Community Health - Exam 1 Blueprint

What is systems thinking?

· Studies how an individual or unit interacts with other organizations or systems

· Useful in examining cause & effect

What is upstream thinking?

· Used to focus on interventions that promote health or prevent illness, as opposed to medical treatment models that focus on care after an individual becomes ill

· Useful in examining preventative measures

Nightingale's environmental theory

· Highlights the relationship between an individual's environment & health

· Focus is preventative care (upstream thinking)

Health belief model - people will make a change if these 4 actions are true

· Perceived susceptibility, seriousness, & threat of a disease

· Modifying factors (age, gender, race, knowledge level)

· Cues to action: advice from Dr., social media, commercials

· More benefits than barriers - take action / more barriers than benefits - will not

Milio's framework for prevention

· Complements the health belief model

· Emphasizes change at the community level

· Connections between health deficits & prevention

· Theorized that large numbers of community members could bring about social change by changing behaviors among themselves

Pender's health promotion model

Does not consider health risk as a factor that provokes change

· Factors that affect individual actions to promote & protect health:

o Personal

o Feelings, benefits, barriers, & characteristics associated with action

o Attitudes of others

Transtheoretical model (TTM) or stages of change (SOC)

1. Precontemplation: unaware of need to change

2. Contemplation: considers change, weighs the benefits with costs

3. Preparation: plans to take action

4. Action

5. Maintenance: implements actions to continue behavior

6. Termination: individual is consistent, efforts to continue are no longer needed

Precaution adoption process model

· Same as TTM but with one more stage

· Un-engagement stage between pre-contemplation & contemplation

· Un-engagement stage: knowing it's bad, but still going through it

Does not include termination stage

What are some examples of determinants of health?

Factors that Influence client health

· Nutrition

· Social support

· Stress

· Education

· Finances

· Transportation & housing

· Biology & genetics

· Personal health practices

What are health indicators?

· Describe the health status of a community & serve as targets for the improvement of a community's health

· Ex: mortality rates, BMI, tobacco use

What is a community?

A group of people & institutions that share geographic, civic, &/or social parameters

What is the goal of community health nursing?

To promote, preserve, & maintain the health of populations by the delivery of health services to individuals, families, & groups in order to influence "community health"

What is the focus of community-oriented nursing?

· Aggregates, communities, populations

· Can include at-risk or unserved individuals & families

What is the primary goal of community-oriented nursing?

Health promotion & disease prevention

What are the nursing activities in community-oriented nursing?

· Usually indirect (program management)

· Can include direct care of at-risk individuals & populations

What is the focus of community-based nursing?

Individuals & families

What is the primary goal of community-based nursing?

Management of acute or chronic conditions

What are the nursing activities in community-based nursing?

· Direct care (one-on-one)

· Illness care: management of acute & chronic conditions in settings such as schools, camps, & prisons

What is public health nursing?

Population-focused & involves a combination of nursing knowledge with social & public health sciences

What is the goal of public health nursing?

Promoting health & preventing disease

What are the 3 core functions of public health nursing? (broad & population-focused)

· Assessment

· Policy development

· Assurance

What is the purpose of assessment?

Monitor health status to identify community health problems

What is the purpose of policy development?

Develop policies & plans that support individual & community health efforts; may also promote laws to increase health of population

What is the purpose of assurance?

Making sure adequate health care personnel services are accessible, especially to those who might not normally have them

What are the key principles of population-focused nursing? (such as uninsured or at risk for specific disease)

· Emphasize primary prevention

· Work to achieve the greatest good for the largest # of individuals

· Recognize that the client is a partner in health

· Use resources wisely to promote best outcomes

What are some factors to consider when providing community health nursing practice?

· Professional collaboration & communication

· Ethics

· Evidenced-based practice

· Advocacy

· Quality

What is an example of public health advocacy?

Nurses working to promote access to clinics for individuals who live in rural communities

What is the purpose of evidence-based practice in community health nursing?

· Uses best practices, expert opinion, & client preferences to change the delivery of client care

· Goal is to improve client outcomes

What are some factors to consider when providing professional communication in community health nursing?

The nurse should incorporate knowledge about variations in verbal & nonverbal communication, literacy needs, & client preferences when interacting with clients & groups

What are some benefits of professional collaboration & communication?

· Increased client adherence to treatment plan

· Reduced admissions to acute care

· Reduced cost of care

· Shared decision-making with clients & family

· Reduced medication errors

Healthy People was initiated in

1979 and every 10 years published national health objectives that serve as a guide for promoting health/preventing disease

What are some examples of preventive services in health promotion & disease prevention?

· Health education & counseling based on scientific evidence

· Immunizations

· Taking preventative medication

· Lifestyle changes

· Other actions that aim to prevent a potential disease or disability

Healthy people objectives impact the following areas

- Chronic Kidney Disease

- FAMILY PLANNING

- food safety

- disability

much much more

Successful screening programs provide accurate, reliable results, can be _____ & quickly administered to large groups, and produce ____ adverse effects

Inexpensively, few

What are some examples of primary prevention?

· Nutrition education

· Family planning & sex education

· Providing immunizations

· Safety education

- advocating for access to health care/healthy environments

What are some examples of secondary prevention?

· Disease surveillance (communicable diseases)

· Screenings

· Cancer (breast, cervical, testicular, prostate, colorectal)

· Diabetes mellitus

What are some examples of tertiary prevention?

· Rehab

· PT & OT

· Support groups

· Nutrition counseling for a management of Crohn's disease

Dietary preferences & end-of-life care for Catholics?

· Avoid meat on Ash Wednesday & Fridays of lent

· Reconciliation & holy communion; priest anoints the sick

Dietary preferences & end-of-life care for Mormons?

· Alcohol, coffee, & tea are prohibited; meat consumptions is limited

· A sacrament may be administered if client requests

Dietary preferences & end-of-life care for Jehovah's Witness?

· Any food with added blood is prohibited, can have it if it's been drained

· Believe the soul cannot live after the body has died

Dietary preferences & end-of-life care for Islam?

· Any meat product not ritually slaughtered are prohibited

- left hand considered unclean (use right to feed, etc)

· Head should be elevated above the body

· Stopping medical treatment is against the will of Allah

· Same-gender Muslim should handle body after death

Dietary preferences & end-of-life care for Judaism?

KOSHER Laws

- allowed meats: animals that are herbivores, cloven-hoofed animals (cows, goats), and animals that are ritually slaughtered

- fish that have scales and fins are allowed

- meat and MILK cannot be prepared or served together

- 24 hour fasting during Yom Kippur (pregnant women, children, and ill are exempt)

- only unleavened bread (no yeast) is eaten during Passover

End-of-Life Care

- client must remain on life support until death

- a dying person should not be left alone (Rabbi's presence is desired)

- autopsy and cremation are NOT allowed

Dietary preferences & end-of-life care for Hinduism?

· Many are vegetarians

· Rituals include tying a thread around the neck or wrist of the dying person, sprinkling with special water, & placing a leaf of basil on tongue

Amish End-of-Life Care

- funerals are conducted in the home

- caskets are plain and simple w/o adornment

-at death, a woman is usually buried in her bridal dress

- there is life after death, either with eternal reward in heaven or punishment in hell

Dietary preferences & end-of-life care for Buddhism?

· Alcohol is prohibited, many are lacto-ovo vegetarians

· Time for medication at shrine is important; clients may refuse medications that alter their awareness (Opiods)

- after death a monk may recite prayers for 1 hr (not in the presence of the body)

What is cultural competence?

A skill the nurse develops in learning to respect individual dignity & preferences, as well as acknowledging cultural differences

What is cultural humility?

Appreciating, understanding & partnering with clients from cultures different than the nurse's culture

What is cultural preservation?

· Assisting the client to maintain traditional values & practices

· Allowing client to practice prayer time

What is cultural accommodation?

· Supporting & facilitating the client's use of cultural practices that are beneficial to the client's health

· Providing a rug for the client

What is cultural repatterning?

· Assisting the client to modify cultural practices that are not beneficial to the client's health

· Helping client turn bed to face Mecca

What is cultural brokering?

· Advocating, meditating, negotiating, & intervening between the client's culture & health care culture on behalf of the client

· Changing schedule to allow client to have prayer time

What is time orientation?

Describes whether an individual focuses more on the past, the present, or the future

- individuals who focus on the past and present have little interest in health promotion behaviors

What are biomedical beliefs?

Focus on identifying a cause for every effect on the body, that the body functions like a machine

- majority of medical facilities function this way

What are naturalistic beliefs?

· Relate the individual as part of nature or creation

· An imbalance in nature is believed to cause disease

· Mexican culture: follow hot-cold theory of balance

What are magico-religious beliefs?

· Link health to supernatural forces, or good & evil

· Voodoo & witchcraft practices

Conveying cultural sensitivity includes?

· Use culturally sensitive language

· Find out what clients know about their health problems & treatments & determine the client's intent to adhere to the prescribed treatment plan

· Incorporate clients' preferences & practices into care

The use of ____ as interpreters is not advisable because clients might need privacy in discussing sensitive matters

Family members

Neighborhood & built environment relates to?

· The quality of the air, land, water, & other surroundings with which people come into contact

· Addresses positive factors such as the presence of sidewalks, bikes lanes, green space & detrimental factors such as crime & violence

What are some environmental risks?

· Toxins: lead, pesticides, mercury, solvents, asbestos, and radon

· Air pollution: carbon monoxide, ozone, aerosols, sulfur dioxide, etc

· Water pollution: wastes, erosion after mining, run-off from chemicals added to soil

· Contamination: food & food products with bacteria, pesticides, radiation and medication

What is the I PREPARE mnemonic used for?

Determining current & past environmental exposures

I PREPARE

· Investigate potential exposures

· Present work: SDS (safety data sheet), PPE

· Residence: age of home, heating

· Environmental concerns: air, water, soil, waste site nearby

· Past work: exposures, farm work, military

· Activities: gardening, fishing

· Referrals & resources: OSHA, local health department, poison control

· Educate: risk reduction, prevention, follow up

Primary prevention in neighborhood & built environment?

· Educate groups to reduce environmental hazards

· Advocate for safe air and water

- support programs for waste reduction and recycling

Secondary prevention in neighborhood & built environment?

· Monitor workers for levels of chemical exposures at job sites

· Assess neighborhoods, schools, work sites, & the community for environmental hazards

- survey health conditions

Tertiary prevention in neighborhood & built environment?

· Educate clients who have asthma about environmental triggers

· Support cleanup of toxic waste sites & removal of other hazards

Access to & quality of health care data collection includes?

· Access to health care facilities & services

· Lack of personal or public transportation to health care facilities

· Language & cultural barriers

· Eligibility requirements for state/federal assistance programs

What is the microeconomic theory?

Examines individual preference & finances, & how those actions affect cost of care & resource distribution

What is the macroeconomic theory?

Focused on aggregate behaviors, economic growth, & employment

World Health Organization

Establishes world standards for antibiotics & vaccines

Veterans Health Administration

Finances health services for active & retired military persons & dependents

U.S. Department of Health & Human Services

· Under the direction of the secretary of health

Funded through federal taxes

The U.S. Department of Health & Human Services consists of which following agencies?

· Administration for children & families (ACF)

· Administration for Community Living (ACL)

· Centers for Medicare & Medicaid services (CMS)

· Agency for Healthcare Research & quality (AHRQ)

· CDC

· Agency for Toxic Substances & Disease Registry (ATSDR)

· FDA

· Health resources & Service Administration (HRSA)

· Indian Health Services (IHS)

· NIH

· Substance Abuse & Mental health Services Administration (SAMHSA)

State departments of health

- Receives funding from state legislatures and public health angencies

- Manages the Women, Infants, & Children program (WIC)

- oversees Children's Health Insurance Program (CHIP)

- Reports notifable communicable diseases to the CDC

Local health departments

· Responsible for identifying & intervening to meet the health needs of the local community

· Report notifiable communicable diseases to state departments of health

· Nurses typically function in roles of caregivers, advocate, case manager, etc.

Affordable Care Act

· Created to help make insurance affordable for all people & decrease the amount of federal spending on health care

· Effects the way Medicare benefits are implemented

In Health Maintenance Organizations (HMO)...

Comprehensive care is provided to members by a set of designated providers

In preferred provider organizations... (PPO)

Predetermined rates are set for services delivered to members; financial incentives are in place to promote use of PPO providers

In medical savings accounts...

Untaxed money is put in an account for the use of medical expenses

What are some goals for global health?

· Eradicating extreme hunger & extreme poverty

· Promoting empowerment of women & gender equality

· Making primary education available worldwide

· Ensuring sustainable water, energy, & sanitization

· Promoting peaceful, just societies

Nursing interventions for global health?

· Work with governments & other developers of policy to promote the rights of nurses

Foster programs that promote environmental sustainability

What are the Healthy People 2030 objectives in regard to food & nutrition?

· Reduce household food insecurity & hunger

· Eliminate very low food security in children

Nurses use epidemiology to do what?

· Provide interventions

· Understand the impact of disease & death on populations & aggregates

· Understand the spread, transmission, & incidence of disease & injury

· Identify cases, recognize patterns, eliminate barriers, provide education & counseling

What is the agent in the epidemiological triangle?

CAUSES THE DISEASE

· Chemical agents: drugs & toxins

· Physical agents: noise & temperature

· Infectious agents: viruses & bacteria

What is the host in the epidemiological triangle?

· The living being that an agent or the environment influences

Susceptible hosts: age, sex, genetics, ethnicity, immunological status, physiological state, occupation

What is the environment in the epidemiological triangle?

· The setting or surrounding that sustains the host

· Social environment: poverty, high risk working conditions, assess to health care

· Physical environment: water/food supply, geography, reservoir/vectors

What is incidence?

Number of NEW cases in the population at a specific time divided by population total x 1,000 = ___ per 1,000

What is prevalence?

Number of EXISTING cases in the population at a specific time divided by population total x 1,000 = ___ per 1,000

What is endemic?

A disease that is present in the population at all times

What is epidemic?

The disease exceeds incidence to a larger area or region

What is pandemic?

Rates of disease happen in multiple countries or continents

How to calculate attack rate?

Number of people exposed to a specific agent who develop the disease divided by total number of people exposed

What do mortality rates provide?

· Information about cause of death

· Crude mortality rate: overall death rates

· Cause-specific rate, case fatality rate: deaths from specific cause

· Infant mortality ratio, age-specific rate: deaths at specific times across the lifespan

What is the virulence?

How ill a disease makes a person or how widespread it can become in a population

What are carriers?

People who can carry the disease but have no symptoms

What are the leading causes of communicable diseases?

Pneumonia & influenza(lower respiratory infections)

· HIV/AIDS

· Diarrheal diseases

· TB

· Malaria/measles

What are the populations at risk for communicable diseases?

· Young children

· Older adults

· Immunosuppressed people

· Clients who have a high-risk lifestyle

· International travelers

· Healthcare workers

How does vertical transmission occur?

Through the sperm, placenta, vaginal contact during birth, & consuming human milk

- (mother to infant)

Airborne mode of transmission

· Droplets: w/in 3 ft. - pertussis, flu, common cold, SARS

· Particles: travel further - measles, chickenpox, TB, COVID-19

Foodborne mode of transmission

· Food infection: norovirus, salmonella, Hep. A, E.coli

· Food intoxication: Staphylococcus aureus

· Clostridium botulinum

Waterborne mode of transmission

· Fecal contamination of water

· Diseases include cholera & typhoid fever

Vector-borne mode of transmission

· Carriers: ticks, mosquitos, fly

· Diseases: West Nile, Lyme disease, malaria, Zika, Rocky Mountain fever