Community Health Nursing 2 PDF

COMMUNITY HEALTH NURSING 2 Central Philippine University – College of Nursing│BESIN, A.M.│BSN 3-A MODULE 1: CHN CONCEPTS * notes halin kay mam lucky :)) CHN Practice Model ASSESSMENT - Monitor health status to verify community health...

COMMUNITY HEALTH NURSING 2 Central Philippine University – College of Nursing│BESIN, A.M.│BSN 3-A MODULE 1: CHN CONCEPTS * notes halin kay mam lucky :)) CHN Practice Model ASSESSMENT - Monitor health status to verify community health problems - Diagnose and (eradicate??) health problems - Generate new insights COMMUNITY HEALTH NURSING POLICY, PROGRAM DEVELOPMENT, ADVOCACY, ➔ is a field of nursing practice where services IMPLEMENTATION are delivered outside of purely curative - Formulate plans that support individual, institutions ex. hospital), but in the family, community health efforts community settings such as home, the - Enhancing the empowering potential of school, places of work, health centers, and people to assume responsibility for health clinics. promotion and disease prevention and management SCOPE OF SERVICES OF CHN - Mobilize partnerships to identify and solve health problems ➔ The scope of services provided covers the whole range of health promotive, preventive, DEVELOP POLICIES THAT SUPPORT INDIVIDUAL curative and rehabilitative nursing services, AND COMMUNITY EFFORTS with bias towards priority given to health - Enforce law and regulations that protect and promotion and disease prevention especially ensure safety for the underserved and high-risk individuals, - Link people to needed personal health families, population groups and areas of the services community. - Ensure the provision WHAT IS COMMUNITY? QUALITY ASSURANCE ➔ group of people with common - Ensure a competent public health and characteristics or Interest living together personal health care workforce within a territory or geographical boundary - Evaluate effectiveness, accessibility, and ➔ place where people under usual conditions quality of personal and population-based are found services. ➔ The community is the object of focus of care in CHN with the family as the unit of service. (family makes up the community) PHILOSOPHY OF CHN Is based on worth and dignity of MAN - (Margaret Shetland) 1 COMMUNITY HEALTH NURSING 2 Central Philippine University – College of Nursing│BESIN, A.M.│BSN 3-A BASIC PRINCIPLES OF CHN FEATURES OF CHN (MAGLAYA P.2) 1. The community is the patient in CHN, the 1. Greater control for both the nurse and the family is the unit of care and there are four client in making decisions related to health levels of clientele: individual, family, population group (those who share common care characteristics, developmental stages and 2. Collaboration between nurse and client as common exposure to health problems – e.g. equals children, elderly), and the community. 3. Recognition of the impact of different factors 2. In CHN, the client is considered as an ACTIVE on health partner NOT PASSIVE recipient of care 4. Nurses’ greater awareness of their clients lives and situations 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general CHARACTERISTICS OF COMMUNITY HEALTH NURSING 4. The goal of CHN is achieved through multi-sectoral efforts 1. It is a specialty field of nursing. 5. CHN is a part of health care system and the 2. lts practice combines public health with larger human services system. nursing 3. It is population based. Principles of CHN were adapted from those 4. It emphasizes on wellness and other than formulated by Mary S. Gardner and by Leahy, Cobb disease or illness. - Health Promotion and and Jones disease prevention of health 5. It includes inter-disciplinary collaboration. 1. CHN is based on recognized needs of a. Community participation communities, families groups and individuals. b. Multidisciplinary approach 6. It amplifies client's responsibility and 2. The CH nurse must understand fully the self-care. objectives and policies of the agency she 7. It is nursing THE community rather than IN represents. the community. 3. In CHN, the family is the unit of service 4. CHN must be available to all regardless of race, creed and socio-economic status. 5. Health teaching is a primary responsibility of the CH nurse. 6. The CH nurse works as a member of the health team. 7. There must be provision for periodic evaluation of CH nursing service. 8. Opportunities for continuing staff education programs for nurses must be provided by the CHN agency. The CHN also has a responsibility for her/his own professional growth. 9. The community health nurse makes use of available community health records. 10. The CHN utilizes the already existing active organized groups in the community. 11. There must be provision for educative supervision in the CH nursing. 12. There should be accurate recording and reporting in CHN. 2  1st Semester|PRELIMS – NCM 3115 1 COMMUNITY HEALTH NURSING II MODULE 1. COMMUNITY HEALTH There must be provision for educative supervision in the CHN. NURSING CONCEPTS There should be accurate recording and reporting in A. DEFINITION CHN. Is a field of nursing practice where services are delivered outside of purely curative institutions (ex. C. FEATURES OF CHN (MAGLAYA P.2) hospital), but in the community settings such as home, 1. Greater control for both the nurse and the the school, places of work, health centers, and clinics. client in making decisions related to health The scope of services provided covers the whole range care. of health promotive, preventive, curative and 2. Collaboration between the nurse and client as rehabilitative nursing services, with bias towards equals. priority given to health promotion and disease 3. Recognition of the impact of different factors in prevention especially for the underserved and high-risk health. individuals, families, population groups and areas of 4. Nurses’ greater awareness of their clients’ lives the community. and situations. B. PHILOSOPHY AND PRINCIPLES (CHN CHARACTERISTICS OF COMMUNITY SERVICE IN THE PHILIPPINES P.17) HEALTH NURSING The philosophy of Community Health Nursing It is a specialty field in nursing. is based on the worth and dignity of a man (Dr. Its practice combines public health nursing. Margaret Shetland) It is population-based. It emphasizes on wellness and other than disease or BASIC PRINCIPLES illness. The community is the patient in CHN, the family is It includes inter-disciplinary collaboration. the unit of care and there are 4 levels of clientele: It amplifies client’s responsibilities and self-care. Individual Family Population group (children, elderly, pregnant D. THEORETICAL MODELS/APPROACHES women) Nightingale’s Environmental Theory Community ▪ External influences and conditions can In CHN, the client is considered as active partner prevent, suppress, or contribute to disease and not passive recipient of care. or death. CHN practice is affected by developments in ▪ Her goal was to help patient retain her own health technology – in particular, changes in vitality by meeting her basic needs through society – in general. control of the environment. The goal of CHN is achieved through multi-sectoral Health Belief Model (HBM) by: social efforts. psychologists Irwin M. Rosenstock, Godfrey M. CHN is a part of health care system and the larger ▪ The health belief model is a theoretical human services system. model that can be used to guide health promotion and disease prevention. ▪ It used to explain and predict individual WHILE THE FOLLOWING PRINCIPLES OF changes in health behaviors. CHN WERE ADAPTED FROM THOSE ▪ People will not change their behaviors FORMULATED BY MARY S. GARDNER AND unless they believe that they are at risk. BY LEAHY, COBB, AND JONES. (CHN Example: those who do not think that they SERVICE IN THE PHILIPPINES P.17) are at risk for acquiring HIV from CHN is based on the recognized needs of the unprotected sexual intercourse are unlikely communities, families, groups, and individuals. to use a condom The CH nurse must understand fully the objectives Milio’s Framework of Prevention and policies of the agency she represents. ▪ The basic treatise is that behavioral patterns In CHN, the family is the unit of service. of populations and individuals who make up CHN must be available to all regardless of the race, populations are a result of habitual selection creed, and socio-economic status. from limited choices. ▪ She challenged the common notion that a Health teaching is a primary responsibility of the CH main determinant for unhealthful behavioral nurse. choice is lack of knowledge. The CH nurse works as a member of the health ▪ Governmental and institutional policies, she team. said set the range of options for personal There must be provision for periodic evaluation of choice making. CH nursing service. ▪ It neglected the role of community health Opportunities for continuing staff education program nursing, examining the determinants of for nurses must be provided by the CHN agency. community health and attempting to The CHN also has a responsibility for his/her own influence those determinants through public professional growth. policy. The CH nurse makes use of the available Nola Pender’s Health Promotion Model (Nursing community health records. Theorists and Their Work 5th Edition p. 624) The CHN utilizes the already existing active ▪ Nola J. Pender graduated her BSN course in organized groups in the community. 1964 at Michigan State University, earned Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 2 COMMUNITY HEALTH NURSING II her M.A. in Human Growth and their age, developmental stage and their Development in the same university. common health problems and concerns. ▪ She finished her Ph. D. in Psychology and aims at promoting the health of school children Education in 1969 at Northwestern and preventing health problems that would University. hinder their learning and performance of their ▪ Pender’s Health Promotion Model focuses developmental tasks. on 3 areas: o Individual characteristics and Occupational Health Nursing experiences, o Behavior-specific cognitions nursing in the work place; it is community and effect, health nursing focused on people in their o Behavioral outcomes places of work. ▪ The theory notes that each person has Occupational health nursing is the specialty unique personal characteristics and practice that provides for and delivers health experiences that affect subsequent actions. care services to workers and worker Lawrence Green’s Precede-Proceed Model population. ▪ Is a cost-benefit evaluation framework which helps program planners, policy The practice focuses on promotion, protection, makers, and other evaluators analyze and restoration of worker's health within the situations and design health programs context of a safe and healthy work efficiently. It is a comprehensive structure for environment. assessing health needs for designing, The foundation of occupational health nursing implementing, and evaluating health practice is research-based with an emphasis promotion and other public health programs on optimizing health, preventing illness and to meet those needs. injury, and reducing health hazards. PRECEDE stands for Predisposing, Reinforcing, Occupational health nursing is “aimed at Enabling Constructs in Educational Diagnosis assisting workers in all occupations to cope and Evaluation which involves assessing the with actual and potential stresses in relation to following community factors: o Social assessment – determine the social their work and work environment. problems and needs of a given population Community Mental Health Nursing and identify desired results. o Epidemiological assessment – identify the Is the application of specialized knowledge to health determinants of the identified population communities to promote and problems and set priorities and goals. maintain mental health, rehabilitate population o Ecological assessment – analyze at risk. behavioral and environmental determinants The psychiatric nurse must possess knowledge that predispose, reinforce, and enable the behaviors and lifestyles are identified. about community resources. o Match appropriate interventions – identify administrative and policy factors that MODULE 2. CONCEPT OF THE influence implementation and match COMMUNITY appropriate interventions that encourage desired and expected changes. A community is a group of people sharing common o Implementation of interventions geographic boundaries and/or common values and interest. It functions within a particular socio-cultural PROCEDE = Policy, Regulatory, and context which means that no communities are alike Organizational Constructs in Educational and (Maglaya p. 10). Environmental Development which involves the identification of desired outcomes and program A. TYPES OF COMMUNITIES implementation: o Implementation – design intervention, URBAN Human settlement with a assess availability of resources, and high population implement program. density and o Process Evaluation – determine if program infrastructure of built is reaching the targeted population and environment. achieving desired goals. SUBURBAN Lower density areas o Impact Evaluation – evaluate the change in that separate residential behavior. and commercial areas o Outcome Evaluation – identify if there is a from one another. They decrease in the incidence or prevalence of are either part of the city the identified behavior or an increase in the or urban area, or exist as identified positive behavior. a separate residential community within commuting distance of a E. DIFFERENT FIELDS (MAGLAYA P.3-4) city. RURAL In general, a rural area School Health Nursing or countryside, is a geographic area that is School health nursing is primarily determined located outside towns by the characteristics of their clientele, which is and cities. Area is an open swath of land that Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 3 COMMUNITY HEALTH NURSING II has few homes or other Location buildings, and not very many people. Community is affected by natural and man-made Population density is variables. very low. Natural – consists of geographic features, climate, flora, fauna. Whether the community is B. CHARACTERISTICS OF A HEALTHY urban or rural. COMMUNITY (MAGLAYA P.11) Man-made – soil, air pollution, agricultural by products, indoor pollution. 1. Awareness that “we are community”. 2. Conservation of natural resources. Social System 3. Recognition of, and respect for the existence of How they interact or link with one another. subgroups. 4. Participation of subgroups in community F. ROLES AND ACTIVITIES OF COMMUNITY affairs. HEALTH NURSE (CHN SERVICE IN THE 5. Preparation to meet crises. PHILIPPINES P.21) 6. Ability to problem-solve. 7. Communication through open channels. Planner/Programmer Identifies needs 8. Resources that are available to all. and priorities, 9. Settings of disputes through legitimate problems of mechanisms. individuals, families, 10. Participation of citizens in decision making. and communities 11. Wellness of high degree among its members. Formulates municipal health C. COMPONENTS OF A COMMUNITY plan in absence of medical doctor Environment Interprets and People implements nursing Economy plan, program Culture policies, Health memoranda, and circular for the Quality of life concerned staff D. FACTORS AFFECTING THE HEALTH OF personnel. Provides technical THE COMMUNITY assistance too rural health midwives in health matters. Provider of Nursing Provides direct Care nursing care to sick or disabled in the home, clinic, school, or work place. Develops the family’s capability to take care of the sick, disabled, or dependent member. Manager/Supervisor Community Motivates and Organizer enhances E. CONDITIONS IN THE COMMUNITY AFFECTING community HEALTH participation in terms of planning, People organizing, These are variables that affect the health of the implementing, and evaluating health community which includes: services. Size Initiates and Density participates in community Composition development Rate of growth or decline activities Cultural characteristics Mobility Social class Education level Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 4 COMMUNITY HEALTH NURSING II Coordinator of Coordinates with Prepares statistical Services individuals, families, data/chart and other and other groups for data presentation. health-related Researcher Participates in the services provided by conduct of survey various members of studies and the health team. researches on Coordinates nursing and health- nursing program related subjects. with other health Coordinates with the programs like GOs and NGOs in environmental the implementation sanitation, health of studies/research. education, dental health, and mental health. MODULE 3. HEALTH STATISTICS AND 1. Trainer/ Identifies and EPIDEMIOLOGY (Maglaya Nsg. Practice in the Health interprets training Community; 4th Ed. P.41) Educator/ needs of the RHMs, Counselor Brgy. Health A. TOOLS Workers (BHWs), and hilots Demography Conduct training for RHMs and hilots Science that deals with the study of the human on promotion and population size, affected by births, death, and disease prevention migration; composition (structure of the Conducts pre and population), and distribution in space. post-consultation It also focuses on population changes – conferences for movement from place to place, trends in fertility clinic clients; acts rates and birth-death rates. as a resource speaker on health Importance of Demography in CHN: and health-related services. 1. To know how large the population is in a Conducts pre- community. marital 2. Characteristics of the population that makes counselling. them exposed to certain health conditions. Health Monitor Detects deviation 3. Helps to determine the nature and magnitude from health of of existing and potential community health individuals, families, problems if he possess the knowledge about groups, and the population size, composition, and communities distribution in space. through contacts/visits with 1.a Source of Data: them. Role Model Provides good An official and periodic enumeration of example of healthful population. living to the During the census, demographic, economic, members of the and social data are collected from a specific community. population group. Change Event Motivates changes These data are then collated, synthesized, and in health behavior of are made known to the public for the purpose individuals, families, of determining and explaining trends in terms groups, and of population changes and planning programs communities that and services. also include lifestyle in order to promote Two ways of assigning people when the census is and maintain health. being takes: Recorder/Reporter Prepares and submits required a) De jure method – done when people are reports and records. assigned to the place they usually live in Maintain adequate, regardless of where they are at the time of the accurate, and census. complete recording b) De facto – people are assigned to the place and reporting. where they are physically present at the time of Review, validates, the census, regardless of their usual place of consolidates, residence. analyzes, and interprets all records and reports. Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 5 COMMUNITY HEALTH NURSING II 1.b Population Size: Solution: Relative increase = Pt – Po Refers to the number of people in a given Po place or area at a given time. = 555,000 – 155,000 Population size allows the nurse to make 155,000 comparisons about population changes over = 2. 571437755 or 2.57 time. Conclusion: The relative increase of The method of measuring population size is to population is 2. 571437755 or 2.57. determine the increase in the population using data c) Composition – population composition obtained during two census periods. refers to a certain variable such as sex, a) Absolute increase per year measures the age, occupation, and educational level. number of people that are added to the population per year. This is computed A. Sex Composition – compares the number of males to the using the following data: number of females in the population. Sex ratio = No. of males Formula: No. of females x 100 Absolute increase per year = The sex ratio represents the number of Pt – Po males for every 100 females in the T population. Where: B. Age Composition Pt – population size at a later year Po – population size at an earlier year 1. Median Age – divides the population T – no. of years between time O and T into two equal parts. So, if the median age is said to be 19 years old, it means Example A half of the population belongs to 19 Scenario: IN 2017, the population rose to years old and above, while the other half belongs to ages below 19 years old. 555,000. What is the absolute increase per year of the population in Guimaras if it had 2. Dependency Ratio – compares the a population of 155,000 in 2014? number of economically dependent with economically productive group in the Given: population. Pt = 555,000 0 – 14 years old and 65 years old and Po = 155,000 above are considered economically T=3 dependent. 555,000 – 155,000 3 15 – 64 years old are considered = 133,333.33 absolute increase per year productive age group Conclusion: There were 133,333.33 people added to the population per year. b) Relative increase is the crucial difference between the two census counts expressed in recent years relative to the population size made during an earlier year census. Formula: Relative increase = Pt – Po d) Distribution Po Urban-Rural Distribution: Where: Simply illustrates the proportion of Pt – population size at a later time people living in urban compared to the Po – population size at an earlier time rural areas. Crowding Index: Example B Describes the ease by which a Scenario: In 2016, a census was communicable disease can be conducted by the Philippine Statistics transmitted from one host to another Authority at the 2nd Congressional District susceptible host. This described by of Iloilo with a population size of 155,000. dividing the number of persons in a Another census was conducted year 2019 household with the number of rooms used by the family for sleeping. with a population size increase to a Population Density: 555,000. Determine the relative increase in Determine how congested a place is. It population of the 2nd district. can be computed by dividing the number of people living in a given land area. Given: Pt = 555,000 Pt = 155,000 Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 6 COMMUNITY HEALTH NURSING II Health Indicators 9. Injuries 10. Heart diseases Crude Birth Rate LEADING CAUSES OF MORTALITY (DOH 2019) Is only a rough measure of fertility in the 1. Diseases of the heart 2. Diseases of the vascular system population since it makes use of the mid-year 3. Pneumonias population (which ignores the number of men 4. Malignant neoplasms/cancer and women incapable of child bearing) as its 5. All forms of TB denominator. This rate is obtained using the 6. Accidents following formula: 7. COPD CBR = Total live births in a calendar year x 1,000 8. Diabetes 9. Nephritis/nephritic syndrome Mid-year population for that year 10. Diseases of the respiratory system Crude Death Rate Life Expectancy Is the total number of deaths to residents in a specified geographic area (country, state, ✓ Refers to the number of years a person can county, etc.) divided by the total population for expect to live; is based on an estimate of the the same geographic area (for a specified time, average age that members of a particular period, or usually a calendar year) and population group will be when they die. The multiplied by 1,000. current life expectancy for Philippines in 2020 is 71.28 years, a 0.18% increase from 2019. CDR = Number of deaths in a year x 1,000 B. PHILIPPINE HEALTH SITUATION Estimated mid-year pop. of the same year The national health situation gives us an idea of the Infant Mortality Rate health situation in the communities where nurses work; Is considered one of the most sensitive indices because of the different conditions prevailing in these of the health conditions obtained in a communities, their health picture expectedly varies. population. Infant deaths are associated with Demographic Profile acute communicable diseases and factors such as environmental sanitation and poor ✓ The Philippines is one of the most populous hygiene. This rate is obtained by the following countries in the world. formula: ✓ In 2000, the country’s population was 75.3 million (109 million in 2020) IMR = total deaths, less than one year of age in a calendar year x 1000 ✓ In 1999, the average life expectancy at birth Total live births in the same year was 68.6 years (71.28 for females and 66.03 for males.); life expectancy during 2019 is at 71 Maternal Mortality Rate years. This rate measures the risk of dying from ✓ 39% of the population was estimated to be in causes with childbirth. Maternal death is 0-14 age group (1994) defined as the death of a mother directly due to ✓ 5% were 60 years old and above pregnancy, labor, and puerperium within 90 ✓ Dependency ratio at 79, means 79 people (0- days of delivery. The MMR is obtained from the 14 and 60 yrs and above) depend of 100 following formula: people in the productive age group (15-59) ✓ There are about 249 people for every square MMR = total maternal deaths in a calendar year x 1,000 kilometer territory. Metro Manila has the highest population density (16,051) and CAR Total live births in the same year has the lowest (75) Specific Rate of Mortality ✓ The population in urban areas is increasing from 37% in 1984 (UNICEF, 1986) the figure to Is the number of deaths from a specified cause 44% ten years later per 1,000 person – years at risk. The ✓ In 2018, a total of 1,668,120 live births were numerator is typically restricted to resident registered, which is equivalent to a crude birth deaths in a specific geographic area. rate (CBR) of 15.8 or 16 births per thousand population. SRM = deaths from a given cause in a year x 1,000 ✓ In 2019, death rate for Philippines was 5.9 per Estimated mid-year population for the same year. 1,000 people. Death rate of the Philippines fell gradually from 8 per 1,000 people in 1970 to LEADING CAUSES OF MORBIDITY (DOH 2019) 5.9 per 1,000 people in 2019. 1. Acute Respiratory Infection ✓ The fertility rate for the Philippines in 2019 was 2. Acute lower RTI (pneumonia) 2.555 births per woman, a 0.97% decline from 3. Bronchitis 2018. The fertility rate for the Philippines in 4. Hypertension 2018 was 2.580 births per woman, a 3.52% 5. Acute watery diarrhea decline from 2017. 6. Influenza ✓ The infant mortality rate for the Philippines in 7. UTI 2019 was 19.239 deaths per 1,000 live births, 8. Tuberculosis a 2.16 decline from 2018. Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 7 COMMUNITY HEALTH NURSING II ✓ Maternal mortality rate: 121 deaths/100,000 Sporadic – refers to a disease that occurs infrequently live births (2017 estimated) and irregularly; occurring occasionally, or in scattered instances. C. EPIDEMIOLOGY AND THE NURSE Examples of sporadic diseases include Epidemiology is the study of the distribution tetanus, rabies, and plague. and determinant of health-related states or events in specified populations, and the Pandemic – an outbreak of disease that occurs over a application of this study to the control of health wide geographic area (such as multiple countries or problems. continents) and typically affects a significant proportion Science concerned with the circumstances of the population. under which diseases occur, where diseases An example of which is COVID-19. tend to flourish and where they do not. Field of science, which is concerned with the Herd immunity – a.k.a community immunity; occurs various factors, and conditions that determine when a high percentage of the community is immune to the occurrence and distribution of health, a disease (through vaccination and/or prior illness), disease, defects, disability, and death among making the spread of this disease from person to groups of individuals. person unlikely. Study of the distribution and dynamics of disease occurrence in human populations as a Seasonal variation – in time series, that part of the basis for determining preventive and control movement which is assigned to effect of the seasons measures. on the year, (e..g. seasonal variation in rainfall) Key terms in this definition reflect some of the For example, seasonal variation in mosquito important principles of epidemiology. abundance in response to annual variation in temperature and rainfall can cause strongly STUDY seasonal patterns of disease incidence. Epidemiology is a scientific discipline with sound SECULAR TREND methods of scientific inquiry at its foundation. Described the occurrence of disease over a Epidemiology is data-driven and relies on a prolonged period, usually years; systematic and unbiased approach to the collection, it is influenced by the degree of immunity in the analysis, and interpretation of data. population and possibly nonspecific measures Epidemiology also draws on methods from other such as improved socioeconomic and scientific fields, including biostatistics and informatics, nutritional levels among the population. with biologic, economic, social, and behavioral C.1 DEFINITION AND RELATED TERM: (FLIP sciences. CLASSROOM) RESEARCH THE MEANING OF DISTRIBUTION THE FOLLOWING TERMS: Epidemiology is concerned with the frequency and Infection Invasion of the body pattern of health events in a population: tissues of a host by an infectious agent, whether Frequency refers not only to the number of health or not it causes a events such as the number of cases of meningitis or disease. diabetes in a population, but also to the relationship of Infectious agent Invasion of the body that number to the size of the population. tissues of a host by an infectious agent, whether The result rate allows epidemiologists to compare or not it causes a disease occurrence across different populations. disease or microorganisms, Pattern refers to the occurrence of health-related helminths and events by time, place, and person. arthropods that are capable of producing Endemic – an infection is said to be endemic in a infectious disease. population when that infection is constantly maintained Infectious disease Are the diseases caused at a baseline level in a geographic area without by various pathogenic external inputs. microorganisms such as virus, bacteria, For example, chickenpox is endemic in the UK, protozoan, fungi, and but malaria is not. other parasites. These Epidemic – is the rapid spread of disease to a large infectious diseases can number of people in a given population within a short be transmitted by animals, humans, period of time. insects, or other agents. For example, in meningococcal infections, an Incubation period The time from the attack rate in excess of 15 cases per 100,000 moment of exposure to an infectious agent until people for two consecutive weeks is s/s of the disease considered an epidemic. appear. Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 8 COMMUNITY HEALTH NURSING II without manifested For example, incubation symptoms and is period of chickenpox is capable of transmitting 14-16 days. the infection; the condition of such an In biology, the incubation individual is referred to period is the time need as the carrier state. for any particular Contact A person recently process of development exposed to a contagious to take place. disease, usually through close association with an For example, the length infected individual. of time for turtle eggs to Incidence The rate of occurrence of hatch is the incubation new cases of a disease period. or condition in a Source of infection The source of infection, population at risk during is one in which of a given period of time infection lives and (usually 1 year) propagates. Can be a Isolation Refers to the precautions man or animal from that are taken in the which the infectious hospital to prevent the agent is secreted into the spread of an infectious outer environment and agent from an infected or from there to other colonized patient to individuals. susceptible persons. Quarantine Restriction of freedom of In certain circumstances, movement of apparently the outer milieu can be well individuals who the source of infection have an exposure to where the agent lives as infectious disease, which a saprophyte (lives on is imposed for the dead matter) maximal incubation e.g. mycoses, legionella period of the disease. Primary case Only applies to infectious Host Any organism that can diseases that spread be infected by a from human to human, pathogen under natural and refers to the person conditions. who first brings a disease into a group of people – a school class, Uses Of Epidemiology community, or country. Secondary case Called as the occurring ✓ elucidation of “cause’’ of disease of a disease due to close ✓ identification of high-risk groups contacts of a primary ✓ evaluation of preventive and control measures case – patient 24 hours for health planning after onset of illness in ✓ understanding the natural history of diseases the primary case. ✓ determine whether epidemiologic data are Secondary case is the consistent with etiological hypothesis next stage to primary ✓ provide knowledge of disease frequency and case. Many diseases will distribution during epidemic and non-epidemic be caused due to times spreading of infections from one person to Functions Of The Epidemiology Nurse another. Reservoir A large quantity of 1. Implement public health surveillance. infectious 2. Monitor local health personnel conducting microorganisms or disease surveillance. parasites resident in 3. Conduct and/or assist other health personnel in animals other than man, outbreak investigation. potentially capable of 4. Assist in the conducted rapid survey and being transmitted to surveillance during disasters. humans; especially, such 5. Assist in the conduct of surveys, program organisms in animals evaluations, and other epidemiologic studies. where they do little to no harm to the host. 6. Assist in the conduct of training course in Susceptible A person who is epidemiology. vulnerable to being 7. Assist in the epidemiologist in preparing the infected by a certain annual report and financial plan. disease. 8. Responsible for inventory and maintenance of Carrier An individual who epidemiology and surveillance unit (ESU) eqp. harbors the specific organisms of a disease Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 9 COMMUNITY HEALTH NURSING II C.2. CAUSATIONS OF DISEASE environmental health programs designed to improve environmental quality. FACTORS OF DISEASE CAUSATION Secondary Secondary prevention focuses on individuals who PREDISPOSING FACTORS are the factors which experience health problems or illnesses and who are create a state of susceptibility, making the host at risk of developing complication. Activities are vulnerable to the agent. These are age, sex, and directed at early diagnosis and prompt intervention, previous illnesses, thereby reducing severity and enabling the client to return to normal. Its purpose is to cure disease, slow ENABLING FACTORS are those which assist in the its progression, or reduce its impact on individuals or development of (or in recovery from) the disease; e.g.: communities. housing conditions, socio-economic status. Tertiary Tertiary prevention occurs when a defect or PRECIPITATING FACTORS are those which are disability is permanent and irreversible. It involves associated with immediate exposure to the disease minimizing the effects of long-term disease or agent or onset of disease; e.g.: drinking contaminated disability by interventions direct at preventing water, close contact with a case of PTB. complications and deteriorations. Tertiary prevention strategies are both therapeutic and rehabilitative REINFORCING FACTORS are those which aggravate measures once disease is firmly established. an already existing disease; e.g.: malnutrition, repeated exposures. EPIDEMIOLOGICAL TRIAD RISK FACTORS are the conditions, quality, or attributes, the presence of which increases the The standard model of infectious disease causation chances of an individual to have, develop, or be under the epidemiological triad theory states that an adversely affected by a disease process. The risk external agent can cause diseases on a susceptible factor need note necessarily cause the disease but host when there is a conducive environment. does increase the probability that the person exposed to the factor may get the disease easily. ❖ Within the epidemiological triad, the agent is known as a “necessary” factor. It has to be DIFFERENT CONCEPTS ON CAUSATION OF present for morbidity, although it may not DISEASES inevitably lead to disease. ❖ For the disease to occur, it needs the GERM THEORY combination of what have been called Was proposed by Louis Pasteur (1882-1895) “sufficient” factors. and Robert Koch (1843-1910). o These would include a host, which Germ theory postulates that every human might be an individual or group of disease is caused by a microbe or germ, which individuals who are susceptible to the is specific for that disease and one must be agent. able to isolate the microbe from the diseased ❖ Susceptibility might be on the basis of age, human being. sex, ethnic group, or occupation. The Germ Theory viewed diseases in terms of o Environmental factors can also be causal network similar to that of Fracastoro, sufficient factors that combine with the but with much more detail about the nature of agent. germs and possible treatments. ❖ The epidemiological triad can be applied to non-infectious diseases where the agent could Organisms that cause the disease inside the be “unhealthy behaviors, unsafe practices, or human body are called pathogens. Bacteria unintended exposures to hazardous and viruses are the best-known pathogens. substances”. Fungi, protozoa, and parasites can also cause disease. WHEEL THEORY Infectious diseases are typically classified as bacterial, viral, protozoal, and so on. Knowing The theory visualizes human disease in the what bacteria are responsible for a particular form of a wheel, which has a central hub disease indicates what antibiotic treatment to representing the genetic components and the apply. peripheral portion representing the Diseases are said to be infectious or environmental components. communicable if pathogens can be passed Like any wheel, the outer part (environmental from one person to another. component) has spikes (3 in this model) and thus divided into 3 sub components, The levels of prevention are the following: representing the social, biological, and physical components of the environment. Primary Primary prevention seeks to prevent a disease or To maintain health, one has to take regular condition at a pre-pathologic state; to stop exercises and adequate rest, follow personal something from ever happening. Primary prevention hygiene, eat nutritionally balanced diet, take strategies emphasize general care of one’s mental well-being and develop health promotion, risk factor reduction, and other social skills to interact in a positive manner health protective measures. These strategies include within society. health education and health promotion programs designed to foster healthier lifestyles and Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 10 COMMUNITY HEALTH NURSING II WEB OF CAUSATION THEORY Invasiveness of an organism – the ability to The “Epidemiological Triad Theory” was very invade the tissues. effectively used by Leavell and Clark in Other factors should be considered in describing the explaining the natural history of disease and agent: levels of prevention. ✓ Infecting dose – the number of organisms The terms primary, secondary, and tertiary necessary to cause a disease prevention were first documented in the late ✓ Method of transmission 1940s by Hugh Leavell and E. Guerney Clark ✓ Site of entrance of organism into the host from Harvard and Columbia University Schools ✓ Host defenses of Public Health, respectively. Both were ✓ Host species pioneers in public health. 2. Reservoir of an - It is the site where it Leavell and Clark described the principles of organism resides, metabolizes, prevention within the context of epidemiologic and multiplies. triangle model of causation of diseases of host, agent, and environment. Source of the organism – site from which it is C.3 EPIDEMIOLOGICAL TRIANGLE transmitted to a ✓ A number of models of disease causation have susceptible host, either been proposed. Among the simplest of these is directly or indirectly through an intermediary the epidemiologic triad or triangle, the object traditional model for infectious disease. ✓ The triad consists of an external agent, a Reservoir and source – susceptible host, and an environment that can be different and can brings the host and the agent together. also be the same, as an ✓ Also called as the Ecologic Model by Leavell individual who is a and Clark, refers to the interplay of agent permanent nasal carrier causative etiologic factor (host possessing of S. Aureus and who intrinsic factors), and the environment (extrinsic disseminates organisms factors). from this site Method Of Transmission B. ETIOLOGICAL FACTORS Is the means by which the agent goes from the Biological Agents source to the host. The four major methods of Virus, fungi, bacteria, helminths, protozoa, transmissions are by contact, common vehicle, ectoparasites by air, or by via vector. Chemical Agents Carcinogens A. EPIDEMIOLOGICAL TRIAD Allergens 1. Agent – any environmental Transfats factor or stressor Nutritive Elements (biological, chemical, Excessive or deficiencies mechanical, physical, Mechanical Factors and psychological) Accidents, trauma whose presence or Physical absence can lead to illness or disease. E.g.: when one is struck by lightning Psychological Etiologic agent – any Stress microorganism that Contact Transmission cause infection The agent is spread directly, indirectly or by airborne droplets. Pathogenicity – ability Direct contact takes place when organisms to cause disease; further are transmitted directly from the source to characterized by the susceptible host without involving an describing the intermediate object, this is also referred as organism’s virulence and person-person transmission; invasiveness. o e.g.: Hepatitis A Indirect Transmission Virulence – refers to the occurs when organism is transmitted from a severity of infection source, either animate or inanimate, to a which can be expressed host by means of inanimate object; e.g.: by describing the pseudomonas organisms from one individual morbidity (incidence of to another by means of a shaving brush. disease) and mortality Droplet Spread (death rate) of the refers to that travel through the air very short infection. distances, that is, less than 3 feet from the source to a host. The organisms are not airborne in the true sense; e.g.: leprosy Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 11 COMMUNITY HEALTH NURSING II Common-vehicle Transmission genitourinary refers to agents transmitted by a common tract, and it may inanimate vehicle, with multiple cases enter fetuses resulting from such exposure. through the This includes diseases in which food or placenta. water as well as drugs and parenteral fluids Development of are the vehicles of infections; e.g.: food- disease in a host borne salmonellosis, waterborne shigellosis, reflects agent and bacteremia resulting from use of IV characteristics fluids contaminated with gram-negative and is influenced organism. by host defense Airborne Transmission mechanisms, Infection spread by droplet nuclei, or dust. which may be The droplet nuclei are the residue from the nonspecific or evaporation of fluid from droplets, are light specific. enough to be transmitted more than 3 feet Specific defense from the source, and may remain airborne mechanisms or for prolonged periods. E.g.: TB – source immunity may be may be from coughing patient who creates natural, resulting aerosols of droplet nuclei that contain from exposure to tubercle bacilli. the infectious Infectious Agents agent, or Infectious agents may be contained in dust artificial, particles, which may become resuspended resulting from and transmitted to hosts. active or passive Vector Borne Transmission immunization. in which arthropods are the vectors. Vector, Nonspecific transmission may be external or internal. defense External or Mechanical Transmission mechanisms include the skin, Occur when organisms are carried mucous mechanically to the vector. membranes, Internal Transmission secretions, when the organisms are carried within the enzymes, the vector. If the pathogen is not changed by its inflammatory carriage within the vector, the carriage is response, called harborage. genetic factors, The other form of internal transmission is hormones, called biologic, the organism is changed nutrition, biologically during its passage through the behavioral vector (e.g.: malaria parasites in the patterns, and the mosquito vector) presence of other diseases. 4. Environment - all factors external to A. EPIDEMIOLOGICAL TRIAD the host may or may not 3. Host Person(s) who predispose the person to may or may not the development of a be at risk of disease. These include: acquiring a disease based Physical Environment on family history Includes of disease, inanimate lifestyle habits objects and and age; the geophysical state of health of condition such a host at any as climate given time a Biological Environment result of the All the things interaction of around the host genetic Socio-economic endowment with Environment the environment Includes over his/her economic entire lifespan. condition, level The organism of economic may enter the development, host through the presence of skin, mucous social problems membranes, and alike. lungs, gastrointestinal tract, or Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 12 COMMUNITY HEALTH NURSING II C. EPIDEMIOLOGICAL METHOD measures were sufficient to It is a tool in nursing process, similar to the nursing resolve the current outbreak. process. The steps are labeled differently but, in the STEP 4 – Plan for Identify the preventive essence, they both involve a series of circular, Control activities based on the dynamic problem-solving actions. knowledge of natural history 1. Who is affected (persons) of the disease in question. 2. Where the affected persons reside (place) 3. When the persons were affected (time) Determine the following: 4. Causal factors of health and disease ✓ populations at risk, occurrence (host, agent, environment ✓ levels of prevention, determinants) feasibility of 5. Prevalence and incidence of health and implementing the disease (frequencies) plan, 6. Prevention and control measures (levels of ✓ priorities in relation to prevention) in relation to the nature life legal mandates, history of a disease or a condition ✓ significance of the problems relative to other community D. EPIDEMIOLOGICAL PROCESS needs, and; It has 8 basic steps; these steps may overlap and ✓ the feasibility of may not always follow a sequential pattern. They are implementing control interrelated and dependent on each other. plan. STEP 1 – a. natural life of history of STEP 5 – Plan implementation must be Determine the condition Implement the multisectoral – nature, extent, and Control Plan multidisciplinary taking into possible b. determinants influencing consideration the beliefs, significance of the condition attitudes, and customs of the problem. primary data community. (essential agent) STEP 6 – Evaluate Apply the problem-solving bacteria/parasite/virus Control Plan approach; how well the - nutrition and objectives were met, how the psychosocial current situation compares to contributory data – the situation prior to the agent, host, investigation. environment Practicability of the control c. distribution patterns – measures and feasibility and date, time, and place cost in terms of money, time, staff, facilities, and community d. condition frequencies – support should be organized. incidence, prevalence, and STEP 7 – Make The nurse makes immediate biostatistical measurement Appropriate Report and accurate reporting which STEP 2 – Develop HYPOTHESIS – a tentative will provide a basis for future Tentative theory or supposition investigations and control Hypothesis/es provisionally adopted to measures. explain facts and to guide in further investigations. It should include what was involved in the This step usually reveals a epidemiological process, variety of generalizations, diagnosis, factors, and events influences, theories, and leading to the epidemic, speculations which require control measures, process appraisal and critical evaluation, and judgement. recommendation for preventing similar situation. A must be selected on the STEP 8 – Conduct Types of Epidemiological basis of needs, interest, and Research Studies: availability of resources. a. historical-analytical The source of infection method – study of the revolves on the host, agent, disease occurrence over long and environment. periods of time. E.g.: leprosy STEP 3 – Collect Identify the group selected for and Analyze Further attack by the disease or b. experimental Data to Test problem under investigation. epidemiology – the method Hypothesis is concerned with Variations can be identified observations made on through the study of attack artificially induced epidemics rates. or diseases in experimental laboratory and is mainly Testing hypothesis helps to utilized for search studies. determine if the initial control Batch Sinagtala 2025 Hautea, R.K.M.  1st Semester|PRELIMS – NCM 3115 13 COMMUNITY HEALTH NURSING II c. field epidemiology – ✓ Make suggestion as to the control and concerned with observation of prevention of future outbreaks a specific disease as it usuall