NR442-Community Health (Weeks One, Two, & Three) First Test questions and answers + rationales for student success

What influenced the Patient Protection and Affordable Care Act?

Strongly influenced by the rising numbers of uninsured & underinsured

What is the goal of Community and Public Health Nursing?

To preserve the health of the community and surrounding population including healing maintenance of individuals, families, and groups within the community.

What is Public Health?

A long term commitment to the community to focus on health promotion and prevention.

*Population based

*Grounded in social justice

*Relies on science of epidemiology

Describe Nursing

Relationship based care in an independent practice that is:

*Grounded in an ethic of caring

*Holistic

*Sensitivity to diversity

What are the goal of Public Health?

*Preventing Disease

*Prolonging life

*Promoting Individual and Community Health

Describe Community-based nursing

All nursing care provided outside of an acute care into the community.

- Provision of personal care to individuals and families in the community.

What are the roles of a Community Nurse?

-Immunizations

-Communicable disease surveillance & control

-Teach & monitor blood borne pathogen control

-Advise on prevention of vector borne diseases

-Teach methods for responsible sexual behavior & screen for STDs

-Screen for TB, identify TB contacts, & deliver directly observed TB treatment.

What is Community-oriented nursing?

All nursing care that is provided within in the overall focus of the well beings of the community.

Describe a community

People, place, social interactions/common characteristics

*Two types

-Geopolitical

-Phenomenological

Describe geopolitical

A spatial designation; a geographic or geopolitical area or place.

Describe phenomenological

Relationally-bound by similar characteristics, goals, and/or interests but do not live in the same area (Military)

What are social determinants of health?

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

-Childhood experiences

-Housing

-Education

-Social Support

-Family income

-Employment

-Communities

-Health Service access

Name some Health Disparities

*Culture

*Literacy

*Language

*Geography

*Socio-economic

*Access

*Gender

*Religion

What are the two major causes of death amoungst all ethics?

*Heart diseases and Cancer

What are some benefits of public health practices?

*Improved life expectancy

*Population-based prevention programs

*Potential issues identified

*Fundings

What is the vision of public health in America?

Healthy people in healthy communities

What is the mission of public health in America?

To promote physical and mental health and prevent diseases, injuries, and disabilities.

What are the essentials of public health service?

*Assessments, Policy developments, and assurance

What are some major public health issues?

*Alcohol, Tobacco, and Substance abuse

*Child and Adolescent growth & developmetal issues

*Chronic and noninfectious diseases

*Disabilities and decreased independence

*Environmental conditions

*Infectious diseases

*Mental Health issues

*Pregnancy & Birth defects

*Service delivery systems

*Unintended pregnancies

What are some public health interventions?

*Surveillance

*Coalition buildings

*Disease & Health investigations

*Outreach programs

*Screenings

*Referrals & Follow-ups

*Case Management

*Delegated functions

*Consultations

*Collaborations

*Community organization

*Advocacy

*Social Marketing

*Policy Development & Enforcement

*Health Disparities evaluated

*Counsiling

What are the core functions of Public Health?

1. Assessment

-Monitor health, diagnosis, & investigate

2. Policy Development

-Informed, educate, empower

-Mobilize community partnership

-Develop policies

3. Assurance

-Enforce laws

-Link to/provide care

-Assure competent workforce

-Evaluate

Describe the Stages of disease history

*Hunting & Gathering - prior to 10,000 BCE

*Settled Villages - 10,000-6000 BCE

*Prindustrial Cities - 6000-18,000 CE

*Industrial Cities - 17,000-18,000 CE

*Present Period - 19,000-20,000 CE

What are some Aggregate Impacts?

*Growing population

*Overpopulated

*Imbalanced Human Ecology (Changes in cultural adaption)

Who is William Rathborne?

The one who Founded the first district nursing association in Liverpool, England and helped establish district nursing throughout England with Nightingale.

Who is Lillian Wald?

She was a Founder of Henry Street Settlement House in NY and Founder of Public Health Nursing, who recognized connections between health and social conditions.

She advocated for the development of national and international policies.

What is NOPHN?

The National organization of Public Health

It improves educational & service standards of public health nursing & promotes public understanding of and respecting of workers.

What are some ways to decrease community acquired illnesses?

*Immunizations

*Nutrition Improvements

*Hygiene & sanitation education and improvements

*Improved medications

*Better Housing

*Innovative emergencies & Critical care services

What is the Nursing process amongst communities?

1. Assessment & Analysis

-Include community members

2. Diagnosis

-ID health issues and problems

3. Planning

-Include community leaders

4. Implementations

-Include community

5. Evaluation

-Includes process & outcomes

-Community members must contribute

What are the benefits of Community assessment?

Identifies community needs, problems, strengths, and resources.

What is involved in Community assessment?

*Defining the community

*Gathering relevant existing data and generating missing data

*Developing databases

*Interpreting data to identify problems & strengths

*Analyzing problems & developing a diagnosis

Describe the Community nursing process

1. Establish partnership

2. Assessment & Analysis

3. Nursing diagnosis

4. Planning

5. Implementation

6. Evaluation

May need to be renegotiated throughout the process

What is considered personal observations?

*Senses: sight, smell, hearing, taste, touch, & body

*Observe community members, read and collect literature on community (newspapers, TV, Publications)

What are existing data sources?

*Secondary analysis:

- vital stats

- census data

- CDC

*National sources:

- special interest groups

- longitudinal research

- state & local, Internet

What are Assessment Parameters?

- Physical environment

- Education level

- Safety and transportation

- Politics and government

- Health & Social Services

- Communication

- Economics

- Recreation

What questions are asked during Intervention work-planning?

*What is to be done?

*How will it happen?

*What resources are needed?

*Who is responsible for the interventions?

*When & Where will each action occur?

*How much time will be required?

*How much will it cost?

*Who will fund it?

What is included in the MAPP model?

*Community Themes & Strengths assessment

*Forces of change assessment

*Community health status assessment

*Local public health systems assessment

-Organize for success

-Partnership development

-Visioning

-4 MAPP assessment

-ID strategic issues

-Formulate goals & strategies

-Eval > Plan > Implement

What is invovled in the Evaluation process

*Formative vs Summative evaluation

*Questions answered by evaluation

*Ensure program met goals

*Documenting accountability by program managers to patients and the funding sources

*Shows whether the program fulfills purpose

*Used to make judgement about a program

*May be used to justify sustaining the program, making any adjustments, expanding/reducing program, or even discontinuing.

What is formative evaluation?

An evaluation throughout the nursing process that does a prior eval of outcome of care. During which the formation of nursing care is delivered., this care is modified throughout.

What is summative evaluation?

An evaluation done at the end, after the interventions, to measure outcomes and goal attainment.

* "The Sum"

* "The bottom line"

What is System Thinking Theory?

The study of how persons/units interact with other organizations/systems

What is Upstream Thinking Theory?

The focus on interventions that promote health and prevent illness

What is the Epidemiology Model?

The study of ways in which determinants of health and disease distributed in population (those who are/are not affected)

What is epidemiology?

The investigation of distribution or patterns of health events and what influences the patterns

-Studies the effect of disease state in population over time

-Predicts future health of community

-Evaluates health services

-Estimates individual risks from group experiences

-Identifies syndromes

-Informs prevention measures before disease becomes irreversible.

-Searches for cause

What is included in the Epidemiological Triangle?

1. Social:

- Nutritive, Chemical, Physical, Infectious, Agents

2. Biological:

- Genetics, Age, Sex, Ethics, Physiological, Immunological, Intercurrents, pre-existing diseases, behavior

3. Environmental:

- Influence existence of the agent, exposure, suscept. (Physical, biological, social environments)

What is Descriptive epidemiology?

It Describes who, why, and when affected

-Localized/Pandemic

-Distribution, deaths, and outcomes

-Person, place, and time model

What are Characteristics of Epidemiology?

-Race

-Ethics

-Age

-Education

-Income

-Marital Status

-Sex

-Occupation

-Geographics

What are some questions for "Time"?

-Is there an increase or decrease in frequency?

-Are there other temporal patterns?

*Secular trends (long term patterns of morbidity/mortality)

*Point epidemics

*Cyclical (Disease patterns)

*Patterns

*Events related to clusters

What is analytic epidemiology?

The factors determined health event

-Exposure, Factors, Behaviors

-Determinants of patterns (how & Why)

What is Ecological Fallacies?

Associations observed at group levels that may not hold true for individuals who make up groups or associations that actually exist, may be masked in group data.

What are Problems and Events Investigated?

-Environmental Exposures:

* lead/heavy metals, Air pollutants, Asthma triggers.

-Infectious Disease:

* Food borne, airborne, contact.

-Injuries:

* Increased homicides/domestic violence

-Non-Infectious Disease:

* Localized/Widespread, rise in cancer, Increase in birth defects

-Natural Disasters:

* Hurricanes, earthquakes

-Terrorism:

* Trade Center, Anthrax

What is a rate in Epidemiology?

A statistic used for describing an event, characteristics, or happenings

-Time is important/proportion

-Makes comparisons among populations

Whar is Crude Rate?

Total Population

What is Specific Rate?

Subgroup of a population

What is Attack Rate?

New cases in those exposed

Whar are Routinely Collected Data?

-Census

-Vital Records

-Surveillance (CDC)

-Medical

-Health Department

-Insurance

What is Rate formula?

(Number of events/population at risk) X 100,000

What Morbidity?

The event that illness or disease symptoms are present and affecting a population

What is Mortality?

The number of deaths as a result of a disease or health event

What is incidence?

New cases of disease or illness

What is incidence rate?

(Number of new cases/population at risk) x 100,000

What is prevalence?

Number of all cases of disease or illness

What is Prevalence Rate?

(All Cases/population at risk) x 100,000

What are vital statistics?

-Death/Birth/Marriage/Divorce Certificate

-Crude birth rates

-Crude death rates

-Infant Mortality (Increase in African American)

-Mortality death rates

What is included in Demographic Data?

-Age

-Sex

-Race

-Ethics

-Social Class

-Occupation

-Marital/Health Status

-Health related behavior

-Use of Health Care

What is endemic?

Disease that occurs at a constant expected level in an area

What is Epidemic?

An unexpected increase of an infectious disease in an area over an extended period of time

What is a pandemic?

Steady occurrence of a disease over a large area/world-wide

What is the Nursing role of epidemiology surveillance?

-Case finding:

* Identifies who may be infected from exposure, identifying risk factors, and high risk behavior locations

-Reporting:

* Mandatory to CDC, 74 diseases

-Surveillance:

* Use of statistic measurements to look for trends, cycles, and monitoring (Who, What, When, Where, and Why)

-Follow-Up Evaluation:

* Is problem controlled?, Measures for preventions

What is the Triangle of Epidemiology?

host, agent, environment

What is a Vector?

Mechanical or Biological role in transmission of disease from source to host (insect).

What is an Agent?

Infectious, chemical, physical

-Microbes

-Bacterial

-Fungus

-Virus

-Parasites

What are Factors of agents?

-Virulence: the ability to produce severe disease

*Higher virulent organisms cause greater morbidity/mortality

-Pathogenicity: Seriousness

-Invasiveness: Spread throughout the rest of the body

-Infective dose: amount of microbes needed to produce a response.

*Highly infectious- Small amount of microbe needed to cause illness

-Resistance

What is a host?

Genetic susceptibility, acquired immutable characters, characteristics, life styles

What are environmental factors?

-Climate

-Plant/Animal

-Human Population Distribution

-Socioeconomic factors

-Working conditions

What is a Wheel Model?

Shows multiplicity of host and environmental factors

-Agent, Host, Environment

What is The Web of Causality?

Multiple population and environmental factors causing illness or disease

-Illustrates the complexity of relationships among casual variables for diesase

Ecological Model

Studies upward/broader context and downward to genetic and molecular etiology

-Encompasses determinate at many levels (biological, mental, behavioral, social, & environmental)

-Includes policy, culture, and economic environment.

Ecosocial Approach

Emphasizes role of evolving macro level factors and microbiological process in understanding health and illness.

-Challenges individual focused risk factors approach to understand disease.

Levels of Prevention

-Primary: Reduction of risk factors before occurrence of disease, condition, or injury

-Secondary: Early detection of potential development of disease, condition, injury

-Tertiary: Treatment of an existing symptomatic disease to delay/prevent progress

Primary prevention

Health promotion:

-Education

-Good Nutrition

-Personality development

-Adequate housing, recreation, & agreeable working conditions

-Marriage Counseling

-Sex education

-Genetics

-Periodic selective exams

Specific Protection:

-Immunizations

-Hygiene

-Environmental sanitations

-Protection against occupational hazards

-Use of specific nutrients

-Prevent/protect against accidents

-Protection from carcinogens

-Avoidance of allergies

Secondary prevention

Early diagnosis & Prompt treatment:

-Case finding measures, individual & mass

-Screening Surveys

-Selective exams (Objective)

-Cure & prevent disease process

-Prevent spread of communicable disease

-Prevent complications & sequelae

-Shorten periods of disability

Disability Limitation:

-Adequate treatment

-Provision of facilities

Tertiary prevention

Rehabilitation:

-Provisions of hospitals/facillities

*Retraining

*Education

-Education for the public on rehabilitation

-Selective placement work therapy

-Shelters

Communicable disease

-Emergence of new pathogens

-Re-emergence of old pathogens

-Appearance of drug-resistant pathogens is creating formidable challenges in U.S./World wide

Vector borne Infections

-Lyme disease

-Rocky Mountain spotted fever

-St. Louis encephalitis

-West Nile encephalitis

-Zika

How many died from the flu pandemic in 1918?

50 Million deaths

Mary Mallon

AKA Typhoid Mary. Cook in several NYC boarding houses from 1896-1906. Caused 28 cases of typhoid & was arrested. Released, changed name & caused several more outbreaks.

3 Topic areas for improved health

1. Immunization & Infectious diseases

2. Sexually transmitted diseases

3. HIV

3 Stages of HIV

1. Primary infection, within 1 month of contract

-May go undetected

-May experience mononucleosis syndrome

2. Incubation period, not symptoms

-Use of strong antiviral therapy (Increases survival time)

3. Symptomatic disease (AIDS)

-Decreased T-Lymphocytes (less than 200mL)

-AIDS related opportunistic infection

AIDS-related opportunistic infections

-Pneumocystis jiroveci carinii pneumonia

-Oral candidiasis

-Pulmonary tuberculosis

-Invasive cervical cancer

-Recurrent pneumonia

Ways of Exposure of HIV/AIDS

-Heterosexual contact

-Homosexual

-IV Drug use

-Hemophilia

-Blood transfusion

Epidemiology Triangle

-Host

-Agent

-Environment

Factors contributing to Host

-Human demographic change

-Risky human behavior

-Human Susceptibility

-Poverty & Social inequality

Factors contributing to Agent

-Evolution of pathogenic infectious agents

-Development of resistance to drugs

-Resistance of vectors to pesticides

Factors contributing to Environment

-Climate & changing ecosystems

-Economic development & Land use

-Technology & Industry

-International travels & commerce

-Breakdown of public health measures

-Deterioration in surveillance systems

Stages of Infection

-Latent period: Infectious agent invades host & found conditions hospitable to replicate.

-Communicable period: Follows latency, begins with shedding of agents.

-Incubation period: Time from invasion to time when disease symptoms first appear. (May overlap with communicable period)

Vaccinations

Provide acquired immunity by exposure to specific infectious agents.

*1983 = 24 doses/11 injections

*2016 = 69 doses/50 injections

Immunity

1. Innate

2. Adaptive

a. Natural-infected with disease & develops immunity from body's antigen-antibody response

-Passive (Maternal)

-Active (Infection)

b. Artificial-Vaccinations

-Passive (Antibody Transmission-mother to fetus, immunoglobulin)

-Active (Immunization)

Immunization

Broad term for a process which active/passive immunity to an infectious disease induced/amplified.

Vaccination

Narrower term referring to the administration of a vaccine or toxoid to confer active immunity.

Communicable Disease Chain

Application & CAT concept map

-Infectious Agent

-Reservoirs

-Portal of exit

-Means of transmission

-Portal of Re-entry

-Susceptible Host