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NR 442 Unit 1, 2, 3, and 4
Terms in this set (86)
a group of people and institutions that share geographic, civic, and/or social parameters. Communities vary in their characteristics and
Public health provides 10 essential services
Assessment, Policy Development, and Assurance
ASSESSMENT: Using systematic methods to monitor the health of a population
● Monitor health status to identify community
● Diagnose and investigate health problems and health hazards in the community.
POLICY DEVELOPMENT: Developing laws and practices to promote the health of a population based on scientific evidence
● Inform, educate, and empower people about
● Mobilize community partnerships to identify and solve health problems.
● Develop policies and plans that support individual and community health efforts.
ASSURANCE: Making sure adequate health care personnel and services are accessible, especially to those who might not normally have them
● Enforce laws and regulations that protect health and ensure safety.
● Link people to needed personal health services
and ensure the provision of health care when
● Ensure a competent public health and personal health
● Evaluate e ectiveness, accessibility, and quality of personal and population-based health services.
Prevention of the initial occurrence of disease or injury
● Nutrition education
● Family planning and sex education
● Smoking cessation education
● Communicable disease prevention education
● Education about health and hygiene issues to specific groups (day care workers, restaurant workers)
● Safety education (seat belt use, helmet use)
● Prenatal classes
● Providing immunizations
● Advocating for access to health care, healthy
Early detection and treatment of disease with the goal of limiting severity and adverse effects
● Community assessments
● Disease surveillance (communicable diseases)
● Cancer (breast, cervical, testicular, prostate, colorectal)
● Diabetes mellitus
● Sensory impairments
● Lead exposure
● Genetic disorders/metabolic de ciencies in newborns
● Control of outbreaks of communicable diseases
● Maximization of recovery after an injury or illness (rehabilitation)
● Nutrition counseling for management of Crohn's disease
● Exercise rehabilitation
● Case management (chronic illness, mental illness)
● Physical and occupational therapy
● Support groups
● Exercise for a client who has hypertension (individual)
Public Health Nursing-ANA definition
Public health nursing is population-focused, and involves a combination of nursing knowledge along with social and public health sciences. The goal of public health nursing is promoting health and preventing disease.
Community Health Nursing-ANA definition
● Community health nursing involves a synthesis of nursing and public health theory.
● The goals of community health nursing are to promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to in uence "community health."
● Community health nurses are nurses who practice in the community. They usually have a facility from which they work (community health clinic, county health department), but their practice is not limited to institutional settings. Care is often delivered in a setting that is part of the client's environment (home, school, workplace).
Focus of Care: aggregates, communities, populations (public health) Can include at‐risk or unserved individuals and families
Primary Goal:Health promotion and disease prevention
Nursing Activities: usually indirect (program management)
Can include direct care of at‐risk individuals and populations
Focus of Care:individuals and families
Primary Goal:management of acute or chronic conditions
Nursing Activities:Direct (one‐on‐one)
illness care: management of acute and chronic conditions in settings where individuals, families, and groups
live, work, and "attend" (schools, camps, prisons)
Population-focused nursing includes assessing to determine needs, intervening to protect and promote health, and preventing disease within a specific population (individuals at risk for hypertension, individuals without health insurance, individuals with a specific knowledge deficit)
Public Health Intervention Wheel
Public Health Intervention Wheel: Levels of Practice
System/group Level of Practice Example
community health nurse working with the state health department and federal vaccine program to coordinate a response to an outbreak of measles in a migrant population.
Community/Population Level of Practice Example
public health nurses working with area high schools to give each student a profile of his or her health to promote nutritional and physical activity lifestyle changes to improve the student's health.
Individual Level of Practice Example
nurse receives a referral to care for an individual with a diagnosed mental illness who would require regular monitoring of his medication compliance to prevent rehospitalization
Diseases that are always present in a population (e.g., colds and pneumonia)
Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles)
The existence of disease in a large proportion of the population: a global epidemic (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome, and annual outbreaks of influenza type A)
credited with establishing modern nursing and a reformer of hospital sanitation methods
- theory of existence of germs
- discovered immunizations and rabies vaccine
-removed germs from fluids/milk
discovered causative agent or cholera and the tubercle bacillus
surgical successes in wound care
discovered antiseptic surgery by using carbonic acid/phenol
Elizabeth Poor Law
Held church parishes responsible for providing relief to the poor
forced children into labor
Goals of Healthy People 2020
- attain high quality and longer lives free of disease
- achieve health equity, eliminate disparities and improve health of all groups
- create social and physical environments that promote good health for all
- promote quality of life, healthy development, and healthy behaviors
Healthy People 2020 Twelve Leading Health Indicators
• Access to Health Services
• Clinical Preventative Services
• Environmental Quality
• Injury and Violence
• Maternal, Infant and Child Health
• Mental Health
• Nutrition, Physical Activity, and Obesity
• Oral Health
• Reproductive and Sexual Health
• Substance Abuse
- affected the health of the community by organizing the community, establishing school nursing, and taking impoverished mothers to testify in Washington, DC
- started public health nursing tradition
established a district nursing service on the Lower East Side of New York City called the House on Henry Street with WALD.
Defining the Community
Aggregate of People: "The Who"
Location in space and time: "The where" and "The when"
Social System: "The Why" and "The How"
Descriptive approach that assesses several community components by driving through a community
STRENGTHS: Provides a descriptive overview of a
● Need for a driver so the nurse can visualize and document the community elements
● Can be time-consuming
● Results based only on visualization and does not include input from community members
Community Assessment Components
Demographic: Distribution, mobility, density, census data
Biological factors: Health and disease status, genetics, race, age, gender, causes of death
Social factors: Occupation, activities, marital status, education, income, crime rates, recreation, industry
Cultural factors: Ethnohistory, hierarchy and roles, language, religion and spirituality, values, customs, norms
Place or Environment
Physical factors: Geography, terrain, type of community, location of health services, housing, animal control
Environmental factors: Geography, climate, ora, fauna, topography, toxic substances, vectors, pollutants
Community Health Diagnosis
Risk of [specific problem or risk in the community] among [the specific population that is affected by the problem or risk] related to [strengths and weaknesses in the community that influence the problem or risk].
Difference between public health nursing efforts and medical efforts
public health- focuses on prevention and health promotion
medical- focuses on managing a disease diagnosis
Inoculation theory; observed people who worked around cattle were less likely to get smallpox
unsanitary conditions=health disparities
Created General Board of Health for England
led to social reform; child welfare, factory management, clean water, sewers, fire plugs, sidewalks
found an association between Cholera cases and water nearby a well
"father of epidemiology"
Health Planning Model
Needs Assessment (4)
1- needs expressed by behavior
2- needs determined by healthcare provider
3- needs perceived by the aggregate/audience/population
4-the relative need/ the gap between advantages and disparities
population-focused data collecting, monitoring the health status of the population, and communicating the data
the promotion of comprehensive health policies not only in your community but also nationally. It includes using research evidence to make decisions about policy
Assurance is making sure the essential services are available and that there is a competent healthcare workforce to provide the services
reflecting on each stage of the plan, lets you change as you go if needed - looking at strengths and weaknesses
were the outcomes achieved? (can be surveys)
Road map to a behavior change model. Evaluate change programs
looking at the end goal, and then factors that attribute to meeting that goal
Patient Protection and Affordable Care Act
puts individuals and families in control of their own health
Epidemiology is the study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection
● Nurses use epidemiological principles to provide health
interventions to targeted groups.
● Epidemiological calculations provide numerical
information about the impact of disease and death on populations and aggregates.
● The epidemiological process is a systematic method of targeting a speci c health need with the goal of improving health. Epidemiology provides a broad understanding of the spread, transmission, and incidence of disease and injury. This information is an important component of community assessment and program planning.
● Community health nurses are in the unique position of being able to identify cases and recognize patterns of disease, eliminate barriers to disease control, and provide education and counseling targeted at a disease condition or specific risk factors
● The agent is the physical, infectious, or chemical factor
that causes the disease.
● The host is the living being that an agent or the
● The environment is the setting or surrounding that
sustains the host.
used to investigate disease patterns to identify whom it a ected, where the issue is located, how it occurs, why or what the cause is, and when the condition started.
Investigation of the causes of disease or etiology
The Wheel Model
Incidence and Prevalence Rates
Incidence and prevalence rates are used to measure the existence of a particular disease, and allow the nurse to compare the rate of disease in one population to another, even though there can be different numbers of people in a given population.
number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
Mortality rates provide information about cause of death. Public health workers can examine overall death rates (crude mortality rate), deaths from specific causes (cause‐specific rate, case fatality rate), or deaths at specific times across the lifespan (infant mortality ratio, age‐specific rate).
Crude Mortality Rate
number of deaths ÷ population total x 1,000 = _____ per 1,000
The probability that a specific event will occur
an exposure that is associated with a disease; increase the rate of disease in people who have them
Likelihood of resulting in an adverse effect after exposure to a specific agent
●Worldwide, communicable diseases are responsible for the deaths of millions each year.
● Leading causes of communicable disease deaths include acute respiratory infections (including pneumonia and in uenza), HIV/AIDS, diarrheal diseases, tuberculosis, malaria, and measles.
Stages on Infection
2- communicable period
3- Incubation Period
infection has invaded host and it is replicating
shedding of agent
usually occurs before symptoms
the time from invasion to the time symptoms first appear
Chain of transmission
Examples are prions, viruses, bacteria, fungi, or protozoa. They act differently from one another, depending on their characteristics and how they interact with their human hosts.
This is the place where pathogens live and multiply. It may be a human, another animal, or part of the environment, such as water or food supply.
Portal of Entry
These are places where pathogens can enter their hosts: respiratory passages, oral intake, or breaks in the skin.
Portal of Exit
These are places where the pathogens exit their hosts: respiratory passages by coughing or sneeze droplets, feces, and draining wounds.
Mode of Transmission
either direct or indirect contact.
Host qualities, such as general health status, personal behaviors, and immunization status, will determine if the host will develop an infection
immediate transfer of infectious agent from an infected host/reservior through physical contact
ex. touch, bite, kiss, sex, mucous droplets
spread through a vehicle of transmission outside the host (fomite or vectors)
occurs when the body produces its own antibodies against antigen (from either infection or vaccine)
temporary resistance donated to host from blood transfusion, placenta, antitoxins, immunoglobulins (only lasts as long as substances in blood stream)
primary vaccine failure
failure for vaccine to elicit any immune response
secondary vaccine failure
waning for immunity following the initial immune response (immunocompromised people or organ transplant)
where an infectious disease is controlled to the point of the prevelance and incidence rate is nearly ZERO
reducing the worldwide incidence of a disease to ABSOLUTE ZERO
Protection due to the immunity of most community members making exposure unlikely
Natural defense mechanisms of the body to resist speci c antigens or toxins
Develops through actual exposure to the infectious agent
Nationally Notifiable Diseases
● Congenital rubella syndrome (CRS)
● Hepatitis A, B, C
● HIV infection
● In uenza-associated pediatric mortality
● Lyme disease
● Meningococcal disease
● Pertussis (whooping cough)
● Poliomyelitis, paralytic
● Poliovirus infection, nonparalytic
● Rabies (human or animal)
● Rubella (German measles)
● Severe acute respiratory syndrome-associated
coronavirus disease (SARS-CoV)
● Tetanus/C. tetani
● Toxic shock syndrome (TSS) (other than Streptococcal)
● Tuberculosis (TB)
● Typhoid fever
● Vancomycin-intermediate and vancomycin-resistant
Staphylococcus aureus (VISA/VRSA)
Live Attenuated Vaccines
Viral: Measles, Mumps, Rubella, Oral Polio, Yellow Fever, Varicella
Determinants of Health
factors that influence the client's health. These can include nutrition, stress, education, the environment, finances, and social status/ stigma (prejudice).
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