Community Exam 1

What are the essential services of public health nursing?

Assessment, Policy Development, and Assurance

What to the essential services do?

a. Essential public health services inform, educate, and empower people regarding health services

Assessment

- collect data

- assess resources and services available

ex. compare teen pregnancy in different states

Policy Development

For nurses by nurses

- Promote the health of the population

- use scientific knowledge base to make decisions about policy

Assurance

Role of public health nurse to ensure community orientated services available

- Make sure that supplies are available for people to take care of their own health + staff are competent

KEY WORDS: ensure, make sure, insure

1. Public Health greatest areas of impact thus far to improve population health

a. Dramatic increase in life-expectancy for Americans during the 1900s credited to improvements in sanitation, control of infectious diseases through sanitation, food safety, immunizations, and other public health activities

i. 47 years was life expectancy (1900) -> increased to 77.9 (2007)

1. Purpose of public health core functions

a. Clarify the role of the government in fulfilling the public health mission

Community Based

combination of population focuses, community orientated strategies, and direct clinical care strategies

ex. vision screening

Community-Orientated

concern for the connection between the health status of the population and the enviroment

1. What is appealing to some nurses about PHN role/function

a. Appealing specialty because of autonomy and independence

b. You get to be in charge of your own practice

Is PHN a specialty?

a. Public health nursing is a specialty because it has a distinct focus and scope of practice and requires specific knowledge base

b. BSN is considered necessary basic prep for beginning staff public health nurse -> often need master's or doctoral level

Marine Hospital Services

a. After the American Revolution we started to standardize public health education and PHN training

b. 1798 we established the Marine Hospital Service

i. Provided health care or merchant seamen when on shore

ii. How this relates to PH: worried about prevention and spread of disease, realization that public health is a global issue!

Elizabethan Poor Law

a. America's Colonial Period and the New Republic

i. During this time, over in England, the Elizabethan Poor Law of 1601 was enacted

ii. US modeled their MEDICAID after this!

Lilian Wald Impact

a. Lillian Wald started settlement houses

i. These were social centers for women to bring children and were taught basic sanitation and nutrition (increased their education and focused on health)

ii. Improved poverty-stricken areas

iii. Most famous/important settlement established: Henry Street Settlement in the Lower East Side of Manhatten

iv. Significant and positive impact about safe and sanitary baby care, still using this theory today

School Nurses

a. School absences due to infection and community diseases were HIGH

c. BUT, illness was often not the reason for absence -> school nurse role to investigate why children are missing school and provide resources

i. Ex. Parents working, caring for younger siblings, etc.)

First school nurse

Lina Rogers

Mary Breckinridge and Rural Nursing Service (Town and Country)

i. Founder of the Frontier Nursing Service in the mountains of Kentucky

1. This is still active in public health today

2. Red Cross established rural nursing service inspired by this (meeting people where they are)

3. For these nurses, KEY is being CREATIVE due to limited resources (ideas for hot water bottles -> hot bricks, salt, sandbags, etc.

ii. Started the first midwives in the US

Crimean War Impact

a. Crimean War 1854-1856

i. Florence noticed more dying in hopsitals than on battlefield

ii. She used simple epidemiological measures, environmental conditions (sanitation, food, air circulation, supplies, etc) and basic nursing care

iii. Decreased the mortaility rate for soldiers!!

1. 40% Mortality to 2% Mortality due to environmental changes (415 per 1,000 to 11.5 per 1,000)

Goals of WHO

a. PRIMARY HEALTH CARE

i. Primary Health Care is the goal of the integration of public health and primary care to improve the health of the community

b. WHOS overall goal is BETTER HEALTHCARE FOR ALL (through primary healthcare)

Primary Care vs Public Health

1. Primary Care: person focused and individual client payments and health insurance

2. Public Health: community focused, tax dollars and federal/state grants

US Department of Health and Human Services

i. Federal level

ii. Is the agency that is most involved in the public health of US citizens

1. Countries marked as having greater need or less developed in terms of healthcare

a. Developed: stable economy, technolpgy, and industry (US and Canada)

b. Underdeveloped: no stable economy, technology, and industry (Indonesia, Africa, Haiti)

i. Public health often poorly defined in lesser developed nations

ii. Still have diseases like measles, mumps, rubeolla, polio

Multilateral Vs Bilateral Organizations

a. Multilateral Organizations:

i. Funding from multiple sources

ii. Ex. WHO and United Nations

b. Bilateral Organization:

i. Single government agency provided aid to lesser developed countries (funding from one source)

ii. USAID (U.S. Agency for International Development)

NGO and PVO

i. NGO: nonprofit organization that operates independently of any government

ii. PVO: nonprofit organization

iii. Ex. Red Cross International

United Nations are a ___________ Organization

Multilateral

Govt, Law, and Policy: USDHHS

a. Executive Branch + Federal Health Agency

b. Addresses health policy

c. Mission is to enhance in the health and wellbeing of all americans, providing for effective health and human service (Public Health is in their Domain)

Branches of Government

Executive, Legislative, Judicial

Executive Branch

i. President, cabinet, administrative departments, and agencies

ii. Suggests, administers, and regulates policy

iii. Ex. US Department of Health and Human Services

Judicial Branch

i. Investigate interpretation of law and their meaning including state's rights

1. Ex. Right of state to grant or not grant abortions

2. Stewart Machince Co. v. Davis

ii. Federal, state, and local courts, guided by the opinions of the Supreme Court

Public Health Policy is __________

IMPORTANT

Governemnt and policy have a big impact on nursing and health

Primary Role of US Government in Healthcare is

FUNDING

i. Government pays for some healthcare services and some training for health care personnel (45% paid for by the government)

Healthy People 2030

a. big focis on Social Determinants of Health/Social Drivers of Health

Abuse and Neglect

a. Everyone is responsible for reporting child abuse and neglect if it's suspected!!!

Advocacy

Influencing others (politics) to adopt a specific course of action (policy) to solve societal problems

1. US spends most health care dollars on ____?

a. Hospital Care and physician services

b. Small fraction spent on public health, research, and construction

1. What caused the dramatic increase in uninsured Americans

a. Sharp increase in uninsured Americans as many have been dropped from employment based health plans

b. Insurance companies rationing -> dropping people they cant support

IOM 1999

a. 1999 Instutute of Medicine (IOM)

i. Released a report called To Err Is Human

ii. Discovered that 98,000 deaths/year due to medical errors

Problems in current healthcare system

a. Cost

b. Aging Population

c. Chronic Conditions (HTN)

1. International disease information - where to get

a. WHO (World Health Organization) website

Medicare vs Medicaid

a. Medicare

i. Provides hospital insurance and medical insurance

ii. 65 years of age and older, permanently disabled, end stage renal disease

b. Medicaid

i. Financial assistance to states and counties to pay for medical services

ii. Poor older adults, blind, initially disabled, and families with dependent children

Medicare Part A and B

a. Part A Medicare:

i. hospital insurance

ii. covers your hospital care, health care, hospice, and skilled nursing care

b. Part B:

i. non-institutional care, medically necessary services

ii. HCP services, doctor's office visits, outpatient care, home health, diagnostics, physiotherapy

Example of Assurance related to Cultural Competence

a. Assurance of policy: making sure people have translators + cultural needs are met

Legal Immigrant

i. make up 80% of the immigrant population

ii. not citizens by are legally allowed to work and live in the US

Non-Immigrant

i. admitted to the US for a limited time duration and for a specific purpose

ii. tourists, students, temporray workers, business executives, diplomats and their families, artists, entertainers, reporters

Refugee

i. people who seek protection in the US because of fear of prosecution on the basis of race, religion, nationality, polictical view, or membership in a certain group if they want to return to their homeland

Culture

i. Set of common beliefs, values, and assumptions about life

Race

i. Biologic variation within a population (ex. Skin color)

ii. GROWTH AND DEVELOPMENT can be different in a certain race as well as skin color, enzymatic differences, susceptibility to disease, laboratory findings

iii. Same race may be of different cultures

Ethnicity

i. Shared feeling of peoplehood

ii. Related to cultural factors

iii. Equally influenced

iv. ETHNICITY AND RACE ARE NOT THE SAME

v. Ex. Jewish

Why important to cultural competence

a. Lack of Cultural Competence

i. Increases barriers to care

ii. Inhibits communication

iii. Creates obstacles

iv. Increases the gap in disparities

b. Cultural competence improves quality of care, lowers cost, and increase positive outcomes

1. Developing cultural competence in nursing - how, why

a. The first step of developming cultural competence is the self-examination and in-depth exploration of one's own beliefs and values as they influence behavior

b. Cultural desire is intrinsic motivation!!

Preservation

: allow them to maintain their traditional values and practices (preserve and accept)

Accomodation

a. supporting the practices that are beneficial to health

Repatterning

a. modify elements that are not beneficial to health

Brokering

interview, negotiate, mediate, and advocating the clients culture and the health care culture to find a common ground

1. Diversifying the nursing workforce - why?

a. We have a need for a more DIVERSE WORKFORCE!

i. The nursing workforce is overwhelmingly white (83%)

Stereotyping, Prejudice, Racism, Ethnocentrism

a. Stereotyping:

i. beliefs and behaviors about a racial or ethnic group without assessing the individual

b. Prejudice and Racism

i. Prejudice: negative stereotyping about a whole group (judging based on sterortype)

ii. Racism: type of prejudice

c. Ethnocentrism

i. The belief that your own cultural group determines the standards by which another groups behavior is judged (you think your way is best)

ii. "Mine is right and I will judge your behavior based on that"

1. Biological variations

a. Racial Diffrences have an effect on...

i. Growth and development

ii. skin color

iii. enzymatic differences

iv. susceptibility to disease

v. laboratory findings

What effects your health almost more than anything?

Income

Environmental health- why should nurses care?

b. Nurses set the example and can guide and drive policy

a. Nurses need to understand and asses these risks of the enviroment and advocate for policies that help suppport healthy enviroments

c. Estimated 24% of global disease and 23% of all deaths due to envirmental factors (WHO)

1. Importance of environmental health and the effects of chemical, biological, and radiological materials

a. We pay attention to biological, chemical, and radiological because these hazards are often found in our air, water and products

1. Exposure and potential harm- observing for signs and symptoms in clients

a. Nurses have historically learned to identify a relationship between enviromental and chemical exposures and their harm by observing signs and symptoms in clients

a. Family's living in poverty may have exposure to enviromental hazards

i. hazards putting them at risk include:

1. limited funds for healthcare

2. poor nutrition

3. homes closer to hazardous waste sites

4. unsafe working conditions

5. (not so much their education)

The greatest source of air pollution in the US

motor vehicles

EBP

a. Canada was the first place to use the term "Evidence Based Practice"

If you want to incorproate EBP in your organization

a. there is one very important first step: cultivate a spirit of inquiry!

b. People need to be interested and curious, want to know how things work, why things work, want them to want more info, etc.

Primary Prevention

1. preventing the disease (before you have the illness), education!!

(a) educate to reduce hazards, advocate for safe air and water, advocate to reduce hazards, advocated for waste reduction and effective waste managment

Secondary Prevention

1. screening, risk for the disease

(a) Hearing or vision screening

(b) survey for health conditions that can be related to exposure, monitor workers for levels of chemical exposures at job sites, screen children for lead poisoning, assess worksites and schools and neighborhoods for enviromental hazards

Tertiary Prevention

1. : have the disease and preventing further complications and help them live with and manage their condition

(a) working with asthma clients to identify triggers (trying to support better living with disease) + cleaning up toxic waste sites

(b) Rehab