Community Exam 1

The unidted states has a _______ insurance system

The Private Insurance System

Medicare Part A

The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care.

Medicare Part B

The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.

Politics

The process of influencing the allocation of resources needed to enable policies involving the strategies needed to achieve the desired goals.

Social System

The relationship the community members form with one another.

What are the Key Lifestyle Risks leading to chronic diseases

Tobacco use Poor nutrition Low physical activity Excessive alcohol use

Common Reasons for Closing Case Management Cases

Client lost to care or does not engage in service. Client chooses to terminate service. Client relocates outside of service area. Mutual agreement. Client is no longer in need of service. Client completed case management goals. Client no longer eligible. Client is referred to a program that provides comparable case management services.

Social Determinants of Health?

-This refers to the conditions in the environments where people are born, live, work, play, worship or congregate and age the affect a wide range of health and quality of life concerns. -Quality education can mean access to better employment which, in turn, leads to better chance of economic stability. -Access to adequate medical insurance and health care providers = better health outcomes and quality of life. -Social integration = support structure during times of difficulty without which, the individual is vulnerable. -Environment = safe housing and clean water/sewage.

difference between hospice and palliative

-While both types of nurses provide comfort - the primary difference is the onset of need. -Palliative care can begin at diagnosis and at the same time as treatment (chronic and progressive medical conditions). -Hospice begins after treatment of the disease has stopped and it is clear that the person is not going to ultimately survive.

Neurodevelopment Concerns

Autism prevalence is now 1 in every 68 children. -, this disorder can range from mild to severe. -Some behaviors may include language problems ( delay in language), motor mannerisms ( rocking, hand flapping), fixation on objects (less interest in other things), and little or no eye contact. -The cause is not known, but genetic and environmental agents may increase risk. -Community nurses may come in contact with this type of child in well-child, immunization clinics, and as school nurses. See this disorder from a parent's perspective.

Physical Health Concerns for school aged childern

Chronic health condioition continues to rise -There are 3 main school-aged health concerns: asthma/ physical health conditions, mental health conditions, and neurodevelopment disorders. These chronic diseases can affect the entire family due to: #Increased demands for child care/ health care. #Parent/guardian needing to be available for the child's care may create monetary issues for the family. #Developmental delays and social issues in children.

Medicaid

-available to certain groups of individuals and is offered by the states. -Covers healthcare services for qualified low-income individuals -Mandatory groups include low-income families, qualified pregnant women and children and individuals receiving Supplemental Security Income (SSI). States then vary in additionally covered groups. -The affordable care act in 2010 created the opportunity for state to expand Medicaid to cover nearly all low income Americans under age 65 (not just low income families, women and children). -Most states have chosen to expand coverage to those adults, and states that have not yet expanded may choose to do so at anytime.

Hospice nursing

-care for terminally clients at the end of their lives, ensuring the clients quality of life rather than working towards a cure. -Their goal is to improve the end of life for their clients, reducing pain, increasing comfort, and helping the patient and their family transition through the process of dying. - work as part of an interdisciplinary team of physicians, clergy / spiritual counselors, and family members. -The term "Hospice nurse" is an umbrella term for Hospice and Palliative.

The National Health Insurance Model

(Canada, Australia, South Korea) Health insurance is provided by the government and financed by premiums; providers are private.

The Bismarck Model

(Germany, Japan, Switzerland) Health insurance is private, financed by employers and employees, but it is not-for-profit and tightly regulated; providers are private.

The Beveridge Model

(Great Britain, Italy, Spain) Health care is provided and paid for by the government as a public service, financed through taxes. Physicians may be public employees on salary, or stay in the private sector and collect fees.

Different cultures approach to family

* Family among Laos may include the hundreds of people in their clan * In Mexico, families remain close throughout multiple generations * Germany & Japan have smaller families and care for the elders at home * United States families come from many cultural groups and many variations coexist

Know the reason of termination of case management services.

- Identification of reasons for case management termination, such as: • Achievement of targeted outcomes or maximum benefit reached • Change of health setting • Loss or change in benefits (i.e., client no longer meets program or benefit eligibility requirements) • Client refuses further medical/psycho- social services • Client refuses further case management services • Determination by the case manager that he/she is no longer able to per- form or provide appropriate case management services (e.g., non-adherence of client to plan of care) • Death of the client - Evidence of agreement of termination of case management services by the client, family or caregiver, payer, case manager, and/or other appropriate parties. -Documentation of reasonable notice of termination of case management services that is based upon the facts and circumstances of each individual case. - Documentation of both verbal and/or written notice of termination of case management services to the client and to all treating and direct service providers. -with permission, communication of client information to transition providers to maximize positive outcomes.

In planning, goals should be what?

- SMART

How can a case manager demonstrate cultural competency?

- The process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each

leadinh health indicators

-Adults engaging in binge drinking of alcoholic beverages during the past 30 days -Adults who meet current minimum guidelines for aerobic physical activity and muscle-strengthening activity -Adults who receive a colorectal cancer screening based on the most recent guidelines -Adults with hypertension whose blood pressure is under control -Cigarette smoking in adults -Employment among the working-age population -Maternal deaths -New cases of diagnosed diabetes in the population LHI's are: -Are core objectives -Focus on upstream measures, such as risk factors and behaviors, rather than disease outcomes -Address issues of national importance Address high-priority public health issues that have a major impact on public health outcomes -Are modifiable in the short term (through evidence-based interventions and strategies to motivate action at the national, state, local, and community level) -Address social determinants of health, health disparities, and health equity -Have new data available periodically, preferably annually Top Causes of Death for men -heart disease -Cancer 0Injuries - Chronic lower respiratory diseases -stroke -diabetes -alzheimers -suicide -flu/pneumonia -Chronic liver disease Top Causes of Death for women 1) Heart disease 2) Cancer 3) Chronic lower respiratory diseases 4) Stroke -The majority are chronic diseases. Yes, even with cancer it often becomes a chronic disease Leading causes of death in total Heart Disease Cancer Chronic Lung Stroke Alzheimer's Disease Diabetes Chronic Kidney Diseas

Advanced Directives

-As we age it becomes more important to have on file a document with wishes about care in the event of cardiac and respiratory arrest. -Also, naming a health care power of attorney is important and a living will documenting what the person would want done or not done. -Any admission to a hospital or other inpatient organization requires that a person be asked about these. Community education about these documents is very important as there are many misconceptions

Asthma

-Asthma is the most common chronic disease increasing to 13% of children in 2013 -Black and non-Hispanic children exhibit the highest rates of this chronic disease -The reason for this is unclear but it appears that air pollution and environmental allergens could be to blame. -Stress, vigorous exercise, and vaping can trigger an attack. Teaching parents to decrease allergens in the home ( dust, dander, mold spores). -School nurses may create an asthma control plan to help with the control and prevention of an acute episode. -In this instance, school nurses would be responsible for education, assessment, and collaboration with teachers, families, and physicians of an asthmatic student.

For a Community Health Assessment, what are the sources of data

-Community and Public Health Nurses collect info in the following ways and from the following sources: #Windshield Survey #Census Data (This includes information not compiled specifically from the census including crime statistics, housing reports and labor reports) #Vital Statistics #Local agencies including chambers of commerce, clinics, hospitals, school nurses, etc.

role functions of case managers

-Conducting a comprehensive assessment of the client's health and psychosocial needs, including health literacy status and deficits, and develops a case management plan collaboratively with the client and family or caregiver. -Planning with the client, family or caregiver, the primary care physician/ provider, other health care providers, the payer, and the community, to maximize health care responses, quality, and cost- effective outcomes. -Facilitating communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services. -Educating the client, the family or care- giver, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made. -Empowering the client to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes. -Striving to promote client self-advocacy and self-determination. -Advocating for both the client and the payer to facilitate positive outcomes for the client, the health care team, and the payer. However, if a conflict arises, the needs of the client must be the priority. -Encouraging the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis. -Assisting the client in the safe transitioning of care to the next most appropriate level.

Care Coordination

-Coordination of a plan or process to bring health services together as a common whole in a cost-effective way. -deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care." -Examples in the inpatient environment are bedside shift report, grand rounds and transition of care both inside and outside the hospital. -reduce costs in the long run, but the more important benefit of care coordination is improved patient quality of life, increased patient independence and better health outcomes.

Infants, Toddlers, and Preschoolers

-Even though the needs of children have been addressed with services and protected by laws, many of the needs continue to go unmet, which makes this population a vulnerable population. -One of the most important roles of a CHN and PHN is to take responsibility to protect and promote the health of this population National perspectives -Accidents and injuries: suffocation (leading cause of infant deaths), falls, burns, drowning (highest in ages 1 to 3 years), motor vehicle crashes, and poisoning Child maltreatment Communicable diseases (respiratory infections [bronchiolitis most common in infants], conjunctivitis, GI problems, and vaccine-preventable diseases) Chronic diseases (asthma, autism, sickle cell anemia, food allergies, MD, and CF) Poor nutrition and dental hygiene Health programs Preventive health programs: immunization programs, parent-training programs, quality day care, and preschool programs Health protection programs: safety and injury programs, protection from child abuse and neglect, secondary and tertiary prevention programs Health promotion programs: infant brain development research and parent-child interactions, developmental screening, programs for children with special needs, and nutritional programs Role of CHN -Assessing each population's current health problems Determining available and needed services Focusing on health promotion and early intervention Educating about family planning, nutrition and exercise, safety precautions, or childcare skills Conducting voluntary immunization programs, encouraging smoking cessation during pregnancy, preventing communicable diseases, and encouraging use of child safety devices Ensuring compliance with laws for immunizations, reporting of child abuse, and violations of environmental health standards Advocating and acting as a resource for families and young children Protecting and preserving the rights of children and families Securing needed services in the community Ensuring adequate resources for a safe and healthy environment for children Lobbing for law changes, initiating efforts to establish needed services

Healthy People 2030

-Healthy People 2030 created data driven national objectives to improve health and wellbeing over the next decade.

What is the benefit of caring for individuals in their homes?

-It is cost effective, patient centered -home health care will become a common nursing model to improve continuity of care due to its focus on... #maintaining health, preventing unnecessary admissions, and meeting the daily needs of those who require assistance with their care.

Mental Health Concerns for school aged children

-It should be noted that the causes of mental health disorders can be caused by genetics and environmental causes. -Physical punishment appears to amplify the risks. -Parental divorce, which is right around 50% in the US could be a factor in some behavior problems. -A refusal to go to school is another common sign. 0In the community health setting, a teacher or school nurse can assist the parents in collaboration, education, and referral to family therapy or support groups.

Our health care system was guided for most of the 20th century on policy options that focus on:

-Medical treatment (versus prevention) -Fee-for-service financing -Employment-based insurance (versus insurance for all) -Significant investment in medical technology and pharmaceuticals -Limited financial support for prevention and public health

Polypharmacy

-Older adults are more likely to be prescribed medications that are duplicate or unnecessary long term. With differing providers health care professionals might not catch this. -Programs to help alleviate this are: #An annual "brown bag" review where older adults bring in their medications and a nurse or pharmacist reviews #On discharge from an inpatient review of medication changes #Improved information sharing between pharmacies #Education on medications

Diabetes/Obesity

-Recently, a category, double diabetes is found when a child or adolescent presents with signs/symptoms of Type 1 and Type 2 diabetes. -School nurses would be influential in the education and monitoring of children's blood sugars either with insulin pumps or finger sticks. -The nurse would also be responsible for collaboration with the family, school staff, and the child's physician.

teen pregnancy

-The United States continues to have the highest of teen birth rates of all industrialized nations. -Most teens still report pregnancies as unintended. -Early parenthood frequently influences the educational, developmental, social, mental health, and financial outcomes especially for the teen mother, but also for her child, family, and community. -teen pregnancy influences the rate of sexually transmitted infections among the teen population, which is among some of the highest. Concerns -Violet's weight gain is low. -Who will care for the baby while she is in school? -Her first prenatal visit was at 27 weeks. -Would Violet and Cory consider adoption for the baby -History of smoking and drinking as well as her diet. infant mortality and teen pregnancy -low birth weight, -higher infant mortality for teen moms, -higher infant mortality for Black adolescents Prenatal teaching related to low weight gain, low back pain, and prenatal care -Discuss healthy eating and nutritional requirements for pregnant teens. -rate her pain on a scale of 0 to 10 and what she is doing to help relieve the pain. -provide some nonpharmacologic approaches to relieving the pain. -CDC for resources for teen pregnancy -Prenantal carer is very important -importance of breastfeeding, ABCs, -infant mortality rate for teen -Teen pregnancy can be linked to low birth weight babies and a lower education rate for mothers. so prevention is key -ostpartum education and teaching on the care of the baby after delivery should begin at the first prenatal visit. -postpartumdepression

Risk Factors for Pregnant Women and Infants

-The most significant impact that community and public health nurses can have on pregnancy outcomes (LBW, preterm birth, infant mortality) is in the area of lifestyle choices. In addition, programs that provide access and funding through federal, state, and local funding greatly influences the ability to provide resources to the maternal infant population. LOOK AT THE SCREEN SHOTS FOR THE EXAM

Cognitive changes (acute or chronic)

-There are normal changes in cognition as we age but NONE OF THOSE should interfere with living and socializing independently. -It is important starting at age 65 that an annual review of cognition status be reviewed (Mini Mental Status Exam [MMSE] or the Montreal Cognitive Assessment [MoCA] be done to document and intervene early for pathological changes

What are Leading Health Indicators (LHI's)?

-These are a subset of Healthy People 2030 objectives selected to communicate high-priority health issues and actions that can be taken to address them. -While all the indicators are important, community health nurses should pay particular attention to the LHI's that are not changing or getting worse: Not changing: -New Cases of Diabetes -Sexually Active Females Receiving Reproductive Health Services -Obesity Among Children and Adolescents -Binge Drinking in Adults Getting worse: -Oral Health Services Utilization -Adolescents with a Major Depressive Disorder within the past 12 Months -Suicide rates

Infant mortality rate (IMR)

-critical population health indicator. -infant mortality rate is the death of an infant before his or her first birthday. -The infant mortality rate is the number of infant deaths for every 1,000 live births. -The IMR is an important marker of the overall health of a society. -The WHO (2015) states that more than half of the deaths for children under 5 years are preventable and the interventions are affordable. The five leading causes of death include: -birth defects -preterm birth and low birth weight -maternal pregnancy complications -sudden infant death syndrome -injuries (i.e. suffocation) -Birth weight is one of the most important predictors of infant mortality. -Low-birth-weight (LBW) are babies weighing less than 5.5 lbs at birth and very-low-birth-weight (VLBW) babies weigh less than 3 lbs and 4 ounces at birth -singleton low birthweight rate increased in 2015 and 2016 -the low birthweight and moderately low birthweight rates among singletons rose from 2014-2016 for each race -preterm births have increased within the last 25 years with the majority of these births occurring late preterm -Even though preterm birth rates have been slowly declining among non-Hispanic White, African Americans and Hispanics; LBW rates were unchanged

Case Management

-development of patient care plans to coordinate and provide care for complicated cases in a cost-effective manner. - a term used to describe a wide variety of patient care coordination programs in acute care hospitals, long term care facilities and other community settings. -Patient populations of all ages can benefit from case management services. -The most current definition of case management from the Commission for Case Manager Certification (CCMC) is "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs." -can also be referred to as care management or care coordination in community health settings like patient centered medical homes, occupational health, geriatric services, ambulatory care clinics, mental health settings and outpatient primary care settings.

Effects of Poverty for school aged child

-effects of poverty are long-lasting -These can include mental health issues, increased rates of depression and anxiety, decreased levels of cognitive development, increased chronic health diseases, and injuries/ accidents. -These children can engage in more risky behaviors such as vaping/ smoking, early sexual activity, alcohol use/ abuse, and delinquent behaviors.

Falls

-falls resulting in injury, such as hip fractures, can be the start of a descent into decreasing independence and premature death -it's important to analyze why someone fell? Is it a balance issue? Or cognitive changes happening? Is it a sign that an impending illness is on its way? There are several programs in the community to encourage the following in order to decrease incidence of falls: -Balance and flexibility exercise programs (eg. Yoga) -Education on side effects of medications (BP, antidepressant, and pain meds are high on the list) -Physical changes (cords, avoiding throw rugs, will lit hallways and stairs)

health promotion

-health promotion of families is a key role of the nurse working in the community, for the community. -The goal of the nurse working in the community is to provide a positive health environment and experience for the family. In doing this we are in turn improving health in the community - which you guessed it, leads to a healthier population! -A huge goal is equal access to health care for all. This includes prenatal care, immunizations, access to counseling and family planning, preventative medicine with routine screenings, senior centers, and recreational activities.

Summary of Maternal and infant mortality

-maternal mortality, LBW, and VLBW births are the three main areas of focus for community/public health and health care providers because they are preventable -The health care providers can reduce the rates and societal costs by outreach, surveillance, health teaching, counseling, and referral

Medicare

-offered by the federal government and is available to those 65 and older, younger people with disabilities and people with End Stage Renal Disease -Original Medicare includes Part A (Hospital Coverage) and Part B (Medical Insurance) -Medicare Advantage - Part C - bundled plan that usually includes parts A, B and D and offers benefits the other don't cover like vision, dental, hearing and more. -Medicare Part D - drug coverage

"Healthy Start": An Example of a Program that Benefits Mothers and Young Children

-strengthens the foundations at the community, state, and national levels to help women, infants, and families reach their fullest potential" What are the Goals of the Healthy Start Program? -reduce differences in access to, and use of health services -improve the quality of the local health care systemem -power women and their families -increase consumer and community participation in health care decisions What are the health outcomes of the Healthy Start Program? -reduce infant mortality rates (IMR) -increase access to early prenatal care -remove barriers to health care access Who Do They Serve?-Communities with infant mortality rates that are at least one and a half times the U.S. national average -Aim to reduce negative birth outcomes such as Maternal Mortality, poverty, education, access to care, and other socioeconomic factors What are the four (4) strategic approaches? -Improve Women's Health -Improve Family Health and Wellness -Promote Systems Change -Assure Impact and Effectiveness How do they help participants? -Enroll women and their families at various stages of pregnancy (pre-conception, inter-conception, and post-conception) -Each family enrolled receives a standardized comprehensive assessment (physical/behavior health, employment, housing, domestic violence risks and more) What are the specific services they provide? -Health care services: prenatal, postpartum, well-baby, adolescent care, reproductive life planning, and women's health -Enabling services: case management, outreach, home visiting, adolescent pregnancy prevention, childbirth education, parenting skill-building, self-esteem building, transportation, translation, child care, breast feeding and nutrition education, father support, housing assistance, job training, and prison/jail-based services -Public Health Services: immunization and health education (i.e. smoking cessation). -Provider Training

School- Child's Work

-the quality of a child's education can and does influence their learning. --Child health has been linked to school success. -Child well-being has been a great concern in the US. 4 objectives for early childhood (birth-8) and middle childhood (6-12): 1. Increase the proportion of children who are ready for school in five domains of development, physical, social-emotional development, learning language, and cognitive development. 2. Increase the number of parents with positive parenting and communication. 3. Decrease the number of children who have poor sleep 4. Increase the number of schools that teach health education.

Five strategies for patient education success

1. Take advantage of educational technology Technology has made patient education materials more accessible. Educational resources can be customized and printed out for patients with the touch of a button. Make sure the patient's individualized needs are addressed. Don't simply hand the patient a stack of papers to read, review them with patients to ensure they understand the instructions and answer questions that arise. Some resources are available in several languages. 2. Determine the patient's learning style Similar information may be provided by a range of techniques. In fact, providing education using different modalities reinforces teaching. Patients have different learning styles so ask if your patient learns best by watching a DVD or by reading. A hands on approach where the patient gets to perform a procedure with your guidance is often the best method. 3. Stimulate the patient's interest It's essential that patients understand why this is important. Establish rapport, ask and answer questions, and consider specific patient concerns. Some patients may want detailed information about every aspect of their health condition while others may want just the facts, and do better with a simple checklist. 4. Consider the patient's limitations and strengths Does the patient have physical, mental, or emotional impairments that impact the ability to learn? Some patients may need large print materials and if the patient is hearing impaired, use visual materials and hands on methods instead of simply providing verbal instruction. Always have patients explain what you taught them. Often people will nod "yes" or say that they comprehend what is taught even if they have not really heard or understood. Consider factors such as fatigue and the shock of learning a critical diagnosis when educating patients. 5. Include family members in health care management Involving family members in patient teaching improves the chances that your instructions will be followed. In many cases, you will be providing most of the instruction to family members. Families play a critical role in health care management. Teaching patients and their families can be one of the most challenging, yet also rewarding elements of providing nursing care. First-rate instruction improves patient outcomes dramatically.

Part 1 Maternal Mortality Rate (MMR)

According to the World Health Organization (2019), globally, one of the major indicators of population health is maternal health -Maternal health is measured by the Maternal Mortality Rate (MMR). -The MMR is a measure of obstetric risk and is determined by dividing the number of maternal deaths by the number of live births per 100,000. Most maternal deaths are the result of the following causes: -complications of pregnancy, labor, and delivery -hypertensive disorders -intervention omissions or incorrect treatment and the chain of events resulting from any one of these -unsafe abortions -In the U.S., the MMR is higher than in other developed countries because of the disparities found among women of color. For example, the MMR for Blacks is four times greater than for Whites and the gap continues to widen -most maternal mortality can be prevented with primary prevention measures. -MMR has decreased worldwide -The MMR for women aged 40 and over -is nearly 8 times that for women under age 25

5 core competencies of case managers

Assess impacting factors Coordinate services Navigate financing Knowledge of nursing concepts Knowledge of community resources

ADPIE-the nursing process of Family assessments:

Assessment: collect detailed health information about families from observations, interactions, and inferences Diagnosis: analyze assessment data to identify patterns of behavior, constraint to health, potential risk, actual risk, and unhealthy routines within and outside the family relationship and their interactions. Planning: identify outcomes in collaboration with family, document the plan of care with clearly defined prescriptive interventions and strategies being sure to use resources within the family and community. Implementation: work with the family to fulfill intervention and strategies in the plan of care, by organizing the care, education about prevention of illness and promoting health, advising on how to use internal and external resources, and collaborating for health promotion activities. Evaluation: with the family systematically and continuously review the process and outcomes to plan for future steps to promote and maintain the health of the family w/ internal and external services. Assess Home Safety

10 essential public health services

Assurance -Build and maintain a strong organizational infrastructure for public health -Improve and innovate through evaluation, research, and quality improvement -Build a diverse and skilled workforce -Enable equitable access Assessment -Assess and monitor population health -Investigate, diagnose, and address health hazards and root causes Policy development -Communicate effectively to inform and educate -Utilize legal and regulatory actions -Strengthen, support, and mobilize communities and partnerships -Create, champion, and implement policies, plans, and laws

4 domains of chronic disease prevention, and provide examples.

Common Risk Factors -High blood pressure. -Tobacco use and exposure to secondhand smoke. -Obesity (high body mass index). -Physical inactivity. -Excessive alcohol use. -Diets low in fruits and vegetables. -Diets high in sodium and saturated fats. Domain 1 : Epidemiology and Surveillance -Epidemiology and surveillance provide essential data to define and prioritize public health problems, identify populations most affected, guide solutions, and monitor progress. Insights can be used to educate decision makers and the public about chronic diseases -Ex: Track chronic diseases and their risk factors and share the information in easy-to-use formats. Ensure coordination among multiple data systems, including behavioral risk factor surveys (e.g., the Behavioral Risk Factor Surveillance System), birth and death certificates (from the National Vital Statistics System), registries of cancer cases and deaths (e.g., the National Program of Cancer Registries), and health care data (e.g., from Medicare data sets). Domain 2: Environmental Approaches -Environmental approaches promote health and support healthy behaviors across the nation, in states and communities, and in settings such as schools, child care programs, work sites, and businesses -Ex: Comprehensive smoke-free air laws that cover all workplaces, restaurants, and -Ex: Community design that encourages walking and biking. Domain 3: Health Care System Interventions -Health care system interventions increase the use and improve the quality of clinical and other preventive services. -These services prevent or enable early detection of disease, reduce risk factors, and manage complications. Interventions that increase access to and build demand for quality preventive services, such as the National Breast and Cervical Cancer Early Detection Program, also reduce population health disparities. -Ex:» Expand population coverage. -Ex: Remove barriers to access to help ensure delivery of care to hardest-to-reach populations. Domain 4: Community Programs Linked to Clinical Services -Strategies that link community and clinical services help ensure that people with or at high risk of chronic diseases have access to the resources they need to prevent or manage these diseases. -Ex: Increase the use of effective community interventions—such as chronic disease self-management programs, the National Diabetes Prevention Program, and smoking cessation services—by making them widely available, ensuring that doctors refer their patients to them, and helping to ensure that they are covered by health insurance.

Things to remember about the family when doing home care

Families have Shared Values -this includes cultural, religious, and societal -Ex:Many catholic families do not use birth control. Some cultures have beliefs about health care that prohibits them from seeking help in a timely manner. Families have Roles #Roles can differ in each family Families have different Distributions #americans typically believe that all roles are equal, but some belive that the father should be the head of the household

indirect costs

Costs that are not assigned directly to the patient, but are related to the provision of services at the organizational level.

Direct Costs

Costs that can be specifically identified with a particular project or activity. For example - supplies or medications.

After the homehealth visit

Family diagnosis: * Identify the family health problems (what family members are directly and indirectly related to the problem, what external problems impact it, how it impacts the family members, the immediate risk, and how to prioritize the problems. * Indicate the factors from family and external environment that are associated with the health problem * Determine the measurements to confirm or verify the health problems Plan of care/intervention -After this is complete the nurse can craft a plan of care or intervention for the family to help promote family health and prevent future illnesses. -Important considerations: 1. The plan should be created with family input and collaboration 2. Do they agree on your diagnoses and are they on- board with the suggested interventions? 3. If we do not have buy-in - it is difficult to proceed from here! 4. The overall goals is to establish a common goal and agreement on the care plan 5. The family may be ready to engage and in this case, we determine the best teaching approach, if not we can continue to gather resources and act as a counselor - giving the patient time to recognize their needs and to move forward with the health promotion.

CMSA Standards of Case Management Practice

Five Core Competencies that each of these standards support: 1. Assess impacting factors. 2. Coordinate services. 3. Navigate financing. 4. Knowledge of nursing concepts. 5. Knowledge of community resources.

When doing a primary assessment in the home, be sure to:

Focus on the family as a total unit: Ask goal-oriented questions Collect data over time: Combine quantitative and qualitative data: #Qualitative (thoughts/perceptions/feelings) #Quantitative (numbers) Exercise professional judgment

Goals fo chronic diseases

Health promotion at all levels focuses on the 3 types of prevention to reduce incidence and complications of those chronic disease General Goals for Health care and Public/Community Health: -Primary • Healthy lifestyle education to increase activity, eat more nutritious meals, and avoid or reduce smoking, drinking alcohol, etc. -Secondary • Screening for early detection / treatment: Breast and testicular self exam, mammograms, PAP, colon screening, prostate -Tertiary • Rehab / prevent further damage

Health promotion

Health services for the child/adolescent have 3 categories: -Prevention- these services could include immunizations, support services, family planning, alcohol/drug prevention programs. -Health Protection- accident and injury control, reduce environmental hazards, infectious disease control. -Health Promotion- information on nutrition, weight control, HIV/AIDS, smoking, alcohol, and drug abuse education.

Home health Nurse

Home Health nurses are responsible for care in the clients homes - caring for those that are unable to care for themselves or are limited in the care they can participate in. -Home health nurses come from many fields such as Medical-Surgical, Mental Health, Gerontology, Pediatrics, & Community / Public Health. -Home health nurses are responsible for patient assessment, developing an individualized plan of care, collaborating with the patient / family / physician / and support staff to provide best care, oversee assistants, evaluate the clients response to treatment, monitor healing and mobilization, case management, and direct nursing care.

General Community Interventions:

IMPROVE environments to make it easier for people to make healthy choices (ie walkability, safety, and green spaces such as parks and walking/bike trails) STRENGTHEN health care systems to deliver prevention services that keep people well and diagnose diseases early CONNECT clinical services to community programs that help people prevent and manage their chronic diseases and conditions

Gender influences health

MEN Research shows that men are less likely to have knowledge of healthy activities (eg. diet), are less likely to participate in education or screening and less likely to go to health care providers in general. Some of this is related to: • Socialization: independent / conceal vulnerability • Hazardous activity (males of all ages are more likely to participate; whether it's driving fast or climbing on the roof to fix something) • Lack of health programs and research - In the areas of motivation for men to increase their participation in primary and secondary prevention activities Major focuses for interventions: Young adult men • Education, career, family • Experimentation (drugs / sex) • Risky behaviors • Question sexuality • HIV & Men • Testicular CA (higher incidence in young men vs older) Middle Adult Men • Physical, emotional, financial demands • Midlife crisis (depression) • Retirement • Reproductive health (increased difficulty in sexual performance. Sexually transmitted diseases) • Heart disease & men • Prostate Health

Falls prevention

Make an appointment Keep moving wear sensible shoes remove home hazards light up your living space use assistive devices

How are clients selected for case management services? What types of clients would benefit?

Pg 15

Medicare Part D

Prescription drug coverage

Reasons to involve registered nurses in care coordination:

Reductions in emergency department visits Noticeable decreases in medication costs Reduced inpatient charges Significant increases in survival with fewer readmissions Lower total annual Medicare costs for those beneficiaries participating in pilot projects compared to control groups Increased patient confidence in self-managing care Increased safety of older adults during transition from an acute care setting to the home Improved clinical outcomes and reduced costs

The referral

When a need is identified, a referral is generated. What is is -The referral form provides brief information about the family and their needs. Who they come from -They can come from doctors or counselors, or they can be from family or friends who feel they need help (Medicare / Medicaid / Private insurance requires a physician's order for certified home health). -The referral may come from the hospital which identified a need for home health/hospice / or palliative care. Why may nurses be referred -As the community health nurse, you may be referred to an individual or family to help with education on COPD and how to cope and avoid stressors, helping a family learn about cholesterol to prevent HTN, or teaching a young mother proper infant immunizations and provide her with the resources to ensure her child can receive the vaccinations they need. This also includes the client who has been identified as being unable to leave their home after discharge or if leaving the home requires a considerable effort.

Age and developmental stage also have a place in focusing interventions. In the following, consider what is the major focus at that stage

Young adult women • Forming identity and intimacy • Spouse & family • Typically healthy, though risky behaviors may remain • Eating disorders • Reproductive health and family planning Middle Adult Women • Health choices: Good or Bad • Undetected diseases • Menopause & hormone related treatment • Osteoporosis • Heart disease • Cancer • Chronic fatigue & Immune dysfunction syndrome

Case management

a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality cost- effective outcomes. the underlying premise is based in the fact that, when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement sources. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. ... Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned.

Policy

a course or principle of action adopted or proposed by a government, party, business, or individual.

Community Health Workers

a frontline public health worker who is a trusted member and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/ intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery

Population

a group of people with common personal or environmental characteristics or all the people in a defined community

Community

a group or collection of individuals interacting in social units and sharing common interests, characteristics, values and goals

cost-benefit analysis

a study that compares the costs and benefits to society of providing a public good This is limiting as a criteria in economics related to healthcare policy because costs and benefits are not distributed evenly among individuals, consumers or providers

Healthy people 2030

addresses, on a national level, social determinants of health and provides a benchmark for communities to compare outcomes through leading health indicators.

Palliative nurses

are for the terminally ill as well as patients with chronic medical conditions to promote quality of life and relieve suffering. -Palliative nurses work in hospitals, nursing homes, assisted living facilities, and private homes - settings where elderly and those with chronic conditions are treated. -Some duties of the Palliative nurse include providing and monitoring pain management, helping to alleviate physical symptoms (e.g. respiratory, nausea), dispense scheduled medications, educate clients and families on symptom management, and the provision of emotion support for clients and their families.

Community health nursing process

assessment -assessing a familt, population/aggregate, an entire community -community health assessment first defines the community being assessed and collects and compiles data to help describe how the community deals with health needs. The assessment looks at 3 dimensions that describe the nature of the community: Aggregates, Space and/or Time Location and Social System. -after an assesmment data is compiled, problems are identified. this replaces the nursing diagnosis step. -Now it's time to plan interventions and set goals, #often accompanied by a Community Health Improvement Plan (also known as CHIP). The CHIP details the proposed interventions for the community and the plans for implementation. Ex:From Portage County's Improvement Plan, proposed strategies to improve the community's mental health outcomes are listed on a graph #the framework that community and public health nurses use in planning interventions revolves around Healthy People 2030 principles.

Core Functions of Public Health

assessment, policy development, assurance

Social Health

community vitality and is a result of positive interaction among groups within the community, with an emphasis on health promotion and illness prevention

Complications of Childbearing

hypertensive disease in pregnancy -pregnancy-related or chronic hypertension can contribute to adverse maternal outcomes of renal failure, pulmonary edema, preeclampsia, and in-hospital mortality. This condition can also negatively affect fetal growth. -The emphasis here is on prevention and the control of hypertension during pregnancy. gestational diabetes mellitus (GDM) -there is a higher risk of hypertension, preeclampsia, urinary tract infections, cesarean section, and future risk of type 2 diabetes. -The infant can be at increased risk because maturation of the fetus is closely aligned with the delivery of maternal nutrients (glucose), and maintenance of glucose levels is essential to the health of the fetus. -The infant is at increased risk for fetal death because GDM has been associated with macrosomia (large-for-gestational-age babies), birth injuries such as broken shoulders, breathing problems and high blood sugars at birth. -PHN and CHN's need to educate the mothers on the importance of daily self-monitoring of blood glucose levels and to do this 6 weeks postpartum and throughout their life. -educate on warning signs of GDM, importance of regular prenatal care, and when to return for the glucose tolerance test around the 24th week of pregnancy. Follow-up care is extremely important! postpartum depression -risks for postpartum depression include a family history of psychiatric illness, poor social support, stressful life events, anxiety during pregnancy, and personality traits of neuroticism, and perfectionism. -Depression can affect anyone! -Some symptoms of perinatal depression include irritability and restlessness; feeling hopeless, sad, and overwhelmed; little energy or motivation and crying unexpectedly; sleeping and eating too little or too much; cognition problems (memory, focus, or decision-making)'; loss of pleasure or interest in activities; and withdrawal from family and friends. -Depression during pregnancy can result in lower birth weight or premature infants and may affect parenting and infant stimulation which can result in delays in infant language development and emotional bonding, lower activity levels, and behavior/sleep problems. -PHN/CHN's can identify this condition and encourage mothers to join support groups and receive group or individual therapy. Referrals can be made for a mental health evaluation if needed. For health promotion, new moms should be educated to sleep while baby sleeps, try not to be the "perfect" homemaker, ask for help from partner with feedings and chores, get out of the house often, and to spend quality time with their partner. -mothers should be encouraged not to drink alcohol or caffeine, but exercise and engage in relaxation techniques (listening to music, meditation, yoga). -PHN/CHN's need to educate on the symptoms of depression and the importance of getting emotional and practical support. fetal or infant death (miscarriage/ectopic pregnancy, stillbirth, or death from SIDS -SIDS is the leading cause of death for infants from 1-12 months of age. -Each year, there are about 3,500 sudden unexpected infant deaths (SUID) in the U.S., occurring among infants less than one year old and having no immediate obvious cause. -unknown causes, and 800 deaths due to accidental suffocation and strangulation in bed -PHN/CHN's have an important supportive role to play in this situation. -Mothers respond to grief in many ways: sadness, shock, disbelief. Mother may have feelings of abandonment, bereavement and guilt. -Psychological counseling may be needed to work through these feelings and emotions (depression or anxiety, etc.). -Parents may benefit from spiritual and psychosocial support from professional caregivers. -Home visits may be made and referrals to mental health counseling or support groups may be helpful. The support should be given for months after the death of the infant to assess the family for signs of unresolved grief.

The Private Insurance System

individuals are either covered by their employers, covered by a private policy the policyholder purchases themselves or they go without coverage at all

community of solution

individuals coming together because of a common problem -For example; survivors of domestic violence

Medicare Part C

managed care health plans offered to medicare beneficiaries under the medicare advantage program

Causal Thinking

relating disease or illness to its cause

aggregates

subgroups or subpopulations that have some common characteristics or concerns -Membership in the same religion - or - same age/generation -include a Community of Solution

Case managers collaborate with all service providers to accomplish care that is what

that is appropriate, effective, client-centered, timely, efficient, and equitable.

Location in Space and/or Time

the "where and when" for instance, individuals who resided on Kent campus during the May 4th shootings in 1970, or Florida residents during the Delta wave of the pandemic.

Public health

the art and science of promoting and protecting the health of the public

Provide some examples of problem or opportunity identification.

• Age • Poor pain control • Low functional status or cognitive deficits • Previous home health and durable medical equipment usage • history of mental illness or substance abuse, suicide risk, or crisis intervention • Chronic, catastrophic, or terminal illness • Social issues such as a history of abuse, neglect, no known social support, or lives alone • Repeated emergency department visits • Repeated admissions • Need for admission or transition to a post-acute facility • Poor nutritional status • Financial issues