NURS 432 Midterm Exam Study Guide: Key Terms & Definitions

what is the definition of a population

- group of people who may or may not interact with each other but who have common health concerns/needs

examples of populations

people of same age, people with disabilities, same race/ethnicity

what are the aims of healthy people 2030

- Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.

- Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

- Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all - "Vital Conditions"

3 core functions for public health

-assessment

-policy development

-assurance

3 core functions for public health: assessment

- Monitor health status to identify health problems

- Diagnose and investigate health problems and hazards in the community

Evaluate the effectiveness, accessibility, and quality of personal and population based health services

3 core functions for public health: policy development

- Develop policies and plans that support individual and community health efforts

- Enforce laws and regulations that protect health and ensure safety

Inform, educate, and empower people with respect to health issue

3 core functions for public health: assurance

- Link people to needed personal health services and assure the provision of health care when otherwise unavailable

- Assure a competent public and personal health care workforce

- Inform, educate, and empower people about health issues

- Mobilize community partnerships to identify and solve health problems

Conduct research into innovative solutions for health problems

what is a health outcome

- Anything that might indicate health or well being of a population

- Could include measures of illness, aspects of health, quality of life

examples of health outcomes

- Cardiovascular disease

- HIV

- Depression/suicide

what is the definition of population health

- Field of study that focuses on the health needs of a specific group of people

- Population health address health needs of entire groups

- These health needs are affected by factors influencing individuals, neighborhoods, communities, and society at large

what are the duties of a population health nurse

- Focus on the health of the overall population

- Attention to determinants of health and their interactions

- Decision making based on scientific evidence of health status, health determinants, and the effectiveness of interventions

- "upstream" investment in strategies that maintain and promote health and address root causes of health and illness

- Application of multiple strategies

- Collaboration across sectors and levels of society

definition of microaggression

o are unintentional, daily, quick statements or actions of a discriminatory nature, based on dominant culture ideology; discriminatory belief systems

o Racial: daily commonplace insults and racial slights that cumulatively affect the psychological well-being of people of color (e.g. belittlement, whether intentional or unintentional)

o Can be directed at any marginalized group and be multi layered

examples of microaggressions

- For transgender people - 'so have you had the surgery yet?'

- For LGBQ people - 'that's so gay'

- For nursing students - 'you're so smart, why didn't you become a doctor?'

definition of prejudice

o Beliefs about groups of people based on specific characteristics of identities that make one group better than another

o The groups have hierarchical differences that are measured or judged

definition of systemic racism

o An umbrella term for the deep-seated inequality in society and antiblack ideologies; it is both historical and ongoing

definition of discrimination

o Actions taken (either implicitly or explicitly) based on prejudiced beliefs that result in treating groups of people differently or creating systems that advantage certain groups over others

- Individual (micro) - Institutional (macro)

definition of intersectionality

o The ways that class, race, gender, ethnicity, sexual orientation, ability, status and other markers of differences intersect to inform individual realities and lived experiences

o Brings attention to the ways that power operates in society to create marginalization of multiple groups while maintaining power of other groups

understand and apply strategies for addressing discrimination and reducing implicit bias in nursing

- Counterstereotype imaging: replace an image of a stereotypical group member with the image of someone who is in that group but does not fit that stereotype

- Emotional regulation: recognize negative reactions (fear, anxiety, frustration) to patients from vulnerable groups and intentionally strive to be empathetic, patient and compassionate

- Individuation: mindfully seek to see the patient as an individual instead of as a member of the stigmatized group. Address any assumptions that are coming up about the group so they are not impacting care of the individual

- Mindfulness: calm our thoughts, take a deep breath, pause before speaking.

- Perspective taking: purposely and empathetically think about what the patient is thinking and feeling, stimulating feelings of caring and compassion. Put yourself in their shoes.

- Partnership building: intentionally frame the clinical encounter as one where the nurse and patient are equals, working collaboratively toward a shared goal

definition of epidemiology

- The examination of the distribution of health and illness within a population, the causes of health outcomes, and using this knowledge to control disease or lessen the consequences of health problems

definition of casuality

o One event is the result of another event

o Links between contributing factors and resulting states of health and illness

example of casuality

· There is e.coli on the lettuce at the company picnic, everyone eats the salad, and then everyone ends up with GI symptoms in the ED

definition of risk

o Probability that a given individual will develop a specific condition

o may be absolute or relative

absolute risk

· Probability that anyone in a given population will develop a particular condition

· Example: risk of breast cancer among US women is one in eight

relative risk

· Probability that someone in a group of people with a particular characteristic will develop the condition when compared to people without that characteristic

· Example: when you look at women who are in a biological family that has a history of breast cancer, the risk is going to be much higher than those who do not have a family history of breast cancer

rates of occurence

o Statistical measures that indicate the extent of a health problem within a group

o Allows comparison between groups of different sizes or divide the instances of an event by the population at risk

o When we are looking for a "rate" we always are going to multiply these divisions by 1000 or 100,000

morbidity

is another term for illness. A person can have several co-morbidities simultaneously.

- are NOT deaths

mortality

is about actual deaths that occur

case fatality

o is the number of people who develop a health problem and will die as a result of it

- Ebola case fatality rate is very high

- HIV/AIDS case fatality rate used to be very high and now it could theoretically be zero if people have access to treatment

what is surveilance in public health

- it is DATA!

- Systematic collection, analysis, and interpretation of data in order to protect the public's health

- AND, the timely dissemination of the data to those who need to know in order to protect public's health

definition of prevalence

o Total number of people affected by a particular condition at a given point

o i.e. how many people have the illness or disease at a certain time

examples of prevalence

o Example: When we want to know how many people were symptomatic and not yet recovered from COVID 19 on June 1, 2020 in Wisconsin.

o Measure of disease BURDEN

o is a measure often used to determine the level of morbidity in a population.

prevalence rate

o statistical measure that tells you the proportion of a population that is affected by a particular condition at a specific point in time. It's calculated by dividing the total number of people with the condition (prevalence) by the total population and then multiplying by a factor (like 1,000 or 100,000) to make the number easier to understand.

o Formula:

- Prevalence Rate=(Total number of cases/ Total population)×1000 (or 100,000)

example of prevalence rate

· If a town has 200 people living with diabetes and the total population is 10,000, the prevalence rate would be:

· Prevalence Rate=(200/10,000)×1000=20 cases per 1,000 people

· The prevalence rate helps to show how common a condition is in a population at a specific time.

incidience

o Number of new cases of a particular condition in a specified time period

example of inciddence

o Incidence would be how many people were newly diagnosed with COVID-19 in Wisconsin between January and June of 2020.

o Measure of disease RISK

incidience rate

o the number of new cases of a particular condition identified during a specific period of time

§ New York City reported 3,870 new cases of COVID 19 from 8/21 - 9/3

· Divide by total population 8,336,817 then multiply by 1000 = 0.46

§ Wisconsin reported 10,295 new cases of COVID 19 from 8/21 - 9/3

· Divide by total population 5,882,000 then multiply by 1000 = 1.75

· Let's pretend NYC had the same number of new cases as WI did...

· Incidence rate would be 1.23 because the population is 3 million people more in NYC

definition of surveillance data

- Ongoing systematic collection and data analysis of health outcomes like infectious diseases

how do nurses find surveillance data

o Nurses are often responsible for collecting and reporting on nationally notifiable diseases to public health officials (filling out a form, making a phone call, or completing information into an online database)

o Nurses use surveillance data to monitor diseases in certain settings (hospital, community, population)

o To track the point of origin of some diseases, manage an outbreak, or investigate disease patterns

o To design and conduct population-level interventions (e.g., policy, environmental interventions) and to evaluate the effectiveness

herd immunity

o Protection due to the immunity of most community members, making exposure unlikely (previous infection/vaccination)

o It is the level of disease resistance of a community or population

natural immunity

o Natural defense mechanisms of the body resist specific antigens or toxins

- We all have which is why all of the viruses/bacteria around us all the time do not make us constantly sick

o When immune system is weak, opportunistic infections can develop from things that would otherwise not make a person sick

example of natural immunity

- Ex. Candida thrush in someone on chemotherapy or mycobacterium avium complex in someone with AIDS

acquired immunity

o Not born with it

o It is when pathogens are introduced to the body from a vaccine or a disease, the body learns to target those pathogens in the future by making new antibodies

-active and passive

active acquired immunity

- When our body produces antibodies in response to infection or immunization

- Requires an exposure to agent

- There are 2 ways to get: body produce antibodies in response to getting infection with causative agent itself or getting an immunization

passive acquired immunity

- Antibodies are given/transferred to the body

· Via mother to newborn and all the body does is store the antibodies that are given to it

· Thru administration of antibodies, plasma proteins or antitoxins

· Does not require exposure to infectious agent

chain of infection

o How the communicable disease gets around, how it moves from person to person

o Causative agent (bacteria, fungus, virus, parasite)

how to break the chain of infection

o Diagnosis and treatment

- Hand hygiene

- PPE (personal protective equipment)

- Food safety

- Cleaning, disinfection, sterilization

- isolation

o antimicrobial stwearrdship

modes of transmission

- Contact (direct and indirect)

- Airborne

- Droplet

- Vector-borne

- common vehicle

vector borne

- vector (mosquito, tick) carries virus from reservoir to susceptible host

common vehicle

- refers to agent transmitted by a food or water as well as drugs and parenteral fluids

o Ex. Food-borne salmonellosis, waterborne shigellosis, bacteremia resulting from intravenous fluids contaminated with gram-negative organism

stages of infections

1. incubation period

2. prodromal stage

3. illness stage

4. convalescent stage

incubation period

pathogen begins replication but does not yet cause symptoms

prodromal stage

- symptoms begin to appear but can be non-specific

illness stage

- pathogen reproduces and disseminates rapidly causing s/s

convalescent stage

affected tissues are repaired, and manifestations resolve

how does the chain of infection occur? Example

- 1. Incubation: after 2 weeks virus is replicating and contagious to others but no symptoms

- 2. Prodromal: acute HIV week 2-4 (fever, chills, swollen lymph nodes, rash, sore throat) - this will resolve

- 3. Illness: asymptomatic (no s/s for 5-15 years but the virus is attacking immune system); AIDS (severe immunosuppression finally shows symptoms and secondary infections - opportunistic infections)

- 4. Convalescent: immediately upon starting antiretroviral therapy

what are the steps for a community health assessment

- Define the community

- Collect data

- Analyze (organize, review, prioritize)

- Establish community diagnoses

- Plan programs

- Implement programs

- Evaluate program interventions

primary data

o data that you collect yourself

o you are the one doing the data collection and you are hearing directly from the individual/respondent

o Can be either quantitative or qualitative

secondary data

o data others have collected

o Someone else is tracking or collection, and you are simply gathering or reporting on what they found

o You did not obtain the data directly from the individual

quantitative data

o information that can be measured and written with numbers

qualitiative data

o information that described something in character

o A researcher has typed up the responses from the key informant interview to begin to review to identify themes

key informant interview

o Direct discussion with community members for the purpose of obtaining ideas and opinions about the community

- Usually leaders of community who also know "pulse" of community and can help identify issues

- Qualitative data can provide more nuanced detail due to the personal interactions and discussion being had

- Offers insights into beliefs and attitudes of the community

example of key informant interview

Example: A public health department wants to understand needs of mothers who have lost an infant to SIDS. They conduct interviews with leaders from several local churches who also connect them to several women who started a support group.

focus group

o a small-group discussion guided by a trained facilitator.

o Advantages is that people can share/bounce ideas off one another and you may glean more details than with only one individual person

o The group's composition and the group discussion are carefully planned to create a nonthreatening environment in which people are free to talk openly

§ Members are actively encouraged to express their thoughts

example of focus group

o Examples: A group of senior citizens meets at the new senior center to ask about needs for programming or other concerns.

- An agency wants to open a group home for developmentally disabled adults in a quiet residential area and convenes a group of prospective neighbors to identify any concerns or ideas

surveys

o Set of questions to collect data about a population and/or problem

o Written, online, or telephone

o Confidential/anonymous and often randomly sampled

example of surveys

- Example: Milwaukee Community Health Survey is an 18 minute phone based survey of 1800 Milwaukee County residents

participant observation

o Also known as "field observation" - many different definitions

o Observation of people, groups, communities going about life/activities as normal

o May or may not interact or question participants about things

example of participant observation

- Distinct from an interview because the researcher/nurse goes TO the people in their everyday life/home/neighborhood, vs the people leaving home to come in specifically for the interview

windshield survey

o Literally driving or walking through a community to observe "through a windshield" with little to no intrusion (they don't know you're there)

o Heavily relies on visualization and taking notes

o Can be combined with participant observation

o Survey components: people, place, housing, social systems

o You will be conducting Windshield Surveys around your clinical sites as directed by your clinical instructor

o Example: Your clinical site is a homeless shelter in an urban neighborhood, and the guests have to leave the shelter each day from 8am - 6pm. Many congregate in that same area or in a local park. You do a windshield survey of this area to better understand other resources available such as food, transportation, restroom facilities, health care, etc.

community empowerment

- Enables communities to identify health problems and act to resolve them

- To address health disparities

- Beneficial!

what is horizontal community empowerment

o Internal to community

o Reflected in community ability to solve problems mobilizing its own resources

what is vertical community empowerment

o Involves efforts to change power structures outside the community

o Leverages outside power and resources to address community concerns

stages of community empowerment

- Involve members of community in identification of the problem or issue to be addressed

- Development of objectives or expected outcomes to be achieved

- Development of strategic approaches to achieve those outcomes

- Management of everyday implementation of the campaign

- Evaluation of its effectiveness

- Building trusting relationships

- Building community members confidence and skill

- Engaging in empowering educational strategies

- Connecting individuals and groups to broader social networks

health outcomes

o Result of a healthcare service or intervention on patient health

- Disease, death, injury, patient experience

health differences

o Difference or variation in health outcomes

health disparities

o Specific kind of difference in measurable health outcomes among socially disadvantages groups

o Health differences that are avoidable, unnecessary and unjust

o Also called health inequalities

social disadvantages

o Someone relative position in social hierarchy (pecking order)

o Groups experiencing discrimination or marginalization based on : economic resources, race ,ethnicity, religion, nationality, gender, sexual orientation

- Economic disadvantage: low income, lack of wealth, inability to purchase goods

- Environmental disadvantage: residing in neighborhood or concentrated poverty and social disadvantages that accompany it

ethical and human rights principles/examples

o Human rights agreements: global consensus on fundamental values for all humans

o Implicit obligation to pay particular attention to segments of population who experience most social obstacles

o Right to health: right to attain highest possible standard of health and the standard of living necessary to protect and promote health

o Nondiscrimination and equality: everyone has equal rights and state is obligated to prohibit policies that have intention or effect of discriminating against certain social groups

what is health equity

- "social justice in health"

- Principle underlying a commitment to reduce and eliminate health dispairities

how to achieve health equity

- Striving for the highest possible standard of health for all people

- Giving special attention to needs of those at greatest risk for poor health based on social conditions

- Striving for health equity is what compels us to examine and address the causes of health disparities (SDOH)

what is the relationship between health and homelessness

- Poor health, illness, injury, or disability can cause homelessness when it leads to insufficient income

- Living on street, facing stressors of unstable housing can exacerbate existing health problems or cause new ones

o Chronic: hypertension, asthma, diabetes, mental health problems

o Acute: infections, injuries, pneumonia, covid-1

o risk of communicable diseases: STDs, TB

o Risk of violence due to lack of privacy or security

o Medications often stolen, lost, compromised due to weather

socioecological model

-Know the spheres of the social-ecological model and examples: Individual, Interpersonal, Organizational, Community, Structures/policy/systems

what is the definition of social determinants of health

- Access to power, money and resources, and the conditions of daily life - the circumstances in which people are born, grow, live, work, and age

what are the structural determinants of health

o Broad set of structural, cultural, and functional aspects of a social system that exert a powerful formative influence on social advantage

o Social advantage or disadvantage shapes access to the intermediary social determinants

o Cannot be measured at individual level

- Governance, macroeconomic policy, social policies, public policy, cultural and societal values

- Left side

what side is structual determinants of health

- Governance, macroeconomic policy, social policies, public policy, cultural and societal values

- Left side

intermediary determinants of health

o Material circumstances, psychological circumstances, behavioral/biological factors

o Members of lower socioeconomic groups live in less favorable circumstances

o Structural determinants have led to inequalities that have resulted in these intermediary determinants not being distributed equally

o Right side

what are socioeconomic positions

- Social class, gender, ethnicity and racism, educational attainment, occupation, income

what is upstream thinking

- Way ot thinking that aim to prevent problems from happening

- Incorporate social determinants of health: social, economic, environmental are origins of health problems that manifest at population level

what is the wheel of public health nursing used

- Public health interventions are population based if they consider all levels of practice

- Inner rings system-focused, community-focused, individual/family focused

primary prevention

-prevent onset of disease

examples of primary prevention

vaccinations, health education programs, wearing helmets, smoking cessation

secondary prevention

detect and treat disease in early stages to stop progression

examples of secondary prevention

regular screenings

teritary prevention

manage disease after it has been diagnosed

examples of tertiary prevention

rehab programs, surgery

when is the sympathetic nervous system triggered

· Happens in seconds, flight or flight

how does the stress response work

· Set of behavioral and physiologic processes provoked by a stressor

examples of stress-related health outcomes

· Stressful experiences during pregnancy may increase risk for preterm delivery, low birth weight, infant mortality

o Babies born preterm are at increased risk for chronic disease as they age

· Children and adolescents have increased risk of obesity, heart disease with increased exposure to stress

· Adults have increased risk for cardiovascular disease with increased levels of stress

Mental health including anxiety, depression, suicidality

social advantage vs disadvantage

· people with greater social status means more likely to experience stress in ways that have been beneficial effects on their health

o Their own sense of being able to successfully meet and resolve challenges is reinforced

· Less social status (social disadvantage) face more frequent and numerous stressors, while having limited social and material resources for coping

what is weathering

· Tenacious high0effor coping with chronic stressors due to marginalization

o Leads to chronic health conditions that are driving mortality rate

o People are not giving up, they are working so hard that they bear health consequences of years of stress