Exam 1 and Exam 3 Material - Community
Terms in this set (71)
- preventing problems before they occur by altering susceptibility or reducing exposure for susceptible individuals
- Health promotion (enhance resiliency and protective factors and target essentially well populations - promotion of good nutrition, regular exercise, provision of adequate shelter) and health protection (reduce or eliminate risk factors - immunizations, water purification)
- Early detection and prompt intervention during the period of early disease pathogenesis
- Implemented after a problem has begun but before s/s appear and targets those populations that have risk factors
- Early diagnosis and treatment
- Examples: mammography, BP screenings, scoliosis screenings, pap smears
- Correction and prevention of deterioration of a disease state
- Limitation of disability and rehabilitation
- Aims are to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning
- Examples: teaching how to perform insulin injections and disease management to a person with DM, referral of a pt. with spinal cord injury for OT and PT, and leading a support group for grieving parents
Community health nursing vs. community-based nursing:
> Community health nursing emphasizes preservation and protection of health; the primary client is the community; services are both direct and indirect
> Community-based nursing emphasizes managing acute or chronic conditions; the primary clients are the individual and the family; services are largely direct
Hunting and gathering:
may have avoided many contagious diseases because the scattered aggregates were small, nomadic, and separated from other aggregates; under these conditions, disease would not spread among the groups
wandering people became sedentary and formed small encampments and villages; the concentration of people in these small areas caused new health problems; people began to live close to their herds , a practice that probably transmitted diseases (salmonella, anthrax, Q fever, TB); they also domesticated plants, a change that may have reduced the range of consumable nutrients and may have led to deficiency disease; they had to secure water and remove wastes, often leading to cross-contamination of the water supply and the spread of waterborne diseases (dysentery, cholera, typhoid, hepatitis A)
populations inhabited smaller areas, therefore preexisting problems expanded; waste removal via water supplies led to disease (cholera); the development of towns led to rodent infestation (plague); spreading diseases by direct contact increased; mumps, measles, flu, and smallpox became endemic
areas became denser and more heavily populated; increased industrial wastes, air and water pollution, and harsh working conditions took a toll on health; increases in respiratory disease (TB, pneumonia, bronchitis); endemics of infectious disease (diphtheria, smallpox, typhoid fever, typhus, measles, malaria, yellow fever); imperialism spread endemics of many diseases to susceptible populations throughout the world because settlers, traders, and soldiers moved from one location to another
infectious diseases continue to causes many deaths in the non-Western world; also remain prevalent among low-income populations and some racial and ethnic groups in the West; Western diseases such as cancer, venous disorders, heart disease, obesity, and DM are less common among populations from nonindustrial communities; common risk factors that contribute to chronic health conditions are changes in diet, environmental alterations, and occupational hazards; a rise in population and greater population density also increase mental and behavioral disorders
Prerecoreded historic times:
- Practices based on superstition or sanitation
- Health practices evolved to ensure survival
o Devised ways to flush water; constructed drainage systems
o Developed pharmaceutical preparations
o Embalmed the dead: helps prevent the spread of disease
o Dealt with pollution
o Hygienic code to protect food and water
o Greek and Roman impact public health
o Hippocratic book on Airs, Waters and Places
o Hygeia, goddess of health, or good living
o Panacea, goddess of curative medicine
o Balance of human life with environmental demands
o Surpassed Greek engineering: Massive aqueducts, bathhouses, and sewer systems
o Addressed occupational health threats: they noted the pallor of the miners, the danger of suffocation, and the smell of caustic fumes; for protection, miners devised safeguards by using masks made of bags, sacks, membranes, and bladder skins
o Priests mediated diseases and dispensed medicine
o Public physicians worked in designated towns: Worked in groups much like today's HMOs; Eared money to care for the poor
o Hospital for sick poor established by Fabiola, a Christian woman
o Monasteries promoted collective activity to protect public health.
o Churches enforced hygienic codes; also established isolation and Leper houses, or leprosaria
o A pandemic ravaged the world in the 14th century. (the bubonic plague - the black death)
o Modern public health practices (e.g., isolation, disinfection, quarantines) emerged.
o A theory about the cause of infection evolved.
o Leeuwenhoek described microscopic organisms.
o Elizabethan Poor Laws were enacted - church parishes were responsible for providing relief for the poor; this law governed health care for the poor for more than two centuries and became a prototype for later U.S. laws
o The Industrial Revolution occurred.
o Poor children were forced into labor (child work laws did not exist at this time)
o Vaccination was discovered by Edward Jenner (for small pox)
o Sanitary Revolution's public health reforms were taking place.
o Communicable diseases ravaged the population that lived in unsanitary conditions.
o Edwin Chadwick examined death rates by occupation and class in England.
o The General Board of Health for England was established in 1848.
o Public health laws were enacted in 1849: Healthy mental and physical development of citizens; Prevention of all dangers to health; Control of disease
o John Snow demonstrated the transmission of cholera via the public water source - he shut down the community' water resource by removing the pump handle from a well and noticed less transmission of cholera
o Waves of epidemics occurred in the United States.
o Lemuel Shattuck published vital statistics in Massachusetts; he called for child health reform.
o The first Board of Health was formed in response.
o The AMA was asked to collect vital statistics.
o Efforts focused on determinants of health (socioeconomic status, housing, food, etc.)
o The advent of "modern" health care occurred.
diseases that are always present in a population (colds and pneumonia)
diseases that are not always present in a population but flare up on occasion (diphtheria and measles)
the existence of disease in a large proportion of the population: a global epidemic (HIV, AIDS, annual outbreaks of influenza type A)
o Credited with establishing "modern nursing"
o Concern for environmental determinants of health
o Emphasis on sanitation, community assessment, and analysis
o Use of graphically depicted statistics and comparable census data
o Political advocate
o Education reform for nurses
- Theory of existence of germs
- Discovered immunizations in 1881 and the rabies vaccine in 1885
- Discovered causative agent for cholera and the tubercle bacillus in 1882
- Surgical success with wound care
outlined shortcomings of U.S. medical schools; within a few years, the report caused philanthropic organizations such as the Rockefeller and Carnegie Foundations to withdraw funding of these schools, ensuring the closure of scientifically inadequate medical schools
first school nurse
o Established Henry Street Settlement in 1893 (along with Mary Brewster)
o Played an important role in establishing public health nursing in the United States—later called "Visiting Nurses Association of NYC"
o Role of Henry Street Settlement was "one of helping people to help themselves" (Wald, 1871)
o Community organization led to the formation of a great variety of programs, including youth clubs, a juvenile program, sex education for local schoolteachers, and support programs for immigrants
o The Children's Bureau and the Social Security Act Legislation formed as a result of these efforts
Community Health Dx:
Increased risk of ____________ (disability, disease, etc.) among ____________ (community or population) related to ____________ (etiological statement) as demonstrated in _________ (health indicators)
resulted in an increase in the number of hospital beds; also improved the quality of care in rural areas; introduced a model of systematic state-wide planning
Regional Medical Programs (RMP):
intended to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals
Partnership for Health Program (PHP):
provided federal grants to states to establish and administer a local agency program to enact local comprehensive health care planning; the objectives were promoting and ensuring the highest level of health for every person and not interfering with the existing private practice patterns
Certificate of Need (CON):
this required government approval for capital investments
National Health Planning and Resources Development Act:
goals and purposes of the new law were to increase accessibility to as well as acceptability, continuity, and quality of health services; control over the rising costs of health care services; and prevention of unnecessary duplication of health resources; the new law addressed the needs of the undeserved and provided quality care
Patient Protection and Affordable Care Act (2010):
- Improved access to health care
- reduction in the growth of medicare spending
planning approach to community health; focused on community participation; basically focused on health promotion with the idea that allowed members of the community to have more control over their health care; community participation is an essential element ; another element is the use of data to develop comprehensive health strategies
mobilizing for action through planning and partnership; helps public health leaders facilitate community priorities about health issues and identify sources to address them; first phase is to mobilize the community; second phase is to guide the community toward a shared vision for long-range planning; third phase is to conduct 4 assessments: identifying community strengths, local health system, health status, and forces of change within the population
Certified home health agencies:
- Meet federal standards
- Receive Medicare payments for services provided to eligible individuals
Non-certified home health agencies:
- Operate outside the Medicare system
- Provide non-Medicare-covered services
(i.e., do not provide skilled nursing care and are not eligible to receive Medicare reimbursement)
o The Outcome and Assessment Information Set (OASIS) is a data set that determines Medicare pay rate and measures outcomes of adult home care patients to monitor outcome-based quality improvement.
- OASIS data set includes sociodemographic, environmental, support system, health status, and functional status attributes of an adult patient.
- OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care.
Public health referrals:
made for clients who are in need of health education or for follow-up of clients with communicable diseases
Home health referrals:
are requested to provide clients with short-term, intermittent, skilled services and rehab.
Federal level subsystem:
- U.S. Department of Health and Human Services
- Surgeon General and numerous other agencies
- Targets general population, special populations, and international health
- IOM Report, HHS in the 21st Century: Charting a New Course for a Healthier America (2008), recommended transformation of system
State level subsystem:
- State health departments
- Responsible for the health of their citizens
- Central authorities in the public health care system
- Dependent on federal level for guidance and resources
- Establish own state laws
To Err Is Human: Building a Safer Health System (IOM, 1999)
focused on safety within the health care delivery system
Crossing the Quality Chasm (IOM, 2001)
focused on developing a new health care system for the twenty-first century, one that improves care
Leadership by Example (IOM, 2003)
was a report requested by Congress that examined the federal government's quality enhancement processes
Who Will Keep the Public Healthy? (IOM, 2003)
- brought public health into the forefront by focusing on issues including globalization, rapid travel, scientific and technological advances, and demographic changes
- In-depth exploration of educational needs for improved public health
- Need for appropriately prepared public health professionals
- New content areas for public health professionals:
Informatics, genomics, communication, cultural competence, community-based anticipatory research, global health, policy and law, and public health ethics
- Old content areas for public health professionals:
Epidemiology, biostatistics, environmental health, health services administration, and social and behavioral science
Keeping Patients Safe: Transforming the Work Environment (IOM, 2004)
- addressed critical quality and safety issues with a focus on nursing care and nurses
- Focused on nurses in acute care and the work environment for safer patient care
- Also looked at nursing shortage, health care errors, patient safety risk factors, nurse's role in quality improvement, and work environment threats to patient safety
Entitlement program to provide health care to the growing population of those 65 years of age or older and people who are disabled or have ESRD.
- Title XIX of the Social Security Act—a public welfare assistance program
- Provides universal health care coverage for the indigent and children
- A joint state and federal venture: mostly covered by the state
- Eligibility for this program depends on the size and income of the family; federal government sets baseline eligibility requirements, but states can lower eligibility
- Priority participation is given to children, pregnant women, and the disabled: biggest portion is children
- paid all of the costs of services covered; preserve the enrollee's right of choice and allow the person to manage his or her own healthcare
- health maintenance organization: designed to provide more comprehensive care, but lacks enrollee freedom of choice; care is somewhat restricted
- point-of-service: combine elements of the HMO and PPO; the individual designates an in-network physician as the primary health care provider; if you go out of the network you will be responsible for most of the costs unless referred by the PCP; interest has dropped off over time
- preferred provider organization: negotiated with health care providers for services at a reduced rate in exchange for a guaranteed increase in consumers; more flexible than HMOs; most common type of insurance plan in the U.S.
employers may specify the amount of money that will be contributed toward health care; the consumers may then customize their health care coverage according to their needs and willingness to pay; consumers have some control over their own health care costs; consumers assume financial responsibility for any costs that exceed the employer's contributing amount
the public's increasing demand for care has increased costs, and the costs need to be controlled; this concept is known as cost containment
Trends in health financing:
- Cost sharing: employer pays a share
- Health alliances: a larger group of people have better purchasing power than a small group
- Self-insurance: small business owners had to buy self-insurance
- Flexible spending accounts: the employee determines how much they are going to spend on uncovered services; put money aside to save in an account
- Health promotion and disease prevention: everyone needs to practice this
Health Care Reform 2010:
- Individual mandate
- Employer requirements
- Expansion of Medicaid
- Expansion of CHIP
- Premium and cost-sharing subsidies to individuals
- Changes to private insurance
- Cost-containment provisions
- Prevention and wellness
- World Health Organization
- directs and coordinates international health efforts, producing and disseminating global health standards and guidelines, helping countries to address public health issues, and supporting health research
- Pan American Health Organization
- works to improve the health and living standards of Americans
- United Nations
- provides the means to resolve global conflicts and formulates policies that affect all nations
- United Nations International Children's Fund
- founded to feed the sick and hungry children and women of the world
- improve the health status of individuals living in areas that lack economic development; has become more focused on health-related initiatives to promote sustainable economic growth
- renown worldwide for being on the cutting edge for infection, poison, chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats; CDC is under the dept. of health and human services; founded to control malaria; today globally recognized for conducting research and investigations and for its action-oriented approach
prevent and resolve conflicts, to enhance freedom and democracy, and to improve health
Bill and Melinda Gates Foundation:
reducing extreme poverty, improving health, and increasing public library access; within Africa: improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria
is a person's tendency to view his or her own way of life as the most desirable, acceptable, or best, and to act in a superior manner toward another culture.
Innate human nature may be good, evil, or a combination of good and evil.
The dominant U.S. cultural group chooses to believe the best about a person until that person proves otherwise.
Destiny, in which people are subjugated to nature in a fatalistic, inevitable manner.
Harmony, in which people and nature exist together as a single entity.
Mastery, in which people are intended to overcome natural forces and put them to use for the benefit of humankind.
The focus may be on the past, with traditions and ancestors playing an important role in the client's life.
The focus may be on the present, with little attention paid to the past or the future.
The focus may be on the future, with progress and change highly valued.
Lineal relationships: Exist by virtue of heredity and kinship ties. Follow an ordered succession and have continuity through time.
Collateral relationships: Focus primarily on group goals—and family orientation is important.
Individual relationships: Personal autonomy and independence dominate; group goals become secondary.
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1: Responsibilities for Care in Community/ Public Health Nursing