Fluent Essays

Epidemiology of Health and Illness.Community Health PlanningImplementation and evaluation Read chapter 5, 7 and 8 of the class textbooks and review the attached PowerPoint presentations. Once done answer the following questions; Define epidemiology and identify the epidemiological models used to explain disease and health pattern in populations. How can you apply the epidemiological methods to describe the stated of health in the community or aggregate?Mention and analyze the factors that have contributed to the failure of health planning legislation to control health care costs.Compare and contrast Freire’s approach to health education with individualistic health education model.As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 2 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard which is a mandatory requirement. A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years must be used. You must post two replies on different dates to any of your peers sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment. The replies can’t be posted on the same day, I must see different dates in the replies in order to verify attendance. A minimum of 800 words is required (excluding the first and reference page). Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.Please check your assignment after the week is due or after it is graded because I either made comments or ask for clarification in some replies or the assignment that required your response. Due dates: Assignment – Wednesday, January 15, at 11:59 PM in the discussion tab of the blackboard, and in the SafeAssign exercise in the assignment tab of the blackboard. chapter_005_pdf.pdf chapter_007_pdf.pdf chapter_008_pdf.pdf Unformatted Attachment Preview 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 ➢ Excesses, ⬤ Chemical agents ➢ Poisons, ⬤ allergens Physical agents ➢ Ionizing ⬤ deficiencies 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___ 4000–250 = 0.02 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_ 200,000 = 0.0145 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 ⬤ ➢ Refers to the specific exposure factor ➢ Often external to the individual ⬤ Attributable risk ➢ 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 Common interests, problems, and needs Alzheimer’s support group Interdependency Group dynamics Fulfillment of goals Group member and leader Population group AIDS patients in Large, unorganized group Assessment of common a given state with common interests, problems, needs, and problems, and needs vital statistics Pregnant adolescents in a school district Application of nursing process to identified needs Organization A workplace A school Organized group in a common location with shared governance and goals Consultant and/or employee application of nursing process to identified needs Community Italian neighborhood Anytown, USA An aggregate of people in Analysis of systems, Community leader, a common location with strengths, characteristics, participant, and health organized social systems problems, and needs care provider Relationship of goals, structure, communication, patterns of organization to its strengths, problems and needs 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 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders ... Purchase answer to see full attachment