Community Exam 2

The Rehabilitation Act (1973)

Ensured that children could not be excluded from schools because of a disability

Required schools provide the health services that the child needs

Education for All Handicapped Children Act (1975)

All children should attend school in the least restrictive environment

Requires schools to develop IEP for children

Individuals with Disabilities Education Act (1997)

Required that more children be allowed to attend schools and required schools to make allowances for children’s special needs

No Child Left Behind (2001)/Every Student Succeeds Act (2015)

Requires accommodations to be made to promote academic achievement for children with disabilities and children living in poverty, children with limited English proficiency, or who were homeless

Individualized Education Plan

Personalized plan made for students who need them to help meet educational needs

Child Nutrition Act/Healthy, Hunger-Free Kids Act

Originally passed to combat hunger and malnutrition among disadvantaged children

Currently is an attempt to address childhood obesity and promote healthy living.

Roles of a School Nurse

• Direct caregiver: Caring for the children in schools who need it

• Health educator: Teaching done to children and faculty regarding health, prevention and promotion, or about a certain illness of a student.

• Case manager: Assist in coordinating care for the child while in school and outside.

• Consultant: Provide health information about policy and assist in policy development and EBP.

• Counselor: Act as a safe person for the student and often play a counselor role.

• Community outreach: Health promotion, wellness programs, screenings, and immunizations.

Purpose and Function of a school-based health center

• Provides a variety of health services to children who may not have access to other community resources

• Operated within schools and on-site

• Allows children to receive timely care and decreases time missed from class

• Allows the school nurse to easily assist families to get health care services for their children

Nursing Interventions provided in the school setting

• Health care services: acute care, pain management, education, chronic disease management

• Mental health counseling and services

• Adolescent sexual health education and services

• Relationship education, dating violence, and sexual assault education

Primary prevention in schools

Preventing injuries, preventing substance abuse behaviors, disease prevention, monitoring immunizations

Education!!

Secondary prevention in schools

Caring for children when they are acutely ill or injured, screening and assessing children, making referrals

Prevention of further injury/illness

Screening for at-risk children

Tertiary prevention in schools

Continued care of children who need long-term health care services

Management of asthma, diabetes, etc.

Nursing role in Occupational Health

Specialty practice that provides for and delivers health and safety programs and services for workers, worker populations, and community groups

Focus on prevention and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards

ADN or BSN prepared

10 roles of Occupational Health Nurse

Clinician, case manager, coordinator, manager, nurse practitioner, corporate director, health promotion specialist, educator, consultant, and researcher

Epidemiological Model: Host

1. Workers, Work families

   1. Each worker is considered a host within the worker population group

   2. Worker characteristics affect their susceptibility to illness and injury

      1. Age, gender, health status, work practices, ethnicity, lifestyle factors

      2. Workers at greatest risk for injury are those with less than one year of experience.

      3. Women in child-bearing years

Epidemiological Model: Agent

1. What is causing the illness or injury?

   1. Biological agents: viruses, bacteria, fungi, and other pathogens

   2. Chemical agents: smoke, asbestos, toxins

   3. Mechanical agents: bad body mechanics, machinery

   4. Physical agents: temperature, radiation, loud noises

   5. Psychological agents: burnout, violence, bullying

Epidemiological Model: Environment

1. Environmental characteristics affecting susceptibility to illness and injury. Affect host and agent interaction

   1. Physical factors 

   2. Social factors: overcrowding, sanitation problems

   3. Psychological factors

Primary Nursing interventions for Occupational Health

Promote health and avoid the problem

• Education of hazards

• Health promotion

• Programs to help with coping

Secondary Nursing interventions for Occupational Health

• Screening

• Health surveillance

• Elimination/modification of hazard producing situation

• Referral to other providers

• Change in job responsibility

Tertiary Nursing interventions for Occupational Health

Restore and achieve maximum level of functioning

• Rehab after illness/injury

OSHA

Purpose is to develop and enforce workplace safety and health regulations

Establish standards that regulate worker’s exposure to potential toxic substances

NIOSH

Purpose is to identify, monitor, and educate about incidence, prevalence, and prevention of work-related injury

Primary goals of Home Health Care

• Provide intermittent services to patients of all ages and all stages of life

• Promote health and wellbeing for patients, their families, and caregivers within their home environment

• Empower patients, families, and caregivers to achieve the highest level of physical, functional, spiritual, and psychosocial health

Skilled Nursing Services provided by home health nurses

Assessment

• Monitor trends, identify and evaluate potential changes in the client’s condition

Teaching

• Medication management

Case management

• Manage the client’s care with all members of the interdisciplinary team

Interventions

• clinical skills

Components of assessing a client’s living environment.

Safety evaluation

• Assess for fall risks (unsecured rugs, uneven floors)

• Exposed electrical outlets

• Extension cords

• Use of oxygen

• Appropriate lighting

• Safety devices

• Other environmental hazards (running water, electricity, heat/air, etc)

Does the client have food in the house to eat?

Is there help with household activities?

Does the client live alone?

Who is the client’s support system?

Is the client able to set up and dispense their own medication?

Does the client have access to health care?

Examples of interprofessional collaboration in home health

Team approach

Members include:

• nurses

• therapists

• social workers

• home health aides

• primary care provider

• specialists

Population Health

Approach to health that aims to improve the health of an entire population AND reduce inequities among population groups

Key components:

• Health determinants

• Health outcomes

• Policy development

Health Determinants

Factors that influence and shape an individual’s or population’s health status

• Include SDOH, lifestyle choices, access to health information and education, environmental factors, genetics, age, and chronic diseases

They interact and influence each other, so contribute disparities and inequalities

SDOH

Conditions in which people are born, grow, live, work, and age that shape health, functioning, and quality of life outcomes and risks

• Non-medical factors

• Not all are impacted by behavior modification

Environmental Health Assessment: I PREPARE

• Used to identify is client’s health problem is influenced by environmental factors

Investigate potential exposures

Present work

Residence

Environmental concerns

Past work

Activities

Referrals and resources

Educate

Foundational Aspects of economic stability

Income and social status

• Employment

• Food insecurity

• Housing instability

• Poverty

Major SDOH and key influencing factors from Healthy People 2030

• Economic stability

• Education access and quality

• Health care access and quality

• Neighborhood and built environment

• Social and community context

SDOH Nursing Clinical Process

1. Ascertain (population level)

   1. Determine prevalence of particular concern for population of interest

   2. Analyze whether population characteristics warrant special attention

2. Assess (individual level)

   1. Screen for concern using evidence-informed measures and supportive practices

3. Address (individual level)

   1. Apply personalized nursing interventions that meaningfully address the concern at hand

      1. Patient education

      2. Resource and interprofessional referrals

      3. Consultation with social worker/case manager/other professional

      4. Support and affirmation

4. Advocate (population level)

   1. Systemically encourage policy makers and funders to devote evidence-informed additional resources to concern

      1. Increase funding

Integration of pop health/SDOH into nursing

Crucial for addressing health disparities and improving patient outcomes, requiring nurses to understand and address factors beyond medical care, such as socioeconomic status and environmental conditions

• Screenings

• Advocating

• Referrals

• Connecting with resources

• Promote health equity

History and significance of Healthy People 2030

Increased focus on SDOH, with an emphasis on how conditions in the environment influence health

Implementation guides for all federal (and most state) health initiatives

Healthy People 2030

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

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

3. Create social, physical, and economic environments that promote attaining full potential for health and well-being

4. Promote healthy develop[ment, healthy behaviors, and well-being across all life stages

5. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all

Structural Racism

The ways that a society is set up in such a way that advantages and opportunities are preferentially given to those of one race rather than to the other

• implicit bias- pain treatment for POC

• health insurance- limitations w/ govt insurance

Health disparities

Differences that exist among specific population groups that prevent them from attaining their full health potential

Closely linked with social, economic, and/or environmental disadvantage

Health Equity

Everyone has a fair and just opportunity to attain their highest level of health

Elimination of health disparities

Target populations

Susceptible to actual or potential stressors that may lead to an adverse effect

Most likely to experience health inequities

Health literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Consequences of low health literacy

• Poor knowledge of chronic conditions

• Medication errors

• Poor nutrition knowledge and behaviors

• High obesity rates

• Less likely to use preventative services

• More likely to report health status as poor

• Higher mortality rates

Health literacy communication strategies

• Appropriate literacy level in preferred language

• Keep info simple and organized

• Use plain language

• Ask patient to use teach-back or read-back

• Provide written information to accompany the information provided verbally

Innovative roles of the nurse when working with target populations

• Lead, create, implement, and evaluate initiatives that support health equity

• Consider unique and innovative opportunities to support populations

SDOH related to obesity and environmental health

1. Economic stability

   1. Income and social status

      1. Employment

      2. Food insecurity

      3. Housing instability

      4. Poverty

   2. Ex: low income family = low access to healthy foods, high risk of obesity and diabetes

2. Education access and quality

   1. Early childhood education and development

   2. Enrollment in higher education

   3. High school graduation

   4. Language and literacy

   5. Ex: underfinanced public school = low graduation rates → unemployment, poverty, poor access to high quality foods, high risk of obesity and diabetes

3. Health care access and quality

   1. Access to health care

   2. Access to primary care

   3. Health literacy

   4. Ex: rural community = increased travel time to health care services, delayed diagnosis and treatment

4. Neighborhood and built environment

   1. Access to foods that support healthy eating patterns

   2. Crime and violence

   3. Environmental conditions

   4. Quality of housing

5. Social and community context

   1. Civic participation

   2. Discrimination

   3. Incartercation

   4. Social cohesion

   5. Ex: relationships/social/cultural opinions r/t importance of nutrition

Primary prevention to address obesity

Farmer’s markets

Nutrition education

Food Bank

Secondary prevention to address obesity

Screening in schools

Tertiary prevention to address obesity

Encourage use of walking trails

Diet changes

Community-based

Focused on individuals in the community

Ex: Obesity screening

Community-oriented

Focused on the community

Ex: Obesity- walking trails, exercise classes

Upstream: Interventions that affect large populations

Regulation/legislation, increased access, economic incentives

Prevent health problems before they occur

Ex: public smoking bans, school lunch program changes

Midstream: Interventions within organizations or populations

No smoking on campus, walking club

Downstream: individual level

smoking cessation programs, nutrition education/counseling, individual treatment and referrals

Environmental health risks

• Lead poisoning

• Climate change

  • Heat, severe weather, pollution, change in vectors, inc allergens, water quality, water and food supply. degradation

• Air quality

  • Point source (fixed): smoke stacks, factory

  • Nonpoint source (moving): Cars, busses

  • Indoor air quality

  • Smoking

• Water quality

• Land and food quality

  • fracking, land use, use of pesticides, growth hormone, abx use

Strategies to reduce environmental health risks

• Reduce, reuse, recycle. Everyone!

• Risk communication

  • provide the right information: accurate, relevant, concise

  • to the right people: those affects

  • at the right time

Environmental Health Risk Assessment

Used to determine the probability of a health threat associated with an exposure

• Step 1: Hazard Identification

  • What health problems are caused by it

  • Known adverse health effects

• Step 2: Dose-Response

  • What are the health problems of different exposures

  • Healthy level of exposure

• Step 3: Exposure assessment

  • How much of the pollutant are people exposed to during a specific time?

  • How many people are exposed?

• Step 4: Risk characterization

  • What is the extra risk of health problems in the exposed population

Role of the RN in environmental health

• Assessment

• Referral

• Community involvement and public participation

• Risk communication

• Epidemiological investigations

• Policy development

Public Health Approach to Violence Prevention

• Define the problem

• Identify risk factors

• Develop and test prevention strategies

• Disseminate and implement strategies

Socioecological Model: Framework for Prevention

Allows us to understand the various factors that put people at risk for violence or protect them. How factors at one level influence factors at another

Individual —> Relationship —> Community—> Societal

• Individual: biological and personal hx factors that inc risk of violence

  • Age, education, income, substance use, hx of abuse

• Relationship: Examines close relationships that may inc risk

• Community: Examine setting where social relationships occur

  • Neighborhoods: densely populated, poverty, gangs, transient community members, diversity

• Societal: Examines societal factors that help create a climate where violence is encouraged or inhibited

  • Cultural norms, religion

Factors that inc risk for abusive patterns

Upbringing

• Previous exposure to violence= greatest predictor

• Abusers have learned that violence is a way to manage confilct

Living Conditions

• Young parents

• Parents with many children

• Substance abuse

• Mental health problems

• Low income

• Crowded living conditions

• Social isolation

Increased stress

• Unemployment

• Marital strains

• Financial stress

Child Neglect

Physical: failure to provide adequate food, clothing, shelter, hygiene, or medical care.

• Often associated with extreme poverty (unintentional)

Emotional: omission of basic nurturing, acceptance, and caring.

• Effects healthy personal development and development of self-esteem

Child Sexual Abuse

¼ girls and 1/13 boys, often committed by someone the child knows

Long-term effects include PTSD, depression, substance abuse, sexual disorders, and suicidal behaviors

• Warning signs

  • Difficulty walking or sitting

  • Change in appetite

  • Bizarre or inappropriate knowledge of sexual behaviors

  • Somatic symptoms

  • Difficulty in social situations and forming relationships

  • Behavioral issues, increased sexual activity

Partner Violence: Signs of abuse

• Bruises and lacerations on face, head, and trunk of body

• Attacks are intentionally inflicted on hidden parts of the body

• Abused women have more physical health problems

  • IBS, HA, sleeping d/o, eating d/o, chronic pain, infections

Dynamics of Partner Violence

• Seriousness is often minimized at first

• Abuse places external blame

• Abuser apologizes and expresses remorse

• Escalates in severity and frequency over time, resourcefulness of abuser lessens

Nursing Interventions for IPV

Communicate honestly, openly, and with sensitivity

Complete screening in quiet and private setting. No one else present

Nursing Interventions for Child Abuse

Stay calm.

Encourage child to speak freely, do not ask detailed questions

Affirm the child and reassure them you believe them

Take action and report it immediately

Nursing Interventions for Elder Abuse

Build trust and confidence

Focus on the client rather than situation

Assess for immediate danger

Provide emergency care as needed

Work with the client to develop a plan for safety

Make needed referrals for community services and legal options

Complete mandatory reporting

Why is substance abuse a national health problem

Current leading ntl health problem in the U.S.

• Causes more deaths, illnesses, and disabilities than any other health problem.

Substance abuse is often a family disease

• Unhealthy coping, fam hx of abuse, codependency

Stigma associated with SA can prevent people from seeking health. Fear of judgement, embarrassment.

Community health nurses are frontline health professionals who can assist those with SA disorders

Opioid Crisis- morphine, heroin, codeine, fentanyl

• #1 cause of drug OD in the U.S.

Harm Reduction Model: Substance Abuse

Attempt to shift substance abuse from being a crime problem to more of a health problem. Increase humility and compassion toward abusers

• Addiction is a health problem → Any drug can be abused → Accurate info can help people make responsible decisions about drug use → People who have substance use disorders CAN be helped

Interventions:

• OD reduction: fent strips, naloxone education and availability

• Reduce sharing of equipment: syringe service, access to safe smoking supplies

Depressants

• Reduce activity of the CNS

• Lower the body’s overall energy level, reduce sensitivity to outside stimulation, induce sleep

• Ex: Alcohol, Benzos, Barbiturates, Opioids

Stimulants

• Increase activity of CNS

• Cause the user to feel more alert or energetic

• Ex: Nicotine, cocaine, caffeine, amphetamines

Primary Prevention of Substance Abuse

• Promotion of healthy lifestyles and resiliency factors

• Education about drugs and their guidelines for use, especially with adolescents

• Inc public awareness about hazards and risks of substance abuse

Secondary Prevention of Substance Abuse

• Identify at risk individuals

• Discuss sources of stress with clients

• Referral to social worker and other services

• Screen for substance abuse disorders

• Work with families to recognize the problem of addiction and codependency

Tertiary Prevention of Substance Abuse

• Preventing relapse

• Rehab services

• Support groups