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Attached Files: Chapter_005 CHN.pptx (285.268 KB) Chapter_007 CHN.pptx (437.119 KB) Chapter_008 CHN.pptx (457.744 KB)Epidemiology of Health and IllnessCommunity Health PlanningImplementation and evaluation Read chapter 5, 7 and 8 of the class textbook and review the attachedPowerPoint presentations. Once done answer the following questions;Define epidemiology and describe the epidemiological triangle and other epidemiology tools in disease control and prevention.Discuss the use of epidemiology in disease prevention.Define and describe the concept of “community as a client.”Describe and discuss the goals of health education within the community setting.As stated in the syllabus please present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion board titled “Week 2 discussion questions”. A minimum of 2 evidence-based references no older than 5 years is required (not counting the class textbook). A minimum of 2 replies to any of your peers are required sustained with the proper references. A minimum of 700 words without counting the first and last page (reference) is required.INSTRUCTIONS:Go to http://www.healthypeople.gov/2020/default.aspx and review the Healthy People 2020 initiative. Pay close attention to the objectives, goals, and indicators.Using your city or county public health department or the CDC, choose 3 population or community based problems such as disease, disaster, crimes, accidents, falls etc.. from the topics outlined in the website and prepare an analysis discussing how these 3 conditions, affect your community and how they were identified and a plan of action to contained them base on healthy people 2020.You can also use the following CDC link https://www.cdc.gov/outbreaks/index.html and identify 3 community infectious outbreaks such as measles and develop the assignment.The presentation must be in APA format with a minimum of 1500 words (excluding first and references page) with a minimum of 4 evidence based references using the required Arial 12 font. Must include the zip code of the city or county chosen. Follow the APA example paper that was sent to you at the beginning of the course for guidance. Make sure references are used according to APA guidelines and electronic references must be from reliable sources such as CDC.
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Chapter 5
Epidemiology
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Epidemiology Is …
… the study of the distribution
and determinants of health and
disease in human populations
(Harkness, 1995)
… the principal science of
public health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Historical Perspective


Investigations of disease pattern in the
community; comparing people who had
disease or who remained healthy
Person-Place-Time Model



Person: “Who” factors, such as demographic
characteristics, health, and disease status
Place: “Where” factors, such as geographic
location, climate and environmental conditions,
political and social environment
Time: “When” factors, such as times of day, week,
or month and secular trends over months and year
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Different Types of Epidemiology

Descriptive Epidemiology




Study of the amount and distribution of disease
Used by public health professionals
Identified patterns frequently indicate possible
causes of disease
Analytic Epidemiology


Examine complex relationships among the many
determinants of disease
Investigation of the causes of disease, or etiology
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Epidemiological Triangle
Figure 5-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Agent of Disease
(Etiologic Factors)

Nutritive elements


Chemical agents


Poisons, allergens
Physical agents


Excesses, deficiencies
Ionizing radiation, mechanical
Infectious agents

Metazoa, protozoa, bacteria, fungi, rickettsia,
viruses
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Host Factors–Intrinsic Factors
(Susceptibility, or Response to Agent)






Genetic
Age
Sex
Ethnic group
Physiological state
Prior immunological experience



Active/, passive
Intercurrent or preexisting disease
Human behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Environmental Factors— Extrinsic
Factors…
… influence existence of the agent, exposure,
or susceptibility to agent
 Physical environment
 Biological environment


Human populations, flora, fauna
Socioeconomic environment

Occupation, urbanization and economic
development, disruption
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Wheel Model of
Human-Environment Interaction
Figure 5-2
Redrawn from Mausner JS,
Kramer S: Mausner and
Bahn epidemiology: an
introductory text, ed 2,
Philadelphia, 1985,
Saunders.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Web of Causation
Figure 5-3
From Friedman GD:
Primer of epidemiology, ed
4, New York, 1994,
McGraw-Hill.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Ecosocial Approach


Emphasize the role of evolving macro-level
socioenvironmental factors along with
microbiological process in understanding
health and illness (Smith & Lincoln, 2011)
Challenges the more individually focused risk
factor approach to understanding disease
origins
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Calculation of Rates

Rates are arithmetic expressions that help
practitioners consider a count of an event
relative to the size of the population from
which it is extracted


Number of health events in a specified period
Population in same area in same specified period
• Proportion multiplied by a constant (k)
• For example, the rate can be the number of cases of a
disease occurring for every 1000, 10,000 or 100,000
people in the population

Can make meaningful comparisons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Morbidity Rates

Incidence rates


New cases or conditions
Attack rate
• Number of new cases of those
exposed to the disease

Prevalence rates

All cases of a specific
disease or condition at
a given time
Figure 5-4
Redrawn from Morton RF, Hebel JR,
McCarter RJ: A study guide to epidemiology
and biostatistics, ed 3, Gaithersburg, MD,
1990, Aspen Publishers.
Prevalence Pot
The relationship between incidence
and prevalence
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Morbidity Rates (Cont.)
Incidence Rate
Number of new cases
_in given time period
× 1000
Population at risk in
same time period
___75___ = 0.02
4000–250
0.02 × 1,000 = 20 per 1000 per time period
Prevalence Rate
Number of existing cases
Total Population
250
_____
= 0.0625
4000
0.0625 × 1000 = 62.5 per 1000
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Mortality Rates
(routinely collected birth and death rates)





Other rates
Crude rates
Age-specific rates
Age-adjusted rates or
standardization of rates
Proportionate mortality
ratio (PMR)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Number of deaths in year
× 100,000
Total population size
_1720_ = 0.0086
200,000
Number of births in year
× 100,000
Total population size
_2900_ = 0.0145
200,000
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Concept of Risk


Risk—probability of an adverse event
Risk factor



Attributable risk


Refers to the specific exposure factor
Often external to the individual
Estimate of the disease burden in a population
Relative risk ratio

Divide the incidence rate of disease in the
exposed population by the incidence rate of
disease in the nonexposed population.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Use of Epidemiology

Disease prevention

Primary prevention
• Health promotion and specific prevention
➢ Secondary and tertiary prevention
➢ Establishing causality
➢ Screening
➢ Surveillance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Use of Epidemiology (Cont.)

Health services




Used to describe the distribution of disease
and its determinants in populations
Study population health care delivery
Evaluate use of community health services
Nurses must apply findings in practice


Incorporate results into prevention
programs for communities and at-risk
populations
Extend application into major health policy
decisions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Community health nurses should exercise
“social responsibility” in applying
epidemiological findings, but this will require the
active involvement of the consumer.
Community health nurses collaborating with
community members can combine
epidemiological knowledge and aggregate-level
strategies to affect change on the broadest
scale.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Epidemiological Methods

Descriptive epidemiology


Focuses on the amount and distribution of health
and health problems within a population
Analytic epidemiology

Investigates the causes of disease by determining
why a disease rate is lower in one population
group than in another
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Analytic Epidemiology

Observational studies




Descriptive purposes
Etiology of disease
No manipulation by investigator
Cross-sectional studies



Sometimes called prevalence or correlational
studies
Examine relationships between potential causal
factors and disease at a specific time
Impossible to make causal inferences
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Analytic Epidemiology (Cont.)

Retrospective studies



Compare individuals with a particular condition or
disease with those who do not have the disease
Data collection extends back in time
Prospective studies



Monitor a group of disease-free individuals to
determine if and when disease occurs
Cohort shares a common experience within a
defined time period
Monitors cohort for disease development
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Analytic Epidemiology (Cont.)

Experimental design

Also called a Randomized Clinical Trial (RCT)
• Subjects assigned to experimental or control group
• Apply experimental methods to test treatment and
prevention strategies
• Ethical considerations with human subject rights review

Also useful for investigating chronic disease
prevention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Chapter 7
Community Health Planning,
Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Figure 7-1
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Levels of
Community Health Nursing Practice
Client
Example
Characteristics
Health
Assessment
Nursing
Involvement
Individual
Lisa McDonald
Individual with various
needs
Individual strengths,
problems, and needs
Client-nurse interaction
Family
Moniz family
Family system with
individual and group
needs
Individual and family
strengths, problems, and
needs
Interactions with
individuals and the family
group
Group
Boy Scout
troop
Alzheimer’s
support group
Common interests,
problems, and needs
Interdependency
Group dynamics
Fulfillment of goals
Group member and
leader
Population
group
AIDS patients
in a given state
Pregnant
adolescents in
a school
district
Large, unorganized
group with common
interests, problems, and
needs
Assessment of common
problems, needs, and
vital statistics
Application of nursing
process to identified
needs
Organization
A workplace
A school
Organized group in a
common location with
shared governance and
goals
Relationship of goals,
structure,
communication, patterns
of organization to its
strengths, problems and
needs
Consultant and/or
employee application of
nursing process to
identified needs
Community
Italian
neighborhood
Anytown, USA
An aggregate of people
in a common location
with organized social
systems
Analysis of systems,
strengths,
characteristics,
problems, and needs
Community leader,
participant, and health
care provider
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Health Planning Model
Figure 7-2
Hogue (1985)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Steps in the Health Planning
Model

Assessment








Meet with group leaders of aggregate to clarify mutual
expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the identified problems and needs to create an
effective plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Four Types of Needs to Assess

Expressed needs


Normative needs


Lack, deficit, or inadequacy of services determined by health
professionals
Perceived needs


Demand for services and the market behavior of the targeted
population
Wants and desires expressed by audience
Relative needs

Gap showing health disparities between advantaged and
disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Factors for Determining Priorities






Aggregates preferences
Number of individuals affected by the health
problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time,
and available resources
May use Maslow’s hierarchy of needs or
levels of prevention to further refine priorities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Community Involvement Is Essential
“Start where the people are!”
 Five spheres of empowerment





Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Steps in the Health Planning Model
(Cont.)

Planning



Determine the intervention levels
• Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
• Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned
interventions according to available resources
• Personal, aggregate, and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Development of Goals and
Objectives


Goals—where we want to be
Objectives—steps needed to get there




Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Steps in the Health Planning Model
(Cont.)

Intervention

Often the most enjoyable stage for the nurse and
the clients
➢ Implementation should follow the initial plan
➢ Should include a variety of strategies
➢ Prepare for unexpected problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Interventions by
Type of Aggregate and System Level
Project
Type of Aggregate
System Level for Intervention
Rehabilitation group
Group
Subsystem and aggregate system
Textile industry
Organization
Aggregate system and suprasystem
Crime watch
Group, organization,
and population group
Aggregate system and suprasystem
Bilingual students
(case study)
Community
Aggregate system and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Steps in the Health Planning Model
(Cont.)

Evaluation




Include the participant’s verbal or written feedback and the
nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s
strengths and weaknesses
Evaluate both formative (process) and summative
(product/outcome) aspects
Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Importance of Each Step in the
Nursing Process

Aggregate assessments must be thorough.



The nurse must complete careful planning and set
goals that the nurse and the aggregate accept.



Should elicit answers to key questions about the aggregate’s
health and demographic profile
Should compare this information with similar aggregates
presented in the literature
Mutual planning is very important.
Interventions must include aggregate participation
and must meet the mutual goals.
Evaluation must include process and product
evaluation and aggregate input.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
PRECEDE-PROCEED Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Federal Legislation Affecting Health
Planning





Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources
Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Comprehensive Health Reform

Patient Protection and Affordable Care Act
(2010)

Preventive services based on evidence-based
recommendations
➢ National strategy to improve the nation’s health
➢ CMMS innovation center
➢ National quality improvement strategy for services
and population health
➢ Improved access to care
➢ Reduction in the growth of Medicare spending
➢ National workforce strategy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Nurses’ Role




Work collaboratively with health planners to
improve aggregate health
Fuse technology with knowledge of health
care needs and skills
Become directly involved in the planning
process
Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Chapter 8
Community Health Education
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Health Education …
… is any combination of learning experiences
designed to predispose, enable, and reinforce
voluntary behavior conducive to health in
individuals, groups or communities.
– Green and Kreuter, 2004
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Health Education’s Goals


To understand health behavior and to
translate knowledge into relevant
interventions and strategies for health
enhancement, disease prevention, and
chronic illness management
To enhance wellness and decrease disability
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Health Education’s Goals (Cont.)


Attempts to actualize the health potential of
individuals, families, communities, and
society
Includes a broad and varied set of strategies
aimed at influencing individuals within their
social environment for improved health and
well-being
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Learning Theories



Humanistic theory helps individuals develop their
potential in a self-directing and holistic manner.
Cognitive theory recognizes the brain’s ability to
think, feel, learn, and solve problems; theorists in this
area train the brain to maximize these functions.
Social learning is based on behavior that explains
and enhances learning through the concepts of
efficacy, outcome expectation, and incentives.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Adult Learners






Need to know
Concept of self
Experience
Readiness to learn
Orientation to learning
Motivation
– Knowles (1980, 1989)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Health Education Models
Health Belief Model (HBM)







Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Self-efficacy
Demographics
Cues to action
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Health Education Models (Cont.)
Health Promotion Model (HPM)

Individual characteristics and behaviors


Behavior—specific cognitions and affect


Prior behaviors, personal factors
Activity-related affect, interpersonal influences, situational
factors, commitment to plan of action, perceived self-efficacy,
immediate competing demands and preferences, perceived
benefits of health-promoting behaviors, perceived barriers to
health-promoting behaviors
Behavioral outcome

Health-promoting behavior
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