B223 Healthy Populations Exam 2

screening

- Secondary Prevention
- detection of disease in its early stages
- treat disease and prevent progression

Benefits of screening and early detection

- reduce cost of disease management
- avoiding costly interventions required for later stages

Advantages of screening

-simple screening tests are cost- effective
-screening processes can be applied to both individuals and larger populations
-some screenings mandated by law
- screening can be one test disease specific or multiple test screening
- creates opportunity for health teaching

Screening Parameters

- early detection
-identify risk factors and populations at risk
-screening is crucial to health promotion

disadvantages of screening

-uncertainty in scientific evidence- possibility of errors
- any margin of error can have serious consequences
- false positive
-false negative

Selection of a screenable disease

- does its significance warrant its consideration as a community problem?
-Can the disease be detected by screening?
-should the screening be done?
-Health benefits- can it be treated?
- emotional and financial costs

epidemiology

method used to find cause of disease( and outcomes) in a population

Morbidity

Diseased state or disability from any cause

Mortality

deaths in a given population as end outcome indices

Significance

level of priority of disease as public health concern

Determinants of significance

-Prevalence and incidence
-quality of life: subjective
-quality of life(severity of disease)
- political and public interest have influence

Estimating Quality of Life

Quality adjusted life year
disability adjusted life

quality of adjusted life year

perfect health minus the disability adjusted life year
- 1 year of excellent health = 1QALY

Disability adjusted life year

-year spent in less than healthy life
-measure of the burden of disease
-Measures gap between current health and excellent health status

screening Criteria

-detection
-diagnostic criteria
-screening measures

screening measures

-reliability
-validity
-consider efficiency/ efficacy of mass screening programs

components of community screening

-community resources
-development of community health program

Development of community health program

- lead agency: oversees development
-partnerships with community stakeholders
-target population, resources, health needs, program strategies identified
-program constraints

Should screening for the disease be done?

- is there any benefit to early detection?
- are there effective treatments available?
- interventions/ treatment modalities

screening guidelines

us preventative services task force puts forth guidelines

Ethical considerations

- request for participation implies a health benefit
- need to clarify issues: prevention, ameliorative, curative
- controversies of screening results

Economic costs and ethics of screening

- cost of health screening
- cost benefit ratio, cost effectiveness, cost efficiency analysis
- goal: determine optimal use of resources to achieve desired health outcome

cost- benefit ratio

- allow comparison of various outcomes in monetary terms
- cost screening vs cost of vaccine
- chronic disease cost calculator

cost effectivness

- determines optimal use of resources to reach desired health outcomes
- limited resources= must choose among various screening options

cost efficiency

- goal is to be efficient- budget limited funds toward optimizing goal
- funds are the focus
-many goals and limited funds

screenable population

- decision based on incidence and prevalence
- goal is to minimize cost, maximize benefits
- person dependent factors
- environmental dependent factors

Affordable Care Act and Prevention Incentives

-focus on prevention and health promotion
-preventives services be covered without copayment or co insurance
created the national prevention council

Nurses role

- development of implementation of screening programs
- decision maker
-planner
-educator
- follow-up

Nursing and Health Education

- health education includes facilitating health related behavior change
-health teaching and promotion is a primary nursing responsibility
-nurses usually function as health care coordinators for patients
- health education principles provide tools and strategies to assess readiness

Health Education

- any combination of planned learning experiences based on sound theories
- provide persons with the information and skills needed to make quality health decisions

Key Components of health education

- teaching- learning strategies
- learners maintain voluntary control to change
- focus on behavior change to improve health

Goals of Health Education

- help individuals, families and communities achieve optimal health
- change health behaviors
- improve health status

Health literacy

degree to which individuals have capacity to obtain health info to make appropriate decisions

Health Disparities

systematic health differences that adversely affect socially disadvantaged groups

Empowerment

belief that once can make a difference in ones health

learning assumptions

fundamental planning to successful health education
- consider developmental stage, cognitive level, individual interest, children need special planning

Family Health Teaching

Family: unit in which health values, habits, and risk perceptions are developed
Goal: help members achieve optimal state of health

Health Behavior Change: Ecological model

health behavior viewed as complex interaction of individuals with environment

Health Belief Model

-Paradigm to predict and explain health behavior
- provide guidelines for nurse
-Guides nurse to choose effective educational strategies

Social Cognitive Theory: Bandura (1997)

-emphasizes the influence of efficacy belief on health behavior
- includes roles of reinforcement and observational learning in explaining health behavior
-modeling

Self- Efficacy

individuals belief in ability to influence his own health

Transtheoretical model of change: Prochaska an d DeClemente (1984)

- stages of change model
-determine where a person is re behavior change
-readiness for change
-respect the person right to choose

Stages of Transtheoretical model of change

- Precontemplation
-Contemplation
-planning
-action
-maintenance

Strategies to facilitate change

- maintain behavior change
-assess behavior
-education about need for/ benefit of change
-motivate unsing personalized messages
-assess/increase self efficacy
-decrease barriers to change
-modify behavior

Ethics

- respect for human dignity
-right to autonomy or self-determination
-promote environment where people can make informed, free choice

Culture

- assess cultural beliefs
-provide culturally sensitive person education
-seek to understand and show respect for cultural differences

Genomics and Health Education

- new opportunities
-facilitate screening and testing
-Ethical issues: what info to disclose and with whom
-Risks I D
- clarify meaning and implications of test results
-nurse include genetics and genomics into education programs

Diversity and Health Teaching

- culturally appropriate education and health promotion is the expected standard
-culture influences health beliefs and impacts prevention strategies
-non english speaking persons are challenging and vulnerable
-Language used should be friendly to LGBT
- respect differences

Community and Group Health Education

- social marketing
-Goal: to change behavior
Ex. Smoking cessation, seat belts, gun safety

Social Marketing

process which uses marketing principles and techniques to influence behaviors

Teaching Plan

- follows marketing and administrative plans
-desired behavior change for health promotion
- plan written from a learners perspective
-individual is an active participant
- plan should clarify learner outcomes

Assessment

- determine learner characteristics and learning needs
- age, developmental stage, level of education
- health beliefs
-motivation
-health risks
- current knowledge and skills
-barriers

Determining expected Learner Outcomes

- outcomes driven by public health, societal and participant goals
-program goals: long range expected outcomes

Cognitive Domain of Learning

new facts or concepts, building knowledge

Psychomotor domain of learning

developing physical skills

Affective domain of learning

recognition of values, beliefs, relationships, attitudes

Blooms Toxonomy Levels of learning

order learning objectives according to complexity
- knowledge
-comprehension
-application
-analysis
-synthesis
-evaluation

Lecture: Teaching Strategies

present large amount of information

Discussion

interaction between teacher and learner

Demonstration/practice

learn psychomotor skills

Simulation

allow to practice responses to challenging situations

stratagies for evaluation

-written or oral test
-demonstrations
-observations
-self reports
-self monitoring

Evaluating the teaching- learning process

-evaluation improves subsequent programs
-statistics may reveal programs impact on public health goals
-include resources for continuing education

Teaching and Organizing Skills

-Learn: nurses need to learn teaching and education skills in health education
-use: use self assessment, goal, and intervention process for own skill development
Evaluate: evaluate skill progression after programs

Classic vitamin-deficiency diseases

- prevalent in the united states until 1940s
-rickets, pellagra, scurvy, beriberi
- no longer common in developed areas
-todays most common deficiencies are iron and calcium which result in anemia and osteoporosis

`Dietary Inadequacy

- most prevalent in developing countries
-some imbalance in us impoverished areas
- anorexia, bulimia, binge eating
-sequela potentially life threatening

Dietary Excess

-obesity or overweight

Four Leading diet related causes of death

CHD, cancer, CVA, DM

Health people 2020 Nutrition Objectives

- designed to reduce obesity in children/adults

Food Insecurity

access to adequate food limited by lack of money

Myplate

food guidance system designed to help individuals make healthy food choices

Dietary reference intakes

- recommended daily allowance
-adequate intake
-estimated average requirement
- tolerable upper intake level

Recommendations of food and nutrition

- focus on optimizing health and decreasing risk of chronic disease through nutrition
- used for planning and assessing diets

Dietary Guidelines for Americans

- follow healthy eating pattern
-focus on variety, nutrient density, amount
- limit calories from sugar, saturated fats
-shift to healthier food and beverage choices
- support healthy heating patterns for all

Food Guidance system

-evolution from myplate
- added recommendations for physical exercise
-interactive through internet
-mysuper tracker and blastoff

Dietary supplements and herbal medicines

-vitamins, minerals, herbs, botanicals, amino acids
unregulated by FDA
vitamin toxicity

2010 food safety modernization act

-FDA given new powers to police food safety
-prevent food contamination

Common food contaminants

E.coli, Salmonellosis

Chemical food contaminants

pesticides and toxic chemicals

Physical food contaminants

dirt, glass chip, wood, metal shavings

Mad cow Disease

bovine spongiform encephalopathy- incurable
- from unsafe meat producing practices
infectious protein like particle

Food safety practices

- clean
-seperate
-cook
-chill

Supplemental nutrition assistance program

Food stamps
monthly allotment to help low income families by nutritious food

National school lunch program

help schools provide balanced low cost/ free lunches

School breakfast program

- having breakfast improves school performance
- follows same guidelines as lunch program

Supplemental nutrition for women, infants, and children

- supplemental foods and nutrition education to low income pregnant/ postpartum women

Commodity Supplemental food Programs

- food distribution to Native American Reservations and other settings

The Older Adults Nutrition service program

- provide older adults with nutritious meals
-meals on wheels, congregate feeding settings

Food Secure

enough money for adequate food vs food insecure

Low income families

- spend significantly higher percent of income on food
-15.1 of us population live below the poverty level

Nutrition Screening

- discover characteristics or risk factors associated with dietary/ nutrition problems
- older adults as disproportionate risk

Cardiovascular disease and nutrition

- goal is to avoid CVD
- balanced diet with emphasis on fruits, vegs, grains