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Community Health Study Guide
Terms in this set (212)
-Every pt has the right to receive just, equal and humane treatment
-The poor, disadvantaged, ones w/o insurance, & ones w/ language barriers are frequently denied their rights in the current healthcare system. They become frustrated, confused, degraded, and unable to cope w/ the system on their own.
-Community health nurse often acts as their advocate- pleading their cause or acting on their behalf
-may need someone to explain which services to expect and which they ought to receive, to make referrals as needed, and to write letters to agencies or health care providers for them
Two goals of advocacy
-help patients gain greater independence or self-determination
-to make the system more responsive and relevant to the needs of patients
Advocacy incorporates four characteristic actions
1) being assertive
2) taking risks
3) communication and negotiating well
4) identifying resources for the client's benefit and obtaining results
-learning that occurs through emotion feeling, or affect.
-Nurses face the task of trying to influence what their clients may value and feel.
-Nurses want clients to develop an ability to accept ideas that promote healthier behaviors, even if those ideas conflict with client's' own values.
affective domain: characterization-consistent
-advocate, behave, uphold, use
affective domain: organization- integration
-adhere, theorize, decide
affective domain: valuing- commitment to value
-choose, commit, describe, act
affective domain: responding- active participation
-contribute, discuss, follow up
affective domain: receiving-active listening
-acknowledge, ask, attend
-Learning is reinforced
-Frequent use of newly acquired info fosters the transfer of learning into other situations.
-third level of cognitive learning, in which the learner cannot only understand material but also apply it to new situations
-approaches the possibility of self-care when clients use their knowledge to improve their own health.
-The client will practice eating well-balanced meals at least 2 times a day." Other verbs at this level include apply, demonstrate, use, discover, prepare, and illustrate.
basic values that guide decision-making
-Self-determination: a person's exercise of the capacity to shape and pursue personal plans for life
-Well-being: state of positive health
-Equity: justice; being treated equally or fair
-doing good or benefiting others; promotion of good or taking action to ensure positive outcomes on behalf of clients.
-actively promote community clients' state interests and their view of well-being. Balancing the benefits of treatment against the risks and costs involved
-complementary to non-maleficence
-sizes are beyond the ability of typical database software tools to capture, store, manage and analyze; large complex data set that can be analyzed to reveal patterns, trends, and associations, related to human behavior and interactions
-nurses add through sharable and comparable documentation in the EHR
-care for both the patient and family unit as a whole. Use EBP to provide the best possible care for each unique patient.
-Caring is the criteria that care is based on. Nurses must have a caring and understanding attitude toward community healthcare. They must understand the differences of available health care in different populations and still provide the highest level of care and compassion.
-Home Health: "Caregiving wheel" promotes patient self-management thru teaching, mobilizing, collaborating, strengthening, and solving
-Degree of participation in educational process directly influences amount of learning
--First question to discuss: What does the pt. want to learn?
-PHN should begin from client's place of interest
-Learning is facilitated when pt. is engaged and fully participates in learning process
-When client chooses own direction, helps to discover own learning resources, formulates own problems, decides own course of action, lives with consequences = maximized his/her learning
-Amount of learning directly proportional to learner's involvement
-Contracting: client participates in the process as a partner to determine goals, content, and time of learning (assists client to develop a sense of accountability for their own learning)
client readiness: physical readiness
ability; health status; environment, gender, task complexity
client readiness: emotional readiness
reflects state of receptivity to change (motivation, anxiety)
client readiness: experimental readiness
reflects learner's past experiences w change (cultural background, coping mechanisms)
client readiness: knowledge readiness
-encompasses learner's knowledge/understanding (learning disabilities, learning style, current knowledge base)
clients as equal partners
-goals of public health cannot be realized without consumer participation
-health status and behavior will not change unless people acceptance apply the community health nurse's proposal
-the process of taking responsibility for one's own health potential
-examples: building safe playgrounds, developing teen employment opportunities, providing senior exercise programs
-encourage health care goals and practices
-develop new programs
-contact resources for client
-promote wellness and ways to monitor own health
clients with special learning needs
-clients who have cultural or language differences, hearing impairments, developmental delays, memory losses, visual perception distortions and problems with fine or gross motor skills, distracting personality characteristics, or demonstrations of stress or emotions
-difficulty that can arise is unexpected behavior from a client who disrupts the group process: ----This client may monopolize the discussion, answer questions asked of others, burst out with personal experiences that have no relevance to the topic, become irritated at the comments of others
---Nurse must diffuse any behavior that has the potential to distract the other learners, this is accomplished by considerately giving the recognition sought by the person while also setting limits
prior to teaching client with learning needs
-find out whether it is possible to teach English or whether modifications are needed
-one of three domains of learning
-involves the mind and thinking process, including recall/recognition and developing intellectual skills
1. Knowledge: lowest level, recall
2. Comprehension: remembering with understanding
3. Application: understand the information and apply it to new situations
4. Analysis: examine and explain
5. Synthesis: integrate material with other learning, generate new idea/ develop plan
6. Evaluation: judges according to a standard
-a collection of people, even if they are widely scattered geographically, can have an interest or goal that binds its members together
-ex) members of a church in a larger area, the members of an international nursing professional organization, and women who have all had mastectomies
Disease occurs in four stages: exposure, incubation, disease/symptoms, transmission
communicable diseases: infectivity
ability to infect a host
communicable diseases: pathogenicity
ability to cause disease in a host
communicable diseases: virulence
ability to cause severe disease in a host
communicable diseases: immunogenicity
ability to produce an immune response in a host
-occurrence of disease at a frequency that is higher than the normal for the population in a given period of time
-diseases that are commonly found in a locality
-endemic occurrence constant over time
-used to describe an outbreak of rubeola in the United States
-epidemic of very large population or worldwide
-global outbreak of a disease
vaccine preventable disease
-mumps, measles, rubella (MMR)
-diptheria, pertussis, tetanus (DPT)
Rabies (hydrophobia)- highest case fatality rate of human infections. Preventable by vaccine & requires immediate treatment
-cholera, giardia, legionella, typhoid
-lyme disease (tick)
-west nile (misquito)
-rocky mountain spotted fever (dog tick)
agents of bioterrorism
-no long immunize for them
-anthrax, smallpox, plague, tularemia, ricin, ebola, dengue
communication and documentation
-Clear communication is imperative in the health care environment and occurs between various individuals on a daily basis by way of verbal, non-verbal and written communication.
-In order for trust to develop between healthcare providers and their patients/residents, it is important that effective communication is developed and maintained.
---SBAR for report
-Documentation is a vital component of safe, ethical, and effective patient/resident care practice
-Each entry must include the date, time, full legal signature and designation as a student and health professions program of the writer. The full legal signature consists of the first name and last name recorded. The instructor or preceptor must co-sign.
-Never delete, alter or modify anyone else's documentation.
-Document only work done personally; never document for someone else.
-All information is confidential!!
incorrect written entry
-Erasures, whiteout, or alteration of spelling errors are not permitted — draw a line through the incorrect word such that it remains legible. The word "error" is to be marked and initialed.
-For submission in wrong chart —> place a diagonal line and write "wrong chart". Date, time and sign.
-Document forgotten or late entries at the next available entry space. Write the current date and time and write "Late entry for" date of missed entry
-Advances in technology results in:
--better communication within and between agencies
--more client involvement in care- self-management/ access to records
--Widespread access to local/state/national/international data--> reliability/validity of internet sources is widely varied
--internet- -> rapid tracing of international spread of infectious disease
-Focus on social determinants of health with communities and populations
-Community -oriented practice focuses on aggregates versus individuals.
-Health promotion and primary prevention:
---Health for All
---Primary Health Care i.e. essential services, goods, and resources
---Looking at the overall health of the community and not focusing on disease processes (life expectancy, morbidity and mortality)
core public health functions
1) Community Assessment
2) Policy Development
3) Health Assurance
--Infectious and noninfectious disease prevention & control
--Environmental health and sanitation
--Emergency preparedness/disaster management
--Family case management
--Health promotion & risk reduction
-a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations
-recognizing the values, beliefs and practices that makeup one's own culture. It also means becoming sensitive to the impact of one's culturally based responses
-the nurse understand own culturally based behavior; asses for:
1) influences related to racial background
2) verbal and nonverbal communication patterns
3) values and norms
4) beliefs and practices
-a combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to use interpersonal communication, relationship skills, and behavioral flexibility to work effectively in cross-cultural situations
Inhibitors to developing cultural competence
-Cultural imposition- imposing one's culture on others
-Ethnocentricism: believing one's own culture sets the standard by which others should be judged
-Cultural blindness: ignorance of cultural practices different from one's own
Conveying cultural sensitivity
-Address client by family name
-Introduce self by name and position
-Be honest about what you know or don't know about their background
-Ask what does the client know about their illness its causes & treatments
-the study of the interactions and relationships between living organisms and their environments; how the environment impacts the health of individuals, families, populations, and communities.
-Ecology has been applied to social ecological perspectives that identify the physical environment, social and cultural factors existing for populations.
ecological model of health
-the circle and concentric rings represent the levels of the environment that can impact health.
-In this model, health is thought to be broadly determined by biological, social, economic, political, and physical factors in the environment, i.e. social determinants of health.
Center & lowest point of the circle:
individual and intrapersonal (internal) factors, i.e. biology, genetics, and life cycle.
Family and interpersonal factors
belonging or membership, family dynamics, and socialization of children.
Outside the family, community factors
effects from larger groups, i.e. culture, income or poverty, and migration.
-Communities interact with other communities within the geographic boundaries of towns, cities, counties, states, and nations forming the larger society.
laws, politics, ethical standards, and social norms, i.e. racism and sexism.
Physical environment -- outermost circle
climate, green space, and built environments.
**also import in the "host" part of the epidemiological triangle
1. Assess learner readiness, needs and abilities
2. Write measurable, objective student learning outcomes
---Measurable with knowledge and behavior
---What behaviors will the learner have
3.Design learning experiences and an environment conducive to learning
4.Implement teaching plan
Evaluate teaching strategies AND learner outcomes
electronic health record (EHR)
-digital/computerized version of patients paper charts
-Enables a healthcare provider to record patients progress in free text, place prescription orders, receive and review results electronically, message patients or fellow providers,and perform a variety of other documentation and clinical tasks.
-Stage 1. Data capture and sharing. Stage 2. Advancing clinical processes. Stage 3. Covers improved outcomes
-Long term coal - help improve the quality and safety of health care. One of the biggest beneficial advantages is ability to enter data once and reuse it multiple times.
-optimize workflow and support decision making, tell the patient's story, collaborate to foster knowledge translation, leverage analytics to extract actionable knowledge, use sharable comparable data and build evidence out of nursing practice.
era of long term health conditions
-While averting mortality, persist through patients ongoing etiology and affect people's daily functioning, decision-making, and cost.
-Longevity has led to a transition where infectious diseases decrease, life expectancy lengthens and the population experiences the degenerative diseases seen in developed countries
-Referred to as "The Lady with the Lamp"
-first code of ethics for nurses.
-Saw nursing as a call to service and viewed the moral character of persons entering nursing as important
-Military hospitals--organized competent nursing care and established kitchens and laundries that resulted in hundreds of lives saved
-Began using biostatistics and promoted five essential components to optimal health and healing--pure air and water, efficient drainage, cleanliness, and adequate living
-Established the first nonreligious school for nurses in 1860 at St. Thomas Hospital in London
-Commitment to poor individuals in communities
Food safety in the community
-local health departments are responsible for food inspections in restaurants, grocery stores, daycare facilities, hospitals, schools, and some food manufacturing plants, and they also investigate consumer complaints
-recalls: when foods are found to be unsafe
-local health departments are responsible for training employees on safe food handling practices when a new restaurant opens
-Local agencies carry out food safety laboratory functions—collecting and testing food and human samples—in some jurisdictions (unless done by state)
-75 % of local health departments have food safety education programs.
-diverse teams, usually including nurses, epidemiologists, environmental health specialists, health educators, and others, working on food safety issues every day.
for-profit health agencies
-generate a return for investors
-required to pay taxes
non-profit health agencies
-restrict use of the organization's assets and require a governance board of directors
-service-driven and charitable role
--Can't endorse a political candidate, no shareholders, and must channel all profits back into the organization
--Provide the majority of safety net services (including most hospitals)
--Funded by a combo of government community block grants, private foundation grants, donations, and volunteers
-science of heredity
"the group of applied techniques of genetics and biotechnology used to cut up and join together genetic material and especially DNA from one or more species of organism and to introduce the result into an organism in order to change one or more of its characteristics"
--Ethical dilemma: being able to pick our characteristics of offspring.
-advocate for: mapping DNA and interventions that can change the outcome for those who are found to be at risk for diseases
-The study of the entire genome
-The identification and plotting of human genes and the study of interaction of genes with each other and the environment
-Beginning to alter how we view and treat disease
Geographic Information Systems (GIS)
-capture, store, manipulate, analyze, manage and present all types of spatial (relating to space) or geographical data.
-allows the user to visualize, question, analyze, and interpret data to understand relationships, patterns and trends. Spatial or mappable data are integrated with conventional data.
-help public health to track the distribution of disease, injury, and death as well as the location of community resources for specific populations and communities
-location-based information; can provide:
--Better understanding of a current situation
--planning/targeting of appropriate interventions
--Monitoring and revision of interventions as needed
--An opportunity for cooperation with other organizations and government departments through a culture of data sharing and working together.
-public health uses: tracking child immunizations, evaluating the spread and clustering of diseases, conducting health policy research and establishing service areas and districts.
health beliefs and practices
-Are useful for explaining the behaviors and actions taken by people to prevent illness and injury
-Nurses find it helpful in assessing the health behaviors and beliefs of culturally diverse populations
Health for all (global healthcare)
-a primary health care initiative
-health care needs and wants may expand infinitely, but resources do not, and all must manage with the resources currently available
-healthcare leaders met at Alma-Ata, Kazakhstan and created this
-national level, it is operational through communities that focus on health care services at the local level rather than building large, tertiary hospitals that cater exclusively to urban, financially secure populations
-Emphasizes PHC that is affordable, culturally acceptable, appropriate, accessible, and delivered through partnerships between national health services systems and local communities
-communities: id-ing their own priority health concerns and planning and implementing their own PHC services which include prevention, health promotion, and curative and rehab care provided by the people themselves
Health literacy and Health outcomes
-ability to obtain, process, and understand health information needed to make informed health decisions
-limited: associated with an increase in preventable hospital visits and admissions; make greater use of services designed to treat complications of disease and less use of services designed to prevent complication
-health outcomes are poor for patients with limited health literacy
-community assessment problem analysis:
-clarify the nature of the problem
---Community input (is it a priority for them? May assess this by asking or by looking at local newpapers, minutes from city council mtg etc.)
-identify community capacity
---community resources ( building blocks that could be enhanced to become a strength)
health promotion and maintenance
-includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. Nursing in particular has a social mandate for engaging in health promotion.
-health education- for example, teaching the dangers of drug use, demonstrating healthful practices such as regular exercise, and providing more health-promoting options such as heart-healthy menu selections.
-Community health promotion then encompasses the development and management of preventative health care services that are responsive to community health needs. Wellness programs in schools and industry are examples.
-goal: raise levels of wellness for individuals, families, populations, and communities.
community health promotion "three-pronged effort"
-Increase the span of healthy life for all citizens
-Reduce health disparities among population groups
-Achieve access to preventative services for everyone
Surgeon General's Report--healthy people 2020
-Provides vision and agenda for significantly reducing preventable death and disability nationwide, enhancing quality of life, and greatly reducing disparities in the health status of populations
-Spread through blood and body fluids
-Acute and chronic infections once exposed (remains alive outside body for about a week)
---Acute: self limiting, develop antibody to virus and have lifelong immunity
---Chronic: unable to get rid of vaccine and remain lifelong carriers of HBsAG and can transmit HBV to other and develop hepatic carcinoma or chronic active hepatitis
-Vaccine recommended for healthcare workers and infants (incidence decreased since vaccine developed)
-Other high risk groups (inmates, drug users, hemodialysis, multiple sex partners, immigrants)
-characteristics of the host can cause variation in susceptibility to the agent (and the ability to recover from the agent).
-Ex. a three-year-old may not know how to cross the road safely = more at risk for motor vehicle accidents, getting hit by a car, compared to someone who is 16 years old. With infectious agents, people at the low and high end of the age spectrum are more susceptible to infectious disease such as the flu.
-age, sex, race, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, family background
identifying eithical situations
-Evaluative statements involve judgments of value, rights, duties, responsibilities (i.e. "Parents should never strike their children) (key verbs:want, desire, refer, should or ought; nouns: benefit, harm, duty, responsibility, right, obligation).
-Moral evaluations refer to judgments that conform to standard of what is right and good; assess human actions, situations, or character traits rather than inanimate objects (i.e. "Parents should take care of their children").
implications for community health nursing
-Focus on social determinants of health with communities and populations
-Health promotion and primary prevention
-Health for All
-Primary Health Care, i.e., essential services, goods, and resources
-All new cases of a disease or health condition appearing during a given time
-Incidence is a rate that quantifies the development of new cases in a population at risk over a period of time, usually one year
-Incidence rate = number of persons developing a disease / total number at risk per unit of time (ex. 200 new cases / 1,000 persons at risk)
-easily transmitted and have high mortality rates
-smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (i.e. Ebola), plague
-Moderately easy to disseminate, have high morbidity rates and low mortality rates
-typhus fever, ricin toxin, diarrheagenic E. Coli, west nile virus
bioterrorism: category C
-easy to produce and have a potential for high morbidity and mortality rates
-hantavirus, influenza virus, TB, rabies
-cipro & doxycycline
antitoxin and IV abx
-progressive muscle weakness
-no approved vaccine
-Airway management with possible ventilation
-Admin of antitoxin
-Elimination of toxin: puking, enemas
-head and body aches
-rash that begins on face and tongue and spreads to trunk, arms, legs, then hands and feet, then turns to pus-filled lesions
-Vaccine provides 10 years of immunity
-Can vaccinate w/in 3 days of exposure
-Contact and airborne precautions
-Supportive care (hydration, analgesia, antipyretics, abx for secondary infect)
-No approved vaccine
-PPE: gown, 2 pairs of gloves, boot covers, N94 mask
-Supportive care (IV fluids, dialysis, airway management, psychological counseling)
-Minimize invasive procedures
-Pneumonic: fever, HA, weakness, SOB, chest pain, cough, bloody/watery sputum
-Bubonic: swollen/tender lymph nodes, fever, HA, chills, weakness
-Septicemic: fever, chills, weakness, prostration, abd pain, shock, DIC, gangrene of nose and fingers
-Vaccine no longer available in US
-gentamicin and fluoroquinolones
-muscle aches/ joint pain
-pneumonia if airborne
vaccine under review by FDA
-in mass casulaty: use deoxycycline or cipro
international health organizations
-united nations: world health organization (WHO)
--policy setters, collect and communicate health of countries; six point agenda includes- promoting development, fostering health security, strengthening health systems, harnessing information/evidence/research, enhancing partnerships, and improving performance through its ongoing reforms
PANHO--pan american health organization
one of the six regional offices of WHO
WHA-- world health assembly
-the highest governing body in the WHO, including 193 member country representatives
world health report
WHO collaborating centers
-focus on specific areas of expertise and carry out the work of the member countries in those areas
-treating people fairly - fair distribution of both benefits & costs among society's members (ex: equal access to healthcare). 3 views of allocation or "fair" distribution.
-Benefits should be given first to the disadvantaged or those who need them most. Decisions based on this view particularly help the needy, although it may mean witholding goods from others who may also be deserving, but less in need (i.e. food stamps)
Determines that benefits should go primarily to those who have been wronged by prior injustice (ie crime victims, racial discrimination)
-Promotes decisions based on equal distribution of benefits to everyone, regardless of need (i.e. Medicare).
-Fair and equitable distribution of wealth, economic opportunity, and access to privileges in society and is tied to human rights. "The view that everyone deserves equal economic, political, and social rights and responsibilities."
-employee who is responsible for planning, directing and overseeing the operations and fiscal health of a business unit, division, department, or an operating unit within an organization.
-responsible for overseeing and leading the work of a group of people.
-provides financial assistance to states and counties to pay for medical services for poor older adults, the blind, maternity care, seniors, needy families, the disabled, and families with dependent children.
-Optional program, all states currently participate Covers 37% of children, 77% of children under the poverty line ; only covers 35% of adults living below the poverty line
-Jointly funded b/w federal and state govt. To provide adequate health care, federal matches state medicaid spending
Funding model for medicaid
-no limit on federal spending allows medicaid to expand during short economic downturns, natural/manmade disasters, epidemics;however as economy contracts (ex. recession) many more people become eligible at a time when state and federal funding are decreasing
Affordable care act and Medicaid
-cover approx 30 million additional people/ Since medicaid covers so many people (about 71 million) many of whom have complex disease processes, it's a large portion of health care spending
--Prior to the ACA childless adults without disabilities were not eligible
--Foster kids covered until age 26 (equal to that of private plans allowing dependent children to remain on parent's plan until that age)
--Expansion was optional, 24 states have not participated
reimbursement for health care providers through medicaid
-Medicaid historically reimbursed providers at a lower rate and slower than medicare, putting financial burden on providers, leading to lack of provider participation and lack of access to care for enrollees.
States and Medicaid
ave discretion on financial criteria for eligibility, scope of services, rate of payment, and program administration as long as they meet minimum federal requirements (mandatory services) :
-outpatient and inpatient hospital services
-early childhood screening and well-child check-ups, physician and NP/Certified nurse midwife services
-lab and x-ray services
-family planning services
-tobacco cessation counseling for pregnant women
-home health care and nursing home services for those over 21 (including rehab services),
-federally qualified health service and rural health clinic services
-transportation to medical care
Medicare and Social security disability insurance
-provides hospital insurance and medical insurance to persons 65 years of age and older, to permanently disabled persons, and to persons with end-stage renal disease
---each region has about 30 plans available costing on average $39/month as of 2015
Part A of medicare
hospital insurance) covers hospital care, home care, hospice care and skilled nursing care (limited)
Part B of medicare
noninstitutional care insurance) covers medically necessary services- health care provider services, outpatient care, home health, and other medical services (diagnostic services and physiotherapy).
Part C of medicare
dded in 1999, called Medicare Advantage. allowed for additional coverage, which included both Parts A and B services. The Part C plans are coordinated care plans that include health maintenance organizations (HMOs), private fee-for-service plans, medical savings accounts (MSAs); these provide full health care coverage costs after a high deductible.
Part D of medicare
prescription benefit plan
-can be combined w/ parts A, B, or C that do not offer prescriptions
migrant health concerns
-b/c earnings have to last a year, generally delayed seeking health care unless illness becomes debilitating.
-tmt only sought if "completely debilitated", pesticide exposure, or work supervisor has been notified.
-poor nutrition, lack of resources to seek care, infectious diseases d/t overcrowding/poor sanitation.
-obesity--females more likely to be obese and have diabetes
-Males more likely to have a stroke
-TB common with farm workers
-more rx HIV infection
migrant hero--Cesar chavez
-founded the first union in agricultural labor history to successfully organize migrant farmworkers, giving a voice to a population otherwise insignificant and unheard.
-He organized several successful strikes, including boycotting California grapes for 5 years in protest of the indiscriminate use of spraying by growers.
-Connected health offers the patient the opportunity to feel constantly linked to the health delivery system and offers the system a just-in-time messaging opportunity that can be motivating, educational, and caring. Disadvantages such as unreliable service compared to landlines. Text messages are a widely recognized communication method in most societies. Text reminders can positively influence health related behavior change & self management of both acute and chronic health conditions. 77% of conditions showed improvement with text messaging, measurements included- med or treatment adherence, appointment attendance, patient satisfaction.
advantages of texting
-simple, cheaper, more private, group communication, less prone to spam, can be stored and revisited later, available in all languages. They overcome barriers of time and access to reach even high-risk populations. It has been used to promote health lifestyle such as to stop smoking or exercise more. They are also helpful in discussing sensitive topics such as sexual assault or reducing risk behaviors (where the patient may feel anxious in a face-to-face conversation).
-text message reminds about immunizations were preferred to phone or mail, which led to higher rates of influenza vaccinations.
-caused by bacteria that are resistant to treatment with at least two of the most powerful first-line drugs: isoniazid and rifampin
-Treatment with second-line drugs; usually four or more for a minimum of six months (up to 24 months)
Native American Indians
-Indian Health service (IHS) provides health care for native american descendent as a condition of the treaty with the US government that essentially took their land and placed them on reservations
-make revenue from casinos and gaming, but are among the nation's poorest groups w/ poverty rate over 2x U.S. average and unemployment nearly 3x national rate
-Health problems tend to be chronic and socially related- poor living conditions, malnutrition, TB, high maternal and infant death rates, obesity, DM, ALCOHOLISM and Fetal Alcohol Syndrome
-avoiding or preventing harm to others as a consequence of a person's own choices and actions.
-taking steps to avoid negative consequences.
-ex) encouraging physicians to prescribe drugs with the fewest side effects, promoting legislation to protect the environment from pollutants emitted from gasoline even if it raises prices, lobbying for lower speed limits to save lives
Nursing process: assessment
-Clarify the nature of the problem (ecology, social determinants, community input, stats)
-Identify community capacity (community strengths & resources)
Nursing process: diagnosis
-Identify who receives the care, identify problems faced by who is receiving the care, identify factors contributing to the problem
Nursing process: planning
-use "best practice"--interventions based on EBP
nursing process: implementing
in the community
nursing process: evaluating
-community health outcomes
official health agencies
-publicly funded and operated by state or local government with the goal of providing population-based health services
-NIH (national institute of health) added projects and initiated greater cooperation with the states and added programs significant to public health
-in 1979 education was made a separate cabinet and department of health education and welfare was renamed U.S. department of health and human services.
orem's self-care model
-focused on the concept of self care: learned goal oriented actions to preserve and promote life, health and wellbeing
-the goal of nursing action is to help people recognize their self care demands and limitations and increase their self care ability.
-basic conditioning factors can be r/t the compounding effect that overlapping factors of inequality such as access issues, discrimination, and racism present. this is known as intersectionality.
orem's self-care model: universal requirements
-activities common to all human beings, which are essential to meet physiologic and psychological needs.
orem's self-care model: developmental requirements
-activities needed to help people progress developmentally.
orem's self-care model: health deviation requirements
-activities needed to help people deal with a diminished level of overall wellness.
--To control and prevent disease or death
--Endemic (higher than normal for population at that time for which we can do something), epidemic (endemic occurrence that is constant over a longer time), pandemic (epidemic of a very large population).
Six Steps: 1. confirm the existence (at least needs to be an endemic, definition above)
2. verify the diagnosis (drug-resistant tb? Ebola?)
3. estimate the number of cases
4. orient to person, place and time (types of people? Region or location? Time of year? When it began?)
5. develop and evaluate a hypothesis in regards to the source (confirm hypothesis if other cases emerge and source is identified)
6. institute control measures (if they make a decrease in the outbreak then conclude hypothesis is correct) Also 6.necessarily communicate the findings to proper agencies
-purposeful interaction among nurses, clients, other professionals, and community members to develop strategies for improving the health of individuals, families, and communities.
-goal-oriented, no hierarchies, use of resources, mutual responsibilities and benefits, boundaries (timeline), mutual trust and respect, open and honest communication, and accepts the roles and skills of participating partners
-Partnerships between community agencies - it is common for public health agencies to seek additional funding assistance from other agencies to support new community health programs or to provide educational information or interventions; acute care hospitals and public health agencies may align over common interests (e.g. influenza, diabetes, and other lifestyle diseases)
--Consultations with experts
--Referrals to other providers/agencies
feedback is important
collaboration example: ABCD (asset-based community development)
--methodology that starts with community assets and strengths, including local persons, community associations and networks, natural resources, and institutions as a means of working with residents to create sustainable communities
--Rather than needs-focused approach, it starts with identifying the types of skills and resources in the community and then consults with the community members on improvements they would like to make
collaboration: CBPR (community-based participatory research)
-involves community members in the entire research process from identifying a topic of importance to the community through implementation and dissemination
--Involving stakeholders in planning and implementing programs and research increases their buy-in and the likelihood of success
-common bacterial cause is Streptococcus Pneumoniae, most common viral causes are influenza, parainfluenza, and RSV.
-s/sx: shaking chills, fever, pleural pain, dyspnea, productive cough of "rusty" sputum, and tachypnea. In infants and younger children, fever, vomiting, and convulsions may be initial symptoms.
-vaccines: pneumococcal protein-polysaccharide conjugate vaccine protects against 10 or 13 of the most common types and in routine vaccine for infants. The 23-valent pneumococcal polysaccharide vaccine(PPV23) available for high risk groups (chronic diseases, immunosuppression health conditions, asplenic), ages 2 years old and up
--vaccine not recommended for healthy population between 2-65
-almost eliminated worldwide
-as long as a single child remains infected with polio, children worldwide are at risk
-Concerned for the health status of population groups and their environment.
-Ex. elderly in a community; people at high risk for heart disease; people in a certain neighborhood
-considered in relation to the rest of the community
-Continually look for problems in the environment that influence community health
-any group of individuals who may or may not have anything in common
-ex) Pregnant and parenting teens, elderly adults with diabetes or gay men with HIV/AIDS.
-an aggregate that shares one or more personal characteristics
-ex) elderly population, homeless individuals or a particular racial or ethnic group.
prescription and OTC drugs: they are not risk free
-reviewed and tested by FDA's center for drug evaluation and research
-Many OTC drugs were once available only by prescription and remain powerful meds
-major side effects, may be contraindicated in people with certain conditions, and may not be safe to use in combo with certain other drugs
-community health nurse's role: Medication instruction and review
prescription and OTC drugs: some prescriptions meds are so expensive that clients cannot afford to take them as prescribed
-older, less expensive, and more frequently used drugs work as well as the newer, more expensive ones
-advocate for them with health care providers to prescribe a less expensive medication or change to the generic form
-samples of drugs available and may be able to use them for medically indigent clients
-low-cost prescription assistance programs
prescription and OTC drugs: efficacy of meds must be assessed
-At times, the use of a new drug or an additional drug does not have the intended effect
-The community health nurse may be able to give the best information to the health care provider about the effectiveness of new meds for a particular client
-how many cases of the disease currently exist. Only way prevalence can decrease in a certain area is if ppl die or move away
-preventing the occurrence of the disease, injury, or disability
-general health promotion and risk reduction, immunizations, and specific protection (bicycle helmet)
-health promotion and addressing risk factors, social, and genetic factors
primary prevention: health education
-information and counseling to reduce risk for disease, injury, or disability.
primary prevention: environmental protection
-Preservation of natural environments and monitoring of built environments to reduce risk for disease, injury or disability
primary prevention: health promotion
-Activities designed to improve overall health & wellbeing and specific protection against disease or injury
--Obviates the occurrence of a health problem, includes measures taken to keep illness or injuries from occurring
--Ex. vaccines, safety devices to prevent injury from falls
-anticipatory planning and action on part of community health professionals
Process of valuing
1) choose the value freely and individually
2) choose the value among alternatives
3) carefully consider the consequences of the choice
4) cherish or prize the value-fell good about the choice
5) publicly affirm the chosen value
6) incorporate the value into behavior, so that it becomes a standard or a pattern of behavior
7) consciously use the value in decision-making
--specific actions for the discovery and ID of people's values. They also assist the decision-making process by explicating the process of valuing itself.
-learning that includes visible, demonstrable skills
1) Learners must be capable of the skill
2) must have a sensory image of how to perform the skill--gained by demonstration, Nurse has to provide them with an adequate sensory image, and best to demonstrate and explain slowly
3) learners must practice the skill--provide guidance and encouragement, practice until skill is smooth, coordinated, and unhesitating
-Ex) may be difficult for an elderly diabetic man with tremulous hands and fading vision to give his own insulin injections
-defined as the probability that disease or other unfavorable health condition will develop
-inherited health capacity, environment lived in, lifestyle choices, quality & accessibility to health care
-ration: statistically compares the incidence of disease in an exposed group to a non exposed group to determine level of risk
-lower the risk for individuals and communities at large based on their specific risk factors for various diseases
-"fix" modifiable factors:
---Community projects to better the environment, education as to what makes a stable/healthy environment
---Education about healthy lifestyle choices to lower disease risk (heart disease, lung cancer, etc.)
---Ensuring access to health care, whether by bringing the system to the patient or finding a way to bring the patient to the health care system.
rural health concerns
-communities with fewer than 10,000 residents and a county population density of <1000 persons per square mile. FAR is less than 6 or fewer persons per square mile and typically great distances to service areas like health care.
-higher rates of CVD, DB, & HIV
-access to services especially for mental health care is typically lacking. Public health services are provided through rural health clinics and critical access hospitals
-Telehealth is helping to reach these population though cell service can be problematic.
rural health concerns: agricultural areas
-toxic exposures to pesticides, fertilizers, & antibiotics can lead to neurological, renal, hepatic, pulmonary, and endocrine dysfunction.
-Mechanical injuries caused by farm equipment mishandling, breakage, and falls can lead to loss of limbs, livelihood, and life.
-lack of health insurance and OSHA protections leave farm families at greater risk for early morbidity and mortality.
-without careful conservation practices, farms can contaminate air, water, and soil.
roy's adaptation model
-Describes people as open and adaptive systems that experience stimuli, develop coping mechanisms and produce responses
-Helps the the nurse understand how a community' ability to adapt to stressors will affect the health of the community
-two processes: regulator and cognator
----4 adaptive modes to the model: physiologic, self-concept, role functioning, and interdependence
roy's adaptation model: regulator process
-stimuli from the internal and external environments are received and this info is processed to produce a response
-Ex: begins with a community's desire to keep adolescents from smoking (internal stimulus) and new state regulations prohibiting the sale of tobacco products to minors (external stimulus). These combined stimuli lead to a city ordinance that prevents the sale of cigarettes to minors (coping mechanisms) resulting in reduced levels of smoking (response) among the population
roy's adaptation model: cognator process
-perceptions, learning, judgment, and emotion are considered in formulating a response to stimuli
-Ex: begin with the stimulus of heavy rainfall in a riverside community, residents perceptions of the amount of rainfall, memories of pasts floods, insights about preventing or managing floods, and level of anxiety all contribute to their plans for evacuation, sandbagging, and soliciting county or state assistance
-Programs that provide disease- testing opportunities to detect disease in groups of asymptomatic, apparently healthy individuals
--Urine Chlamydia and GC
--Mantaoux TSTs for TB infection
--HIV- oral fluid testing, rapid fingerstick, enzyme immunoassay
----Must be confirmed with Western blot or immunofluorescence assay if positive result obtained
----Must follow five C's: consent, confidentiality, counseling, correct results, and connect to care
-Validity- test's ability to accurately identify those with the disease
-Reliability- test's ability to give consistent results when administered on different occasions by different people
-Predictive value- important for determining whether screening intervention was justified
-Yield- the number of positive results found per number tested
-Clients are autonomous and responsible for their own health and have the right to make decisions concerning their health; independence
-Achievement aided by nurse advocacy
-self-judgment about a person's goals and choices is conducive to an individual's sense of well-being
-Informed consent derives from self-determination
-self-determination and taking personal responsibility for health care decisions should be nurtured-->Includes informing clients of options and reasoning behind all recommendations
2 situations in which self-determination should be restricted:
-When some objectives of individuals are contrary to the public interest or the interests of others in society (endangering others with a communicable disease)
-When a person cannot fully comprehend the options, the consequences of actions and the true costs and benefits, he may not have adequate capacity for making health care decisions
-gather the "who, when, where and what" these elements are used to determine the "why"
-systematically collects, organizes, and analyzes current, accurate and complete data for a defined disease condition. The resulting information is promptly released to those who need it for effective planning, implementation, and evaluation of disease prevention and control programs.
10 elements of surveillance
1. Mortality registration
2. Morbidity reporting
3. Epidemic reporting
4. Epidemic field investigation
5. Lab reporting
6. Individual case investigation
8. Utilization of biological agents and drugs
9. Distribution of animal reservoirs and vectors
10. Demographic and environmental data
surveillance for agents of bioterrorism
-HCPs asked to be alert to:
---Temporal or geographic clustering of illnesses (ppl who attended same public gathering) esp. Those with with clinical signs that resemble outbreak: unexplained fever with sepsis, pneumonia, rash, or flaccid paralysis.
---An unusual age distribution for a common disease (i.e. chicken-pox like disease in adults without a child source)
Nurses play vital role in collecting data, making diagnoses, investigating and reporting cases and providing info to general public:
1. Investigating sources and contacts in outbreaks of pertussis in school settings or shigellosis in daycares
2. Performing TB testing and contact tracing
3. Collecting and reporting info pertaining to notifiable communicable diseases
4. Performing infection control in hospitals
5. Providing morbidity and mortality statistics to those who request them
-human beings and the natural environment must coexist harmoniously for human survival.
-public must protect the environment and promote healthy characteristics in the population and communities in which they live
-currently not sustainable because energy use exceeds supply and pollutants are changing the natural landscape of plant and animal life and threatening both human life and ecosystems.
-Solutions to improve: include strategies that are socially desirable, economically feasible, and ecologically viable
-Ex] increased use of coal increases air pollution from the toxic emissions released in the coal-fired power plants that are often referred to as greenhouse gasses that contribute to the climate change
---Current estimates indicate that the global need for oil has exceeded the available resources that are not sustainable
---Hospitals generate as much as 5 million tons of solid waste annually; much of which include hazardous materials
---Health Care Without Harm: created by nurses, all leading organization that promotes environmentally responsible health care
how people learn best
-being involved, practice, reinforcement, multiple delivery modes, safe environment, consistent with patient beliefs and level of edu
1. Assess learner readiness, needs, and abilities
---Learning styles, knowledge surveys, growth and development, motivation, beliefs, literacy
2. Write learning objectives
---measurable → what knowledge, what behavior
---behavioral→ what will learner do to show achievement, what domains involved
3. Teaching strategies
---Use principles of teaching and learning (how does the individual learn best)
---Determine learner readiness
---Create an environment conductive to learning
---Have fun and be creative
4. Teaching plan
---Learning goal (aim)
---Performance criteria (when, accuracy, consistency, independence)
-Formative or process
---Was strategy implemented as planned
-Summative or outcome
---What percent achieved the written learning outcomes
the concept of health
-"A holistic state of well-being, which includes soundness of mind, body and spirit"
-Emphasize on wellness and also the capacity to lead a fulfilling and productive life ("quality of life")
-Strong relationship between health and environment
-Different views of health based on cultural background and religion
-Prerequisites of health from WHO include: peace, shelter, education, food, income stable ecosystem, sustainable resources, social justice, and equity
the health continuum: wellness-illness
-A person's state of health is in flux, either improving or deteriorating
-Two ends of spectrum: total disability/death vs. optimal health
-The health of an individual/family/community moves back and forth along this continuum throughout their lifespan
subjective and objective dimensions of health
-Subjective- how people feel (fluctuates often)
-Objective- how people function in their environment carrying out activities and achieving goals (can be observed)
---Together, these provide overall picture of a person's health and where they land on the health continuum
the economics of health care
-science of making decisions regarding scarce resources
-concerned with production, distribution, and consumption of services
-Broken down into two theories: microeconomics and macroeconomics
-deals with supply (quantity of goods or services) and demand consumer's willingness to purchase goods or services)
--Increase in supply usually correlates with decreased demand, lowering prices
--Decrease in supply correlates with increased demand, raising prices
-concerned with broad variables that affect the country as a
whole. (production, consumption, investment, international trade, inflation, and unemployment on an aggregate level).
--> focus is on larger view of economic stability and growth
-we have the lowest life expectancy rate, highest infant mortality rate, and highest prevalence of chronic disease.
-->Factors affecting this can be the high amounts of obesity, higher costs
for prescription drugs and physician services, and the use of expensive technology
-->estimated preventable hospital costs are between 16 and 18 billion dollars annually.
world health assembly
-sponsored by the WHO-meets in Geneva and very involved in public agenda for health (193 countries)
-each world region attend to bring policies and recommendations for implementation at regional and local levels
world health organization
-established by united nations
-policy setting organization that helps collect and communicate data about the health of countries around the world; helps to develop policies that promote health in all regions of the US and other countries
---Provides leadership and technical support, monitors health trends, sets norms and standards, and spurs research worldwide
---Serves as a catalyst to mobilize the resources of national governments, financial institutions, and bilateral partners for health development
-six point agenda
-Collaborating Center - centers that focus on a specific area of expertise and carry out the work of member countries in these areas
-multinational or multilateral meaning that support governments, organizations, and universites all over the world
-created "health for all"
-One of the greatest achievements of WHO is the eradication of smallpox
WHO six point agenda
1. Promoting development
2. Fostering health security
3. Strengthening health systems
4. Harnessing information/evidence/research
5. Enhancing partnerships
6. Improving performance through reforms
WHO "health for all"
-Basic elements of PHC:
-Education concerning health problems and their prevention
-Promotion of food supply and proper nutrition
-Adequate supply of safe water and basic sanitation
-Maternal and child health including family planning
-Immunization against major infectious disease
-Prevention and control against endemic disease
-Appropriate treatment of common diseases and injuries
-Provision of essential drugs
---Includes methods to keep illness or injuries from occurring
-Providing childhood vaccinations
-Encouraging elderly to install and use safety devices
-Teaching young adults healthy lifestyle behaviors
-Prevent communicable diseases such as rubeola, poliomyelitis, varicella
---Includes anticipatory planning and action on the part of the community health professionals
unique methods of health care deliver
universal imperatives of health care
-include: Mortality, morbidity, daily functioning, decision-making, cost of, and access to health care
Framework for global community health nursing
1) context: the population, the provider, the procedure/intervention
2) eras of health conditions: era of infectious disease, chronic long term conditions, and social conditions
universal imperatives of health care: mortality
-A government's first priority is to keep its population alive and free from illness
-Community without resources cannot maintain this
-Poor countries will focus on preventing mortality and evidence-based interventions that will ensure survival of the people
-When morality is priority the physician is required
universal imperatives of health care: morbidity
-the conditions that make people sick
-Will look to this when people are not dying
universal imperatives of health care: daily functioning
-Must focus on necessities first
-Sometimes extra health care team members don't exist in communities
universal imperatives of health care: decision-making
-Communities need options to choose from
-Internet and privatization evolves options for decision-making about providers to use and sources for health information
universal imperatives of health care: cost
-Many countries do not have the resources to support the necessary research and programming to address the issues that may involved them and their border nations
-Because of health services being rationed, restricted, and placed under insurance schemes, nations are forced to weigh cost of managing some health conditions over others
-Most of the time they opt for those that can be addressed with the least input and the maximum benefit
-Research can often be very expensive and beyond many countries resources
universal imperatives of health care: access
-Major concern is not having health services available and accessible
-Access to health care refers to the ease with which an individual can obtain needed health care services
-Several factors influence access worldwide
----Language, insurance, belonging to a military establishment (having priority), socioeconomic status, illiterate, remote/rural areas, gender (because of religious taboos)
-Considers socioeconomic factors and also the environmental origins of disease and health problems... intervening where the root cause is
-ex) program to improve heart health looks at factors such as second hand smoke in public place, unhealthy food choices in schools and public places, and how to build environment promoting safe outdoor activity
-environmental health history in nursing assessments in order to create better tracking of environmental exposures, embedding environmental health information into nursing practice settings, increase educational efforts to inform individuals and families of environmental health hazards, knowing information, engaging in environmental health research to advance our understanding of etiology and prevention, advocate for individuals at risk
vaccine-preventable diseases: birth
hepatitis B - 1st dose
vaccine-preventable diseases: 2 months
-hepatitis B- 2nd dose
-rotavirus- 1st dose
-DTaP- 1st dose
-HiB- 1st dose
-PCV13- 1st dose
-Inactivated poliovirus (IPV)-1st dose
vaccine-preventable diseases: 4 months
-rotavirus- 2nd dose
-DTaP- 2nd dose
-HiB- 2nd dose
-PCV13- 2nd dose
-Inactivated poliovirus (IPV)-2nd dose
vaccine-preventable diseases: 6 months
-hepB - 3rd dose (until 18 mos)
-DTaP- 3rd dose
-PVC13- 3rd dose
-IPV- 3rd dose (until 18 mos)
vaccine-preventable diseases: 12-15 months
-DTaP: 4th dose (until 18 mos)
-HiB: 3rd or 4th dose
-PCV13: 4th dose
-MMR: 1st dose
-Varicella: 1st dose
-HepA: 2-dose series (until 19-23 mos)
vaccine-preventable diseases: 4-6 years
-DTaP: 5th dose
-IPV: 4th dose
-MMR: 2nd dose
-Varicella: 2nd dose
vaccine-preventable diseases: 11-12 years
-Meningococcal: 1st dose
-TdaP: continue DTaP (?)
vaccine-preventable diseases: 16 years
-Meningococcal: 2nd dose
-Lice and scabies are vectors that can transmit its disease. By themselves they are very contagious and can be transmitted through casual contact such as at the beach.
-sharing towels or combs
-Lyme disease - deer tick
-Malaria - mosquito
-Rocky Mountain Spotted Fever - dog tick
-Typhus - lice
-West Nile - mosquito
-Toxoplasmosis - bird
*biological transmission: vector is necessary for the development of the infectious agent before transmission (i.e. mosquitoes that carry West Nile virus and the fleas that transmits plague)
*Mechanical transmission: organism is going along for a ride (for example a bird can transmit toxoplasmosis physically to another bird or human being)
Paradigm that underscores first things first
-One must be alive and well before interventions can focus on functioning or decision-making
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