Community Health Exam 1

Epidemiology

Study of the distribution and factors that determine health-related states in a population to improve health of communities

Distribution

Patterns of health events in populations to understand health outcomes in terms of who, what, where, when, how, and why

Determinants of health

The how and why (factors) that determine and influence the patterns of health events

Analytic epidemiology

Investigates the cause of disease (how does it occur?)

History of Epidemiology (3)

-4th century BCE: Hippocrates

-18+19th century: comparison group experimentation and quantitative methods

-20th century: shifted from looking at single agents to determining multifactorial etiology, bioterrorism preparedness, development of genetic and molecular techniques

Proportions, rate, and risk

-Proportions: ratio looking at the rate of spread of the disease in relation to population

-Rate: measure of the frequency of a health event in different populations at certain periods

-Risk: probability that an event will occur

Measures of incidence

the number of new cases or events in a population at risk during a specified time

Prevalence proportion

a measure of existing disease in a population at a particular time

Incidence and prevalence compared

Prevalence is less accurate because it refers to duration in addition to the risk for getting disease, but incidence is affected only by factors related to the risk for developing disease and not to survival or cure.

Attack rate

proportion of persons who are exposed to an agent and develop the disease

Epidemiologic triangle (agent, host, environment)

-Agent: animate or inanimate factor that must be present or lacking for a disease or condition to develop

-Host: living species capable of being infected or affected by an agent

-Environment: all that is internal or external to a given host or agent and that is influenced and influences the host and/or agent

Web of Causality

Complex interrelationships of factors interacting with each other to influence the risk for disease

Ecological Model

Helps study different levels of the web of causality both to broader and more concise levels

Primary Prevention

Interventions that promote health and PREVENT disease before it happens (ex: immunizations and teaching)

Secondary Prevention

Interventions designed to prevent the spread of disease once it occurs (ex: health screenings, labs regularly, family hx)

Tertiary Prevention

Interventions aimed at preventing complication and disabilities from an already existent disease (ex: therapy, diabetes edu for dx pts, rehab)

Validity

Whether or not the testing is measuring what it's supposed to

Sensitivity

How accurately the test identifies those with a specific condition/trait

Specificity

How accurately the test identifies those without the condition/trait

Positive predictive value

Proportion of people with a positive test (who have the disease)

Negative predictive value

Proportion of people with a negative test (who are disease free)

Primary data

Original data collected for specific epidiologic studies

Secondary data

-Routinely collected data (birth certificates, census)

-Data for other purposes (insurance records, health department, etc.)

Cohort studies

group of people sharing some similar characteristic of interest to be studied

Case-control studies

Subjects enrolled BECAUSE they are known to have the outcome of interest

Cross-sectional studies

provides a snapshot of a specific population

Ecological studies

Bridges descriptive and analytical epidemiology

Clinical trials

investigates the effectiveness of an intervention (randomized)

Vertical transmission

passed from parent to offspring (sperm, placenta, breastmilk)

Horizontal transmission

infection passed from person to person (contact, indirect contact, airborne, vector-borne)

Common vehicle

transportation of the infectious agent from an infected host to a susceptible host (food, water, blood, saliva)

Vectors

arthropods that can transmit infection by depositing the infectious material near the host (ticks, snails, etc.)

Endemic

constant presence of disease within a geographic area

Epidemic

presence of the in excess of the region it normally resides in

Pandemic

epidemic worldwide and effecting various people groups

Surveillance

Gather the who, when, where, and what to answer the why

HIV (first reports of AIDS, decreased time period, population, testing)

-1981

-Decreased from 2014-2018

-Highest in 25-29 year olds

-Western Blot test

General stages of HIV (3)

-Primary infection (within about 1 month of contracting the virus)

-Clinical latency (shows no symptoms)

-Final stage of symptomatic disease

Groups at risk for HIV

-minorities

-homosexuals

-sub-saharan africa populations

Hepatitis A virus (transmission, most at-risk population)

-Transmitted: fecal-oral

-Silent in children

Hepatitis B virus (transmission, populations-4)

-Transmitted: blood and body fluids (survive for at least 1 week)

-Populations: injection drug users, hemodialysis pts, immigrants, STD pts

Hepatitis C virus (transmission, popularity)

-Transmitted: blood or body fluids

-Most common chronic blood-borne infection in the US

Public Health

the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort

Core Functions of Public Health (3)

-Assessment

-Policy development

-Assurance

Services of Public Health (7) (Mr.Midle)

-Monitor community health status

-Inform and educate people

-Mobilize community partnerships to identify and solve health problems

-Develop policies and plans to support health efforts

-Enforce laws and regulations that ensure safety

-Link people to needed personal health services

-Research and evaluate effectiveness of health practices

Population Health

the health status of a defined population of individuals including distribution of health status within the group

Population-focused public health nursing

problems and solutions are defined and implemented with a specific population/community as a whole in mind

Community-oriented public health nursing (goal, definition)

-Goal: prevent disease and disability; promote, protect, and maintain health

-Provision of disease prevention and health promotion to populations and groups (smoking cessation clinic)

Community-based nursing (goal, definition)

-Goal: manage acute and chronic conditions

-Practice focuses on "illness" care of INDIVIDUALS within the community (home health, pt teaching)

Public Health Nursing Practice (goal, definition)

-Goal: prevent disease and disability and promote and protect the community as a WHOLE

-Raises questions about the community's overall health status and associated factors

Evidence-based practice

Best available evidence from various sources used to determine appropriate interventions and cost effective means of care

Evidence-based public health

A public health endeavor where there's judicious use of evidence derived from a variety of science and social science research.

Evidence-based nursing (definition, external evidence, internal evidence)

-Integration of the best evidence available, nursing expertise, and the values and preferences of the patients served

-External evidence: includes research and other evidence such as reports and professional guidelines

-Internal evidence: includes the nurse's clinical experiences and the client's preferences

Highest level of evidence

Double-blind randomized controlled trials (RCT)

Steps in the Evidence-based practice Process (7)

0. cultivating spirit of inquiry

1. Asking clinical questions

2. Searching for best evidence

3. Critically appraising evidence

4. Integrating evidence into clinical practice

5. Evaluating outcomes of practice

6. Disseminating EBP results

Approaches to evaluating evidence (grade-3, domains of evaluation-3)

-Graded on: quality, number of well-designed studies, and presence of similar findings

-Domains: quality, quantity, and consistency

Federal role in public health (3)

-Implement policies

-Provide funding

-Survey nation's health status and needs

State role in public health (3)

-Monitors health status

-Enforces laws and regulations that protect and improve public health

-Distributes funds for community health programs

Local role in public health

Implementing and enforcing health codes

Emerging public health issues (7)

-Increasing rates of drug resistance

-Behaviorally influenced issues

-Emergency preparedness

-Unequal access to healthcare

-Racial and ethnic disparities in health outcomes

-Prevention of bioterrorism

-Disposing hazardous waste

Education requirements of public health nurses (2)

-Baccalaureate degree

-Nursing certification

Roles of Public Health Nurses (8)

-Advocate

-Case manager

-Referral resource

-Assessor of literacy

-Educator

-Direct primary caregivers

-Role model

-Disaster responders

Congregation vs. Parish

-Congregation: a variety of faith institutions/faith-based organizations

-Parish: geographical area served by a congregation

Spiritual care vs. religious care

-Spiritual care: unique to the individual's purpose in life , the fulfilling of that purpose, and living it out wholeheartedly

-Religious care: stems from the specific doctrines and rituals oof a certain denomination or set of beliefs

History of faith community nursing (3)

-Roots in the Judeo-Christian tradition

-Concept introduced into churches in 1984

-Faith nurse community took place in areas where healthcare was less accessible

Roles of a faith community nurse (5)

-Providing care to individuals, families, congregations

-Explore health needs of the congregation

-Personal health counseling

-Health education

-Support emotional needs

Education requirements of a parish nurse (4)

-Bachelor's degree

-Valid nursing license

-3-5 years in professional nursing

-Mature faith

Issues within Parish nursing (5)

-Professional issues

-Documentation issues

-Ethical issues

-Legal issues

-Financial issues

Hospice services vs. palliative care

-Hospice services: provided at end of life and don't include curative treatments but rather comfort, normally patients have <6 months left (funded)

-Palliative care: includes a wider range of services that optimize the quality of life, not limited to days or weeks prior to end of life, can include curative treatment (no federal designation)

Family

defined by the individual and includes any caregiver or significant person who assists the client in need of care at home

Home Health Care (focus, scope of practice, key to success)

-Wellness and health care promotion/prevention

-Practice autonomously and have very little structure

-The nurse must earn trust form the family as a guest in their home

Transitional care (goal, definition)

-Goal: decreasing hospital readmission rates

-actions to ensure coordination and continuity of health care as client is transferred from different locations/levels of care

Omaha System (definition, model order-6)

-Used to guide practice decision, sort and document client data, and provide a framework for spread of info amongst health professionals (fosters collaboration)

-Order: collect and assess data, state problem, ID admission problem and rating, plan and intervene, ID interim/dismissal problem rating, evaluate problem outcome

Importance of medication mgmt and infection prevention in home health

By achieving certain outcomes, these organizations can receive funding

How can accreditation help home health organizations?

It can help increase funding of the organization

Education of Home Health Nurses

-Bachelor's

-Nursing certification

School Nurse Functions (5)

-Insuring all children get needed health care

-Insures nurses keep track of state-required vaccines

-Carries out required screening of the children

-Coordinate health education program for the school

-Children with disabilities can learn and be successful

Educational requirements of school nurses (2)

-Bachelor's degree

-School nurse certification

*Advanced practice nurses can also work in school settings

School nurse roles (7)

-Direct caregiver

-Health educator

-Case manager

-Consultant

-Counselor

-Community outreach

-Researchers

Levels of Health Prevention of School Nursing

-Primary: preventing childhood injuries, handwashing, required vaccines, substance abuse edu

-Secondary: emergency equipment in office, giving medication in school, screening for lice, referring children

-Tertiary: administering meds for existing conditions (asthma, diabetes, etc.), individual education plans (IEP)

Medication Admin Standards for School Nurses (4)

-Need signed parental consent form with medications approved by primary care provider

-Prescribed meds need original prescription label and be in original container

-OTC meds must be stored in original and labelled containers

-Current drug book must be kept in office to be consulted

Occupational health nursing

-Specialty practice that provides and delivers health and safety programs and services to workers and working groups

-Focuses on the promotion/restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards

Roles of occupational health nursing (10)

-Clinician

-Case manager

-Coordinator

-Manager

-Nurse practitioner

-Corporate director

-Health promotion specialist

-Educator

-Consultant

-Researcher

Education of an occupational health nurse

Graduate degree (NP or advanced level nurse)

Epidemiologic Model in the Work-Place

-Host: any susceptible human being (all employed individuals)

-Agent: factors associated with illness and injury (environmental, chemical, physical, etc.)

-Environment: all external conditions that influence the interaction of the host and agents

Functions of Occupational health nurses

-History and assessment of exposure to occupational hazards

-Occupational health history

-Teach about workplace hazards and preventive measures

-Worksite walk-through to identify risks

Function of OSHA and NIOSH

-Occupational safety and health administration (OSHA): improves worker health and safety by establishing standards and regulations and by educating workers

-National institute for occupational safety and health (NIOSH): responsible for investigating workplace illnesses, accidents, and hazards