chn - chap 3.pdf

CHAPTER 6: FAMILY HEALTH NURSING ❖ FAMILY DATA ANALYSIS Data analysis is done by comparing findings with accepted standards for individual family members and for the family unit. The nurse correlates findings in the different data categories an...

CHAPTER 6: FAMILY HEALTH NURSING ❖ FAMILY DATA ANALYSIS Data analysis is done by comparing findings with accepted standards for individual family members and for the family unit. The nurse correlates findings in the different data categories and checks for significant gaps in information or the need for more details related to a finding. ❖ SYSTEM OF ORGANIZING FAMILY Data (adapted from Nies and McEwen, 2011) Family Structure and characteristics are reflected in: ✓ Data on household membership ✓ Demographic characteristics ✓ Family members living outside the household ✓ Family mobility ✓ Family dynamics (emotional bonding, authority and power structure, autonomy of members, division of labor, and patterns of communication, decision making, and problem and conflict resolution). ✓ Data on family structure can be visualized clearly through graphic tools such as genogram ecomap and family tree. Socioeconomic characteristics include: ✓ Data on social integration (ethnic origin, languages and dialects spoken, and social networks) ✓ Educational experiences and literacy ✓ Work history ✓ Financial resources Leisure time interests ✓ Cultural influences ✓ Spirituality or religious affiliation Family Environment ✓ Refers to the physical environment inside the family’s home/residence and its neighborhood. Family Health and Health Behavior include: ✓ Family’s activities of daily living ✓ Self-care ✓ Risk behaviors ✓ Health history ✓ Current health status ✓ Health care resources (home remedies and health services) ❖ FAMILY NURSING DIAGNOSIS Nursing diagnoses may be formulated at several levels: ✓ As an Individual family member ✓ As a family unit ✓ As the family in relation to its environment/community. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  International (NANDA-I, 2011) ✓ Serve as a common framework of expressing human responses to actual and potential health problems. Family Coping Index ✓ This tool is based on premise that nursing action may help a family in providing for a health need or resolving a health problem by promoting the family’s coping capacity. ❖ NINE AREAS OF ASSESSMENT OF THE FAMILY COPING INDEX (Freeman and Heinrich, 1981): i. Physical Independence → Family members’ mobility and ability to perform activities of daily living (personal hygiene) ii. Therapeutic Competence → Ability to comply with prescribed or recommended procedures and treatments to be done at home. iii. Knowledge of Health Condition → Understanding of the health condition or essentials of care according to the developmental stages of family members. iv. Application of Principles of Personal and General Hygiene → practice of general health promotion and recommended preventive measures. v. Health Care Attitudes → family’s perception of health care in general. vi. Emotional Competence → Degree of emotional maturity of family members according to their developmental stage. vii. Family Living Patterns → Interpersonal relationships among family members, management of family finances, and the type of discipline in the home. viii. Physical Environment → includes home, school, work, and community environment that influence the health of family members. ix. Use of Community Facilities → ability of the family to seek and utilize, as needed, both environment-run and private health. ❖ FORMULATING THE PLAN OF CARE Planning involves: o priority setting o establishing goals and objectives o determining appropriate interventions to achieve goals and objectives. Stancope and Lancaster (2010) ▪ The nurse’s role at this stage consists of offering guidance, providing information, and assisting the family in the planning process. Priority Setting – determining the sequence in dealing with identified family needs and problems. 1. Family safety: A life threatening situation is given top priority. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  2. Family perception: Priority is given to the need that the family recognizes as urgent or important. 3. Practicality: Together with the family the nurse looks into existing resources and constraints. 4. Projected effects: The immediate resolution of a family concern gives the family a sense of accomplishment and confidence in themselves and the nurse. ❖ ESTABLISHING GOALS AND OBJECTIVES Goal ▪ Desired observable family response to planned interventions in response to a mutually identified family need. Objectives ▪ the desired step by step family responses as they work toward a goal. ▪ Workable, well stated objectives should be SMART: ✓ S: Specific ✓ M: Measurable ✓ A: Attainable ✓ R: Relevant ✓ T: Time bound ❖ DETERMINING APPROPRIATE INTERVENTIONS o Freeman and Heinrich categorize nursing interventions into three types: ▪ 3 Types of Nursing Interventions: 1. Supplemental Interventions – actions that nurse performs on behalf of the family when it is unable to do things for itself. 2. Facilitative Interventions – actions that remove barriers to appropriate health action such as assisting the family to avail of maternal and early childcare services. 3. Developmental Interventions – aim to improve the capacity of the family to provide for its own health needs such as guiding the family to make responsible health decisions. o Implementing the Plan of Care I. Implementation is the step when the family or the nurse execute the plan of action. ❖ EVALUATION – To evaluate is to determine or fix the value. Formative Evaluation – judgment made about effectiveness of nursing interventions as they are implemented. Summative Evaluation – determining the end results of family nursing care and usually involves measuring outcomes or the degree to which goals have been achieved. ASPECTS OF EVALUATION: ✓ Effectiveness – determination of whether goals and objectives were attained. ✓ Appropriateness – suitability of the goals/objectives and interventions ✓ Adequacy – degree of sufficiency of goals/objectives and interventions ✓ Efficiency – relationship of resources used to attain the desired outcomes Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ FAMILY-NURSE CONTACTS The family-nurse relationship is developed through family-nurse contacts, which may take the form of a: ▪ Clinic Visit ▪ Group Conference ▪ Telephone Contact ▪ Written Communication ▪ Home Visit CLINIC VISIT o takes place in a private clinic health center, barangay health station. o Major advantage: ▪ A family member takes the initiative of visiting the professional health worker, usually indicating the family readiness to participate in the health care process. ▪ Because the nurse has greater control over the environment, distractions are lessened, and the family may feel less confident to discuss family health concerns. GROUP CONFERENCE o Appropriate for developing cooperation, leadership, self-reliance and or community awareness among group members. o The opportunity to share experiences and practical solutions to common health concerns is a strength of this type of family-nurse contact. WRITTEN COMMUNICATION o used to give specific information to families, such as instructions given to parents through school children. HOME VISIT o Home visit is a professional, purposeful interaction that takes place in the family’s residence aimed at promoting, maintaining, and restoring the health of the family or its members. o Advantages: 1. It allows first-hand assessment of the home situation. 2. The nurse can seek out previously unidentified needs. 3. It gives the nurse an opportunity to adapt interventions according to family resources. 4. It promotes family participation and focuses on the family as a unit. 5. Teaching family members in the home is made easier by the familiar environment and the recognition of the need to learn as they are faced by the actual home situation. 6. The personalized nature of home visit gives family a sense of confidence in themselves and in the agency. o Disadvantages: 1. The cost in terms of time and effort. 2. There are more distractions because the nurse is unable to control the environment. 3. Nurse’s safety. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  o Phases of Home Visit I. PREVISIT PHASE Nurse contacts the family, determines the willingness for a home visit, and sets an appointment with them. A plan for the home visit is formulated during this phase. The ff. are specific principles in planning for a home visit: Being a professional contact with the family, the home visit should have a purpose. Purposes: o To have a more accurate assessment o To educate the family about measures of health promotion, disease prevention and control of health problems. o To provide supplemental interventions for the sick, disabled or dependent family member. o To provide family with greater access to health resources in the community. Use information about the family collected from all possible sources such as records, other personnel or agency, or previous contacts with the family. The home visit plan focuses on identified family needs, particularly needs organized by the family as requiring urgent attention. The client and the family should actively participate in planning for continuing care. The plan should be practical and adaptable. II. IN-HOME PHASE This phase begins as the nurse seeks permission to enter and lasts until he or she leaves the family’s home. It consists of initiation, implementation, and termination. o Initiation ▪ It is customary to knock or ring the doorbell and at the same time, in a reasonably loud but nonthreatening voice say, “Tao po. Si Jenny po to, nurse sa health center?” ▪ On entering the home, the nurse acknowledges the family members with a greeting and introduces himself and the agency he represents. ▪ Observes environment for his own safety and sits as the family directs him to sit. ▪ Establish rapport by initiating a short conversation. ▪ States the purpose of the visit the source of information. o Implementation ▪ Involves the application of the nursing process, assessment, provision of direct nursing care as needed, and evaluation. o Termination ▪ Consists of summarizing with the family the events during the home visit and setting a subsequent home visit or another form of family-nurse contact. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ Use this time to record findings, such as vital signs of family members and body weight. III. POSTVISIT PHASE Takes place when the nurse has returned to the health facility. Involves documentation of the visit. ❖ THE NURSING BAG Frequently called the PHN bag is a tool used by the nurse during home or community visits to be able to provide care safely and efficiently. Serves as a reminder of the need for hand hygiene and other measures to prevent the spread of infection. Nursing bag usually has the ff. contents: - Articles for infection control - Articles for assessment of family members - Note that the stethoscope and sphygmomanometer are carried separately. - Articles for nursing care - Sterile items - Clean articles - Pieces of paper Use of the Nursing Bag o Bag technique helps the nurse in infection control. o Bag technique allows the nurse to give care efficiently. o It saves time and effort by ensuring that the articles needed for nursing care are available. o Bag technique should not take away the nurse’s focus on the patient and the family. o Bag technique may be performed in different ways, principles of asepsis are of the essence and should always be practiced. ❖ For infection control the ff. activities should be practiced during home visits: 1. Remember to proceed from “clean” to “contaminated”. 2. The bag and its contents should be well protected from contact with any article in the patient’s home. 3. Line the table/flat surface with paper/washable protector on which the bag and all of the articles to be used are placed. 4. Wash your hands before and after physical assessment and physical care of each family member. 5. Bring out only the articles needed. 6. Do not put any of the family’s articles on your paper lining/washable protector. 7. Wash your articles before putting them back into you bag. 8. Confine the contaminated surface by folding the contaminated side inward. 9. Wash the inner cloth lining of the bag, as necessary. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 7: THE NURSING PROCESS IN THE CARE OF THE COMMUNITY ❖ THE NURSING PROCESS IN THE CARE OF THE COMMUNITY A community is a group of people who: Have a common interest or characteristics Interact with one another Have sense of unity or belonging Function collectively within a defined social structure to address common concerns A community may be phenomenological (functional) or geopolitical (territorial) ❖ PRINCIPALS OF COMMUNITY HEALTH NURSING 1. Community is the focus of care; nurse responsibility is to the community as a whole 2. Give priority to community needs 3. Work with the community as an equal partner of the health team 4. Focus on primary prevention for appropriate activities 5. Promote a healthful physical and psychosocial environment 6. Reach out to all who may benefit from a specific service 7. Promote optimum use of resources 8. Collaborate with others working in the community health ❖ Conditions in the community affecting health People Location Social system ❖ Characteristics of a healthy community A shared sense of being a community based on history and values A general feeling of empowerment Existing structures that allow subgroups within the community to participate in decision making The ability to cope with change, solve problems, and manage conflicts within the community through acceptable means Open channels of communication Equitable and efficient use of community resources ❖ Aims 1. Achieve a good quality life 2. Create a health supportive environment 3. Provide basic sanitation 4. Supply access to health care ❖ COMMUNITY ASSESSMENT o the data needed to be collected depend on the objectives of community assessment. o In general, the nurse needs to collect data on the three categories of community health determinants: people, place, and social system. ❖ DATA COLLECTED FOR THE HEALTH P.A.T.C.H: (Planed Approach To Community Health) PROCESS FOR HEALTH PLANING Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  1. Community Profile - Demographic educational and economic data 2. Morbidity and Mortality Data - Including unique health events (e.g., completion of barangay health station, a typhoon that caused flooding of residential areas) 3. Behavioral Data - Focusing on behavioral risk factors, such as smoking, drinking, and leading a sedentary lifestyle, and prevailing good health practices in the community, such as breast feeding and getting regular exercise 4. Opinion Data - from community leaders, such as what they think about the main health problems of the community their causes, measures that may alleviate or correct them Problem-oriented assessment is focused on an aspect of health: focusing on what’s problem the community have in mind ❖ TOOLS IN COMMUNITY ASSESSMENT Collecting Primary Data ▪ Observation Ocular survey/ windshield survey ▪ Survey ▪ Informant interview Talks to the community people Key informants: consist of formal and informal community leaders or persons of position and influence ▪ Community forum Pulong–pulong sa barangay Focus group o Secondary Data Source ▪ Health records and reports ▪ Field Health Service Information (FHSIS) recording and reporting tools ▪ FHSIS is as basis for: i. Priority setting by local governments ii. Planning and decision making at different levels (barangay, municipality, district, provincial, and national) iii. Monitoring and evaluating health program implementation  The FHSIS Manual of Operations i. Individual Treatment Record (ITR) – Building block of FHSIS ▪ Health workers are advised not to rely on client-maintained ii. Target Client List ▪ Target Client List for prenatal care ▪ Target Client List for postpartum care ▪ Target Client List of under 1-year-old children ▪ Target Client List for family planning ▪ Target Client List for sick children Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ National Tuberculosis Program Register ▪ National Leprosy Control Program Central Registration Form iii. Summary Table (Accomplished by Midwife) iv. Monthly Consolidation Table (MTC)  The Reporting Forms (as Enumerated in The FHSIS Manual of Operations) i. Monthly Forms (Regularly prepared by the midwife and summited to the nurse) a. Program Report (M1) ▪ Contains indicators categorized as maternal care, childcare, and family planning b. Morbidity Report (M2) ▪ contains list of all cases of disease by age and sex. ii. Quarterly Forms (Prepared by the nurse) a. Program Report (Q1) ▪ 3-month total indicators categorized as maternal care, family planning, childcare, dental health, and disease control b. Morbidity iii. Annual Forms a. A-BHS - Demographic, environmental, and natality data b. Annual Form 1 (A-1) - Prepared by the nurse and is the report of the RHU or health center. - It contains demographic and environmental data and data on natality and mortality for the entire year. c. Annual Form 2 (A-2) - prepared by the nurse, is the yearly morbidity report by age and sex d. Annual For 3 (A-3) - prepared by the nurse, yearly report of all mortality by age and sex disease registry census data ❖ COMMUNITY DIAGNOSIS Community diagnosis is the process of determining the health status of the community and the factors responsible for it. In this phase, the health workers make a judgement about the community’s health status, resources and health action potential or likely hood that the community will act to meet health needs to resolve health problems. This consist of: ▪ The health risk or specific problem to which the community is exposed. ▪ The specific aggregate or community with whom the nurse will be working to deal with the risk or problem. ▪ Related factors that influence how the community will respond to the health risk or problem application of this nursing diagnosis Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ PLANNING COMMUNITY HEALTH INTERVENTIONS Planning for community health interventions is based on findings during assessment and formulated nursing diagnosis. Planning Phase – involves priority setting, formulating goals and objectives, and deciding on community interventions. → Active participation of the people → To foster participation, the community should have genuine representation in the planning group. → Deciding on community representatives will be facilitated if the community has been organized earlier. Priority Setting ▪ Provides the nurse and the health team with a logical means of establishing priority among the identified health concerns. ❖ CRITERIAS TO DECIDE ON A COMMUNITY HEALTH CONCERN FOR INTERVENTION [ACCORDING TO THE WORLD HEALTH ORGANIZATION (WHO)] ▪ SIGNIFICANCE OF THE PROBLEM → is based on the number of people in the community affected by the problem or condition. → If the concerns are: Disease Condition – this may be estimated in terms of its prevalence rate Potential Problem – its significance is determined by estimating the number of people at risk of developing the condition. ▪ THE LEVEL OF COMMUNITY AWARENESS AND THE PRIORITY ITS MEMBERS GIVE TO THE HEALTH CONCERN → A MAJOR consideration. → Shuster and Goeppinger (2004) also mentioned community motivation to deal with the condition. ▪ ABILITY TO REDUCE RISK ▪ Related to the availability of expertise among the health team and the community itself. ▪ Involves the health team’s level of influence in decision making related to actions in resolving the community health concern. ▪ COST OF REDUCING RISK ▪ The nurse must consider economic, social, and ethical requisites and consequences of planned actions. ▪ ABILITY TO IDENTIFY THE TARGET POPULATION ▪ For the intervention is a matter of availability of data sources, such as FHSIS, census, survey reports, and case-finding or screening tools. ▪ AVAILABILITY OF RESOURCES Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ To intervene the reduction of risk entails technological, financial, and other material resources of the community, the nurse, and the health agency.  For a realistic and useful outcome, the priority-setting process requires the joint effort of the community, the nurse, and other stakeholders, such as the other members of the health team. ▪ The group defines guidelines for discussion, particularly on the manner of reconciling differences of opinion. ▪ Shuster and Goeppinger (2004) suggested a flexible process using the nominal group technique wherein each group member has an equal voice in decision making, thereby avoiding control of the process by the more dominant members of the group. ▪ This technique is appropriate for brainstorming and ranking ideas, when consensus- building is desired over making a choice based on the opinion of the majority. ▪ The group makes a list of the identified community health problems or conditions. Each of the identified problems is treated separately according to a set of criteria agreed upon by the group such as those suggested by the WHO.  As suggested by Shuster and Goeppinger (2004), the following steps are carried out: 1. From a scale of 1 to 10, being the lowest, the members give each criterion a weight based on their perception of a weight based on their perception of its degree of importance in solving the problem. 2. From a scale of 1 to 10, being the lowest, each member rates the criteria in terms of the likelihood of the group being able to influence or change the situation. 3. Collate the weights (from step 1) and ratings (from step 2) made by the members of the group. 4. Compute the total priority score of the problem by multiplying collated weight and rating of each criterion. 5. The priority score of the problem is calculated by adding the products obtained in step 4 After repeating the process on all identified health problems, compare the total priority scores of the problems. The problem with the highest total priority score is assigned top priority, the next highest is assigned to second, and so on. ❖ FORMULATING GOALS AND OBJECTIVES ▪ Goals are the desired outcomes at the end of interventions ▪ Objectives are the short-term changes in the community that are observed as the health team and the community work towards the attainment of goals. → Serves as instructions, defining what should be detected in the community as interventions are being implemented. → Specific, measurable, attainable, relevant, and time-bound (SMART) objectives provide a solid basis for monitoring and evaluation. ❖ DECIDING ON COMMUNITY INTERVENTIONS o The group analyzed the reasons for the people’s health behavior and directs strategies to respond to the underlying causes. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ For example, reasons for preference of home delivery over facility-based delivery should be identified. If the majority of the women would choose to have a home delivery because of cost or lack of access of birthing facilities, strategies should then be focused on improving facility-based services. But if the primary reason is sociocultural, the planning team may opt to concentrate on providing opportunities for skills development of traditional birth attendants and/or exerting effort to gain the trust and confidence of the women and their families. ▪ In the process of developing the plan, the group takes into consideration the demographic, psychological, social, cultural, and economic characteristics of the target population on one hand and the available health resources on the other hand. ❖ IMPLEMENTING THE COMMUNITY HEALTH INTERVENTIONS ▪ Often referred to as the action phase ▪ IMPLEMENTATION is the most exciting phase for most health workers. ▪ Aside from being able to deal with the recognized priority health concern, the entire process is intended to enhance the community’s capability in dealing with common health conditions/problems. ▪ The nurse’s role therefore may be to facilitate the process rather than directly implement the process rather than directly implement the planned interventions. ▪ Implementation also entails coordination of the plan with the community and the other members of the health team. This requires a common understanding of the goals, objectives and planned interventions among the members of the implementing group. ▪ Collaboration with the other sectors such as the local government and other agencies may also be necessary. ❖ EVALUATION OF COMMUNITY HEALTH INTERVENTIONS ▪ Evaluation approaches may be directed structure, process, and outcome. a. Structure Evaluation - involves looking into the manpower and physical resources of the agency responsible for community health interventions. b. Process Evaluation - examining how assessment, diagnosis, planning, implementation, and evaluation were undertaken. c. Outcome Evaluation - determining the degree of attainment of goals and objectives. - Ongoing evaluation or monitoring is done during implementation to provide feedback on compliance to the plan as well as on need for changes in the plan to improve the process and outcomes of interventions. ❖ STANDARD OF EVALUATION ▪ The bases for a good evaluation are its utility, feasibility, propriety, and accuracy. (CDC, 2011) i. Utility → the value of the evaluation in terms of usefulness of results. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  → The evaluation of community health interventions will be great use to the community health group o it helps the group gain insight into strengths and weaknesses of the plan and the manner of its implementation. ii. Feasibility → answers the question of whether the plan for evaluation is doable or not, considering available resources. → Resources include facilities, time, and expertise for conducting the evaluation. iii. Propriety → involves ethical and legal matters. → Respect for the worth and dignity of the participants in data collection should be given due consideration. → The results of evaluation should be truthfully reported to give credit where it is due and to show the strengths and weaknesses of the community o strengths to encourage further growth and weaknesses for remedial action, if possible. iv. Accuracy → refers to the validity and reliability of the results of evaluation. Accurate evaluation begins with accurate documentation while the community health process is ongoing. CHAPTER 8: APPLICATIONS OF EPIDEMIOLOGY IN COMMUNITY HEALTH ❖ EPIDEMIOLOGY o the study of the DISTRIBUTION and DETERMINANTS of health-related states or events in specified populations, and the application of this study to the prevention and control of health problems ❖ DISTRIBUTION o refers to the analysis by time, places and classes of people affected. ❖ DETERMINANTS o include all the biological, chemical, physical, social, cultural, economic, genetic, and behavioral factors that influence health. ❖ PRACTICAL APPLICATIONS OF EPIDEMIOLOGY 1. Assessment of the health status of the community or community diagnosis 2. Elucidation of the natural history of disease 3. Determination of disease causation 4. Prevention and control of disease 5. Monitoring and evaluation of health interventions 6. Provision of evidence for policy formulation Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ TYPES OF HEALTH INDICATORS AND THEIR EXAMPLES TYPE OF HEALTH INDICATOR EXAMPLES Health status indicators - Prevalence, incidence (morbidity) Health status indicators - Crude and specific death rates, maternal (mortality) mortality, infant mortality, neonatal mortality, postnatal mortality, child mortality, etc. Population indicators - Age-sex structure of the population, population density, migration, population growth (crude birth rate, fertility rate) Indicators for the provision of - Access to health programs and facilities, health care availability of health resources (facilities, health manpower, finances) Risk reduction indicators - Causes consulting health provider., infants exclusively breast-fed for the first 6 months Social and economic indicators - Quantity of suspended particulate matter, hydrocarbons, oxidants. Portability of drinking water Disability indicators - DALYs, indicators of restricted activity, indicators of long-term disability Health policy indicators - Allocation of manpower and financial resources, mechanisms for community participation, collaboration between government and non-government organizations ❖ HEALTH INDICATORS o These are quantitative measures usually expressed as rates, ratio, or proportions that describe and summarize various aspects of the health status of the population. o Also used to determine factors that may contribute to a causation and control of diseases, indicates priorities for resource allocation, monitors implementation off health programs, and evaluates outcomes oh health programs. ❖ MORBIDITY INDICATORS o Generally based on the disease specific incidence or prevalence for the common and severe diseases such as malaria, diarrhea, and leprosy. ❖ PREVALENCE PROPORTION (P) ▪ Measures the total number of existing cases of disease at a particular point in time divided by the number of people at the point in time. ▪ Thus, if the point in time is the time of examination, then the denominator is the number of people examined. ▪ Prevalence can be calculated by: Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Where F is any number of the base 10 that is used as a multiplier to avoid having decimals as the final value of the indicator. Incidence – measures the number of new cases, episodes, or events occurring over a specified period, commonly a year within a specified population at risk. ❖ FACTORS AFFECTING PREVALENCE INCREASED BY DECREASED BY - Longer duration of the - Shorter duration of the disease disease - Prolongation of life of - High case-fatality rate from disease patients without care - Increase in new cases - Decrease in new cases - In-migration of cases - In-migration of healthy people - Out-migration of healthy - Out-migration of cases people - In-migration of susceptible - Improved cure rate of cases people - Improved diagnostic facilities COHORT – a group of people who share a common defining characteristic. ❖ INCIDENT DENSITY RATE ▪ Computed using the total person-time at risk for the entire cohort as the denominator ▪ This indicator measures the average instantaneous rate of disease occurrence. ▪ It can be calculated as: ❖ MORTALITY INDICATORS ▪ Crude Death Rate (CDR) ▪ The rate with which mortality occurs in a given population. ▪ It is computed as: ▪ Factors affecting CDR includes age, sex composition of the population, the adverse environmental and occupational conditions. ▪ Specific Mortality Rate (SMR) ▪ Shows rate of dying in a specific population group. ▪ It can be calculated as: ▪ Cause-Of-Death Rate (CODR) ▪ Identifies the greatest threat to the survival of the people, thereby pointing to the need for preventing such deaths. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ It can be calculated as: ▪ Infant Mortality Rate (IMR) ▪ A good index of health in a community because infants are very sensitive to adverse environmental conditions. ▪ Thus, a high IMR means low levels of health standards that may be secondary to poor maternal health and child health care, malnutrition. ▪ It can be calculated as: ▪ Neonatal Mortality Rate (NMR) ▪ It can be calculated as: ▪ Postnatal Mortality Rate (PNMR) ▪ It can be calculated as:  Neonatal mortality rate and postnatal mortality rate add up to the IMR. The reason for such division is that the causes of neonatal deaths, that is, deaths among infants less than 28 days old are due mainly to prenatal or genetic factors. ▪ Maternal Death ▪ Death of a female from any cause related to or aggravated by pregnancy or its management during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. ▪ It can be calculated as: ▪ Case Fatality Rate (CFR) ▪ The proportion of cases that end up fatally. It gives the risk of dying among persons afflicted within particular disease. ▪ It is similar to an incidence proportion because it also a measure of average risk. ▪ It can be calculated as: ❖ POPULATION INDICATORS Include not only the population growth indicators but also other population dynamics that can affect the age-sex structure of the population and vice versa. Crude Birth Rate (CBR) Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ Measures how fast people are added to the population through births. ▪ Measure of population growth. ▪ It can be calculated as: A CBR greater than or equal to 45/1,000 live births implies high fertility while a ▪ level less than or equal to 20/1,000 live births implies low fertility. ❖ EXAMPLES OF HEALTH MILLENIUM DEVELOPMENT GOALS AND HEALTH INDICATORS GOAL/TARGET HEALTH TARGETS HEALTH INDICATORS Goal: 4 - Reduce child mortality - Under-five mortality rate Target: 5 - Reduce by two-thirds - Infant mortality rate between 1990 and 2015, - Proportion of 1-year old the under-five mortality children immunized against rate measles Goal: 5 - Improve maternal - Maternal mortality ratio Target: 6 health - Proportion of births - Reduce by three attended by skilled quarters between 1990 personnel and 2015 the maternal mortality ratio Goal: 6 - Combat HIV/AIDS, - HIV prevalence among Target: 7 malaria, and other pregnant women aged 15- diseases 24 years - Have halted by 2015 and - Condom use rate of the begun to reverse the contraceptive prevalence Target 8 spread of HIV/AIDS rate - Have halted by 2015 and begun to reverse the - Ratio of school attendance incidence of malaria and of orphans to school other diseases attendance of no orphanage aged 10-14 years - Prevalence and death rates associated with malaria - Proportion of population in malaria risk areas using effective malaria prevention and treatment measures - Prevalence and death rates associated with TB - Proportion of TB cases detected and cured under DOTS Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ General Fertility Rate (GFR) ▪ A more specific rate than CBR since births are related to the segment of the population deemed to be capable of giving birth, that is, the women in the reproductive age groups. ❖ Population Pyramid ▪ A graphical representation of the age-sex composition of the population that should also be examined during the assessment of the health status of the community. ❖ SOURCES OF HEALTH DATA Census Hospital data Vital registration system Health insurance Disease notification School health program Disease registers Downloadable data sets Surveillance system Surveys ❖ Disease Registry ▪ A compilation of information about a particular disease. ▪ The aim of disease registry is to include all cases of the disease in the registry without duplication. ❖ DISEASES SURVEILLANCE SYSTEMS IN THE PHILIPPINES 1. Notifiable Disease Reporting System (NDRS) 2. Field Health Service Information System (FHSIS) 3. National epidemiology Sentinel Surveillance System (NESSS) 4. Expanded Program on Immunization Surveillance System (IPE Surveillance) 5. HIV/AIDS Registry ❖ STAGES IN THE NATURAL HISTORY OF DISEASE AND THE LEVELS OF PREVENTION STAGES IN THE NATURAL HISTORY OF DISEASE Stage of Stage of Subclinical Stage of Clinical Resolution Susceptibility Disease Disease Stage The person is not The person is still The patient now The patient yet sick but may apparently healthy manifests either recovers be exposed to the since clinical recognizable signs completely from risk factors of the manifestations of and symptoms for the disease disease, for the disease are not example, vaginal becomes a instance, multiple yet shown, although bleeding. chronic case sex partners in pathologic changes with or without the case of have already disability or cervical cancer. occurred. dies. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  LEVELS OF PREVENTION Primary Level Secondary Level Tertiary Level ✓ Health ✓ Pap smear ✓ Applicable to education - can detect this limit the ✓ immunization early stage so disability and that prompt restore the treatment can be functional initiated to avoid capability of the progression of patient. the disease. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020