Mortality is defined as the number of deaths (from a disease or in general) per 1000 people and typically reported in annual (yearly) basis. It is primarily distinguished by the following: crude death rate (a measure of one mortality from all causes which may result in a decrease in a population), infant mortality rate (measures the risk of dying during the 1st year of life per 1,000 live births. It is a good index of the general health condition of a community since it reflects the changes in the environmental and medical conditions of the community; maternal mortality rate (measures the risk of dying related to pregnancy, childbirth and pueperium per 1000 live birth); fetal death rate or perinatal death rate (measure pregnancy wastage per 1,000 births. Death of the product of conception occurs prior to its completion, irrespective of duration of its pregnancy); standardized mortality rate (SMR) or age-specific mortality rate (ASMR) – This refers to the total number of deaths per 1000 people of a given age (e.g. 16-65 or 65+).
In the district of Waikato where in, the highest of Maori mortality and morbidity rate in children ages’ 1- 14 was in Rural Waikato. They make up the 37.5% (Rural Waikato) and 26.2% (urban Waikato) in the over all population of the Waikato district. The top 10 Report is the first significant overview of the most important indicators of child and youth health in the Auckland and Waikato regions. These are the details: (1) Infant mortality (2) Maori mortality (3) Youth mortality (4) Avoidable hospitalizations (5) Infectious disease rates (6) Asthma admissions (7) Lower respiratory tract admissions (8) births to teenage mothers (9) dental health and, (10) hearing loss. Given the data, we shall take note that primary health care providers shall ensure accessibility and quality health care in order to improve the general health status of the people.
In the context of morbidity rate, which is refers to either to the incidence rate or to the prevalence rate of a disease. The leading cause of morbidity rate is asthma causes high morbidity, with high rates for school (and later work) absenteeism, recurrent primary care presentations (generally requiring repeated courses of oral antibiotics), and hospitalisation with exacerbations requiring intravenous antibiotics. This is mostly high in Maoris’ children and adult, followed by the pacific children.
In particular, we shall focus in the promotion of health and disease prevention. How? By proper assessment (physical examination, interview and observation and at the same time evaluating previous records in the health center); Diagnosis is needed for planning purposes which comprises of the statement of the unhealthy task and the statement of the factors, which are maintaining the undesirable response. Planning, at this point, there must be a consideration of the community members with the primary health care provider so, as to promote self-reliance. There must also be prioritisation of the problem using the fallowing criteria: (1) nature of the problem, (2) modifiability (3) preventive potential (4) salience. Interventions must be competency-based teaching since; one way to stimulate learning is through health teachings. Evaluation is utilized as to validate the following interventions if it’s effective, efficient, adequate and appropriate.
Health is measured by the increase of life expectancy of an individual, group or population. There are multiple factors that determine health of a person. These are genetic, lifestyle, environmental and socioeconomic factors. When we say genetic these refers to the genes of the individual how it cope with present environment; individual lifestyle such as drinking and smoking habit, carcinogenic diet with less fruits and vegetables, and no exercise; environmental factors would refer to improper waste disposal, unhygienic eating habits and lack of drainage system in the community. Socioeconomic factors determine the health status of every individual. Primarily, it is because access to effective health care services of reasonable quality is an essential requirement in an advanced society but due to the presence of poverty not all individuals have that access. If possible, there must be a relative distribution of wealth. Health is best served in more socially unified, equal societies with smaller burden of relative deprivation while in developed societies they have government and non-government that organizations that funds health care provider in order to be of service to the least fortunate ones or to those individuals whose location is way far from the main health care provider. Socioeconomic inequality such as unemployment, inferior housing facilities, and over populated areas are determinants of a slower development and the quality of life is poorer since, health would be their least priority. They have to meet first their basic needs such as food, clothing and shelter and if they become ill, it is likely for them to self-medicate due to the reason that their budget is limited or sometimes they don’t pay attention to their health. With that, there will be exacerbation of the symptoms thus, resulting to complications and possibly death.
Part II:
Interventions would be efficient and effective by knowing the etiology of the problem and its causative factors in order to render symptomatic treatment as well as medical treatment.
Problem: Asthma in age groups 1-14 yrs old is one of the leading causes of morbidity rate.
Etiology: Asthma is a chronic inflammatory disorder of the airways that cause airway hyperresponsiveness, mucosal edema and mucus production. The inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. What differentiates asthma from other obstructive lung disease is that it is entirely reversible, either spontaneously or with treatment. Cough with or without mucus production, dyspnea and wheezing. Asthma attacks often occur at night or early in the morning, possibly due to circadian variations that influence airway receptor thresholds
Predisposing factors: Chronic exposure to airway irritants or allergens increases the risk for developing asthma. Common allergens can be seasonal (eg, grass, tree, and weed pollens) or perennial (eg, mold, dust roaches, or animal dander) Precipitating Factors: These are Airway irritants (eg, air pollutants, cold, heat, weather changes, strong odors or perfumes, smoke), exercise, stress, emotional upsets, sinusitis with post-natal drip, medications, viral respiratory tract infections, gastroesophageal reflux.
Overview of Nursing Interventions is done through educational home-visits and in the clinical setting:
Home-based Management:
Pharmacological Management:
Potential Barriers to care chiefly would be patient’s compliance in the medication regimen. The primary measure(s) of adherence must be one or more well-defined, valid and reliable assessments of individual-level patient adherence behavior. The adherence intervention(s) must be designed to improve patient adherence by targeting the individual patient, his/her formal or informal health-care providers, the health care system or environment, or a combination of these. It must start from the patient whose mind set is to heal his self in order to deliver the care effectively. If patient and the primary health care providers aren’t that interested to undergo such actions, prevention of re-occurrence wouldn’t be possible. It is always best to say, “Prevention is better than cure.” Second, there must be lifestyle modifications such as increase fluid intake, integrate fruits and vegetables in the diet and exercises that the body can tolerate; consecutively this is done, to get the desired effect of the interventions implemented. Explaining that this is one way to gear up or boost the immune system against harmful antigens. There must also be a need to modify the environment by maintaining cleanliness at home. To add another barrier would be the inadequate availability of resources and lack of primary health care providers in rendering care. It is essential that these two are adequate enough in every district; since the main target here are of those hard to reach areas mostly of financial instability status that at times, with no appropriate educational background, a competent care giver must go for a home visit(s) to enforce health teachings and at the same, for them to realize their faulty actions that had resulted to undesirable health status. Moment of realization must be emphasize for one to make an account of the unhealthy actions and replaced it with the appropriate behaviour towards healthy living. Part III A guideline describes critical decision points in assessment, diagnosis, treatment and evaluation of treatment. Guidelines must be based on the actual and potential problems that were identified and prioritized. This is critical in implementation of the planned care in order to meet the objectives that have been set. Therefore, they could keep track the ups and downs of the agency and be able to give way for further revisions if needed for the betterment of their services. Guidelines to address a problem through the Nursing Process: 1. Scope and nature of the problem. In here one must present relevant data that constitutes the emergence and escalating rise of the said disease in children through bar graphs from previous and recent years; through demographic data, vital health statistics, community dynamics such as studies of disease surveillance and utilization of health services. In turn, survey could be done if the said assessment was reliable and in fact, manageable in years to come. Assessment provides an estimate of the degree to which a family, group or community is achieving the level of health possible for them, identifies specific deficiencies or guidance needed and estimates possible effects of nursing interventions. 2. Setting of goals. A goal is a declaration of purpose or intent that gives essential direction to action. Specific Objectives of care are made with the individual or family in terms of activities of daily living, and adaptive functioning based on remaining capabilities resulting from this condition and capability to cope with his or her disease condition or environment. These objectives are stated in behavioral terms: specific, measurable, attainable, realistic and time-bounded. The nurses prioritizes these objectives. 3. Constructing an Action plan. This is concerned with choosing among from the possible courses of actions selecting the appropriate types of intervention, identifying appropriate and available resources for care and developing an operational plan. The course of action may have positive and/ or negative effects. The positive consequences must be weighed against those with negative aspects. The ability of the family to cope or solve its own problems and make decisions on health matters should be considered. The most appropriate action is selected such as those clients could not perform by themselves, those that facilitate actions that remove barriers to care and that those improve the capacity of the clients to act in their better half. The appropriate resources are identified which include the family, neighborhood, the schools, the industrial population; the whole medical system – the hospitals, clinic, public and private practitioners of medicine, health units of welfare departments, voluntary health agencies, and other health related agencies: non-health facilities such as social educational and counseling agencies. 4. Developing an operational plan. To develop an operational plan, the community health nurse must establish priorities, phase and coordinate activities. Plans of care are prioritize in order of urgency to determine those that need the earliest client (individual, family or community.) These plans are broken down to manageable units and properly sequenced. Periodic evaluation and modification of the plan is necessary. The plan and activities should be coordinated with various services so that it would synchronize with the total health program. Development of evaluation parameters is done in the planning stage and based on the standards set by the nursing services, problems identified, goals and priorities as reflected in the plan or program of nursing care for the clients. 5. Implementation of planned care. This involves various nursing interventions which have been determined by the goals or objectives which have been previously set. The primary health nurses carry out nursing procedures which are consistent with the nursing care plan, are adapted to present situations which promote safe and therapeutic environment. The primary health nurses involve the patient and his or her families in the care provided in order to motivate them to assume responsibility for his / their care, and able to teach and maintain desired level of function, explaining client’s confidence and ability to care himself/ themselves. Thus, the role of the primary health nurse shifts from direct care give to that of a teacher. To maintain his/her optimum level of functioning, the client needs the support of how own knowledge and that of those around him/her. The utilization of the support system provides a harmonious, orderly care to enable to function optimally. He/ she become his/her own best to get services for help. Friends, neighbors, church members, community agencies, organization both government and private are various resources that can be tapped. The nurses monitor the health services provided and make proper referrals. Documentation is an important function primary health nurses. This provide data which is needed to plan the client’s care and ensure its continuity; serves an important communication tool for various team members; furnishes written evidence were made in his/her plan of care and whether such has been effective. They are legal records to protect the agency and the health care providers or the client himself/herself. They also provide data for research and education. 6. Evaluation if care and services provided. Evaluation is interwoven in every nursing activity and every step of the primary health nurses. Structural elements include the physical setting, instrumentalities and conditions through which nursing care is given such philosophy, objectives, building organizational structure, financial resources such as budget, equipment and staff. Outcome elements are changes in the client’s health status that result from nursing intervention. These changes refer to the results of care provided and clients served, includes modification of symptom, signs, knowledge, attitudes, satisfaction of those served/including members of the nursing and health team; skill level and compliance with treatment regimen. Quality assurance efforts are now recommend that evaluation of structure process and outcomes criteria be made. This will evaluate the effectiveness of nursing care needs or changes in behavior, condition, or compliance. Evaluation based on professional practice include conformity with the accepted community and public standard of practice, continued refinement and enhancement of nursing skills through continued field experience and a program of continuing education. Evaluation based on structure include the cost-benefit ratio, qualifications and the number of members of the health team especially nurses in proportion to the populations served and the material resources in the terms of quantity and quality. Evaluation based on information gathered is utilized to improve community health nursing services as part of the total community health services.
Credit:ivythesis.typepad.com
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