Nurs. 404 Final Flashcards
Relative study design strength
- Epidemiologic research can be descriptive or analytical. Study designs are based on the problem under study and range in strength on a continuum, with the weakest design being the retrospective design and the strongest being the experimental design.
What designs are used to examine causality?
Quasi-experimental and experimental designs are used to examine causality.
What is the gold standard for research design?
The “gold standard” for research design is the randomized, control group design
Epidemiological research
- Findings from descriptive epidemiologic studies lead to hypotheses for future research.
- Epidemiologic research identifies community/public health problems and describes the natural history and etiology of diseases
True or false
Observational studies may be either descriptive or analytical.
True
True or false
Observational studies may be either descriptive or analytical.
True
Descriptive studies
Descriptive: identifies characteristics of individuals, situations, or groups and the frequency with which certain phenomenon occur. Disadvantage: no interventions or treatments included. Have 2 subcategories; case studies and cross-sectional studies
Case studies vs cross sectional studies
b. Case studies: in-depth analysis of an individual, group, or social institution.
c. Cross-sectional studies (prevalence studies): the population to be studied is defined, and data are collected from members of the group about their disease and exposure status. Good studies for examining the relationship between a variable and a disease but not for determining cause and effect, which requires the collection of data over time.
Analytical studies
Analytical: are on a continuum, ranging from strongest to weakest designs. 2 analytical designs, he prospective correlational design and the retrospective correlational design are “weaker” designs on the continuum. Two different types of analytical studies: cohort and case-control studies.
What is a cohort?
Cohort (prospective): monitor subjects over time to find associations between risk factors and health outcomes. Stronger than case control studies; however they are more expensive. Advantages: they minimize selection biased, a threat to internal validity, and provide preliminary evidence of the incidence of a risk factor.
Case control studies
f. Case-control studies (retrospective studies): work backward from the effect to the suspected cause. Two groups (control group and case subjects) are compared to determine the presence of specific exposures and risk factors. Advantages: allow for the examination of multiple exposures for a single outcome, are suitable for studying rare diseases and those with long latency periods, require fewer case subjects, generally are quicker and less expensive to conduct than cohort studies. Disadvantages: they aren’t appropriate for studying rare exposures, they are subject to bias because of the method used to select control trials, and they do not allow the direct measures of the incidence of disease.
Quasi experimental studies
g. Quasi-experimental studies: are weaker because assignment of subjects into groups is not randomized, or the researcher is unable to manipulate the variable under study.
Quasi experimental studies
g. Quasi-experimental studies: are weaker because assignment of subjects into groups is not randomized, or the researcher is unable to manipulate the variable under study.
Care management-coordination of a plan or process to bring health services together as a common whole in a cost-effective way
• Care management-coordination of a plan or process to bring health services together as a common whole in a cost-effective way
o a term coined to define the evaluation of healthcare interventions, including need and appropriateness of are, and the actions taken to attain effective and efficient outcomes
o Often used as a synonym with “utilization management,” which is a key component in the care of clients because of continued rising medical costs
Case management-development and coordination of care for a selected client and family
• Case management-development and coordination of care for a selected client and family
o The Case Management Society of America defines case management as “a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes”
Care management is r/t case management
o Care management is r/t case management
• Without case management, care management could not be successful, thus, case management can be considered a building block of care management
o Case management involves an intensive process called disease management
Disease management
• Disease management- a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant
o Emphasizes prevention at the secondary and tertiary level using EBP guidelines
o Collaborative practice models are a key to the success of disease management
- Levels of prevention as it relates to care management, case management and disease management
• Care Management (utilization management)-
o In many cases, advances in technology including the use of predictive modeling and other methods of data analysis, are creating opportunities for utilization management to be targeted to specific disease management areas more precisely
o Case study- Eleanor- Care management and utilization management will inevitably benefit her by helping professional caregivers, such as her physician, help discuss anticipatory needs (primary?) such as home care as more disability evolves from her advancing chronic comorbid conditions (could be tertiary here???)
o Evaluates healthcare intervention (secondary prevention)
True or false
Case management- healthcare professionals advocate for resources needed by the client- secondary and tertiary
true
Disease management and levels of prevention
• Disease management- emphasizes prevention at the secondary and tertiary level
- Roles of a parish/faith community nurse
• Parish nursing is an approach to holistic care to clients and families in the community • The seminal work of Westberg identified seven key roles of the parish or faith community nurse: o Health educator o Personal health counselor o Referral agent o Coordinator of volunteers o Developer of supportive groups o Integrator of faith and health o Health advocate
- Phases of a home visit
• Initiating the visit
o Many home care agencies receive referrals
• Generally, homecare agencies make sure that an initial visit is made within 24 hours of receiving referral
• When receiving a referral, it is particularly important to make sure that the orders and directions for care are clear and accurate
• If necessary, a clarifying call should be made to person who referred the client prior to home visit
• Preparation
o Documentation is critical
• All appropriate paperwork required for the assessment of the client and family must be available
o Equipment
• The home care nurse must bring supplies and equipment that may be needed for the visit depending on diagnosis and specific skilled need
• Ex) sterile/clean dressings, urinary catheters, walker, sterile saline solution, distilled water, antimicrobial agents and paper towels
• A homecare nurse does not use client sink areas to wash his/her hands to decrease the chance of cross-contamination
• In addition, the nurse must keep equipment that is often used and may be needed unexpectedly in his/her trunk (to decrease theft and damage to the vehicle)
o Directions
• Getting directions for the home visit is very important
• GPS can help home care nurses locate clients
• Becoming familiar with the directions of routes (N, S, E, W), using landmarks and making sure that unusual locations are explained before one leaves for a visit, is important
o Personal safety
• Safety prevention for home care nurses is a part of preparing
• Box 11.3 in the text book- Safety Tips for Home Care Nurses
• When and where will I go to the bathroom? When and where will I eat? What will I do if I get lost? What will I do if I am involved in an automobile accident?
• Carrying a functioning cell phone and heaving a list of emergency numbers to call is critical
The actual homevisti
• The actual visit
o Includes introducing home care services to the client and family, as well as the process of obtaining help from the home care agency when a home visit is not occurring
o The key component of the first in-home visit is assessment
o The home care nurse is a guest in the client’s home and must obtain the client’s permission and ask for the client’s guidance about how to carry out the initial assessment in the context of the home
o It is necessary to carry out an overall assessment of the clients and family’s strengths, weaknesses, and challenges.
o In addition, it is also essential to assess home safety risks:
• Medication errors- sometimes, in the freedom of their own home, clients refuse to take medications, forget to take medications, do not fill prescriptions because of cost, or need a renewal of a prescription and do not know how to proceed or do not have access to a pharmacy, etc.
• At the initial home visit, it is important to develop a medication profile that is accurate and will be reviewed at each visit- it is critical to talk about the use of prescribed medications with OTCs and herbal supplements and develop a plan that includes the client and family being vigilant about medication safety
• Risk of falls- 55% of fall related injuries occur with falls inside the home
• The home care nurse can make plans with the family or home care agency to make environmental modifications that can decrease the chance of a fall (intrinsic and extrinsic factors)
• Risk of abuse and neglect- unfortunately, in community settings, there can be instances when clients and family members can be victims of abuse and neglect
• This is often hidden until home care nurses or other home care personnel enter the home and observe the potential or actual abuse or neglect
• One important cautionary note is that home care nurses need to be careful about making judgments r/t identifying abuse and neglect involving clients and families
•Termination of the visit
o In terminating the initial visit, it is critical to make sure that clients and families know how to reach the home care nurse at any time of the day and that is an emergency plan understood by the client and the family
o It is equally important to establish an initial plan of care and to make a plan for the next scheduled visit
• If there are any circumstances that would impede future visits, it is important to address these at this time (smoking, pets, etc.)- maybe make a “no smoking” contract, or a contract that the pet will be put in another area next time
•Postvisit planning
o After the initial visit, the home care nurse establishes a specific plan of care that may include other healthcare disciplines and home health aide services
o Outcomes are established and a schedule of planned visits are organized
o The most crucial postvisit activity is the establishment of outcome measures so that the home health team can plan an intervention approach that allows reasonable time and effort for healthcare providers and the client and family
Epidemiologic triangle
- Epidemiologic triangle- as used in infection diseases
a. Model that scientists have developed for studying health problems
b. Helps us understands infectious diseases and how they spread
c. Agent (microbe that causes the disease) – the “what” of the triangle
d. Host (the organism that is harboring the infection) – the “who” of the triangle
e. Environment (external factors that cause or allow disease transmission) – the “where” of the triangle
f. Disease is caused by these 3 factors together!
g. Examples:
i. Individuals living in the temperate climate of the US do not contract malaria at home, but they may become infected if they change their environment by traveling to a climate where malaria-carrying mosquitoes thrive.
ii. HIV performs its deadly work not by directly poisoning the host but by destroying the host’s immune reaction to other disease-producing agents.
Epidemiologic triangle
- Epidemiologic triangle- as used in infection diseases
a. Model that scientists have developed for studying health problems
b. Helps us understands infectious diseases and how they spread
c. Agent (microbe that causes the disease) – the “what” of the triangle
d. Host (the organism that is harboring the infection) – the “who” of the triangle
e. Environment (external factors that cause or allow disease transmission) – the “where” of the triangle
f. Disease is caused by these 3 factors together!
g. Examples:
i. Individuals living in the temperate climate of the US do not contract malaria at home, but they may become infected if they change their environment by traveling to a climate where malaria-carrying mosquitoes thrive.
ii. HIV performs its deadly work not by directly poisoning the host but by destroying the host’s immune reaction to other disease-producing agents.
Infectious Agents
a. Infectious Agents
i. Biological agents capable of producing an infection/infectious disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths.
ii. Pathogenicity – ability of the infectious agent to cause disease in a susceptible host
1. Depends on the infectivity of the infectious agent, its ability to invade, and destroy body cells, produce toxins, and its virulence
Hosts
b. Hosts
i. Factors that determine whether a person is at risk for an infection/disease includes ages, sex, race, physical and emotional health, immune status
Portals of entry and exit
c. Portals of entry and Exit
i. Skin, respiratory tract, alimentary tract, genital tract, conjunctiva, and vertical transmission from parent to offspring
ii. Example: fecal-oral transmission of Hep A through indirect contract with infected fecal material
Reservoir
d. Reservoir (environment)
i. Can be humans, animals, plants, insects, water and soil
ii. Zoonoses – infections transmitted from animal reservoirs to humans
1. Ex. Rodent transmitted plague, hantavirus, monkeypox
iii. Changes in the env’t tend to have the greatest influence on the transmission of microbial agents that are waterborne, airborne, foodborne, or vector-borne or those that have an animal reservoir
Transmission
e. Transmission
i. Airborne
1. Microbes are carried in the air in small particles at distanced that exceed a few feet when a person breathes, coughs, sneezes, speaks, or sings
2. Examples: TB
Direct contact
ii. Direct Contact
1. Occurs through direct body surface to body surface contact and physical transfer of microbes between a susceptible host and an infected or colonized person (or animal)
2. Example: STD, STI, bird flu
Indirect contact
iii. Indirect Contact
1. Involves contact of a susceptible host with a contaminated intermediate inanimate objects (i.e. surgical instruments, needles, toys, soiled clothing, bed linen, food, water, contaminated hands)
2. Also includes vector transmission (animals or insect carriers of infectious agents)
a. Example: malaria
Droplet
iv. Droplet
1. Form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission
2. Considered a separate route of transmission
3. Droplets are generated from the source person primarily during coughing, sneezing, and talking and are propelled at a short distance (
Droplet
iv. Droplet
1. Form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission
2. Considered a separate route of transmission
3. Droplets are generated from the source person primarily during coughing, sneezing, and talking and are propelled at a short distance (
What is an Endemic?
a. Endemic – disease, infection, or infectious agent occurs when it becomes prevalent within a population or geographic area
i. Example: chloroquine-resistant malaria is endemic in most of Africa, the middle east, and Asia and all of the south pacific islands
What is an epidemic?
b. Epidemic – refers to a significant increase in an infection/disease beyond the expected (endemic) level in a certain population and/or geographic area
i. Occur when a new infectious agent emerges or reemerges
ii. A pandemic is an epidemic that generally spreads worldwide (example: SARS)
Common source outbreak and propagated outbreak
A common source outbreak is an outbreak characterized by exposure to a common, harmful substance. A propagated outbreak is an outbreak resulting from direct or indirect transmission of an infectious agent from an infected person to a susceptible host; secondary infections can occur.
Review the recipe for a homemade oral rehydration solution
Stir one level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water or water that has been boiled and cooled.
What are the risk factors for STDs?
- Having multiple sexual partners
- Not using a condom during sex
- Having other STDs
- Having a sexual partner who has had an STD
• Emerging infectious disease – definition
• Newly identified clinically distinct infectious disease, or the reappearance (reemergence) of a known infectious disease after its decline, with an incidence that is increasing in a certain geographic area or among a specific population
