Community Midterm Flashcards
Community Definition
5 core elements:
- Sense of place
- Common interests and perspectives
- Sense of identity/cohesion
- Interpersonal Relationships
- Diversity (social, economic)
Community should be involved in every step of the nursing process!
- Community Assessment
Comprehensive evaluation of the community. Engaging the community in collecting, analyzing, and interpreting data on health outcomes and determinants to identify resources to address priority needs. Facilitates better understanding of the community, identify assets, determine community priorities, engage stakeholder, identify potential barriers.
- Community Diagnosis
Analyse assessment findings, prioritize problems. Diagnosis is of the priority issues.
- Planning for Community Health
Set SMART goals and objectives. Use a logic model.
Logic model
Graphic depiction of connections showing what program will accomplish. A series of “if-then” relationships.
Components of a logic model (4)
Situation statement - what is the problem?
Inputs - personnel, $, equipment etc
Outputs - activities, participation
Outcomes - short, medium, long term
The Guide to Preventive Community Services
A collection of evidence-based findings of the Community Preventive Services Task Force. Resource to help select interventions to improve health and prevent disease. Reviews intervention approaches for communities.
- Implementation
What actions or changes will occur. Utilize roles found in Minnesota Wheel to promote health, prevent disease. Need to know: who will carry out changes, when will they happen, for how long, what resources are needed. Plan should be complete, clear, current.
- Evaluation
Understanding what a program does and how well it does it.
- Engage stakeholders
- Identify program elements to monitor
- Select key evaluation questions
- Determine how the information will be gathered
- Develop a data analysis and reporting plan
- Ensure use and share lessons learned
Formative Evaluation
How are we doing? Review of objectives in order to revise, used midway through a project, adapt in real time. (Example: project could also become a business)
Summative Evaluation
How can we do better next time? (Example: DARE didn’t do anything about drugs, but promoted relationships between kids and law enforcement)
Public Health definition
What we do collectively to assure conditions in which people can be healthy. Mission is to fulfill society’s interest in assuring conditions in which people can be healthy.
Public Health Nursing definition
Synthesis of nursing theory and public health theory, applied. Population based, prevents disease and disability, promotes and protects the health of the community.
Quad Council
Alliance of 4 national nursing organizations. Sets national policy agenda and provides voice for public health nurses.
Determinants of Health
The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.
Socioecological Model
Individual Interpersonal Organizational Community Public Policy
Health Impact Pyramid
Counseling and Education Clinical Interventions Long-lasting protective interventions Changing the context to make default decisions healthy Socioeconomic factors
(least to most effective)
Levels of Prevention
- Primary - prevent initial occurrence of disease. Vaccines, hand washing, helmets.
- Secondary - early detection of disease and early treatment to limit severity and adverse effects. Screening.
- Tertiary - maximize recovery after illness or injury. Rehab, support group, case management
3 Core Public Health Functions
- Assessment
- Policy Development
- Assurance
Core Public Health services - Assessment
- Monitor Health Status
- Diagnose and Investigate
Core Public Health services - Policy Development
- Inform, educate, empower
- Mobilize community partnership
- Develop policies
Core Public Health services - Assurance
- Enforce laws
- Link to or provide care
- Ensure competent health workforce
- Evaluate effectiveness accessibility of services
- Research new solutions
Minnesota Wheel - what is it?
Evidence based interventions derived from public health nursing.
- Population based
- Levels of practice (system, community, individual)
- Interventions (17)
Population of interest
Populations that are essentially healthy but trying to protect/promote health
Population at risk
Common identified risk factor or exposure
Population-based means….
Focus on entire population, both population at risk and of interest.
5 Components of Population-Based Practice
- Focused on entire population
- Grounded in Assessment of the population health status, determined through a community health assessment
- considers broad determinants of health (SES, housing, culture)
- Emphasizes all levels of prevention, but mostly primary
- Intervenes with communities, systems, individuals, families.
3 Levels off Public Health Practice
- Individual - change attitudes, beliefs, practices, behaviors of individuals or families
- Community - changes in norms, attitudes, awareness, practices, behavior
- Systems - changes in organizations, policies, laws. Most effective for lasting impact
Minnesota Wheel Generalities
Right side: Individual, family, group (Purple, green, blue)
Left side: Systems and communities (yellow, orange)
Purple
Surveillance
Investigation
Outreach
Screening
Green
Referral and Follow-up
Case Management
Delegated Functions
Blue
Health teaching
Counseling - emotional level
Consultation
Orange
Collaboration
Coalition Building
Community Organizing
Yellow
Advocacy
Social Marketing
Policy Development & Enforcement
Epidemiology
Study of the distribution and determinants of health related states in specified populations, and the application of this study to control health problems.
Epi Triangle
Host - Agent - Environment
Vector is in the middle of the triangle. Shows relationships and interrelatedness.
Agent
Any element or force that is capable of causing disease or injury or disability. Biologic/infectious, physical, chemical, nutritional, psychological
Host
Any population at risk for developing a disease.
Environment
Context in which host and agent interact. Biological, social, physical conditions (access to clean water, sanitation, sharing living space with animals)
Vector
Animate objects that carry agent to susceptible host (animals, insets(
Fomites
Inanimate objects that can transport microbes.
Wheel of Causation
Biologic Environment - Social Environment - Physical Environment. All involved with potential infection of host, with genetic core at the center
Web of Causation
Model that represents multiple causation, de-emphasized role of a single agent. Complex. Looks at antecedents of illness. Helpful for chronic disease, drug use.
Natural History
Tells us whether we can screen, intervene, or what progression of a disease is over time in the absence of treatment
Prepathogenisis
Before you get sick. Focus on primary prevention, education, nutrition, sanitattion
Pathogenesis
Exposure, subclinical, latency and illness. Screening, case finding, early treatment to cure disease or limit disability, prevent spread!
Subclinical disease
No signs and symptoms, but may be detectable with labs or other screenings
Clinical disease
Marked by onset of symptoms. Spectrum of disease - mild to fatal.
Chain of Transmission
Infectious Agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Host
Reservoir
Any environment in which pathogen lives/grows/multiplies. Human, animal, water, soil.
Portal of exit
Body fluids, placenta, skin
Direct mode of transmission
Passed from person to person via droplet, skin to skin, sex
Indirect mode of transmission
Airborned, vehicles (fomites, water), or vectors (fleas, ticks). Use precaution can break chain of infection - PPE, condoms
Incidence rate
of new cases a disease that occurs during a specified time period in a population at risk for developing the disease
Denominator is those at risk (ie women for uterine canceR)
Prevalence rate
# of affected persons in the population at a specific time/ # of people in a population at the time.
Denominator for prevalence is the whole population, not just the population at risk! Snapshot of a certain point in time.
Period Prevalence
How many people have the disease at any time during a specified period (year, decade, month).
- Period prev: have you had asthma during the last 2 years?
- Point prev: do you currently have asthma?
Crude mortality rate
Occurrence of death in the entire population.
Total # deaths in a year/
Total midyear population
Cause-specific mortality rate
Total deaths from a stated cause in one year/
population
Age-specific mortality rate
# people dying in age group/ total population in that age group
Proportional mortality ratio
# of deaths from a specific cause within a time period/ total deaths in the same time period
(% of all deaths were from that specific cause)
Case fatality rate
# of deaths from a specific disease/ # of cases of the same disease
Ebola case fatality rate is 90%
Attack rate
# of people exposed to a specific agent who develop the disease / total # of people exposed
(32 people ate crab, 26 got sick)
Endemic
Habitual presence of disease in a defined geographical area. (Obesity, STI, malaria)
Epidemic
Occurence in a community or region of a group of illnesses of similar nature, clearly in excess of normal. (aka outbreak - E. coli)
Pandemic
Widespread, often global
Outbreak investigation
Establish and verify the diagnosis of reported cases. Identify agent. Search for additional cases, describe and orient the data. Formulate/test hypothesis. Implement control and prevention measures. Communicate findings.
Example: John Snow w/cholera
Epidemic Curves
Distribution fo the times of onset of the disease, pattern of spread, magnitude, time trend, exposure/incubation period.
Types:
Person to person
1. Propagated
Common source
- Point Source
- Continuous
- Intermittent
Point Source
Short term, one time exposure. Potato salad at a picnic. One rise, uniform fall
Continuous
Common source but longer period of exposure, such as contaminated water. People get sick, continue getting sick until source is fixed
Intermittent
Common source, spread out over time. Many peaks and valleys, but peaks do not get bigger, and stay spread apart
Propagated
Peaks continue to get bigger. Disease is communicable. Eventually stops because of herd immunity.
Attack rates
# of people who got sick / # of people who were exposed
Aka how many got sick/how many ate crab
Screening objectives (2)
M1. Primary: detection fo a disease in its early stages to treat it and deter its progression
2. Secondary: reduce cost of disease management by avoiding costly interventions required at later stage
Types of screening (3)
Mass - entire population
Specific/Targeted - for specific high-risk populations (tb for hospital employees)
Periodic - screen a discrete but well subgroup of the population based on predictable risks or problems (developmental screening for kids, paps)
Disadvantages of screenign
Not 100% accurate. Cost of false positives are undue worry, stigma, invasive testing, unnecessary treatment. Cost of false negatives are loss of opportunity for early interventions, may engage in risky behavior due to “negative status”
Significance
Is this disease really a public health concern? how many people affected? Level of threat?
Detection
Can we screen for this disease? Does it have the correct instruments/technology?
Sensitivity
Ability of a test to correctly identify true positives.
Poor sensitivity = high false negatives
TP / (TP + FN)
Specificity
The ability of a test to correctly identify true negatives.
Poor specificity = high false positives
TN = (TN + FP)
Ethical principles
Autonomy (informed consent)
Beneficence
Non-malefisence
Social justcie
Observational studies (4)
Cross-sectional
Cohort studies
Case-control studies
Case studies
Cross-Sectional Studies
Snapshot or cross section. Can’t determine cause and effect. Less time intensive to conduct, good for point prevalence.
Cohort Studies
Study a population over time, look at exposures and outcomes. Can determine cause and effect! Requireslots of participants, expensive, time consuming because over many years, high dropout rate.
Case-Control Studies
Work backwards from outcome to suspected cause. Gives information about rare diseases
Case Studies
In depth analysis of individual, group, or social institution. Small sample size, can’t determine cause and effect
Randomized Control Trial
Highest level of data. Random allocation, experimental vs control group
Quasi-experimental designs
No random allocation to groups. Often used for “natural experiments”, sometimes used pre/post intervention.
Consistency
Same exposures cause same outcome each time
Biological plausibility
Physiology makes sense
