EVIDENCE-BASED PRACTISE in RELATION TO HEALTH

Evidence Based Practices: CORE

CONCEPTS
Adopted from PPT. by Elvira A. Casanas---MAN
(from CAROLINE E. Brown---Evidence Practice;
Step-by-Step)AJN Series by Melnyk & Stillwell
(CE)
 GOALS OF EBP

 Provide
practicing nurse the evidence
based data to deliver effective care.
 Resolve problem in clinical setting.
 Achieve excellence in clinical delivery.
 Reduces the variations in nursing care and
assist with efficient and effective decision
making.
 OBJECTIVES
At the end of this presentation the student
will be able to:
 Define Evidence-Based Practice
 Describe process and outline EBP
 Understand PICO elements and search
strategy
 Identify resources to support EBP
 EVIDENCE BASED-PRACTICES RELATED TO HEALTH EDUCATION

Purposes of Evidence Based-Practices on

Health Education:
 Formaking sure that each client get the best
possible services.
 Update knowledge and is essential for
lifelong learning.
 Provide clinical judgment.
 Improvement of care provided and save lives.
 Introduction
It was during the 1980's the term”evidence based-
practice medicine” emerge to describe the
approached that used scientific evidence to
determine the best practice.

Evidence based-practice movement started in

England.

Evidence-Based medicine (EBM) or Evidence-based

pracice (EBP), is the judicious use of the best
 currentevidence in making decisions about
the care of individual patient.

 Evidence-based practice represents both an

idealogy and a method.

 Theidealogy springs from the ethical

principle that client deserve to be provided
with the most effective interventions
possible.

The method of EBP is the way we go about

finding and then implementing those
interventions.
 Evidense-Based nursing-It is a process by
which nurses make clinical decisions using
the best available research evidence, their
clinical expertise and patient preferences
(mulhall, 198)

Evidence Based medicine or practice-The

conscientious, explicit, and judicious use of
current best evidence in making decision
Why you do what you do each
day?
What INFORMATION do you base your
nursing care on???

“The Goal of EBP is to change practice-to

locate the best evidence and put it into
practice.”RN. com EBP CE
The sources of information that shape clinical
practice...
 Colleagues
 Textbooks
 The Internet
 Educational Events
 Pharmaceutical and other Industry
 Reading the Journal articles
 What you learned in school
 Bases for nursing care
Pravikoff et al., A 2005 survey of 760 RN in
the U.S., working in clinical practice, found
out that:
 67% get information for practice from
other nurses
 58% do not use research reports to support
their practice
 82% never used a hospital library
 54% were not familiar with the term EBP
 67% never searched CINAHL
 72% hadn't evaluated research reports

“Most nurses practice according to what

they learned in nursing school, their
experience , and what colleagues share in
the clinical setting.”
Estabrooks, 1998; 2003 and Pravikoff 2005
 COMMON DRIVERS
How Patient Care is Practiced...
Ritual...accepted practices versus research
proven practices...That “that's the
way we've always done it”
syndrome.
Tradition...The way I learned how to do it.
Personal opinion....without assessments of
underlying assumption.
Arrogance...I have to be right syndrome.
Lack of concern ...for patient's values.
 The NEED for EBP
 “EBP is essential to transform health care
by providing proven effective treatments.
At present there is a gap between theory
and practice that results in diminished
patient care, inefficient practice, and an
excessive time lag between the discovery
of knowledge and its incorporation into
clinical practice.” (Salmond 2007) p. 460
Knowledge translation -17 years.
of knowledge and its incorporation
into clinical practice.” (Salmond 2007)
p. 460 Knowledge translation -17 years.
“An extensive body of knowledge exists
now that needs to be incorporated into
practice.”
(Drenning 2006)
Practices supported by research
 improves outcomes.
Knowledge explosion makes it impossible
to “keep up”

EBP provides means to:

 Standarsize best practices
 Improve adherence to best practice
 Makes relevant data available at the bedside
when needed.
 Why does EBP MATTER?

“Research shows that EBP leads to higher

quality care, improved patient's
outcomes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care. (Melnyk, 2010)
 EBP has demonstrated that...
 28%better patient outcomes if patients receive
care based on the best and latest
evidence from well-designed studies
compared to traditional practice. (Heater
1988)
“Patients should receive care based on the
best available scientific knowledge”
IOM Crossing the Quality Chasm: A New Health system for
21st Century, 2001.
 Why does EBP matter to
you?

 “Higher level of satisfaction among health care

providers who use evidence-based approach in
delivering patient care than those who deliver
care steeped in tradition.” Dawes M. (1996)
 Status of EBP
 Abundance of Knowledge exists waiting to be put
into practice (@ 17 years lag time)
 Growing expectation that EBP is part of everyday
clinical practice
 IOM wants 90% compliance by 2020
 Only 10 to 15% of clinicians currently take a
consistent EBP approach to care
One study that surveyed 1200 practicing
nurses found that only 21% had implemented
a new research finding in the previous six months.
 Barriers to EBP in nurses
The nurse does not have enough time to read
research, or implement new ideas.
Overwhelming patient loads
The nurse is unaware of the research, or
doesn't perceive it as informing practice
The nurse doesn't have authprity to change
practice
 The amount of research is overwhelming
 Inadequate resources and lack of
administrative support
 Lack of EB mentors to work with providers.
 Other Deficits among nurses:
 Inadequate EBP knowledge and skills
 EBP only recently included in nursing
education
 Never learned how to research an electronic
database
 Not able to differentiate between research
reports or assess the quality
 Still lacks comfort, skills, time access to
appropriate materials to engage in EBP
 Factors that facilitate EBP

 EBP knoledge and skills

 Belief
in the value of EBP & the ability to
implement it
A culture that supports EBP provides the
necessary tools to sustain evidence- based
care
 EBP mentors
 Transition towards EBP
The movements that have been involved in
transitioning health care delivery include:
Quality Assurance/Process improvement
Knowledge translation movement
Evidence based practice
EBP based practice
Research and its utilization
EBP: Evidence based: Consumer: patient
choice
 Evidence-Based Practice is DEFINED as:
“a problem-solving approach to the delivery of
health care that integrates the best from
studies and patient care data with clinical
expertise and patient preferences and values.”

“an approach to providing care that integrates

nursing experiene and intuition with valid and
curent clinical research to achieve best
outcomes.” (p. 460)
 What are your experience
telling you?
What has been the
experience of your CLINICAL
colleague EXPERTISE

What are the patient wants?

Optimal What are they willing to do?
Decision
RESEARCH PATIENT
EVIDENCE PREFERENCES

What does the research

say?
 EVIDENCE BASED-PRACTICE PROCESS

1. Ask the burning clinical question

2. Collect the most relevant and best
evidence
3. Critically appraise and critisize the
evidence
4. Integrate all evidence with one's clinical
expertise, patient preferences, values in
making a practice decision or change
The Merging of Science and Art EBP within
a Context of Caring Results in the Highest
Quality of Patient Care:

See next slide

 Content of Caring

Research Evidence&
Evidence- Based Theories

Clinical Expertise & Evidence from

assessment of the patient's history and Quality
Clinical
condition as well as health care Patient
Decision
resources Outcome
making

Patient's Preferences
and Values

EBP CONCEPTUAL FRAMEWORK

 EBP SEVEN STEPS
Step Zero: Cultivate a spirit of inquiry
1. Ask the burning clinical question in
PICOT format
2. Search and collect the most relevant and
best evidence
3. Critically appraise the evidence
4. Integrate all evidence with one's clinical
expertise, patient preferences, and values
 in making a practice decision or change
5. Evaluate the outcomes of the practice
decisions or changes based on evidence
6. Dessiminate EBP results
The process of doing EBP IS SIMILAR TO THE
NURSING PROCESS
Assess
Assess
Ask Diagnosis
Acquire & appraise Plan
Apply Improvement
Analyze Evaluate
Advance & adopt
The Process of Doing Evidence-Based Practice
Assessing Asking
CATALYST

Acquiring
Advancing &
Adopting

Appra
isi ng

Adopted by the San An

a ly
Diego Consortium for zin
Nursing Excellence g
Applying
The CATALYST and ASSESSING

L YS T
CATA
 The CATALYST...
 Inquiring clinicians set the prpocess of EBP iin
motion. Inquiring clinicians possess curiosity
and inquisitiveness, they question the status
quo!!!
 The catalyst may come from many sources.
 Some examples are new research,
ineffective systems for providing care,
new technologies, and questioning
ritual practices.
Becoming an Inquiring Nurse Starts with...
 Undestanding why...

By asking questions!!!
Why are you giving care this way?
Why do you do what you do each day?
Is there evidence to support the current
practice?
Is there a better way?
Step Zero: A Spirit of Inquiry
Strategies for building a Spirit of Inquiry:
Think about these clinical Who can assist me to
questions when caring for your enhance my EBP
patient... know ledge and skills?

Ask why?..why am I doing Who can be my mentor?

what am I doing for my Which of my practices are
patients? currently EB and which do
not have supporting
evidence?
Where can I find the best When is the best time to
evidence to question my current clinical
practices and with whom?

answer my clinical questions?

 Integrate philosophy and mission
 Administrative commitment
 Integrate throughout organization
 Create an environment that promotes
critical thinking, autonomous decision
making, empowerment
 Introduce staff to EBP
 Provide tools and access
 S IN G
A S S ES
 ASSESSING
 Leads the inquiring provider to gather
information about why a practice the way
it is.
 Itinvolves gatheirn evidence from
colleagues, plocoes, and data sources to
understand the history of the practice and
to confirm that a problem exists with the
practice.
 ASSESSING CONFIRMS THE RELEVANCE

Once you know more about why something is

done a certain way you can make a
determination of the relevance and
importance of a problem for the particular
unit and the organization.
 ING
ASK
 STEP ONE

Asking the right question:

Facilitate literature searches
Guides your plan
Narrows your focus
Searchable
Answerable
 The EVIDENCE-BASED Practice Process

1. Asking a clinical question (PICOT)

2. Searching for the best evidence
3. Critically appraisning the evidence
4. Integrating evidnece into practice
5. Evaluating the results
6. Disseminating the evidence
 Comparison of Background & Foreground
Questions
Background Question: Foreground Question:
A. Broad & basic knowledge question A. A specific question that, when

commonly answered in textbooks. answered, provides evidence for

May begin with “What” & “When” clinical decision making.
1.) What is the best method to Includes PICOT elements:
prevent pressure ulcers? (1) population (P)
2.) What is sepsis? (2) intervention/issue of interest (I)
3 ) When do the effects of (3) comparison intervention or
Furosemide peak? issue of interest (C)
(4) outcome (O)
(5) and sometimes time (T)
 Why si the PICOT question so important?
 The PICOT format provides a consistent,
systematic way to identify the components
of a clinical issue.

Structuring a clinical question with PICOT

helps to clarify the components which will
guide the search for evidence.
A well-built PICOT question increases the
likelihood of finding the best evidence
quickly and efficiently.
 PICOT Format

 Foreground questions ask for specific

knowledge to inform clinical decisions or
actions.

 PICOT Format:
 Problem/ Population Outcome
 Intervention Timeframe
 Comparison intervention (optional)
 The Basic PICOT question:
 Inand among your patient or population,
does your intervention, (versus your
comparison), result in or affect your
outcome?
 Asking a Question with PICO
P: I: C: O:
Population Intervention Comparison Outcome
Describe as Describe the Use a What is the
specifically intervention comparison if clinical
as of intererst, it fits to do so, outcome
possible this may be a this may be an add the
treatment, alternative, a timeframe if
risk factor, placebo, important
perception usual care (T)
 Asking the Clinical Questions

 In mechanically ventilated patients (P),

how does a weaninig protocol (I) compared
with no weaning protocol (C) affect
ventilator days (O) during ICU length of
(T) stay?
 In hospitalized adults (P), how does hourly
 rounding (I) compared with no rounding (C)
affect fall rates (O)?
 P: I: C: O:
Population Intervention Comparison Outcome
Example In post do as compared reduced risk
cardiac Identification to usual care of skin tears?
surgery protocols
patient

Example In patients does listening as compared reduced

undergoing to taped music to live music anxiety and
diagnostic increase
procedures patient
satisfaction?
Example in acute care does nurse as compared increase
units walking to taped patient
rounds reports satisfaction
and missed
treatments?
 Exercise: Scenario
 Scenario: You are interested in reducing
the number of elderly patients
that fall during their hospital stay
and the severity of injury.
Currently
the rate of falls is higher in your
unit than in other units in the
hospital and the national
benchmark. There are a variety of
 currently being used in the hospital and you
want to know where to start on your unit
to address this problem.

What is your PICO Question?

 Question

Population-in elderly patient does

Intervention-fall assessment
Comparison-compared to an interactive
class session
Outcome-provide the knowledge and skills
required to teach patients
diabetic self-care management?
 IRI N G
ACQU
 STEP 2:
Search for the Best Evidence

 Develop PICOT question

 Identify keywords and terms from PICO
 Identify standardized subject headings
 Combine subject headings and keywords
to narrow or broaden your search
 Evaluate your search results
 Revise the search in light of your results
 COLLECTING the EVIDENCE

The EVIDENCE

All the evidence in the world

Publishedevidnce
Published evidence

Indexed evidence

Evidence I can Trust

Evidence I can access

Evidence I choose to use
 The Evidence you search for should be
driven by your PICO question...
 Answeringthe backgound question. A
number of textbooks, handbooks and data
bases may be consulted to effectively
answer background questions.

 Answering the foreground question. The

highest level of research evidence available
to answer the question.
LEVEL of EVIDENCE
...but it was in a nursing
journal - so doesn't that
mean it s good???
 Types of Questions
 Diagnosis
 Therapy (Treatment)
 Prognosis
 Etiology/harm
 Prevention
 Cost-effective
 Quality of life
 Levels of Evidence:
Treatment (Therapy) Questions
Systematic reviews or meta-analysis or clinical guidelines

One well-designed RCT

Well-designed research without randomizqation

Well-designed case-control or cohort studies

Single descriptive or qualitative study

Expert opinion, expert committee

“Not everything that counts can
be counted, and not everything
that can be counted counts.”
~Albert Einstein
 Levels of Evidence:
Experiential (Quality of Life)
Questions

Systematic Rviews of Qualitative and Descriptive Research

Single Qualitative Research

Expert Opinions, Expert Committees

Evidence from Quantitaative Research

 Scenario~You are interested in reducing the
the number of elderly patient that
fall during their hospital stay and the
severity of injury.

 Question

Population - elderly hospitalized

patients does
Intervention - fall assessment
Comparison - usual care
Outcome - prevent falls or reduce the
number and severity?
 I SI NG
A PP R A
Step 3: Critically Appraise the Evidence

 Purpose of critical appraisal is to determine

value of the evidence for practice.
 Rapid critical appraisal of a studies's worth
asks 3 questions...
 Rapid Critical Appraisal
 Attempt to answer 3 questions:
 Are the results of the study or systematic
review valid?
(Validity) of the evidence)
 What are the results and are they reliable/
important?
(Realibility) of the evidence)
 Are the findings clinically relevant to my
patients?
 (Applicability) of the evidence to your population
 N G
P P LYI
A
 Step: 4

Integrate the evidence with clinical expertise

and patient preferences and values.

“Research evidence alone is

not sufficent to justify a
change in practice.”

(Melnyk, 2010)
 Can you draw conclusions based on your
literature based?
 Have you completed an exhaustive search?
 Dothemes emerge from your literature
base/research summary?
 What levels of evidence are contained
within the articles found?
 What conclusion can you make?
*A body of reliable evidence
*Inconclusive evidence
*No evidence
 Is there a
sufficient
literature base?

YES NO

Design Practice Best Practice Conduct research

Change with other types
of evidence
 Balancing the Literature
Patient
Preferences

Clinical
Experise Evidence

Evidence
Based
Decision

Health care Clinical

resources Context
Moving Forward Applying the Evidence to Your
Practice
 Develop recommendations for practice.
 Integratethe evidence recommendations,
with collaboration with patients, into a
plan of care.
 Completehuman subject protection
requirements.
 Making the project a reality
1. Define project plan
2. Define the protocol (what you are
changing)
3. Specify outcome measures
4. Determine method for data collection:
a.Develop a system for managing data
collected
b.Plan to maintain integrity of data
5. Implement process
6. Draw conclusion about success: adopt
change - reject change - modify change
 ZI N
N A LY
A
G
ANALYZING:

STEP 5: This step invlves

Evaluate answering the questions:

the outcomes of  Did ypu do what you set
the practice out to?
decisions or  Where there any
changes based unintended
on evidence consequences of the
change in practice?
 ANALYZING
 Evaluating in health care providers' own
setting.
 Importantto consider bias and confounding
influences.
 Patient evaluation of experiences as well as
nurses's evaluation must be considered.
 Interdisciplinary collaboration is essential.
 C IN G &
ADVA N
PT I N G
ADO
 Step 6: Disseminate EBP Results
ADVANCING ADOPTING
 This step involves
sharing what your  This steop involves
experience was with planning for broader
others. adoption of the
 It involves disseminating the practice beyond your
outcomes of your patient, unit, service
project and the lessons or division. Not all
you learned projects will proceed this far.

through the process

 DEFINITIONS
 Evidence--It is something that furnishes
proof of testimony or something legally
submitted to ascertain in the truth of the
matter.

 Evidence-Based practice-It is a systemic

interconnecting of scientifically generated
evidence with the tacit of the expert
practitioner to achieve a change in a
 Evidence-based nursing--It is a process by
which nurses make clinical decisions using
the best medical decisions using the best
available research evidence , their clinical
expertise and patient preferences (mulhall
1988).

 EvidenceBased-medicine or practice-The
conscientious, explicit and judicious use of
current best evidence in making decision
 aboutthe care of individual patient. (Dr. David
Sackett Rosenberg, 1996).

 EBP in NURSING is a way of providing nursing care

that is guided by integration of the best available
scientific knowledge with nursing expertise. This
approach requires nurses to critically assess relevant
scientific data or research evidence and to implement
high quality interventions for their nursing practice
 (NLM PubMed)
Why evidence-based practice matters to students?
(Original post 2017)
 Examples of EBP in effect:
 Therewas a time when milking chest tubes
and bathing children in alcohol were
standard practices. Although at the time
the nursing interventions may have seemed
rational, evidence-based practice has
proven otherwise. EBP continues to change
the way nurses care for their patients.
 Forexample, during (the author's round
she recounted) one of my clinical
rotations, a seasoned nurse corrected me
for not aspirating a syringe during an
intramuscular injection. Current evidence-
based research suggests that aspirating
intramuscularly is no longer a standard of
practice since no evidence supports its
practice and it can cause trauma to
patients.
 Expand your knowledge about EBP with
these tips:
 Knowwhat evidence-based practice
means:
 Evidence-based practice is a clinical
decision-making process in which clinicians
use theory-derived, research-based
knowledge to inform their decisions about
care delivery. 
 Consideration of individual needs, preferences
and resources are also included. EBP replaces
policies and procedures based on other
sources of evidence such as tradition or
authority. It takes into account three things
nursing students should consider at all times:
 best practice evidence,
 patient preferences and
 clinical expertise.
 Understand how these practices have changed
nursing care.
 Hereare just a few examples of how EBP has
changed nursing care. You can find many more
examples in the literature.
 The BRAT (Bananas, Rice, Applesauce, and Toast)
diet is no longer a nutritional recommendation
for gastrointestinal upset in children. The
American Academy of Pediatrics now
recommends that children be returned to a well-
balanced diet as soon as possible.
 Nurse-driven protocols now guide nursing
practice regarding the best time for
removing urinary catheters to prevent
urinary tract infections.
 Aspirinwas previously used to control fever
in the pediatric population, but it is no
longer a standard practice because it
increases the risk of Reye’s syndrome.
ICU ABCDEF Bundle is a combination of multiple
evidence-based interventions that can collectively
reduce delirium, improve pain management and
reduce long-term consequences for patients in the
ICU.
A: Awakening trials for ventilated patient's;
 B: Spontaneous breathing trials; 
C: Coordinated effort between the RN and
respiratory therapist to perform the
spontaneous breathing trial when the
 patientis awakened by reducing or
stopping the patient’s sedation; 
 D:A standardized delirium assessment
program, including treatment and
prevention options; 
 E:Early mobilization and ambulation of
critical care patients.)
•  Turning patients every two hours is no
longer a standard of care.
 The timing for turning patients should be
dependent upon their condition and their
risk for skin breakdown.
For example, one patient may need to be
turned every 15 minutes and another
patient may need to be turned
every hour.
 Appreciate how EBP is important to student
nurses :
 Theevidence-based interventions we
learn can improve patient outcomes,
help to provide high quality care,
reduce costs and
eliminate practices that have become
obsolete or are not effective.
 As nursing students and future nurses, we
hold a promise of continuous learning, and
it is essential to build evidence-based
knowledge over time. As students, it is
never too early to start thinking like a
nurse who is driven by evidence-based
practices.
 Discuss it with others
 One of my clinical assignments each semester
is to find new evidence-based practices that
can help nurses on the unit improve care.
 Notonly do we as nursing students have the
power to educate staff, but we also can serve
as a great resource, helping staff to provide
better care and improve patient outcomes.
 Asa student, you can suggest implementing
evidence-based practices as a standard of
practice. Embrace its positivity knowing it
will help the care of your patients. You can
print out evidence-based practices for your
unit and perhaps leave it at the nurses’ desk
or in the break room.
 Start
a journal club or join one and come
together with nurses who are willing to bring
change to the units where you work.
 Evidence-based practice change starts with
you as a student. Be the change agent, and
never be afraid to advocate for the care of
your patients.

 Key points to keep in mind:

• It’s important for student nurses to learn
the value of evidence-based practice, in
order to provide high-quality care.
 It is never too early.
  EBP isa based on research, evidence on best
practices, and the consideration of individual
patient’s needs, preferences.
 During clinicals, do research on the medical
conditions your patients have. It will help you
provide a higher level of care.
 Be proactive in suggesting EBP during clinicals
or helping to bring more attention to EBP
research.
 Learn how to search for EBP:
 You probably will notice on the units where
you work there are specialty populations
and patients with similar diseases. To
provide a higher level of care, look up
evidence-based practices for that particular
population. Hospital units or your university
library usually have nursing databases to
search for specific journal articles.
 THANK YOU!
STAY HOME/KEEP SAFE
Future Directions for Client Education
 In the Code of Ethics of the Society for
Public Health Education, Inc. (SOPHE) it
states that “Health Educators take on
profound responsibilities in using
educational processess to promote health
abd influence well-being.” the Code of
Ethics (Unabridged Version), Society for
Public Health Education, Inc., Article IV
deals with the Responsibility in Employ-
 ing Educational Strategies and Methods and
states that, “In designing Strategies and
Methods, the health educator.......should
be aware of his/her possible impact on the
community and other health professionals
nd must not place the burden of change
solely on the target population but must
involve other appropriate groups to bring
about effective change.
 ISSUES and TRENDS in HEALTH EDUCATION

TRENDS IMPACTING ON HEALTH CARE

1. Social---demographic trends like aging of
the population requires emphasis
on self-reliance and maintenance
of a halthy life status over an
extended life span particularly
dealing with degenarative diseases
and disabilities; lifestyle related
diseases which arre the major
causes of morbidity and mortality
are highly preventable and will need
more intensive health education
efforts.
2. Economic---the shifts in [ayer coverage,
emphasis on managed care and
earlier hospital discharge, and the
 issue on reimbursement for health
services provided require more
intensive patient education to allow
the patient and his family a more
independent, compliant and
confident magement of care.
3. Political--- the federal government has
formulated national goals and
objectives directed towards the
 development of effective health
education programs which will create
awareness of health risks and
encourage the adoption of healthy
lifestyles.
The role of health education in
promotion of health and prevention
of illness in containing the cost of
 hospitalization and health care
expenses has already been
recognized by politicians and
health care administrators.

Health Issues: Biological, Psychological and

Sociological Aspectsnof Health and
Disease (Biopsychosocial model or
BPS, Santrock, J.W. [2007].)
 The biopsychosocial approach was developed at
Rochester decades ago by Drs. George Engel and
John Romano. ... The biopsychosocial approach
systematically considers biological, psychological,
and social factors and their complex interactions
in understanding health, illness, and health care
delivery.
The Biopsychosocial model (“BPS”) is an
approach that states that human experience
of health or illness is greatly affected or
determined by the interplay or interrelatedness
of the following factors:
1.) biological---(concerned with the
functioning of the different
organ systems of the body
and its coping or adaptive
mechanisms like immunity
level, genetic suscptibility or
predisposition
 2. psychological---perceptions, thoughts,
emotions, attitudes and
behaviors
3. social factors---socieconomic status,
cultural beliefs and
practices, poverty,
technology,
evironmental influences
and conditions
 This
model shows a direct link between the
mind and the body and an indirect link
with the intervening social or
envirnmental factors.

 Thebiological component seeks to explain

the cause of illness or disease as a result of
the breakdown in the physical
orphysiological functioning of the body.
 The psychosocial aspect deals with how the
individual perceives the health threats and the
state of emotional control, discipline, and
motivation to stay healthy.
Psychosocial factorscan cause a biological
effect by predisposing the patient to risk
factors and risk taking behaviors.

Ex. A depressed person may become an

alcoholic to temporarily forget his/her
 problems which may lead to liver cirrhosis
and even death.

The social or sociological factor is

concerned with the individual'sperception of
his/her ability to deal with the ehalth threats
or health problems and the barriers posed by
the society or the environment towards the
attainment of health and healthy lifestyle.
 This is in line with Bandura's social cognitive
theory dealing with self-efficacy.
In contrast to the traditional approach which
explained the disease process as a result of a
malfunction or breakdown in the biological
functions of the body which is caused by
pathogenic microorganisms, congenital anomaly or
trauma to the organ system(s), the Biopsycho-
social model (BPS) states that the disease
process is due to the combination of all three
 factors. This is more in consonance with
Holism or the holistic approach to health
which can only be done through the
multidisciplinary approach healthcare which
is being followed by U.S. and other European
countries.

HEALTH EDUCATION TODAY AN FUTURE

TRENDS
 Dueto the heightened technological advances
whic are occurring by the nanosecond,the
health educator is faced with enormous
challenges as well as opportunities due
to the increasing demand of society for
health education and preventive care and
the heavy reliance on technology for the
delivery an acquisition of information via
the information highway or internet.
 Today, we see a return to population-
based health promotion and maintenance
vis-a-vis the hospital-based emphasis and
preference for healthcare during the last
few decades. Its emphasis is on the health
of the community and the adaptation of
healthy behaviors and lifestyle through
healthe empowerment of the people.
 Thus, today's health educator is also considered
 as
a Community Health Worker whose
main concern is to improve the health of
the people by using different methods
and strategies.
 Thecall for developing global health
strategies with the integration of health
education and action is now a clamor
that can no longerr be ignored.
 Globalization, war, terrorism, social
instability, disease poverty ans
environmental degradation are among the
key challenges facing the world today
(Otieno, 2005). The pandemic AH1N1
influenza, HIHV/AIDS and severe acute
respiratory syndrome (SARS), as wellas bio-
terrorism preparedness receive utmost
priority and attention from the governemnt
of different nations. Clear strategies for
 for global health capacity-building at the
national level must be developed as well as
adequate training for public health
professionals where concerted action is
undertaken to build their capacity must be
given top priority. The development,
testing and validation of global health
training and action are therefore necessary
in integrating theory, practice and policy
 domains. The outomes of such initiatives
have the potential for facilitating learning
and teaching on critical health challenges i
the twenty-first centrury.

EMERGING TRENDS IN HEALTH CARE

In the United States of America, patients are
being discharged qicker due to the:
1.) New “healthcare economics”
 a.There is the present on primary care and
the continuing development of
managed care which advocates the
early discharge of clients from the
hospital to reduce healthcare
insurance costs and prevent
“overtreatmetn of patients” which are
unethical practices of some doctors and
hospitals. This is mandated by the
managed care programs in the U.S.
(Rodwin 1993, Vandenburgh 1999).
Anew stress on health outcomes, as
opposed to structures or processes of
care(“Health Outcomes Methodology”
2000) is being done to find out if the
centers have the requisite number of
qualified medical directors, nurses,
physical therapists, autoclaves, elevating
beds, policies, and so forth.
Recommendations were also issued by
the Agency for Health Care Research
 and Quality which attempted to
standardize medical practice for several
diseases based on studies determining
the most effective care.
b. Providers will increasingly establish
“centers of excellence” to provide
services effectively and at moderate
cost (Weiss 1999). Only a few
centers will perform given operations.
 Physician resistence will occur, but the
balance of power in health care has
already swung to payers (i.e., the
insurance and managed care
companies) who will use these facilities
instead of local hospitals, where cost
and quality are currently not as subject
to the rigorous controls ((Follard,
Goodman, and Stano 1997).
c. Decentralization of care, also known as
Medical Prosumerism, is an emergent
issue.
Prosumerism is a movement away
from purchasing completed goods and
services in favor of purchasing portions of
them piecemeal similar to the do-it-yourself
movement in home improvement. “In health
care, similar prosumerism is encouraged
 by significant patient opportunities to gain
knowledge through the internet and
medical data bases. Patients now frequently
make their own choices as to diagnoses,
treatments, medical products, and
practitioners.” (Toffer 1980).
d. Alternative medicine is another form of
Prosumerism (Goldstein 2000). Here,
consumers use a wide variety of folk
 practices to promote health and
potentially cure diseases. These
practices range from the use of
traditional herbs as medicines to the
use of meditation or guided imagery.
Accupuncture, accupressure, aroma-
therapy, yoga, and massage therapy
are other alternative interventions.
e. Medical globalization. Like other
 industries, health care is increasingly
subject to globalization. Currently, U.S.
citizens cross borders to purchase
inexpensive medications or ones not
available in this country.

Increasingly, however, they also make the

journey to Canada or Mexico to obtain
surgery or other complex procedures at
cheaper prices. Savings
 result from lower capital adminis-
trative, nursing, and otherr hospital
staff costs in those countries.

Medical Globalization is a trend which

is not new to the Philippines. This is now
termed as medical tourism where centers of
excellence or hopitals and centers with
worldwide class facilities or amenities have
become one of the foremost tourist attractions
in the country. Added to this is the reality that
people from other counties obtain services and
costs of tretments and medications at a very
reasonable and affordable price.

2.) Advances in Medical technology

The most current development in managed
care is disease management
 (Hunter and Fairfield 1997). Disease
management systems “seek to improve
patient compliance with optimal health
behavior by promoting proper ppointment
keeping, self-administration of treatments,
and proper general health behavior in terms
of lifestyle issues.

These systems range ffrom simple

ticklers, where a nurse reminds patients to
ahve their lab values monitored, to home
terminsals or computers through which data
are monitored and clinical instructions
received. It is not yet certain if disease
management will be cost saving and clinically
effective, but there is potential kfdor this to
occur.
 THIRD PARTY REMBURSEMENTS:
 What is Third-Party Reimbursement?
This means that a third-party, such as your
health insurance plan, reimburses you for
healthcare costs.
 A third-party
payer is an entity that pays
medical claims on behalf of the insured. 
  Examples of third-partypayers include
government agencies, insurance companies,
health maintenance organizations (HMOs),
 and employers.
 Types of Third Party Payers:
 Public
options include Medicare for adults
over 65,
 TRICAREestablished by the Department of
Defense, and
 Medicaid,which is a joint plan funded by
states and the federal government for those
with low income.
 What is a third party payer in insurance?
 third-partypayer. An entity (other than
the patient or the health care provider)
that reimburses and manages health care
expenses.
 Third-party
payers include insurance companies,
governmental agencies, and
employers.
 The term “third-party payment” refers to
anyone paying for medical treatment who
isn't the patient. This may be a public
entity or a private one. The government
use funds obtained from current workers'
taxes instead of insurance premiums to pay
healthcare providers.
 What is a third party plan?
 One of the most common types is third-
party insurance is automobile
insurance. Third-party offers coverage
against claims of damages and losses
incurred by a driver who is not the insured,
the principal, and is therefore not covered
under the insurance policy. The driver who
caused damages is the third party.Jun 25,
2019.
On Wellness
 OBJECTIVES:
 Ourchallenge is to determine how we can
put more emphasis on promoting
wellness and preventing illness.
To do this,
we need to learn more about how
healthy we are and the factors that
influence health and wellness.
 Wellness is a state of emotional, mental,
physical, social and spiritual well-being,
that enables people to reach and maintain
their personal potential in their

communities.
 The five aspects of well-being in our
definition are each important on their own,
but even more so because they are
interconnected.
 Forexample, we know that a child who is
physically active, will not only be more
likely to be physically healthy, but will also
likely do better in school.
Likewise we know that seniors who are
socially active also tend to be more
physically and mentally healthy.

Many factors such as having a job, being

involved in your community, having a
good education, eating properly, being safe
from harm, being able to read, being a
a good parent, and being fit and active,
have a great impact on how healthy we are.
These factors, called the determinants of
health, are the foundation on which a
healthy society is built.

The determinants of health include:

personal health practices and coping
 skills; healthy child development;
education; employment and working
conditions; health services; income and
social status; social support networks;
physical environments; biology and genetic
endowment; gender; and culture.
Source:
What about WELLNESS?
A Discussion Guide
Fall 2000
THANK YOU
STAY SAFE