Community Health Nursing PDF

COMMUNITY HEALTH NURSING Research in community health ranges from simple MARGARET SHETLAND PHILOSOPHY inquiries to complex agency or organizational studies....

COMMUNITY HEALTH NURSING Research in community health ranges from simple MARGARET SHETLAND PHILOSOPHY inquiries to complex agency or organizational studies. Philosophy - a system of beliefs that provides a basis Attributes of nurse researchers include a questioning for and guides action. A philosophy provides the attitude, careful observation, open-mindedness, direction and describes the whats, the whys, and the analytical skills, and tenacity. hows of activities within the profession. According to Margaret Shetland, the philosophy of COLLABORATOR CHN is based on the worth and dignity of a man. Collaboration with clients, other nurses, physicians, FEATURES OF CHN social workers, physical therapists, nutritionists, attorneys, secretaries, and otheR colleagues is a part Preventive approach to health of the CHN. It is characterized by being population or Collaboration is defined as working jointly with others aggregate-focused in a common endeavor to cooperate as partners. It is developmental in nature With the existence of a prepayment mechanism for LEADER consumers of community health nursing services Care for different levels of clientele The role of a leader is distinguished from the role of a manager. ROLES AND ACTIVITIES OF COMMUNITY As a leader, CHN directs, influences, or persuades HEALTH NURSE others to effect change that will positively affect people’s health. Acting as change agent and influencing health CARE PROVIDER/CLINICIAN planning at local, state, and national levels are elements of the role of leader. CHN provides care along the whole range of the wellness-illness continuum Promotion of health and prevention of illness are HEALTH BELIEF MODEL (HBM) highlighted Developed in 1958 by a group of U.S. Public Health Service social psychologists. Believed that individual EDUCATOR must know what to do and how to do it before they can take action. Major limitation of HBM is that it As educator, nurses seek to facilitate client learning places the burden of action exclusively on the client. on a broad range of topics ADVOCATE PRECEDE – PROCEED MODEL Developed by Dr. Lawrence Green and colleagues. CHN as advocate is to help clients find out what services are available, which ones they are entitled to, PRECEDE and how to obtain these services. A second goal is to influence change and make the Stands for system more relevant and responsible to clients’ - Predisposing, needs. - Reinforcing, and - Enabling MANAGER - Constructs in - Educational Serve as managers, they supervise client care and - Diagnosis and ancillary staff, do case management, run clinics, and - Evaluation, used for community diagnosis. conduct community health needs assessment projects. The nurse engages in four steps of the management PROCEED process: planning, organizing, leading, and controlling evaluation. An acronym for - Policy, RESEARCHER - Regulatory, and - Organizational CHN engages in systematic investigations, collection, - Constructs in and analysis of data to enhance community health - Educational and practices. - Environmental  COMMUNITY HEALTH NURSING - Development is a model for implementing POPULATION COMPOSITION and evaluating health programs based on PRECEDE. The characteristics of population as to age, sex, occupation or educational level PREDISPOSING FACTORS POPULATION Refer to people’s characteristics that motivate them toward health-related behavior. This includes attitudes, beliefs, and values WHAT IS POPULATION? A population is defined as a group of individuals of ENABLING FACTORS the same species living and interbreeding within a given area. Refer to conditions in people and the environment Population is a collection of persons alive at a that facilitate or impede health related behavior. This specified point in time who meet certain criteria includes skills, availability, accessibility & referrals. POPULATION PROJECTIONS REINFORCING FACTORS Are a common demographic tool. They provide a basis Refer to feedback given by support persons or groups for other statistical projections, helping governments resulting from the performance of the health-related in their decision making behavior. This includes Support from family, peers, teachers, employers, healthcare providers. Components of population growth Birth → Death → Migration TYPES OF COMMUNITY SOURCES OF DEMOGRAPHIC DATA GEOPOLITICAL COMMUNITY Census – conducted by a national government and attempts to enumerate every person in a country. Territorial Example: School ♡ Census Method A spatial designation, geographical or political area, ❣ De Jure or place (Maurer and Smith, 2013) ❣ De Facto Sample Survey – is data gathered from small number of people proportionate to the general PHENOMENOLOGICAL COMMUNITY population Registration System – deals of recordings of vital Functional Example: Barangay events It includes social groups, professions, or religious groups POPULATION SIZE DEMOGRAPHIC DATA WHAT IS “NATURAL INCREASE”? WHAT IS DEMOGRAPHY? is defined as the difference between live births and deaths in a specified period of time. “Demography is the study of the size, territorial distribution, & composition of population, changes therein.” (Duncan & Hauser 1972) Natural Increase = Number of Births - Number of deaths (specified year) (specified year) (specified year) Literally translated from the Greek, 'demography' means 'description of the people. WHAT IS “RATE OF NATURAL INCREASE”? POPULATION SIZE Is defined as the difference between live crude births rate and crude death rate in a specified period of time. Refers to the number of people in a given place at a Known as the natural population change given time Rate of Natural Increase = Crude Births Rate - Crude Death POPULATION DISTRIBUTION Rate (specified year) (specified year) (specified year) Is the specific geographic location  COMMUNITY HEALTH NURSING WHAT IS “ABSOLUTE INCREASES PER YEAR”? WHAT IS “MEDIAN AGE”? Is the age that divides a population into two Measures the number of people that are added to the numerically equally sized groups - that is, half the population per year people are younger than this age & half are older. It is a single index that summarizes the age Absolute Increase per year distribution of a population Pt - Po WHAT IS “DEPENDENCY RATIO”? 一一一一 t Pt = population size at a latter time The age population ratio of those typically not in the Po = population size in an earlier time labor force & those typically in the labor force It is used to measure the pressure on the productive t = number of years between time o and time t population. WHAT IS “RELATIVE INCREASE”? total population of the 0 to 14 and 65 and above age group The actual differences between the two census counts ___________________________ x 100 expressed in percent relative to the population size total population of 15 – 64 age group made during an earlier census. Also known as the population growth rate, it measures the average yearly percentage change over the same WHAT IS “AGE AND SEX COMPOSITION”? time frame. Known as the age and sex structure. The universal characteristics of human populations Relative Increase are fundamental to understanding demographic Pt - Po processes of fertility, mortality & migration. 一一一一 Age composition may be summarized in terms of age Po groups (e.g., 0-15 years, 15-64 years and 65 or above). Pt = population size at a latter time The age and sex composition is depicted at the same Po = population size in an earlier time time using a population pyramid. POPULATION PYRAMID POPULATION COMPOSITION Size of the population under investigation is depicted The sex ratio is the ratio of males to females in a on the horizontal axis, and age is aligned on the population vertical axis. Sex Ratio = number of males ______________________ x 100 number of females WHAT IS “SEX COMPOSITION”? The sex ratio is the ratio of males to females in a population Sex Ratio = number of males POPULATION DISTRIBUTION ______________________ x 100 number of Population distribution means the pattern of where females people live. It denotes the spatial pattern due to dispersal of population, formation of agglomeration WHAT IS “AGE DISTRIBUTION”? and linear spread. URBAN – RURAL DISTRIBUTION Age distribution, also called Age Composition In population studies, the proportionate numbers of persons in successive age categories in a given Illustrates the proportion of the people living in urban population areas compared to the rural areas. A population with persistently high fertility, for instance, has a large proportion of children and a small proportion of aged persons.  COMMUNITY HEALTH NURSING CROWDING INDEX Is an alternative measure of household crowding. It is defined as the number of usual residents in a dwelling divided by the number of rooms in the dwelling Crowding Index = number of persons in a household _______________________ number of rooms used for sleeping POPULATION DENSITY is calculated as population divided by total land area. It is the people per sq. km of land area. Population Density = number of people ________________________ land area in terms of square meter or kilometer WEEK 3 CONT… the underlying socio-economic and cultural patterns of a society in different ways. MEDIAN AGE The sex ratio is the ratio of males to females in a - The age that divides a population into two population. numerically equally sized groups - that is, half the people are younger than this age and half are older. FORMULA: - It is a single index that summarizes the age distribution of a population. Census – is the procedure of systematically acquiring and recording information about the members of a given Ex. In Brgy. Pandayan there are 5,200 males and 4,800 population. females. Compute for the sex ratio: De Facto Census – allocates them to the place where enumerated — normally where they spend the night of the day enumerated. Interpretation: The sex ratio is 108.33 meaning there are De Jure Census – tallies people according to their regular 108 males for every 100 females in the community. or legal residence. WEEK 4 Urban - rural distribution - Illustrates the proportion of the people living in INFANT MORTALITY RATE (IMR) - best index of urban compared to the rural areas. overall health of the community - Infant mortality is the death of an infant before Sex composition his/her first birthday. - extremely vital for any meaningful demographic - It is the number of infant deaths for every 1,000 analysis. Changes in sex composition largely reflects live births.  - Best indicator of general health status of an area. - The higher the index means that the higher number - It reflects changes in the environment and medical of the population reaches 50 years of age. condition. - The measure of the longevity of life is a very good - A high IMR indicates that such an area is not indicator in comparing the health status of conducive to growth and development. different countries. FORMULA: FORMULA: EX. In a given year, a community has the ff mortality data: EX. In a community in a given year (1), the number of infant total number of deaths is 1000 while the number of deaths deaths is 25 while the total number of live births is 2,500. of aged 50 years and above is 700. Compute for the Compute for the IMR. Swaroop’s index. Interpretation: The IMR is 10 per 1000 live births, Interpretation: The Swaroop’s index is 70%, meaning that meaning that for every 1000 live births, 10 infants die 70% of all deaths occur among individuals aged 50 years before reaching the age of 1. and above. This indicates that a significant proportion of deaths are among older adults, which might suggest a SWAROOP’S INDEX higher life expectancy in the community. - an index of deaths above 50-year old. - It is said that the higher this rate the better is the health status of the population. RATES VS RATIO EX. In Barangay X, there were 1,200 live births in year 2018. Total population that same year was Rates – Shows the relationship between the vital event and 80,000. Compute the crude birth rate. those persons exposed to the occurrence of the said events, within a given area and during a specified unit of time. Interpretation: The natality rate/CBR is 15 live births per Ratio - is used to describe the relationship between (2) 1000 people, meaning every 1000 people in the population numerical quantities or measures of events without taking 16 babies were born in that year. particular considerations to the time or place. PREVALENCE RATE/PROPORTION - Measures total Crude - pertains to the general population number of existing cases of disease at particular point in time divided by the number of people at that point in time Natality Rate/Crude Birth rate - measures how fast people are added to the population through births. Increased by: - The crude birth rate is the annual number of live longer duration of disease births per 1,000 population prolongation of life of pt w/o cure - It measures population growth and is affected by: increase in new cases (increase in fertility incidence) marriage pattern and practices of the place in-migration of cases sex and age composition out-migration of healthy people and birth registration practice. in-migration of susceptible people FORMULA: improved diagnostic facilities (better reporting) Decreased by: shorter duration of disease high-case fatality rate from disease decrease in new cases (decrease in incidence) in-migration of healthy people out-migration of susceptible people improved cure rate of cases FORMULA: EX. The total population is 5,000 while the number of people with old and new cases is 1,200. Compute the prevalence rate. Interpretation: The prevalence rate is 24 cases per 100 people, which means out of 100 individuals in the population, 24 have the disease at that specific point of time. WEEK 5 a change in a health condition or other defined characteristics. Contain all: Terminologies Biological Epidemiology - The study of the occurrence and Chemical distribution of health conditions such as disease, death, Physical deformities in the human population. It is a highly Social quantitative discipline based on principles of statistics and Cultural research methodologies. Economic Generic behavioral factors that influence health Surveillance - MOST crucial role of a nurse epidemiologist Distribution -Epidemiology is concerned with the frequency and pattern of health events in a population. Pattern - refers to the occurrence of health-related events by time, place, and person. Time patterns may be Analysis by: annual, seasonal, weekly, daily, hourly, weekday versus weekend, or any other breakdown of time that may Places influence disease or injury occurrence. Time Classes of people affected Frequency - refers to the number of health events and the relationship of that number to the size of the Levels of Prevention population. It compares disease occurrence across different populations. Primary prevention - prevent the disease or injury before it occurs Determinants - Refers to any factor, whether event, characteristic, or other definable entity, that brings about Primordial Prevention - focusing on prevention of emergence of risk factors  Specific Protection – removal of the risk factors of Analytical Epidemiology - to analyze the causes or reduction of their levels determinants of disease through hypothesis testing. Health Promotion – activities include provision of Intervention or Experimental Epidemiology - answers proper nutrition, safe water supply and waste questions about the effectiveness of new methods for disposal system, vector control, promotion of controlling diseases or for improving underlying conditions. healthy lifestyle, and good personal habits Specific Measures - includes provision of Evaluation Epidemiology - to measure the effectiveness of immunization and prophylaxis to vulnerable or at different health services and programs. risk groups. Steps of Epidemiological Investigation Secondary - treat existing health problems at the earliest possible time. 1. OPERATIONALLY DEFINE WHAT CONSTITUTE A “CASE” - includes all screening and test for early detection of a disease like operation timbang, BSE, TSE, Case - a set of standard criteria for classifying whether a mammography person has a particular disease,syndrome, or other health condition Tertiary Prevention - Reduce magnitude of residual effects of both infections and non-communicable disease. Screening - is the presumptive identifications of (ex. Rehabilitation) unrecognized diseases or defects Phases of Epidemiology Case finding - is done to look for previously unidentified cases of diseases Descriptive Epidemiology - describes frequency & distribution of disease in a given population and observes & Sensitivity - is the proportion of persons with disease who records existing patterns of occurrence of disease. test positive on a screening test. Specificity - is the proportion of persons without a 4. ESTABLISH THE DESCRIPTIVE EPIDEMIOLOGIC disease who have negative results on a screening test. FEATURES OF THE CASES 2. IDENTIFY THE CASES - Case classification Time - The occurrence of disease changes over time. Some of these changes occur regularly, while others are Suspected: A case that meets the clinical case definition. unpredictable. Probable: A suspected case as defined above or ongoing Time Variations: epidemic and epidemiological link to a confirmed case. Cyclical Variation Confirmed: A suspected or probable case with laboratory FLUCTUATION in incidence confirmation. short period of time Due to seasonal (Ex. Measles) “CASE“ is classified as suspected or probable while waiting for the laboratory results to become available. If Secular Variation - changes in the TREND of disease laboratory provides report, case can is reclassified as occurrence over a long period of time. either confirmed or “not a case” Short Time Fluctuations 3. VERIFY THE EXISTENCE OF AN OUTBREAK COMMON SOURCE EPIDEMIC - Simultaneous exposure of Outbreak - carries the same definition of epidemic, but is a large number of people to a common infectious agent. often used for a more limited geographic area. PROPAGATED EPIDEMIC - Person-to-person transmission Cluster - is the aggregation of cases grouped in place & time that are suspected to be greater than the number Place - Describing occurrence of disease by place provides expected, even though the expected number may not be insight into: known. geographic scope of the problem geographic variation Characterization by place - refers not only to place of 9. DISSEMINATE FINDINGS OF INVESTIGATION residence but to any geographic site pertinent to disease THROUGH MEDIA AND OTHERS FORMS TO occurrence. INFORM PUBLIC a map provides a more striking visual display of place data. Types of Epidemic Host Cyclical/Seasonal Epidemic - rainy (dengue, colds); summer (sore eyes, heat stroke) Chance - Number of source of infection, location of source of infection/host Point Source Epidemic - single event, simultaneous Exposure Rate/Contact Rate - Depends on exposure (e.g food poisoning) frequency of contact Propagated Epidemic - person to person transmission, more Herd Immunity - Depends on the number of spread immunes 5. RECORD THE CLINICAL MANIFESTATION OF Secular Variation - change of disease overtime CASES 6. FORMULATE A HYPOTHESIS REGARDING Patterns of Diseases (Sporadic, Endemic, Epidemic) PROBABLE ETIOLOGIC AGENT, SOURCES OF INFECTION, MOT, & THE BEST APPROACH FOR Endemic - Habitual presence of disease in a given CONTROLLING AN OUTBREAK. geographic location 7. TEST HYPOTHESIS BY COLLECTING RELEVANT Epidemic - Situation when there is a marked upward SPECIMENS FROM PATIENT AND FROM fluctuation in disease incidence ENVIRONMENT 8. IMPLEMENT PREVENTION AND CONTROL Pandemic - Worldwide occurrence MEASURES TO PREVENT RECURRENCE OF A SIMILAR OUTBREAK Sporadic - When disease occur every now and then affecting only small number of people relative to total population Types of Evaluation Short Term/Outcome (immediate impact) - Evaluates the extent to which a project accomplishes its intended results. - It measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve Long Term/Impact (Sustainable effect) - assesses in interval the program effectiveness in achieving its ultimate goals The essence of impact evaluation is for comparison Process (Programs's actual implementation) 4 questions about NOH