Community Health Nursing 2 (Lecture-Prelim-Midterm) PDF

**COMMUNITY HEALTH NURSING 2 (LECTURE-PRELIM-MIDTERM)** **OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES** **INTRODUCTION:** - In the same manner that the Department of Health and the public health system have evolved into what it is response to the challenges of the times, so has...

**COMMUNITY HEALTH NURSING 2 (LECTURE-PRELIM-MIDTERM)** **OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES** **INTRODUCTION:** - In the same manner that the Department of Health and the public health system have evolved into what it is response to the challenges of the times, so has Public Health Nursing practice been influenced by the changing global and local health trends. These global and country health imperatives brought public health nursing into new frontiers and have positioned nurses to emerge as leaders in health promotion and advocacy. This perception has been validated by a WHO report acknowledging the significant contribution of the nursing workforce to the achievement of health outcomes, particularly that of the Millenium Development Goals. **GLOBAL AND COUNTRY HEALTH IMPERATIVES:** - Public health systems are operating within a context of ongoing changes, which exert a number of pressures n the public health system. These changes include: 1. **Shifts in demographic and epidemiological trends in diseases**, including the emergence and re-emergence of new disease\'s and in the prevalence of risk and protective factors; 2. **New technologies for health care, communication and information;** 3. **Existing and emerging environmental hazards** some associated with globalization; 4. **Health reforms**. September 2000- year when the global community, represented by the United Nations General Assembly decided to adopt a common vision of poverty reduction and sustainable development. This vision is exemplified the [Millenium] Development Goals (MDSs) which are based on the fundamental" - Values of freedom - Equality - Solidarity - Tolerance - Health - Respect for nature - Shared responsibility **LAWS AFFECTING PRACTICE OF PUBLIC HEALTH NURSING (TOPIC 1)** - **REPUBLIC ACT NO. 6713** -- March 25, 1983, known as the **Code of Conduct and Ethical Standards for Public officials and Employees**. This code [upholds a time-honored principal] that public office is a public trust. It is the policy of the state [to promote high standards of ethics in public office]. Public officials and employees with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives and uphold public interest over personal interest. - **Letter of Instruction No**. **949** the legal basis of primary health care date October 19, 1979, instructs the **Department of Health and all officials and personnel of the Department to design**, develop and implement programs which will [focus on health development at the community level particularly in rural areas, effectively utilize this system] in order to control or eradicate the immediate and specific health problems confronting Filipino communities. - With the passage of **R.A. 7160 of the Local Government Code,** the **responsibility for the delivery of basic services and facilities** of the national government has been transferred to the local government. This [involves the devolution of powers, functions and responsibilities] to the local government both provincial and municipal. - **Executive Order No. 503** provides for **the rules and regulations implementing the transfer of personnel, assets, liabilities and records** of national government agencies whose functions are to be devolved to the local government units. - **Republic Act No. 7305 --** is known as **Magna Carta for Public Health Workers.** This Act aims: [to promote and improve the social and economic well-being of health workers], their living and working conditions and terms of employment; to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and to encourage those with proper qualifications and excellent abilities to join. and remain in government service. - **Republic Act No.** **6758 standardized the salaries of government employees** which include the nursing personnel. - **Republic Act 7883 (February 20, 1995) -- Barangay Health Worker's Benefit's and Infective.** - **Republic Act 2382** is known as the **Philippine Medical Act.** This Act defines the practice of medicine in the country. A person [shall be considered as engaged in the practice of medicine who shall, for compensation, fee, salary or reward] in any form paid to him directly or through another, physically, mental condition or ailment, real or imaginary regardless of the remedy of treatment administered, prescribed or recommended. - **Republic Act 1082 -** The **First Rural Health Act implemented in 1953** called for [the employment of more physicians, dentists, nurses, midwives and sanitary inspectors] who will live in rural areas where they are assigned to help raise health condition of the barrio people and thus help abate the still high incidence of preventable diseases in the country as a whole. **It created the 1^st^ 81 Rural Health Units**. - **Republic Act 9173 -- "Philippine Nursing Act of 2002".** An act providing for a more responsive nursing profession, repealing for the purpose **RA 7164** otherwise known as **Philippine Nursing Act of 1991** and for other purposes. It is an act declaring the policy of the state [to assure responsibilities for the protection and improvement of the nursing profession] instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. - **Republic Act 3573** in 1929 declared that all communicable diseases **should be reported to the nearest health station**, and that any person may be inoculated, administered or injected with prophylactic preparations. These diseases include: actinomycosis, acute anterior (adult or infant) poliomyelitis, cerebro-spinal meningitis (epidemic), diphtheria, food poising, glanders, influenza, leprosy, malaria, measles, plague, pneumonia, mumps, opthalmia, neonatorum, tetanus, [trachoma, tuberculosis, typhoid, paratyphoid fever, typhus fever, variola or smallpox, varioloid, varicella, viscount\'s angina, whooping cough and yellow fever.] - **Republic Act 1891 amended R.A. 1082 in 1957.** It **strengthened health and dental services in the rural areas and created rural health** units of eight categories of staffing pattern corresponding to population groups of municipalities to be based on a more equitable and scientific distribution on the radio of personnel to population. - **Republic Act 8749 -- The Clean Air Act** approved in year 2000 but took effect in January 2001. - **Presidential Decree No. 825** requires **penalty for improper disposal of garbage & other forms of uncleanliness**. - **Presidential Decree No. 856** - the **Code on Sanitation** provides for the control of all factors in man\'s environment that affect health, including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary & recreation facilities, noise pollution, unpleasant odors & control of nuisance. - **Republic Act 9211** - **Tobacco Regulation Act. June 23, 2003**. - **Republic Act 8976** - **Philippine Food Fortification**. November 7, 2000. - **Republic Act 6365** - established a **National Policy on Population & created the Commission of Population**. - **Presidential Decree No. 1204** - amends P.D. No. 79 w/c included the **active participation of the Secretaries of the Department of Local Government & Community Development and the national family planning, health & welfare program.** - **Presidential Decree No. 791** - the **revised Population Act** **defines the objectives, duties & functions of the [POPCOM]**. Among others [it empowers nurses & midwives to provide, dispense & administer acceptable methods of contraception] after having training & authorization by the POPCOM in consultation w/ the appropriate licensing bodies. - **Executive Order No. 2009**. **The [Family Code] of the Philippines.** - **Republic Act 9255** (February 24, 2004) Provides for illegitimate children to **use the surname of their fathers**. - **Presidential Decree No. 965** requires applicants for **[marriage license]** to receive instruction on the family planning & responsible parenthood. - **Republic Act 7432 (April 23, 1992)** - maximize the **Contribution of Senior Citizens to Nation Building, Grant Benefits & Special Privileges**. It entitles the elderly to a **20% discount** in all public establishments & free medical & dental check up & hospitalization in all government hospitals. - **Republic Act 7600**- **Rooming-in & Breastfeeding**. - **Republic Act 9288**- **Newborn Screening**. April 4, 2004. - **Republic Act 9262 (March 8, 2004)**- **Anti-Violence Against Women & the Children.** March 8, 2004. - **Organ Donation Act of 1991.** - **Republic Act 7885- Advance Corneal Transplantation in the Philippines.** - **Republic Act 7719 (May 5, 1994) - National Blood Service.** - **Republic Act 7875 (February 14, 1995)- National Health Insurance Act of 1995.** - **Republic Act No. 6675-the Generics Act of 1988** w/c promotes requires & ensures the production of an [adequate supply, distribution, use & acceptance of drugs & medicines] identified by their generics name. - **Republic Act 6425** - known as the **Dangerous Drug Act** states that the [sale, administration, delivery, distribution & transportatio]n of prohibited drugs are punishable by law. - **Republic Act 4073** **liberalized the [treatment of leprosy]**. Except when the patient requires institution treatment, no person afflicted w/ leprosy shall be confined in a leprosarium. They shall be treated in a government skin clinic, rural health unit or by a duly licensed physician on domiciliary basis. - **Republic Act 8423**- created the **Philippine Institute of Traditional and Alternative Health Care (PITAHC)** to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care. **SUSTAINABLE DEVELOPMENT GOALS (TOPIC 2)** - According to the World Health Organization the **Sustainable Development Goals (SDGs)** [aim to transform our world]. - They are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice, and prosperity. - In 2015, all the countries in the United Nations adopted the [2030 Agenda for Sustainable Development]. It sets out 17 Goals, which include 169 targets. - Sustainable Development is development that meets the needs of the present without compromising the ability of future generations to meet their needs. It is a **visionary plan** that calls for [integration of economic development, social equity, and environmental protection]. It is development that puts people at the center and that is just, equitable and inclusive. - SDGs is the common acronym for the **Sustainable Development Goals,** also referred to as [Global Goals for Sustainable Development]. - The concept of the SDGs was agreed at the Rio+20 Summit (United Nations Conference on Sustainable Development) in 2012. The Rio+20 Outcome Document called for the SDGs to be "**global in nature and universally applicable to all countries, while taking into account different national realities, capacities and levels of development".** **HOW TO ACHIEVE THE SUSTAINABLE DEVELOPMENT GOALS?** - It is crucial to harmonize [three core elements]: **economic growth, social inclusion and environmental protection.** There elements are interconnected, and all are crucial for the well-being of individuals and societies. **WHY DO SDGs MATTER?** - The goals will stimulate action over the next fifteen years in areas of critical importance for humanity and the planet including: poverty eradication, food security, health education, gender equality, access to water, sanitation, clean energy, decent jobs , key infrastructure, strong institutions, inequality reduction, sustainable urbanization, responsible production and consumption patterns, climate change mitigation and adaptation, and ecosystem conservation. **GOALS \#1: NO POVERTY** - SDGs is to: "**End poverty in all its forms everywhere."** Achieving SDG 1 would end extreme poverty globally by 2030. - SDG 1 aims [to eradicate every form of extreme poverty including the lack of food, clean drinking water, and sanitation.] Achieving this goal includes finding solutions to new threats caused by climate change and conflict. SDG 1 focuses not just on people living in poverty, but also on the services people rely on and social policy that either promotes or prevents poverty. **GOAL \#2: ZERO HUNGER (NO HUNGER)** - SDG 2 is to: "End hunger, achieve food security and improved nutrition, and promote sustainable agriculture." Indicators for this goal are for example the prevalence of diet, prevalence of severe food insecurity, and prevalence of stunting among children under five years of age. - The five outcome targets are: ending **[hunger]** and improving access to food; ending all forms of **[malnutrition]**: **[agricultural productivity]**: sustainable food production systems and resilient agricultural practices: and genetic diversity of seeds, cultivated plants and farmed and domesticated animals: investments, research and technology. **GOAL \#3: GOOD HEALTH & WELL-BEING** - SDG 3 is to: \"Ensure healthy lives and promote well-being for all at all ages.\" - Important indicators here are life expectancy as well as child and maternal mortality. Further indicators are for example deaths from road traffic injuries, prevalence of current tobacco use, and suicide mortality rate. **GOAL \#4: QUALITY EDUCATION** - SDG 4 is to: \"Ensure inclusive and equitable quality education and Promote lifelong learning opportunities for all. - The seven outcome targets are: free primary and secondary education: equal access to quality pre-primary education; affordable technical. vocational and higher education; increased number of people with relevant skills for financial success; elimination of all discrimination in education; universal literacy and numeracy: and education for sustainable development and global citizenship. **GOAL \#5: GENDER EQUALITY** - SDG 5 is to: \"Achieve gender equality and empower all women and girls Indicators include, for example, having suitable legal frameworks and the representation by women in national parliament or in local deliberative bodies. The three means of implementation targets are: - fostering equal rights to economic resources, property ownership, and financial services for women. - promoting empowerment of women through technology - adopting and strengthening policies for gender equality, and supporting legislation to enforce it **GOAL \#6: CLEAN WATER & SOLUTION** - SDG 6 is to: \"Ensure availability and sustainable management of water and sanitation for all.\" - The [Joint Monitoring Programme (JMP)] of WHO and UNICEF is responsible for monitoring progress to achieve the first two targets of this goal. Important indicators for this goal are the percentages of the population that uses safely managed drinking water and has access to safely managed sanitation. **GOAL \#7: AFFORDABLE & CLEAN ENERGY** - SDG 7 is to \"Ensure access to affordable, reliable, sustainable and modern energy for all.\" - One of the indicators for this goal is the percentage of population with access to electricity (progress in expanding access to electricity has been made in several countries, notably India, Bangladesh, and Kenya). Other indicators look at the renewable energy share and energy efficiency. **GOAL \#8: DECENT WORK & ECONOMIC GROWTH** - SDG 8 is to: \"Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all.\" Important indicators for this goal include economic growth in least developed countries and the rate of real GDP per capita. - Further examples are rates of youth unemployment and occupational injuries or the number of women engaged in the labor force compared to men. **GOAL \#9: INDUSTRY, INNOVATION, & INFRASTRUCTURE** - SDG 9 is to: \"Build resilient infrastructure, promote Inclusive and sustainable industrialization, and foster innovation.\" Indicators in this goal include for example, the proportion of people who are employed in manufacturing activities, are living in areas covered by a mobile network, or who have access to the internet. An indicator that is connected to climate change is \"CO2 emissions per unit of value added. **GOAL \#10: REDUCED INEQUALITY** - SDG 10 is to: \"Reduce inequality within and among countries.\" - Important indicators for this SDG are: income disparities, aspects of gender and disability, as well as policies for migration and mobility of people. **GOAL \#11: SUSTAINABLE CITIES & COMMUNITIES** - SDG 11 is to: \"Make cities and human settlements inclusive, safe, resilient and sustainable.\" Important indicators for this goal are the number of people living in urban slums, the proportion of the urban population who has convenient access to public transport, and the extent of built- up area per person. **GOAL \#12: RESPONSIBLE CONSUMPTION & PRODUCTION** - SDG 12 is to: \"Ensure sustainable consumption and production patterns.\" One of the indicators is the number of national policy instruments to promote sustainable consumption and production patterns. Another one is global fossil fuel subsidies. - An increase in domestic recycling and a reduced reliance on the global plastic waste trade are other actions that might help meet the goal. **GOAL \#13: CLIMATE ACTION** - SDG 13 is to: "Take urgent action to combat climate change and its impacts by regulating emissions and promoting development in renewable energy." - In 2021 to early 2023, the Intergovernmental Panel on Climate Change (IPCC) published its Sixth Assessment Report which assesses scientific, technical and, and socio-economic information concerning climate change. **GOAL \#14: LIFE BELOW WATER** - SDG 14 is to: "Conserve and sustainably use the oceans, seas and marine resources for sustainable development." - The current efforts to protect oceans, marine environment and small-scale fishers are not meeting the need to protect the resources. Increased ocean temperatures and oxygen loss act concurrently with ocean acidification to constitute the deadly trio of climate change pressures on the marine environment. **GOAL \#15: LIFE ON LAND** - SDG 15 is to: "Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss." It is to protect and restore terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and stop biodiversity loss. - Global and regional efforts to sustain forest ecosystems as well as their social, economic and environmental functions are essential, in particular for developing countries and the tropics. **GOAL \#16: PEACE, JUSTICE AND STRONG INSTITUTIONS** - SDG 16 is to: "Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels." - Rates of birth registration and prevalence of bribery are two examples of indicators included in this goal. **GOAL \#17: PARTNERSHIPS FOR THE GOALS** - SDG 17 is to: "Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development." Increasing International cooperation is seen as vital to achieving each if the 16 previous exchange, expertise, technology, and financial resources is recognized as critical to overall success of the SDGs. - The goal includes improving north-south and South-South cooperation. Public-private partnerships which involve civil societies are specifically mentioned. **"LEAVE NO ONE BEHIND"** - This phrase was the guiding principle of world leaders of 193 countries in solving the most pressing problems of today. This was also actually the official motto set by the United Nations (UN) for the Sustainable Development Goals (SDGs). **FIELD OF OPPORTUNITIES IN NURSING (TOPIC 3)** **CLASSFICIATION OF FIELD OF NURSING IN GENERAL** - **HOSPITAL OR INSTITUTIONAL NURSING** - Comprises all the basic components of comprehensive patient care and family health. - Community health center as the concept/hospital. - Participate as a member of the health care team to all phases of patient care, ill and well. - Perform nursing measure that will meet the patient's and family to plan care once discharge. - Function involved using the nursing process whether this be personal care, rehabilitation measure or health instruction. - Participate in the research and training carried on the hospital. **PUBLIC HEALTH NURSING/COMMUNITY HEALTH NURSING** - Focus on the promotion of health and prevention of disease. - Deeper involvement and close cooperation of work with all members of the health team such as sanitary engineers, social workers, nutritionist, BHW. **ADVANTAGES:** - Focuses of nursing care is only F and C health rather than on an individual basis, able to see the total picture of F and C health. - It gives the nurse better perspective of the health condition of the community in the health program and role in nation building. - Their main role/job is to find themselves custodian of employees health records, counselor and adviser of the workers, and first aide to the injured. **NURSING EDUCATION** - Capable of promoting interest and competent in the subject they teach. - Expert in providing nursing care in the chosen field and are good role model. - Salaries are higher than those working in the hospital. **MILITARY NURSING** - When famed Tandang Sora led nursing the sick and the wounded Katipunan Revolutionaries in 1980, military nursing in the Philippines maybe said to have begun. - To meet the nursing needs of today's patients in AFP medical facilities. **FLIGHT NURSING** - Peculiar only to the military and to the Air Force- who is responsible for patient, military or otherwise who different fields of nursing are being evacuated from battle areas to the nearest installation for treatment. **SCHOOL NURSING** - Primarily concerned in the health of the school's student thru: - Organization and implementation of the school health programs. - Coordination of health program - Evaluation - Health of school personnel **CLINICAL NURSE/CENTER** - Generally restricted to the care of patient who are not confined to bed as require general skills. **INDEPENDENT NURSING PRACTICE** - Nurse is self employed and provide professional nursing services to client/patient and their families. - They reach out and offer their services rather than expect clients to seek their help. **OPPORTUNITIES FOR NURSING ABROAD CATEGORIES:** - Immigrant - Short term employment **THE FILIPINO FAMILY** - Based on the Philippine constitution, Family Code with focused on religious, legal, and cultural aspects of the definition of family. **Section 1.** The state recognizes the Filipino Family as the foundation of the nation. Accordingly, It shall strengthen its solidarity and actively promote its total development. **Section II**. Marriage, as an inviolable social institution, is the foundation of the family and shall be protected by the state, **Section III**. The state shall defend: 1. The right of spouses to found a family in accordance with their religious convections and the demands of responsible parenthood 2. The right of children assistance including proper care and nutrition, and special protection and the conditions prejudicial to their environment or development 3. The right of the families or family association to participate in the planning and implementation of policies and programs of that affect them. **Section IV**. The family has the duty to care for its elderly members but the state may also do through Just programs of social security, **TYPES OF FAMILY** - Factors that may affect or change the types of family: a. Birth b. Death c. Migration d. Separation e. Growth of family members **ACCORDING TO STRUCTURE** **Classification:** 1. **NUCLEAR --** composed of a mother, father, with child/children living together but apart from both sets of parents and other relatives. 2. **EXTENDED --** composed of two or more nuclear families economically or socially related to each other. - **Multigenerational**, including married brothers and siters and families. 3. **SINGLE PARENT --** divorced or separated, unmarried or widowed male or female with at least one child. 4. **BLENDED/RECONSTITUTED --** a combination of two families with children from both families and sometimes children of the newly married couple. It is also a remarriage with children from previous marriage. **TYPES OF FAMILY ACCORDING TO:** **[AUTHORITY]** 1. **PATRIARCHAL --** full authority is on the [father or any male member of the family]. **Explanation:** when making decisions the father is the one who has the right or the power to decide. For example, in a health care setting the father is the one who will choose certain or specific services that will benefit at the same time to meet the needs of the whole family. 2. **MATRIARCHAL --** full authority is on the [mother or any female of the family. ] **Explanation**: In this kind of family, the mother is responsible for decision making. Even though the father is present at home the mother has the full she is the one making decisions regarding for their needs. authority and she is the one making decisions regarding for their needs. In the first two types of family when one of the parents is deceased already the children take charge. In patriarchal any of the male child in the family and in matriarchal any female member of the family will act as the decision maker. It doesn\'t matter whatever age of the child, even the eldest or the youngest as long as they can make a good decision. 3. **EGALITARIAN/EQUILITARIAN --** husband and wife exercise an **equal** or a more or less amount of authority. **Explanation:** As the term suggest in this type of family both father and mother have the authority especially In making decisions. It\'s just like they are Joining forces and power to have a healthy home and to merely achieve the needs of their children. 4. **DEMOCRATIC --** everybody is involved in **decision making.** **Explanation:** In this type of authority the decisions may come from anyone in family. They share their ideas related to decisions and they make their decisions as one. Everyone can suggest or take part in making decisions suitable for their family and to meet their needs. 5. **METRICENTRIC -- mother decides/takes charge** in absence of the father. **Explanation**: It is just like the matriarchal wherein the mother is the one with the authority, the only difference is that in this type of family the father is not present in the family. For example, if the father is already dead or working abroad of course the mother takes charge in decision making. 6. **PATRICENTRIC -- father decides/take charge** in decision making. **Explanation:** In contrast with matricentric this is the type of a family wherein the father makes decisions if the mother is away. **EPIDEMIOLOGY AND THE NURSE (TOPIC 4)** - **EPIDEMIOLOGY** - is the study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events in specified population, and the application of this study to the control of health problems. This emphasizes that epidemiologist are concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health. TWO MAIN AREAS OF INVESTIGATION: 1. The [first] are describes the distribution of health status in terms of **age, gender, race, geography, time** and son might be considered in an expansion of the discipline of demography to health and diseases. 2. The [second] are involves **explanations of the patterns of disease distribution in terms of casual factors.** USES OF EPIDEMIOLOGY: According to Morris, epidemiology is used to: - Study the history of the health population and the rise and fall of diseases and changes in their character. - Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to define their relative importance and to identify groups needing special attention. - Study the work of health services with a view of improving them. Operational research shows how community expectations can result in the actual provisions of service. - Estimate the risk of disease, accident, defects and the chances of avoiding them. - Identify syndromes by describing the distribution and association of clinical phenomena in the population. - Complete the clinical picture of chronic disease and describe their natural history. - Search causes of health and disease by comparing the experience of groups that clearly defined by their composition, inheritance, experience, behavior and environments. The Epidemiology Triangle THE EPIDEMIOLOGY TRIANGLE CONSITS OF 3 COMPONENTS: 1. **HOST -** is any organism that harbors and provides nourishment for another organism. 2. **ENVIRONMENT -** is the sum total of all external condition and influences that affects the development of an organism which can be biological, social, and physical. It affects both the agents and the host. 3. **AGENT -** is the intrinsic property of microorganism to survive and multiply in the environment to produce disease. 4. **CAUSATIVE AGENT -** is the infectious agent or its toxic component that is transmitted from the source of infection to the susceptibility body. 3 COMPONENTS OF THE ENVIRONMENT: 1. **PHYSICAL ENVIRONEMENT -** is composed of the inanimate surroundings such as the geophysical conditions of the climate. 2. **BIOLOGICAL ENVIRONMENT -** makes up the living things around us such as plants and animal life. 3. **SOCIO-ECONOMIC -** which may be in the form of level of economic development of the community and presence of social disruptions. Classification of Agents, Host and Environmental Factors which determine the occurrence of Disease in Human Population: +-----------------------------------+-----------------------------------+ | 3. AGENTS OF DISEASE | ETIOLOGICAL FACTORS: | | | | | | EXAMPLES: | +===================================+===================================+ | A. Nutritive Elements | Cholesterol | | | | | - Excess | Vitamins, Proteins | | | | | - Deficiencies | Carbon Monoxide, drugs | | | | | B. Chemical Agents | Ragweeds, poison ivy | | | | | - Poisons | Heat, light, ionizing radiation | | | | | - Allergens | Hookworm, Schistosomiasis | | | | | C. Physical Agents | Rheumatic Fever, lobar | | | | | D. Infectious Agents | Pneumonia, typhoid | | | | | - Metazoa | Histoplasmosis, athlete's foot, | | | Rocky Mountain, spotted fever, | | - Protozoa | Measles, mumps, chicken pox, | | | poliomyelitis, rabies | | - Bacteria | | | | | | - Fungi | | | | | | - Rickettsia | | | | | | - Viruses | | +-----------------------------------+-----------------------------------+ | 1. HOST FACTORS (Intrinsic | | | Factors) -- influence | | | exposure susceptibility or | | | response to agents | | +-----------------------------------+-----------------------------------+ | A. Genetic | Sickle cell disease | | | | | B. Age | Fatigue pregnancy, puberty, | | | stress | | C. Sex | | | | Hypersensitivity | | D. Ethnic group | | | | Prior infection, immunization | | E. Physiologic | | | | Maternal antibodies, gamma | | F. Immunologic Experience | globulin | | | | | - Active | Personal hygiene, food handling | | | | | - Passive | | | | | | G. Inter-current or pre-existing | | | disease | | | | | | H. Human behavior | | +-----------------------------------+-----------------------------------+ | 2. ENVIRONMENTAL FACTORS | | | (Extrinsic factors) -- | | | influence existence of the | | | agent, exposure or | | | susceptibility to agent | | +-----------------------------------+-----------------------------------+ | A. Physical environment | Geology, climate | | | | | B. Biological environment | Density | | | | | - Human population | Sources of food, influence on | | | vertebrates | | C. Socio-economic environment | | | | Exposure to chemical agents | | - Occupation | | | | Urban crowding, tension | | - Urbanization | | | | Wars, disasters | | - Disruption | | | | | | - | | +-----------------------------------+-----------------------------------+ **PATTERNS OF OCCURRENCE AND DISTRIBUTION** - The variables of disease as to person, time and place are reflected in distinct patterns of occurrence and distribution in a given community. The following are the characteristic features of those patterns of disease occurrence: **1. SPORADIC OCCURRENCE -** is the intermittent occurrence of a few isolated and unrelated cases in a given locality. The case are few and scattered so that there is no apparent relationship between them and they occur on and off, intermittently, through a period of time. **Example**: Rabies occurs sporadically in the Philippines. In a given year, there are few cases during certain weeks of the year, while the few cases are occurring. the cases are scattered throughout the country, so that the cases are not related at all to the cases in other area. 2. **ENDEMIC OCCURRENCE** - is the continuous occurrence throughout a period of time, of the usual number of cases in a given locality. The disease is more or less inherent in that locality, it is in a way already identifiable with the locality itself. Example: Schistosomiasis in endemic In Leyte and Samar, Filariasis is endemic in Sorsogon, Tuberculosis is endemic practically in all specific areas of the country. 3. **EPIDEMIC OCCURRENCE -** is of unusually large number of cases in a relatively short period of time. The number of cases is not in itself necessarily big or large, but such number of cases when compared with the usual number of cases may constitute an epidemic in a given locality, as long as that number is so much more than the usual number in that locality. **Example**: There has been no case of bird\'s flu in any area of the country, so that the occurrence, so that the occurrence of few cases in a given area in a given time would constitute a bird\'s flu epidermic. 4. **PANDEMIC -** is the simultaneous occurrence of epidemic of the same disease in several countries. It is another pattern occurrence from an international perspective**.** **EPIDEMICS** Factor's Contributory to Epidemic Occurrence: - **[AGENT FACTOR]** - the result of the introduction of new disease agents into the population. It may also result from changes in the number of living microorganisms in the immediate environment or from their growth in some favorable culture medium. - **[HOST FACTORS]** - are related to lower resistance as a result of exposure to the elements during floods or other disaster, to relaxed supervision of water and milk supply or sewage disposal, or to changed habit of eating. The host factor may be related to change in immunity and susceptibility to population density and movement, crowding, to sexual habits, personal hygiene or to changes in motivation as result of health education. - **[ENVIRONMENTAL FACTORS]** - in the physical environment; temperature, humidity, rainfall may directly or indirectly influence equilibrium of agent and host. OUTLINE OF PLAN FOR EPIDEMIOLOGICAL INVESTIGATION: 1. **Establish fact of presence of epidemic.** - Verify Diagnosis do clinical and laboratory studies to confirm the data - Reporting - Is there an unusual prevalence of the disease? 2. **Establish time and space relationship of the disease** 3. **Relations to characteristic of the group of community** 4. **4. Correlation of all data obtained** **EPIDEMIOLOGY AND SURVELLIANCE UNITS** - Epidemiology and Surveillance units have been established in regional and some local office as support to the public health system. As an epidemiologic information service, the unit is mainly responsible for providing timely and accurate information on disease in the locality. Such information will be used mainly as basis for identifying health problems, allocation of resources and other discussions in health care. **Among its responsibilities includes:** a. **Surveillance of infectious diseases with outbreak potential** b. **Assisting local government units in investigation of outbreak and their control** c. **Developing information package on public health** d. **Providing technical assistance related to epidemiology** **PUBLIC HEALTH SURVELLIANCE** - Public Health Surveillance- is an on-going systematic collection, analysis, interpretation and dissemination of health data. - Surveillance system- is often considered information loops or cycles involving health care providers, public health agencies and the public. - The cycle begins when cases of diseases occur and are reported by health care providers to the public health agencies. Information about cases are relayed to those responsible for disease prevention and control and others \"who need to know\". Because health providers, health agencies and the public have responsibility on disease prevention and control, they should be included among those who receive feedback of surveillance information. Others who need to know may include other government agencies, potentially exposed individuals, employers, vaccine manufacturers, private voluntary organization. Public Summaries, Interpretations Health Care Providers Report Recommendations Health Agencies **Figure above**. Information loop involving health care providers, public health fancies and the public. **ROLE OF THE NURSE IN SURVELLIANCE** - One of the areas where public health nurse function as researcher is disease surveillance. **Surveillance** - is a continuous collection and analysis of data of cases and death. It is also important in monitoring the progress of the disease reduction initiatives and an integral part of many programs. The objectives of surveillance are: **1. To measure the magnitude of the problem.** **2. To measure the effect of the control program.** **THE NATIONAL EPIDEMIC SENTINEL SURVEILLANCE SYSTEM (NESSS) AND ITS ROLE** **National Epidemic Sentinel Surveillance System -** is a hospital-based information system that monitors the occurrence of infectious diseases with outbreak potential. It also serves as a supplemental information system of the Department of Health. **Objectives**: - To provide early warming on occurrence of outbreaks. - To provide program managers, policy makers, and public administrators, rapid, accurate and timely information so that inventive and control measures can be instituted. **THE NESSS DATA SHOWS:** - Trends of cases across time - Demographic characteristics of ratio - Estimates case fatality rat cases - Clustering of cases in a geographical area - Information to formulate hypotheses for disease causation **DISEASE UNDER SURVELLIANCE (NESSS)** **Laboratory Diagnosed** 1. Cholera 2. Hepatitis A 3. Hepatitis B 4. Malaria 5. Typhoid Fever **CLINICAL DIAGNOSED** 1. Dengue Hemorrhagic Fever 2. Diphtheria 3. Measles 4. Meningococcal disease 5. Neonatal tetanus 6. Non-Neonatal Tetanus 7. Pertussis 8. Rabies 9. Leptospirosis 10. Acute Flaccid Paralysis (Poliomyelitis) **UNDER SURVELLIANCE SYSTEM:** 1. Acute Flaccid Paralysis 2. Measles 3. Maternal and neonatal tetanus 4. Paralytic shellfish poisoning 5. Fireworks and related injury 6. HIV/AIDS **Why is there a need to investigate an outbreak?** **Importance of Outbreak Investigation:** - Control and prevention measure - Severity and risk to others - Research opportunities - Public, political or legal concerns - Program considerations - Training **SOURCES:** - Surveillance data - Medical Practitioner - Affected person/group - Concerned citizen - Media **STEPS IN OUTBREAK INVESTIGATION:** **Step 1 -** Prepare for field work **Step 2-** Establish the existence of an outbreak **Step 3 -** Verify Diagnosis **Step 4 -** Define and Identify cases - **Establish a case definition** - **Identify and count cases** **Step 5 -** Perform descriptive epidemiology **Step 6 -** Developing Hypotheses **Step 7-** Evaluate hypotheses **Step 8 -** Refine hypotheses and execute additional studies **Step 9 -** Implement control and prevention measures **Step 10 -** Communicate findings **Step 11 -** Follow-up Recommendations **FUNCTION OF THE EPIDEMIOLOGY NURSE:** a. Implement public health surveillance b. Monitor local health personnel conducting disease surveillance c. Conduct and/or assist other health personnel in outbreak investigation d. Assist in the conduct or rapid surveys and surveillance during disasters e. Assist in the conduct of surveys, program evaluations and other epidemiologic studies f. Assist in the conduct of training course in epidemiology g. Assist the epidemiologist in preparing the annual report and financial plan Responsible for Inventory and maintenance of epidemiology and surveillance unit (ESU) equipment. **SPECIFIC ROLE DURING EPIDEMIOLOGICAL INVESTIGATIONS:** - Maintains surveillance of the occurrence of notifiable disease. - Coordinates with other members of the health team during the disease outbreak. - Participates in case findings and collection of laboratory specimens. - Isolates cases of communicable disease. - Renders nursing care, teaches and supervises giving of care. - Performs cases of communicable disease. - Gives health teachings to prevent further spreads of disease to Individual and families. - Follow up cases and contacts. - Organizes, coordinates and conducts community health education campaign/meetings. - Refers cases when necessary. - Coordinates with other concerned community agencies. - Accomplishes and keeps records and reports and submits to proper office/ agency. **VITAL STATISTICS (TOPIC 5)** **STATISTICS** - Refers to a systematic approach to obtaining, organizing and analyzing numerical facts so that conclusion may be drawn from them. **VITAL STATISTICS** - Refers to the systematic study of vital events such as births, illness, marriages, divorce, separation and deaths. **STATISTICS OF DISEASE (MORBIDITY) AND DEATH (MORTALITY)** - Indicate the state of health of a community and the success or failure of health work. Statistics on population and the characteristics such as age and sex, distribution are obtained from the ***National Statistics Office (NSO).*** Births and Deaths are registered in the ***Office of the Local Civil Registrar*** of the municipality or city. In cities, births and deaths are registered in the ***City Health Department.*** **USE OF VITAL STATSITICS:** - Indices of the health and illness status of a community - Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services. **SOURCES OF DATA:** - Population census - Registration of Vital data - Health Survey - Studies and researches **RATES AND RATIOS:** - **RATES --** shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specified unit must come from the total population exposed to the risk of same event (Denominator). - **RATIO --** is used to describe the relationship between two (2) numerical quantities or measures of events without taking particular considerations to the time or place. These quantities need not necessarily represent the same entities, although the unit of measure must be the same for both numerator and denominator of the ratio. - **CRUDE OR GENERAL RATES --** referred to the total living population. It must be presumed that the total population was exposed to the risk of the occurrence of the event. - **SPECIFIC RATE --** the relationship is for a specific population class or group. It limits the occurrence of the event to the portion of the population definitely exposed to it. **CRUDE BIRTH RATE (CBR)** - A measure of one characteristic of the natural growth or increase of a population. **CRUDE DEATH RATE (CDR)** - A measure of one mortality from all causes which may result in a decrease of population.  **INFANT MORTALITY RATE (IMR)** - Measure the risk of dying during the 1^st^ year of life. It is a good index of the general health condition of a community since its reflects the changes in the environment and medical condition of a community. **THE NESS DATA SHOWS:** - Trends of cases across time - Demographci characteristics of cases - Estimates of cases in a geographical area - Information to formulate hypotheses for disease causation. **FORMULAS** 1. **% OF PREMATURE BABIES** 2. **SEX RATIO AT BIRTH** 3. **INFANT MORTALITY RATE**  4. 5. **CRUDE BIRTH RATE** 6. **% LOW (VERYLOW) BIRTH WEIGHT** 7. **INFANT MORTALITY RATE** 8. **PREGNANCY-RELATED MORTALITY RATE**