COURSE-B.

SC NURSING IV YEAR

SUBJECT:COMMUNITY HEALTH NSG II

UNIT :4

COMMUNITY HEALTH NURSING APPROACHES,

CONCEPTS AND ROLES AND RESPONSIBILITIES
OF NURSING PERSONNEL
EPIDEMIOLOGICAL APPROACH

PROBLEM SOLVING APPROACH

EVIDENCE BASED APPROACH

EPIDEMIOLOGICAL APPROACH

Prepared by
Prof. S.Mahalakshmi,
Prof, HOD. Chn. Dept
M.Sc (N), M.Sc, M.Phil()psy, ph.D.
 OBJECTIVES

• define epidemiology
• list out the aims of epidemiology
• enlist the uses of epidemiology
• mention methods of epidemiology
• discuss the approaches of epidemiology
• describe the nurse role in epidemiology
 INTRODUCTION
• Epidemiology is the basic science of preventive
and social medicine.
• It began with Adam and Eve both tried to
investigate the qualities of “forbidden fruit”.
• The Greek physician Hippocrates father of
epidemiology the first person to have examined
the relationship between the occurance disease
and environmental influences. epidemiology
• Epi means=among,demos=people,logos=study.
 DEFINITION

• Epidemiology is the study of the distribution and

determinants of health related state or events in
specified populations and application of this
study to control and prevent the health
problems.( John.M.Lost, 1988).
• The study of frequancy, distribution and
determinant of disease is known as
epidemiology.(International epidemiological
Association).
 AIMS OF EPIDEMIOLOGY

• Epidemiological studies aimed to determine......

• Distribution & size of the disease problem in
human population
• Etiological factors in the pathogenesis of disease
• Methods of data to planning, treatment,
prevention and control of diseases.
• Help to priorities among healthcare services.
 Uses of epidemiology

• It helps to the description of the health status

of the population.
• Evaluation of the intervention(health care
services).
• Planning health services, policy and programs.
 USES OF EPIDEMIOLOGY Con....

• Determine the facts :

 Methods contd...

• Descriptive: study of the occurrence and

distribution of disease
• Analytic: determine the validity of a hypotheseis
concerning the occurrence of disease
• Experimental: find out the cause and effect
relationship,
 METHODS Cont...

• Descriptive method:
Study of the occurrence and distribution of
disease.
Eg: Time,
Place,
Person,
 METHODS Cont..

Analytical method:
Further studies to determine
The validity of a hypothesis
Concerning the occurence of
disease.
 METHODS Con...

• Experimental method:
• Deliberate manipulation of the causes is
predictably followed by an alteration in the effect
not due to chance.
 APPROACHES OF EPIDEMIOLOGY

1.Asking Questions
2.Making Comparision
• 1.Asking questions: Related to health events:
What is the event?( health problem) Where
did it happen?
When did it happen?
Who are affected?
Why did it happened
How are the activities to be organized?
 EPIDEMIOLOGICAL APPROACH

• Example: Coronovirus
• Apply your approach:
 APPROACH Cont....

• Making Comparision:
• This approach is to make comparisions and
draw the inferences
• Comparsion may be made between different
population at a given time eg. Coronovirus
spread between China and India or America.
• Between various sub groups of population
eg.male and female population.
• Between various periods observation eg.
Summer, winter seasons.
 MAKINGCOMPARISON Con...

• Epidemic: The occurance of an infection disease

clearly in excess of normal expectancy and
generated from a common or propagated source.
.Endemic: The habitual presence or usual occrance of
a disease within a given geographical area.
.Pandemic: A worldwide epidemic affecting an
exceptionally high proportion of the global
population.
 TOOLS OF MEASUREMENTS

1.Rates
2.Ratios
3.Proportions
 MEASURMENTS Cont...

• Birth Rate
• Death Rate
• Prevalence Rate
• Incidence
• Morbidity
• Mortality
• Crude birth Rate
• Crude death Rate
 MEASUREMENT Cont...

• Prevalence Rate:
Number of people with disease at
specified time
X 1000
Number of people in population at risk at
specified time
 MEASUREMENT Cont...

• Death rate:
• Death rate = No. of death in one year
X1000
Mid year population of same
year
 MEASUREMENT Con...

• Rate it includes:
• Numerator
• Denominator
• Time specification
• Multiplication
 MEASUREMENT Cont...

• Time specifiation: It usually a callender year.

• The rate is expressed per 1000 or 100,000.

• Various categories of rates:

•Crude rate: These are actual observation rates.
eg: Birth rate and Death rate.

Specific rate: Rates due to specific causes, eg: (coronovirus disease).

Disease occuring in specific groups(age and sex) during specific time

period (Annual, monthly, weekly)
 MEASUREMENT Cont...

• Standardized rate: These are obtained by direct

or indirect method of standardization.eg:age and
sex standardized rates.
• Ratio: It used for two variables either X or Y.
X/Y
• X:Y
• eg: Doctor – patient ratio, Nurse – patient ratio
• Child and woman ratio
 MEASUREMENT Cont...

.Incidence rate:
It is defined as the number of new cases occuring
in adefined population during a specified time
period. Commonly used only for new cases

No. of new cases of specific disease during a

given time period
X1000
Population at risk during that period
 MEASUREMENT Con....

• Relative Risk (RR):

Incidence rate among exposed
X100
Incidence rate among non exposed
 MEASUREMENT Con...

• Relative Risk(RR):
 MEAUREMENT Cont.....

• Proportion: It represent as a percentage. It is the

part of the whole.

The number of coronavirus disease rate

X100
Total number of people in the same
 MEASUREMENT Cont...

• Numerator: It refers to the number of times an

event has ocured in a population during
specified time period.
• It is a component of denominator.
• Denominator: Related the particular population
or related to the total event.
 MEASUREMENTS Cont...

Example:1 March 29/2020

MEASUREMENTS Cont.....

Example:2
 MEASUREMENT Cont...

• Incidence rate:
• Morbidity and mortality- compare – male and
female due to disease or New cases.
• Incidence commonly used only for new cases.
• New cases = 500/40000 population
=12.5/1000/Year.
 MEASUREMENT Cont...

• Proportion or Attack rate: It is an

cumulative incidence during an outbreak
eg: epidemic – coronovirus.
 MEASUREMENTS Con.......

• Comparison of coronovirus cases( morbidity

&mortality). As on 6/3/2020
 NURSES ROLE

• Screening
• Notification
• Evaluation of health care services
• Management
• Prevention and control of diseases
 NURSE ROLE Con....

• Screening:
 NURSE ROLE Con....

• Notification:
 NURSES ROLE Con.....

• Evaluation of health services:

 NURSE ROLE Con...

• Management(1 & 2)
NURSE ROLE Con....
 NURSES ROLE Con...

• Prevention & control of

• diseases:
• Hand hygiene
 NUESE ROLE Cont...

• Personal hygiene:
 NURSES ROLE Con...

• Prevention and control of disease:

• Do regular exercises &
• Yoga(meditation)
 NURSE ROLE Cont...

• Prevention of diseases
• Eat healthy food.
 NURSE ROLE Cont...

• Prevention and control of diseases:

• Avoid junk food & high cholesterol food:
 SUMMARY

• Epidemiological approach:
Epidemiological approach gives definition, aims,
uses, methods, measurements and especially
the nurses role to improve knowledge and
reduce morbidity and mortality rate. Without
doubt it increases the health status of population
and economy of our country.
 REFERENCE

• Park. k(2015). Text book of preventive and

social medicine. Bharnot publishers.
• Mahajan B.K & Gupta MC(2013). Text book of
preventive and social medicine. Mumbai: New
Delhi: Jaypee brothers, Medical publishers.
. wwwjaypeebrothers.com>pg Details.
.www. research gate net> publishers community
medicine.
www.net.reference
 QUESTIONS

Answere to the questions:

1.Define epidemiology? Explain nurse role in
epidemiological apprach?(9marks)

2. Describe the purposes of epidemiology?(5)

1. What is epidemic? Give one eg.(2 marks)

2. Numerator?(2marks)
3. Incidence of coronovirus in tamil nadu?(2marks)
 B.Sc.Nursing IV year
Community Health Nursing II
Community Health Management

Problem Solving and Evidence Based

Approach
Mrs.Ponnambily Chandy Jobin
Assistant Professor
 1

Objectives
● Define PSA
● List the purposes of PSA
● Describe the steps of PSA
● Define EBP
● List the goals of EBP
● Describe the steps of EBP
 2

● PROBLEM SOLVING APPROACH

1. Definition
● A systematic approach to defining the problem

and creating a vast number of possible

solutions without judging these solution.
● “Problem solving is a cognitive processing

directed at achieving a goal where no solution

method is obvious to the problem solver”
 3

● 1.2 Purpose
● Train the students in the act of reasoning.
● Gain and improve the knowledge
● Solve puzzling question
● Overcome the obstacles in the attainment of
objectives.
 4

1.3 Steps
● Formation and appreciation of problem-The
nature of the problem should be made very
clear to the students so that they can
understand the actual solution for the problem.
● Collection of relevant data and information-
● The students should be stimulated to collect
data in a systematic manner full co- operation
of the students should be secured.
 5

1.3 Steps
● Organization of data-The students should be
asked to sift the relevant material from the
superficial one put in a scientific way.
● Drawing of conclusion-After the organizing data
discussions should be arranged collectively and
individual with each student so that essential
thing is done by the students themselves.
● Testing conclusion-No conclusion should be
accepted without being properly verified. The
corrections of the conclusion must be proved.
 6

EVIDENCE BASED APPROACH

● 2.1 Definition
● It is systemic inter connecting of scientifically
generated evidence with the tacit knowledge of
the expert practitioner to achieve a change in a
particular practice for the benefit of a well-
defined client / patient group.
 7

● 2.2 GOAL OF EBP

● Provide practicing nurse the evidence based
data to deliver effective care.
● Resolve problem in clinical setting.
● Achieve excellence in care delivery.
● Reduces the variations in nursing care and
assist with efficient and effective decision
making.
 8

2.3 STEPS IN EBP

● Facilitate critical thinking about the practical
application of research findings
● Result in the use of evidence in the context of
daily practice
● Mitigate some of the human errors made in
decision making.
 9

● 2.4 Advantages of EBP

● Provide better information to practitioner
● Enable consistency of care
● Better patient outcome
● Provide client focused care
● Structured process
● Increases confidence in decision-making
● Generalize information
● Contribute to science of nursing
● Provide guidelines for further research
● Helps nurses to provide high quality patient
care
 10

● 2.5 Disadvantages of EBP

● Not enough evidence for EBP
● Time consuming
● Reduced client choice
● Reduced professional judgement/ autonomy
● Supress creativity
● Influence legal proceedings
● Publication bias
 References
● Sackett DL, Strauss SE, Richardson WS,et
al.Evidence-based medicine: how to practice
and teach EBM. London:
Churchill-Livingstone,2000
● Steves R, Hootman JM. Evidence-based
medicine: what is it and how does it apply to
athletic training? J Athl Train2004;39:83–7.
● Brownson RC, Baker EA, Leet TL,et
al.Evidence based public Health. New York:
Oxford University Press,2003
● Gray GE, Pinson LA. Evidence-based
medicine and psychiatric practice. Psychiatr
Q2003;74:387–99.
● Sackett DL. Evidence-based medicine.
Semin Perinatol1997;21:3–5
 Questions
I. Short notes (4*5m= 20 marks)
1)Describe the steps of Problem Solving Approach?
2)Describe the advantages and disadvantages of
Problem Solving Approach?
3)Describe the steps of Evidence Based Practice?
4)Describe the advantages and disadvantages of
Evidence Based Practice?
II. Short answers (5*2m= 10 marks)
1)List the goals of Problem Solving Approach
2)Define Problem Solving Approach
3)List the purposes of Problem Solving Approach
4)List the goals of Evidence Based Practice
5)Define Evidence Based Practice
THANK YOU