Community Health ch 14&15

7 Basic steps of RN surveillance for RNs to follow

1. Determine whether surveillance is appropriate for the situation 2. Organize knowledge of the problem 3. Est. clear criteria for what constitutes a case. 4. Collect sufficient data from multiple valid sources. 5. Analyze the data. 6. Interpret the data and disseminate to decision makers. 7. Evaluate the impact of the surveillance system.

Steps in an Investigation

1. first confirm that the disease or event outbreak exists or whether there is a false alarm. Find out the nature, location, and severity of the problem. 2. Verify the diagnosis and develop a case definition tp estimate the magnitude and nature of the problem. compare current indexes with usual and baseline incidence. 3. assess the need for outside consultation 4. report the situation to state, if required. check state reportable diseases list 5. use early and continuing control measures on the basis of magnitude and nature of the condition (eliminating a contaminated product, modifying procedures, treating carriers, immunizing those who might contract the infectious disease.) 6. make a request to save lab specimens until the investigation is complete 7. seek additional cases and collect critical data and specimens. encourage immediate reporting of new cases. search for other cases that may have occurred in the past or are now occurring. 8. use a specific data collection form. characterize cases by person, place, and time 9. evaluate client characteristics and possible exposure sites. draw tables or spot maps. Draw an epidemic curve. determine type of source 10. develop a tentative hypothesis. summarize common agent, environment, host factors, and exposures. 11. refine the hypothesis. test the hypothesis 12. evaluate effects of control measures. communicate findings.

National Response Framework

A guide for conducting a nationwide all-hazards response; aligns key roles and responsibilities across the Nation. It's the common platform for disaster response. It's a written approach enabling all emergency responding entities the ability to work together more effectively and more efficiently.

mixed outbreak

Common source followed by person-to-person contact. Ex: spread of food borne gastroenteritis

intermittent or continuous source

Exposure over days or weeks also known as a continuing common source outbreak. Ex: influenza

Active System

In the ____ _____ the public health nurse, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem. The active system is costly to use and requires a lot of personnel, but does offer a complete picture of the number of existing cases. Therefore it is used on a limited basis for investigating after a disease outbreak has been recognized (e.g., when several school children become ill after eating lunch in the cafeteria). Ex. Nurse makes contact to request information about diseases.

Sentinel System

Selects either randomly or intentionally a small group of health care workers from whom to gather data. Requires more time and resources, but can often produce more detailed data on cases of illness because the health care workers have agreed to participate. In the case of influenza the health care provider collects nasopharyngeal swabs from each patient at selected sites to identify the type of influenza virus. Collection of such data from all health care workers would not be possible. This system is used to report the number of cases of influenza seen during a given period to make projections about the severity of the "flu season." This system cannot be used to follow specific clients or initiate prevention and control interventions for individuals. Costly

Special Systems

Special systems are developed for collecting particular types of data and may be a combination of all the previous systems.

State Notifiable Disease

The time frame in which each disease is reported varies by each state. For legally reportable diseases, states compile new cases of diseases and transmit the data electronically, weekly, to the CDC. Ongoing analysis of this data has led to better diagnosis and treatment methods, national vaccine schedule recommendations, changes in vaccine formulation, and recognition of new or resurgent diseases

Passive System

___ ____ case reports are sent to the local health departments by health care providers, and then summarized and sent forth to the state health department, national government, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization (WHO). Each state determines for itself which of the diseases and conditions are of importance to the state's health; and legally requires the reporting of those diseases to the state health department by health providers, agencies, and laboratories. This system is less expensive and relies on healthcare providers, laboratories, and hospitals to report. Usually reports vaccine preventable diseases. Occurs continuously because people seek medical attention. It identifies outbreaks and trends in outbreaks over time.

National Notifiable Diseases

a CDC policy requires that state health departments report selected diseases to the National Notifiable Disease Surveillance System. It is a nationwide collaboration at the local, state, federal and international level to share notifiable disease-related health information.

National Response Plan

a national doctrine for preparedness to include Emergency Support Function

Data Sources for Surveillance

a variety of clinical, administrative, and lab data are reported to the state and serve as sources of morbidity and mortality data for the purpose of surveillance.

hosts

age, sex, race socioeconomic status, genetics, lifestyle choices

factors that must be considered as causes of outbreak are categorized as:

agents, hosts, environmental factors (physical and biological), socioeconomic behavior, personality, culture of group, crowding, sanitation, or availability of health services

disaster

any natural or human-mad incident that causes disruption, destruction and devastation that cannot be alleviated without assistance

Nurses should be aware of and report ____

any psychological or sociological health hazards such as overcrowding, extreme disrespect, and anger in vulnerable populations that could lead to unrest and violence

Purposes of Surveillance

assess public health status. define public health priorities. plan public health programs. evaluate interventions and programs. stimulate research.

Disaster secondary prevention

assessing disaster victims for triage and care

Symptoms that may signal need for stress management include:

being reluctant or refusing to leave the scene until the work is finished denying needed rest and recovery time feelings of overriding stress and fatigue engaging in unnecessary risk-taking activities difficulty communicating thoughts, remembering instructions, making decisions, or concentrating engaging in unnecessary arguments having a limited attention span refusing to follow orders.

Components of a comprehensive Public Health response to outbreaks of illness

detecting outbreak determining cause identifying factors that place people at risk informing medical and public communities about treatments, health consequences, and preventative measures

personal preparedness

disasters require nurses to respond quickly, which requires that nurses plan for their own needs and the needs of their families. basically taking care of them and their families

Homeland Security Presidential Directive-8

established policies to strengthen the preparedness of the US to prevent, protect against, respond to, and recover from threatened or actual terrorist attacks and major disasters, including a goal for national preparedness

Individual Stress Reactions

exacerbation of chronic disease children may demonstrate regressive behaviors older adults' reactions depend on physical health, strength, mobility, independence, and income

honeymoon phase

happy to be alive; share stories with friends and loved ones

Community preparedness

have a written plan?

4 phases of Community Stress Reactions

heroic, honeymoon, disillusionment, reconstruction

Point source

illnesses occurring in one particular geographical location, at a single point in time and place in which all cases have been exposed to the source; occurs over one incubation period

Disaster Management Cycle

includes prevention, preparedness, response, and recovery

national system of homeland security

includes public health preparedness and response as a core part of its national strategies, and every aspect involves public health nursing

biological factors

insects that transmit disease

reconstruction phase

longest; homes, schools, and churches have to be rebuilt, reestablished, to get to normalcy

heroic phase

need for people to do whatever they can to help others survive. overworked responders can present a danger to themselves or others.

what should data be and what does it do?

needs to be valid and reliable. spatial maps and table by time frames or charasteristics can display it correctly. data displays are a step in analysis that shows what is happening graphically. it reduces assumptions made about the event and provides a means for describing the event using quantitative data to help in stating a hypothesis or best guess about what is happening.

Propagated outbreak

no common source, with gradual spread from person to person over more than one incubation period. usually transmitted by direct person-person contact. Ex: spread of Tb, HIV, hepatitis, yellow fever

First level of response

occurs at local level with responders such as fire department, law enforcement, public health, and emergency services

Common Source (or exposure)

outbreak is infected by the common infectious agent or source. Ex: contaminated water or food poisoning at a single restaurant

Recovery competencies include:

participating in after-action processes, contributing to disaster plan modifications, and coordinating efforts to address the psychological and public health impact of the event

tertiary prevention

participating in home visits to uncover dangers that may cause additional injury to victims or cause other problems (i.e., house fires from faulty wiring)

Disaster Primary Prevention

participation in a disaster management plan for the community

disillusionment phase

people wake up and notice that additional help and reinforcement is needed and isn't there yet

collaboration

promotes the development of a comprehensive plan and a directory of emergency responses and contacts for effective communication and information sharing. RNs are often in the forefront of response to be made in the surveillance process.

Professional Preparedness

public health nurses need to be aware of and understand the disaster plans at the workplace and in the community. Nurses take time to read and understand workplace and community disaster plans and participate in drills, etc. keep copy of license, ID badge, BP cuff, stethoscope, PPE on hand or in car. this avoids having people impersonate nurses.

prevention (mitigation)

reducing risks to people and property from natural hazards before they occur.

people who witness or experience a terrorist attack may have:

repeated thoughts about the attack, fear that may even prevent them from leaving their home, survivor's guilt, sense of grief and loss, and hesitation to express feelings

the national preparedness goal

resulted in the National Preparedness Guidelines and the National Response Plan. The NRP is an all-discipline, all-hazards comprehensive framework for managing domestic incidents. The NRP was updated in 2008 and re-titled the National Response Framework

Examples of data sources for surveillance

sources include vital stats, clinical and service reports, billing data, registries, surveys, and sentinel surveillance systems.

socioeconomic factors

terrorist behavior

Disease surveillance

the ongoing systematic collection, analysis, interpretation and dissemination of specific health data for use in public health. allows RNs to monitor disease trends in order to reduce morbidity and mortality and to improve health

Investigation Objectives

to control and prevent disease or death, identify factors contributing to the disease outbreak or event occurrence, implement measures to prevent occurrences

physical symptoms of stress on disaster workers

tremors, headaches, nausea, and colds or flulike symptoms

physical environmental factors

weather, temp, humidity, physical surroundings

aspects of personal preparedness

work with family members, keep important documents in waterproof container, keep a 3-day water supply and food that will not spoil, change of clothing and protective footwear, first-aid kit with week's supply of prescription and OTC meds, med list, allergies, emergency tools