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If we construct a graph using these class limits as the base of our rectangles treatment for uti bactrim generic erythromycin 250mg with amex, no gaps will result infection movie generic 500 mg erythromycin overnight delivery, and we will have the histogram shown in Figure 2 antimicrobial lotion purchase 500 mg erythromycin mastercard. We refer to antimicrobial bar soap discount erythromycin 500mg mastercard the space enclosed by the boundaries of the histogram as the area of the histogram. Each cell contains a certain proportion of the total area, depending on the frequency. This, as we have learned, is the relative frequency of occurrence of values between 39. From this we see that subareas of the histogram defined by the cells correspond to the frequencies of occurrence of values between the horizontal scale boundaries of the areas. The ratio of a particular subarea to the total area of the histogram is equal to the relative frequency of occurrence of values between the corresponding points on the horizontal axis. The Frequency Polygon A frequency distribution can be portrayed graphically in yet another way by means of a frequency polygon, which is a special kind of line graph. To draw a frequency polygon we first place a dot above the midpoint of each class interval represented on the horizontal axis of a graph like the one shown in Figure 2. The height of a given dot above the horizontal axis corresponds to the frequency of the relevant class interval. Note that the polygon is brought down to the horizontal axis at the ends at points that would be the midpoints if there were an additional cell at each end of the corresponding histogram. The total area under the frequency polygon is equal to the area under the histogram. This figure allows you to see, for the same set of data, the relationship between the two graphic forms. Stem-and-Leaf Displays Another graphical device that is useful for representing quantitative data sets is the stem-and-leaf display. A stem-and-leaf display bears a strong resemblance to a histogram and serves the same purpose. A properly constructed stem-and-leaf display, like a histogram, provides information regarding the range of the data set, shows the location of the highest concentration of measurements, and reveals the presence or absence of symmetry. An advantage of the stem-and-leaf display over the histogram is the fact that it preserves the information contained in the individual measurements. Such information is lost when measurements are assigned to the class intervals of a histogram. As will become apparent, another advantage of stem-and-leaf displays is the fact that they can be constructed during the tallying process, so the intermediate step of preparing an ordered array is eliminated. To construct a stem-and-leaf display we partition each measurement into two parts. The stem consists of one or more of the initial digits of the measurement, and the leaf is composed of one or more of the remaining digits. All partitioned numbers are shown together in a single display; the stems form an ordered column with the smallest stem at the top and the largest at the bottom. We include in the stem column all stems within the range of the data even when a measurement with that stem is not in the data set. The rows of the display contain the leaves, ordered and listed to the right of their respective stems. When leaves consist of more than one digit, all digits after the first may be deleted. Decimals when present in the original data are omitted in the stem-and-leaf display. As a rule they are not suitable for use in annual reports or other communications aimed at the general public. They are primarily of value in helping researchers and decision makers understand the nature of their data. Solution: Since the measurements are all two-digit numbers, we will have one-digit stems and one-digit leaves. For example, the number 57 on the second line shows that there are 57 observations (or leaves) on that line and the one above it.
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In this system antibiotics for uti pregnant discount erythromycin 250 mg fast delivery, a level 1 trauma center is the highest level of available trauma care and a level 4 trauma center is the lowest level of available trauma care antibiotics simplified buy generic erythromycin 500mg. Imagine that we are interested in estimating the survival rate of trauma victims treated at hospitals within a large metropolitan area antibiotics for acne and yeast infections generic 250 mg erythromycin fast delivery. Suppose that the metropolitan area has a level 1 bacteria in blood purchase erythromycin 500mg visa, a level 2, and a level 3 trauma center. We wish to take samples of patients from these trauma centers in such a way that the total sample size is 30. Solution: We assume that the survival rates of patients may depend quite significantly on the trauma that they experienced and therefore on the level of care that they receive. As a result, a simple random sample of all trauma patients, without regard to the center at which they were treated, may not represent true survival rates, since patients receive different care at the various trauma centers. One way to better estimate the survival rate is to treat each trauma center as a stratum and then randomly select 10 patient files from each of the three centers. This procedure is based on the fact that we suspect that the survival rates within the trauma centers are less variable than the survival rates across trauma centers. Therefore, we believe that the stratified random sample provides a better representation of survival than would a sample taken & without regard to differences within strata. It should be noted that two slight modifications of the stratified sampling technique are frequently employed. In the first place, a systematic sample of patient files could have been selected from each trauma center (stratum). The second modification of stratified sampling involves selecting the sample from a given stratum in such a way that the number of sample units selected from that stratum is proportional to the size of the population of that stratum. Suppose, in our trauma center example that the level 1 trauma center treated 100 patients and the level 2 and level 3 trauma centers treated only 10 each. Discuss how you would use stratified random sampling and stratified sampling proportional to size with this example. Which do you think would best represent the population that you described in your example? The previous section highlighted the importance of obtaining samples in a scientific manner. Appropriate sampling techniques enhance the likelihood that the results of statistical analyses of a data set will provide valid and scientifically defensible results. Because of the importance of the proper collection of data to support scientific discovery, it is necessary to consider the foundation of such discovery-the scientific method-and to explore the role of statistics in the context of this method. The scientific method is recognized universally as the only truly acceptable way to produce new scientific understanding of the world around us. It is based on an empirical approach, in that decisions and outcomes are based on data. Making an Observation First, an observation is made of a phenomenon or a group of phenomena. This observation leads to the formulation of questions or uncertainties that can be answered in a scientifically rigorous way. For example, it is readily observable that regular exercise reduces body weight in many people. In this case there are two observable phenomena, regular exercise and diet change, that have the same endpoint. Formulating a Hypothesis In the second step of the scientific method a hypothesis is formulated to explain the observation and to make quantitative predictions of new observations. Often hypotheses are generated as a result of extensive background research and literature reviews. Explicit definitions of these terms are given in Chapter 7, which discusses the science of testing hypotheses. Suffice it to say for now that a research hypothesis from the weight-loss example would be a statement such as, "Exercise appears to reduce body weight. A statistical hypothesis may be stated using quantitative terminology as follows: "The average (mean) loss of body weight of people who exercise is greater than the average (mean) loss of body weight of people who do not exercise. The role of the statistician in this step of the scientific method is to state the hypothesis in a way that valid conclusions may be drawn and to interpret correctly the results of such conclusions.
Nurses collaborate with other healthcare professionals and patients for improving health through clinical prevention antimicrobial activity of xanthium strumarium 500mg erythromycin for sale. In populationfocused nursing antimicrobial zeolite and its application order erythromycin 500mg with mastercard, the aggregate are you contagious on antibiotics for sinus infection purchase erythromycin 250mg otc, community antibiotics chlamydia erythromycin 250mg line, or population is the unit of care. Populationfocused nursing involves identifying determinants of health, prioritizing primary prevention when possible, actively identifying and reaching out to those who might benefit from a service, and using available resources to assure best overall improvement in the health of the population (American Nurses Association, 2007). For instance, populationfocused interventions involve reaching an appropriate level of herd immunity in the community and ensuring that information about appropriate screenings reach the entire population, not just those who choose to come to healthcare facilities. Collaboration with other healthcare professionals and populations is necessary to promote conditions and healthy behaviors that improve population health. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. Use evidencebased practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and followup throughout the lifespan. Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions. Assess the health, healthcare, and emergency preparedness needs of a defined population. Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty, and other emergency situations. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and the prevention of illness, injury, disability, and premature death. Participate in clinical prevention and populationfocused interventions with attention to effectiveness, efficiency, costeffectiveness, and equity. Advocate for social justice, including a commitment to the health of vulnerable populations and the elimination of health disparities. Use evaluation results to influence the delivery of care, deployment of resources, and to provide input into the development of policies to promote health and prevent disease. Sample Content prevention and harm reduction ecological model as framework for understanding determinants of health public health principles fundamentals of epidemiology and biostatistics (distribution, incidence, prevalence, rates, risk factors, health status indicators, and control of disease in populations) public health core functions systems theory ethical, legal, and economic principles related to clinical prevention and population health cultural, psychological, and spiritual implications of clinical prevention and population health environmental health risks health literacy health behavior change theories theoretical foundations and principles of individual and populationfocused education and counseling genetics and genomics nutrition global health occupational health, including ergonomics 25 evidencebased clinical prevention practices complementary and alternative therapies population assessment individual and populationfocused interventions. Inherent in professional practice is an understanding of the historical, legal, and contemporary context of nursing practice. Professionalism is defined as the consistent demonstration of core values evidenced by nurses working with other professionals to achieve optimal health and wellness outcomes in patients, families, and communities by wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability (Interprofessional Professionalism Measurement Group, 2008). As discussed in the American Nurses Association Code of Ethics for Nursing (2005, p. Civility is a fundamental set of accepted behaviors for a society/culture upon which professional behaviors are based (Hammer, 2003). Professional nursing has enjoyed a long tradition of high respect from the public (Gallup Poll, 2006). Historically, nurses have provided 26 care for patients within a context of privileged intimacy a space into which a nurse is allowed and in partnership with the patient creates a unique, healing relationship. Through this connection, the nurse and patient work toward an understanding of a wide variety of physical, psychosocial, cultural, and spiritual needs, healthillness decisions, and life challenges. Professional nursing requires a balance between evidencebased knowledge, skills, and attitudes and professional confidence, maturity, caring, and compassion. Therefore, essential to the care of diverse populations is the need for evidencebased knowledge and sensitivity to variables such as age, gender, culture, health disparities, socioeconomic status, race, and spirituality. In addition, nurses are prepared to work with patients across the lifespan who require genetic technologies and treatments. Baccalaureate education includes the development of professional values and valuebased behavior. Understanding the values that patients and other health professionals bring to the therapeutic relationship is critically important to providing quality patient care. Baccalaureate graduates are prepared for the numerous dilemmas that will arise in practice and are able to make and assist others in making decisions within a professional ethical framework.
Experiential learning is a critically important component of a population health program antimicrobial 3-methyleneflavanones erythromycin 250mg with mastercard. Students learn by doing antibiotics after root canal cheap erythromycin 250mg otc, and must go into the community to antibiotics in agriculture buy generic erythromycin 250 mg on line apply the population health concepts they learn in the classroom to antibiotics for uti can you drink alcohol erythromycin 250 mg with amex real-life situations. Participants emphasized that it is necessary to be flexible and creative when identifying appropriate sites for clinical experiences, and they suggested a variety of types of sites and community settings, beyond hospitals. Interprofessional education, in which nursing students regularly interact with other health professions students, was also considered desirable and valuable. Some cited as reasons for satisfaction strong faculty and leadership and positive student learning outcomes. Others described their program as "a work in progress" or, in the case of community colleges, wished that they had more room in their crowded curriculum for additional population health content. Nursing Education and the Path to Population Health Improvement According to participants, there are a number of potential challenges related to offering a population health nursing program. In general, perceived challenges related to an overall lack of awareness, understanding, and prioritization of population health in general-as well as to the logistics of offering a population health program. Specifically, participants mentioned: Difficulty changing the status quo as it relates to teaching nursing. Competing priorities and lack of awareness, understanding, and prioritization of population health content by administrators, faculty, and students. Lack of qualified faculty to teach population health and requirement that nursing faculty be nurses themselves. Difficulty finding appropriate sites for clinical placements and restrictive related rules and licensing requirements. Participants offered a number of suggestions to overcome these challenges and enhance effectiveness in teaching population health to nursing students: Provide professional development to existing faculty-webinars, expert presentations, roundtable discussions. Develop resources, materials, and a toolkit to help educators develop or expand their population health curriculum-include suggested curriculum and core content; ways to embed content in existing courses; specific assignments; examples of clinical sites; best practices and advice. Offer online forums, bulletin boards, or other convenient means to interact with nurse faculty or administrators teaching population health across the country. Broaden the definition of approved sites for clinical rotations and what counts as clinical hours. Provide population health-related professional development opportunities and additional schooling to licensed, practicing nurses. Begin teaching population health concepts early in the nursing curriculum, addressing basic population health concepts and skills. Expand opportunities for experiential learning and interprofessional education and interaction. Develop communications initiatives regarding the importance and relevance of population health, targeted to faculty and administrators of nursing schools, students, and employers. Create expanded national awareness of the key role of nurses (not just physicians) in population health. Offer grants, monetary incentives, or start-up money to nursing schools that offer a graduate program in population health. Provide grants to students studying population health to help offset tuition costs. Leaders identified some real-world strategies that are effective in the application of population health concepts. Technology-related strategies include use of electronic health records in various ways to identify populations and communicate with them; text reminders to patients; wearable health monitors; telehealth; e-visits with physicians and pharmacists; and geomapping and use of other data sets. Participants currently work in partnership with a variety of community organizations to address a number of issues. Examples include public health departments; local government; business organizations; nonprofits; citizen coalitions; law enforcement; churches; and insurers. Student Competencies Nursing knowledge in population health is evaluated in a number of ways, depending on the course objectives and level of students.
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