Final

Population - Definition

• All people occupying an area OR all those sharing one or more characteristics

• Do NOT necessarily interact with one another

• Variety of ways to define → Geography or common qualities

Population - Examples

• Prisoners

• Senior Nursing Majors

Community - Definition

• Collection of people who share important feature of their lives

Community Classifications

1. Geographic

2. Common Interest

3. Health Problem

Geographic Community - Definition

• Provides clear target for analysis of health needs

Common Interest Community - Definition

• Collection of people with interest or goal that binds them together

• Widely scattered

• Large variety of possibilities

Health Problem Community - Definition

• Group of people that come together to solve a problem that affects them all

• May or may NOT be geographic

• Important force for change

Health Problem Community - Examples

• Flint Michigan lead in the water → Used the media to gain attention for help

• Idaho food insecurity → Made a food pantry/grew food and brought it to those in need

Wellness

• Health + Capacity to develop a person’s potential to lead to a fulfilling and productive life (QOL)

Health Continuum

• Illness and wellness are a balancing scale that is always changing

Core Functions of Public Health - Three Functions

1. Assessment

2. Policy Development

3. Assurance

Core Functions of Public Health - Assessment

• Health needs

• Risks

• Environmental conditions

• Political agendas

• Financial and other resources

• *All parts of the assessment will be gathered in a variety of ways (Interviews, surveys, etc.)

Core Functions of Public Health - Policy Development

• Synthesize and analyze assessment data to create comprehensive public health policy

• Provide leadership to evaluate health concerns and develop a plan

Core Functions of Public Health - Assurance

• Pledge that the services necessary to achieve goals are provided

• May require encouraging actions

• DOING THE WORK to make the changes needed based on assessment

Core Functions of Public Health - Examples

Manager - Definition

• Utilize problem-solving functions to manage health services

Manager - Actions to Function

1. Planning → Assess needs and define goals in order to carry out strategic/operational planning

2. Organizing → Framework for people/tasks to reach desired outcomes

3. Leading → Directs, influences, or persuades others to effect change through two way communication

4. Controlling → Monitors plan and makes sure it stays on course

5. Evaluating → Adjust or correct plan to meet desired goals

Early Home Care Nursing - Progression

1. Religious and charitable groups with no knowledge about diseases

2. Medieval Times → Development of sick institutions including hospitals

3. Early 1600s → St. Frances de Sales organized Friendly Visitor Volunteers

4. 1617 → St Vincent de Paul started Sisters of Charity in Paris consisting of nuns and laywomen to serve the poor and needy

District Nursing (1800s-1900s) - Definition

• Visiting nursing

  • Worked outside the hospital in community settings

  • Focused on care and health promotion including cleanliness and wholesome living

1800s → Industrial Revolution - General Info

• Life Expectancy = 40 (better in rural areas)

• COD = Cholera, TB, typhoid, accidents, childbirth

• Food = Markets or grown

  • Refrigeration in late 1800s

• Day = 12-16 hour work days, child labor, pollution

  • Florence Nightingale

1800s → Industrial Revolution - Nurses Roles

• Began professionalizing → Training schools

• Public health began addressing poor conditions and epidemics

• Worked in hospitals, poorhouses, emerging clinics

• District nurses did home visits in urban areas

1960s → Post War Modernization - General Info

• Life Expectancy = 70 years

• COD = Heart disease, cancer, stroke, accidents

• Food = Grocery stores, refrigerators/freezers, use of canned, frozen, and processed food

• Day = 9-5, women questioning their place in traditional roles

1960s → Post War Modernization - Nurses Roles

• Licensed, trained professionals

• Working in hospitals, schools, public health departments

• Growth of community health nursing, school nursing, and occupational health

• Began specialized roles → Peds, OR, Psych

• NP movement emerging

Steps of EBP

Steps of EBP → Step 0 - Cultivating Spirit of Inquiry

• Must continually examine, question, and challenge current practice to make effective change → Ask the questions!

Steps of EBP → Step 1 - Ask the Question

• In the form of PICOT

What does PICOT stand for?

• P → Patient/Population/Problem

• I → Intervention

• C → Comparison

• O → Outcome

• T → Time

Steps of EBP → Step 1 - PICOT Examples

Steps of EBP → Step 2 - Find the Evidence

• Search for all relevant research on clinical questions and critically analyze the evidence

  • Look at BIG data sources

Steps of EBP → Step 3 - Critically Appraise Evidence (3 Questions)

1. What is the evidence’s validity?

   • Is it true/legit?

2. Is the evidence reliable?

   • Is there bias? Large enough sample size?

3. Is the evidence applicable?

   • Does is look at your population?

Appraising Evidence - Definition

• Systematically examining research to assess its trustworthiness, value, and relevance in a specific context

Steps of EBP → Step 4 - Integrating the Evidence

• Decisions based on evidence, clinical expertise, and knowledge of patient’s values

  • ALWAYS consider if you can apply the findings to your population and if it will benefit them

Steps of EBP → Step 5 - Evaluate Outcomes of Change

• Compare baseline and post-intervention data

• Necessary to ensure you have achieved the best results

• Collect data using a method that is efficient, cost-effective, and reliable

Steps of EBP → Step 6 - Disseminate Outcomes of EBP

• Share to improve the C/PHN

• Can be used in the future

Meta-Analysis Review - Definition

• Statistical method used to combine results of multiple smaller research studies to increase statistical power of overall findings

Ethical Principles

Respect - Definition

• Treating people as unique, equal, and responsible moral agents

• Emphasizes a person’s importance as a member of the community/healthcare team

Autonomy - Definition

• Freedom of choice

• Right to be involved in the decision making process

Beneficence - Definition

• Doing and promoting good

Nonmaleficence - Definition

• Avoiding or preventing harm

• Avoiding negative consequences

Justice - Definition

• Treating people fairly

• Fair distribution of benefits and costs

Veracity - Definition

• Tell the truth

• Accurate information in timely manner and treating patients as equals

Fidelity - Definition

• Remaining true to your work and keeping promises

• Leads to improved decisions and better health

Ethnocentrism - Definition

• Preference for one’s own culture

• Biased belief that one’s culture is the best approach to life

Ethnorelativism - Definition

• Ability to understand and value different cultures from their own terms, without judging them as superior or inferior to one's own culture

Five Characteristics Shared by ALL Cultures

1. Learned

2. Integrated

3. Shared

4. Tacit

5. Dynamic

Enculturation - Definition

• Process of learning one’s culture

  • Patterns of cultural behavior are acquired

Culture Traits - Integrated

• “Whole”

• View in relation to connection to other components and to whole NOT independently

Culture Traits - Shared

• Product of aggregate behavior, not individual habit

• Share values within a culture

• Provide standard for behavior

• Expands understanding of human behavior

Culture Traits - Tacit

• Unspoken and unexpressed

• “Just know” how to act and what to expect from others

Medicare - Definition

• Federal health insurance for adults age 65 ad older and people with disabilities

Medicare A - Definition

• Hospital insurance

Medicare A covers …?

• Inpatient hospitals

• Limited-skilled nursing facilities

• Home health and hospice services

Medicare B - Definition

• Preventive insurance

Medicare B covers …?

• Outpatient visits

• Services to diagnose and treat health issues

• Preventive services

Medicare C - Definition

• Medicare advantage

Medicare C is a … plan that replaces … and …?

• Private plan

• Medicare A and B

Medicare C covers …?

• Regional provider networks

• May cover dental, vision, and prescriptions

Medicare D - Definition

• Drug plan

Medicare D covers … and is a … plan?

• Prescription drugs

• Voluntary plan

Patient Protection and Affordable Care Act (ACA) - Definition

• Eliminated pre-exisiting conditions exclusions

• Expansion for Medicaid

• Requirement of preventative care without copay

Deductible - Definition

• Amount paid by the insured person out of pocket before insurance coverage kicks in

Premium - Definition

• Regular, monthly payment made to an insurance company to keep health insurance coverage active

  • Done regardless of whether medical services are used that month

  • Cost for having insurance, separate from out-of-pocket costs

Managed Care - Definition

• Systems that contract to coordinate medical care for specific groups to promote provider efficiency and control costs

• Managed by regulating use of services and levels of provider payment

Managed Care - Examples

• Health Maintenance Organizations (HMO)

• Preferred Provider Organization (PPO)

Epidemiologic Triangle - Components

1. Host

2. Agent 

3. Environment

Epidemiologic Triangle - Host Definition

• Susceptible human or animal who harbors and nourishes disease-causing agent

  • Can get the disease

Epidemiologic Triangle - Host Examples

• Me and you

Epidemiologic Triangle - Agent Definition

• Factor that causes or contributes to health problem or condition

  • Can be infectious or noninfectious

Epidemiologic Triangle - Agent Types

• Biologic → Bacteria, viruses , worms, insects, fungi

• Chemical → Liquid, solid, or gas forms

• Nutrient

• Physical → Anything mechanical that can cause trauma

• Psychological → Like terrorism

Epidemiologic Triangle - Agent Examples

• Flu

• Covid

• RSV

Epidemiologic Triangle - Environment Definition

• All external factors surrounding the host that might influence vulnerability or resistance

  • Both physical and psychosocial

    • Physical → Geography, climate, weather, water, food supply, animals, plants

    • Psychosocial → Social, cultural, economic conditions

Incidence Rate - Definition

• All new cases of a disease or health condition appearing during a given time

Incident Rate - Purpose

• Describe how quickly disease occurs in a population → DISEASE RISK

• Can utilize to monitor intervention effectiveness

  • Denominator people MUST have potential to move to the numerator

Prevalence Rate - Definition

• All of the people with a particular health condition existing in a given population at a given point in time

Prevalence Rate - Purpose 

• Describe a specific point in time → DISEASE BURDEN

  • Numerator now includes both new cases and pre-existing cases

Natural History of a Disease - Definition

• Any disease or health condition which follows a progression known as its natural history

• Refers to events that occur before the disease development, during its course, and during its conclusion

Natural History of a Disease - Stages

1. Susceptibility

2. Subclinical Disease

3. Clinical Disease

4. Resolution/Advanced Disease

Natural History of a Disease - Susceptibility Stage

• Host and environment factors influence population’s vulnerability

  • People have not really been exposed to the disease yet

Natural History of a Disease - Subclinical Disease Stage

• Invasion by causative agent; people are asymptomatic

  • People are exposed to the disease, but are asymptomatic

Natural History of a Disease - Clinical Disease Stage 

• Disease or condition evident in population

  • S/S develop in people so that a diagnosis can be made

Natural History of a Disease - Resolution/Advanced Disease Stage

• Disease or condition concludes in renewed health, disability, or death

  • People recover, adapt, or are disabled after disease

Active Immunity - Definition

• Long term → Sometimes lifelong

• Naturally via fighting infection and surviving

• Artificially via vaccines

Passive Immunity - Definition

• Short term

• Naturally when protection is transferred from another another animal or human to help → Wanes with time (decreases in strength)

  • Ex: Measles → Get the vaccine at 1 year old because mother has vaccine and passes antibodies

Cross Immunity - Definition

• Immunity to one agent providing immunity for another related agent

  • Ex: Cowpox vaccine protects against smallpox

Herd Immunity - Definition

• Population Immunity

• Fraction of population that needs to be immune to protect the rest

  • Depends on how infectious the disease is

Modes of Transmission - Definition

• How a disease is passed from one source to another

  • Person to person

  • Animal to person

  • Person/Animal indirectly via reservoir

Modes of Transmission - Direct Examples

• Person to person

• Animal to person

Modes of Transmission - Indirect Examples

• Reservoirs → Ex: Contaminated water

Disease Transmission - Human Reservoir Definition

• Person to person disease transmission without intermediaries

• Ex:

  • STDs

  • Measles

  • Mumps

  • Streptococcal infection

  • Many respiratory pathogens

Disease Transmission - Animal Reservoir Definition

• Animal to animal disease transmission with humans as incidental hosts

Disease Transmission - Environmental Reservoir Definition

• Plants, soil, and water that house diseases

• Ex: Fungal agents

Measles - Causes

• Rubeola virus

Measles - Transmission

• Airborne

• Direct contact

• *Can get it from just being in the same room where a person with measles has been

Measles - S/S

• PROMINENT RASH

• Early → 4-7 days after exposure

  • Runny nose, cough, red and watery eyes, small white spots inside the cheeks

When do Measles S/S usually start?

• 10-14 days after the exposure

Most people who get measles die from … related to the disease?

• Complications!

Measles - Complications

• Blindness

• Encephalitis

• Severe diarrhea and dehydration

• Ear infections

• Severe breathing problems → Includes pneumonia

Bioterrorism - Definition and Examples

• Deliberate release of biologic agents to cause harm

• Ex:

  • Anthrax

  • Smallpox

  • Mpox (Monkeypox)

Smallpox - Definition

• Disease caused by the variola virus that was eradicated in 1980