Lecture Notes: Aggregates in the Community and Family Health (VOCABULARY Flashcards)

Aggregates and Target Populations

• Aggregates are groups that have a common characteristic. Aggregates or target populations can be defined based on special interests or geographic locations. Identify aggregates when planning targeted health interventions.

• NCLEX Connections: Aggregates receive services from community health nurses. These include individuals from infancy to death, families, and groups within the community.

Children (birth to 12 years) and Adolescents

• The income level of caregivers affects the children in many ways. Children living in families with low-income status can face low food security, are at risk for homelessness, and might have difficulty learning and developing cognitively.

• SDOH (Social Determinants of Health): Access to care is a concern for children. Legislation such as the Affordable Care Act (ACA) and programs like Medicaid and the Children’s Health Insurance Plan promote access to care for children who might face health disparities.

• Health Concerns and Leading Causes of Death for Children:

  • Perinatal conditions and congenital anomalies

  • Sudden, unexplained infant death (SUID)

  • Motor vehicle and other unintentional injuries

  • Infant mortality associated with maternal health, socioeconomic status, and access to medical care

• Health Concerns and Leading Causes of Death for Adolescents:

  • Motor vehicle and other unintentional injuries

  • Homicide

  • Suicide

• Screening and Preventive Services – Children:

  • Height and weight . ext{(height/weight measurements for growth monitoring)}

  • Vision and hearing screenings

  • Dental health assessment

  • At birth: hemoglobinopathy, phenylalanine level, T4, TSH

  • Immunization status (check CDC current schedules) ext{(immunizations)}

  • Lead exposure screening

  • Cholesterol and triglyceride levels

  • Nutrition assessment

  • Physical activity assessment

• Screening and Preventive Services – Adolescents:

  • Height and weight; Vision and hearing; Dental health

  • Rubella serology and immunization history

  • Substance use disorders, including tobacco

  • Immunization status

  • Mental health screenings

  • Cholesterol and triglyceride levels

  • Nutrition assessment

  • Physical activity assessment

• National Health Goals (QEBP) for Children / Adolescents:

  • Reductions in: dental caries, obesity, infant mortality

  • Increases in: newborn blood spot screenings and follow-up testing; access to a medical home; health education in schools; childhood immunizations; use of child safety restraints; physical activity; breastfeeding rates (infants)

• Community Education (Children and Adolescents):

  • Anticipatory guidance (for parents and caregivers)

  • Breastfeeding support

  • Safe sleeping positions

  • Nutrition guidance

  • Physical activity promotion

  • Substance use risk awareness and prevention

Older Sections: General Population Health Goals and Screening

• Overall context for all ages includes routine screening and preventive services with age-appropriate focuses.

• For both children and adolescents, there is emphasis on preventive services that align with National Health Goals and SDOH considerations (e.g., access to care, immunizations, healthy behaviors).

Adults

• Adults: Health can be influenced by multiple factors, including genetics and environment. The environment includes societal and cultural expectations for gender that influence disease risk and the valuation of prevention and treatment.

• Most social determinants of health (SDOH) related to major adult health concerns are chronic rather than infectious diseases.

• While screening recommendations are generalized for aggregates, nurses should tailor screenings to individual client factors.

• Life expectancy in the United States is lower than in many other developed countries, despite high healthcare expenditures.

• Health Concerns and Leading Causes of Death in Adults:

  • Heart disease

  • Diabetes mellitus

  • Mental health disorders

  • Sexually transmitted infections (STIs)

  • Colorectal cancer (cancers of all types are a public health concern)

  • Stroke

  • Obesity

• Female Health Focus:

  • Reproductive health: childbearing, menopause, preconception counseling

  • Malignant neoplasms: breast, cervix, ovaries

  • Osteoporosis

• Male Health Focus:

  • Unintentional injuries

  • Erectile dysfunction

  • Malignant neoplasms: prostate, testes

• Screening and Preventive Services – Adults (general list):

  • Height and weight

  • Dental health

  • Blood pressure

  • Cholesterol (ages 45 to 65 years)

  • Fecal occult blood test / sigmoidoscopy (ages 45 years and older)

  • Immunization status

  • Diabetes mellitus screening

  • HIV/STI screening

  • Skin cancer screening

  • Nutritional screening (obesity)

• Depression screening is also noted among general preventive considerations.

• National Health Goals (QEBP) for Adults:

  • Reductions in: diseases involving bone (osteoporosis), death from cancer, sexual violence, incidence of HIV/AIDS, fatal and nonfatal injuries, unplanned pregnancies, excessive alcohol use and tobacco use

  • Increases in: use of barrier and hormonal contraception; early and adequate prenatal care for pregnant clients; ability to identify warning indicators of a heart attack and stroke; abstinence from alcohol, nicotine, and other substances among pregnant clients

• Community Education (Adults):

  • Nutrition; STI prevention; substance use disorders

Older Adults

• The population of older adults is increasing; they are the fastest growing aggregate in the U.S. population.

• Many older adults live alone; nurses should ensure access to healthcare services and assistance for clients living alone.

• SDOD (Social Determinants of Health) Considerations for Older Adults:

  • About one third of prescriptions in the U.S. are for older adults.

  • Most older adults have at least one chronic health concern, often more.

  • The Administration on Aging (Older Americans Act) promotes health services for older adults through states via local nonprofit agencies funded by the U.S. government.

  • Healthy People has a topic area specific to older adult health.

  • Health promotion targeting older adults affects both individual health and population health.

• National Health Goals (QEBP) for Older Adults:

  • Reductions in: moderate to severe functional limitations, hospitalizations due to heart failure, inappropriate medication use by older adults with a disability, hospitalizations due to pressure injuries, emergency department visits due to falls

  • Increases in: use of clinical preventive services

• Community Education (Older Adults):

  • Community resources and programs; healthy meals and snacks; nutritional supplements; exercise; dental health; injury prevention; car and fire safety; fall prevention; abuse and mistreatment; medication safety

• In-Service Question (Older Adult Health):

  • A public health nurse planning an in-service asks which information to include:

  • a) The percentage of older adults in the population is decreasing. (False; it is increasing)

  • b) The proportion of older adults who live alone is increasing. (True and supported by the content)

  • c) Older adults take one-half of all prescription medications. (Not stated; the content notes about one third of prescriptions; this option is misleading)

  • d) Older adults have a decreased recovery time following injury. (Not supported; older adults often have slower or more complicated recovery)

The Family as a Client: Definitions and Approaches

• The family is the basic unit in community-oriented nursing; nurses promote healthy families through assessment, planning, implementation, and evaluation.

• A family is defined as individuals who identify themselves as family members and have interdependent relationships providing emotional, financial, and/or physical support.

• Families can take many structures and forms.

• Home visits allow observation of home environment and identification of barriers and supports to health-risk reduction.

• Approaches to nursing care of a family:

  • Family as a component of society: Monitors how families interact with other institutions (schools, medical facilities, financial institutions, congregations); used to study and implement population-focused interventions (e.g., immunization campaigns for disadvantaged populations).

  • Family as a system: Studies how interactions among family members affect the whole family function; directed at promoting family health by focusing on how members interact.

  • Family as a client: Examines the family unit functioning first, then individual needs; used to assess how family health is impacted by each member’s reaction to a health event.

  • Family as context: Focuses on the individual first, then the family; uses the family as a resource to support health and recovery of an individual.

• SDOH in family nursing: Social determinants influence family health and clinical outcomes.

Family Health Risk Appraisal and Tools

• Tools used in family assessment:

  • Genograms: Used to gather basic information about family structure, relationships, and health/illness patterns; used to identify hereditary risks and repetitive patterns (e.g., cancers, heart disease, diabetes). Genomics refers to the study of genetic information and how it is expressed; helps identify specific individual risks and prevention opportunities.

  • Ecomaps: Visual diagram of the family unit in relation to other units (school, work, church, friends, extended family); used to understand the relationship between family members and the community; assesses social support networks and social risk.

• SDOH example: Economic stability, particularly access to nutritious food, can influence family health.

• Behavioral Risk: Information about family health behaviors, including health values, health habits, and health risk perceptions.

• Environmental Risk: Examples include home hazards and exposure risks (e.g., radon) identified via ecomaps or home assessments.

• Health Risks Related to Food Insecurity (examples by age group):

  • Children: Anemia, poor cognitive ability, anxiety, asthma, poor oral health

  • Adults: Depression, hypertension, hyperlipidemia, sleep disorders

  • Senior adults: Poor overall physical health and depression

Genogram vs. Ecomap: Classification Exercise (Examples)

• Genogram: Focuses on familial relationships, heredity, and health patterns within the family.

• Ecomap: Focuses on interactions with external systems and social supports (e.g., school, work, church, healthcare providers).

• Example items commonly classified:

  • Barriers to access → Ecomap

  • Allergens within the home → Ecomap

  • Families unable to have a child or maintain a pregnancy → Genogram

  • Passive smoke exposure → Ecomap

  • Household hunger → Ecomap

  • Intimate partner violence → Genogram

  • Positive parenting → Ecomap

  • Health education provided by an agency (Head Start, school system, college, workplaces, health departments) → Ecomap

  • Home testing for radon → Ecomap

  • Health insurance coverage → Ecomap

  • Individuals who have a usual primary care provider → Ecomap

  • Family health literacy → Genogram or Ecomap (contextual, often linked to family resources, but typically discussed as a broader contextual factor)

Health Promotion, Transitions, and Crises

• Crisis and Transitions in families:

  • Family crisis occurs when a family cannot cope with an event and resources are inadequate for the demands.

  • Transitions are times of risk for families (e.g., birth/adoption, death, child leaving home, marriage, major illness, divorce, loss of main income).

  • Transitions require changes in behaviors, decision-making, reallocating roles, learning new skills, and accessing new resources.

• Characteristics of Healthy Families:

  • Members communicate well and listen to each other; affirmation and support for all members; mutual respect; trust; shared humor and interaction; leisure activities together; shared religious foundation; privacy of individuals; shared sense of responsibility; traditions and rituals; willingness to seek help when problems arise.

Family Health Risk Appraisal Details

• Genograms capture: basic information about family, relationships, and health/illness patterns; used to identify hereditary risks and inform prevention.

• Genomics: study of genetic information and its expression; helps identify specific individual risks for prevention.

• Ecomaps capture: interactions with schools, work, church, friends, extended family; shows social support networks and community connections.

• Economic stability as an SDOH: access to nutritious food influences family health.

• Examples of health risks related to food insecurity (as above).

Practice and Applications in Public Health Nursing

• When planning care for aggregates, consider how SDOH, access to care, and community resources affect health outcomes.

• Use genograms to identify hereditary risk patterns and to guide preventive recommendations.

• Use ecomaps to map social supports and barriers to care, informing community-based interventions.

Summary of Key Points (Integrated)

• Aggregates are targeted populations defined by characteristics or geography and are essential for targeted interventions.

• Children and adolescents face health risks shaped by caregiver income, housing stability, and access to care; preventive services and immunization are central.

• National Health Goals (QEBP) set reductions and increases in multiple health indicators across age groups, with emphasis on access to care, immunizations, preventive services, and healthier environments.

• Adults face chronic disease burdens influenced by genetics, environment, and lifestyle; screenings should balance population guidelines with individual factors.

• Older adults represent a rapidly growing and vulnerable population with unique needs, including nutrition, fall prevention, medication safety, and access to services; community education and geriatric-focused resources are critical.

• Family-centric nursing uses four perspectives (component of society, system, client, context) to plan assessment and care; Genograms and Ecomaps are core tools for assessing family health risks and social supports.

• Transitions and crises require proactive planning, skill-building, and resource mobilization within families.

• Practical exercise: distinguish Genogram (family structure and heredity patterns) from Ecomap (external social connections and supports) when documenting family health risks and resources.

• Example data references:

  • One-third of prescriptions are for older adults: rac{1}{3} of prescribed medications.

  • Age references: 45 to 65$$ years (cholesterol, FOBT), as well as general adult screening timelines.