NUR603 – Nursing Care of Populations (Jeanne Hayes)
MODULE 2 Overview: Concepts of Epidemiology
Did you ever wonder how we found out that cigarette smoking is linked to lung cancer? Maybe someone casually observed that every person he knew with lung cancer was a smoker. Perhaps for a while, saying that smoking causes lung cancer was treated as an “old wives’ tale”. But at some point someone decided to study the issue in greater depth and began collecting statistics and doing various types of research. Finally there was enough evidence to establish a mathematical correlation – that very frequently people who smoked also had lung cancer. Correlation differs from causation. Correlation refers to the frequent co-occurrence of certain factors with a specific disease, while causation takes it a step further and states a cause and effect relationship between a factor and the disease. Even then, there usually are other co-occurring factors contributing to disease causation, such as the genetics of the victim, his lifestyle factors such as occupation, education, and nutrition, and the effectiveness of prevention efforts by the health care system (in which nurses play a leading role).. In the case of infectious disease, the person and the germ meet – but if the person is very old or very young, tired, malnourished, stressed, and/or doesn’t wash his hands, disease is more likely than if the person were young, strong, and practiced good health habits. In other words, there are usually multiple co-occurring factors needed to cause disease – a web of causation (p. 224, text). All of this information – a body of knowledge and a system of research methods – has been produced by the science of epidemiology. In its early days, infectious disease was the main concern. Epidemiology is now concerned with virtually any kind of health problem – accidents, chronic disease, and mental illness, for example. As our understanding of risk factors for health problems grows, our ability to prevent disease will grow too. The final frontier is in the human mind – do we want to be well badly enough to implement lifestyle practices that will enhance rather than tear down our health? How can we as nurses work with people in a way that motivates them to choose healthy behaviors?
MODULE 3 Overview: Overview of Health Promotion
How can nurses “sell” patients on behavior changes that will improve individual and national health?
Why shouldn’t we just mind our own business? It turns out that we have made a lot of inroads into the health problems of the past century, so much so that now at least 80% of people tend to die of a chronic disease they have had for a long time – 20 or 30 years sometimes!
According the Surgeon General, the next frontier is getting people to adopt lifestyle change and healthy behaviors. It would seem that this isn’t rocket science, but on second thought, it seems to be even more difficult.than landing a woman on the moon! There are different ways of looking at health-related behavior change.
There is an adaptation of an economic model that says that people will change if they think that they will benefit and it doesn’t “cost” too much in energy, effort, or time. This is the Health Belief Model. (Be careful to not confuse this with the Health Field Model!)
Others have applied the principles of change theory to the adoption of healthy behaviors (Lewin and Prochaska, for example).
Another concept that I am seeing frequently is Motivational Interviewing in which the nurse phrases things in such a way that the patient is stimulated to make changes and think that it is his own idea.
When all is said and done, many are invited to change but few choose to respond, or they may begin to change and quickly accept defeat. Nurses are by definition “change agents”. Our patients have problems and they look to us to bring about some kind of change – pain relief, oxygenation, etc, and we know just what to do! How about our patients who are obese, Type 2 DM, hypertensive? That kind of change is a lot more difficult! In this unit we are going to learn about primary, secondary, and tertiary prevention/interventions for health promotion (not to be confused with primary, secondary, and tertiary levels of care!) Please be able to differentiate these concepts – we will be using them throughout the course and in the final project.
Perhaps we can understand our patients and their difficulties in making lifestyle changes by taking a closer look at ourselves. Has anyone tried to lose weight or stop smoking or incorporate exercise in their lifestyle? I have – many times – and I end up back at Square 1. My problem is not lack of knowledge. My head knows what to do and how to do it. How come I am still overweight? The first one to find the missing piece – as long as it is not too difficult or expensive, will receive the Nobel Prize and get very rich – and I think it should be a nurse!
I have posted several resources to help you get a grip on health-related changes. Please pay careful attention to the models for change and play around with the ideas in your head a bit. Maybe you could even practice on your kids or husband or co-workers.
Next week there will be an online exam, so you may want to get caught up on anything you haven’t read yet. It will be an open-book exam, but the book is not very useful if you have not read it at least once. You will have 80 minutes for 50 scrambled questions and answers, and the questions will be focused more on using information than recognizing definitions.
Regarding health promotion:
Review the concept of health promotion and the form for documenting your attendance at a health promotion event/ program prior to attending.Document your experience on the assigned form. Please post it under Module 11. You often can find relevant health promotion programs at web sites of hospitals, newspapers, and other community publications. The drop-dead due date for this is Week 11, but I am assuming you will want to plan your work out over the whole term.