SEMINAR

SUBJECT - ADVANCED NURSING PRACTICE

EVALUATOR MODERATOR
DR NURNAHAR AHMED MISS L. IRIS DEVI
ASSISTANT PROFESSOR PH D SCHOLAR
LGBRIMH LGBRIMH
TEZPUR TEZPUR
EPIDEMIOLOGY IN NURSING
 INTRODUCTION

“I keep six honest serving men; they

taught me all I know . Their names are
what, why, when , how, where and who “
 BASIC TERMS

• Epidemic
• Infection
• Communicable disease
• Chronic diseases
 HISTORICAL BACKGROUND

• Epidemiology began with Adam and Eve both trying to

investigate the qualities of the “ forbidden fruit “ .
• Hippocrates was cited as an ancient precursor of
epidemiology in the fourth century BC ( Timmreck
,1994.)
CONTD.,,,,

• However, the foundation of modern epidemiology

was laid down in the late 19th century.
• The application of epidemiology in nursing
traced back to Florence Nightingale .
 MEANING OF EPIDEMIOLOGY

EPI DEMOS

LOGOS
 DEFINITION : -
• Epidemiology is the study of the frequency, distribution
and determinants of health related states or events in
a specified population and the application of this
study to control health problems .
- Last, 1988.
• Epidemiology is the study of the distribution and
determinants of health and disease in human
population to enable health services to be planned
rationally, disease surveillance to be carried out,
and preventive and control programs to be
implemented and evaluated.
- WHO
 PURPOSES OF EPIDEMIOLOGY
• To prevent , control and eradicate health and health
related problems.
• To reduce / minimize the impact of these problems.
• To promote health and quality of life of people at
large.
 AIMS OF EPIDEMIOLOGY
According to the International Epidemiological Association
( IEA ) ,

 To describe the distribution and magnitude of health and

disease problems in human populations .
• To identify etiological factor risk ( risk factors ) in the
pathogenesis of disease and
• To provide the data essential to the planning,
implementation , and evaluation of services for the
prevention , control, and treatment of diseases and to the
setting up of priorities among those services
The ultimate aim of epidemiology is
to lead to effective action –
To eliminate or reduce the health problem or its
consequences , and
To promote the health and well- being of society as a
whole.
CONCEPTS BASIC TO EPIDEMIOLOGY

• THEORIES OF • DYNAMICS OF
DISEASE DISEASE
CAUSATION TRANSMISSION
 THEORIES OF DISEASE CAUSATION

1. GERM THEORY -
2. EPIDEMIOLOGICAL TRIAD -
3. MULTIFACTORIAL CAUSATION THEORY -
4. WEB OF CAUSATION -
DYNAMICS OF DISEASE TRANSMISSION
COMPONENTS OF EPIDEMIOLOGY –

1. Disease frequency – Inherent in the definition of

epidemiology is measurement of frequency of disease ,
disability or death , and summarizing this information in
the form of rates and ratios .
 2. Distribution of disease -
An important function of epidemiology is to study these
distribution patterns in the various subgroups of the
population by time, place and person.
 3. DETERMINANTS OF DISEASE –

• A unique feature of epidemiology is to test etiological

hypotheses and identify the underlying causes of
disease.
BASIC MEASUREMENT IN
EPIDEMIOLOGY
 TOOLS OF MEASUREMENT

•1. Rate – A rate measures the occurrence of some

particular event ( development of disease or the
occurrence of death ) in a population during a given
time period .
• The rate is expressed per 1000 or some other round
figure ( 10000, 1000,000).
A RATE COMPRISES THE FOLLOWING ELEMENT -

• a) Numerator – Numerator refers to the number of times

an event ( e.g., sickness, birth, death etc.) has occurred in
a population , during a specified time period .
• b) Denominator – In epidemiology, data or facts about a
population is called denominator .
THE VARIOUS CATEGORIES OF RATES ARE –

i) Crude rates
ii) Specific rates
iii) Standardized rates
2) RATIO :-

• Ratio expresses a relation in size between two random

quantities.
• Broadly, ratio is the result of dividing one quantity by
another. It expressed in the form of – x : y or x/ y
 3) PROPORTION : -

• A proportion is a ratio which indicates the relation in

magnitude of a part of the whole.
• A proportion is usually expressed as a percentage .
• Proportion = Numerator/ Denominator x 100
 SCOPE OF MEASUREMENT IN
EPIDEMIOLOGY –
a. Measurement of mortality –
i) Crude death rate – It is defined as “ the number of deaths (
from all causes ) per 1000 estimated mid – year population in
one year , in a given place “ .
Crude death rate= Number of deaths during the year /
Mid – year population x1000
ii) Specific death rate – The specific death rate
may be a) cause or disease specific , b) related
to specific group. C) specific time period.
iii) Case fatality rate( ratio ) - It is simply the ratio of deaths
to cases.

• Case fatality rate ( Ratio ) = Total number of deaths due to a

particular disease / Total number of cases due to the same
disease x 100
iv ) Proportional mortality rate ( ratio ) –

• Proportional death rate = Number of deaths from the specific

disease in a year / Total deaths from all causes in that year x
100
v ) Survival rate -

Survival rate = Total number of patients alive after 5

years / Total number of patients diagnosed or treated x
100
Vi ) Standardized rates – It is used to compare the death rates
of two populations with different age composition.

• Standardization is carried out by one of the two methods –

Direct or Indirect Standardization
A) DIRECT STANDARDIZATION :

• In direct standardization a standard population is

selected for which the number in each age and sex
group is known.
 INDIRECT STANDARDIZATION -

• Standardized Mortality Ratio (SMR): Standardized mortality

ratio is a ratio of the total number of deaths that occur in the
study group to the number of deaths that would have been
expected to occur if that study group had experienced the death
rates of a standard population
Observed deaths
SMR = ----------------------------- x 100
Expected deaths
B . Measurement of morbidity –

Morbidity has been defined as “ any

departure, subjective or objective , from a state
of physiological well- being “ .
• Incidence :- Incidence rate is defined as “ the number of
new cases occurring in a defined population during a
specified period of time “.

Incidence rate = Number of new cases of specific

disease during a given time period / Population at risk
during that period x 1000
 • Prevalence : -
The term disease prevalence refers specifically
to all current cases ( old and new ) existing at a given
point in time , or over a period of time in a given
population.
PREVALENCE IS OF TWO TYPES –

i) Point prevalence – It is defined as the number of all

current cases ( old and new ) of a disease at one point
of time , in relation to a defined population.
• Point prevalence = Number of all current
cases of a specified disease existing at a
given point in time / Estimated population
at the same point in time x 100
• ii) Period prevalence – It measures the
frequency of all current cases existing
during a defined period of time ( e.g., annual
prevalence )expressed in relation to a
defined population.
• Period prevalence = Number of existing cases (
old and new ) of a specified disease during a given
period of time interval / Estimated mid – interval
population at risk x 100
 RELATIONSHIP BETWEEN PREVALENCE
AND INCIDENCE -

P=IXD
= Incidence x mean duration
where, population is stable ,
incidence and duration are unchanging ,
• c. Measurement of disability
• d. Measurement of natality
• e. Measurement of medical needs, health care
facilities , utilization of health services and other
health – related events.
• f. Measurement of the presence , absence or distribution
of the characteristics or attributes of the disease.
• g. Measurement of the presence, absence or distribution
of the environmental and other factors suspected of
causing the disease.
• h. Measurement of demographic variables.
 EPIDEMIOLOGICAL APPROACH

A ) Asking questions –
Epidemiology has been defined as “ a
means of learning or asking questions … and
getting answers that lead to further questions .”
Related to health events Related to health action
• What is the problem? • What can be done to reduce this
problem and its consequences ?

• What is the its magnitude ? • How can it be prevented in the future ?

• Where did it happen ? • What action should be taken by the

community / health services/ other
• When did it happen ?
agencies.
• Who are affected ?
• What resources are required ? How are
• Why did it happen ? the activities to be organized ?
B) MAKING COMPARISONS –

• The basic approach in epidemiology is to make

comparisons and draw inferences.
EPIDEMIOLOGICAL
METHODS / STUDIES
 1. OBSERVATIONAL STUDIES :-

• Observational studies allows nature to take its own

course , the investigator measures but does not
intervene.
 A ) DESCRIPTIVE EPIDEMIOLOGY -

These studies are concerned with observing the distribution

of diseases or health related characteristics in human
populations and identifying the characteristics with which
the disease in question seems to be associated.
STEPS IN DESCRIPTIVE STUDIES
 DESIGNS OF DESCRIPTIVE STUDIES

1. Cross – sectional studies : - It is also called

prevalence study .
• Cross sectional studies are useful for detailed
community assessment , study of morbidity and
underlying factors especially chronic diseases.
2. LONGITUDINAL STUDIES : -
• These studies are useful for studying the natural
history of diseases, finding out incidence rate of
diseases and identifying risk factors of diseases.
 2. ANALYTICAL EPIDEMIOLOGY : -

• Analytical studies are more specific in focus, test

hypothesis and attempt to determine causal factors
of disease.
• Analytical studies comprise two distinct types of
observational studies .
 A) CASE CONTROL STUDY : -

exposure and outcome Effect

have already occurred

Cause
start of the study .
BASIC STEPS IN THE STUDY
• Case control studies have been used effectively for
studies of various cancers and other serious
conditions such as cirrhosis of liver , and congestive
heart failure etc.
 B) COHORT STUDY : -

• usually undertaken to obtain additional evidence to

refute or support the existence of an association
between suspected cause and disease.
 THE DISTINGUISHING FEATURES OF COHORT
STUDY ARE –

• a ) the cohorts are identified prior to the appearance

of the disease under investigation .
• b ) the study groups , so defined , are observed over a
period of time to determine the frequency of disease
among them .
• c ) the study proceeds forward from cause to effect .
 TYPES OF COHORT STUDIES : -
• A) Prospective cohort studies : - A prospective cohort
study is one in which the outcome has not yet occurred
at the time the investigation begins. Most prospective
studies begin in the present and continue into future.
 •B) Retrospective cohort studies : - A
retrospective cohort study is one in which
the outcomes have all occurred before the
starts of the investigation .
C) Combination of retrospective and prospective
cohort studies : - The investigator identifies the cohort
from past records and traces forward till date .
• The same cohort is followed up further for assessment
prospectively up to the desired period .
STEPS OF COHORT STUDY
2. EXPERIMENTAL EPIDEMIOLOGY : -

•In the 1920s “ experimental epidemiology “

meant the study of epidemics among colonies of
experimental animals such as rats and ,mice.
 AIMS OF EXPERIMENTAL STUDIES
• a) to provide “ scientific proof “ of etiological factors which
may permit the modification or control of those diseases .
• b) to provide a method of measuring the effectiveness and
efficiency of health services for the prevention, control and
treatment of disease and improve the health of the
community.
TYPES:

Experimental studies are of two types-

A )Randomized controlled trials.

B) Non – randomized controlled trials

 A )RANDOMIZED
CONTROLLED TRIALS
STEPS OF RANDOMIZED CONTROLLED TRIAL
DESIGN
B) Non – randomized
controlled trials
 USES OF EPIDEMIOLOGY

Morris has identified seven distinct uses of epidemiology –

 To study historically the rise and fall of disease in the
population.
Community diagnosis
Planning and evaluation
Evaluation of individual’s risks and chances
Syndrome identification
Completing the natural history of disease
Searching for causes and risk factors
APPLICATION OF EPIDEMIOLOGY IN HEALTH
CARE DELIVERY –

1.Application of observational studies : -

• Descriptive studies helps us understand the magnitude
of the health problem.
• Epidemiological data help in understanding the
delivery of health care services
• Evaluating efficacy, efficiency and effectiveness of
health intervention .
• Identifying risk factors for a disease: - Such
information is used in the planning primary prevention
program, particularly for non- communicable diseases.
 2. APPLICATION OF EXPERIMENTAL
EPIDEMIOLOGY

Experimental studies are a boon to clinical medicine .

 3. NEWER APPLICATION

• The newer areas of interest are - in evaluating health

services , evaluation of screening program, and use of
epidemiology by legal experts.
• Other advancing areas are genetic epidemiology , cancer
epidemiology , occupation and environment
epidemiology.
 ROLE OF A NURSE IN EPIDEMIOLOGY

1. PREVENTIVE ROLE.
2. PROMOTIVE ROLE.
3. CURATIVE ROLE.
4. REHABILITATIVE ROLE.
CONCLUSION
 REFERENCES

• Park K.Textbook of Preventive and Social

Medicine. 23rd ed. Jabalpur: Banarsidas Bhanot
publisher; 2015
• Stanhope M & Lancaster J. Community Health
Nursing. 4th ed. Mosby; 1992. p. 207-30.
• Brar NK & Rawat HC.Textbook of Advanced Nursing
Practice. New Delhi: Jaypee. Brothers Medical
Publishers (p) Ltd; 2015. p. 269-92.
• Allender JA & Spradley BW. Community Health
Nursing. 6th Ed. Lippincott Williams & Wilkins; 2012. p.
154-75.
THANK YOU