Assignment: Final Paper: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem

Throughout this course, you have been applying an epidemiological approach to analyze a population health problem. In previous weeks, you have developed distinct sections of your paper; it is now time to finalize and submit a cohesive, polished version of work. This paper serves as your Major Assessment for this course and must be uploaded by Day 3of this week.

To prepare:

· Finish incorporating any feedback from the submitted sections of your paper.

To complete:

Write a 12- to 15-page paper that includes the following:

Section 1: The Problem

· A brief outline of the environment you selected (i.e., home, workplace, school)

· A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)

· Research question/hypothesis

Section 2: Research Methods

· The epidemiologic study design you would use to assess and address your population health problem

· Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)

· Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)

Section 3: The Intervention

· An outline of an intervention you would implement to address the population health problem with your selected population based on the results of the study in Section 2 (Note: If you selected a descriptive study design, you are still required to outline an intervention that might be developed based on future research.)

· A review of the literature that supports this intervention

Section 4: The Impact

· An explanation of the health outcome you would be seeking and the social impact of solving this issue

Section 5: Evaluation

· An evaluation plan based upon the health outcome that you have chosen and your anticipated results

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in- text citations and reference list are correct.

By Day 3

Submit your Major Assessment paper.

Week 10: Chronic Disease Management: Mortality and Morbidity

The management of chronic disease poses a significant health care challenge in the United States and elsewhere. By the year 2030, chronic disease will cost the world over 47 trillion dollars annually (Bloom, et al, 2011; Jaslow, 2011). As noted in Week 6, many of the factors that contribute to chronic illness—such as poor diet, lack of activity, drug and alcohol use, and smoking—are lifestyle choices. Consider, for instance, diabetes: the significant increase in prevalence from 1980 to 2007 is explainable almost entirely by lifestyle choices. Most adults report having the condition long term, and the direct and indirect costs associated with it are substantial (Nash, Reifsnyder, Fabius, and Pracilio, 2011).

As a nurse leader, what opportunities do you see for reducing morbidity and mortality—and, ultimately, for diminishing the tremendous personal and societal costs—related to chronic disease?

You have explored many of the facets of epidemiology throughout this course; this week, you will examine the study of chronic disease. You will investigate models and frameworks for managing chronic disease, as well as how the challenges of managing chronic disease inhibit the delivery of quality health care.

Learning Objectives

Students will:

· Analyze a chronic disease model and its relationship to a chronic disease

· Evaluate current challenges in delivering effective quality health care as it relates to chronic disease management

Learning Resources

Required Readings

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Structure, systems, and stakeholders. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
In Chapter 4 the current structure of the United States health system and the influence on population health is discussed. Stakeholders are identified, and the relationships between the structure, system and stakeholders is  explored.

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Coordinated care delivery models. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

Chapter 12 examines the influence of accountable care organizations and ambulatory care organizations on the current health care delivery system. Examples of successful organizations are explored.

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Developing the workforce to enhance population health. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

In Chapter 7 the authors address the social determinants driving population health. The strategies needed to develop a workforce that will be able to support current population health strategies is discussed.

Dossey, B. M., Rosa, W. E., & Beck, D.-M. (2019). Nursing and the sustainable development goals: From Nightingale to now. AJN American Journal of Nursing, 119(5), 44–49. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NAJ.0000557912.35398.8f

Easley, C., Petersen, R., & Holmes, M. (2010). The health and economic burden of chronic diseases in North Carolina. North Carolina Medical Journal, 71(1), 92-95.

This short reading presents an analysis of the economic effects of selected chronic diseases resulting in increased hospitalization, with a focus on behaviors that may be changed to prevent these diseases.

Kim, T. W., Saitz, R., Cheng, D. M., Winter, M. R., Witas, J., & Samet, J. H. (2011). Initiation and engagement in chronic disease management care for substance dependence. Drug & Alcohol Dependence, 115(1-2), 80-86.

This article presents a study on treating substance abuse as a chronic disease. The authors discuss challenges to treatment options and propose methods for more appropriately managing treatment for substance dependence as a chronic illness.

Tenforde, M., Jain, A., & Hickner, J. (2011). The value of personal health records for chronic disease management: What do we know? Family Medicine, 43(5), 351–354.

This reading examines evidence related to the value of electronic personal health records (PHRs), noting that additional research is needed to evaluate this for chronic disease management.

United Nations. (2011, September 19). Non-communicable diseases deemed development challenge of ‘epidemic proportions’ in political declaration adopted during landmark general assembly summit. Retrieved from http://www.un.org/News/Press/docs/2011/ga11138.doc.htm

The United Nations met in September 2011 to collaborate on global plans to address the control and prevention of chronic diseases. This report from the general assembly notes the high cost of not managing chronic disease worldwide.

Yale School of Public Health. (2012). Chronic disease epidemiology. Retrieved from http://publichealth.yale.edu/cde/index.aspx

Yale School of Public Health sponsors this site. Explore the information presented on addressing chronic disease through epidemiology.

Florida Department of Health. (n.d.). Bureause of epidemiology: Surveillance and investigation guidance. Retrieved March 5, 2012, from http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/surveillance-and-investigation-guidance/index.html

This Florida-based agency monitors chronic disease conditions in Florida’s population using a variety of population-based surveillance systems.

World Health Organization. (2012). Chronic diseases and health promotion: Integrated chronic disease prevention and control. Retrieved from http://www.who.int/chp/about/integrated_cd/en/

The World Health Organization monitors chronic diseases worldwide. This website provides an overview of their programs, monitoring efforts, and activities they engage in to reduce the incidence of chronic disease globally.

Discussion: Addressing Chronic Disease

According to the Population Health course text, “Roughly 40 million Americans are still uninsured and 112 million Americans (almost half of the U.S. population, 45%) suffer from at least one chronic condition in the United States, an estimated 125 million persons have at least one chronic condition, and half of these persons have multiple chronic conditions” (Nash, Skoufalos, Fabius, and Oglesby,  2021, p. 5 ).

This week’s Learning Resources examine numerous health problems that result in a need for ongoing care. As you have explored this week, many costs are associated with chronic disease—both in terms of lives lost and socioeconomic burden. What can be done to help reduce chronic disease at the population level?

For this Discussion, you will take an in-depth look at chronic disease, and you will evaluate ways to address this issue through the application of chronic disease models and frameworks. In addition, you will consider the impact of the challenges of managing chronic disease on quality of care delivery.

To prepare:

· Review the application of chronic disease models as a method for managing chronic diseases at the population level.

· Consider characteristics of chronic disease models and how to apply them as presented in the Learning Resources.

· Consult The Chronic Care Model (Figure 1–1 (p. 9) in Population Health: Creating a Culture of Wellness, and consider examples of determinants and outcomes of population health with chronic diseases in a specific subpopulation. Then, select one chronic disease on which to focus for this Discussion.

· Ask yourself, “What are the challenges of managing this chronic disease? How do these challenges limit the ability to deliver effective quality care?” Conduct additional research using the Walden Library and credible websites as necessary.

By Day 3

Post a cohesive scholarly response that addresses the following:

· Identify your selected chronic disease.

· Describe the application of a chronic disease model to address this disease at the population level. Include your rationale for selecting this particular model.

· Discuss one or more current challenges related to the management of the chronic disease, and explain how these challenges limit the ability to deliver effective quality care.

1.5 pages in APA and cite at least 3 sources

Assignment: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem

Continue improving upon your paper, paying careful consideration to the feedback you have received on the drafts you have submitted in previous weeks. Your Final Paper will be due by Day 3 of next week.

Week in Review

This week, you analyzed a chronic disease model and its relationship to a chronic disease and evaluated current challenges in delivering effective quality health care related to chronic disease management.

In the final week, you will consider emergency preparedness and disaster management strategies and how these strategies are used to cope with disasters.

To go to the next week:

Week 11

More sources

https://www.who.int/home/cms-decommissioning

https://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/index.html

https://journals.lww.com/ajnonline/Fulltext/2019/05000/Nursing_and_the_Sustainable_Development_Goals_.27.aspx

Discussion 2: Factors That Impact Population Health

In this Discussion, you bring together the concepts that have been presented throughout this course by analyzing a current population health topic from an epidemiological approach. Consider the cultural, ethical, regulatory, and legal factors that may influence your selected topic.

To prepare:

· Review the case study, presented on page 288 of your course text, Population Health: Creating a Culture of Wellness. Consider the cultural, ethical, and legal factors presented in the case study and how they influence the Michigan Primary Care Transformation Project.

· With these thoughts in mind, select a current public health initiative that has been discussed in the popular press or available at the CDC website or your state’s health department website.

· Consider this initiative through the lens of an epidemiologist, and identify what you think are the three most important issues related to culture, ethics, regulatory, or legal aspects of the public health initiative.

· Consider how current health care legislation might impact your selected public health initiative. Conduct additional research as necessary.

By Day 4

Post a cohesive response that addresses the following:

· Provide a summary of your selected public health initiative, and include a reference to the article (and URL to the article, if possible).

· Analyze the cultural, ethical, regulatory, and legal factors that influence your specified population health topic.

· Evaluate how current health care legislation may positively or negatively impact your selected public health initiative.

Write 1.5 page and cite at least 3 sources

Anatomy and Physiology 1 Lab Name ________________________________

Case Study Assignment. You are a medical student working your way through college and are assigned to a hospital given background information on a patient. You were provided the chief complaint and brief history of the patient outlined below. You are asked by the nurse in charge to read the following case, investigate the topic (severe burns and function of the integumentary system) and complete a written report in MLA format including references addressing each of the questions identified below. Use this link for guidance on MLA writing format: https://owl.purdue.edu/owl/research_and_citation/mla_style/mla_formatting_and_style_guide/mla_general_format.html

Total length of your report should be about two to three pages. The purpose of this assignment is to put things you are learning in the course (lecture and lab) into context using real life situations. This assignment’s focus is to investigate real issues of the integumentary system and epithelial tissues.

Chief Complaint: A 60-year-old female was admitted for severe second- and third-degree burns following her rescue from a burning house.

History: Lily Tigre, a 60-year-old female, was received in the emergency room and was reported to have been rescued from her burning house by the neighbor. The neighbor’s family dog was able to wake up the neighbor and they saw flames coming from the windows and heard a person screaming. Investigations at the scene suggest the patient was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, the patient had been rescued but emergency crews reported she had suffered severe burns and excessive smoke inhalation.

In the emergency room, Lily was unconscious. She had second-degree burns over 9% of her body and third-degree burns over 18% of her body — both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 60 / 37; heart rate = 212 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted, and fluids were administered through each. Her vital signs stabilized, and she was transported to the intensive care unit (ICU).

Lily regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.

Lily began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers. She lost 17 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories (“Kcals”) per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

Questions for you to address in your report. Your supervisor asks you to prepare a 2 to 3 page report to accomplish two things: 1) evaluate your knowledge about the integumentary system and how the body deals with severe stress as well as the specifics about the case; and 2) your supervisor needs to be apprised of the case in an official capacity. You are to address each of the items below in report form (MLA format means complete sentences and paragraphs with references). Assume you are writing your report to your supervisor relaying information about a patient (Lily). You are given clues in the above Case on pertinent information. It is likely you will need to use outside resources like your textbook as well as internet for your investigation. For example, your textbook would be a great resource for addressing the second item below, but you might need to research a little more to item 3. Your grade will be based on how well (professional) the report is written, how well each of the items below are addressed, and the accuracy of your report.

1. Provide a brief summary of the case.

2. In your summary, describe each of the three major layers that make up healthy skin.

3. In your report, explain what first-degree burns, second-degree burns, and third-degree burns are and how this relates to the patient.

4. Investigate and explain the process of debridement and how it relates to this patient.

5. Investigate why this patient was relatively pain-free when she woke up.

6. Explain why this patient’s blood pressure was so low and her heart rate was so high upon arrival at the emergency room (ie. What is causing this)

7. Explain why it was important to immediately administer intravenous fluids to this girl.

8. Investigate “broad-spectrum” antibiotics, and why they were administered and why antibiotics needed to be switched. Is healthy skin normally colonized by bacteria?

9. Address skin-grafting and why it was necessary in this patient? (Why not just let the skin heal on its own?)

10. In your report to your supervisor, describe the series of events that occur in skin which is healing with the help of a skin-graft.

11. Investigate decubitus ulcers and why bedridden patients are at risk for developing them. Explain in the report where on the body such ulcers most commonly occur.

12. Explain why the patient lost so much weight despite being on a very high-calorie diet.

13. Provide a conclusion of what long-term problems the patient may face as a result of extensive scar tissue formation over her trunk and her right elbow.