MODULE –I

CHAPTER 1

TITTLE: Community Health Nursing Concepts

A. DEFINITION:
Community Health Nursing
 is the synthesis of nursing and public health practice applied to promote and protect
the health of population .
 it combines all the basic elements of professional, clinical nursing with public health
and community practice.

B.THEORETICAL MODEL AND APPROACHES:

1.Health belief model (HBM)- is a theoretical model that can be used to guide health promotion and
disease prevention programs.

 It is one of the widely used models or understanding health behaviors.

EXAMPLE:
 People will not change their health behaviors unless they believe that they are at risk.
For example, those who do not think that they are at risk of acquiring HIV from
unprotected intercourse are unlikely to use a condom.
 Young people who don't think they're at risk of lung cancer are unlikely to stop smoking

2.MILIO’S FRAMEWORK FOR PREVENTION

  NANCY MILIO a nurse and leader in public health policy and public health education developed a
framework for prevention that includes concepts of community – oriented, population focused care.
 Six propositions relating to health promotion and disease prevention. health needs, and
its health-sustaining resources.
 All human beings make health choices that are the easiest for them to make, most of the
time.
 The framework provides that the health status existing in the population occurs due
to too little or excess critical health sustaining resources whereby people who are
have enough and safe food, shelter, water and environment are vulnerable to
infectious diseases which too much food will lead to obesity.

 Health is also influenced by organizational behavior which includes policy makers

since they provide options available to thus influencing selections made by
individuals.

 Milio (1976) provides that an individual’s health selections are influenced by the
objective to maximize valued resources therefore selection is based to personal
resources and societal resources. Change in choice making among a large number
of people in the population leads to social change and that teaching and learning
may be insignificant in affecting behavior patterns if new health …

3. NOLA PENDER’S HEALTH PROMOTION

 The Health Promotion Model was designed by Nola J. Pender to be a “complementary

counterpart to models of health protection.” It defines health as a positive dynamic
state rather than simply the absence of disease.
 Health promotion is directed at increasing a patient's level of well-being.
 It’s purpose is to assist nurses iv knowing and understanding the major determinants of
health behaviors as foundation for behavioral counseling to promote well-being and
healthy lifestyles.
4. LAWRENCE GREEN’S PRECEDE-PROCEED MODEL

 The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974

by Lawrence W. Green that can help health program planners, policy makers and other
evaluators, analyze situations and design health programs efficiently. It provides a
comprehensive structure for assessing health and quality of life needs, and for designing,
implementing and evaluating health promotion and other public health programs to meet
those needs.
 One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial
attention to outcomes, rather than inputs. It guides planners through a process that starts
with desired outcomes and then works backwards in the causal chain to identify a mix of
strategies for achieving those objectives.
 A fundamental assumption of the model is the active participation of its intended audience —
that is, that the participants ("consumers") will take an active part in defining their own
problems, establishing their goals and developing their solutions.
In this framework, health behavior is regarded as being influenced by both individual and
environmental factors, and hence has two distinct parts.
  First is an "educational diagnosis" – PRECEDE, an acronym for Predisposing, Reinforcing
and Enabling Constructs in Educational Diagnosis and Evaluation.
 Second is an "ecological diagnosis" – PROCEED, for Policy, Regulatory,
and Organizational Constructs in Educational and Environmental Development. The model is
multidimensional and is founded in the social/behavioral sciences, epidemiology,
administration, and education.
 The systematic use of the framework in a series of clinical and field trials confirmed the utility
and predictive validity of the model as a planning tool.
C.DIFFERENT FIELDS

1. SCHOOL HEALTH NURSING

2. OCCUPATIONAL HEALTH NURSING

3. COMMUNITY MENTAL HEALTH NURSING

 CONCEPT OF THE COMMUNITY

 DEFINITION OF COMMUNITY
COMMUNITY-A collection of people who interact with one another and whose common interests or
characteristics form the basis for a sense of unity or belonging.

- A group of people who share something in common and interact with one another, who
may exhibit a commitment with one another and may share a geographic boundary.

1. Types of the Communities

2. Characteristics of a Healthy Community

3. Components of a Community

4. Factors affecting Health of a Community

5. Roles and Activities of Community Health Nurse

Introduction

• Disease management in the community is challenging as illnesses are interwoven with social, economic,
genetic and environmental risks in ways that are difficult to understand and more difficult to change.

• In the face of these challenges, how can nurses succeed in their goal to improve public health?

Health Belief Model

• Provides the basis for much of the practice of health education and health promotion.

• Developed by a group of social psychologists to explain why the public failed to participate in screening for
tuberculosis.

• “Behavior is based on current dynamics confronting an individual rather than prior experiences “ –Kurt Lewin
 Constructs of the Health Belief Model

• Perceived severity/ seriousness

• Perceived susceptibility

• Perceived benefits

• Perceived barriers

• Cues to action

• Self-efficacy
Health Belief Model

• Limitations of the model:

– It places the burden of action exclusively on the client.

– It assumes that only those clients who have distorted or negative perceptions of the specified disease or
recommended health action will fail to act.

– It focuses the nurse's energies on interventions designed to modify the client's distorted perceptions, without
acknowledging the health professional's responsibility to reduce or alter health care barriers other than
patients’ perspectives.

Milio’s Framework for Prevention

• Provides a complement to the Health Belief Model

• Provides a mechanism for directing attention “upstream.”

• Provides for the inclusion of economic, political, and environmental health determinants; therefore,
the nurse is given broader range in the diagnosis and interpretation of health problems.

• Encourages the nurse to understand health behaviors in the context of their societal milieu.

Milio’s Propositions

• Population health results from deprivation and/or excess of critical health resources.

• Behaviors of populations result from selection from limited choices; these arise from actual and
perceived options available as well as beliefs and expectations resulting from socialization, education
and experience.

• Organizational decisions and policies (both governmental and non-governmental) dictate many of the
options available to individuals and populations and influence choices.

Milio’s Propositions

• Individual choices related to health promotion or health damaging behaviors is influenced by efforts
to maximize valued resources.

• Alteration in patterns of behavior resulting from decision making of a significant number of people in a
population can result in social change.
• Without concurrent availability of alternative health-promoting options for investment of personal
resources, health education will be largely ineffective in changing behavior patterns.

Pender’s Health Promotion Model

• Explores the many biopsychosocial factors that influence individuals to pursue health promotion
activities.

• Contains seven variables related to health behaviors, as well as individual characteristics that may
influence a behavioral outcome.

• Does not include threat as a motivator, as threat may not be a motivating factor for clients in all age
groups.

Seven Variables of Pender’s Health Promotion Model

• Prior related behaviors

• Personal factors

• Behavior specific cognition and affect

– Perceived benefits of action

– Perceived barriers to action

– Perceived self-efficacy

• Activity-related affect

– Interpersonal influences

– Situational influences

• Commitment to a plan of action

• Immediate competing demands and preferences

• Health-promoting behavior

Precede-Proceed Model

• Developed by Dr. Lawrence W. Green and colleagues.

• Provides a model for community assessment, health education planning and evaluation.

Precede-Proceed Model

• PRECEDE: stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and
Evaluation.

– A model for community diagnosis

• PROCEED: stands for Policy, Regulatory, and Organizational Constructs in Educational and
Environmental Development
– a model for implementing and evaluating health programs based on PRECEDE

Precede-Proceed Model

• Predisposing factors refer to people’s characteristics that motivate them towards health-related
behavior.

• Enabling factors refer to conditions in people and the environment that facilitate or impede health-
related behavior.

• Reinforcing factors refer to feedback given by support persons or groups resulting from the
performance of the health-related behavior.

CHAPTER 7: THE NURSING PROCESS IN THE CARE OF THE COMMUNITY Instructional slides

Chapter Outline

• Principles of Community Health Care

• Conditions in the Community Affecting Health

• Characteristics of a Healthy Community

• Nursing Process in Community Health Care

– Community Assessment

– Community Diagnosis

– Community Health Planning and Implementation

– Evaluation of Community Health Interventions

Objectives

• Upon completion of this chapter, the reader will be able to do the following:

• Illustrate the principles of community health nursing.

• Describe conditions affecting the health of a given community.

• Recognize characteristics of a healthy community.

• Utilize the nursing process in managing community health concerns.

Principles of Community Health Nursing Adapted from the 8 Principles of Public Health by the
American Nurses Association (2007)

1. Focus on the community as the unit of care.

2. Give priority to community needs.

3. Work with the community as an equal partner of the health team.

4. In selecting appropriate activities, focus on primary prevention.

5. Promote a healthful physical and psychosocial environment.

6. Reach out to all who may benefit from a specific service.

7. Promote optimum use of resources.

8. Collaborate with others working in the community.

Conditions in the Community Affecting Health

1. People

▪ include size, density, composition, rate of growth or decline, cultural characteristics, mobility, social
class and educational level

2. Location

▪ Including natural (i.e., geographic features, flora & fauna) and man-made variables

3. Social System

▪ include the family, economic, educational, communication, political, legal, religious, recreational, and
the health systems (Allender, et al., 2009)

Characteristics of a Healthy Community Adapted from Hunt, 1997 and Duhl, 2002

▪ A shared sense of being a community based on history and values

▪ A general feeling of empowerment and control over matters that affect the community as a whole

▪ Existing structures that allow subgroups to participate in decision-making in community matters

▪ The ability to cope with change, solve problems, and manage conflicts within acceptable means

▪ Open channels of communication and cooperation among the members of the community

▪ Equitable and efficient use of community resources, with the view towards sustaining natural
resources.

A healthy community is in fact,

“The process of enabling people to increase control over, and to improve, their health”. - Ottawa
Charter (WHO, 1986)

Community Assessment

▪ Collect data on the three categories of community health determinants: people, place, and social
system

▪ Planned Approach to Community Health (PATCH) is a community health planning model that builds on
a set of quantitative and qualitative data for profiling (Box 7-1)

▪ Approaches:
1. Comprehensive needs assessment - broad

2. Problem-oriented assessment – focused

Primary Data Collection Data that have not been gathered before and are collected by the nurse

Observation

• Ocular/ Windshield Survey

• Participant Observation

Survey

Informant Interview

Community Forum

Focus Group Discussion

Secondary Data What is already known; Taken from existing data sources

Vital registries

Health records and reports

Disease registries

Publications

• Print & Electronic

Census Data

Community Diagnosis

▪ As a finding: A quantitative and qualitative description of the health of citizens and the factors which
influence their health

▪ As a process: Determining a community’s a) health status b) resources, and c) health action potential
or the likelihood that the community will act to meet health needs or resolve health problems

The Omaha System Problem Classification Scheme

▪ Environmental

▪ Psychosocial

▪ Physiological

▪ Health-related behaviors

• Areas of Concern under the 4 domains

• Identify if problem is:

• Promotion

• Potential

• Actual

• Level of clientele

• Cluster of signs and symptoms that describe the problem

Planning is a logical process of decision making involving:

1. Priority-setting

2. Formulating goals and objectives

3. Deciding on community interventions

Priority-Setting

• Criteria

1. Significance of the problem

2. Level of community awareness

3. Ability to reduce risk

4. Cost of reducing risk

5. Ability to identify the target population

6. Availability of resources

• requires the joint effort of the community, the nurse, and other stakeholders, such as other members
of the health team

Formulating Goals and Objectives Deciding on Interventions

• GOAL

– desired outcome at the end of interventions

• OBJECTIVE

– short-term changes in the community that are observed – serve as instructions – must be SMART

– demographic, psychological, social, cultural, and economic characteristics of the target population VS.
health resources

Implementation

• Remember: process is intended to enhance the community’s capability in dealing with common health
conditions/problems

• Implementation entails:
– Facilitating the process

– Coordinating the plan with the community

– Collaboration with other sectors and agencies

THE COMMUNITY

➢ A group of people who share something in common and interact with one another, who may exibit a
commitment with one another and may share demographic boundary.

➢ A group of people who share common interests, who interact with each other, who function
collectively within a define social structure to address common concerns.

MAURER AND SMITH (2009) further addressesd the concept of the community and identified four
defining attributes.

1 .People

2. Place

3. Interaction

4. Common characteristics, interests, or goals.

TWO MAIN TYPES OF COMMUNITIES:

1. GEOPOLITICAL COMMUNITIES/TERRITORIAL COMMUNITIES: are formed by both natural and

Manmade boundaries.

2. PHENOMENOLOGICAL COMMUNITIES: refer to relational, interactive groups, in which the place or

Setting is more abstract, and people share a group perspective or identity based on culture, values,

History, interests, and goals.

PRINCIPLES OF COMMUNITY HEALTH NURSING

1. Focus on the community as the unit of care

2. Give priority to the community needs

3. Work with community as an equal partner of the health team.

4. Focus on primary prevention

5. Promote a healthful physical and psychosocial environment.

6. Reach out to all who may benefit from a specific service.

7. Promote optimum use of resources.

8. Collaborative with others working in a community.

CONDITIONS IN THE COMMUNITY AFFECTING HEALTH

FEATURES:

1. People

2. Location

3. Social System

CHARACTERISTICS OF A HEALTHY COMMUNITY:

1. A shared sense of being a community based on history and values.

2. A general feeling of empowerment and control over matters that affect the community as a whole.

3. Existing structures that allow subgroups within the community to participate in decision making in

Community matters.

4. The ability to cope with change, solve problems, and manage conflicts within the community through

Acceptable means.

5. Open channels of communication and cooperation among the members of the community.

6. Equitable and efficient use of community resources, with the view towards sustaining resources.

A HEALTHY CITY: aims to;

1. Achieved a good quality of life

2. Create a health-supportive environment

3. Provide basic sanitation and hygiene needs.

4. Supply access to health care.

COMMUNITY ASSESSMENT:

➢ The data that need to be collected depend on the objectives of community assessment.

➢ PATCH – Planned Approach to Community Health. “PRECEDE MODEL” – include the quantitative and
qualitative data.
A.COMPREHENSIVE NEEDS OF ASSESSMENT

DATA COLLECTED FOR THE PATCH PROCESS FOR HEALTH PLANNING:

1. Community profile

2. Morbidity and Mortality data

3. Behavioral data

4. Opinion data

B. PROBLEM-PORIENTED ASSESSMENT

TOOLS FOR COMMUNITY ASSESSMENT:

A.PRIMARY DATA

COLLECTING PRIMARY DATA:

1. OBSERVATION

2. SURVEY

3. INFORMANT INTERVIEW

4. COMMUNITY FORUM

5. FOCUS GROUP

B.SECONDARY DATA SOURCES

1. REGISTRY VITAL EVENTS

2. HEALTH RECORDS AND REPORTS

The FHSIS – Field Health Service Information System-is the official recording and reporting system of
the DOH and is use by the NSCB to generate health statistics.

➢ It is therefore a basis for:

1. Priority setting by local government

2. Planning and decision making at different levels of barangay, municipality, district, provincial, and
national.

3. Monitoring and evaluating health program implementation.

THE FHSIS MANUAL OPERATIONS (DOH-IMS, 2011) Lists and describes the following recording tools.

L. Individual Treatment Record (ITR)

ll. Target Client Lists(TCLs) are the second building block of the FHSIS.These service records have the
following purposes;

a. To plan and carry out patient care and service delivery since midwives and nurses use TCLs to monitor
target or eligible populations for particular health services.

b. To facilitate monitoring and supervision of service delivery activities.

c. To report services delivered.

d. To provide clinic data base that can be accessed for further studies.

The following are the TCLs maintained in RHU and Health Centers;

1. TCL for Prenatal Care

2.TCL for Postpartum Care

3. TCL of under 1 y/o children

4. TCL for family planning

5. TCL for Sick Children

6. National Tuberculosis Program TB register

7. National Leprosy Control Program-Central Registration Form

lll. The Summary Table – accomplished by the midwife.(1yr) record – 12 months.

✓ Monthly summary of morbidity (10 leading causes)-municipality/city.

✓ Source of data for any research survey.

lV.Monthly Consolidation Table (MCT)- accomplished by the nurse based on the summary table.

✓ Source document for the quarterly Form and the Output table of the RHU or Health center.

THE REPORTING FORMS, as enumerated in the FHSIS Manual of Operations (DOH-IMS, 2011), are the
following:

1. MONTHLY FORMS are prepared by the midwife and submitted to the nurse, who then uses the date
to prepare the Quarterly Forms.
a. PROGRAM REPORT (M1) Contains indicators like:

1. Maternal Care

2. Child Care

3. Family Planning

4. Disease Control

b.MORBIDITY REPORT (M2) Contains a list of all cases of disease by age and sex.

2. QUARTERLY FORMS are usually prepared by the nurse.

✓ There should be only one Quarterly Form for the municipality/city.

✓ In municipalities/cities with two or more RHUs or Health Centers, the consolidation is done under the
direction of the Municipal/City Health Officer

✓ Quarterly forms are submitted to the Provincial Health Office

A.PROGRAM REPORT (Q1) – Contains the 3 – month total of indicators categorized as maternal care,
family planning, child care, dental health, and disease control.

B. MORBIDITY REPORT (Q2) – Is a 3-month consolidation of Morbidity Report (M2)

3. ANNUAL FORMS:

a. A-BHS is a report by the midwife that contains demographic, environmental, and natality date.

b. ANNUAL FORM 1 (A-1) prepared by the nurse and is the report of the RHU or health center. It
contains demographic and environmental data, and data on natality and mortality for the entire year.

c. ANNUAL FORM 2 (A-2) prepared by the nurse, is the yearly morbidity report by age and sex.

d. ANNUAL FORM 3 (A-3) also prepared by the nurse, is the yearly report of all deaths (mortality) by age
and sex.

DISEASE REGISTRIES: a listing of persons diagnosed with a specific type of disease in a defined
population.

CENSUS DATA-NSO

HEALTH STATISTICS AND EPIDEMIOLOGY

STATISTICS - refers to both quantitative data, and the classification of such data in accordance with
probability theory and the application to them of methods such as hypothesis testing.

Health statistics include both empirical data and estimates related to health, such as mortality,
morbidity, risk factors, health service coverage, andhealth systems.

EPIDEMIOLOGY IS the branch of medicine which deals with the incidence, distribution, and possible
control of diseases and other factors relating to health.
TOOLS:

1. DEMOGRAPHY: is the branch of social size, structure, which deals with the study of size, structure and
distribution of populations, along with the spatial and temporal changes in them in response to birth,
migration, ageing and death.

The three main sources of demographic and social statistics are censuses, surveys and administrative
records.

These three data sources are the principal means of collecting basic demographic and social statistics as
part of an integrated programme of statistical data collection and compilation.

Community Assessment

▪ Status

▪ Structure

▪ Process

Types of Community Assessment

Community Diagnosis

▪ A process by which the nurse collects data about the community in order to identify factors which may
influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis
and develop and implement community health nursing interventions and strategies.

2 Types:

Comprehensive Community Diagnosis - aims to obtain general information about the community

Problem-Oriented Community Diagnosis - type of assessment responds to a particular need

Steps:

Preparatory Phase

1. Site selection

2. Preparation of the community

3. Statement of the objectives

4. Determine the data to be collected

5. Identify methods and instruments for data collection

6. Finalize sampling design and methods

7. Make a timetable
Implementation Phase

1. Data collection

2. Data organization/collation

3. Data presentation

4. Data analysis

5. Identification of health problems

6. Prioritization of health problems

7. Development of a health plan

8. Validation and feedback

Evaluation Phase

Biostatistics

▪ DEMOGRAPHY – study of population size, composition and spatial distribution as affected by births,
deaths and migration.

▪ Sources: Census – complete enumeration of the population

2 Ways of Assigning People

1. De Jure – People were assigned to the place they usually live regardless of where they are at the time
of census.

2. De Facto – People were assigned to the place where they are physically present atare at the time of
census regardless, of their usual place of residence.

Components:

1. Population size

2. Population composition

▪ Age Distribution

▪ Sex Ratio

▪ Population Pyramid

▪ Median age – age below which 50% of the population falls and above which 50% of the population
falls. The lower the median age, the younger the population (high fertility, high death rates).

▪ Age – Dependency Ratio – used as an index of age-induced economic drain on human resources
▪ Other characteristics

▪ Occupational groups

▪ Economic groups

▪ Educational attainment

▪ Ethnic group

3. Population Distribution

▪ Urban-Rural – shows the proportion of people living in urban compared to the rural areas

▪ Crowding Index – indicates the ease by which a communicable disease can be transmitted from 1 host
to another susceptible host.

▪ Population Density – determines congestion of the place

Vital Statistics

▪ The application of statistical measures to vital events (births, deaths and common illnesses) that is
utilized to gauge the levels of health, illness and health services of a community.

Epidemiology

▪ the study of distribution of disease or physiologic condition among human population s and the factors
affecting such distribution

▪ the study of the occurrence and distribution of health conditions such as disease, death, deformities or
disabilities on human populations

1. Patterns of disease occurrence

Epidemic

▪ A situation when there is a high incidence of new cases of a specific disease in excess of the expected.

▪ when the proportion of the susceptible are high compared to the proportion of the immunes

Epidemic potential

▪ an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes,
ecologic changes, or socio-economic changes
Endemic

▪ habitual presence of a disease in a given geographic location accounting for the low number of both
immunes and susceptible .E.g. Malaria is a disease endemic at Palawan.

▪ The causative factor of the disease is constantly available or present to the area.

Sporadic

▪ disease occurs every now and then affecting only a small number of people relative to the total
population

▪ intermittent

Pandemic

▪ global occurrence of a disease Steps in Epidemiological Investigation:

1. Establish fact of presence of epidemic

2. Establish time and space relationship of the disease

3. Relate to characteristics of the group in the community

4. Correlate all data obtained

2. Role of the Nurse

▪ Case Finding

▪ Health Teaching

▪ Counseling

▪ Follow up visit

THE PHILIPPINE HEALTH SITUATION

✓ The Philippines has made significant investments and advances in health in recent years.

✓ Rapid economic growth and strong country capacity have contributed to Filipinos living longer and
healthier.

✓ Health insurance now covers 92% of the population.

✓ Maternal and child health services have improved, with more children living beyond infancy, a higher
number of women delivering at health facilities and more births being attended by professional service
providers than ever before.
✓ Access to and provision of preventive, diagnostic and treatment services for communicable diseases
have improved, while there are several initiatives to reduce illness and death due to no communicable
diseases (NCDs).

✓ Deep inequities persist between regions, rich and the poor, and different population groups.

✓ Many Filipinos continue to die or suffer from illnesses that have well -proven, cost-effective.

✓ Many people lack sufficient knowledge to make informed decisions about their own health.

✓ Rapid economic development, urbanization, escalating climate change, and widening exposure to
diseases and pathogens in an increasingly global world increase the risks associated with disasters

• The Government's vision for the Philippines has been translated by the Department of Health into the
Philippine Health Agenda 2016-2022.

Reducing health inequities is singled out as the most important result of three health guarantees:

1) Ensuring financial protection for the poorest people;

2) Improving health outcomes with no disparities

3) Building health service delivery networks for more responsiveness

The global vision of the world in 2030, spelled out in the Sustainable Development Goals, aligns with
the Philippines' 25-year vision AmBisyon Natin 2040.

WHO supports the Government of the Philippines to foster well-being

✓ Accelerate progress towards the targeted elimination of TB, the AIDS epidemic, malaria and neglected
tropical diseases

✓ Address the high burden of viral hepatitis ✓ Intensify control and treatment of dengue and
chikungunya

✓ Strengthen the implementation of maternal, neonatal and child health policies across the country
with a special focus on vulnerable groups

✓ Expand population coverage under the national vaccination programme.

✓ Maximize opportunities for healthy lifestyles.

✓ Accelerate the introduction of tobacco-free societies

✓ Increase the responsiveness of health services to people's needs

✓ Enable reproductive choices for all women and men

✓ Optimize the health sector contribution to preventing and addressing gender-based violence and
violence against children

✓ Support the implementation of the Asia Pacific Strategy for Emerging Diseases and
Public Health Emergencies and disaster risk management for health

✓ Co-lead the national Health Cluster response in emergency situations

✓ Improve access to clean air, safe water and safe food.

✓ Advocate for "green" health-care facilities and the reduction of carbon emissions

✓ Support the implementation of The Philippine Action Plan to Combat Antimicrobial

✓ Work with Government departments, legislators and organizations on health-related taxation laws
and regulations and to promote multispectral collaboration.

✓ Support the educational sector and youth organizations, through the Department of Education and
the Commission on Higher Education.

✓ Enable cities and islands to act as drivers for population health

✓ Enhance the Philippines' standing in regional and global health

✓ Address the issue of road and traffic injuries as a major public health concern

DEMOGRAPHIC PROFILE

Demographics is defined as statistical data about the characteristics of a population, such as the age,
gender and income of the people within the population. When the census assembles data about
people's ages and genders, this is an example of assembling information about demographics.

▪ The current population of the Philippines is 109,902,061 as of Monday, September 21, 2020, based on
World meter elaboration of the latest United Nations data.

▪ The Philippines 2020 population is estimated at 109,581,078 people at mid-year

▪ The Philippines population is equivalent to 1.41% of the total world population.

▪ The Philippines ranks number 13 in the list of countries (and dependencies) by population.

▪ The total land area is 298,170 Km2 (115,124 sq. miles)

▪ 47.5 % of the population is urban (52,008,603 people in 2020)

▪ The median age in the Philippines is 25.7 years.

EPIDEMIOLOGY AND THE NURSE

1. CONCEPTS AND DEFINITION: EPIDEMIOLOGY

➢ ASPECTS OF EPIDEMIOLOGY

A.EPIDEMIOLOGY AS A DESCRIPTIVE SCIENCE

 • Descriptive -Analytic Epidemiology

• Collection of information for analysis (refer to page 208)

a. General factors influencing occurrence and distribution (a. agent b. host environment)

b. Description of occurrence and distribution of disease.

c. Natural history of disease

❖ How to discover disease

a. Historical studies of disease occurrence

b. Community Diagnosis of health and disease

c. Estimation of rise of morbidity and mortality

❖ For more effective preventive medicine

B.EPIDEMIOLOGY AS CONSTRICTIVE SCIENCE

• Epidemiologic Investigations

• Steps in Epidemiologic Methods

a. Definition of problem and clarification of objectives.

b. Critical appraisal of existing information
c. Formulation of hypothesis
d. Verification of hypothesis
e. Practical application

❖ To discover disease

a. Searching for causes of disease process and epidemics

b. Observing the range, aptitude, and group behavior of clinical syndromes in populations.

c. Evaluating the effectiveness of preventive programs

❖ For more preventive medicine

2. NATURAL LIFE HISTORY OF DISEASE

a. PREPATHOGENESIS PERIOD

b. PERIOD OF PATOGENESIS
(THE EPIDEMIOLOGICAL PROCESS)

I: Determine the nature, extent and scope of the problem

A. Natural life history of condition

B. Determinants influencing condition

1. Primary data(essential agent)

a. Parasite/bacteria/virus

b. Nutritional

c. Psychosocial

2. Contributory data

a. agent

b. host

c. environment

C.DISTRIBUTION PATTERN

1. Person

2. Place

3. Time

D.CONDITION FREQUENCIES

1. Prevalence

2. Incidence

➢ THE EPIDEMIOLOGICAL TRIANGLE:

✓ LEVELS OF PREVENTION

a. agent

b. host

c. environment

❖ PERSON – PLACE – TIME RELATIONSHIP

✓ SPORADIC

✓ ENDEMIC
✓ EPIDEMIC

✓ PANDEMIC

➢ THE EPIDEMIOLOGICAL PROCESS AND INVESTIGATION

a. Who is affected

b. Where the affected persons reside

c. When the persons were affected

d. causal factors

e. prevalence

f. prevention and control measures

STEP I: DETERMINE THE NATURE, EXTENT, AND POSSIBLE SIGNIFICANCE OF THE PROBLEM STEP

II: DEVELOP TENTATIVE HYPOTHESIS (SES) STEP

III: COLLECT AND ANALYZE FURTHER DATA TO TEST HYPOTHESIS

The community nurse performs the following actions:

1. Demonstrate differences in attack rates in people exposed and not exposed to source of infection.

2. Apply statistical test to data to determine if variations are random or they are statistically significant.

3. Collect clinical and environmental specimens for processing in the laboratory.

STEP IV: PLAN FOR CONTROL

1. Population at risk

2. Primary, secondary and tertiary preventive measure available that would

a. Alter the behavior or susceptibility of the host

b. Destroy the agent

c. Eliminate the transmission of the agent

3. Feasibility of implementing the control plan

4. Priorities in relation to legal mandates

❖ CHAIN OF INFECTION

1. ETIOLOGIC AGENT
2. MODE OF TRANSMISSION

a. Contact transmission

b. Common – vehicle transmission

c. Airborne transmission

3. Host

➢ THE CHAIN OF TRANSMISSION

Pathogenic agent- reservoir- portal of exit- transmission- portal of entry- host susceptibility.

➢ BREAKING THE CHAIN OF TRANSMISSION:

STEP V: IMPLEMENT CONTROL PLAN

REASONS:

a. Prevent additional cases

b. Prevent outbreaks in the future.

STEP VI: EVALUATE CONTROL PLAN

STEP VII: MAKE APPROPRIATE REPORT

STEP VIII: CONDUCT RESEARCH

➢ COMMUNITY DIAGNOSIS:

➢ NANDA

➢ OMAHA CLASSIFICATION SYSTEM FOR COMMUNITY DIAGNOSIS

3 COMPONENTS (OMAHA SYSTEM, 2011a)

a. Problem classification sceme

b. Intervention shceme

c. Problem rating scale for outcomes

PROBLEM CLARIFICATION SCHEME – CLIENT ASSESSMENT

The identified problems or areas of concern are classified in four levels:

• The first level and most general level of classification is composed of 4 domains:

• Refer to (page 144 box 7.4)

1. ENVIRONMENTAL

2. PSYCHOSOCIAL

3. PHYSIOLOGICAL

4. HEALTH RELATED BEHAVIORS

• The 2nd level consists of problems concern under the 4 domains (page 144)

• In the 3rd level is classified into 2 sets of qualifiers

1. Area of concern is categorized into health promotion, potential problem, or actual problem

2. Level of clientele (individual, family, or community) involved is identified

• The 4rth level is made up of clusters of signs and symptoms (OMAHA SYSTEM, 2011b)

❖ PLANNING COMMUNITY HEALTH INTERVENTION

❖ PRIORITY SETTING-(WHO)

1. SIGNIFICANCE OF THE PROBLEM

2. COMMUNITY AWARENESS

3. ABILITY TO REDUCE RISK

4. COST OF REDUCING RISK

5. ABILITY TO IDENTIFY THE TARGET POPULATION

6. AVAILABILITY OF RESOURCES

❖ FORMULATING GOALS AND OBJECTIVES (PAGE 148)

❖ DECIDING ON COMMUNITY INTERVENTIONS

❖ IMPLEMENTING THE COMMUNITY HEALTH INTERVENTIONS

❖ EVALUATION OF COMMUNITY HEALTH INTERVENTION