Community healthy exam 1

What is population health/community health nursing?

• different lens

• local, state, regional, global health

• prevention

• multiple settings

• consideration of others

• diversity

equality vs equity

• equality: everyone gets the same - regardless if its needed or right for them

• equity: everyone gets what they need - understanding the barriers, circumstances, and conditions

what is health?

evolving but WHO originally “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity”

what is population?

community group of people who have at least one thing in common, which can be personal or environmental, and who may or may not interact with each other

what is community?

group of people who share something in common, who interact with one another, and who may exhibit a commitment to one another and may share a geographical border

public health nursing

practice of promoting and protecting the health of populations using the knowledge from nursing, social, and public health sciences

population focused

goals of promoting health and preventing disease and disability for all people through the creation of conditions in which people can be healthy

different populations at risk

• mentally ill and/or insured people who are unable to be treated by a primary care

• constantly “treating” the same preventable disease

• homelessness

• addiction

• poor environmental sanitation and air pollution

• child abuse

• sexually transmitted infections (STIs)

• teen pregnancies

community health nursing

• population focused

• requires a nurse to plan, deliver, and evaluate care

• broad field

• promote well being → across the lifespan → diverse populations

health promotion and disease prevention

1. strategies to promote health and wellness

2. national health goals are guidelines

3. three levels of prevention: primary, secondary, and tertiary

healthy people 2030

• healthy people 2030 sets data-driven national objectives to improve health and well-being over the next decade

• decrease in healthcare expenses and has improved the length of lifespans

• increased focus on healthy living

health promotion provided by community health nurse

1. helps to achieve a healthy lifestyle

2. preventative services provided more than one setting in community

3. plans and implements inexpensive and reliable screening programs for at risk population

what are the three levels of prevention

• primary

• secondary

• tertiary

primary prevention (prevent)

• reduce the risk of disease before it happens:

  • vaccinations

  • target modifiable risks - what are they? what are non-modifiable risks?

  • for example, cardiovascular disease (CVD):

    • improve diet

    • increase physical activity

    • other ideas?

• reduce the risk of an injury before it happens:

  • wearing seatbelts

  • no texting while driving

  • any others?

• prevention of problems before they occur

• health promotion and health protection

secondary prevention (screen/ detect)

• early detection and intervention

• early diagnosis and treatment

• ex:

  • cardiovascular - BP/Lipid screening and post-MI stress testing

  • cancer - mammography, Pap/HPV, colonoscopy, and LDCT

  • infectious - HIV/TB screening and post exposure prophylaxis

  • metabolic - glucose, HbA, and lipid panels

  • mental health - depression, substance use and cognitive screening

  • musculoskeletal - DEXA scan and fall risk assessment

  • vision/hearing - diabetic eye exams, glaucoma screening, and hearing screening

  • oral health - dental exams and oral cancer screening

tertiary prevention (treatment/soften impact)

• correction and prevention of deterioration of a disease state

• limitation of disability and rehabilitation

• reduce - reduce the long term impact of the chronic diseases

• minimize - minimize complications

• prevent - prevent disability

• improve - improve overall quality of life

public health

health promotion and disease prevention

community health

health promotion in a specific geographic area

population health

focuses on the needs of a specific group

core functions of public health

• assessment: gathering/analyzing health data

  • example - epidemiological statistics

• policy development - collaboration with lawmakers

  • development of public health policies

• assurance - improve accessibility and delivery of services

trends in public health nursing

• technology

  • public health informatics (PHI) integration

  • telemedicine

• aging

  • more chronic illness

  • increased health care spending

  • shortage of providers

  • quality of life ethical issues

• workforce shortage

  • baby boomer retirements

  • increased need for population health nurses

• medicalization

  • increased use of pharmaceuticals

  • takes focus away from preventative lifestyle changes

• focus on populations

  • health care should address social determinants of health

community health nursing

• goal: decrease health inequities

• addresses social determinants of health

• practice settings

  • schools

  • workplaces

  • churches

  • correctional facilities

  • home health

• outcomes are measured more broadly than in population health and often include the community member as a whole instead of individually

• intervention are preventative

community oriented nursing vs community based nursing

community oriented nursing:

• focus: health of a community or population (aggtregates)

• goal

• activities

community based nursing

• focus: individuals and families, and illness care

• goal

• activities

population health nursing

• assist pts in managing health conditions in community

• connect pts to community resources

• coordinate care across health care spectrum

• create health initiatives that target specific population

• goal: overall improvement in quality of life

• population health target groups are those with or “at risk” for specific health conditions

population focused nursing

key principles:

• main goal achieve the greatest good for the greatest number of people

• primary prevention is priority

• the pt is a partner in care

• use resources wisely

What is SDOH

Social determinants of health: external factors that influence health

• five categories:

  • economic stability: (employment, income, expenses, debt, medical bills, support)

  • access to and quality education: (literacy, language, early childhood education, vocational training, higher education)

  • access to and quality of health care: (health coverage, provider availability, provider linguistic and cultural competency, quality of care)

  • neighborhood/built environment: (housing, transportation, safety, parks, playgrounds, walkability, zip code)

  • social and community context: (social integration, support systems, community engagement, discrimination, stress)

what is the ecological model

factors that influence health behavior in society

• shows how internal and external factors affect behavior and is helpful in looking at what determinants can positively or negatively affect health behaviors when developing health program

• working in then out

  • internal - beliefs

  • interpersonal - interactions with others

  • institutional. - rules and regulations of an organization

  • community related - social norms

  • public policy - laws and policies by the government on any level

health belief model

• internal motivation for improving health

• looks at internal factors that motivate people to practice any kind of health related behaviors, specifically their perceptions of their own health and any possible threats to it

• believes individuals are more likely to take preventative action

• if they perceive the threat of a health risk to be serious

stages of change (transtheoretical) model

• readiness to adopt healthy behaviors

• 6 stages:

  • pre-contemplative (not seeing a need to change)

  • contemplative (see the need for change but blocked by barriers to adopt change)

  • preparation (creating a plan to change)

  • action (implementing the plan to change)

  • maintenance (implementing and maintaining the plan for change

  • termination (the healthy behavior is ingrained without thoughts to engage in previous behavior)

social cognitive theory

• beliefs about self and interpersonal relationships

• provides opportunities for social support through instilling expectations, self efficacy, and using observational learning and other reinforcements to achieve behavior change

nightingale’s environmental theory:

• prevent disease and promote healing

• it is based on five points, essential to obtain a healthy home

• example: clean water air, basic sanitation, cleanliness and light

• believed that a healthy environment was fundamental for healing and preventing disease

Milio’s Framework for prevention

an individual’s health and lifestyle choices are influenced by resources, availability, cost and convenience more than knowledge from education

pender’s health promotion model

• internal motivation factors to adopt a healthy lifestyle

• explains the factors underlying motivation to engage in health promoting behaviors

• focuses on people’s interactions with their physical and interpersonal environments during attempts to improve health

• helps nurses understand factors that affect an individual’s health and guide them toward healthier behaviors

  • people are more likely to engage in healthy behaviors when they perceive less barriers, see greater benefits, and believe in their own abilities

precaution adoption process model:

• explains how a person comes to decisions to take action

• how individual translates that decision into action

• stages of being unengaged, between unaware and contemplating an action

• no termination stage

upstream/downstream thinking

• upstream: focus on larger issues

  • is encouraged and seeks to implement wide reaching, systemic change; this also addresses and potentially fixes things before problems develop

  • examples:

    • government funded health insurance

    • affordable housing

• downstream:

  • current problems, narrow focus

4 ethics principles

• respect for autonomy

  • the pt has the right to choose, self determination

  • ability to make informed decision independently

  • nurse must respect pt’s decisions

  • ex: pt saying they doesn’t want chemo

    • pt refuses to do adls

• non-maleficence

  • do no harm

  • ex: notice nurse pulled to high a dose from a med and you make the nurse aware so it can be fixed

• beneficence

  • do what is good for the pt

  • protect pt from harm

  • nurses must act in best interest of pt

  • ex: ppt in bed for most of morning, hasn’t moved and is uncomfortable, so help pt move position and check for pressure ulcers

• distributive justice

  • fair distribution of benefits and burden on the society based on the needs on the society itself and its members

  • fairness and treatment based on equality

  • nurses must ensure all resources are distributed fairly

  • ex: 2 pts use call light, one needs a new remote and the other is a fall risk and needs to use the restroom, who do you help first??? fall risk pt

WHO

World health organization (who)

• goals

  • address global emergencies

  • improve health care inequities

  • promote health worldwide

  • end poverty and hunger

  • ensure clean water and sanitation

  • reduce inequalities

  • protect ecosystems

• expanded the definition of health to include overall well being

• WHO recommends direct observed treatment (DOT)

  • ex: to make sure pt swallowed med before leaving room

UNICEF

United Nations Children’s Fund

• similar to WHO but focuses on children

• works in over 190 countries

• goals:

  • protect children’s rights

  • provide emergency relief, clean water, sanitation

• administers more vaccination worldwide than any other agency

CDC

Center for Disease Control and Prevention

• protects health of the public

• goals:

  • secure global health

  • eliminate disease

  • end epidemics

CMS

Center for Medicare and Medicaid Services

• medicare

  • federally managed

  • adults 65 years and older

  • under 65 years with disability

• medicaid

  • state managed

  • low income individuals

OSHA

Occupational Safety and Health Administration

• addresses workplace injury and death

• maintains safe workplace

  • personal protective equipment (PPE)

  • contaminants

  • unfair labor practices

USDA

United states department of agriculture

• food insecurity

• WIC - women, infants, and children

• snap - money for families for fruits and vegetables

• school lunches

advocacy in community health nursing

• advocating for the needs of a whole population is priority

• works in the best interest of the pt

• the nurse uses expertise

• advocate for all vulnerable populations

• advocacy for pts (individuals, families, aggregates, communities, or populations)

Advocacy

public health policy: a legislated set of decisions, plans, and actions specifically directed at desired health outcomes for individuals, families, or communities

clients have the rights

1. to make their own decision

2. to have a trusting relationship with the nurse

3. to be responsible for their own health

4. to have the nurse advocate for their services

nursing advocacy

• supporting a cause, idea, or policy for someone else

• examples:

  • providing education so pt can make informed decisions

  • speaking for pt when they are unable to do so

  • providing community resources to pt

  • requesting appropriate PPE in the workplace

ANA

American Nurses association

• publishes resources to guide nursing practices

• defines scope and standards of nursing practice

regulations and standards

• who: lpn, rn, aprn

• what: the care and commitment to protect and promote the health and wellbeing of your pt

• where: nursing care is provided wherever it is needed

• when: whenever there is a need to provide nursing care

• why: basically, because nurses want to provide quality care and have positive pt outcomes

• how: how nurses provide care following the scope of practice guidelines utilizing the tools provided to them

ANA standards of practice

• assessment: data collection

• diagnosis: data analysis and formation of diagnoses

• outcomes identification: expected outcomes/goals determines

• planning: plan of care developed

• implementation: intervention implemented

• evaluation: goal achievement evaluated

legal standards

• legal guidelines for providing safe care to pts

• determines by nurse practice act in specific state of practice

• reports of legal misconduct can be made to state board o nursing

• examples of unprofessional conduct

  • criminal behavior

  • false documentation

  • providing care of out of nursing scope

  • being under the influence

  • abuse

  • not following standards of practice

ANA code of ethics

• ethics refers to standards of conduct, particularly right and wrong behaviors

• includes nine provisions

  • compassion

  • commitment

  • advocacy

  • responsibility

  • self regard

  • safety

  • health care advancement

  • human rights

  • social justice

• provisions guide nurses to provide evidence based quality of care

• focus on moral values

• nurses must understand their own ethics and values because moral dilemmas frequently come up while caring for pts and the community

  • nurses must be able to recognize when ethical dilemmas occur and be able to apply professional ethics and core values in their judgment and decision making

  • doing a complete assessment of the dilemma will allow the nurse to thoroughly comprehend what alternative actions there might be to resolve it

social justice

• defined as equal rights, equal treatment, and equitable opportunities

• nurses need to have a commitment to social justice

• when achieved, inequities can be eliminated

• important for nurses to advocate for social justice

communication skills

• allows nurse to perceive pt’s verbal and nonverbal communication accurately

• essential to the nurse pt relationship

• ineffective communication makes advocacy difficult

nursing and health policy

• nurses have a big influence on health policy

• ways to get involved

  • communicate with stakeholders and policymakers

  • advocate for specific approaches or policies

  • maintain active membership in professional organizations

evidence-based practice (EBP)

1. provides new knowledge that helps to shape health policy

2. develop policies to improve health using quality data

3. evaluates several factors before application of EBP: cost, safety, and community demographics

EBP in the community

• nurses contribute to EBP through application of research in community

• in collaboration with:

  • educational institutions, health care, facilities

  • community based participatory research (CBPR)

community based participatory research

• include partners, professionals, and community residents

• support members and develops leadership within community

• promotes collaborative relationship with health professionals

quality assurance

• quality assurance: ensures we are following the existing standards

  • ex: everyone checked off w/ finger sticks

• provides specific:

  • standards, measurement tools

  • processes to improving quality

• enhanced through:

  • credentials of health care providers

  • adherence to policies

  • compliance with legal guidelines

• nurses use the data from the reports and data when devising strategies for care

• quality management improves quality and performance

quality improvement

• there is a problem and we need to fix it

  • ex: skin breakdown, fall risk, medication errors, injuries, etc

• known as continuous quality improvement (CQI)

• uses objective data to analyze and improve processes

• public health nurses follow the CQI process

• nurses can evaluate quality by examining the following aspects of care

  • effectiveness

  • timeliness

  • client-centered

  • equity

  • safety

  • efficiency

collaboration and communication

1. communicate in teams, interact with other professionals, and inform stakeholders

2. communicate with pt

3. supervise programs, coach employees, mentor, and manage conflict

interprofessional collaboration (partnership)

• academic institutions, and others conducting research

• businesses and pertinent industries

• community organizations, coalitions, and advocacy groups

• community service agencies such as school, law enforcement, urban planning, and emergency response

• faith based organizations

• health care providers and facilities

• legislative, regulatory, and policymaking bodies

• local, state, and federal public health organization

• members of the public health team, such as epidemiologists, social workers, health promotion specialists, nutritionists, environmental health workers, and health educators

Social determinants of health

• forces beyond an individuals control

• affects well being, quality of life, and health

• non-medical conditions and circumstances that affect health

• the mission of the office of minority health

  • improve the health of radical and ethnic minority populations

  • development of health policies

  • programs which eliminate health disparities

cultural health beliefs

• affect how people think/feel about health and health problems

• when and from whom to seek health care

• how they respond to recommendations

  • such as healthcare treatment and adherence

cultural influence on health

• beliefs about cause of illness vary w/in cultures

• religious beliefs may dictate treatment options

  • ex: Jehovah’s witnesses do not receive blood transfusions

• dietary habits vary w/in cultures

• interpersonal communication varies

  • ex: male head of household speaks for females

nursing considerations

• culture affects:

  • individuals perception

  • behavior pattern

  • approach to health and illness

• nursing essential:

  • asking questions, and asking their approach and what their needs are

  • embrace diversity with genuine curiosity

  • continuous learning and self reflection

  • achieve health equity for all individuals

• culturally aware nurses:

  • understand, communicate, and interact

  • pts of all races, ethnicities, ages

  • genders, sexual orientations, and abilities

• cultural awareness, humility

  • diversity, safety fundamental to nursing

cultural competence

• having the ability to understand, communicate, and interact with people across all different cultures

• results in improved health outcomes

• embraces diversity

components of cultural competence

• cultural awareness: knowledge, awareness, and acceptance of other cultures

• cultural humility: communication reflects sensitivity and appreciation for diversity

• cultural safety: self reflection and critique of power imbalances causing health inequities

cultural assessment

• identify ways with which the pt’s culture

  • impact perceptions, beliefs, values

  • experiences with health, wellness

  • illness, suffering, and death

• remain accepting, respectful and welcoming of human diversity

• most important:

  • prior to an assessment, perform a self assessment to avoid bias

• during assessment consider what influences health promotion

  • environmental control:

    • some cultures believe that some things are predestined and there is nothing you can do about it

  • time orientation

    • past, present, future

      • ex: westerns future focused, health promotion

    • past and present focuses

      • ex: husband harming pt, she said she didn’t mind and that in her past life she was very bad so in this life she is being punished and in the next life everything would be better because it is bad now

  • social organization

    • decisions made by a whole group

    • ex: grandma has cancer

      • in american society, we tell grandma she has cancer and we can do chemo, radiation and treatment

      • in other religions grandma has cancer, they don’t tell her that she has it, treat it, or tell her she is going to die

what are the four health belief and practices

• biomedical beliefs

• naturalistic beliefs

• magico-religious beliefs

• biological variations in health

biomedical beliefs

the body is a machine, if something breaks down, we find the cause and we treat it

naturalistic belief

eastern culture belief, imbalance in the body, individual is part of nature and when a disease happens it is due to imbalance and then need to fix the balance

magico-religious beliefs

illness is related to supernatural forces

• ex: good and evil, the evil eye

  • pray to god, divine intervention

  • you need to be baptized before death

biological variations

genetics, color of skin

• ex: pt from african heritage can have genetic markers for sickle cell anemia

demonstrate cultural sensitivity

1. use sir name

2. introduce self

3. use culturally sensitive language

4. be honest about what you know or do not know about the culture

5. what does the pt understand about his health, treatment, and plan

data collection: cultural assessment

• collection of self identifying data

  • pts ethnic background and religious preference

• ask questions on how the pt perceives their health

• assess how cultural factors affect

  • effectiveness nursing of interventions

cultural assessment parameters

• ethnic background

• religious preferences

• family structure

• language and literacy needs

• communication needs

cultural bias

• implicit bias

  • unconscious attitudes that precede unintentional discrimination

• stereotyping

  • simplified and standardized beliefs about a group of people

  • not always an accurate reflection of group

  • can impair communication, lower adherence to treatment plan, and negatively affect internal motivation to change lifestyle behaviors

  • unfair judgement by health care providers makes pts less likely to seek out preventative care and to delay treatment at later stages

health disparities

• differences in medical conditions or health outcomes in a specific population

  • most often w/in marginalized groups

• rooted in systemic racism

• influenced directly by social determinants of health

• ex:

  • black americans are 6x as likely to die from HIV compared to white americans

  • end stage renal disease is double in hispanic diabetic population as compared to non-hispanic white diabetic populations

improving health disparities

• diverse nursing workforce needed

  • cultural similarities between nurse and pt improves outcomes

• development of cultural competence

• being culturally competent health care organization positively impacts health, social, and business outcomes

nursing interventions

• establish partnerships with community organizations and engagement

  • neighborhood associations

  • social media pages for information exchange

  • after school and extracurricular activities

vulnerability

• results from individual and social factors

  • individual: preexisting illness, age

  • social: education, employment, housing, etc

• increases likelihood of developing health problems

• increased risk of health disparities

  • populations faced with health disparities are broader than racial and ethnic minorities and include underserved rural residents, populations with lower socioeconomic status, and sexual and gender minorities that confront discrimination and social disadvantage

SDOH

• contributes to health inequities and disparities

• socioeconomic status is major factor linked to disparaties

nurse’s role with vulnerable groups

• patient advocacy

  • equal treatment despite social factors

• culturally sensitive care

• address social determinants of health

• nurses that are culturally sensitive understand that this is an essential component of pt care from establishing rapport to the ability to make appropriate diagnosis through an understanding of pts language related to health and illness

social and community context

• children who have incarcerated parents

• dysfunctional family units (cps and dcf, domestic violence shelter, women and childrens shelter, we are mandatory reporters for abuse)

• bullying and violence (anonymously report violence, centers for counseling, friends are everywhere campaign)

• STIs and adolescent pregnancy (planned parenthood, public health department)

• SDOH

  • 1. neighborhood

  • 2. education

  • 3. economic stability

  • 4. health care

  • 5. social/community

  • 6. food (ati added)

strategies to improve social context

• studies have demonstrated that people function best and live longer with established ties to trusted groups of friends and family

• an infants brain grows and is positively molded w/in a supportive, nurturing environment

  • having consistent, responsive caregivers in the first years of life is important for the emotional health of a child

• one goal of healthy people 2030 is to increase the proportion of adolescents who have an adults they can talk to about serious problems

  • having strong positive relationships with adults can prevent adolescents from participating in risky behaviors that could lead to unhealthy outcomes later in life

• promote positive family relationships

• mentoring for adolescents

  • boys and girls club of america

• programs to prevent STIs and pregnancy in adolescents

  • healthy teen network

• support groups and counseling

neighborhood and built environment

• violence

• unsanitary water supply

• air pollution

• secondhand smoke

• noise

• failing infrastructure

• occupational hazards

• built environment refers to human made environment that provides the setting for living, working, and playin and supporting infrastructures such as water supply and energy networks

• people of color with low incomes are more likely to live in built environments with failing infrastructure that is harmful to their health

• blue workers tend to be exposed more to workplace health hazards than white collar workers

environmental health

• focuses on the interrelationship between a person, their environment and health

• contains assessment and control of environmental factors that affect health

• targets disease prevention and building healthy environment

• environmental health risks:

  • toxins: lead (lowers IQ, behavior issues, slow growth, wet cleaning, hire contractors, more updated housing draw blood to look at lab lvls, chelation therapy and bowl lavage), pesticides, mercury

  • air pollution: carbon monoxide, particulate matter, aerosols

  • water pollution: wastes, erosion after mining or timbering

  • contamination: food and food products with bacteria, pesticides

IPREPARE (exposure history) assessment

• Investigate potential exposure

• Present work (chemical industry)

• Residence

• Environmental concerns

• Past work (veteran)

• Activities (hobbies)

• Referrals and resources

• Educate

the community health nurse’s role

• encourage public participation to improve the environment

• develop a risk communication blog

• perform individual and population risk assessments

• conduct epidemiological investigations

• participate in policy development

nursing interventions: environmental health

• primary prevention

  • individual: educate to reduce hazards in environment

  • community: educate in groups to reduce hazards in environment; support programs = waste reduction

• secondary prevention

  • individual: survey health conditions r/t environment and occupational exposure. environmental health hx

  • community: survey health conditions r/t environment and occupational exposure

• tertiary prevention

  • individual: refer homeowners to lead diminishing resources and educate about asthma triggers

  • community: be active in consumer and health related organizations and support cleanup of toxic waste

global health

• our country’s health is determined by global health influences such as:

  • wars and political unrest

  • natural and man made disasters

  • limited resources and structure in lesser developed nations

  • international travel (increases spread of disease)

goals for global health

• educating hunger and extreme poverty

• making primary education available worldwide

• promoting empowerment of women and gender equality

• promoting a sustainable use of ecosystems, including forests and oceans

• developing global partnerships and promoting equality

• promoting individual well being an healthy lives

• ensuring sustainable water, energy, and sanitation

• promoting economic growth, industrialization, and innovation

• making safe human settlements and cities

• combating the effects of climate change

• promoting peaceful just societies

nursing interventions: global health

• support healthcare workers in countries that lack healthcare professionals

• promote the benefits of nursing as a profession focused on, health promotion, disease prevention, and healthcare cost reduction

• work with government agencies to develop policies to promote the rights of nurses

ANA principles of environmental health for nursing practice (do not need to memorize, but good to know)

1. knowledge of environmental health concepts is essential to nursing practice

2. the precautionary principle guides nurses in practice to use products that do no harm to human health/environment and takes preventative action in uncertainty

   1. better safe than sorry

3. nurses have the right to work in an environment that is safe/healthy

4. healthy environments are sustained through multidisciplinary collaboration

5. materials, products, technology, and practices in the environment impact nursing practice, are based on the best evidence

6. approaches to promoting a healthy environment respect the diverse values, beliefs, cultures, and circumstances of pts and their families

7. nurses asses the quality of the environment in which they practice and live

8. Nurses, other health care workers, clients, and communities have the right to relevant and timely information about potentially harmful products, chemicals, pollutants, and hazards to which they are exposed.​

9. Nurses participate in research of the best practices that promote a safe and healthy environment.​

10. Nurses must be supported in advocating for and implementing environmental health principles in nursing practice

health policy

• rules or laws that guide actions to improve health outcomes

• impacts health as local, state, and national levels

  • ex:

    • federal - affordable care act

    • state - medicaid

    • local - health department regulations

• health policy is influenced by economic factors and is often complicated with ideological and political debates about the best policy to be implemented

• for individuals, groups, communities or societies

• policies are created by governments, institutions and others

• depends on the type of facility, their care, etc

• ex:

  • FERPA - education

  • employee health policies (tobacco free zone, PPE requirements)

  • HIPPA (privacy policy, etc)

  • drug policies (procedures for handling certain meds)

quality improvement

fix the problem after a policy is broke or an incident occurs

quality assurance

checking to ensure adherence w/o specific incident

federal poverty level for one person vs family of 4 (DO NOT NEED FOR EXAM)

• one person → $15,000

• family of 4 → $33,000

public sectors

• health care delivered by the government

• paid for with taxes

• strengths

  • government funding improves access

• weaknesses

  • limited funding

  • bureaucracy: due to rules and regulations enacted by law, access to health care services can become difficult

• nurses are in a unique positions to influence policies that can impact the health of large populations in the public sector

• examples of public sectors: department of health and human services, centers for disease control and prevention (CDC), centers for medicare and medicaid (CMS)

costs of healthcare

• costs continue to rise

• provider shortage

  • especially primary care

• rising cost of medical education

• lack of funding

• shortage of PCP’s impacts costs of caring for chronic diseases