TEST II Flashcards
demographic characteristics, health, and disease status
Person factors of who
geographical location, climate and environmental conditions and political and social environment
Place: “Where” factors,
, time of day, week, month and secular trends over months and years
Time: “When” factors
Epidemiological triangle
AGENT, HOST, and ENVIRONMENT.
Model implies rate of disease will change when the balance among the three factors altered
Epidemiological triangle: AGENT, HOST, and ENVIRONMENT
number of health events in specified period/population in same area in same specified period xk
rate
Morbidity rates include which rates too
prevalence rates and incidence rates
test’s ability to identify client with disease correctly.
Sensitivity
the extent to which the test can correctly identify those who do not have the disease.
Specificity:
The best screening test have what attributes
high sensitivity and high specificity
A mechanism for the ongoing collection of community health information. Monitoring for changes in disease frequency is essential to effective and responsive public health programs.
· Allows nurse to evaluate the effectiveness of existing programs and implement interventions targeted to high-risk groups.
Disease Surveillance
Uses of epidemiology in health services
Apply study results into prevention programs for communities and at-risk populations.
· Aim of health policy planning is to achieve positive health goals & outcomes for improved societal health.
· Community health nurses should exercise “societal responsibility” in applying epidemiological findings. Requires active involvement of citizen consumers.
Focuses on the amount and distribution of health and health problems within a population.
· Purpose is to describe the characteristics of both people who are protected from disease and those who have a disease.
· Person, place, time factors
Descriptive Epidemiology
Investigates the causes of disease by determining why a disease rate is lower in one population group than in another.
· This method tests hypotheses generated from descriptive data and either accepts or rejects them on the basis of analytic research.
· Epidemiologist seeks to establish cause-and-effect relationship between preexisting condition or even and the disease.
Analytic Epidemiology
· Investigator can begin to understand the factors that contribute to disease by observing disease rates in groups of people differentiated by experience or exposure.
· Unlike experimental studies, this type of study does not allow the investigator to manipulate the specific exposure or experience that may influence disease development.
Observational studies
What type of research are cross sectional studies, prospective studies, and retrospective studies?
They are types of observational researches
-Examine relationships between potential causal factors and disease at a specific time.
Cross-sectional Studies: prevalence or correlational studies.
a type of study that compare individuals with a particular condition or disease with those who do not have the disease.
- Investigators also select a control group from the general pop. A greater proportion of exposed cases than controls suggest a relationship between the disease and the risk factor.
- Data collection extends back in time to determine previous exposure or risk factors.
Retrospective Studies
a study that monitors a group of disease-free individuals to determine if and when the disease occurs.
- Longitudinal/cohort/incidence studies
- Ex: birth cohort consists of all people born within a given time period. Study will assess the cohort with respect to an exposure factor associated with the disease. Looks for disease development. It summarizes data collected overtime by the incidence rates of new cases.
Prospective Studies
-A study method to test treatment and prevention strategies. Randomly assign subjects at risk for a particular disease to an experimental or control group. Only experimental group receives intervention.
Experimental Studies(analytical epidemiology)
a collective process which assesses, plans, implements, coordinates, monitors, and evaluate options and services to meet an individual’s health needs through community and available resources to promote quality cost-effective outcomes.
case management
rapid changes in the healthcare environment and increased management care programs, also greater emphasis on health care cost occurred in what years
occurred during 1990-2005:
may deny reimbursement to healthcare providers who exceeds the expected cost.
Managed Care Organizations (MCOs)
Identify etiological factors of disease to encourage the most effective primary prevention activities and develop treatment modalities……who’s goal is this?
Epidemiology
activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals
Primary prevention
Health promotion and specific protection are considered forms of what type of prevention
Primary prevention
those actions that are general in nature and designed to foster healthful lifestyles and a safe environment: eg: promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise
Health promotion
efforts reduce or eliminate risk factors and include such measures as immunization and water purification
Specific protection
those measures designed to detect disease at its earliest stage, namely screening and physical exams that are aimed at early diagnosis
interventions that provide for early treatment and cure of disease
epi data and clinical trials determine effective tx are crucial in disease identification eg: mammograms, guaic stool tests, tx of infections and dental caries
note: occurs after pathogenesis
Secondary prevention
includes the limitation of disability and rehab of those of irreversible disease such as diabetes and spinal cord injury
epi studies examine risk factors affecting function and suggest optimal strategies in the care of the pts with chronic advanced disease
Tertiary prevention
What do the following establish?
Strength of association, dose response relationship, Temporally correct relationship, Biological plausibility, Consistency with other studies, Specificity
Causality
goals are to decrease fragmentation, enhance the clients quality of life, contain costs.
goal of nursing case management
Answers the question, “among people who are well, how often is the test right?”
Specificity
Answers the question< “among people with disease, how often is the test right?
Sensitivity
Types of screening programs
selective vs universal
Relevant for high risk group, low risk to benefit ratio,
eg: alcohol misuse, chlamydia, dental disease, depression, hearing, HIV, osteoperosis, skin cancer
Selective screening
Easy to administer to large numbers of people, accurate results, referrals are a must, low risk high benefit,
REcomended adult screenings: BMI, BP, cholesterol, occult blood, mammogram, PAP
Universal screening
is a notion which supports taking protective action before there is complete scientific proof of a risk; that is, action should not be delayed simply because full scientific information is lacking. Originated from concern that the use and release of hazardous substances into the environment have had negative consequences and that the public must become involved in calling attention to these activities.
precautionary principle
Who does this describe?
Tend not to leave their culture behind
Travel back to homeland frequently
Maintain stronger ties with family in native land due to technological advances in communication tools
Recent increase in Asian and African immigrants
More likely to have immigrated for political reasons
New wave of immigrants
a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values and practices with the goal of using this knowledge to provide culture specific and culture universal nursing care to people
Leininger’s Transcultural nursing:
What are these characteristics of?
learned from birth through the processes of language aquisition and socialization
shared by members of the same cultural group
adapted to specific conditions related to environmental and technical factors and to the availability of natural resources
it is dynamic
all pervasive and universal phenomenon
Culture
person’s tendency to view his or her own way of life as the most desirable, acceptable, or best and tendency to act in a superior manner towards people of another culture
ethnocentrism:
used for fairly large aggregates of people who share characteristics that are not common to all members of the culture and that enable them to be a distinguishable subgroup. ethnicity, religion, occupation, health related characteristics, age, sex and geo location frequently used to identify subcultures
subculture:
refers to desireable or undesireable state of affairs
universal feature of all cultures altho types and expressions of values differ widely
value:
rules by which human behavior is governed and result from the cultural values held by the group
norms:
· Identify target population
· Determine screening and eligibility
· Arrange services, monitor and follow-up, assessing, reassessing, planning care
· Assist clients with complex health care system, and continuity of care.
Possible management functions
method to monitor and control services
HMO- Health Maintenance Organization,
Origins of case management
long history of mentally ill elderly patient and community setting
Public Health
o Assists the client or patient through a complex, fragmented, and often confusing health care system to obtain appropriate care
· System-centered case management
o Recognize that health care resources are finite
o Medicare, MCOs, and insurance companies demand cost-effective health care
· For hospitalized patients
o Health care services coordination begin either upon the patent’s admission or shortly therefore after and continues following the patient’s discharge
Client-centered case management
Trends that influences Case Management:
Prospective Payment system (PPS) in the acute care setting, health care provider receives a fixed amount money based on the relative costs of resource they use to treat medicare patients with in each diagnosis-related group.
Third party negotiates reimbursement
Trend: health costs continue to escalate, population’s age and elderly are increasing, suffering from chronic illnesses.
maximize the quality and cost efficiency of health care services. Through regular reviews and audits, they ensure that patients receive the care they need without burdening the health care system with unnecessary procedures, ineffective treatments or overlong hospital stays. Utilization review nurses also help insureds to make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage
Utilization review
knowledgeable in business, clinical, and efficacy skills, influential in the community, have autonomy in collaboration, must be aware of new changes in health care environment, new regulations, and frequently emerging reimbursement schedules.
Examples of needed skills and knowledge of case managers
Listen actively – respect others when they are talking.
Speak from your own experience instead of generalizing (“I” instead of “they,” “we,” and “you”).
Do not be afraid to respectfully challenge one another by asking questions, but refrain from personal attacks – focus on ideas.
Participate to the fullest of your ability – community growth depends on the inclusion of every individual voice.
Instead of invalidating somebody else’s story with your own spin on her or his experience, share your own story and experience.
The goal is not to agree – it is to gain a deeper understanding.
Be conscious of body language and nonverbal responses – they can be as disrespectful as words.
Strategies to better care for health of diverse populations
- Take a Stand: Advocating for Change
a. Nurses must make individual & collective decisions about which interests they want to serve with their specialized knowledge and skills. - Asking Critical Questions
a. Consider relationships between non-health and health policies. They should ask how policies concerning ecological preservation, energy, housing, immigration, civil rights, crime, nutrition, and minimum wage might affect the well-being of people. - Facilitating Community Involvement
a. To work with the community, nurses need to create the context in which people can identify health-damaging problems in their environments. In order to participate in change, affected people need to be able to ID and work on solving environmental problems. Second role is to provide support, information, and expertise to groups to assist them in meeting the goals they set for environmental change. - Forming Coalitions
a. Form coalitions between groups who have not previously socialized or acted together to produce social change. Initiate dialogue and build a strong base of collective support. Join with communities to eliminate hazards and improve public health. - Using Collective Strategies
Community Health Nursing practice
Cultural Differences in Causation of Illness
(cause and effect, function, measurement)
1. All events in life have a cause and effect.
- The human body functions more or less mechanically (i.e., the functioning of the human body is analogous to the functioning of an automobile).
- All life can be reduced or divided into smaller parts (e.g., the human person can be reduced into body, mind, and spirit).
- All of reality can be observed and measured (e.g., with intelligence tests and psychometric measures of behavior).
Biomedical
Cultural Differences in Causation of Illness: (natural balance, harmony)
This viewpoint is found most frequently among Native Americans, Asians, and others who believe that human life is only one aspect of nature and a part of the general order of the cosmos. Individuals from these groups believe that the forces of nature must be kept in natural balance or harmony to maintain health and well-being.
Naturalistic
Cultural Differences in Causation of Illness: (supernatural)
The basic premise of this explanatory model is that the world is seen as an arena in which supernatural forces dominate. The fate of the world and those in it depends on the action of supernatural forces for good or evil. Examples of magical causes of illness include the belief in voodoo or witchcraft among some blacks and others from circum-Caribbean countries. Faith healing is based on religious beliefs and is most prevalent among selected Christian religions, including Christian Scientists. Various healing rituals may be found in many religions, such as Roman Catholicism,
Magicoreligious
Leading Causes of preventable deaths in US
Healthy People 2010: of the worldwide preventable diseases, 25% are caused by poor environmental quality.
The environment directly affects health status and plays a major role in quality of life, years of healthy life lived, and health disparities. Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular systems. Secondhand smoke containing toxic and cancer-causing chemicals contributes to heart disease and lung cancer in nonsmoking adults. Globally, nearly 25% of all deaths and the total disease burden can be attributed to environmental factors.1
Poor air quality contributes to cancers, cardiovascular disease, asthma, and other illnesses. Poor water quality can lead to gastrointestinal illness and a range of other conditions, including neurological problems and cancer
Leading cause of preventable deaths in US
Represents the percentage of deaths resulting from a specific cause relative to deaths from all causes.
· Helpful in identifying areas in which public health programs might make significant contributions in reducing deaths.
Proportionate mortality ratio (PMR): also describes mortality.
· High (PMR) Proportionate mortality ratio ratio indicates?
= low overall mortality.
This model implies The development of disease is dependent on the extent of the host’s exposure to an agent, the strength of virulence of the agent, and the host’s genetic or immunological susceptibility. Disease is also dependent on the environmental conditions existing at the time of exposure which include the biological, social, political and physical environment.
Epidemiological triangle
