208 final exam

nurs 208 final exam.

what are the 4 levels of prevention?

1. primordial prevention
2.primary prevention
3.secondary prevention
4. tertiary prevention

what is primordial prevention?

prevention of the risk factors themselves, beginning with a change in social and environmental conditions where these risk factors are thought to develop.

ex: food security

what is primary prevention?

they are "upstream" actions to protect against disease/injury before the signs and symptoms happen. (ex: immunizations, infant car seats, folic acid)

What is secondary prevention?

"midstream" actions that promote early detections of disease/injury. (ex: screening for cancer, mammography clinics)

what is tertiary prevention?

"downstream actions" that minimize the residual disability from disease and help the clients to live productively without limitations (ex: rehabilitation after suffering a head injury)

what caused the creation of the Ottawa charter and why was it created?

the Ottawa charter was created as the result of a international conference held in Ottawa in 1986.

it was created to increase awareness of the social determinants of health and also action and strategies for health promotion. it moved away from "the experts" being in control to more roles of advocate, facilitator, supporter, and mediator.

what is the population health promotion model?

is a Canadian developed model In the shape of a cube to help us understand the who, what, how and why of intervention or action on multiple levels across a society to create healthy change.
it helps us to understand, genetics, biology, and the social determinants and how they play a role.

it also helps us understand how our decisions are based on evidence and research, this is why it is shown under the cube.

what are the 4 stages of the cycle of oppression?

1.stereotyping
2. prejudice
3.discrimination
4.oppression

what is harm reduction?

it is a philosophy and a set of services and a practice.

-it focuses on preventing the harm of behaviour but not eliminating those behaviours themselves. it is an evidence based approach.

-accepting people
-avoiding judgement
being compassionate etc.

ex: the clean needle clinic for drug users.

what are 4 P's of social marketing?

Product
Place
Price
Promotion

why is it important to apply an equity lens to harm reduction services offered by registered nurses?

an equity lens helps us understand that
use and the harms of use are increased by social conditions (abuse, trauma, grief, loss, and social determinants of health such as low income and inadequate housing).

what is the susceptibility stage?

also called the pre-pathogensis. or etiologic phase. happens before the onset of disease
disease is in a population by individual areas do not have it yet.

only risk factors are present in this stage.

what is the subclinical stage?

there is pathological changes
also called the incubation period when speaking about infectious diseases

begins with invasion of an infectious agent, and continues until it multiples enough to produce host reaction and clinical symptoms.

during this stage they can still transmit disease.

what is the clinical stage?

onset of signs and symptoms, ideally diagnosis is made as soon as symptoms start appearing.

what is social justice?

Is the view that everyone deserves equal rights and opportunities this includes the right to good health.
To work to this we must address the social, economic, and political origins of health inequalities (THE ROOT CAUSE).

what does the danger of a single story mean?

it means essentially viewing someone as a stereotype or a "single story" that you may know and placing everyone in that same story; for example.

the lady in the video spoke about not realizing a family could make crafts and beautiful things as she couldn't see them as anything else other than poor.

what is cultural awareness?

If working with indigenous people, for example it would be important to informed yourself on history and values related to indigenous identities.

what is cultural sensitivity?

being sensitive to the ways that someone else's culture may be different than your own culture.

what is cultural competence?

The ability to understand, appreciate, and interact with people from cultures or belief systems, that is different from your own cultures and beliefs

what is cultural humility?

is the process of self reflection, so we can understand personal and systemic biases and to develop and maintain respectful processes and relationship that are based on trust. This involves realizing we are a learner this helps us better understand someone's experience.

what is cultural safety?

it is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health care
System.

The result of cultural safety is an environment free
Of racism and discrimination, where people feel safe
When receiving health care.

Cultural safety focuses on respect, empathy, and collaboration.
This cultural safety grows when the values or respect, empathy and collaboration are applied to our understanding about differences within culture.
We can do this by developing our cultural awareness, sensitivity and competence through cultural humility.

racism vs race

racism: is the systematic practice of denying people access to rights, representation, or resources based on racial differences., this becomes evident when we only use it to describe people of colour.

race: has no biologic reality, and is therefore meaning less, it's a social construct.

why does health status of immigrants decline after arriving to Canada?

This is caused by many factors, SDOH
Income, unemployment, discriminations, barrier to access health services etc.

what is the main barrier to a nurse understanding culture?

the biomedical Eurocentric foundation of nursing practice. This means the dominance of white European ways of thinking and knowing

what is a contemporary understanding of culture?

-process that continuously happens between people
-culture is constantly in flux (changing)
-privilege of being able to define the cultures of others.

what is advocacy?

is it the action to influence the decision makers in communities and governments to support a policy or cause that is health promoting.
Enhances the power of individuals and the communities by having them participate in identifying their problems or issues and in developing solutions.

*working with people not for people

what are ways to address systemic health inequities?

1. Advocate

2. Political action

3. Nurses can work locally, nationally, or internationally with nursing professional groups who are committed to addressing health inequities

4. Counter stigma and discrimination

5. Engage peers and leaders in discussions related
To systemic problems that exacerbate vulnerability, to poor health and health inequities


6. Choose to write letters to the editors or opinion editorials

Shakira case study: old woman that visits her husband needs medical attention but can't get it herself, what do you do?

it is inadequate to just respond to health problems without looking upstream!
What could she do to help?

-speak with the manager to help identify community support who they could partner with
-suggest having a monthly clinic run out of the long term care facility.
-establish a citizen group, starting programs
-involve family members in the initiative.

what are ways that someone could be vulnerable in terms of healthcare?

-an immigrant who's first langauge is not french or english

-being in poverty

-being disabled

-being in older age

what is the difference between equality and equity?

Equality is giving everyone the same equal resources
Without taking into account their life situation.
From the surface it seems "fair" but really it isn't
Giving everyone the same treatment regardless of the SDOH

Equity is giving everyone the needed resources
They need for their own personal situation so that everyone indeed does actually have a fair chance.
Giving them what they need to be healthy

*think of image of people using block to look over the fence

how do health promotion and population fit together?

Population health pov helps us to identify the full range of factors that determine health, it helps us to look at health as a bigger picture.
Health promotion pov, guides action on these found factors to improve the health of the overall population.

what is health protection?

Is a wide range of activities undertaken by public health departments and also by some government agencies such as the public health agency of Canada.

what is the health promotion act?

powerful legislation
That affords the MOH (minster of health) the ability to take extreme measures to preserve public health.

what is the overlap of health promotion and disease prevention?

-health promotion is in it's purest form
With children and young adults, where the threat of illness is more remote (distant)

It tends to over lap with the older adult, health promotion and disease prevention as
They are at higher risk for disease/illness.

what is health promotion?

It is the process of enabling people to increase control over the SODH and improve their health.
It is a social-political process involving multiple interventions over a prolonged period of time.
Action at several levels and across sectors.

what is the role of the minister of health?

maintaining and improving the health of Canadians

-Jean-Yves Duclos

what is the role of the chief public health officer?

improving health of
Canadians and strengthen our ability to respond to
Outbreaks and emergencies.

-Theresa tam

what are the roles and functions of a community health nurse?

1.health promotion
2. Prevention and health protection
3. Health maintenance, restoration and palliation
4. Professional relationships
5. Capacity building
6. Health equity
7. Evidenced informed practice
8. Professional responsibility and accountability

what is the Canada health act?

It has 5 pillars or standards that provincial health insurance programs must respect in order to receive funding from the government.

The 5 standards are:
1. Public admin.
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility

what are the 5 standards of the Canada health act?

Public admin, all admin of provincial health
Insurance must be carried out publicly and non profit. Records are subject to audit


comprehensiveness, they must cover all essential services

Universality, all insured residents can get health services.

Portability, moving resident still entitled for 3 months to allow them to make new arrangements

Accessibility, all residents have reasonable access.

primary care vs primary health care:

-primary care is the first level of contact between a healthcare provider and a patient it is part of the levels of care.

-PRIMARY HEALTHCARE
Is the foundation of Canada's healthcare system
It is a model for improving the health of Canadians
By promoting health and preventing illness
Is it essential healthcare that is made available to all citizens universally.

what is a population health approach?

-range of factors determine health
Aims to maintain and improve the health of the population, aims to reduce health inequities.
It is an upstream way and is evidence based
Multiple strategies are applied.

what is the socioenviromental approach?

Views health as a product of social and environmental
Determinants that provide incentives and barriers
(health is tied to social structures)

The Epp report, health for all a framework
For health promotion, it focused on 3 health promotion challenges,
1. reducing inequities
2. increasing prevention
3. enhancing coping
Upstream, proactive approach.

what is the behavioural approach?

-focused on health as product of healthy lifestyle
Choices. It put the responsibility for health on the individual

The LaLonde report of 1974 was a new perspective on
The health of Canadians. And it identified 4 influences
On health:
1. Human biology
2. Lifestyle
3. The environment
4. Health services

-but by the 80s people began to identify limitations to
This approach

what were the 4 things the Lalonde report identified?

1.human biology
2.lifestyle
3. the enviroment
4. health services

what is the medical approach?

Focus is curing disease and health problems
Downstream approach
Heavy in hospital care
Also known as a reactive approach instead of
Proactive.

what are the approaches to healthcare?

\-medical -behavioural -socioenviromental -population

what are the different points of care?

Primary: is the first level of contact with a patient and a provider think a walk in clinic

Secondary: referred to by a primary care provider
Involves diagnosing and treatment.
Tertiary: is specialized care referred to by primary or secondary healthcare provider and is usually in a large research hospital.

Quaternary: highly specialized care, a doctor that specializes in that very rare diagnosis.

what are the provincial and federal divisions of the government?

Provincial jurisdiction:
Each province is responsible for the admin
And their own delivery of healthcare services
They decide how many doctors, nurses, and other workers are needed for this job.
They receive funding from the federal government

Federal jurisdiction:
Responsible for the money to the provinces healthcare services.
Is responsible for services to first nations and Innuit veterans and inmates of federal prisons.

Also approval of drugs and they assess environmental risks.

define epidemiology:

-the study of the occurrence and distribution of disease
Taking SODH into consideration.
-intervention and stragery to solve

the objectives of epidemiology, distribution and determinants:

distribution: understanding the frequency and pattern of health events in a population.

determinants: understanding the causes and other factors that influence occurrence of disease and other related events.

distribution

understanding the frequency and pattern of health events in a population

determinants

understanding the causes and other factors that influence occurrence of disease and other health related events

what are the two types of epidemiology?

descriptive ( looks at the distribution) and analytical (looks the determinants)

descriptive epi

describing characteristics and distribution of health concern.

who, what (Is the health concern), when,

looks at the distribution of disease

ex: how many new cases of traumatic brain injury were reported among teens in Canada last year.

analytical epi.

analyzing the patterns of the health concern

the why, why are some more susceptible than others

looks at the etiology (causes of disease) and the associated determinants (how)

ex: why is there an increase in cases of traumatic brain injury.

who is the father of modern epidemiology?

John snow (1854)

-contaminated water was to blame for making people sick

what is the epidemiological triangle?

it is a tool to look at the 3 components that effect the spread of disease.

agent characteristics
host characteristics
environmental characteristics

-disease is the 3 parts of the triangle and how these components come together.

other than covid what are some examples of public health concerns impacting Canadians?

-hypertension
-anxiety and depression
-rsv outbreak
-opioid crisis

what is an agent?

thing that has to be present or lacking for disease to happen.

what is pathogen icy:

the ability to cause a disease

what are vehicles of infection?

food, water, biological products and fomites (inanimate objects) mode of indirect transmission.

things that aren't living. think of "vehicle like a car, they aren't living but they get things places"

what are vectors?

living things that can pass infections between humans or from animals to humans.

mosquitos, fleas, ticks

what is an association?

reasonable evidence that a connection exists between a stressor or environmental factor and a disease or health challenge.

what is a causation?

an association that has been confirmed and there is a definite, statistical, cause and effect relationship between a particular stimulus and occurrence of a disease.

what are rates?

a measure of frequency of a health event in a specified population in a defined time period.

it takes into account the size of a population, so comparisons can be made across different population groups.

what is the formula for rates?

number of events/ population at risk x 100 000 (or another standard given base)

population at risk

compromises those for whom there is some finite probability of experiencing the event,

*usually those who have already experienced the event are excluded from the population that is monitored.

what are measurements of mobility?

# of reported cases or occurrences of a disease in a population

what is incidence rate?

# of new cases of disease that occur during a specified period of time in a population at risk.

(measure of risk)

the time period must be specified

what is the formula for incidence rates?

# of new cases / # at risk of developing disease during time period x 10n

incidence: 20 people attended a church picnic on the weekend. by Monday 4 people had food poisoning symptoms. on the Tuesday there was 2 new cases reported. what is the incidence rate for this occurrence?

A) two new cases/ 16 at risk
B) two new cases/ 20 at risk
C) six cases/ 20 at risk
D) 4 cases/ 16 at risk

A

incidence another example:

there are a total of 150 beds at northwood Halifax. over the course of one weekend, 10 residences test pos. for covid. on Tuesday public health officials record the addition of 6 new cases. what is the incidence rate for this occurrence?

A) 6 new cases/140 at risk x 10 000=429
B) 6 new cases/ 150 at risk x 10 000=400
C)6 new cases/134 at risk x 10 000 = 448
D) 6 new cases/ 144 at risk x 10 000= 417

A

prevalence rate

measure of existing disease in a population at a given time.

good measure of burden of disease in the community for planning health services.

what is the only way to lower prevalence rate?

death or cure

formula for prevalence?

n of cases present in a population at a certain time/ n of people in population at a specified time x10n

prevalence example:

northwood bed example. 150 beds. 10 cases, 6 new cases

16/150 x1000 =107

what happens to prevalence as incidence increases?

prevalence increases

public health paradox

paradox: a new measure introduced that improves survival, but net effect is an increase in prevalence (more people living with disease)

*difficult to convince some policy makers that a program is successful of prevalence is increasing.


ex: pancreatic cancer: low incidence (doesn't happen a lot) short duration, low prevalence.

what is the measure of mortality?

reflects incidence and prevalence of death ONLY

define crude:

compare the number of deaths from a specific cause within the entire population

specific in epidemiology:

compare the # of deaths from a specific cause within a particular group with that whole subgroup.

how to calculate crude annual mortality rate?

total deaths from all causes in 1 yr/ # of all people in the population at midyear x 100 000.

what are maternal and infant mortality rates used for?

used globally as an indicator of health and avalibility of health services

if health infrastructure is very good, maternal and infant mortality rates are generally low.

what does a case fatality rate tell us?

the case fatality rate is often used as a measure of the severity of a disease. it is the proportion of known cases who died of the disease in question