Community: History of Community Health and Upstream Thinking

What is community nursing?

typical population and community based, programs developed for specific communities

What is public health nrusing?

global health, environmental factors, epidemiology, society as a whole

What is epidemiology

Is the study of diseases in populations of human and other animals in correlation with how when and where they occur

How does community and public health nursing differ from regular, traditional nursing?

Regular traditional nursing focuses on individual client care and acute care services

Community and public health focuses on community as client and global health and improving global health of communities

Geopolitical communities

Defined by natural or man made boundaries

Geopolitical communities: EXAMPLES

Cities, counties, state nations

Phenomenological communities:

Interactive groups

People who share same perspective or interests based on culture values goals

Phenomenological communities: EXAMPLES

Schools, university churches, organizations, or social events

Population

Denotes a group of people having common personal or environmental characteristics

So its ALL people in defined community

Ex. Iu students made of different students :That’s population,

Aggregate

subgroup of subpopulation that have some common characteristic or concerns

nternational students are aggreagate

With each change, individuals had to alter the environment to accomodate to

_____ _____ which then had an overall effect on _______ _______

GROUP LIVING & Aggregate health

It is important that nurses should be aware that populations from each stage consisted a variety of people with what?

1. DISTINCT CULTURAL TRADITIONS

2. BELIEFS

3. PRACTICES

Example: nurse practicing in American community may need to individualize care FOR 

for immigrants from settled village in developing country

Why is individualizing care important?

Acknowledges unique beliefs and practices

Example of a unique population here in Fort Wayne that needs individualized care

BURMEESSE POPULATION

It is believed that hunter and gatherers may have avoided many contagious diseases because these groups did what?

They were scattered, small separated from others

 "New Stone Age" which is considered the settlements. Wondering people became more sedentary and started to form small camps or villages. The concentration of people in these small areas caused new health problems. People began domesticating their animals and living close to their herds which ultimately led to the transmission of diseases such as:

1. samonella

2.TB

3.anthrax

How were the settlers becoming sick with Anthrax?

they started to domestic animals and living close to herds, serious life threatening causes (sheep, cattle, deer)

Can you still become sick with Anthrax today in modern times? If so, how?

breathing or drinking  contaminated spores, contaminated animal products

What is the most common route of TB transmission?

Inhalation of aerosolized bacteria

Dysentery:

infection of intestines leading to diarrhea water borne

 

Cholera:

infection of sm. Intestine lead to dehydration and diarrhea water borne

Typhoid:

water borne, high fevers

Hepatitis A: 

liver infections transmitted fecal oral route from contaminated water

What were the four diseases that spread by increased close contact during the development of preindustrial cities in the 1600s?

1. Mumps

2. measles

3.small pox

4. influenza

As preindustrial cities transitioned into industrial cities, urban areas became denser and more heavily populated. What four health hazards occurred because of industrialization?

1. air waste

2.air pollution

3. water pollution

4.harsh working conditions

What three respiratory diseases were at an increase during the industrialization era of the 18th and 19th century?

1.        TB

2. PNEUMONIA

3. BRONCHITIS

The leading causes of death in modern, present times has transitioned from

_______ to ________ in the Western world

INFECTTIOUS DISEASES to CHRONIC ILLNESSES 

Infectious diseases remain prevalent amongst:

1. LOW INCOME POULATIONS

2. Ethnic minority groups

What are some examples of Western diseases:

1. CANCER

2. HEART DISEASE

3. OBESITY

4. HTN

5. DIABETES

Western diseases happen to be less common among populations from

Non industrial communities.

What contributes to the common health problems seen in the Western World?

Area in which we live

What are four indicators of not meeting the socioeconomic criteria in a developing country?

1. LOW INCOME

2. UNDERDEVELOPED INDUSTRIALIZED BASE

3. LOW STANDARD OF LIVING

4. LACK OF ACCESS TO MODERN TECHNOLOGY

As a result, developing nations frequently experience a lack of:

1. JOBS

2. FOOD

3. CLEAN DRINKING WATER

4. EDUCATION

5. HEALTHCARE

6.HOUSING

Developed countries

USA, JAPAN, FRANCE, GERMANY, ITALY

UNDERDEVELOEPD COUNTRIES

HAITI, ETIOPHIA, PHILLIPINES

Endemic Definition:

DISEASES ALWAYS PRESENT IN POPULATION

Endemic examples

COLDS, PNEUMONIA, CHICKEN POX, MALARIA IN SOME ARES, LOW FREQUENCY

Epidemic definition:

UNEXPECTED SUDDEN INCREASE IN NUMBER OF DISEASE CASES IN A CERTAIN GEOGRPAHICAL REGION

OUTBREAK OF DIEASES OF MANY PEOPL MAY SPREAD THROUGH COMMUNITES, CAN BE SEVERE W/ REACHING PANDEMIC LEVEL IF IN ONE REGION

epidemic example:

SEASONAL FLU, SMALL POX, POLIO, DIPHTERIA, MEASLES, WEST NILE, FENTYAL OPIOID CRISIS

Pandemic definition

WHEN EPIDEMIC COMES WIDE SPREAD SPRAEADS OVER SVERAL CONTINIENTS

pandemic examples:

COVID 19, PAST FLU PANDEMICS, BUBONIC PLAGUE

What is the difference between an epidemic and a pandemic?

DEGREE TO WHICH IT IS SPREAD

Who are the two leaders who had an impact on addressing aggregate health?

1. Florence Nightingale

2. Lillian Wald

Florence Nightingale was credited for establishing what?

modern nursing

Nightingale was known for her contributions to the health of soldiers during the Crimean War. She believed what four nursing interventions would improve overall health outcomes?

1. clean water

2. clean linens

3. access to adequate sanitation

4. quiet resting environments

Nightingale believed the use of what was necessary to direct health policy at the administrative and political levels?

NEED TO USE STATSISTCS

What is the definition of health policy?

DEFINED AS DECISIONS PLANS AND ACTIONS UNDERTAKEN TO ACHIEVE SPECIFIC HEALTHCARE GOALS IN SOCIETIES

What is an example of a common health policy?

Smoke free policies

Lilian Wald was credited for establishing what?

PUBLIC HEALTH CARE NURSING

 

What was the name of the district nursing service that Lilian Wald established in NYC in 1893? Who was this service for? And what was the role of this service?

 House on Henry street, role was one of helping people to help themselves through development of centers od social action aimed at the needs of the community

What kind of nurses did Wald advocate for?

Nurses in public schools

At the time, school nurses could do what?

1. Physical assessments

2. treat minor infections

3.taught health to students and parents

What kind of federal agency was developed due to Wald’s growing concerns regarding children dying in infancy from preventable illness, children living in poverty, and children working under terrible conditions?

            The children’s bureau

What was the main responsibility of THE CHILDRENS BUREAU?

INVESTIGATED MATTERS INTO WELL FARE OF CHILDREN

Upstream thinking:

LOOK UP WHERE ARE THE REAL PROBLEMS, WHERE DO THEY LIE

TRIES TO CHANGE VARIABLE THAT CONTRIBUTE TO POOR HEALTH OF POPULATION

Downstream thinking:

ARE WE TOO BUSY RECUSING VICTIMS

GEARED TO REACTIONARY INTERVENTIONS THAT FOCUS ON INDIVIDUALS

What does manufacturers of illness refer to?

GROUPS THAT CAUSE DISEASE CAUSING BEHAVIORS

What are some examples of manufacturers of illness?

1. ALCOHOL

2. TABACO

3. FOOD MANUFACTURERS

4. Cigarettes

Upstream thinking focuses on what three things that are precursors of poor health?

1. economic

2. political

3.enviormental

What are some examples of “upstream” actions that nurses as a whole or as a profession can get together to do:

a lot of chemicals are not banned, so push to ban these by legislations

What are three different healthcare settings where we’ll be taking care of patients “downstream.”

1. MAJORITY OF HEALTH CARE SYSTEMS

2. ACUTE/CRITICAL CARE
3. ER/ED

Downstream focus interventions for obesity could include individual behavior strategies such as:

1. INDIVIDUAL BEHAVIOR STRATEGIES TO REDUCE WEIGHT

2. LIFESTYLE CHANGES

3. BARIATTRIC SURGERY NURSING CARE

Upstream focus interventions for obesity could include individual behavior strategies such as: 1. HEALTH POLICY CHANGES

1. HEALTH POLICY CHANGES

2. VENDING MACHINES IN SCHOOLS WITH HEALTHEIR CHOICES

3. SCHOOL LUNCH PROGRAM MODIFICATIONS

Define microscopic focus:

Individual response to health and illness

Example of microscopic focus:

lead poisoning

Nursing intervention(s) for microscopic focus

modifying individuals behavior by changing their perceptions of belief system

Define macroscopic focus

community based approach

Example of macroscopic focus:

examine community factors of lead pop

Nursing intervention(s) for macroscopic focus

see lead pipes, or stats

three theories listed on the slide help guide

DATA COLLECTION and allow for

INTERPRETATION in a clear and organized manner.

IT WILL BE EASY FOR NURSE TO ADRESS NURSE PROBLEMS

Microscopic examines the _____  level and more_____ activities are emphasized.

INDIVIDUAL, DOWN STREAM

Macroscopic examines the_____ level and more ______activities are emphasized.

SOCIETAL, UPSTREAM

Macroscopic is similar to the upstream analogy, the term macroscopic refers to a broad scop that incorporates MANY_____ to aid in understanding a health problem.

MANY VARIABLES 

The benefit of viewing a problem from the upstream & macroscopic perspective emphasizes the _______that proceed or play a role in the development of health problems.

 VARIABLES

Is Orem’s self-care deficit theory of nursing a microscopic approach or a macroscopic approach?

MICROSCOPIC APPROACH

The self-care theory focuses on the individual’s ability to perform what?

SELF CARE

Self-care is defined as what?

PRACTIVE OF ACTIVITES THAT ONE STARTS AN PERFROMS TO MAINTAIN LIFE BEING

Self-care is an important component of primary, secondary, or tertiary care prevention?

PRIMARY

When there is a self-care deficit, that is when nursing is needed! Nursing is required when a person is

incapable of effective self-care!

Is the Health Belief Model a microscopic approach or a macroscopic approach?

HBM microscopic approach

The Health Belief Model is based on the assumption that the major determinant of preventative health behavior is what?

DISEASE AVOIDANCE

Is the burden of action placed exclusively on the client or on the nurse?

CLEINT

The client only has two options which is:

1. ACT

2. NOT ACT

Only patients who have a negative perception of a specified disease or a negative perception of a recommended health action towards that specific disease will

FAIL TO ACT

The concept of disease avoidance includes

1.  Perceived susceptibility

2.  Perceived seriousness

4.  Cues to action

5.  Perceived benefits to preventative health action

6.  Perceived threat

7.  Likelihood of taking a recommended preventative health action

What is perceived susceptibility?

            People will no change unless they are at risk

What are two examples of perceived susceptibility?

Those who think they wont get HIV from unprotected sex will not use a condom

Smokers think they will not get lung cancer

What is perceived seriousness?

Probability a person will change their behaviors to avoid consequence

What is an example of perceived seriousness?

People are less likely to use condoms when they think STD are minor inconveniences

What does modifying factors include?

1. Knowledge about disease

2.and prior contract

How does this information affect health related behaviors indirectly by affecting...?

1. seriousness

2. susceptibility

3.benefits

4.  behaviors

What is the example provided about the modifying factor of knowledge?

If someone has a lot of knowledge on std they will more likely wear a condom than if they didn’t learn about STDS

What Is the example provided about the modifying factor of prior contact with the disease?

If someone got chlamydia, they’ll be likely to wear a condom to prevent contracting it again

How is 'cues to action' defined?

External events that promote desire to make a health change

What are the two examples of cues to action provided:

1. death of family member from cancer

2.BP band present at health fair

Why are cues to action important for our patients?

Helps moves or motivate oneself to make change

What is the example provided about perceived benefit?

You wont stop smoking if you don’t think it’ll improve your life in any way

What is the example provided about perceived barrier?

Everyone goes out drinking on Friday and makes it hard not to fall into that and cut down on intake of alcohol

After applying all seven concepts of disease avoidance while interviewing the patient, you as the nurse should come up with interventions designed to do what?

MODIFY CLEINT DISTORTED VIEW OF LIFESTYLE BEHAVIOR