Epidemiology and Community Health Nursing: A Detailed Application

This report delves into the application of epidemiology within community health nursing, specifically addressing the prevalence of diabetes mellitus among South Asian immigrants in Toronto. It examines the role of epidemiology in understanding disease processes and informing public health strategies. The report explores the impact of diabetes, the importance of primary health care, and various health promotion strategies, including the Chronic Care Model. It presents research questions regarding the roles and responsibilities of registered nurses in diabetes care, along with facilitators and hindrances in providing care. The study also highlights the application of community health knowledge and theory in nursing practice, emphasizing the importance of patient education and self-management. The report underscores the need for interventions and the role of nurses in managing diabetes and promoting patient well-being, referencing relevant studies and the Registered Nurses Association of Ontario (RNAO) guidelines.

Running Head: APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Name of the Student:
Name of the University:
Author Note:

1APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Table of Contents
Introduction:....................................................................................................................................2
Diabetes Mellitus amongst the South Asian immigrants in Toronto:..............................................2
Purpose:...........................................................................................................................................3
Primary Health Care Approach:.......................................................................................................3
Strategies of Health Promotion:...................................................................................................3
Epidemiology Concepts in dealing with diabetes:.......................................................................4
Research questions:.........................................................................................................................4
Application of Community Health Knowledge and Theory in Nursing Practice:...........................5
Conclusion:......................................................................................................................................6
References:......................................................................................................................................7

2APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Introduction:
Epidemiology is considered as the study of the process of causing diseases amongst a
specific or different groups of population. The epidemiological information is mainly used for
planning and evaluating the strategies to forbid the occurrence of any kind of diseases or
illnesses. It has been observed that epidemiology has become one of the most integral part of
describing a disorder or disease. They help in collecting data along with providing a clear and
precise interpretation of the said collected data from conducting a survey on specific or different
groups of people. Diabetes has been observed one of the most prevalent amongst the South Asian
immigrants in Toronto (Deepa et al, 2015). Diabetes is one of the most one of the growing
diseases that is mainly caused due to inadequate production of insulin in the body. The level of
blood sugar increases out of its limits which becomes impossible for the insulin produced in the
body to break them, leading to the release of the glucose directly in the bloodstream.
Diabetes Mellitus amongst the South Asian immigrants in Toronto:
As compared to the long term residents, the immigrants to the Canada are observed to
find a 40 percent higher risk of developing prediabetes. This is one of the condition which act as
one of the early signs of an individual to develop Type 2 diabetes in the near future (Korat,
Willett & Hu, et al 2014). Many of the active researches have been conducted to study and
measure the incidences of prediabetes amongst the particular population. Surveys project that the
young adults of South Asian descent (Benchimol et al, 2015) are known to develop prediabetes a
decade earlier than the usual population of the Western European descent.

3APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Purpose:
Primary Health Care Approach:
With the increase in the age and obesity of the global population, the public health of
diabetes mellitus is also on a hike. Evidences prove that there is a substantial scope present for
the improvement in the ways of intervention. Access to the medications and diabetic supplies are
made easier. The principle also follows the promotion of the individualized programs which help
in addressing the unique individual factors such as the age, socioeconomic status, race/ethinicity,
mental illnesses or the co-morbid medical conditions. The study conducted by (Uppal, Sibbald &
Melling, 2016) surveyed the individuals where asked about their opinions with respect to the
health care system and health care providers. Involving the patients in every aspect and part of
their diagnosis and treatment is very necessary. Understanding the diabetes management of a
particular individual in a community would help in giving insights to the changes that need to be
incorporated that might help in building a healthier population.
Strategies of Health Promotion:
The Chronic care model (Gee et al, 2015) and the patient centred medical home are the
two models that have been used to provide the right type of care to the patient suffering from
diabetes mellitus. Logically and globally many policies and principles are implicated, which help
in improving the access to and help in the training of the primary care and specialists who treat
the diabetic patients. The primary health care providers performing through such system-wide
reforms are observed to continue be the champions of treating their patient’s right and also aid in
diminishing the burden of diabetes worldwide.

4APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
 Study Design :
The study proposed by (Uppal, Sibbald & Melling, 2016), defines a series of studies that are
conducted on various ethnic groups detected with coronary heart disease. In order to surface the
deep issues and create more awareness amongst the people, qualitative phenomenological
methods were applied. These methods helped in providing the Sikh community with
motivational insights and helped in managing the diabetes in much better ways. The study helped
in highlighting the rates of the increasing number of patients being detected with diabetes. Due to
the vast diversity in the community the study shall help in understanding the Sikh immigrants as
they struggle with the management of diabetes in Toronto. Purposive sampling techniques are
incorporated to include the participants to take part in the survey. The interview transcripts,
additional field notes and the memos are registered and all the data are analysed.
 Demographics:
The study participants included women and men of the Sikh community and all were
immigrants to Canada and ranged in between the ages of 44 and 70. The average aged
participants were of the mean age of 56. The participants were presented with a program
where the immigrant’s experience with diabetes management were discussed.
 Strength of the data collected:
Maintaining a healthy diet had become one of the biggest challenges that are faced by the
individuals participating in the study. The study that was projected in (Uppal, Sibbald & Melling,
2016) took place in a temple where it was seen that the individuals usually avoid the dining area.
The survey further suggested that it should be taken as an initiative by the temple authorities to
reduce the unhealthy factors. The survey also asked the individuals to incorporate lifestyle

5APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
changes and check for the results by which diabetes could be controlled. These parameters could
be easily incorporated into the Community Nursing Practice and can help in the management of
diabetes. The transition of the individuals from an active lifestyle in the South Asia and suddenly
shifting to the sedentary lifestyle in Canada is one of the most common hindrance that the
individuals face while adjusting to the environment. Involving the community and educate them
about the details and paradigm of Diabetes is necessary, which can help in raising awareness
amongst the individuals. Moreover, this shall also make them more aware of the risk factors of
diabetes and can help them know about the consequences of the said disorder.
Epidemiology Concepts in dealing with diabetes:
The burden of the disease in relation to diabetes have a huge rise in all over the country
and is mainly highlighted due to the rise in the prevalence of irrational health styles and obesity.
The latest estimates project that the prevailing global estimation of diabetic patient ranges from
382 million people across the world in the year 2013 and has been expected to hike to a 592
million by the year 2035. Type 1 and Type 2 are the two main types of diabetes, with the major
amount being addressed to Type 2 diabetes. The premature morbidity, reduction in the life
expectancy, financial, mortality and other causes of the diabetes help in making an important
public health condition. Many of the uncertainties that act as an optimal strategy helps in the
increase of the uptake of screening and delivering ultimate patient care. Rather than detecting the
whole population for diabetes, the primary care teams are able to focus on efforts that shall help
in the earlier detection, and providing intensive treatment of the arising risk factors amongst the
nurses and help the individuals who are at a high risk of developing diabetes.

6APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Research questions:
Given with the increase in the number of the people with diabetes over the past years in
Toronto, it would be logical to presume that the majority of the nurses are under the impression
of possessing active and adequate knowledge regarding diabetes inpatient care. Moreover the
focus was completely on the patient who are suffering from diabetes are receiving high quality
and adequate amount of care. However, there had been many evidential studies where the
patients have frequently reported of poor experiences regarding the inpatient care specifically
with relation to the lack of knowledge in the field of diabetes. Furthermore, zero or no studies
were found to be conducted regarding any global or national roles and responsibilities need to
shown or applied for the patients with diabetes. The research questions that follows are included
below:
1. What are the roles and responsibilities of registered nurses for people with diabetes?
2. What are facilitators or hindrances that may appear while taking care of the people with
diabetes and how to educate the people along with their family regarding self-
management of diabetes.
3. What is the level of knowledge or the level of education the nurses possess regarding
diabetes and providing care regarding that?
Application of Community Health Knowledge and Theory in Nursing
Practice:
It has been observed that diabetes that out of the four Canadians are surviving with
diabetes or undiagnosed diabetes. In Toronto as of 2013, it was observed that 1.3 million people
had been diagnosed with diabetes as a complex chronic illness, which was mainly responsible for

7APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
the rise in the cost of the health-care system to millions annually. The registered nurses have a
major role to play in the intervention and prevention of this particular chronic illness, diabetes.
The management (Munshi et al, 2016) of this particular disease is regarded important, as diabetes
is mainly responsible for many complications such the disorders in the kidney, eye or the nerve
issues. Another most prevailing error that had been observed is the occurrence of the foot ulcers
(Ren et al, 2014) amongst the diabetic patients. Providing the patients with proper interventions
and asking them to self-manage foot care in order to prevent such a scenario. The nurses are also
found to act as active caregivers who help in prescribing medication with respect to diabetes.
(Registered Nurses Association Organization) RNAO has been seen to recognize this area of
actions and has developed the two best practice norms with respect to the improvement of care
for the diabetic patients. The RNAO implicated that the Registered Nurses and other health care
personnel have the ability and the responsibility to help and lower the rate of the Canadian
patients suffering from diabetes and help them be up-to-date with all the latest information
regarding diabetes. They are also responsible to provide reliable information and notify the
patients by providing them with active guidance on how to manage diabetes on their own by
providing evidence based care.
Conclusion:
In comparison to the long term residents the immigrants to Canada have been observed to
have a 40 percent of higher the risk of developing prediabetes that act as an early detector or
predictor of an individual more likely developing Type 2 diabetes in the near future and other
associated diseases such as cardiovascular diseases or renal disorder. The paper deals with the
nurses finding interventions with the incorporation of public health care approaches along with
the implication of the chronic care model, which helps in making strategies and helps in the

8APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
promotion of various training programs to help the particular community to deal with diabetes.
The paper also discusses various incorporation of health concepts by the nurses to promote and
manage the interventions in diabetes and make the patients self-efficient to manage diabetes on
their own. Diabetes, have one of the growing chronic illnesses, which have seen a rapid hike in
their growth over the past few years in Canada and worldwide as well, thereby to promote and
manage the disease and their risk factors that might cause them in the future are highly
necessary.
References:
Baptista, D. R., Wiens, A., Pontarolo, R., Regis, L., Reis, W. C. T., & Correr, C. J. (2016). The
chronic care model for type 2 diabetes: a systematic review. Diabetology & metabolic
syndrome, 8(1), 7.
Benchimol, E. I., Manuel, D. G., To, T., Mack, D. R., Nguyen, G. C., Gommerman, J. L., ... &
Guttmann, A. (2015). Asthma, type 1 and type 2 diabetes mellitus, and inflammatory
bowel disease amongst South Asian immigrants to Canada and their children: a
population-based cohort study. PLoS One, 10(4).
Deepa, M., Grace, M., Binukumar, B., Pradeepa, R., Roopa, S., Khan, H. M., ... & Anjana, R. M.
(2015). High burden of prediabetes and diabetes in three large cities in South Asia: The
Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study. Diabetes
research and clinical practice, 110(2), 172-182.

9APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Egbujie, B. A., Delobelle, P. A., Levitt, N., Puoane, T., Sanders, D., & van Wyk, B. (2018). Role
of community health workers in type 2 diabetes mellitus self-management: A scoping
review. PloS one, 13(6).
Gee, P. M., Greenwood, D. A., Paterniti, D. A., Ward, D., & Miller, L. M. S. (2015). The eHealth
enhanced chronic care model: a theory derivation approach. Journal of medical Internet
research, 17(4), e86.
Grady, P. A., & Gough, L. L. (2014). Self-management: a comprehensive approach to
management of chronic conditions. American Journal of Public Health, 104(8),
e25-e31.
Hollis, M., Glaister, K., & Anne Lapsley, J. (2014). Do practice nurses have the knowledge to
provide diabetes self-management education?. Contemporary nurse, 46(2), 234-241.
Korat, A. V. A., Willett, W. C., & Hu, F. B. (2014). Diet, lifestyle, and genetic risk factors for
type 2 diabetes: a review from the Nurses’ Health Study, Nurses’ Health Study 2, and
Health Professionals’ Follow-up Study. Current nutrition reports, 3(4), 345-354.
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., ... &
Haas, L. B. (2016). Management of diabetes in long-term care and skilled nursing
facilities: a position statement of the American Diabetes Association. Diabetes
care, 39(2), 308-318.
Ren, M., Yang, C., Lin, D. Z., Xiao, H. S., Mai, L. F., Guo, Y. C., & Yan, L. (2014). Effect of
intensive nursing education on the prevention of diabetic foot ulceration among patients
with high-risk diabetic foot: a follow-up analysis. Diabetes technology &
therapeutics, 16(9), 576-581.

10APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING

11APPLICATION OF EPIDEMIOLOGY IN COMMUNITY HEALTH NURSING
Uppal, G., Sibbald, S. L., & Melling, J. (2016). Exploring diabetes management amongst
immigrant Sikhs in the Greater Toronto Area: a qualitative study. Ethnicity &
health, 21(6), 551-563.