J Club 151:3, pp.1-1. DiCasmirro_2025 Retrieved from: Clinical Information Access Portal (CIAP). (N.D.) "EBP Learning Module: Introduction to Evidence-Based Practice and CIAP: Levels of Evidence." Evidence Levels of  Clinical Practice Guidelines ▪ Developed by experts who identify & appraise the evidence, draw conclusions & make recommendations about best practices ▪ Optimize patient care- informed by a systematic review of evidence & an assessment of the benefits & harms of alternative care options What clinical practice guidelines have you used in your practice? DiCasmirro_2025 Appraising Evidence https://www.nccmt.ca/uploads/media/media/0001/01/5aad550fc93cb202f01048e98b174b5e70233359.pdf DiCasmirro_2025 How do CHNs Implement & Participate in Evidence-Informed Practice ✓Assist client with decision making ✓Ensure evidence is at an appropriate literacy level for each client ✓Discuss with client benefits & risks of an intervention ✓Consider client preferences & values in practice decisions ✓Program evaluation ✓Involved in gathering survey data DiCasmirro_2025 When you think of ‘epidemiology’, what comes to mind? Slide developed by Adena Miller (2023) and adapted with permission What is Epidemiology? Epidemiology Greek: Greek: Greek: ‘on/upon’ ‘people’ ‘a study’ “The study of what is affecting a population” Why does a disease affect some people, but not others? Epidemiology helps detect factors that influence disease or health problems so we can intervene to improve people’s health Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in History: John Snow & Cholera Slide developed by Adena Miller (2023) and adapted with permission  Florence Nightingale Image retrieved from: https://www.cbc.ca/radio/quirks/florence-nightingale-used-mathematics-to-improve-health-care-1.5561127 Epidemiology in History: Framingham Study Image source: Mahmood et al. 2013 Slide developed by Adena Miller (2023) and adapted with permission  Framingham Study ▪ Identified causality between risk factors & cardiovascular disease ▪ hypertension ▪ high cholesterol ▪ increased body weight ▪ Findings have helped HCPs identify heart disease risk early on & implement prevention strategies Slide developed by Adena Miller (2023) and adapted with permission Epidemiological Triangle Changes in any one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a patient’s risk for disease. An E.coli outbreak was identified at a workplace potluck lunch. What may have been the: ▪ Agent ▪ Host ▪ Environment DiCasmirro_2025 Client Situations Using the Epidemiological Triangle DiCasmirro_2025 Types of Epidemiology Descriptive - aka ‘Population health assessment’ ▪ Monitoring/analyzing health-related data detecting trends - the who, when & where ▪ https://www.tbdhu.com/datadashboard Slide developed by Adena Miller (2023) and adapted with permission Types of Epidemiology Cont’d Analytical ▪ Uncover cause & effect associations for the disease or health concern - the why & how ▪ Can be prevention or treatment focused Slide developed by Adena Miller (2023) and adapted with permission The Epidemiological Approach 1. Start with descriptives ▪ Who? ▪ When? ▪ Where? 2. Move to analytical - WHY? HOW? ▪ Intervene to impact how the disease or concern is impacting the population ▪ Literature review ▪ Research a treatment or approach ▪ Monitor effectiveness of your approach over time DiCasmirro_2025 Slide developed by Adena Miller (2023) and adapted with permission The Epidemiological Approach: TBDHU HIV Outbreak In 2023, a statistically significant increase of HIV cases was found in Thunder Bay. 1. Start with descriptives: ▪ WHO? Who in the population is being most impacted? ex. females, age 18-40s ▪ WHEN? What time period? ex. Nov 2022-July 2023 ▪ Where? City of Thunder Bay *data has been changed to protect individuals impacted* Slide developed by Adena Miller (2023) and adapted with permission The Epidemiological Approach: TBDHU HIV Outbreak (2018) In 2023, a statistically significant increase of HIV cases was found in Thunder Bay. 2. Analytical epidemiology ▪ WHY? What are the common factors among cases? ▪ Under-housed, street-involved ▪ HOW? ▪ Spread through shared contaminated drug use equipment ▪ Intervene to help slow or stop the spread? ▪ Increased testing in street-involved population, testing incentives, increase availability of clean drug equipment, assisted cases with treatment adherence ▪ Monitor population over time to see if there is a reduction in transmission ▪ Monitor incidence rates and case data *data has been changed to protect individuals impacted* Slide developed by Adena Miller (2023) and adapted with permission Commonly Encountered Epidemiological Measures Mortality: ▪ # of deaths due to a disease in a population Morbidity: ▪ Occurrence of disease in a population ▪ 2 rates describing morbidity rates in a population: ▪ Incidence rate: New cases or conditions ▪ Prevalence rate: All cases of a specific Image retrieved from: disease or condition at a given time https://www.tandfonline.com/doi/full/10.1080/24733938.2022.2062897#d1e 162 DiCasmirro_2025  Incidence Rate # of new cases in a time period Total population at risk during same time period Example: 80 new cases of breast cancer found among population of 80,000 women aged 50-75 in 2016 80 80000 =0.01 DiCasmirro_2025 Prevalence Rate # of ppl in pop with disease in timeframe Total population at risk during same timeframe Example: 8000 women screened for breast cancer from Jan 2015 to Dec 2015. 35 previously dx & 20 newly dx. 55 8000 =0.006875 DiCasmirro_2025 Analytical Measures of Association in Epidemiology ▪ Measures of association indicate the strength of the relationship between variables being studied ▪ Some of the most frequently used measures of association in epidemiology are: ▪ Risk - Probability that an event will occur within a specified period ▪ Relative risk – Probability of the occurrence of a disease for persons who are exposed & persons who are not exposed to the risk factor ▪ Helps answer: Are some pops more at risk of or vulnerable to a specific disease than others? DiCasmirro_2025 Relative Risk (Risk Ratio) Risk of disease (incidence) in exposed population Risk of disease (incidence) in unexposed population Ex: CHN compares the incidence of childhood asthma in a population exposed to a certain air pollutant with the incidence in a population not exposed to same air pollutant *Every ratio has a referent category (group other groups are compared to) -> not exposed to air pollutant DiCasmirro_2025 Interpreting Relative Risk If the resulting # is = to 1, indicates both groups have the same risk of the disease/health concern If the resulting # is >1, indicates increased risk for exposed group is higher than the risk in the unexposed group If the resulting # is , or < What does this mean? Risk Ratio 1? Cumulative risks associated =2.64 >1 with community, family, peer/individual environments & early substance use (cigarettes, alcohol) in childhood were predictive of early adolescent onset cannabis use How might CHNs use this evidence to inform their practice? DiCasmirro_2025 Analytical Measures of Association in Epidemiology Cont’d ▪ Odds Ratio: Odds/probability that an event is the same for 2 groups ▪ An estimate of the relative risk factor Exposed persons with the disease/unexposed persons with the disease Exposed persons without the disease/unexposed persons without the disease ▪ Ex: CHC has 200 male pts btw 45 and 65, 50 have LC and 150 do not. 35 of those with LC are smokers while 15 pts without LC are smokers. *Every ratio has a referent category (group other groups are compared to) DiCasmirro_2025  Interpreting Odds Ratios ▪ If the resulting # = 1, indicates both groups have the same odds of the outcome (disease/health concern) ▪ If the resulting # is >1, indicates exposed group has increased odds of the outcome ▪ If the resulting # is , or < What does this Ratio 1? mean? An association was =2.07 >1 found between infection with human herpes viruses and MS OR=2.07. How might CHNs use this evidence to inform their practice? DiCasmirro_2025 95% Confidence Intervals (CIs) ▪ To rule out chance, we need ▪ If the CI: confidence intervals ▪ Doesn’t include 1, results are statistically significant ▪ Tells us whether the ratio is ▪ Does include 1, results are not statistically significant or not statistically significant ▪ Used to estimate the precision ▪ If the entire CI is on the same of the ratio side of 1 (either above of ▪ Provides a range of values within below), you can assume results which we would expect the are statistically significant “true” result to lie 95% of the time DiCasmirro_2025 95% Confidence Intervals (CIs) Cont’d ▪ Width of CI gives a sense of the ▪ The wider the CI, the less precision confidence we have ▪ Narrower CIs indicates a higher ▪ Wider CIs indicates a low level of precisions of the result precision of the result Ex: 95% CIs (1.13-1.98) Ex: 95% CIs (2.57-24.85) DiCasmirro_2025 Practice Activity Part 1 Individual, family and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years: A systematic review and meta-analysis (Tinner et al., What did they find? 2022) Universal Odds 95% Interpretation Interventions Ratio CIs Effect on: Alcohol Tobacco Cannabis Other Illicit drugs DiCasmirro_2025 Practice Activity Part 2 Individual, family and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years: A systematic review and meta-analysis (Tinner What did they find? et al., 2022) Targeted Odds 95% CIs Interpretation Interventions Ratio Effect on: Alcohol Tobacco Cannabis Other Illicit drugs DiCasmirro_2025 Practice Activity Part 3 Jacobs, W., Merianos, A.L., Quinn, P. et al. Association of self-reported use of cannabis for the purpose of improving physical, mental, and sleep health with problematic cannabis use risk. BMC Public Health 23, 1560 (2023). What did they find? Relative Risk 95% CIs Interpretation Ratio Sleep health= Mental health= Physical health= DiCasmirro_2025 Epidemiology in Present-day Public Health The Ontario Public Health Standards outline what epidemiologists must do in public health units: ▪ Surveillance of infectious diseases (ex. STIs, COVID-19) and health problems (ex. opioid-related mortality) in the population ▪ Surveillance of how determinants of health impact the local population In public health, your ‘patient’ is a ‘population’ Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in Present-day Public Health Cont’d ▪ Data comes from external sources: ▪ Census ▪ Canadian Community Health Survey ▪ Hospital stay databases ▪ Internal sources: ▪ Internal EMR systems, spreadsheets Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in Present-day Public Health Cont’d Surveillance of health problems in the population Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in Public Health Cont’d Surveillance of health problems in the population Source: PHO snapshots (Canadian Community Health Survey data) Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in Public Health Cont’d Surveillance of SDOH Source: TBDHU SDOH Report (2018) Slide developed by Adena Miller (2023) and adapted with permission Epidemiology in Public Health Cont’d Slide developed by Adena Miller (2023) and adapted with permission Epidemiology & Nursing ▪ Many medical & nursing interventions have been developed through epidemiology ▪ Outbreak management ▪ Contact tracing ▪ Use epidemiological data to inform nursing practice ▪ Knowing populations you care for – who is at high-risk ▪ Often, data nurses chart feeds into larger databases ▪ Used to inform local health systems ▪ The public, etc. Slide developed by Adena Miller (2023) and adapted with permission BREAK TIME DiCasmirro_2025  What is a Community? ▪ People & the relationships that emerge among them as they develop & commonly share agencies, institutions, & a physical environment ▪ May be defined by geography or a common interest or focus Function is to meet a wide variety of collective needs Working with the Community DiCasmirro_2025  Most definitions of community include the following 3 dimensions: ▪ People (residents) ▪ Place (geographic & time) ▪ Function (aims & activities of the Communities community) DiCasmirro_2025 The Community-as-Partner Model A partnership conveys an equal relationship between the CHN & community Individuals in the community are the CHN’s partners & need to be included during the entire community health nursing process DiCasmirro_2025 Community-as-Partner Model Cont’d In order for a CHN to gain access to the Important aspects of community community, the community must partnership: 1. Perceive that a need exists 1. Role negotiation (who will do what) 2. Believe that the CHN can help address this need 2. Role separation (CHN as data collector, & 3. Perceive that its information & contributions are CHN as facilitator) valued 4. Be assured of confidentiality for non-public information 5. Be involved from the beginning in this partnership DiCasmirro_2025 What are the differences between community as client & community as partner? DiCasmirro_2025  Community as a Client Community as a Partner Interventions for total population Focus on collective or common good of the population CHN is viewed as an expert CHN emphasizes community strengths and/or assets to work on community-identified priorities Community assessment focusses CHN works in partnership with the on use of epidemiological data & community in an approach that is disease occurrences supportive & meaningful for community members Interventions often directed by Interventions community driven government protocols DiCasmirro_2025  Partnership: ▪ Relationship between individuals, groups, organizations, or governments, in which the parties are actively working together in all stages of assessment, planning, implementation, & evaluation Community Community Partnership: Partnerships ▪ Collaborative decision-making effort in health planning that community members & professionals & Coalitions participate in with the goal of reducing health inequalities & improving community health Coalition: ▪ 2 or more groups that share a mutual issue or concern and join forces, thereby increasing their influence in achieving a common goal DiCasmirro_2025 Partnerships & Collaboration Common reason for forming a Effective partnerships often have the partnership is to build capacity in following characteristics: the system: ▪ Equality in decision making ▪ For cost reduction and ▪ A shared vision containment ▪ Integrity ▪ To avoid duplication of services ▪ Agreement on specific goals ▪ To coordinate services ▪ A plan of action to meet the goals ▪ To most effectively address client health care concerns DiCasmirro_2025  What is interprofessional collaboration? Interprofessional What are the interprofessional competencies necessary for Collaboration interprofessional collaboration? What is interprofessional education? DiCasmirro_2025  Community Development Occurs when a community is engaged in a dynamic, continuous process of social change that can lead to permanent enhancements in people’s lives 3 Components: 1) Capacity building 2) Intersectoral networking 3) Local area development DiCasmirro_2025 Community Development Cont’d Community capacity: ▪ Identifies and works with existing community strengths to promote a positive view of the community ▪ Capacity building helps communities become stronger on the basis of these strengths rather than focusing on their weaknesses DiCasmirro_2025 Asset Mapping Identifying community-based initiatives such as community development, strategic planning, and organizational development 3 approaches to asset mapping: ▪ Whole-assets approach ▪ Storytelling approach ▪ Heritage approach DiCasmirro_2025 DiCasmirro_2025 Outcomes of Community Development Sustainability Community competence DiCasmirro_2025 CHN help mobilize communities to achieve their goals using the Community Health Nursing Process DiCasmirro_2025 Community Health Nursing Process Assessment Analyzing/ Evaluation Diagnosis Implementatio Planning n DiCasmirro_2025 Example of Nursing Process in the Community DiCasmirro_2025 Assessing Community Health Community health assessment: ▪ Critically think about the community ▪ Getting to know and understand the community client as partner Community health assessment helps to: ▪ Identify community strengths, resources, assets, capacities, & opportunities ▪ Clarify health concerns ▪ Identify community constraints ▪ Identify the economic, political, & social factors affecting the community ▪ Identify the Determinants of Health affecting community health Reasons for: ▪ Validate existence of suspected health concern ▪ Identify community assets & gaps in resources ▪ Determine health status of population/aggregate DiCasmirro_2025  Data collection & interpretation: ▪ Gathering or compiling existing data ▪ Generating missing data ▪ Interpreting data ▪ Identifying community abilities & health concerns Steps in Assessing Data collection methods: Community Directly observed: 1. Informant interviews Health 2. Focus groups 3. Participant observation 4. Windshield survey 5. Community forum Reported: 1. Secondary analysis of existing data 2. Surveys DiCasmirro_2025 Windshield Survey An observational method used as part of a community assessment that scans the community’s environment DiCasmirro_2025  ▪ Objective view of the community ▪ Offer insight into assets that community members take for granted or don't see ▪ Can be the easiest and quickest way to get an overview of the entire Why conduct a community ▪ Allow clear comparisons among WS? different neighborhoods in a city, villages in a rural area, etc. ▪ Can be very useful in understanding specific aspects of a community ▪ Give you a “feel” for the community DiCasmirro_2025 DiCasmirro_2025  Assessment issues: ▪ Gaining entry or acceptance is a major hurdle to Steps in assessment ▪ Confidentiality is important but is affected by Assessing the legal requirement to disclose information in Community some cases (e.g., child abuse) Health How can CHNs gain trust & entry into a Cont’d community? DiCasmirro_2025 Practice Question You have been asked to collect data about a community’s health facilities, vital statistics, and values regarding health. Which data collection method is most appropriate for each type of data & why? Data Item Method of Data Collection Health facilities Vital statistics Values DiCasmirro_2025 Community Health Nursing Process Assessment Analyzing/ Evaluation Diagnosis Implementation Planning DiCasmirro_2025 Analysis & Planning Phase 1) Identify priorities, goals & objectives 2) Identify interventions & activities DiCasmirro_2025 Establishing Priorities Helpful ranking criteria: 1. How aware is the community of the health concern? 2. Is the community motivated to resolve or better manage the health concern? 3. Is the CHN able to influence a solution for the health concern? 4. Are experts available to solve the health concern? 5. How severe are the outcomes if the health concern is unresolved? 6. How quickly can the health concern be solved? DiCasmirro_2025 Establishing Goals & Objectives ▪ Goals = broad statements of desired outcomes ▪ Reduce the prevalence of vaping among adolescents within the community. ▪ Objectives = precise statements indicating the means of achieving the desired outcomes ▪ A school-based vaping prevention intervention will be implemented in 75% of schools in the community by June 2023. DiCasmirro_2025 Identifying & Prioritizing Intervention Activities ▪ Intervention activities: The strategies used to meet the objectives, the ways in which change will be affected, & the ways in which the health concern cycle will be broken ▪ CHN provides training for all health educators on implementing CATCH My Breath school-based intervention ▪ If alternative intervention activities exist, they must be identified & evaluated DiCasmirro_2025 Community Health Nursing Process Assessment Analyzing/ Evaluation Diagnosis Implementation Planning DiCasmirro_2025 Factors Impacting Implementation 1. The CHN’s role: ▪ Change agent: stresses gathering and analyzing facts and implementing programs ▪ Change partner: includes enabler-catalyst, teacher of problem-solving skills to address health concern, and activist advocate 2. The community health concern and the CHN’s role: ▪ The nurse’s role depends on the nature of the health problem, the community’s decision-making ability, and professional and personal choices 3. The social change process and how receptive the community is to innovation DiCasmirro_2025 Community Health Nursing Process Assessment Analyzing/ Evaluation Diagnosis Implementatio Planning n DiCasmirro_2025  Evaluation: ▪ Appraise the effects of activities or program ▪ Begins in the planning phase Role of outcomes: ▪ Outcome measures answer questions about results of interventions ▪ Questions include the following: Evaluation ▪ Which interventions have been effective & why? ▪ Which interventions were ineffective & why? ▪ Has the health concern been resolved, or the risk reduced? ▪ What lessons have been learned? ▪ What changes are needed? DiCasmirro_2025  Working With Groups, Teams & Partners DiCasmirro_2025 Tuckman & Jensen’s 5 Stages of Group Development DiCasmirro_2025  Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Forming Storming Norming Performing Adjourning Group Group Group Group Group members, as members members members members strangers, begin to start to feel focus on the recognize focus on express their part of the group work the need for Group getting to know each other. feelings as they focus on real group; they recognize the benefits with sharing of ideas in a supportive termination of the group and Development issues. of the group reaching its goal. group environment. therefore work toward completion of the tasks and disengage from other group members. DiCasmirro_2025  Authoritarian Laissez-faire 4 Styles of leadership Democratic Group Shared Leadership Strong leadership is essential for groups to function effectively DiCasmirro_2025  Conflict is an inevitable part of most group interactions Group Handing Group Conflict: Conflict Remain calm & positive Use direct & objective communication Use facts Intergroup – 2 or more groups DiCasmirro_2025 Common Conflict Resolution Strategies DiCasmirro_2025 4 Strategies for Collaborative Practice in the Hard Spots DiCasmirro_2025 Strategy 1: Relate to What Is Relate to the emotion, not the trigger Remember the 5 Cs Don’t throw the second dart or set up the target Stay in the present moment DiCasmirro_2025 Strategy 2: Relate Appropriately in Inappropriate Situations Enlist the 5 Ws Don’t eat the poison Don’t “thing” it Be discerning & deliberate DiCasmirro_2025 Strategy 3: Promote Well-Being Look for capacity Take in the good Look for the join DiCasmirro_2025 Strategy 4: Be a Transforming Presence Be the change you wish to see Play the cards to best of your ability DiCasmirro_2025 Group Evaluation CHNs working with groups need to observe & examine how the group is functioning, to determine group effectiveness A group evaluation form can be used for the formative & summative evaluation of a group DiCasmirro_2025 Public Health Virtual What: Part 1: Community Assessment Where: https://can-sim.ca/accessjama/Community-Assessment- Simulation PHN1/#/ Assignment DiCasmirro_2025  Alan is a CHN and a member of a committee assigned to assess the health care needs of the aging baby boomers in Woodsbury, a small northern community. The community is located in a scenic area near a large freshwater lake. The winter temperatures can vary from −15° to −40° Celsius. The average snowfall has been declining but is usually around 80 cm. The summers are dry and warm. The major industries in the community are mining and forestry. The unemployment rate has been low, but due to declining demand for some resources, the unemployment rate has been steadily increasing. Alan and the committee are aware that as the baby-boomer population ages, health care providers need to prepare for a rapid increase in the number of people older PRACTICE CASE STUDY than 65 years. The committee’s purpose is to make suggestions to the district health unit or local health integration network and municipal officials about how to prepare for the increase in health services that will be needed for the older adults in the area. Caring for Older Adults The ethnic composition of this community is 80% White (consisting of French in the Community Canadians and those of British, Finnish, German, and Dutch descent) and 20% Indigenous. Currently, 25% of the population in Woodsbury is older than 65 years. However, in 25 years, this percentage is expected to increase to more than 50%. Many of these older adults have practised a lifestyle that included a high-fat diet, smoking, and frequent alcohol use. Consequently, many have heart disease or chronic obstructive pulmonary disease. Currently, five primary health care providers are in the community. Waiting times to see these health providers range from 1 to 3 weeks. Only one of these providers specializes in geriatric care. One 54-bed long-term care facility is in the most northern location of the district, located 100 km from Woodsbury. Because of the rural location, there is no public transit system. The long- term care residents are dependent on family or friends for transportation. DiCasmirro_2025 Practice Case Study Questions: 1. Define the community. 2. Outline the data collection methods that Alan might decide to use to assess the community. 3. Present the available data on this community. 4. Identify potential community partners that Alan and the committee might consider working with. DiCasmirro_2025 Next Week DiCasmirro_2025