Module 4 & 5 Test

Gulf War and the Global War on Terror

- Sand, dust, and particulate matter - Burn pits - Shrapnel - TBIs - Heat stroke or heat exhaustion - Chemical exposure - Chromium exposure - Infectious diseases Chronic multi-symptom illness (CMI)

Psychosocial Issues: Widowhood

- Seen more in women: Loss of companionship and intimacy, Loss of one's sexual partner, Feelings of grief, Loneliness and less efficient financial management, Changes in relationships with children, married friends, and other family members - Possibly raising their grandchildren: Increase of number of children under 18 years living in households maintained by grandparents

Additional Health Concerns: Hearing loss

- Sensorineural health loss - Presbycusis - Conductive hearing loss

Early Attitudes Toward People with Disabilities

- Set apart from others - Viewed as different or unusual - Viewed as unclean and/or sinful - Served as entertainers, circus performers, and sideshow exhibitions

Alzheimer Disease (AD)

- Slow progressive brain disorder: begins with mild memory loss; progresses through stages to total incapacitation and eventually death. - Diagnosing is difficult; mimics conditions such as depression and other types of dementia; often reached after all other conditions ruled out - Assessment tools include: Mini-Cog, Mini-Mental State Examination, Clock drawing test - No cure and limited treatment options are available. - Behavioral and physical changes create many challenges for caregivers, family, and friends. - Management strategies include: Appropriate use of available treatment options, Management of coexisting conditions, Coordination of care among professionals and caregivers, Participation in activities and adult day care programs, Support groups and support services

Developmental Disabilities

- Conditions that are manifested by limitation before the legal age of adulthood, which is 18

National Guard and Reserves

- Considered part-time - Reserves report to the federal government - National Guard administered by each state - Serve no more than 39 days a year unless called to action

Major Legislation Affecting Women's Health Services: Occupational Safety and Health Act (OSHA)

- Enacted in 1970 - Ensures safe and healthful working conditions

Major Legislation Affecting Women's Health Services: Family and Medical Leave Act (FMLA)

- Enacted in 1993 - Provides 12 weeks of unpaid leave each year for family and medical reasons

Childhood Health Issues

- Accidental injury is the leading cause of death in children ages 1 to 14. - Auto safety: Safest place for children under 13 is the back seat; Never leave children unattended in the car: Heatstroke can occur in only a few minutes of being left unattended. - Head injuries: Cycling, Skateboarding, Other wheeled sports - Childhood obesity: Health crisis; it can lead to numerous health problems. - Childhood immunization: Benchmark of child health. - Environmental concerns: Can be found in air, water, lead poisoning, and from toxic exposure to chemicals. - Child maltreatment: An indicator of children's physical and emotional health status. - Children with special health care needs: Frequently need multiple health care services.

Crime

- Robbery - Purse-snatching - Pocket picking - Car theft - Various scams - Identity theft particularly vulnerable for older adults

Breast-feeding

- "Breastfeeding is a natural and beneficial source of nutrition and provides the healthiest start for an infant. In addition to the nutritional benefits, breastfeeding promotes a unique and emotional connection between mother and baby." —American Academy of Pediatrics (2012) - The 2011 Surgeon General's call to Action to Support Breast-feeding suggests action at increasing societal support for breast feeding women. - Health professionals should assist with providing: Lactation consultants, Childbirth educators, Physicians, Doulas, Trained home professionals

Women's Health

- "Essential to the development of health care for women are the concepts of health promotion, disease and accident prevention, education for self-care and responsibility, health risk identification and coordination for illness care when needed." —Preamble to a New Paradigm for Women's Health, Choi (1985)

Prevalence of Disability

- 15% worldwide, over 1 billion people, have some form of a disability. - In the United States: - 12% to 20% are disabled. - 6.3%, more than 15 million people, have a mental disability. - 3.6 million people use wheelchairs. - 8.4 million people have emotional disorders.

Contemporary Conceptualization of People with Disabilities

- 1950: Association for Retarded Children (ARC) began to advocate for children with intellectual disabilities - "world's largest community-based organization of and for people with intellectual and developmental disabilities" —ARC (2013) - Concept of independent living began with the deinstitutionalization movement in 1960s to 1970s

Handicap

- A disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role

Health and Social Services to Promote the Health of Women: Medicaid (1965)

- A federal- and state-funded health insurance program for the poor - Expanded under ACA to persons under 65 with an income below 133% of poverty level - Largest source of funding for people with limited income, regardless of age eligibility - Five broad coverage groups: Children, pregnant women, adults in families with dependent children, individuals with disabilities, individuals 65 years or older

Impairment

- A problem in body function or structure—activity limitation or participation restriction

Legislation Affecting People With Disabilities: Ticket to Work and Work Incentives Improvement Act

- Addressed employment and benefit issues for persons with disabilities - Signed into law in 1999, amended in 2008 - Increase access to vocational services and provided methods for retaining health insurance - Provided higher cap to accommodate earnings when beneficiaries make progress in their employment plans but before they reach the level of earnings that would terminate their benefits —U.S. Department of Education

Family Health Assessment

- Addresses family characteristics, including structure and process and family environment - Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family - Additional information obtained through observation of family and their environment

Adolescent Health Issues

- Adolescent sexual activity: Often unprotected and can result in pregnancy and STIs - Teen childbearing and parenting: Often have long-term negative consequences for both child and mother. - Violence: Among youth is a complex public health problem with multifaceted risk factors, Teen dating violence can be physical, sexual, or psychological/emotional. - The use of tobacco, alcohol, and drugs has serious and long-lasting consequences for adolescents and society. - Significant factors in overall well-being: Parents' or caregivers' income, education, and stability, Security and safety of the home, Nutritional and environmental issues, Health care access and use

The Family of a Child with a Disability: Siblings responses influenced by such factors as:

- Age of the sibling, their reservoir of coping strategies - Strength of other peer relationships - Perception of the parent's burden in caring for the CWD - Desire a sibling to protect parents from the concerns about the CWD - Impact of the CWD on family plans and social activities

Additional Health Concerns: Visual impairment

- Age-related cataracts - Macular degeneration - Diabetic retinopathy - Glaucoma

Concepts of Aging

- Aging is a natural process. - Chronological age: • The young-old (ages 65 to 74) • The middle-old (ages 75 to 84) • The old-old (ages 85 and older) • The elite-old (more than 100 years old) - Functional age: • Functional ability and the ability to perform activities of daily living (ADLs) • A better measure of age than chronological age

Understanding Family Nursing

- All families have the capacity for transforming their quality of life and family health. - All verbal and non-verbal family communication is meaningful. - All families possess a cultural heritage that is integral to family health and family life

Family Health

- American families are changing. - Television families have allowed American families to identify with developmental landmarks and understand the changing family. - U.S. Census Bureau (2014), definition of family since 1930 and unchanged: A family includes a householder and one or more people living in the same household who are related to the householder by birth, marriage, or adoption.

Population

- Americans are living longer than ever before and the older population will continue to grow. - Currently people who survive to age 65 can expect to live an average of 19.3 years. - 2014 life expectancy of people who survive 85 years is 7 more years for women and 5.9 more years for men. - Racial and ethnic composition - Older population is becoming more diverse. - Geographic location - Number of seniors differs by geographic location.

Characteristics of the Changing Family

- Americans are putting off life's big milestones, like marriage - Number of children per woman is falling. - 37% of the LGBT population will have a child. - Families are more blended and constructed differently: More step-siblings and step-parents, More babies born to unmarried women, More interracial marriages - Cohabitation: "a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage" has increased over time —U.S. Census Bureau (2008, 2011) - Birth rate among teenagers is the lowest it has been in four decades. - Proportion of children younger than 18 years living with grandparents increased since 2007. - Gay and lesbian family—made up of cohabiting couple of same sex who have a sexual relationship

Definitions and Models forDisability

- Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 define having a disability by how it limits carrying out a major life activity such as the ability to: o Breathe o Walk o See o Hear o Speak o Work o Care for oneself o Perform tasks o Learn

Sharing Responsibility for Improving Child and Adolescent Health: Community/Public Health Nurse's Role

- An advocate for improved individual and community responses to children's needs - A researcher for effective strategies to serve women and children - A participant in publicly funded programs - A promoter of social interventions that enhance the living situations of high-risk families - A partner with other professionals to improve service collaboration and coordination - Understand the legal and ethical implications of decision making

Disability

- An umbrella term covering impairments, activity limitations, and participation restrictions

Posttraumatic Stress Disorder

- Anxiety attacks, hallucinations, nightmares, irritability, sleeplessness, and cardiovascular and gastrointestinal disorders. - British dubbed conditions "shell shocked" - DSM-III in 1980 codified the diagnosis as posttraumatic stress disorder (PTSD)

National Agenda for Disability Model

- Any condition of the body or mind that makes it more difficult for the individual to do certain activities and interact with the world around them, which influences their quality of life —CDC (2015)

American Uniformed Services branches:

- Army, makes up 39% of all military personnel - Air Force - Navy - Marine Corps - Coast Guard

Common Health Concerns: Chronic Illness

- Arthritis - Hypertension - Diabetes

Intervention in Cases of Chronic Illness

- As many as 90% of families are dealing with chronic illness in a family member. - Affects of chronic illness on the family: Financial stressor/burden, Sex and intimacy, Interpersonal relations, Social/leisure life

Military Culture: Health care norms

- Avoid care because of stigma of appearing weak - Information may not be kept confidential - Will cause financial hardship - Negative attitudes regarding providers

Strategies for the Public Health Nurse Caring for People with Disabilities

- Be familiar with effective strategies for communicating and caring for individuals with disabilities - Procure knowledge related to health conditions that may result form or lead to disability - Be aware of resources available and legal implications that affect the PWD - Work with the interprofessional care team to form alliances with the client and family to reduce or eliminate barriers - Incorporate true essence of advocacy - Discern the needs and resources of the client and family

Legislation Affecting People With Disabilities: The Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008

- Became law in July 1990 - Landmark civil rights-styled legislation prohibits discrimination against people with disabilities. - Equal opportunities for people with disabilities in relation to: Employment, transportation, public accommodations, public services, and telecommunications

Substance Abuse

- Binge drinking - Benzodiazepine - Opioids - May be due to losses associated with aging such as loss of family and friends, a job, retirement, failing health, or relocation - Warning signs less obvious - Screening: CAGE, SMAST-G, AUDIT

Disability Prevalence by Age, Race, and Sex

- Blacks 22.2% higher rate of disability than - Asians 14.5% - Hispanics 17.8% - Non-Hispanic whites 17.6% - Females had a higher rate of disability (19.4%) than males (17.4%) in all racial groups. - Disability prevalence and disability severity levels rise with aging - 2005 statistics: o Roughly half of people age 65 years and older are disabled. o 36.6% of 65 years and older persons have disabilities considered severe. —Brault (2012) o Highest incidence occurred in 80 years and older - 55.8% had severe disability - 30.2% needed personal assistance

Vietnam War

- Cancer - Stroke - Hypertension - Lung conditions - Exposure to Agent Orange—herbicide used to kill vegetation that provided cover to the enemy

Moving from Individual to Family

- Care takes place increasingly in the home. - Include the patient's family in meeting health and rehabilitation goals - Family interviewing—assess families' responses to "normative" events such as birth and retirement or to "paranormative" such as chronic illness and divorce

Public Assistance Programs

- Cash assistance - Food stamps - Subsidized housing - Social Security—Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs - Social Security Administration definition of disability—unable to work because of a medical impairment lasting at least 12 months or that is expected to result in death

Breast-feeding: Baby

- Cells, hormones, and antibodies in breast milk - Lower risk of asthma - Lower risk of obesity - Lower risk of diabetes - Lower risk of SIDS

Delegation of Scarce Resources

- Children's Health Insurance Program (CHIP) increased access to health care for many low-income children. - In 2009 the Children's Health Insurance Program Reauthorization Act renewed and expanded coverage of CHIP from 7 million children to 11 million children. - The ACA of 2010 keeps CHIP program in place until 2019.

Chronic Conditions

- Chronic condition—condition that persists for at least 3 months or longer, regardless of time of onset - Women are more likely to be ill, whereas men are at greater risk for death. - Men have higher morbidity and mortality rates for conditions that are the leading causes of death.

CHAMPVA

- Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA) - Health care services for civilian beneficiaries - Eligibility: Spouse or child of veteran who has been rated permanently and totally disabled for service-connected disability by a VA or regional office, Surviving spouse or child or veteran who died from a VA-rated service-connected disability, Surviving spouse or child of veteran who was at time of death rated permanently and totally disabled from a service-connected disability, Surviving spouse or child of a military member who died in the line of duty, not as a result of misconduct

Ethical Issues for People Affected by Disabilities

- Clients' spiritual perspectives play an important role in decision making when there is a change in health status or a life-threatening illness. - Differences in quality of life and justice perspectives intersect with concerns about control of health care costs. - Disability rights proponents recognize the devaluation of PWD may promote their unnecessary and untimely death.

Health Promotion Strategies for Women

- Collaboration and an interdisciplinary approach - Promote health and detect disease at an early stage. - Women desire to become more knowledgeable about their own health: Health promotion for low-income, underserved women may differ from that for middle-class women; Knowledge deficits about one's own health prevail among women regardless of socioeconomic or educational level. - Urinary tract infection and dysuria - Diseases of the reproductive tract: Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID), and toxic shock syndrome (TSS) - Chronic diseases: Evidence suggests that CVD and metabolic syndrome in most women are preventable; Hypertension is the most common type of chronic hypertensive disorder in women; Diabetes - Arthritis: Osteoarthritis (OA) most common form of the disease, Degeneration of joints more common with increasing age and in women, Occurs in 25% to 50% of postmenopausal women - Breast cancer: 1 out of 8 women will have breast cancer in their life - Lung cancer: Responsible for more deaths yearly in U.S. women than breast cancer in 2013 219,709 women diagnosed with lung cancer - Gynecological cancers: 20% of all malignant diseases in women occur in the genital tract., Ovarian cancer is a silent killer; Usually reached an advanced stage when discovered - Mental disorders and stress: Women's emotional state can be influenced by ovarian function of menstruation to cessation of menstrual periods.

Strategies to Improve Child and Adolescent Health

- Collect/analyze data tracking well-being of children and adolescents. - Establish goals and set measurable objectives using Healthy People 2020. - Implement health promotion and disease prevention strategies: More significant and cost-effective for children than other age groups. - Utilize public health programs targeted to children and adolescents.

Men's Health Care Needs: Significant approach in the future will be to reach men in the:

- Community - Schools - Workplace - Public settings

Understanding Family Nursing: Families have inherent:

- Competencies - Strengths - Unique interactional processes that influence: Family health beliefs, Goals and actions

Theories That Explain Men's Health: Reporting of health behaviors

- Data collection on health behaviors may not be accurate. - Males are less likely than females to participate in the data collection process. - Social pressure for males to be less expressive (suppress their emotions) may help explain gender differences in reporting health behaviors.

Measurement of Disability: HHS standard public health survey questions

- Deafness or difficulty hearing? - Blindness or difficulty seeing? - Among those 5 years and older: difficulty concentrating, remembering, or making decisions because of physical, mental, or emotional issues? - Among those 5 years and older: difficulty walking, climbing stairs, dressing, or bathing? - Among those 5 years and older: difficulty doing errands independently, such as grocery shopping or going to a doctor's appointment, secondary to a physical, mental, or emotional condition?

Sudden Infant Death

- Death cannot be explained after a thorough investigation, including autopsy, examining death scene, and review of clinical history.

Depression

- Depression is a condition that interferes with daily life such as the ability to work, sleep, concentrate, eat, and enjoy life: Can lead to suicide - Maybe overlooked as older adults experience death of loved ones, retirement, stressful life events - Treatment may consist of medication alone or in conjunction with psychotherapy.

Preconception Health

- Developing fetal organ systems are highly vulnerable to effects of poor maternal: Nutrition, Drugs, Alcohol, Tobacco, Chronic maternal diseases, Environmental toxins and other exposures - Fetus can suffer damage as early as 3 days after a missed period, even before a woman knows she is pregnant. - Healthy lifestyle for women regardless of intent to become pregnant and maintaining: Weight and good nutrition, Tending to chronic disease problems, Up to date on vaccinations, Avoiding environmental toxins, Decreasing stress and eliminating abusive relationships, Avoiding illicit drugs, tobacco, alcohol - Preconception counseling as a prevention strategy: Effective contraception to avoid unintended pregnancies and lengthen pregnancy spacing, Recommend intake of folic acid 400 µg daily, Encourage healthy lifestyle modifications

Office of Research on Women's Health: Overarching themes for research:

- Developmental, psychological, spiritual, and physiological factors effect on lifespan - Female determinants' (such as genetics and gender expectations) effect on health - Health disparities and diversity - Diseases and conditions affecting women - Career development and advancement of women in the sciences

Activity Limitation

- Difficulty encountered by an individual in executing a task or action

Roles of the Community Health Nurse

- Direct care: Variety of settings - Educator: Health education, Sensitive to cultural issues - Counselor: Women's health, Reproductive health

The Social Meaning of Disability

- Disability is a label that signifies social marginalization. - Two key points: 1. It is possible for a person to be disabled without recognizing himself as such. 2. It is possible for one to be disabled without being recognized as such by others. —Grue (2016)

Nurse's Role in End-of-Life Issues

- Discuss and educate patients about end-of-life issues. - Inform other members of the health care team about advance directives. - Make sure that the document is visible and accessible in the patient's chart. - Encourage patients to discuss their wishes with their family. - Encourage patients to discuss with physician so it becomes part of medical record.

Nutrition Checklist

- Disease - Eating poorly - Tooth loss/mouth pain - Economic hardship - Reduced social contact - Multiple medications - Involuntary weight loss/gain - Need assistance in self-care - Elder years (>80 years old)

Factors That Impede Men's Health: Lack of health promotion

- Disease prevention and health promotion not often reflected in a man's perception of health - Focus on disease cure in the present health care system

Additional Health Concerns: Common dental problems

- Dry mouth - Receding gums - Tooth cavities - Hypersensitivity of teeth - Tooth discoloration

Reproductive Health

- Dysmenorrhea: Problem affecting approx. 50% to 80% of female population between 15 and 24 years of age —Nelson (2004) - Nutrition: Includes total life nutritional experience - Sexually transmitted diseases (STD): Commonly found among U.S. women; Most common Chlamydia trachomatis followed by Neisseria gonorrheae -

Disability and Public Policy

- Early American public policy—people with disabilities require governmental protection and provision and have little capacity for independence —Rubin and Millard (1991) - Contemporary disability policy—minimizes a disadvantaged view - maximizes opportunity for people with disabilities to live productively in their community

Prenatal Care

- Early and regular prenatal care enhances chance of a healthy, full-term baby. - Health education and counseling - Risk identification - Monitoring and treatment of symptoms - Referral to health, nutrition, childbirth education, social services to optimize a healthy pregnancy

Institutional Context of Family Therapists

- Ecological framework—blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment - Social network framework—involves all connections and ties within a group; social support - Transactional model—system that focuses on process as opposed to a linear approach

Levels of Prevention: Tertiary Prevention

- Education and resource utilization

Research in Women's Health

- Efforts to include women in studies have grown; not based only on male subjects - NIH Office of Research on Women's Health (ORWH) established in 1990 - Many topics examined based on special task force recommendations - Research on financing and delivery of health services for women

Military Rank

- Enlisted personnel (E1 through E9) include noncommissioned officers and petty officers. - Comprise 80% of military workforce - Warrant officers (W-1 through W-5) are highly specialized experts. - Commissioned officers (0-1 through 0-10) highest ranks, similar to managers/leaders of a company

Sharing Responsibility for Improving Child and Adolescent Health: Parents Role

- Ensure health of fetus - Breast feed and provide nutritious food - Immunizations - Receive needed health care services - Acquire healthful lifestyles

Legislation Affecting People With Disabilities: The Individuals with Disabilities Education Act (IDEA)

- Ensures a free and appropriate public education to children with disabilities in least restrictive settings - Development of individualized education plan (IEP) - Registered professional school nurse is essential member of the team participating in the identification and evaluation of students who may be eligible for services.

Theories of Aging: Biological theories

- Events that occur randomly and accumulate over time (stochastic theories) - Predetermined aging (nonstochastic theories)

Breast-feeding: American Academy of Pediatrics (AAP) recommends:

- Exclusive breast-feeding for first 6 months - Breast-feeding in combination with introduction of complementary foods until at least 12 months - Continuation of breast-feeding for as long as mutually desired by mother and baby

WWII Veterans

- Exposed to high levels of noise, exposed to radiation at Hiroshima and Nagasaki - Battle of the Bulge fought cold injuries - Exposed to mustard gas experiments

Korean War Veterans

- Extreme cold injuries - Noise - Occupational hazards

Alcohol and Illicit Drugs

- FASD range from mild, subtle, to severe learning disabilities - Children with FASD are at risk for: Psychiatric problems, Criminal behavior, Unemployment, Incomplete education - Children with FASD may also have: Physical abnormalities, Growth deficiencies, Central nervous system disorders - An estimated 10.2% of pregnant women drink during pregnancy

Elder Safety and Security Needs

- Falls: Aging, chronic illness, and medications increase risk, Broken hips, TBIs - Driver safety: Impaired by sensory disabilities, medications - Residential fire-related injuries - Cold and heat stress: Hypothermia, heatstroke, heat syncope, heat exhaustion, and heat cramps

Structural-Functional Conceptual Framework

- Family is viewed according to its structure, or parts of the system, and according to its functions, or how the family fulfills its roles. - Internal structure; five categories: Family composition, the family members, and changes in family constellation, Gender, Rank order, or positions of family members by age and sex, Subsystem or labeling of the subgroups or dyads through which the family carries out its functions, Boundaries, or who participates in the family system and how he or she participates - External structure: Extended family, including family of origin and family of procreation, Larger systems, such as work, health, and welfare - Context—background or situation relevant to an event or personality in which the family system is nested - Five categories: 1. Ethnicity 2. Race 3. Social class 4. Religion 5. Environment

Factors That Impede Men's Health: Mission orientation

- Focused on maintaining an effective workforce - Financial support for curative—not preventive—care - Reluctance to take time off from work for care

Sources of Income

- Four sources for population aged 65 and over: Social security, Earnings, Pension, Assets - The proportion of the older population living in poverty has decreased but is affected by gender, marital status, race, and ethnicity. - With aging, a good percentage of income is spent on health care.

Active duty

- Full time personnel - Overseas deployment lasts between 6 and 15 months - May have periods of working nearly 24 hours every day 7 days a week

Measurement of Disability: U.S. Census Bureau Survey of Income and Program Participation (SIPP)

- Gathers info on income, employment, health insurance, and government transfer programs - Longitudinal survey administered over 4-year period among the same respondents - Asks respondents about functional activities, activities of daily living (ADLs), and instrumental activities of daily living

Demographic Characteristics

- Gender: Older women outnumber older men. - Marital status: Older men are more likely than older women to be married. - Education: Educational attainment has increased among older adults. - Living arrangements: As age increases and widowhood rise, the percentage of population living alone increases; Older women are more likely than men to live alone.

Systems Theory

- General systems theory—explains how the family unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem). - Negative influences on the family include violence, community-acquired diseases, disasters.

Theories That Explain Men's Health: Biological factors

- Genetics, effects of sex hormones, and physiological differences influenced by genetics, hormones, and environment

Assessment Tools

- Genogram: a tool that helps the nurse outline the family's structure; diagram of the family, generally three generations - Family Health Tree: mechanism of recording family's medical and health histories. - Ecomap: Depicts a family's linkages to their suprasystems

Poverty

- Greatest threat to child's health - United States highest rate of poverty than most industrialized countries and rising - Factors associated with poverty include: Parental education, Employment, Single parenting - Poor children face health and socioeconomic risks: - Have less access to nutritious food, shelter, and health care - Often deprived of good schools, libraries, and other community resources - Deaths from unintended injuries, maltreatment, homicide, STIs, and infectious diseases - Live in substandard housing, stressful home lives, may live surrounded by drugs and crime, lack positive and nurturing adult role models

The Family of a Child with a Disability: Parents

- Grieve the loss of the idealized or expected child over time - Redefine their image of the expectations for the child and themselves as individuals/parents/marital partners/members of a culture and society

Racial and Ethnic Disparities

- Health People 2020 targets persistent differences in health among children of varying racial and ethnic groups and calls for the elimination of disparities in health. - Community health nurses can develop an understanding of differences in health based on race, ethnicity, and economic circumstances.

Social Factors Affecting Women's Health

- Health care access - Education and work - Employment and wages - Working women and home life - Family configuration and marital status

Public Health Programs Targeted to Children and Adolescents

- Health care coverage programs: Affordable Care Act, Medicaid and CHIP Health Insurance Programs, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) - Direct health care delivery programs: Maternal and Child Health Block Grant (Title V), Community and Migrant Health Centers Program, School-Based Health Centers, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Health Promotion and Disease Prevention for PWD

- Health care problems frequently unrecognized and untreated - Persons may not be able to communicate their symptoms and/or unable to share in decision making - May exhibit behavioral problems that discourage health care providers from caring for them

Child and Adolescent Health

- Health habits adopted by children and youth profoundly influence their potential to lead healthy, productive lives. - The physical and emotional health of a child plays a pivotal role in the overall development and well-being of the entire family. - Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential.

Common Health Concerns: Medication use

- High prevalence of chronic diseases = large numbers of medication - Older adults responsible for more than a third of total outpatient spending on prescription medications - Polypharmacy makes older adults vulnerable to drug interactions and dangerous adverse reactions.

Suicide

- High success rate among elderly - "Double suicides" involve spouses or partners. - Associated with: Depression, Chronic illness, Physical impairment, Medical conditions that significantly limit functioning or life expectance, Unrelieved pain, Financial stress, Loss and grief, Social isolation, Alcoholism

Living Arrangements

- Housing and residential services: Older adults typically prefer to "age in place" or live in their own homes as long as possible. - Alternative housing options for older adults: Alternative housing options are available with services to help seniors.

Social and Structural Constraints

- Identify what prevents families from receiving needed health care or achieving a state of health - Usually based on social and economic causes: Literacy, education, employment; If disadvantaged, often unable to buy health care from private sector; Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers)

Sharing Responsibility for Improving Child and Adolescent Health: Employer Role

- Improve health of individual children or community - Make health care more accessible to families with children by offering affordable health insurance that covers employees and dependents - Support nursing mothers - Offer flexible leave for prenatal and pediatric health care - Offer time off for sick newborn or children

Reproductive Health: Healthy People 2020 initiative:

- Improve maternal and infant health - Decrease adolescent pregnancy - Focus on positive "all pregnancies should be intended"

Global Perspective on Culture and Disability

- Individuals in other parts of globe have varying perspectives and experiences of disability. - Some cultures believe a child born with a disability is the result of some past wrongdoing. - Researchers believe education on preventative measures will decrease prevalence of disabilities. - Rural, undereducated, poor may not be getting suitable treatment for disabilities.

Infant Mortality

- Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status. - United States ranks 19th in infant mortality behind most other industrialized nations. - U.S. Infant Mortality has dropped every year since 1940 (not 2002) - Attributable to public health measures and improved standard of living: Improved sanitation, Clean milk supply, Immunizations, Nutritious food, Enhances access to maternal health care - Technological advances in neonatal care also contributed: For example, synthetic lung surfactant

Structural-Functional Conceptual Framework: Functional assessment

- Instrumental functioning: routine activities of daily living - Expressive functioning: affective or emotional aspects - Emotional communication - Verbal communication - Nonverbal communication - Circular communication - Problem solving - Roles - Influence - Beliefs - Alliances and coalitions

Characteristics of Healthy Families

- Interact with each other; listen and communicate repeatedly in many contexts. - Establish priorities and understand that family needs are the priority. - Affirm, support, and respect each other. - Have flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision-making. - Teach family and societal values and beliefs and shares a religious core. - Foster responsibility and value service to others. - Have a sense of play and humor and share leisure time. - Have the ability to cope with stress and crisis and grow from problems. - Know when to seek help from professionals. —DeFrain (1999) and Montalvo (2004)

Community Health Nursing Services for Men: Primary preventive measures

- Interest groups in men and men's health - Men's growing interest in physical fitness and lifestyle - Policy related to men's health - Health services for men

"Knowledgeable Client" and "Knowledgeable Nurse"

- Intersystem model refers to the first-described person as the "Knowledgeable Client" - Client has been living with disability for extended period of time, is sensitive to needs of their body. - Nurse should ask client what works best for them and what goals the client is pursuing. - Clients need the services of the "Knowledgeable Nurse" - Clients newly diagnosed can benefit from the information about the disability and the available community and governmental resources.

Levels of Prevention: Secondary Prevention

- Routine screening for cervical cancer, STIs, breast self-examinations, and mammograms

Intimacy and Sexuality

- Intimacy includes need for close friendships and relationships as well as spiritual connections. - Normal physiological changes occur with age. - Estrogen levels in women decrease after menopause causing several issues such as vaginal dryness, which can be treated with estrogen creams, tablets, etc. - Men's testosterone levels decrease causing erectile dysfunction, which often is due to an underlying medical condition.

Substance Use Disorder (SUD)

- Involves a pattern of alcohol, tobacco, and illegal and prescription drugs that results in marked distress and/or impairment —American Psychiatric Association (APA) (2003) - Binge drinking and cigarette smoking are the most prevalent.

Models of Care for Communities of Families

- Kentucky Partnership for Farm Family Health and Safety - Involving farm families, universities, and various community-based organizations - Farming identified as most dangerous occupations in the United States - The Health Access Nurturing Development Services Program (HANDS) - Voluntary home visitation program for any new parent targeting at-risk families that include first-time parents

Applying the Nursing Process

- Knowledge of self, previous life experiences, and values is crucial in planning home visits - Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home - Flexibility is important in working with families.

Theories That Explain Men's Health: Gender-linked behavior

- Largest gender differences in mortality rates occur for causes of death associated with gender-like behavior; Tobacco use: lung cancer, bronchitis, emphysema, asthma; Substance abuse: cirrhosis, accidents, homicide; Poor preventative health habits and stress: heart disease; Lack of other emotional channels: cirrhosis, suicide, homicide, accidents

Sudden Unexplained Infant Death

- Less than 1 year of age - Occurs suddenly and unexpectedly - Cause of death not immediately obvious before investigation - Half of SUID die from SIDS - 1994 Federal government and private entities launched the "Back to Sleep" campaign: Heighten awareness of the safety of positioning infants on their backs for sleep, SIDS death declined by >50% - As a result of success of the "Back to Sleep" Campaign, in 2010 the "Safe to Sleep" campaign was launched: Included other actions to reduce risks of other sleep-related causes of death (e.g., suffocation)

Women's Mortality Rate

- Life expectancy for Americans is at an all-time high. - Cardiovascular disease (CVD)—#1 leading cause of death in women. - Cancer rates are increasing as a result of lifestyle choices, environmental carcinogens, and increase in life expectancy. - Maternal mortality—deaths of women while pregnant or within 1 year after the end of the pregnancy: Ectopic pregnancy is the leading cause in the first trimester. Associated with PID, IUDs, and STDs

Breast-feeding: Mother

- Lower risk of breast and ovarian cancer - Lower risk of type 2 diabetes - Saves more than $1500 per year on formula and supplies - Saves costs to treat illnesses

Ethical Issues for People Affected by Disabilities: The Patient Self-Determination Act (PSDA) of 1990:

- Mandated health decisions communicated and protected and that patients, upon admission to a health care facility, are asked if they have a durable power of attorney or an advance directive. - Determining appropriate care for infants, children, and adults is a complex issue for families to consider.

Moving from Individual to Family: The CHN nurse in the interview process uses:

- Manners and professionalism - Therapeutic conversations - Genogram and ecomap - Therapeutic questions - Identifying family or individual strengths and commending them - Issues in family interviewing - Many locations, family informant, family health portrait, involvement of children - Intervention in cases of chronic illness

The Changing Family

- Many definitions of family exist. - Vary by professional discipline and the type of family described - Wright and Leahey (2012) state "The family is who they say they are" (p. 70). - "Family" means any person(s) who play a significant role in an individual's life. This may include a person(s) not legally related to the individual. Members of "family" include spouses, domestic partners, and both different-sex and same-sex significant others. "Family" includes a minor patient's parents, regardless of gender of either parent ... without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles. —Human Rights Campaign ( 2017) - Regardless of the definition of the family, what is evident is the importance of the family unit to society - Families have two important purposes: Meet the needs of society, Meet the needs of the individual family members - The family is the "buffer" between the individuals and society.

Moving from Individual to Family: Issues in family interviewing

- Many locations/settings - Family members experience similar risk factors (i.e., physiological, behavioral, and environmental). - Family health portrait tool - Involvement family in newborn assessments to gauge adjustment

Preterm Birth and Low Birth Weight

- Preterm birth: Birth before 37 weeks of gestation - Low birth weight (LBW): Infant born less than 5.5 pounds - Important predictors of infant health - Greater risk of death than full term - Greater risk of mental and physical disabilities: Cerebral palsy, Visual problems (e.g., retinopathy of prematurity), Feeding problems, Hearing loss, Developmental delays - Late preterm (34 to 36 completed weeks gestation) carry risk for: Physical problems, Developmental delay

Sexual Health, Education, and the Potential for Abuse

- Many parents or caregivers are not comfortable addressing what is integral to the quality of life and well-being for the PWD: Sexual behavior - Health care professionals often consider sexual behavior: Less acceptable, Somehow unsafe, Inappropriate for PWD, Assume they are asexual and eliminate sexual assessment and conversation from client education —Shandra and Chowdhury (2012) - Violence and abuse more prevalent than other populations - May be lack of inhibition as well, predisposing some individuals to perpetrate the sexual abuse —Euser et al. (2016) and Normand and Sallafranque-St-Louis (2016) - Children with IDD represented 25.9% of the maltreated allegations with 29% of those allegations validated. —Maclean et al. (2017)

Use of Medical Care

- Men do not engage in health protective behaviors as frequently as women. - Most men do not have routine check-ups, including screenings. - Men seek ambulatory care less often than women: Men delay medical treatment; Sicker when they do seek health care; therefore, require more intensive medical care. - Men tend to have longer lengths of stay in the hospital than women.

Theories That Explain Men's Health: Socialization

- Men enculturate their sons to believe that risking personal injury demonstrates masculinity. - Men are more likely to change health behaviors when supported by female family members.

Morbidity

- Men tend to perceive themselves to be in better health than do women. - Common indicators of morbidity rate: Incidence of acute illness, Prevalence of chronic conditions, Use of medical care

Factors associated with preterm and LBW

- Minority status - Chronic stress - Maternal age of <17 years and >35 years - Chronic health problems of mother - Lack of prenatal care - Multiple births - Certain problems with the uterus or cervix - Low socioeconomic status - Unhealthy maternal habits - Induced labor without indication - Elective C-section births

Prevalence of Disability in Children

- More than 8% of U.S. children under 15 years of age have some kind of disability. - About half were classified as severe disabilities. —Brault (2012) - Among children with special needs almost 32% had ongoing emotional, behavioral, or developmental conditions requiring treatment. - Almost 60% reported difficulty with one or more emotional or behavioral factors.

Women's Morbidity Rate

- More women than men are hospitalized each year in the United States. - Women are more likely than men to be disabled from chronic conditions. - Women are more likely than men to have surgery; many surgeries relate to reproductive health. The most frequently occurring interruption in women's mental health relates to depression

The Experience of Disability

- Most people whose lives do not end abruptly will experience disability in their later years. - Temporary disabilities have different experiences than those with permanent disabilities. - Those who have lost a limb or stroke learn to incorporate modifications for living into their daily routines. - Those who become disabled because of a chronic illness may be reluctant to use assistive devices. - In many cases a disability result in a downward spiral: - Unable to work; lose job and benefits - Loss of home - Apply for state or federal disability benefits, feeling qualified, but warned there is a waiting period and to expect to be initially rejected - Nurse should: Engage in active listening, Help clients connect with comprehensive social services by maintaining knowledge of resources

Nutrition

- MyPlate - Older adults require the same or higher levels of nutrients for optimal health outcomes. - Poor diet quality is associated with: Cardiovascular disease, Hypertension, Type 2 diabetes, Osteoporosis, Some types of cancer

Other Community Voluntary Services

- Networking: Help women advance careers, improve lifestyles, and increase income and success. - Crisis hotline services: Provide counseling to battered women, battering parents, rape victims, those considering suicide, and those with multiple needs. - Women's organizations: Promote voluntary involvement with community; many others have made women's health a major item on their agenda.

Approaches to Meeting the Health Needs of Families

- New frontier is to direct intervention at the family level rather than the individual client level. - Nursing assessment and interventions must not stop at with the immediate social context of the family; it must also consider the broader social context of the community and society. - Friedman and colleagues suggest reasons why it is important for nurses to work with families: The family is a critical resource, In a family unit any dysfunction that affects one or more family members will affect the members and unit as a whole, Case finding nursing may find other risks when working with the family, Improve nursing care through holism.

Attitudes Toward People with Disabilities: Eighteenth Through Twentieth Centuries

- No scientific model for understanding and treating - Disability seen as an irreparable condition caused by supernatural agency - Viewed as sick and helpless - Industrial revolution stimulated a societal need for increased education - If not third-grade level = feeble-minded - Special schools established in early 1800s

Anxiety Disorder

- Normal age-related worries experienced by older adults: financial concerns, health problems, reduced social interactions due to loss of friends through death and relocation - Anxiety disorder causes people to have feelings of intense fear and distress that prevent them from performing everyday tasks. - Generalized anxiety disorder: Excessive, exaggerated anxiety and worry about everyday events

Developmental Theory

- Normal families traverse from marriage to death - Family life cycle (Duvall & Miller, 1985) - Leaving home - Beginning family through marriage or commitment as a couple relationship - Parenting the first child - Living with adolescent - Launching family (youngest child leaves home) - Middle-age family (remaining marital dyad to retirement) - Aging family (from retirement to death of both spouses)

Elder Abuse

- Not only a health concern but also a legal problem - Abuse is defined as the willful infliction of pain, injury, or debilitating mental anguish, unreasonable confinement, or deprivation by a caretaker of services that are necessary to maintain mental and physical health. - Four types of elder abuse: 1. Physical abuse 2. Psychological/emotional abuse 3. Financial or material exploitation 4. Neglect - Abuser is frequently the: Spouse, Adult child, Sibling, Friend or caregiver - Nurse should report suspected abuse to the local Adult Protective Services through their state hotline.

Differentiating Illness from Disability

- Nurse should not assume a need for an intervention - Ask the client if they want assistance - Listen to understand - Collaborate with person/family to make plans and goals - Collaboration promotes self-determination and allows choices that foster personal values and preferences

Physiological Changes

- Occur in all body systems in response to aging - Rate and degree of changes are highly individualized. - These changes are influenced by: Genetic factors, Diet, Exercise, The environment, Health status, Stress, Lifestyle choices, And many other elements

Patient-Centered Community Care and Veterans Choice Program: Veterans Choice Program:

- Outsources veteran care when needed care cannot be received at the VHA in a timely manner (within 30 days of date clinically indicated by VHA provider) or within reasonable distance (within 40 miles of veteran's home)

Challenges Facing U.S. Families: Aging Populace

- People 65+ represented 14.5% of population in 2014 and expected to grow to 21.7% by 2040. - By 2060, there will be about 98 million older persons, more than twice their number in 2014. - Oldest subgroup of this population is the "oldest-old" those over 85 years. And the greatest increase in the 90 to 94 year old age group. - Older population comprises 23.1% of total disease burden worldwide. - Aggregate has the most burdensome diseases: Ischemic heart disease, Stroke, Chronic obstructive pulmonary disease, Diabetes - Challenging living arrangements - Draining economic recourses - Sandwich generation: Adult caring for elderly parent in their home or providing financial support

A Historical Context for Disability

- People with disabilities have sometimes been viewed as mascots and fascinating freaks. - In other cases they have been isolated, ridiculed, and discriminated against, or worse, marked for extermination.

Men's Health Care Needs

- Permission to have concerns about health and to talk openly to others about their concerns - Support for the consideration of gender-role and lifestyle influences on their physical and mental health - Attention from professionals regarding factors that may result in illness or influence a man's expression of illness, including such things as occupational factors, leisure patterns, and interpersonal relationships - Information about how their bodies function, what is normal, what is abnormal, what action to take, and the role of proper nutrition and exercise - Self-care: testicular and genital self-examinations - Physical examination and history-taking that include sexual and reproductive health and illness across the lifespan - Treatment for problems of couples, such as interpersonal problems, infertility, family planning, sexual concerns, and STDs - Help with fathering (i.e., being included as a parent in child care) - Help with fathering as a single parent, particularly with a child of the opposite sex, in addressing the child's sexual development and concerns - Recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change - Adjustment of the health care system to men's occupational constraints regarding time and location of health care sources - Financial ways to obtain these goals

Reproductive Health: HIV/AIDS:

- Persistent health threat to women in United States - Risk factors for barriers to prevention of HIV/AIDS • Young age at sexual initiation • Lack of awareness regarding disease and condom use • Sexual inequality in relationships • Biological vulnerability to sexually transmitted infections • Substance abuse • Poverty; dropping out of school • Stigma surrounding testing and treatment • Working in the sex trade • Participants in unprotected sex

Healthy People 2020: Objectives for measurement of this goal include increasing the proportion of:

- Persons with health insurance - Covered preventive services - Persons with a usual PCP - Persons who have specific ongoing care

Legislation Affecting People With Disabilities: ADA refers to a "qualified individual" as a person with a:

- Physical or mental impairment that substantially limits one or more major life activities or bodily functions - A person with a record of such an impairment - Person who is regarded as having such an impairment - Prohibits discrimination against a person with a disability

Self-Assessment: Perception of Disability

- Picture what it is like to be born with a disability. - Envision yourself unable to use your arms or legs or being confined to a wheelchair and dependent on the assistance of others. - Consider preparing yourself for the day with the use of one arm, from a wheelchair. - Further complicate the situation with a significant health concern such as diabetes that requires close monitoring or medication. - Consider individuals who were healthy since birth and just became disabled by a disease or accident o How do they adapt to living in their old environment? o How would their employment be affected? o Financial resources, and personal and emotional support? - Think about living in a family affected by disability. o Consider the impact of a child with a disability on parental activities and family roles. - What is the experience of living with a disability within your community?

Men's Health Care Needs: Call for political processes that set:

- Policy, for health marketing techniques - Advocacy

Polytraumatic Injuries and Pain

- Polytrauma is two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities Chronic pain - Combat operations impart physical stress - Work long hours - Carry heavy packs - Wear heavy armor - 2009 study reveals 29% Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans report chronic widespread pain.

Health Care Use

- Preventative health and dental care offer children and parents a chance to periodically meet with health care providers to: - Discuss child's physical and emotional growth and development - Learn about good nutrition - Address safety issues, such as car seats and seatbelt - Receive immunizations and vision and hearing screening - Learn about potential environmental threats to the child's health - Begin prompt treatment for condition discovered during examination - Ask questions or obtain a referral when necessary

Healthy People 2020: Access to quality health care affects:

- Prevention of disease and disability - Quality of life - Preventable death - Overall life expectancy

Major Legislation Affecting Women's Health Services: Title VII of the Civil Rights Act of 1964

- Prevents discrimination based on sex, race, color, religion, or national origin - Amended to also include pregnancy and childbirth - Sexual harassment is a violation of Civil Rights Act

Healthy People 2020

- Primary goal is to increase the quality and years of healthy life - Specific goals designed to promote healthy outcomes for older adults

Sharing Responsibility for Improving Child and Adolescent Health: Government's Role

- Promote and ensure children's health - Public health programs - Monitoring health

Health and Social Services to Promote the Health of Women: ACA of 2010

- Protection from being denied coverage by insurance companies - Protection from being charged more for health care services because of their gender - Preventive care without copays including: Well-women visits with screening and counseling for gestational diabetes, HPV, STIs, HIV, contraception, and intimate partner violence; Breast-feeding counseling support and supplies

Health and Social Services to Promote the Health of Women: Women's health services

- Provide primary health care needs, as well as reproductive and maternity care services including: Eating disorders, All forms of abuse, Disease prevention, including smoking cessation, Health promotion focusing on nutrition, exercise, and stress management - The National Women's Health Network is a strong advocate for women's concerns.

Community Health Nursing Services for Men: Tertiary prevention measures

- Provide rehabilitation with sex role and lifestyle considerations - Provide counseling on lifestyle, role changes, and job retraining - Give men permission to express emotions - Adapt goal setting to meet men's needs - Keep time away from work to a minimum - Develop new concepts of community care - Provide specific services for men; adapt care to meet needs of male population in the community

Sharing Responsibility for Improving Child and Adolescent Health: Community's Role

- Provide support to families - Ensure access to health care - Promote well-being - Provide safe neighborhoods - Education - Housing - Social service programs

Major Legislation Affecting Women's Health Services: Public Health Service Act (1982)

- Provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery. - Includes the Family Planning Public Service Act

Major Legislation Affecting Women's Health Services: Social Security Act

- Provides monthly retirement and disability benefits to workers and survivor benefits to families

Nursing Interventions

- Provision of age-related health screenings - Early surveillance of diseases based on knowledge of common comorbidities - Maintenance of proper weight: Counseling on appropriate nutrition and social inclusion through enhanced physical activity - Identification of caregivers and support systems - Identification of access to care issues - Transportation, financial, and environmental barriers - Safety of the physical environment - Assistive technology and potential for abuse - Knowledge of resources

Legislation Affecting People With Disabilities:

- Qualified individual must meet legitimate skill, experience, education, or other requirements of an employment position. - Must be able to perform essential job functions, contained within a job description, with or without reasonable accommodations

Longevity and Mortality

- Rates of longevity are increasing for both men and women. - Life expectancy for both male and females has increased: Since the 1970s gender gap in longevity decreased. - Factors influencing mortality rates include race or ethnic origin, socioeconomic status, and education. - United States lags behind other countries in premature mortality rates for males. - Males lead females in mortality rates in each leading cause of death. - Males at higher risk for death resulting from unintentional injury, suicide, and homicide.

Veteran Suicide

- Rates of suicide higher among veteran population - Male veteran rates were highest in 18 to 19 and 75 and older age groups - Females highest in 18 to 29 age group - An average of 20 veterans died by suicide each day - Increased risk among veterans who experienced MST and PTSD

Levels of Prevention: Primary Prevention

- Recognize risk for disease and target health care behaviors to reduce risk - Never smoking, following a nutritious diet, safe sex practice, avoiding drugs, limiting alcohol consumption, and staying physically active

Recommended Health Care Screenings and Examinations

- Recommendations are very useful to community nurses educating older adults about the benefits of screening and early detection of disease.

End-of-Life Issues: Patient Self-Determination Act (PSDA) of 1990

- Requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess advance directives. - Living will - Durable power of attorney - DNR (do-not-resuscitate) order - Physician Orders for Life Sustaining Treatment (POLST)

Psychosocial Issues

- Retirement: Cope with change in social status and possibly income level - Relocation: Desire to move closer to family, Due to health reasons, Inability to maintain home

Factors That Impede Men's Health: Barriers to men's health:

- Risk-taking behaviors - Infrequent use of health care system - Gaps in preventive health behavior - Differences in illness and health orientations - Reporting of health behavior - Little effort has been made to create a male-specific health care climate

Disability in the Twentieth Century

- Special interest groups emerged - Early 1920: first federal vocational rehabilitation legislation passed - Focused on limitations in the amount or type of work that people with disabilities could perform —Longmore (1987) - Involuntary sterilization of many with intellectual disabilities - Hitler's euthanasia or "good death" program - Killed at least 5000 disabled children - Killed 70,000 adults with disabilities by 1941 - Over 200,000 people exterminated because they were "unworthy of life"

TRICARE

- Sponsored by the Department of Defense (DoD) - Provides health care for: Active duty military personnel, Their families, Their survivors - Eligibility for TRICARE disqualifies one for CHAMPVA

Theories That Explain Men's Health: Orientation toward illness and prevention

- Stereotypical view of men as strong and invulnerable is incongruent with health promotion. - Men lack the somatic awareness and are less likely to interpret symptoms as indicators of illness. - Men may have a desire to rationalize symptoms and deny their susceptibility to disease, thus delaying treatment.

Military Culture: Structure and uniformity, governed by rules and standards

- Strong sense of service - Hierarchal class system - Solutions focused on actions - Unique dialog and expressions - Reluctance to show weakness

Community Health Nursing Services for Men: Secondary prevention measures

- Tailor health care clinics to men's needs - Provide screening services for men

Moving from Family to Community

- The health of a community is measured by the well-being of its people and families. - Challenge to the CHN is to provide care to communities and populations not just the individuals and the family. - CHN nurses compare city data with county data, and then county data with state data, and national data.

Issues of Pregnancy and Infancy

- The health of the mother before, during, and after pregnancy has a direct impact on the health and well-being of her children. - A comprehensive approach is needed to: Identify and treat potential risks, Overcome barriers to good health before, between, and beyond pregnancy, Protect and promote the health of women and children, Ensure the health of future generations - Identify and treat potential risks good health before, between, and beyond pregnancy to promote health of mother and child, for example: Mothers with uncontrolled medical conditions; Low birth weight, Fetal exposure to drug, alcohol, tobacco, poor nutrition; Chronic conditions, Environmental exposures; Chronic conditions throughout childhood and maybe adolescence/adulthood, Children lacking preventive health care necessary immunizations; likely to have preventable diseases or chronic conditions in life

Disability: A Social Construct

- The interactive relationship between a person and the demands of the environment characterizes disability across may conceptual definitions or models. —Costa-Black et al. (2013) - Culture, education, and the social organization can shape how all individuals perceive disability.

Prenatal Substance Use

- The use of tobacco, alcohol, or illicit drugs in any combination is dangerous to a woman's health and worsens infant health and development outcomes. - Smoking is one of the most preventable causes of infant morbidity and mortality. - Alcohol can lead to fetal alcohol spectrum disorder (FASD). - Drugs can cause permanent harm to an unborn baby.

Veteran Health Risks

- Traumatic brain injury (TBI) - Noise - Radiation - Amputation - Occupational hazard exposures - Posttraumatic stress disorder (PTSD) - Military sexual trauma (MST) - Polytrauma - Chronic pain - Substance use disorder - Suicide

Chronic Multi-symptom Illness (CMI)

- Unexplained symptoms including: Fatigue, Dizziness, Headaches, Cognitive disfunction, Musculoskeletal pain, respiratory problems, Rashes, Diarrhea - Affected approximately 250,000 veterans from the 1991 Gulf War

Other Issues in Women's Health

- Unintentional injury or accidents: Intimate partner violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States. - Disabilities resulting from acute and chronic conditions: Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment.

Additional Health Concerns: Incontinence may be due to

- Urinary tract infections - Vaginal infection and irritation - Constipation - Certain medicines

Discussion of the Theories of Men's Health

- Use gender-specific interview techniques to obtain the most accurate health history. - Be aware of personal gender bias in data collection. - Be aware of the accuracy and interpretation of secondary sources of information. - Help men learn how to provide support to the caregiver or to develop a caregiver role. - Acknowledge that gender-linked behaviors increase risks: Lifestyle factors (e.g., use of tobacco, substance abuse, poor preventive health habits and stress, lack of emotional channels), Men's unwillingness to seek preventive care, Men's unwillingness to seek health care when a symptom arises

Cost of Care

- VA hospitals and clinics are not a type of health insurance: - Compensation for their duty and service to the country - Veterans do not "pay into" their VA benefits - "Coverage" received in form of VA benefits is not transferable to non-VA providers • Except through formal contracts deem appropriate by VA and providers - Standardized copays for medicines - Annual cap of $700.00 on amount they must spend

Overview of the American Uniformed Services

- Veteran is a person who has served in the military. - Legal definition: Any individual who completed service for any branch of armed forces is a veteran as long as they were not dishonorably discharged. - Any person who served in U.S. Public Health Service and some employed by National Oceanic and Atmospheric Administration are also veterans. - There are 18.8 million veterans in the United States in 2015. - Public health nurses must be aware of the needs, histories, and experiences of this population.

Eligibility and Enrollment

- Veteran is eligible for VA benefits when they fulfill two requirements to service and separation: 1. Service: must have served in active duty for 24 consecutive months or full period of call (Reserves and Guard); some exceptions exist 2. Separation must have been under any condition other than dishonorable. - Service-connected disability a disease or injury that was incurred or aggravated as a result of or during the veteran's active duty - Helps to sort veterans into treatment by Priority Groups

Physical Activity and Fitness

- Walking is best form of exercise. - Barriers to exercising: Lack of safe area to exercise, Pain and fatigue, Impairment in sensory function and mobility - Nurses should understand the beneficial effects of exercise and identify barriers that prevent exercise.

Wellness and Health Promotion

- Wellness is different than "good health." Wellness exists at one end of a continuum with illness at the other end. Health promotion programs focus on helping individuals to maintain their wellness, prevent illness, and manage any chronic illnesses that the individual may have. Preventive health services are valuable in improving the individual's health status to maximum wellness potential.—Nies and McEwen (2019)

Theories That Explain Men's Health

- Why "females are sicker, but males die sooner"? - Biological factors, including genetics, effects of sex hormones, and physiological differences, which may be influenced by genetics, hormones, and environment - Socialization - Orientations toward illness and prevention - Data collection of health behavior —Waldron (1995e) and Verbrugge and Wingard (1987)

Men's Health

- Women live longer than men. - Health care use greater among women than men. - Death rate higher for men than women in terms of the major causes. - Women's health has specialty; men's health has not established a specialty.

Theories of Aging: Psychosocial theories:

- how one experiences late life (behavioristic) - Disengagement theory—withdrawal, decreased interaction - Activity theory—remaining active and involved is necessary to maintain life satisfaction - Continuity theory—continue through life as in previous years

Military Sexual Trauma

- military sexual trauma (MST) a broad continuum of traumatic experiences that are sexual in nature - Includes: Physical assault of a sexual nature, Battery of a sexual nature, Sexual harassment that occurred while the veteran was serving on active duty

Patient-Centered Community Care and Veterans Choice Program: Patient-Centered Community Care (PC3):

- program for veterans needing certain primary care or inpatient-related care - PC3 also covers some skilled home health care and home infusion therapy.

Family Theory

1. Any "dysfunction" that affects one member will probably affect others and the family as a whole. 2. The family's wellness is highly dependent on the role of the family in every aspect of health care. 3. Family wellness can be raised by reducing lifestyle and environmental risks. 4. Commonalities in risk factors and diseases shared by family members can lead to case finding within family. 5. Understanding of the individual is only truly assessed within larger context of the family. 6. Family as a support system must be incorporated into the treatment plan.

Infant Mortality: Five leading causes of infant death are:

1. Congenital defects 2. Disorders related to short gestation or low birth weight 3. Maternal complications of pregnancy 4. Sudden death syndrome (SIDS) 5. Accidental suffocation

Approaches to Family Health: There are four frameworks for meeting family health needs:

1. Family theory 2. Systems theory 3. Structural-functional conceptual framework 4. Developmental theory

Four stages in the disabling process:

1. Pathology 2. Impairment 3. Functional limitation 4. Disability

The Veterans Administration (VA): Three subdivisions:

1. Veterans Health Administration (VHA) under the VHA: provides all types of health care in every setting, inpatient, outpatient, long-term care 2. Veterans Benefits Administration (VBA): responsible for unemployment, pension, home loans, vocational training, educational benefits 3. National Cemetery Administration

Spirituality

Involves "finding core meaning in life, responding to meaning, and being in relationship with God/Other" —Manning (2013) - Nursing interventions should address spiritual needs and concerns as part of holistic care: Interventions include nurses' presence, active listening, caring touch, reminiscence, prayer, hope, nonjudgmental attitude, facilitation of religious practices, referral to spiritual care experts.