NR 503-MIDTERM EXAM 2023 100% correct questions and answers

Epidemiology Science of public health. Study of disease within populations & risk factors. Risk factors are genetic, environmental, social, cultural, or on some direct action by the individual. Servers to find the "why" of a disease & then to analyze the disease screening, treatment, prevention, and monitoring. population health focuses on risk, data, demographics, and outcomes Outcomes End result that follows an intervention Aggregate defined population Community Multiple aggregates Data Compiled information Prevalence Existence of a disease. Number of all cases of the disease Incidence Measures appearance of a disease over a period of time. Surveillance Collection, analysis, and dissemination of data. High-risk An increased chance of poor health outcomes Morbidity Presence of illness in a population Mortality Tracking deaths in an aggregate Vital statistics statistics on live births, deaths, fetal deaths, marriages and divorces Cases Criterion used to make decisions whether the patient has a disease or health event Social Justice The view that everyone deserves equal economic, political and social rights and opportunities-including the right to good health Inter-professional collaboration Collaborative action oriented toward a common goal of improving quality & safety of patient care. Involves responsibility, accountability, coordination, communication, cooperation, assertiveness, mutual respect, and autonomy. HP2020 4 goals: 1) attain high-quality lives preventable disease 2) achieve health equity, eliminate disparities, improve health of all groups 3) create social and physical environments that promote good health. 4) promote quality of life, healthy development, and health Determinants of Care Range of personal, social, economic, and environmental factors that influence health status Risk Analysis Characterization of the potential adverse health effects of human exposures to environmental hazards health disparities Differences of health statuses between various populations. Sensitivity Measures the proportion of actual positives that are correctly identified as such (e.g., % of sick people who are correctly identified as having the condition) Specificity True negative rate Measures actual negatives that are correctly identified as such (e.g., % of healthy people who are correctly ID's as not having the condition) Positive Predictive Value (PPV) Probability that subjects with a positive screening test truly have the disease Epidemiological triangle Triad with an external agent, host, and an environment that cause the disease. Environmental factors and genetics play a role. Disease transmitted directly or indirectly. Outright symptoms or subclinical disease. Confounding Variable Extra variable not accounted for and can ruin the experiment. Can introduce bias. Study methods Descriptive. Analytic. Experimental. Descriptive study methods Describes person, place, and time. Provides data for program planning, resource planning, and generates a hypothesis. Correlational studies, case reports and studies, and cross-sectional studies. Analytic Study Methods Consists of observational and experimental Case control and cohort Experimental Study Methods RCT (new drug testing), Field trial (conducted on those at high risk for getting the disease), Community trial (research conducted on an entire community or neighborhood) Test a hypothesis Rapid Cycle Improvement Models Identifies, implements, and measures changes made to improve a process or a system. Tested over 3 months or less 4 STAGES: PLAN (ID an opportunity to improve and plan a change or test of how something works), DO (carry out a plan on a small number of patients), STUDY (examine the results. Goal achieved?), ACT (use your results to make a decision or make changes, establish a quality improvement plans) How to pick a screening tool Usefulness and appropriateness: a) validity b) specificity c) sensitivity d) reliable e) cost-effective f) improve outcomes for the patient g) continuous variable screening h) positive predictive value i) negative predictive value Validity The ability of that test to distinguish correctly who has a disease Continuous variable screening not (+) or (-) A continuum of values Population "normal" is a range of normal values Considered positive when they have a specific value or level to their screening test. Positive predictive value true positive/everyone that has been tested people in a population who are screened as (+) and who actually have the disease Negative predictive value true negatives/everyone that has been tested Where to find a screening tool? US Preventative Services Task Force Agency for Healthcare Research & Quality SAMHSA-HRSA Descriptive Epidemiology Natural History of Disease defines differences, similarities, and correlation keys of any health problems Time and place Learns extent and pattern of the public health problem being investigated Detailed description of the health of a population by using tables, graphs and maps Can identify areas or groups within the population that have high rates of disease and creates clues for the disease with hypotheses Causation cause of the disease or issue process An increase in a casual factor or exposure causes an increase in the outcome of disease Primary: use of flu vaccinations Secondary: Test for influenza Tertiary: giving Tamiflu to a positive flu patient Active Surviellance Case by case basis Each specific person's information is entered into a database. Passive Surviellance Where the information is pulled from the database Cohort study identifies a group exposed to a particular factor AND a comparison group not exposed AND measures/compares the incidence of disease to the two groups Great for outbreaks in small populations Used when looking for multiple outcomes observational, not reliable, measured over time Case-control study comparing groups with and without the disease compared with past exposures that are RARE if high odds of exposure then this is an ASSOCIATION Large populations AND when disease outcome is uncommon less reliable, inexpensive, easy to conduct, works well with outbreaks too many confounding variables which alter results ex: link between lung cancer to smoking When does bias become a problem? When it is not representative of the entire population RCT vs. Case-control clinical trials RCT: carefully planned, introduces a treatment, reduces bias, comparison between intervention groups and control groups, provides evidence of cause and effect CASE-CONTROL: comparing those with and without the condition, use data collection or patient recall, less reliable Randomized Controlled Trial (RCT) Experiments that introduce a treatment to study its effects on real people. less bias (randomizing and bias) comparison between intervention groups & control groups are randomly selected Planned AND provides sound evidence of cause & effect GOLD STANDARD cross-sectional study Describe a relationship between disease AND other factors at one point in time in a defined population No comparison group Lack of info on timing of exposure AND outcome relationships AND include prevalent cases Compare diagnostic tests called PROSPECTIVE, BLIND COMPARISON to the gold standard Varying degrees of illness Sensitivity AND specificity of new test compared to that of the gold standard intervention group that receives treatment Estimates of prevalence Monitor trends prospective study an observational study in which subjects are followed to observe future outcomes over a period of time PROS: high-quality data, future proof, strong validity CONS: expensive and time-consuming retrospective study examines exposures to suspected risk in relation to an outcome that is established at the start of a study sources of error and bias odds ration provides an estimate of relative risk PROS: inexpensive, quick results CONS: missing data, definitions adapted to bias, unmeasured confounder (after thoughts) Scientific misconduct The violation of standard codes of scholarly conduct and ethical behavior in professional scientific research. Plagiarism OR falsification OR fabrication of data randome error Occur from unpredictable change Too high or too low systemic error Is biased, incomplete or inacurrate Confounding error True association exists between exposure and outcome. Association is confounded by another variable or exposure. Highest level of data systematic review OR meta-analysis of RCT studies based on methodological quality of design, validity, and applicability to patient care factors that determine quality of care effectiveness patient safety timeliness patient centeredness How is website credibility determined Who runs the site? Why site is created? Who sponsors the site? Does info. favor the sponsor? Where did the info. come from? Is it up to date? What is the privacy policy? ***Medical library association, Health on the Net Foundation, US National Library of Medicine provide guideline for evaluation on-line information What are key indicators when assessing a model of care? Pain management Consistency of communication Staff Mix Client satisfaction Prevention of tobacco Use Cardiovascular disease Prevention Caregiver Activity ID of Primary Caregiver ADL Independence activities of daily living Psychosocial interaction Triple Aim Initiative Seeks to reduce the cost per capita of care, improve the health of population, and enhance patient experience and outcomes Social justice & health inequalities Social justice speaks to equal health care and the quality of health care to all individuals. Social justice isn't performed when population health care will not be adequate Campaign for Action Movement to utilize medical professionals,(especially) nurses, to increase overall satisfaction with their medical care Utilized interdisciplinary care within the healthcare realm to assist patients in a holistic approach to ensure positive patient outcomes. To double the number of nurses with their DNP by 2020-diversifies the field, encourage leadership within nursing, assisting with continued nursing education. Uses primary care to assist with preventable measures by education internal validity A measure of accuracy of an experiment. It measures if the manipulation of the independent variables, or treatments, actually caused the effects on the dependent variable(s). External validity (generalizability) Refers to whether the results of a study can be generalized to other situations and other people, controlled by: random sampling, situational control, and cause/effect relationships. Gold Standard test with 100% sensitivity & specificity Probablity study of laws of chance Clinical significance Referring results that have clinical significance likelihood ratio combines sensitivity & specificity data to help clinician quantify how much the odds of disease change based on positive & negative results Infectious disease Goal to disrupt the chain of infection Heirarchy of Evidence Systematic reviews RCT Cohort Studies Case-control studies Case Series, Case Reports Editorials, Expert Opinion 4 Types of Causation 1) Necessary-disease only occurs is disease is present 2) Sufficient-Exposure always leads to disease 3) Necessary BUT not sufficient: factors happen in a temporal sequence. 4) Sufficient BUT not necessary: A specific factor can cause a disease process, but other factors can cause the same disease. 5) Neither sufficient NOR necessary: Specific factor can be combined with other factors to produce a disease Best way to establish causation Observation of humans who have a trait, factor, or exposure, and so on. 6 ways to establish causation 1) Temporal relationship-associated factor must be present before the disease 2) Strength of association-The stronger the relationship, the more likely it is casual 3)Dose-response relationship-dose increases, so does the risk of development of the disease 4)replication of findings-findings can be found repeated in other studies 5) Biological plausibility-current knowledge on the factor or exposure and the response of the human body on the cellular level is consistent with the findings Risk factor A condition that may adversely affect an individual's health Odds Ratio the ratio of the odds o development of disease in a non-exposed person Absolute Risk Incidence of a disease in a population Attributable risk how much of the risk (incidence) of the disease we hope to prevent if able to eliminate exposure to the agent in question Relative risk Ratio of risk of disease in exposed individuals to the risk of disease in non-exposed individuals Social determinants of health medical care, public health interventions, characteristics of social environments, physical environments, genetics, and individual behavior Non-communicable disease Main cause of illness & disability in the US. Responsible for the greater part of healthcare costs according to the CDC surviellance Surveillance of poor health outcomes in acute care facilities is one way in which APRNs can identify causative factors & design interventions to reduce costs and improve care.