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4 CHAPTER

4 CHAPTER. Theoretical and Conceptual Models. Conceptual mode: Set of relatively abstract and general concepts Addresses phenomena of interest to a discipline Directs attention to relevant client situations, interventions. Theoretical and Conceptual Models (continued).

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4 CHAPTER

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  1. 4 CHAPTER

  2. Theoretical and Conceptual Models • Conceptual mode: • Set of relatively abstract and general concepts • Addresses phenomena of interest to a discipline • Directs attention to relevant client situations, interventions

  3. Theoretical and Conceptual Models (continued) • Systematic approach to • Assessing health status of a population • Planning nursing interventions • Implementing interventions • Evaluating effectiveness of nursing care

  4. Two Useful Types of Models: • Epidemiologic models • Examine factors that influence health and illness • Nursing models • Suggest interventions to protect, improve, or restore health

  5. Epidemiology • Study of distribution of health and illness within a population • Factors that determine population’s health • Use knowledge generated to control development of health problems

  6. Epidemiologic Perspectives: • Causality • Risk • Rates of occurrence

  7. Causality • Link between contributing factors and states of health and illness • One event is the result of another event • Evolution of concepts of causation • Will of God • Natural causes • Specific causes • Multifactorial causes

  8. Risk • Estimated likelihood a particular condition will occur • Probability that a given individual will develop a specific condition • Populations at risk • Groups with greatest potential to develop a particular health problem • Result of presence or absence of specific factors • Become target groups for interventions

  9. Rates of Occurrence • Statistical measures • Indicate extent of health problems in a group • Allow comparison between groups of different sizes • Several rates have wide use in epidemiology, those most important are the prevalence rate, and the incidence rate.

  10. Prevalence Rate • Refers to all of the people with a particular health condition existing in a given population at a given point in time. • Eg. If a nurse discovers 50 cases of measles in an elementary school that has 500 students the prevalence of measles on that day would be 10 %.

  11. Prevalence Rate Conti • Prevalence Rate= Number of persons with a characteristic × 100% Total number in population • Prevalence • Total number of people affected by a particular condition • Specified point in time

  12. Incidence Rate • Refers to all new cases of a disease or health condition appearing during a given time. • Incidence rate= Number of persons developing a disease × 100% Total number at risk per unit of time • Incidence • Number of new cases of a particular condition • Specified time period

  13. Morbidity and Mortality • Used to assess health status • Develop interventions • Evaluate long term outcomes • Morbidity is ratio of number of cases to number in population

  14. Morbidity and Mortality (continued) • Morbidity rate: is the relative incidence of disease in a population, the ratio of the number of sick individuals to the total population

  15. Morbidity and Mortality (continued) • Mortality is ratio of number of deaths of a particular category to number in population, or the sum of deaths in a given population at a given time.

  16. Epidemiologic Statistics • Case fatality rates • Percentage of persons with a condition who die of that condition • Survival rates • Proportion of people with a condition remaining alive after a specified period • Survival time • Average length of time from diagnosis to death

  17. Epidemiologic Models • Provide direction for community health nurses • Strategies for interventions • Collection and interpretation of data • Control health-related conditions

  18. Three Types of Models: • Epidemiologic triad • Web of causation • Determinants of health models

  19. Epidemiologic Triad Model • Agent • Host • Environment

  20. Elements of the Epidemiologic Triad Model

  21. Host • is a susceptible human or animal who harbors and nourishes a disease-causing agent • Many physical (i.e.. Age), psychological (i.e.. Stress response), and life style factors (i.e.. Diet) influence the host’s susceptibility and response to an agent.

  22. Agent • Is a factor that causes or contributes to a health problem • Biologic: bacteria, HIV virus • Chemical: dusts, solid gases • Nutrient agent: excess vitamin A can be toxic • Physical: earthquake • Psychological: events that produce stress leading to health problems.

  23. Environment • Refers to all the external factors surrounding the host that might influence vulnerability or resistance. • Physical environment: climate • Psychosocial environment: social, cultural.

  24. Web of Causation • Emphasizes interconnectedness of causal components • Multiple factors influence health • Direct causes • Proximal to health event • Indirect causes • Distal from health event

  25. Web of Causation for Adolescent Tobacco Use

  26. Determinants of Health • Various factors affect health and illness • Social • Environmental • Biological • Psychological • Behavioral/lifestyle

  27. Determinants of Health (continued) • Various factors affect health and illness • Health care/health systems • Genetics

  28. A Composite Determinants of Health Model

  29. Community Health Nursing Models • Developed as result of professional practice • Utilize systematic, scientific inquiry

  30. Types of Models Applied to Community Health Setting • Serve as a conceptual model for nurses to understand the interrelationships that exist among the specific concepts

  31. Neuman’s Health System Model • Client system striving to prevent penetration or disruption of the system by a variety of stressors • http://currentnursing.com/nursing_theory/Neuman.html

  32. The Interventions Wheel Model • Consists of 17 identified community health nursing interventions that cross over three levels of population-based practice • Individual-focused • Community-focused • System-focused practice

  33. The Los Angeles County Public Health Nursing Practice Model • Links public health nursing with principles of public health practice. • Community health nursing is a multidisciplinary endeavor; clients must be active participants in the endeavor. • Community health nursing practice is population-based. • Community health nursing practice is based on the core functions and essential services of public health. • Community health nurses engage in the interventions described in the intervention wheel model.

  34. The Community-as-Partner Model • Incorporates Neuman’s health systems model and the nursing process

  35. Resources • Nursing Theorist pageBriefly describes and categorizes all the nursing theories with web links to individual theorists. • The Madeleine Leininger web site includes original works and writings by Dr. Madeleine Leininger, the founder of the worldwide Transcultural Nursing movement.

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