Public Health Chapters 11, 15, & 18 Review

what are the steps of change by Kurt Lewin?

-unfreezing

-changing

-refreezing

unfreezing

-when the desire for change develops

-involves initiating the change

-motivated intrinsically or by some external force

changing

-when new ideas are accepted & tried out

refreezing

-when the change is integrated and stabilized in practice (new normal)

what are the 3 domains of learning?

-cognitive

-affective

-psychomotor

cognitive domain

-involves the mind & thinking processes

-deals with the recall or recognition of knowledge and the development of intellectual abilities & skills

-includes remember, understand, apply, analyze, evaluate, & create

affective domain

-learning that occurs through emotion, feeling, or affect

-deals with changes in interest, attitudes, & values

-difficult to measure but can be done through the use of self-report tools

-1. learners willing to listen, show awareness, and be attentive

-2. learners become active participants by responding to information in some way

-3. learners attach value to information (acceptance to commitment)

-4. internalize idea or value, consistent practice

psychomotor domain

-physical skills that are demonstrated through neuromuscular coordination

-learners must be capable of skill, have a sensory image of how to perform it, and must practice

social determinants of health

-the conditions in which people are born, grow, live, work, & age

-social & economic opportunities (access to finances & healthcare clinics)

-safe housing (radon & asbestos levels)

-quality education (health literacy)

-clean water, food, & air

-safe workspaces

-equitable social interactions

-adequate community resources

PRECEDE-PROCEED model

-8 total phases that mimic the nursing process

PRECEDE

Predisposing, Reinforcing, and Enabling Constructs in Educational/Ecological Diagnosis & Evaluation

-social, epidemiologic, education/ecological assessments, administrative/policy assessment & intervention alignment, implementation

PROCEED

Policy, Regulatory, and Organizational Construct for Educational and Environmental Development

-process evaluation, impact evaluation, outcome evaluation

what are the steps of the teaching process?

-interaction

-assessment & diagnosis

-setting goals & objectives

-planning

-teaching

-evaluation

evolutionary change

-gradual, modifications done in small increments

-helps reduce culture shock

-ex: decrease the number of cigarettes smoked per day

revolutionary change

-drastic, rapid change

-asking the patient to give up a behavior all at once

-new goals & behavior

-ex: quit smoking cold turkey

Pender's Health Promotion Model (HPM)

-revised in the 1980s

-focuses on predicting behaviors influencing health promotion

-individual characteristics & experiences

-behavior-specific cognitions & affect

-behavioral outcomes

principles of the C/PHN

-focus on the community (client or unit of care is the population)

-give priority to community needs (priority obligation is to achieve the greatest good for the greatest number of people)

-work in partnerships with the people (client as an equal partner)

-focus on primary prevention

-promote a healthful environment

-target all who might benefit

-promote optimum allocation of resources

-collaborate with others in the community

community

-the collection of people who interact because of geography, common interests, or goals

grand theories

-frameworks composed of concepts & relational statements that explain a phenomena or question

-highly abstract

-not directly applicable to nursing

middle-range theories

-limited scope

-less abstract

-intended to be used for practice & research

-self-care of chronic illness (maintenance, monitoring, & management)

self-management

-the process of recognizing changes in signs & symptoms, making decisions about self-care actions, & evaluating outcomes of that action

what are the dimensions of community as a client?

-status, structure, & process

OR

-location, population, social system

status

-most common measure of health community

-morbidity/mortality data

-identify physical, emotional, & social determinants of health

structure

-refers to the services & resources of the community

-provide means for assessing community needs

process

-reflects on the community's ability to function effectively

-community, state, & national levels

location

-community boundaries

-location of health services

-geographic features

-climate

population

-all of the people who occupy a certain area (city, country, state)

-look at the size, number of health care providers, is it crowded or spread out

-identify demographics, literacy, growth or decline, culture, mobility, & SES

social system

-health care delivery system (hospital, NP or PA services, tele-health, clinics)

what are the sources of community data?

-primary

-secondary

-national sources

-state & local sources

primary data

-information gathered by talking to people

-ex: health team members, client records, community health statistics, census bureau data, reference books, research reports, HEDIS measures, CHNs

secondary data

-records produced by people who know the community well

-cross check or validate these sources through focus groups, surveys, or other primary data collection methods

national data sources

-USDHHS

-CDC

-Healthy People 2030

state data source

-state health department

local data source

-social service agencies

methods for collecting community data

-surveys

-descriptive epidemiological studies

-geographic information system analysis

-community forums & social media

-focus groups

survey

-series of questions that provide a broad range of data

descriptive epidemiological studies

-examine the amount & distribution of disease within a population

-helps identify individuals at greatest risk

geographic information system analysis

-integration of research methods & analytic techniques for medical, geography, & epidemiology

-good for collecting, analyzing, & displaying public health data

community forums & social media

-qualitative assessments used to solicit the opinions of the community

-ex: town hall meetings

focus groups

-designed to obtain the opinions of a small group of 5-15 people

Roger's Model of the Science of Unitary Human Beings

-grand theory

-emphasized that the individual and environment should be viewed as one unit

-focusing on the individual without examining her or his environment or examining parts of a community (like healthcare or housing) does not provide an adequate picture of its totality in relation to the person

-incorporates 3 principles of developmental theory ->

1. life proceeds in one direction along a rhythmic spiral

2. energy fields follow a certain wave pattern and organization

3. human & environmental energy fields interact simultaneously & mutually, leading to completeness & unity

what is a community needs assessment?

-the process of determining real or perceived needs of a defined community

what are the different types of community needs assessments?

-windshield survey

-problem-oriented assessment

-community subsystem assessment

-comprehensive assessment

-community assets assessment

windshield survey

-familiarization with the community

-comprehensive

-can be expensive so not often used

-involves walking through the community and talking to people to gather information

problem-oriented assessment

-begins with a single problem and assesses the community in terms of that problem

-collect data on prevalence/incidence

-obtain information on policies

-identify programs & services

-used when familiarization or comprehensive assessment is not feasible

community subsystem assessment

-focus on a single dimension of community life

-ex: survey of religious organizations in the community

-useful for conducting a more thorough assessment

comprehensive assessment

-seeks to discover all relevant community health information

-review existing studies & all readily available data on the community

-expensive & time-consuming

community assets assessment

-focuses on the strengths & capacities of a community rather than its problems

-evaluates variables such as the needs & goals/resources available

planning to meet community health needs

-planning: use tools to create clear objectives, use the correct frameworks/models, systematic process

-implementing: adequate preparation is needed

-evaluating: measuring or judging the effectiveness of goal or outcome attainment

formative evaluation

-focuses on the process during actual intervention & development of performance standards

summative evaluation

-focuses on outcomes of interventions, effect & impact of plan

what are the 3 types of crisis?

-developmental

-situational

-traumatic

developmental crisis

-period of disruption during normal growth & development

-gradual onset, precipitated by a life transition point

-response to development demands and society's expectations

-ex: issues during pregnancy

situational crisis

-unexpected period of upset in physical or psychological being

-may be internal (cancer) or external (losing a job)

-ex: rape

traumatic crisis

-unexpected, overwhelming, and unusual event that can result in death, destruction, severe injury, or sacrifice

-ex: natural disaster

Munchausen sydrome by proxy

-a mental illness in which the parent or caregiver attempts to bring attention to self by injuring or inducing illness in their child

-the child is only ill when they are along with their caretaker (ex: only mom has witnessed a seizure)

child abuse

-an act or failure on the part of a parent or caretaker which results in death or serious physical/emotional harm

-ex: malnutrition

child neglect

-lack of resources necessary for physical, emotional, medical, or educational needs

-ex: child unattended, not dressed properly for weather, unkempt, inadequate medical care

child exploitation

-a range of crimes and activities involving the sexual abuse or exploitation of a child for the financial benefit of any person or in exchange for anything of value (food, shelter, clothing, drugs, etc.) given or received by any persons

-ex: selling of child pornography

emotional/psychological abuse

-psychological mistreatment or neglect which impairs a child's self worth and sense of security & being loved

-ex: rejection, scorn, terrorism, isolation, exploitation, lack of emotional response, exposure to domestic violence, verbal threats

-S/S: depression, acts older than age, suicidal thoughts

dynamics & characteristics of a crisis

-crisis are personally perceived by the individual at different levels

-internal or external force that disrupts a system of balance

-attempts to restore balance via coping

-precipitation by a specific identifiable event that becomes too much for usual problem-solving skills

-normal in that all people feel overwhelmed occasionally

-CHN must help individual confront the crisis

-resolution can be positive or negative

what is the timeframe for a crisis to resolve?

-4 to 8 weeks

know the characteristics/behaviors of an abuser in IPV

-controlling

-aggressive

-likely male

-substance use problems

-depression

-history of abuse

-loner

-poor sense of self-worth

-low earnings or unemployed

-conduct disorders as a child

-personality disorders

-emotional immaturity

-desire for power & control

what are the phases of intimate partner violence?

-tension building

-acute explosion

-honeymoon

-denial

tension building phase

-longest phase (up to several weeks)

-victim feels like they are "walking on eggshells"

-abuser is edgy, in a negative mood, verbally abusive, and controlling

-blames & yells at victim/criticizes them ("you made me do it")

-victim attempts to appease partner in hopes of calming the situation, may avoid family & friends

acute explosion phase

-shortest phase (1-2 days)

-most violent phase which is triggered by an external event or the abuser's state of mind

-victim may fight back or try to leave

honeymoon phase

-abuser may feel embarrassed so they apologize and promise it won't happen again

-victim forgives abuser & cycle restarts

denial

-common in each phase of IPV

-used to minimize the seriousness of the behavior and allows the cycle to continue