Community Exam #2

d.) instrumental functioning. Difficulty with activities of daily living is an example of instrumental functioning. Expressive functioning refers to affective or emotional aspects of function.

A client is having difficulty performing his activities of daily living. This means he is having difficulty with a.) expressive functioning. b.) affective functioning. c.) emotional functioning. d.) instrumental functioning.

a.) Legislative, executive, or judicial branches of the government Public policy refers to decisions made by legislative, executive, or judicial branches at the local, state, or federal levels of government.

Decisions on public policy are made by which part of the federal government? a.) Legislative, executive, or judicial branches of the government b.) Only the executive branch (president, governor, mayor) c.) Supreme Court d.) House of Representatives and Senate

-Bill proposed by legislative branch. -Both branches have to pass a bill before it goes to executive branch -President signs (becomes law) or vetoes -2/3 vote by Congress can override veto --Balance of power- president doesn't have all the power if ⅔ congress votes for law it can still pass even if president vetoes it

Objective #2: Describe the legislative, judicial, and administrative (executive) processes involved in establishing federal, state, or local health policy?

Nurses are the largest group of healthcare providers in the US We could have a powerful collective voice -Change agent- nurses need to know how to influence creation of healthcare legislation. -Contribute to the election and appointment of key officials. -Must become invested and competent in healthcare policy -Get to know your legislators- Write, email, personal visits; -Participate in professional organizations -Speak publicly about issues (city council meeting) -Contribute to PAC (political action committee)

Objective #6: Discuss the nurse's role in political activities?

Chief Nursing Officers have a seat at the executive table at most nursing organizations -That has a voice that says what nurses need and want Using evidence-based practice and clinical research to improve client outcomes -Make policies on this Petition for reimbursing nursing services -We can get reimbursed for things we do Work with interdisciplinary team members to influence private policy -Working with providers, therapists

Objective #7: Discuss nursing's involvement in private health policy?

a.) providing information but allowing the person to make the decision. The community health nurse's advocacy for the person affected by a disability extends beyond a resource and referral coordinator role or speaking on the other's behalf. People with disabilities want to speak for themselves. They want to be in control of their lives and their health care. The health care providers should provide information and then leave the choice up to the person. The community health nurse's support should continue even when the client or family's health care decisions conflict with the health care provider's recommendations.

One strategy for the community health nurse in caring for people with disabilities is becoming a powerful advocate. This involves a.) providing information but allowing the person to make the decision. b.) supporting the person's choice if it does not conflict with the nurse's. c.) taking control of the person's life and health care. d.) speaking on the person's behalf.

The CHA led to the development of the Community Health Improvement Plan (CHIP) Developed the 5 main subcommittees under our Community Health Improvement Plan (CHIP) consisting of community partners who are working to improve our health outcomes in our community plus a focus on Access to Care: -Mental Health -Addiction (Hope Partnership Project) -BreatheWell (Smoking Cessation and Air quality) -Live Well (Obesity prevention) -Child Safety/Infant Mortality

Our Community Health Improvement Plan and the Partners for a Healthier Ross County?

-Americans w/disabilities act 1990 -Individuals disabilities education act- free public education -Rehabilitation act- prohibits discrimination for federal empolyment -Ticket to work act- higher cap to accommodate earnings w/o terminating benefits. Also assists with obtaining health insurance

Outline federal legislation that supports the people with disabilities?

b.) Europe. A total of 52% of the individuals who are foreign born in the United States were born in Latin America. This is the highest percentage for foreign-born persons.

Over 13% of residents in the United States were born in other countries. More than half (52%) of these individuals were born in a.) Asia. b.) Europe. c.) Africa. d.) Mexico and Latin America.

At-risk families: -Single parenting increases the risk of decreased resources- social emotional and financial -Grandparents are parenting in the absence of parents due to divorce, incarcerations, substance use, death or disability of parents and neglect

Parenting effect on Health?

Unique Health Risks: Exposure to smoke (burning oil wells), Leishmaniasis (a parasitic disease that is found in parts of the tropics, subtropics, and southern Europe), Chemical or Biological Agents, Depleted Uranium, Infections

VA Guest Speaker: Persian Gulf War?

Unique Health Risks: Length and time of service, Exposure to Agent Orange, Infectious diseases, Drug abuse, Homelessness

VA Guest Speaker: Vietnam?

Unique Health Risks: Infectious Diseases, Wounds, Mustard Gas Testing, Exposure to Nuclear Weapons, Nuclear Cleanup

VA Guest Speaker: WWII?

a.) Learning occurred, but additional support and education are needed. The client exhibits learning by striving over the past year to comply with the prescribed diet, improve her exercise program, lose weight, and take the prescribed medications. Learning is described as enduring change that involves modification of insights, behaviors, perceptions, or motivations. The client perceives that additional support and health education will improve her diabetes management.

A client meeting with a community health nurse inquires about diabetes education classes. The client's health records reveal the diagnosis of diabetes was made a little over 1 year ago. The client reports partial compliance with diet, gradual improvement in her exercise program, and a 15-pound weight loss. The client reports that she takes her medication as prescribed but rarely monitors her blood glucose level. Which statement best reflects the impact of initial diabetes education on this client? a.) Learning occurred, but additional support and education are needed. b.) It is apparent that the diabetic education was totally inadequate. c.) It is not possible to draw any conclusions about the education. d.) The education did not work because this client is noncompliant.

b.) Family health tree A family health tree provides a mechanism for recording the family's medical and health histories. The genogram is a tool that helps the nurse outlines the family's structure. The ecomap is used to depict a family's linkages to their suprasystems. Option D is not an assessment tool used by the community health nurse.

A client provides information regarding medical and health history. This is an example of which assessment tool? a.) Genogram b.) Family health tree c.) Ecomap d.) Ancestry mapping tool

d.) The nurse knows that more difficult words will pose a barrier to some clients. Materials written at a simpler level can be effective learning tools for clients who read at different levels. The nurse should not make assumptions about the client's education. Simplifying the words would not necessarily assist non-English-speaking clients.

A community health nurse is asked to review a draft of a brochure developed for distribution to clients. The nurse finds the brochure generally well designed but suggests replacing several words with simpler words that have fewer syllables and are more commonly used. What is the best explanation for the nurse's recommendation? a.) The nurse assumes the clients are uneducated because they have low income. b.) The nurse knows that English may not be the primary language of many clients. c.) The nurse is assuming that most of the client's will read at a third-grade level. d.) The nurse knows that more difficult words will pose a barrier to some clients.

b.) The client is listening carefully. Eye contact is among the most culturally variable nonverbal behaviors. Although most nurses have been taught to maintain eye contact while talking with clients, individuals from culturally diverse backgrounds may misconstrue this behavior. Asian, Native American, Indochinese, Arab, and Appalachian clients may consider direct eye contact impolite or aggressive, and they may avert their own eyes during the conversation. Native American clients often stare at the floor when the nurse is talking. This culturally appropriate behavior indicates that the listener is paying close attention to the speaker.

A community health nurse is caring for a Native American client who often stares at the floor while the nurse is talking. The nurse knows this indicates which culturally appropriate behavior? a.) The client is showing respect to the nurse. b.) The client is listening carefully. c.) The client's religion forbids him from making eye contact with women. d.) The client is depressed.

c.) extended family. An extended family includes a husband, wife, children, as well as other blood relatives. A nuclear family includes the husband, wife, and child or children. A communal family is a group of men and women with or without children. A nuclear dyad is the husband and wife alone, either childless or with no children living at home.

A community health nurse is caring for a family that includes the husband, wife, children, and other blood relatives. This type of family is called a(n) a.) nuclear family. b.) communal family. c.) extended family. d.) nuclear dyad.

a.) The Department of Public Highway and Safety b.) Emergency department staff (both doctors and nurses) from local hospitals c.) Teachers and coaches from area schools e.) City or county government Limited resources are available in rural areas, and more can be accomplished when resources are pooled. Also, to ensure a more successful outcome, all players with a vested interest in the problem should have a voice in the problem-solving approach. This would include public personnel (city and county government, police, teachers) and private groups (RNs and MDs). Less important for looking at children's issues, however, would be private employers.

A community health nurse is concerned about reducing the fatal injuries to America's rural children. To address this problem, the nurse organizes a community of solution (see Chapter 1). For this group, it would be important to have representatives from all groups or organizations: (Select all that apply.) a.) The Department of Public Highway and Safety b.) Emergency department staff (both doctors and nurses) from local hospitals c.) Teachers and coaches from area schools d.) Area employers e.) City or county government

d.) Preparing meals Instrumental activities of daily living involve such things as going outside the home, shopping, tracking money or bills, light housecleaning, and preparing meals. Seeing and walking are functional activities. Dressing is an activity of daily living.

A community health nurse is reviewing the results of SIPP (Survey of Income and Program Participation) used by the U.S. Census Bureau to collect disability data. Which will the nurse find classified as an instrumental activity of daily living? a.) Seeing b.) Walking c.) Dressing d.) Preparing meals

d.) defined by its members. The families of today are defined by the members because of the numerous definitions of family. Many different types exist, such as single-parent families, second families or grandparents raising children, gay or lesbian families, or traditional families.

A community health nurse needs to understand that most families in today's society can be described as a.) blended. b.) nuclear. c.) extended. d.) defined by its members.

b.) Adults learn better in a facilitative and nonrestrictive environment. According to Knowles' theory about adult learners, adults learn best in unstructured environments. The comfortable, informal environment in the example encourages clients to express themselves and allows the nurse to learn more about each client's motivation and readiness to learn.

A community health nurse often provides health education for individual clients. Her office has a play center because some clients bring small children with them. She routinely offers her clients bottled water, juice, or soda. She works with her clients at a small table rather than at her desk. Which statement below best sums up her approach? a.) Clients enjoy hospitality, but her approach has no support in learning theory. b.) Adults learn better in a facilitative and nonrestrictive environment. c.) The nurse's approach simply takes the clients' minds away from their troubles. d.) This approach is too informal and contrary to most learning theories.

a.) PC3 Patient-Centered Community Care (PC3) is a program for veterans needing certain primary care or inpatient-related care, particularly for female veterans after delivery and requiring limited newborn care. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA. TRICARE is sponsored by the Department of Defense (DoD) and provides health care for active duty military personnel, their families, and their survivors. VHA is the Veterans Health Administration, which provides health care to veterans.

A female veteran has just given birth to her first child. Which resource is most appropriate for this veteran at this time? a.) PC3 b.) VHA c.) CHAMPVA d.) TRICARE

c.) lobbyist. A lobbyist is a person, who voluntarily or for a fee, represents him- or herself, or another individual, organization, or entity for the purpose of influencing policy or legislation. An advocate is a person who supports a cause or policy. A policy maker is one who creates policies. An expert is one who has extensive knowledge or skill in a particular field.

A person who acts as a representative for another person or organization before the legislature is called a(n) a.) advocate b.) policy maker. c.) lobbyist. d.) field expert.

a.) suicide. Risk factors for suicide among veterans include non-Hispanic white race/ethnicity, male gender, sexual minority status, preenlisted and/or current mental health conditions, history of self-directed violence, substance use, poor physical health and functioning, intimate partner conflict, lack of social support, and sexual trauma.

A single white male veteran served two tours in Afghanistan. The veteran has returned home from Afghanistan where he lives alone, begins drinking alcohol daily around 11 am, and watches television from rising until bedtime. This veteran is at high risk for a.) suicide. b.) cognitive impairment c.) chronic pain d.) unresolved conflict

d.) health policy. Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal. Nursing policy specifies nursing leadership that influences and shapes health policy and nursing practice. Fiscal policy is related to finance. Social policy is policy associated with individuals and communities.

A statement of a decision regarding a goal in health care and a plan for achieving that goal is called a.) nursing policy. b.) fiscal policy. c.) social policy. d.) health policy.

a.) polytrauma. The term polytrauma refers to 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. Polytrauma is often the result of a blast-related event, and frequently includes TBI.

A veteran has a traumatic brain injury (TBI), hearing impairment, and an amputated arm. The nurse knows that this patient is suffering from a.) polytrauma. b.) posttraumatic stress disorder. c.) military sexual trauma. d.) substance use disorder.

d.) Veterans include those that have served in the active military, naval, or air service. Legally, a veteran is an individual who has served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. There were 18.8 million veterans in the United States in 2015. People who have served in the U.S. Public Health Service and some persons employed by the National Oceanic and Atmospheric Administration are also veterans.

A veteran is a person who has served in the military. Which statement about veterans is correct? a.) There are 5 million veterans in the United States today. b.) Employees of the National Aeronautics and Space Administration (NASA) are considered veterans. c.) People who were honorably discharged from the military are still considered veterans. d.) Veterans include those that have served in the active military, naval, or air service.

b.) Parkinson disease The VA awards disability compensation for the following conditions to anyone who served in the Republic of Vietnam from 1962 to 1975: AL amyloidosis, chronic B-cell leukemia, chloracne, diabetes mellitus type 2, hodgkin disease, ischemic heart disease, multiple myeloma, non-Hodgkin lymphoma, Parkinson disease, peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft tissue sarcomas, and Lou Gehrig disease (or AML).

A veteran was awarded VA disability compensation for a medical condition he contracted in 1965 while serving in Vietnam. Which condition did this veteran most likely have? a.) Cardiac dysrhythmia b.) Parkinson disease c.) Diabetes type 1 d.) Irritable bowel syndrome

b.) Need to use a powered wheelchair A disability involves any restriction or lack of ability (resulting from an impairment) to perform an activity in a normal manner or within the normal range. Using a powered wheelchair is the only option that fits this description. The other options would be classified as impairments.

According to the ICF (International Classification of Functioning, Disability, and Health), which would be classified as a disability? a.) Detached retina b.) Need to use a powered wheelchair c.) Spinal cord injury d.) Amputation

d.) a 60-year-old person who has been homeless for 9 months. Those at high risk for death are individuals who have been homeless for 6 months or more with one or more conditions: More than three hospitalizations or emergency department (ED) visits in 1 year? More than 3 ED visits in the previous 3 months? 60 years or older? Cirrhosis of the liver? End-stage renal disease? History of frostbite, immersion foot, or hypothermia? HIV/AIDS? Co-occurring psychiatric, substance abuse, and chronic medical conditions

According to the vulnerability index, the individual at highest risk for death is a.) a 46-year-old person who has been homeless for 2 months and has HIV. b.) a 22-year-old person who lives in a homeless shelter and is addicted to heroin. c.) a 65-year-old person who is being evicted from his home after living there for 25 years. d.) a 60-year-old person who has been homeless for 9 months.

-Learn better in facilitated, nonstructured environments -Want a self-directed, self-empowering learning environment -WIIFM- Why they need to know? -Concept of self- adults can self-direct -Experience- use previous experience to enhance learning -Readiness to learn!!!!!!!- developmental tasks -Orientation to learning- time relevant, focus on immediate issues -Motivation- effected by self-esteem, life goals, quality of life and responsibility

Adult Learners?

Vulnerable to environmental and occupational hazards -Farmers- exposure to sun so increase risk for skin cancer -Equipment, chemicals, exposure to elements: --Grain bins, tractors --Bigger risk of fatality if they get injured 10x more likely: ----Due to being alone when farming ----All alone and no one around or even close Pesticide poisoning symptoms- headache, dizziness, diaphoresis, nausea and vomiting -Agent orange (round up) Transient work that follows the harvest High fatality rate when injured

Agricultural Workers- Objective 4?

b.) Partnering with the county extension agent to offer tractor safety classes Tractor-related accidents, especially overturns, are the most frequent cause of farm accidents. Encouraging the use of helmets is important, but the most important measure would be to offer tractor safety education. Working with local health care providers to encourage use of personal protective equipment, such as hearing and respiratory protection and offering a class for local health care providers addressing the signs and symptoms of pesticide toxicity are less important measures.

Agricultural workers are at high risk for occupational injuries and illnesses. To reduce the most common cause of fatalities among youth on farms, which is the most important strategy for the community nurse to implement? a.) Planning a community media campaign advocating the use of helmets b.) Partnering with the county extension agent to offer tractor safety classes c.) Working with local health care providers to encourage use of personal protective equipment, such as hearing and respiratory protection d.) Offering a class for local health care providers addressing the signs and symptoms of pesticide toxicity

Solicit feedback from focus groups Asses relevancy: (Table 8.2) -Attraction -Comprehension- reader should be able to summarize main points -Acceptability- is it culturally acceptable -Persuasion- need to feel as if it is significant to them -Self-efficacy- is the message doable? Do they feel they can carry it out? Consider: format/layout, font/type, visual content, aesthetic quality and appeal, assessment of reading level Learner verification- involves intended members and helps uncover unsuitable aspects of the material

Apply a systematic process to developing culturally and literacy relevant health education materials, messages, media, and programs?

The ecomap portrays an overview of the family in their situation; it depicts the important nurturant or conflict-laden connections between the family and the world. -It demonstrates the flow of resources, or the lacks and deprivations. -This mapping procedure highlights the nature of the interfaces and points to conflicts to be mediated, bridges to be built, and resources to be sought and mobilized. Shows family links to suprasystems: As with the genogram, the nurse can fill out the ecomap during an early family interview, noting people, institutions, and agencies significant to the family. Helps looking outside family unit to figure out what help they need: -Flow of Resources -Identifies possible Conflicts -Shows missing "Connections" For example: -The sample ecomap of the Garcia family suggests that few contacts occur between the family and the suprasystems. The community health nursing student was able to use the ecomap to discuss with the Garcia family the types of resources available in the community and the types of relationships they wanted to establish with them.

Assessing the Family- Ecomap?

Based on the genogram Records family medical/health history Note: -Cause of death -Genetically linked diseases --​​Including heart disease, cancer, diabetes, hypertension, sickle cell anemia, allergies, asthma, and mental retardation -Environmental and occupational diseases -Psychosocial problems --​​Such as mental illness and obesity -Infectious diseases --Like STD's, Hep C, HIV • Familial risk factors from health problems • Risk factors associated with the family's methods of illness prevention, such as having periodic physical examinations, Papanicolaou smears, and immunizations • Lifestyle-related risk factors (elicited by asking what family members do to "handle stress" and "keep in shape")

Assessing the Family- Family Health Tree?

-Diagram of family structure --Tells how people are connected -Children left (oldest) to right (youngest) -Opens discussion about family history and health issues

Assessing the Family- Genogram?

General Questions • In what branch of the military did you serve? • Where did you serve? • Did you serve in combat? • What was your job in the military? • Did you sustain any injuries related to your military service? • What were you exposed to: chemical (pollution, solvents, etc.), biological (infectious disease), or physical (radiation, heat, vibration, etc.)? • What precautions were taken (avoidance, personal protective equipment [PPE], treatment, etc.)? • How were you exposed (inhaled, on skin, swallowed, etc.)? • How concerned are you about the exposure? • Where were you exposed? • When were you exposed? • Who else may have been affected? Post Traumatic Stress: • Have you ever experienced a traumatic or stressful event that caused you to believe your life or the lives of those around you were in danger? • Are you experiencing trauma-related thoughts or feelings? • Are you having nightmares, vivid memories, or flashbacks of the event? • Are you feeling anxious, jittery? • Are you experiencing a sense of panic that something bad is about to happen? • Are you having difficulty sleeping or concentrating? Military Sexual Trauma: • During military service did you receive uninvited or unwanted sexual attention, such as touching, pressure for sexual favors, or sexual remarks? • Did anyone ever use force or threat of force to have sexual contact with you against your will? • Did you report the incidents to your command and/or military or civilian authorities? Blast Concussions/Traumatic Brain Injury: • During your service, did you experience: • Heavy artillery fire, vehicular, or aircraft accidents • Explosions (improvised explosive devices, rocket-propelled grenades, land mines, grenades) or fragment or bullet wounds above the shoulders • Did you have any of these symptoms immediately afterward: • Loss of consciousness or being knocked out • Being dazed or seeing stars • Not remembering the event • Diagnosis of concussion or head injury

BOX 22.2 Assessment Questions about health of veterans?

d.) An individual who spends most nights at public or private places not designed for regular sleeping accommodations HUD defines homelessness in four categories: (1) literally homeless, (2) imminent risk of homelessness, (3) homeless under other federal statutes, and (4) fleeing/attempting to flee intimate partner violence. An individual who spends most nights at public or private places not designed for regular sleeping accommodations is considered literally homeless. Literally homeless is defined as individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided. An individual whose residence lacks access to public water and electricity, an individual who has a permanent nighttime residence in the housing for mentally ill people, and an individual imprisoned or detained under an act of Congress or state law are not considered homeless under the HUD definition.

Based on the Department of Housing and Urban Development (HUD) definitions of homelessness, which individual would be considered homeless? a.) An individual whose residence lacks access to public water and electricity b.) An individual who has a permanent nighttime residence in the housing for mentally ill people c.) An individual imprisoned or detained under an act of Congress or state law d.) An individual who spends most nights at public or private places not designed for regular sleeping accommodations

b.) Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families. Several types of farming activities are associated with higher than expected occurrences of acute and chronic respiratory conditions. The role of the nurse is to refer patients to appropriate health care providers and provide support and education for affected people and their families. Farmers have a lower rate of cardiovascular disease, use of mental health services, and tobacco use than their urban cohorts.

Based on the common illnesses and risky health behaviors among farmers, the community health nurse should implement which health promotion activity? a.) Partner with the local health department to offer smoking cessation classes for farmers and their spouses. b.) Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families. c.) Collaborate with health care providers to conduct skin assessments at a meeting of local farmers. d.) Work with mental health consultations to outline a community-based program to address the high rate of suicide and depression among farmers. e.) Plan, implement, and evaluate an outreach program designed to improve the cardiovascular status of farmers and their families.

-The financial burden of the cost of healthcare is a major challenge for families. The Patient Protection and Affordable Care Act (ACA), when implemented in 2010, made sweeping changes resulting in large numbers of families receiving health insurance either through expanded Medicaid programs or the availability of insurance markets offering lower insurance rates. One popular change allowed families to insure dependent adult children up to the age of 26 on the family policy. ​​-Globalization has also affected the family. In many areas manufacturing has replaced agriculture as primary employmentLoss of jobs results in financial decline, personal bankruptcies, and downward social mobility. All of these forces impact individual and family health.

Changes that Affect Family?

-Americans are putting off life's big milestones. The median age for first marriage is 29 for men and 27 for women compared with 2013 when more than one-in-four of people ages 18 to 32 years were married. -Today, an American woman is expected to have 1.9 children. This is below what is considered 'replacement rate' of 2.1 children per woman. -Three million (37% of lesbian, gay, bisexual and transgender [LGBT]) will have a child at some point in their life. -Intermarriage among people of different races is increasingly common. In 1980 there were only 7% of people who married a spouse of another race, and in 2010 this had doubled. -The rate of cohabitation, which is defined as "a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage," has also increased over time

Changing Family?

-Chronic disease uses 86% of nation's health care costs -Patient symptom management -Individual and family adjustment: --The CHN (Community Health Nurses) can intervene to assist the family coping with related stressors. Also significant is the fact that a resource such as third-party reimbursement forces most families to learn to manage the chronic problems with limited or infrequent intervention from health professionals. -Identify primary caregiver for additional support needs -Home visits helpful to see dynamics and environment: --To see how they do day to day things --Community health worker helps by Going to see environment ---How do they store their insulin? ---Go to grocery store and help manage their condition

Chronic Disease in the Family?

Health Literacy: degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. -Social determinate of health -Cultural and conceptual knowledge, print health literacy (writing and reading skills), oral health literacy (listening and speaking), and numeracy -Critical component to empowerment 4th-6th grade reading level

Communication Concerns: Health Literacy?

Empowerment: Help individuals, families, and groups gain insight and mastery over life situations through problem solving and dialogue. Application to Health Education (Nursing Actions): -The nurse works with community members in identifying and defining issues and creates mechanisms for discussion and problem solving and identifying other factors that have an impact on everyday lives. Principle of Relevancy: Know what issues are important to community members (these may differ from the issues important to nurses). Application to Health Education (Nursing Actions): -The nurse holds "town hall meetings" and community group discussions to allow members to share concerns and important issues. -The nurse encourages the community to define issues (what is important to them). -The nurse facilitates communications with community members to help them make decisions about health programs and messages. Principle of Participation: Learn by doing. Application to Health Education (Nursing Actions): -The nurse encourages group support. -The nurse recognizes that active rather than passive participation results in greater likelihood of attitude and behavior changes. Issue Selection: Identify problems that the community believes are specific, meaningful, and attainable. Application to Health Education (Nursing Actions): -The nurse uses problem-solving techniques to help group members identify relevant issues (e.g., group process activities, door-to-door surveys, charlas/talking circles). Creation of Critical Consciousness: Encourage relationships of equality and mutual respect among group members and educators to identify root problems and generate appropriate action plans. Application to Health Education (Nursing Actions): -The nurse uses problem-posing dialogue (Freire, 2005) to understand root issues and devises creative and innovative methods to transform situations. Social Capital: Foster relationships (networks) between community members (i.e., trust, engagement) Application to Health Education (Nursing Actions): -The nurse encourages community members to work together to improve social networks: they work together on a particular health gap in their community through partnership activities.

Community Health EducationKey Concepts?

Hospice and Home Health: -Hospice: Hospital/LTC base in rural settings, Hospice House in urban settings Informal Care Systems: Lay caregivers used heavily in rural communities -Churches -Maybe more comfortable getting care from lay person Rural Public Health Departments: Assessing local health status, addressing local health issues, providing access to care (Community needs assessments) -Funding: lack of funding for rural health dept- had to do grants and levys to continue to keep health dept open Rural Mental Health Care: Lack of providers, care comes from PCP (they don't know much on mental health more generalized), stigma or unaware of mental health issue -Lack of mental health care Emergency Services: Prehospital care (paid vs. volunteer), emergency room care and trauma care -Volunteers: slow response time, lack of training -Paid: is on the scene so quicker response time, more training -"Time is muscle", the "Golden Hour" proximity can make it difficult -Time is muscle- talks about the heart -Golden hour- is trauma intervene within an hour

Community-Based Care?

Why do definitions matter? -Conceptual (Canada & Europe) and Legal (US) are different In Europe the "home" has three domains:​ -Physical: The physical domain meant having an adequate dwelling for which a person/family has exclusive possession -Social: The social domain meant being able to maintain privacy and enjoy relations -Legal: Meant having exclusive possession, security of occupation, and legal title to occupation In Europe there are 4 types of classifications for homeless living arrangements: -Rooflessness, Houselessness, Insecure housing & inadequate housing Canada has 4 different conceptual categories for homelessness: -Unsheltered, Emergency sheltered, Provisionally accommodated & At risk

Conceptual definitions regarding homelessness?

-Introduce self to client and family/visitors -Ask the client how they would like to be addressed -Respect the space, distance, and intimacy of the client's culture -Avoid stereotypes or generalizations -Pay attention to nonverbal communication (nurse and client) -Use an interpreter when indicated --Community health nurses may be/become bilingual to work within their community --To prevent the disconnect between yourself and the client

Cross-Cultural Communication?

1.) Social justice 2.) Critical reflection 3.) Knowledge of cultures 4.) Culturally competent practice 5.) Cultural competence in health care systems and organizations 6.) Patient advocacy and empowerment 7.) Multicultural workforce 8.) Education and training in culturally competent care 9.) Cross-cultural communication 10.) Cross-cultural leadership 11.) Policy development 12.) Evidence-based practice and research

Cultural Competence Standards?

Family is defined by the client: -Structural differences -Functional diversity -Acculturation -Primary provider of care for children -Ask questions, don't assume!!

Culture and the Family?

Three subdivisions:​ Veterans Health Administration (VHA): provides all types of healthcare in every setting, inpatient, outpatient, long-term care​ Veterans Benefits Administration (VBA): responsible for unemployment, pension, home loans, vocational training, educational benefits​ National Cemetery Administration: Provides burial, headstone, gravesite -Veteran is eligible for VA benefits when they fulfill two requirements to service and separation:​ --Service: must have served in active duty for 24 consecutive months or full period of call (Reserves and Guard); some exceptions exist​ --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 Veteran benefits Benefits received at VHA are not a health insurance, they are a benefit -Veterans do not need to "pay into" this service like a premium -It is non-transferable to other HCP -Copays are standardized and caps on medications are affordable ($700) -Transfer of care will be provided if services not offered at VA or wait is long CHAMPVA - some civilian family benefits if requirements are met -Service member is permanently or totally disabled -Service member died from service connected disability -Service member was totally or permanently disabled at time of death -Service member died in line of duty (not due to misconduct), may be TRICARE instead TRICARE - care for families of active duty military & their families/survivors

Describe elements of the Veterans Health Administration, including benefits, eligibility, costs of care, and outreach programs?

Historically recognized as "different" and set apart. Isolated, ridiculed or even killed. -Then became seen as "helpless" & expected to comply w/ any & all treatment 1920/1930s Eugenics, selective breeding, involuntary sterilization 1940s WW2 Hitler extermination children then institutionalized adults 1950s Association for Retarded Children ARC -intellectual disabilities 1960/1970s Independent living - moving away from institutions 1973 - Rehabilitation act - prohibits discrimination for federal employment 1975 - Individuals disabilities education act (IDEA) - Free public education (IEP) 1990 - Americans w/ disabilities act - prohibits discrimination w/ employment, transportation, programs, accommodations, hospitals etc.

Describe historical attitudes and perspectives surrounding disability that have contributed to treatment of people with disabilities?

PTSD: -Cognitive behavioral therapy & medication (SSRIs) -Specialty services: prolonged exposure & cognitive processing therapy & EMDR Suicide prevention: -Suicide prevention coordinator (SPC) at every VHA; coordinates care Mental health/substance abuse disorders: -Peer support specialists, tx for mental health and/or SUD, vet centers TBI: -Acute LTC Home; multidisciplinary approach. RN as case manager Amputations: -Amputation system of care (ASoC) - access to rehab/prosthetics Chemicals, old, radiation, pollutants: -Education to HCP for care, disability compensation info & registry assistance Homelessness: -Jail diversion & housing-first orientation

Describe nursing interventions to improve the health of the veteran?

-Humanistic- help people help themselves, use self-directing behavior -Develop their potential in self-directing and holistic manner

Describe the application of the Humanistic learning theory to the individual, family, or aggregate?

-One of most fundamental nursing task -Community- promote health, prevent disease, and maintain optimal wellness -Improve connection between scientific discovery and delivery of interventions -Influence the health and well-being of communities through original and inventive activities- culturally, linguistically and educationally relevant

Describe the goals of health education within the community setting?

Definitions -Disability- an umbrella term covering impairments, activity, limitations and participation restrictions -Developmental disabilities- conditions that are manifested by age 18 -Impairment- a problem in body function or structure -Activity limitation- difficulty encountered when executing a task/action -Handicap- a disadvantage that prevents fulfillment of an expected roles

Differentiate among the definitions, models, and social constructs of disability?

-Small percentage of population controls most of the resources -Racially and ethnically diverse groups are disproportionately lower SES -"Land of opportunity" applies more to middle and upper class -SES corelates with access to care and quality of care. Lower to lower and higher to higher

Distribution of Resources?

A.) Executive Rationale- The executive branch is responsible for the administration and enforcement of public health laws. Regulatory agencies under executive power draft the specific rules and regulations.

Now that the legislation has become law, which branch of government is responsible for drafting rules and regulations and enforcing the law? A.) Executive B.) Judicial C.) Legislative

A.) Perform a culturological assessment of the community D.) Perform a cultural self-assessment E.) Volunteer to serve on the county health department's advisory council Rationale- A culturological assessment of the community is an important part of the overall assessment process that is essential to any effective community health effort. A cultural self-assessment is necessary to identify personal beliefs, values, and attitudes that may interfere with the nurse's ability to see health issues from the perspective of those being served. Finally, being a part of the county health department's advisory council provides an opportunity to affect the political aspects of health care for the community client.

During the course of the community forum, a nurse points out that the elimination of disparities in health is a current focus of Healthy People 2030. They advocate for an ongoing process to look at the health status of the community as a whole, with an emphasis on disparities in the new immigrant population. Which of these follow-up activities would be appropriate to their role as a community health nurse? (Select all that apply.) A.) Perform a culturological assessment of the community B.) Discourage employers from rapid hiring of immigrants C.) Provide educational sessions to teach traditional healers how to use Western medical processes D.) Perform a cultural self-assessment E.) Volunteer to serve on the county health department's advisory council

Health Belief Model: -Disease specific -Value of health and illness -Focuses on avoidance of behavior -Client perceptions: --Perceived susceptibility: Belief that disease state is present or likely to occur --Perceived severity: Perception that disease state or condition is harmful and has serious consequences --Perceived benefits: Belief that health action is of value and has efficacy --Perceived barriers: Belief that health action is associated with hindrances (e.g., cost) --Self-efficacy: Belief that actions can be performed to achieve the desired outcome (one's confidence) --Modifying factors (demographic, psychosocial, structural): Age, gender, education, experience, motivation --Cues to action: Influencing factors to get ready for action (e.g., educational materials, text messaging, billboards, newspapers, computer apps, blogs, reminder cues) Health Promotion Model: -Explains why clients participate in health promoting behaviors -Interactions with physical and intrapersonal environment -Focuses on individual characteristics, experience, thoughts about behavior

Education Models?

Emergency response program Rural challenges: -Resource limitation -Separation and remoteness -Low population density -Communication

Emergency Prepardeness?

Nurse's role: -Support learner participation -Emphasize empowerment -Promote community engagement -Resource person, participates with the group Paulo Freire- Brazilian educator: -Learner in active role -Knowledge from the group more powerful than info from educator -Looks are social and political aspects of health problems

Empowering Clients?

Establish Inclusion and trust: -Warm greeting- introduce self -Attending to immediate concerns -Offer comfort- environment comfortable for learning -Culturally effective care- value diversity Leads to development of trust: -Need to trust the nurse to trust the content

Enhancing Communication?

-Monitor health status- identify and solve health problems -Diagnose and investigate health problems and hazards -Educate and empower people -Mobilize community partnerships to identify and solve health problems -Develop policies and plans that support community health efforts --Drafting policies, working with school nurses -Enforce laws and regulations to protect health --Shut down restaurants if they need to -Connect people to personal health care and provide necessary healthcare --TB skin test, immunizations -Assure competent healthcare workforce --More at the state level; licensing of HCP -Evaluate effectiveness, accessibility and quality of health services in the community --Triannual community health needs assessment -Research for innovative solutions to health problems --Meet the people's needs related to COVID

Essential Public Health Functions?

-Inclusion and trust first -What does your community member want to know? -Identify motivating factors -The Basics- stick to what's important -Breakup your teaching -Avoid medical jargon -Use Teach Back -Be encouraging -Teaching formats: brainstorming, demonstration, lecture, role playing, community wide programs, town hall meetings, -PAGE 145- WHOLE LIST OF HELPFUL TIPS FOR EFFECTIVE TEACHING

Examine innovative and effective teaching and learning strategies that exemplify community-centered health education for the individual, family, or aggregate/group?

Nurse's role: -Support learner participation -Emphasize empowerment -Promote community engagement -Resource person, participates with the group -Nurses hold the process together and are catalysts for change in delivering humanistic care -Nurses: activate ideas, offer appropriate interventions, identify resources and facilitate group empowerment

Examine the nurse's role in community education?

A veteran describes anyone who has served time in the military The legal definition is someone who has completed their service and had any discharge other than dishonorable -Some may be hesitant to call themselves veterans due to the character of their discharge. But in terms of exposure/health any service matters Branches include: Army (largest) Marines, Navy, Air Force & Coast Guard. -Different terms depending on their branch (soldier, marine etc.) -Active or reserve; Career or single term -Enlisted member or commissioned officer -History of deployment, combat or not Military culture: Regardless of branch, rank or term of service the military culture is standard -Structure and uniformity, governed by rules and standards​ -Strong sense of service​ -Hierarchical class system​ -Solutions focused on actions​ -Unique dialog and expressions​ -Reluctance to show weakness​ Health care norms​ -Avoid care because of stigma of appearing weak​ -Fear that information may not be kept confidential​ -Fear of financial hardship​

Explain basic terms and the culture associated with U.S. military service personnel?

WWII Veterans -Exposed to noise/radiation, cold injuries and chemicals (mustard gas experiments) Korean war veterans -Extreme cold injuries, noise etc. Vietnam veterans -Worse if served "in country" than elsewhere -Agent orange exposure - certain cancers ppg 440 -Disability compensation if served in Vietnam 1962 - 1975 w/ above conditions -Higher rates of CA, stroke, HTN & lung conditions Gulf war & War on terror -Particulate matter exposure from burn pits, dust/sand -TBI/shrapnel from IED, heat stroke/exhaustion, chemicals & disease exposures -Chronic multisymptom illness (CMI) - gulf war associated

Explain some of the commonly occurring health issues encountered among veterans of different wars and conflicts?

Three broad factors singly and interactively contribute to homelessness​: -Shortage of affordable housing: Factors contributing to the shortages include market forces that inhibit the private housing sector's production of affordable rental housing, decreases in the federal government's spending on assisted housing for low-income families, and the increasing inequality of incomes among groups within the larger population. Examples: -Any houses to buy? -Housing should cost no more than 30% of your income -Houses that are for sale have extremely high prices -Air bnb take houses off the market and people who buy ugly houses and flipped them take starter homes off the market and flip them into expensive homes -Income insufficient to meet basic needs​: With the lack of affordable housing in combination with insufficient income, people have to spend much of their income on rent, leaving them without adequate resources for other necessities, such as food, clothing, and health care. This situation substantially increases their risk for homelessness. -Inadequate & scarce support: Some people experiencing homelessness have individual characteristics that, in interaction with the structural conditions of shortage of affordable housing and insufficient income, perpetuate their homeless condition. Included in this latter group are people whose serious chronic mental health and/or substance abuse problems preclude their functioning in the workforce and whose behaviors frequently interfere with their ability to obtain housing stability. People in this group need income assistance and comprehensive and accessible behavioral and physical health care. Examples: -Huge waiting lists for government housing -Need to have an ID (need an address, birth certificate, SS card) if homeless you probably don't have those -Might have records of loitering, breaking an entering, petty theft because they are homeless but cannot get government housing if you have these on your record

Factors That Contribute to Homelessness?

Should assess- family information and community context -Standardized tools -May be used across multiple visits Addresses: -Family characteristics -Structure and process -Family environment --Food Desert

Family Health Assessment Tools?

c.) establishing the nursing goals based exclusively on the physician's orders. Family interviewing skills include social skills (manners), therapeutic conversations, use of tools such as the genogram or ecomap, use of therapeutic questions, and commending family and individual strengths. Assessment, goals, and interventions are completed and planned in collaboration with the family.

Family interviewing requires the community health nurse to understand or develop specific skills. All demonstrate appropriate family interviewing skills or techniques except a.) introducing oneself by name and addressing the client appropriately, such as "Mr. Jones." b.) planning the focus for the family visit in advance and engaging all family members present during the home visit. c.) establishing the nursing goals based exclusively on the physician's orders. d.) including time to identify family strengths and commend the family on these during the family assessment.

Have all been put into play; minority wasn't receiving adequate resources; turned away from care -Racial and Ethnic Approaches to Community Health -National Breast and Cervical Cancer Early Detection Program -Ryan White Comprehensive AIDS Resources Emergency (CARE) Act B -National Institute on Minority Health and Health Disparities

Federally Sponsored Initiatives?

Important Definitions: Rural- Farming community: lots of land and space between people -Anything that is not considered an urban area is a rural area. -Rural/ micro area is 10,000-49,999 people Ex: chillicothe Urban (metropolitan): areas that have 50,000 people or more. Ex: columbus, cincinnati Core-based statistical area (CBSAs): helps us look at different populations differently Disparities: something that puts someone at a disadvantage Ex: gender, ethnicity, socioeconomic status, education, geography Agriculture: anything from farm to table Ex: Out in fields harvesting grains, raising hogs/cattle, working in meat plant, grocery stores, restaurant

Important Definitions for Chapter 24: Rural and Migrant Health?

-Reimbursement doesn't align with caring for the family -Interactions between family members and society -Interviewing: --Manners: ---Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. --Therapeutic conservation and questions: ---This type of conversation is focused and planned and engages the family. The nurse must listen and must remember that even one sentence has the potential to heal or help a family member. The nurse encourages questions, engages the family in the interview and assessment process, and commends the family when strengths are identified. Every encounter, whether brief or extended, has "healing potential." Therapeutic conversation may initiate further discussion that brings the family together on issues. focused on what we are there to do. ---What do the families want to get out of this visit --Family genogram: ---These tools provide essential information on family structure and together are an efficient way to gather information such as family composition, background, and basic health status in a way that engages the family in the interview process. --Commendations: ---Sharing strengths reinforces immediate and long-term positive relationships between the nurse and family. Interviews that identify and build on family strengths tend to progress to more open and trusting relationships and often allow the family to reframe problems, thereby increasing problem solving and healing. ---Identifying the families strengths and letting them know what they are doing well. Builds trust -Settings- Home, Medical Facilities, Work and School Sites, Housing complexes, Substance abuse programs --Home visit- helps us see it. So we can better understand

Focus on the Family?

Models of justice: Market justice vs. social justice Market justice - Entitled to things according to their individual efforts -Which has been the dominant model, purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. --it's your fault, you get what you work for Social justice - All are entitled to certain things (healthcare, minimum income) -All people are equally entitled to key ends (i.e., access to health care and minimum standards of income). Consequently, all members of society must accept collective burdens to provide a fair distribution of these ends. Moreover, social justice is a foundational aspect of public health and nursing. --Everyone is going to take a hit to provide this Thinking upstream: -Think of river as homelessness and homeless are ppl in it - downstream -Upstream is prevention; This would be addressing primary contributors to homelessness

Framework for care: Models of Justice and Thinking Upstream?

SDH (5 Broad dimensions of): -Economic stability​ -Education​ -Social and community context​ -Health and health care​ -Neighborhood and built environment Public intervention wheel: -Provides guidance in identifying types of interventions -Downstream: screening, outreach, case management -Upstream: community organizing, policy development

Framework for care: Social Determinants of Health (SDH) and Public Intervention Wheel?

Organizations- associations that set and enforce standards in a particular area; a group of individuals who voluntarily enter into an agreement to accomplish a purpose. -Emergency Nurses Society; The Red Cross -Anyone who comes together for a common goal Administrative agencies- departments of the executive branch with the authority to implement or administer particular legislation. -FDA, CDC, once administers pass the law these places makes sure they can be implemented -Provision money to support COVID (grants to health departments to either help get more staff, PPE, speciality units, etc) Legislators- appointed or elected officials in the legislative branch of government, propose bills

Group Definitions for policy formation?

b.) the private sector. The private sector includes employers, professional organizations (e.g., American Hospital Association), nonprofit health care organizations (e.g., American Heart Association), and for-profit corporations that deliver, insure, or fund health care services outside government control. The public sector is concerned with providing government services. A stakeholder is one who can affect or be affected by the actions of an organization as a whole. An expert is one who has extensive knowledge or skill in a particular field.

Groups such as professional organizations, nonprofit health care organizations, and corporations that sponsor health care are/is called a.) the public sector. b.) the private sector. c.) stakeholders. d.) field experts.

-On a single night in 2021, more than 326k people were experiencing sheltered homelessness. 131k were families (41k households) -The number of people staying in sheltered locations decreased by 8% between 2020 and 2021 - why? --Stimulus checks and unemployment got extra $600, american rescue act- helped with children -Unaccompanied youth unaffected except for small groups (disproportionately affected???) -A decrease of 9% for unaccompanied youth though some groups experienced an increase

HUD 2020-2021 Estimates?

Mission- "The Federal Office of Rural Health Policy (FORHP) works to increase access to care for underserved people in rural communities. We do this through our grant programs and public partnerships." Healthcare Provider Shortage Areas (HPSA) Medically Underserved Telemedicine/Telehealth: -In rural areas may not have internet access or service to do these Rural Health Research

Health Resources and Services Administration (HRSA)- Objective 5?

d.) work and be productive. Rural residents generally describe themselves as healthy if they can do their usual work and remain productive. Performing activities of daily living may be one part of being productive. Avoiding hospitalizations and maintaining social connections are the most frequent descriptions of health by rural residents.

In contrast to people who live in urban areas, rural residents frequently describe their health by their ability to a.) avoid hospitalizations. b.) maintain social connections. c.) perform activities of daily living. d.) work and be productive.

Adults​: -Higher morbidity rates​ & poor physical health -Higher rates of pregnancy and complications​ --Stressed about where you're going to live can lead to complications -Substance use disorder​ & criminal activity​ -Marital dissolution​ & escape from domestic violence --Huge proportion of women being homeless Families: -Single parent- can't work because you have no one to watch their child -Hard to be a good parent when worried about money and trying to prove the basic necessities ​ Youth:​ -Drug/alcohol abuse, unintentional injuries, depression & suicidal ideation --Women are highly vulnerable staying in these places and are more prone to experiencing violence -Family disruption & school failures -Unintended pregnancy, STI, physical/sexual abuse --May not have access to birth control --Women more likely to use alcohol or drugs during pregnancy -Prostitution or "survival sex"; involvement with the legal system​ --Engaging in sexual activities in exchange for things you need to live --Which can cause complications with the legal system if caught --Can be male or female​

Health Status of the Homeless Population?

Federally Qualified Healthcare Center (FQHC): provide care to underserved populations (they see more medicaid medicare people) -Medicare -Medicaid -Sliding scale based on income level Rural health clinic: reimbursed at higher Medicare and Medicaid rates Critical Access Hospitals: small hospitals -allow people to have access to healthcare -Ex- adena pike -Cost-based reimbursement for inpatient Medicare and outpatient services

Healthcare Facilities in Rural Populations?

Goal: Promote health and safety in community settings. Some objectives related to Rural Health: -Increase CPR and AED use in non-traumatic cardiac arrest -Reduce household food insecurity and hunger: --Make sure people have access to things people will need --Snack pack programs where schools send food home with kids -Increase number of voters: --Get out and vote -Increase the proportion of local jurisdictions that have a health improvement plan

Healthy People 2030 goal and its relation to public health?

Florence Nightingale- first nurse to exert political power -Pressure on government -Used research, hygiene importance, early ambulation -"I need these things to take care of soldiers (laundry, kitchen, supplies, money) Sojourner Truth- human rights activist and federal funding to train nurses -Federal rights activist -Racist and sexist policies that limited african american and females Clara Barton- Red Cross champion -Helped organize Red Cross -Worked in US Civil War Lavinia Dock- campaigned to allow nurses to control nursing, -Founded NLN (National LEague of Nursing) -Wanted nurses to control their own profession Lillian Wald- championed for child labor laws, Children's Bureau -Recognized working conditions and health Mary Breckenridge- created Frontier Nursing Service for rural health in Kentucky Susie Walking Bear Yellowtail- worked to improve health care on reservations -Native American Nurse and walked from reservation to reservation -Established Native American Nurses Association Florence Wald- champion for hospice care -Nursing leader for hospice care (helped develop hospice) Dr. Ruth Watson Lubic- nurse-midwife, opening birthing centers, decreasing infant mortality -Developed Free standing birth centers where women can go and give birth; because of this less infant deaths

History Lesson- Influential Nurses for Policy Change?

Important to ask people if they served in the military - not whether they are a "veteran". May not identify as a veteran Question table 22.2: -Which branch did you serve in? How long did you serve? -Have you experienced a traumatic/stressful event? -Do you have nightmares, vivid memories or flashbacks? -Were you exposed to chemicals and did you use PPE? -Did you experience accidents, heavy artillery fire, explosions etc. -Did you have a loss of OC, problems remembering or "concussion"? -Did you receive unwanted sexual attention? Did anyone force sexual contact?

Identify assessment strategies to improve the health of veterans?

What does your client need? -Clients have been living with disability for an extended period of time, and are sensitive to the needs of their body. - "Knowledgeable Client"​ -Nurses should ask the client what works best for them and what goals the client is pursuing. ​ -Clients newly diagnosed can benefit from the information about the disability and the available community and governmental resources - need the "Knowledgeable Nurse"​ -The Patient Self-Determination Act

Identify ethical issues related to the care of people with disabilities?

-Disability can be acute/chronic can be temporary/permanent -How might impact be affected if it was d/t chronic progression vs acute? -How might the likelihood to accept help differ if the condition was temporary vs permanent and progressive? -Picture how this might affect your daily life (job, hobby, family etc.) -Nurses must possess education & be aware of varied resources -Nurses should also be able to educate regarding possibly uncomfortable topics (sexual health, potential for abuse etc.) -A nurse must also care for the family - of a disabled child, spouse or parent -Nurses should be aware of behavior that makes client care more difficult

Identify the unique living experiences of disabled persons and their families?

c.) 19th century During the 19th century, the Industrial Revolution stimulated a societal need for better education. Those who could not reach the equivalent of a contemporary third-grade education were labeled as "feebleminded." In Biblical times, people with disabilities were often viewed as unclean or sinful. In the 18th and 19th centuries, people saw disability as an irreparable condition caused by supernatural agency. Special interest groups for people with disabilities began to develop in the 20th century.

In which era were people with mental disabilities labeled as "feebleminded" because they could not reach the minimum educational level? a.) Biblical times b.) 18th century c.) 19th century d.) 20th century

Nurses have the power to influence healthcare policy Nurses have an obligation to further their profession and promote positive health outcomes. -Can do that through political activity Nurses need to understand how the government works at the national, state and local level to participate in the process. Engaging with legislators is an important step that even novice nurses can take to influence policy -Can engage with legislators by writing them Administrative agencies provide support and consequences for health care organizations and providers that don't follow the rules -FDA, provide support with funding

Key Points for Chapter 10: Policy, Politics, Legislation and Community Health Nursing?

Family is defined by its members -Going to get told; don't assume Look of the family is changing -Okay to have two moms, Foster care without a parent, just a grandma, etc. Family is influenced by its history and environment (community) -Tools for health history: Subjectively (asking), genogram (structure and connection), Family Health Tree (Health history), Ecomap Frameworks used by community health nurses must be applied to the community -General systems theory Nurses should use tools to conduct a thorough assessment of the family, including their community -In the home is the best place to visit Nurse can influence the health of a community by assessing and intervening with families -Families impact the community around us -Finding things wrong with the family could tell CHN that is could be a common problem for everyone

Key Points for Chapter 20: Family Health?

The U.S. population is shifting to a minority majority. -Need to understand culture and do better at learning minority cultures Communicating with clients from a different culture requires mutual respect and trust -Introducing yourself, respecting their space (other slide) Solutions to health problems must reflect the community needs and priorities -It needs to be what they need so have conversations with them The community health nurse must provide care using the principle of social justice -Do what is best for everybody Communicate health education in a culturally appropriate manner -Use preferred language and do it in an environment for their culture and with people that is appropriate for them based on culture Two federal agencies help support these efforts- Office of Minority Health and Indian Health Services -Help support minority health issues -Indian Health Services- on Native American Reservations

Key Points from Chapter 13: Culture?

d.) Social learning theory Social learning theory's premise is based on behavior explaining and enhancing learning through the concepts of efficacy, outcome expectation, and incentives. Humanistic theories help individuals develop their potential in self-directing and holistic manners. Although social learning theory is largely a cognitive theory, it also includes elements of behaviorism.

Knowledge of various learning theories is important for community health nurses involved in health education. Enhancing self-confidence and self-efficacy are important aspects of which learning theory? a.) Cognitive learning theory b.) Humanistic learning theory c.) Behavioral learning theory d.) Social learning theory

Laws: are rules of conduct or procedure; they result from a combination of legislation, judicial decisions, constitutional decisions, and administrative actions. Statutes: are any laws passed by a legislative body at the federal, state, or local level. Public health law: legislation, regulations, and court decisions enacted by government at the federal, state, and local levels to protect the public's health. -Ex: Police power, disease and injury prevention, and the law of populations.

Law definitions for policy formation?

c.) The client's developmental stage and roles have an impact on readiness to learn. The client's social roles and the tasks associated with the client's developmental stage must be considered because they will have an important influence on the client's learning experience. Gathering information to plan and time the meetings and understand the desired outcomes is necessary, but the most important reason to obtain the information is to understand the client's readiness to learn.

Learner assessment is an important aspect of health education. The assessment performed by the community health nurse includes questions about the client's age, family roles, social roles, and various responsibilities. Which is the most important reason for obtaining this information? a.) The nurse will need this information to plan the meetings with the client. b.) The information will help the nurse to understand the client's desired outcomes. c.) The client's developmental stage and roles have an impact on readiness to learn. d.) The information is necessary to understand how much time the client will have.

2 most important for community health are Housing and Urban Development (HUD) & Education (ED) HUD has 4 different categories of homelessness: Category 1: Literally Homeless​ -Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided (no house) Category 2: Imminent Risk of Homeless​ -Individuals and families who will imminently lose their primary nighttime residence Category 3: Homeless Under Other Federal Statutes​ -Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition Category 4: Fleeing/Attempting to Flee Domestic Violence (DV) -Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. ED purpose is to ensure equal access to the same free public school (including preschool) education for all students ED definition is broader than HUD & includes those who are: -"Doubling up" (more than one family in a household), abandoned in hospitals & awaiting foster care placement Health and Human Resources (HHS) also includes: -Runaway: "a person under 18 years of age who absents himself or herself from home or place of legal residence without the permission of his or her family" -Homeless youth: "a person under 18 years of age who is in need of services and without a place of shelter where he or she receives supervision and care"

Legal definitions for Homelessness (HUD)?

A.) Advocacy B.) Lobbying Rationale- This type of action is considered both advocacy and lobbying. She is advocating a position based on the interests of those she is serving. As she does this, she is trying to influence the legislators, which makes the action lobbying.

Lisa is a community health nurse who has been working as a school nurse for 7 years. She has always been aware of the impact of policy decisions on her nursing practice. She is now at a point in her career where she would like to increase her political involvement. Lisa has been following legislation that would change childhood immunization requirements for school entry. She is planning to meet her elected representative to discuss the impact of this legislation on her practice. This action is considered (Select all that apply.) A.) Advocacy B.) Lobbying C.) Balance of powar D.) Legislative surveillance E.) Policy initiative

Migrant and seasonal farmworkers have poorest health and least access to healthcare of any aggregate in the United States. -85% are Hispanic, Latino or African American Migrant- move to find work -Migrant workers MOVED to find work Seasonal- work seasonally when work is available -Don't work full time so don't have benefits like insurance Usually have low income and migratory status (migrant workers) Public health nurses often provide episodic and preventive services: -Wanna make sure they have their vaccines- covid, flu -Migrant health program to provide resources for them May have multiple barriers- cultural, economic, linguistic and transportation -These people are overworked with little money/ no days off -No insurance -Not great living conditions especially migrant workers -Rely on transportation from their employer

Migrant and Seasonal Farmworkers (MSFW)?

b.) serve as an advocate working to gain health care access for these farm workers. One of the greatest needs of the migrant and seasonal farm workers is the lack of access to health care. The community health nurse is in a strategic position to advocate for change to restructure health services and thus reduce this rural health disparity. Providing direct care for communicable diseases is important but does not meet the overarching goal of getting adequate health care access to migrant farm workers. Participating in political activities with an emphasis on changing immigration laws and learning to speak Spanish to improve communication with this specific population do not address the health care needs of migrant farm workers.

Migrant and seasonal farm workers constitute a high-risk population because of their low income and migratory status. These workers lack adequate access to preventive services. The most important role of the rural community health nurse in meeting the health care needs of this vulnerable population is to a.) address the multiple communicable diseases of these farm workers. b.) serve as an advocate working to gain health care access for these farm workers. c.) participate in political activities with an emphasis on changing immigration laws. d.) learn to speak Spanish to improve communication with this specific population.

Practice of professional nursing within the physical and sociocultural context of sparsely populated communities Factors- isolation, scarce resources, wide range of practice skills Positive job satisfaction- autonomy, professional status, and being valued by the agency/community Must be an expert generalist- encountering a range of issues- maternal health, pediatrics, geriatrics, mental health, medical-surgical, occupational, and school -Maybe the only nurse around so you need to know a little about everything

Modern Rural Health Community Nurse?

Forming coalitions- join with other notable organizations to influence policy. Nurses for a Healthier Tomorrow is an example Lobby for legislation- try to influence or persuade legislators to support your interests. -"Special-interest groups" are typically represented by lobbyist. Educate legislatures on the issues and stance of their constituents. Political action committees- fundraising arm of professional associations, businesses and labor organizations that can contribute to political campaigns -American Nurses Association raise money to pay for a lobbyist to help them get their message across Campaigning- stuff envelopes, door-to-door, call banks and hosting "Meet the Candidate" nights. Nurses working for government must be aware of rules -Example: Sign in the front yard -VA nurses must be aware Voting Power- 4 million of us!!!! If every RN voted, influence on healthcare policy could be unstoppable Public Office- local, state and national level. Nurses can advance nursing practice and public health through political offices.

Nurse's role in political activities?

b.) establishing a partnership between the parent and health care team. Nurses can help the parents and family members adjust to a child with a disability by providing information about the child's condition, providing sources of emotional support from social networks and support groups, empowering and enabling the parent for decision making on behalf of the child, and establishing a partnership between the parent and health care team.

Nurses can help parents and family members adjust to a child with a disability by a.) withholding some noncritical information about the condition to decrease the impact. b.) establishing a partnership between the parent and health care team. c.) making decisions on behalf of the child and the family. d.) teaching the family to avoid social networks and support groups to refrain from codependency.

a.) conducting and supporting health policy research. c.) working with health care professionals to influence change in the quality of health care. d.) writing letters to educate legislators about health care issues. e.) monitoring the quality ratings of health care organizations and suggesting changes that would improve care. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. This would serve to validate the importance of nursing within the health system. External strategies that nurses can use to influence private health policy include participation in discussion regarding quality and managed care. Nurses should work cooperatively with other health professions to influence managed care organizations to improve quality of care. Nurses should monitor the quality ratings of health care organizations and suggest changes that would improve care. Writing letters to legislators is a direct way to communicate opinions and concerns. Avoiding controversial discussions on health policy, however, will not foster positive changes.

Nurses' involvement in policy can be achieved by (Select all that apply.) a.) conducting and supporting health policy research. b.) avoiding discussions that involve health policy that may be controversial. c.) working with health care professionals to influence change in the quality of health care. d.) writing letters to educate legislators about health care issues. e.) monitoring the quality ratings of health care organizations and suggesting changes that would improve care.

-Cultural diversity varies by community -By 2060, minorities will be in the majority -Minorities are underrepresented in the practice of nursing. Many clients won't receive care from someone with which they can identify. -Racial and Ethnic Diversity Index- measures the probability that two people chosen at random will be from different racial and ethnic groups. Racial Health Care Disparities: U.S. Population -White Americans more likely to have insurance than Hispanics or -African Americans -Larger portion of Hispanic and African Americans report fair or poor health compared to non-Hispanic whites -Adults- Hispanics (30%) and African Americans (20%) lack usual source of health care. 16% of whites report the same -Children- Hispanics 33% more likely than non-Hispanic white children to lack usual access to health care. -Focus of Healthy People 2030 -Reduce or eliminate disparities by ensuring health insurance and medical home.

Objective #1: Critically analyze racial and cultural diversity in the United States?

Census definition: 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... Contemporary definition: "a family is two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family" Human Rights Commission definition: "Family" means any person(s) who plays 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 the gender of either parent ... without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and other persons operating in caretaker roles.

Objective #1: Definition of Family?

Government: structure of principles and rules determining how a state, country, or organization is regulated. Executive branch- President, Vice-president and administrative agents; governors and mayors Legislative branch- members of Congress, state representatives and senators, city council Judicial Branch- Supreme Court (federal and state), Court of Common Pleas, Juvenile Court -Judges Administrative Agencies- U.S. Food and Drug Administration, Department of Health and Human Services, Centers for Disease Control, Centers for Medicare and Medicaid Services

Objective #1: Discuss how the structure of government affects the policy development process?

Madeleine Leininger's Theory of Culture Care, Diversity and Universality -Culture specific- unique to designated culture --That culture has that belief or value --Not always shared with other cultures -Culture universal- common values and behaviors, seen in multiple cultures --Gender roles --Religious belief (some kind but might not always have the same one) --Share a common language --Marriage (what does the wedding look like?) --Celebration life about birth? --Death practices -What nurses do- cultural care: -Preservation and maintenance: --Goal is to help people from a particular culture, identify them, and help them maintain their culture through the care we provide -Accommodation and negotiation: --Nurses get creative; certain things from their culture that are not health practices (smoking practice (Native Americans), food that they eat that might be high in fat) --Negotiate with them to obtain a health care goal -Repatterning and restructuring: --Help patient modify health behaviors while we respect their culture values

Objective #2: Analyze the influence of sociocultural, political, economic, ethical, and religious factors that influence the health of culturally diverse individuals, groups, and communities?

Health of families can affect community health in both positive and negative ways. -The health of a community is measured by the well-being of its people and families. Circumstances such as low-birth-weight infants, lack of health insurance, homelessness, violence, poverty, and low employment rates provide a description of families and nations. CHNs provide family nursing to improve individual and family health; however, the potential result may be improving the health of society. -Health of a community is measured by the well-being of its people and families. -Community health nurses provide family nursing to improve individual and family health; however, the potential result may be improving the health of society. -Care of entire populations is the major focus for family nursing

Objective #2: Family Impact on the Community?

1.) Meet the needs of society: -Procreation: birth and death rates -Socialization: varies on families. If you get out in the world and socialize or if you stay close to home and don't get out much (Can lead to a lack of social norms) 2.) Meet the needs of individual: -basic needs (food, shelter, clothing, affection) -support spouses or partners by meeting affective, sexual, and socioeconomic needs -instruct the children in societal rules and provide values needed for growth and development.

Objective #2: Purpose of Family?

4 million+ nurses in the U.S. Have the ability to change health policy (work through a group like american nurses association) Roles: -Patient advocates: --What we need to take care of our patients (talk with legislation) -Change agents: --Help enact that change as a role model -Policy makers: --Organizational level or institutional level --Important to get involved in local policy -Consultant with legislators: --Taking the opportunity to talk to them --Talk about concerns about issues in healthcare and influence change -Labor Organizations: (UNIONS) --Another way nurses can band together to demand change --American Nurses Association

Objective #3: Examine the power of nursing to influence and change health policy?

-General systems theory -Structural-Functional Conceptual Framework -Developmental theory

Objective #3: Family Theory?

Orientation: understand people have different orientations based on their culture -Example: future oriented focused on new technology -Human Nature: --What is the character of innate human nature (human nature orientation)? --May feel separated from nature --People are good or evil --Destiny is set and they can't change that? -Perso-Nature: --The following three perspectives examine the ways in which the person-nature relationship is perceived: ---• Destiny, in which people are subjugated to nature in a fatalistic, inevitable manner ---• Harmony, in which people and nature exist together as a single entity ---• Mastery, in which people are intended to overcome natural forces and to put them to use for the benefit of humankind -Time: --• The focus may be on the past, with traditions and ancestors playing an important role in the client's life. For example, many Asians, Native Americans, East Indians, and Africans hold particular beliefs about ancestors and tend to value long-standing traditions. In times of crisis, such as illness, individuals with a values orientation emphasizing the past may consult with ancestors or ask for their guidance or protection during the illness. --• The focus may be on the present, with little attention paid to the past or the future. Individuals with this focus are concerned with the current situation, and they perceive the future as vague or unpredictable. Nurses may have difficulty encouraging such individuals to prepare for the future (e.g., to participate in primary prevention measures). • The focus may be on the future, with progress and change highly valued. Individuals with a future focus may express discontent with the past and present. In terms of health care, they may inquire about the "latest treatment" and the most advanced equipment available for a particular problem. -Activity: --Being, in which a spontaneous expression of impulses and desires is largely nondevelopmental in nature --Growing, in which the person is self-contained and has inner control, including the ability to self-actualize --Doing, in which the person actively strives to achieve and accomplish something that is regarded highly -Social: --Lineal relationships: These exist by virtue of heredity and kinship ties. These relationships follow an ordered succession and have continuity through time. --Collateral relationships: The focus is primarily on group goals, and family orientation is important. For example, many Asian clients describe family honor and the importance of working together toward an achievement of the group versus a personal goal. --Individual relationships: These refer to personal autonomy and independence. Individual goals dominate, and group goals become secondary.

Objective #3: Identify the cultural aspects of nursing care for culturally diverse individuals, groups, and communities?

-Communication -Provide Health Information and Education -Deliver Health Services -Train health professionals from minority groups --Want people to be taken care of by people that look like them --More access to schools for minority groups -Promote community organizations to cooperate in improving minority health --Let African Americans know about hypertension education -Research minority health issues

Objective #4: Apply the principles of transcultural nursing to community health nursing practice?

Negotiating prescription drug costs for Medicare: -Past set costs that are super high for drugs and they could not lower and this is trying to help lower them -Dollar for dollar it is better to spend money on prevention rather than treatment EMTALA- Emergency Medical Treatment and Labor Act: -Have to provide all patients with medical screening -Permission to transfer -Can not turn away patients Substance Use Disorder: -Issue because costs healthcare a lot of money; can be an ethical concern for nurses because we have to take patient's pain as what they say it is (drug user stigma); Do not have the resources to take care of this issue; Patients need to WANT help and to get better; Can be a leading cause to other issues that cost us money (hurt people, steal, homelessness, etc) Homelessness: -Because of loitering, littering, puts a negative look on the community -Can contribute to overcrowding of the jails Abortion- Roe versus Wade (common law): -Overturned at the federal level but state is in charge with how they want to control the situation -States can make their own individual law on abortion -"Hands-off" federal government Safe Drinking Water: -Not as common in Ohio but still an issue in our country -Flint? Michigan; Jackon, Mississippi (Both were public health emergencies)

Objective #4: Discuss current health policy issues?

-Ecological framework -Social Network framework -Transactional model

Objective #4: Family Health Intervention moves to Social Action?

Perform a home visit: -Gather referral information -Review assessment forms -Identify intervention tools

Objective #5: Assessment- Home Visit?

Ideal- administrative agencies create policies that equitable distribute services to the right people, at the right time and at a reasonable cost Reality- Key stakeholders want a say in policy development. Established programs are hard to discontinue. The steps- cost-benefit analysis, bill proposal (usually a draft of final bill), lots of steps and back-and-forth, finally becomes law, maybe waiting period before it is enforced

Objective #5: Identify the social and political processes that influence health policy development?

Agency for Healthcare Research and Quality (AHRQ) Transforms how primary care is organized and delivered Multidisciplanary team and the patient navigate the healthcare system together -Run list for patient who needs maybe A1C tested, Incorporates population health concepts Primary care provider (PCP) is the "Captain" of the ship but everyone works together to meet the Triple Aim: -Improved patient outcomes -Better satisfaction with care -Lower healthcare costs: prevent patients from getting duplicate procedures, keep them out of er as a minute clinic

Patient-Centered Medical Home (PCMH)?

Better health status in rural areas

Perception of Health Status in Rural areas?

Policy- course of action or instruction, based on values, beliefs and attitudes of those creating policy. Public policy- formed by governmental bodies, fundamental concern to the state and the whole of the general public. Issues such as health care, pollution, and the economy. --Involves everyone --Ex: A local or regional effort to prevent the sale of tobacco or alcohol to minors. Public policy directs that the right to health of the majority must be preserved over individual freedoms and corporate interests. Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal. Nursing policy specifies nursing leadership that influences and shapes health policy and nursing practice. Social policy- social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society. Institutional policies are rules that govern worksites and identify the institution's goals, operation, and treatment of employees. -Happens at worksites Organizational policies are rules that govern organizations and their positions on issues with which the organization is concerned -System focused and broad Public health law: -Ex: New York State Public Health Law §2164: "Every person in parental (statute) relation to a child in this state shall have administered to such child an adequate dose of an immunizing agent against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, Haemophilus influenza type B, and hepatitis B..." Common law: -Ex: The Supreme Court decision in Roe v. Wade, making first-trimester abortion legal, is an example of how common law becomes enforceable. Regulation: -Ex: Reporting of communicable diseases to state and local health departments, which then report them to the Centers for Disease Control and Prevention. Treaty: -Ex: Multilateral treaty: Treaty to eliminate all forms of discrimination against women.

Policy, policy and more policies?

-Conduct a cultural self-assessment -Conduct a "culturological" assessment -Seek knowledge about local cultures --Take time to learn about any of the cultures that you might interact with -Recognize political issues of culturally diverse groups --Some are illegal immigrants and will not go seek healthcare for the fear of getting deported --African Americans are vulnerable from fear of cops -Provide culturally competent care -Recognize culturally-based health problems --May be certain health conditions that occur in certain cultures so be aware of them

Steps nurses can take to ensure culturally competent care?

a.) attracting candidates who are sympathetic to particular health care issues. PACs are nonpartisan entities that promote the election of candidates believed to be sympathetic to their interests. The purpose of specific PACs could be to promote certain health care issues or health care reform or to obtain financing for certain professional organizations.

Political action committees (PAC) are formed by professional organizations, business, or labor groups for the purpose of a.) attracting candidates who are sympathetic to particular health care issues. b.) lobbying legislation about health policies. c.) being an advocate for health care reform. d.) providing financing to professional organizations.

b.) viewing a dead body. c.) having a history of mental illness. d.) surviving a natural disaster. PTSD can develop among those involved in car accidents, natural disaster survivors, and victims of rape or incest. Factors that contribute to an individual developing PTSD include getting injured or seeing another person injured, viewing a dead body, feeling helpless, having little or no social support after a traumatic event, dealing with extra stress after the event (e.g., loss of a loved one, pain, and injury), or having a history of mental illness or substance abuse. Haivng recurring nightmares and experiencing chronic pain are symptoms of, not causes of, PTSD.

Posttraumatic stress disorder (PTSD) can develop due to (Select all that apply.) a.) having recurring nightmares. b.) viewing a dead body. c.) having a history of mental illness. d.) surviving a natural disaster. e.) experiencing chronic pain.

HUD counts using 2 methods: -Point- in-time (PIT) count: Of sheltered homeless people on a single night in late January of every year and submit these data to HUD -Annual Homeless Assessment Report (AHAR): In addition to total population prevalence, the AHAR includes subpopulations—individuals, families, the chronically homeless, and veterans. ED counts all youth enrolled in school & uses broader definitions ED provides services to children not included in HUD counts (ECHY) -Collects info from schools and gathers students "nighttime residence" -Issues data on an annual basis

Prevalence of Homelessness?

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​

Provide evidence-based interventions to promote function and health management for persons with disabilities and/or chronic illnesses?

States control most of the jurisdiction for public health law: --Example: masking mandates: different state to state -Delegate implementation of public health to local health districts. --Example: They're the front lines that are administering the vaccines for covid -License healthcare workers -License healthcare facilities Federal government control most of the funding: -Can withhold funding from states if don't comply with federal programs --Example: Stick and carrot? Give money to places that are doing a good job, take medicare, etc. State decisions usually supercede federal input -Example: Federal can tell us what to do but the state has the final say. Federal can withhold money from state though

Public Health and Government: What does each level of government control?

a.) all people are entitled to the status they create for themselves. c.) all people are entitled to happiness if they put forth enough effort. d.) all people are entitled to the income they work for. Market justice has been the dominant model in the United States and purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. In contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to health care and minimum standards of income).

Public health policy in the United States is influenced by two types of justice, market justice and social justice. Examples of market justice include (Select all that apply.) a.) all people are entitled to the status they create for themselves. b.) all people are entitled to a livable minimum wage. c.) all people are entitled to happiness if they put forth enough effort. d.) all people are entitled to the income they work for. e.) all people are entitled to access to health care.

RCHD implements the 10 essential public health services through our programs, services, interventions, and partnerships Examples include: Community health assessments, disease surveillance, investigation of disease occurrence, disease prevention, education, outreach, enforcement, policy development, health promotion and education, collaboration with community partners.

RCHD's Role in the Community and Public Health?

Family: -Diverse -Complex -No two families look the same -Never assume anything between a family Sandwich Generation- Caring for: Adults taking care of both of them (STRESSES them out) -Parent(s) -Child(ren) Nuclear Family: Mom, Dad, and biological children where they stay together until the kids grow up and move out -Not nearly as common at all anymore

Reality of Family?

-Materials appropriate for audience -Appealing and culturally/linguistically relevant -Information accurate and up-to-date -Message clear and understandable -Promote self-efficacies and motivation Social Media: -Connects community members -Facilitates engagement and collaboration -Tool for health promotion and education -People are more connected today than ever before -Interactive communication -Sharing of health information -Personalize and reinforce health messages -Empower community members to make informed health decisions

Relate and apply factors that enhance the suitability of health education materials, messages, media, and programs for an intended audience?

Census: helps determine who gets what money (funding) Health care providers: good access to information; what are they seeing in community Local records: birth and death rates; help keep track of population Focus groups: bring people together to ask questions -Difficulties getting people together: transportation, right time for everyone Older residents: know area history

Rural Health Data Sources?

Outmigration: -leads to nursing shortage, people leaving rural areas Aging Workforce Declining nursing school enrollment Rural facilities: -Lower pay -Longer days-to-fill for positions -Less community activities/resources/schools Innovation- Transition to Practice program, Tuition Reimbursement, Distance Learning (online learning), Multistate Compact License

Rural Healthcare and the Nursing Shortage?

Aging in Place Outmigration of young adults: -They are the people who are having babies -They can work Immigration of older persons from metro areas: -These people lived the urban life and moved to more rural areas -Concerns for older people moving to rural areas would be cost going up, longer wait times everywhere they go like restaurants and doctors office Community stressors: -Adequate health care: Lack of mental health resources -Housing: Access to housing; May not have the funding to afford it -Transportation: Increase risk of wrecks; Limited mode of transportation; May have to call for uber, family to drive them, or may have to walk -Human Services: Ex: Social work, job assistance- typically limited -Tax base (funding): Lack of industry and commerce

Rural health trends- Objective 3?

a.) 50 More than 50% of the nation's poor live in rural areas, while 15% of the nation's elderly live in rural areas.

Rural residents in the United States compose more than _____% of the nation's poor. a.) 50 b.) 35 c.) 20 d.) 18

-Religious organizations -Beauty and Barber shops -Truck Stops -Adult Education/Literacy Centers -Youth Centers -Senior Centers -Homeless Shelters -Mobile Health Units -Libraries -Shopping Malls -Community buildings- VFW, Rotary, YMCA

Settings for Health Education?

b.) Members may benefit from hearing about the smoking cessation experiences of others in the group, and sessions may provide health education. Adults may draw upon their many life experiences and the shared experiences of others. Such activities can be a valuable part of the health education experience. Skilled facilitators enhance the effectiveness of informal group activities, but it is not necessary for each group member to be trained in group dynamics. The other options do not reflect Knowles' assumptions about adult learners.

Smoking cessation programs often are provided to adults who meet in small groups. Educational sessions include both formal and informal activities. Sharing of experiences of the members of the group is sometimes encouraged. Which statement is most reflective of Knowles' assumptions about adult learners? a.) Members of the group may enjoy sharing sessions about the smoking cessation experiences of others, but such sessions are not health education. b.) Members may benefit from hearing about the smoking cessation experiences of others in the group, and sessions may provide health education. c.) Members will likely perceive sharing sessions about smoking cessation experiences as a waste of time and drop out of the group. d.) Members, unless trained in group dynamics, will not be able to fully benefit from sharing sessions about smoking cessation experiences.

Constraints prevent families from achieving optimal health Social: -Literacy -Education -Employment Structural: -Hours of service -Transportation -Availability of interpreters Constraints that effect multiple families should be addressed at the aggregate level

Social and Structural Constraints?

Unique Health Risks: Victimization experiences, including physical and sexual abuse -Higher rate of adjustment disorder than males -Feel as if there is a lack of equal opportunities -Women experience PTSD at more than twice the rate of men -Vulnerable for reasons other than the trauma of war: sexual harassment or assault in the line of duty

VA Guest Speaker: Caring for women veterans?

-Going to need a lot more services than others; would qualify for medicare -Not always physical in nature (Figure 21.2) -15% of population worldwide (over 1 billion people), have some form of a disability -Blacks (22.2%) higher rate of disability than Asians, Hispanics, Non-Hispanic whites -Females of all races have a higher rate (19.4%) -Increased rates w/ age; Roughly ½ of people over 65 years are disabled -> 80 years - 55% w/ severe disability​ & 30% needed personal assistance -8% of children <15 have some disability w/ or w/o emotional or behavioral problems

Summarize the prevalence of various disabilities.​ pg. 414?

b.) in imminent risk of homelessness. Imminent risk of homelessness defines those who will imminently lose their primary nighttime residence. The literally homeless have no fixed, regular, or adequate nighttime residence. Unaccompanied youth and families with children who are defined as homeless under other federal statues but do not fit into the other HUD defined categories of homeless may be defined as homeless under this HUD definition. Finally, individuals and families who are fleeing or attempting to flee intimate partner violence or other life-threatening conditions that relate to violence against the individual or family are defined as homeless.

The Brown family is being evicted from their home and will be moving into a homeless shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition, the Brown family is a.) literally homeless. b.) in imminent risk of homelessness. c.) homeless under other federal statutes. d.) fleeing or attempting to flee intimate partner violence.

d.) providing grants to provide for education and recruitment. The nursing workforce development programs administered by the HRSA through Title VIII provide federal support for nurses' workforce development. The HRSA does not establish nursing schools but provides federal funding for nursing education at the undergraduate and graduate levels and favors institutions that educate nurses for practice in rural and medically underserved communities. The other options do not assist nursing workforce development.

The Health Resources and Services Administration (HRSA) assists nursing workforce development by a.) establishing schools of nursing. b.) supporting organizations with a political agenda for health care. c.) providing federal funds to promote health care reform. d.) providing grants to provide for education and recruitment.

a.) a child abandoned in a hospital. The definition of a homeless child according to the U.S. Department of Education includes children and youth who are: Sharing the housing of other persons because of loss of or inadequate housing? Abandoned in hospitals? Awaiting foster care placement

The U.S. Department of Education defines a homeless child as a.) a child abandoned in a hospital. b.) a child in foster care. c.) a child in a group home. d.) a child living with a grandparent.

a.) Ecological framework The ecological framework is a blend of systems and developmental theory that focuses on the interaction and interdependence of humans (families) as biological and social beings with the environment. Using this framework the community healh nurse would assess the family as a system within the context of their environments. The social network framework involves all the connections and ties within a group. In the transactional model, the term transaction refers to a system that focuses on process as opposed to a linear approach. General systems theory is a way to explain how the family as a unit interacts with larger units outside the family and with smaller units inside the family.

The community health nurse assesses the family as a system within the context of their environments using which approach? a.) Ecological framework b.) Social network framework c.) Transaction model d.) General systems theory

Unique Health Risks: Nuclear Testing Exposure and Nuclear cleanup exposure

VA Guest Speaker: Cold/Atomic War?

b.) The nurse and client must partner in establishing health education priorities for the client Lasting health behavior change depends on learner participation in determining health education needs and priorities. The nurse and patient should partner together to establish health education needs and priorities. The other options do not give the client the opportunity to establish his health education priorities.

The community health nurse is working with a client who has recently been diagnosed with diabetes. The physician has prescribed a diet and recommended adding an exercise regimen. Assessment reveals the client has been smoking two packs of cigarettes per day for approximately 30 years. Which statement most accurately reflects the appropriate approach for establishing health education priorities for this client? a.) The nurse must assist the client to recognize that smoking cessation should be the highest priority. b.) The nurse and client must partner in establishing health education priorities for the client c.) The client does not have his priorities in order and must be informed by the nurse as to the most important priority. d.) The nurse should not discuss smoking cessation because this is not the client's most important health issue.

d.) Developmental theory Developmental theory is based on stages of family development and family life cycles. A basic premise of developmental theory is the understanding that specific life events, such as separation of parents, divorce, and remarriage, can affect the functioning of each family member and the entire family. Options A, B, and C do not focus on family development and life cycles.

The community health nurse understands that events such as divorce, remarriage, or separation of parents have the potential to affect the family and individuals within the family. This demonstrates the nurse's understanding of which family theory? a.) Structure-function family theory b.) Family systems theory c.) Family communication theory d.) Developmental theory

a.) internal structure. Family composition, gender, and rank order are all examples of internal structure. External structure refers to the extended family and larger systems.

The composition of the family is an example of a.) internal structure. b.) external structure. c.) subsystem. d.) large system.

c.) the increase in distribution of technology, providing more education and health services. Rural patients are able to access specialty services such and radiologic or dermatologic examinations through telemedicine, and rural people are increasingly taking advantage of the Internet to access information to make health decisions. Expansion and increased distribution of technology in rural areas has increased access to health care services and health education through distance programs for rural residents. Health care providers remain scarce in rural areas. Rural hospitals and clinics generally have Medicare services. There is still inadequate public transportation from most rural areas to tertiary hospitals.

The greatest promise for improving health outcomes for rural residents is a.) the increase in health care providers migrating to rural areas. b.) the expansion in Medicare services to rural hospitals and clinics. c.) the increase in distribution of technology, providing more education and health services. d.) the expansion of public transportation, allowing rural residents to travel to tertiary care hospitals for specialty services.

B.) State government Rationale: Most public health law falls under state jurisdiction, although federal governmental agencles (such as the Centers for Disease Control and Prevention) may serve in an advisory capacity to state governments.

The immunization legislation makes its way through both branches of the legislature and is signed into law by the executive. As a public health law, this legislation is most likely under the control of the: A.) Federal government B.) State government C.) Local government D.) No government

c.) Americans with Disabilities Act (ADA). The ADA is landmark civil rights legislation that provides a clear and comprehensive mandate against discrimination toward people with disabilities in everyday activities. The IDEA addresses the educational needs of children with disabilities. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work. The Civil Rights Act prohibits discrimination based on race, ethnicity, religion, and sex.

The landmark civil rights legislation that uses the authority of the federal government to guarantee equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications is the a.) Individuals with Disabilities Education Act (IDEA). b.) Ticket to Work and Work Incentives Improvement Act (TWWIIA). c.) Americans with Disabilities Act (ADA). d.) Civil Rights Act.

a.) lack of health insurance. Rural health leaders identified ten priorities for health care in rural America, with access and affordability to care topping the list. Surveys have found rural uninsured people are more likely to have a usual source of care compared with their urban counterparts. An increase in communicable diseases and social isolation of rural dwellers were not listed as a priority health concern identified by rural health leaders.

The number one health concern identified by the majority of rural health care leaders is a.) lack of health insurance. b.) limited access to health care. c.) increase in communicable diseases. d.) social isolation of rural dwellers.

d.) "My primary care copay is $15 a visit and outpatient specialist copays are $50 per visit." VA primary care copays are $15 per visit, and outpatient specialist copays are $50 per visit. VA benefits are not a health insurance plan where the veteran has to "pay into" the system. VA benefits are rewarded in exchange for the veteran's service to the country. The "coverage" received in the form of VA benefits is not transferable to other non-VA providers, except through formal contracts deemed appropriate by the VA and its providers. The VA always bills an individual's private insurance for medical care, supplies, and prescriptions provided for nonservice-connected conditions. Any monies collected from a veteran's private insurance offsets his or her copayments, and furthermore, the veteran is not responsible for any balance the private insurance does not cover.

The nurse is assisting Sargeant Earl in applying for VA benefits. Which statement made by Sargeant Earl indicates he understands VA benefits? a.) "This is a wonderful health insurance program that will cover all of my health care needs." b.) "I can see any provider I wish under the VA health insurance plan." c.) "I still need to carry private insurance to assist with the most expensive treatments." d.) "My primary care copay is $15 a visit and outpatient specialist copays are $50 per visit."

Unique Health Risks: Cold Injury, Disability

VA Guest Speaker: Korean War?

a.) Self-efficacy One component of the Health Belief Model is self-efficacy. Self-efficacy refers to the degree to which the client believes in his or her ability to be successful in taking the necessary actions to accomplish the desired outcome. Other components of the Health Belief Model include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, demographics, and cues to action.

The nurse is meeting with a client who has been referred for assistance with smoking cessation. During their first meeting, the client states he is very doubtful about his ability to stop smoking. In the Health Belief Model, the client's belief that actions can be performed to achieve the desired outcome is referred to by which term? a.) Self-efficacy b.) Perceived susceptibility c.) Perceived benefits d.) Cues to action

D.) Understand that some clients are present oriented, and fit the client in so care can be given Rationale- The option that is focused on meeting the client's need and cultural preferences without being judgmental is the nurse's next action.

The nurse made a follow-up appointment for a client at the clinic, but the client did not come. Two days later the client presented at the clinic explaining that a temporary job had come up and they could not come back until they had finished and been paid for the job. Which action should be taken by the nurse next? A.) Explain that patients are seen by appointment only, and set up another appointment for the client B.) Reinforce the need to plan ahead before arranging another appointment C.) Stress that health is the number one priority, and try to fit the client in sometime the same day D.) Understand that some clients are present oriented, and fit the client in so care can be given

b.) Clara Barton. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. In 1882, she successfully persuaded Congress to ratify the Treaty of Geneva, which allowed the Red Cross to perform humanitarian efforts in times of peace. Lavinia Dock was a writer and political activist. Sojourner Truth was an advocate for abolishing slavery and supporting women's rights. Mary Breckenridge developed nursing in rural Kentucky in the 1920s, establishing the Frontier Nursing Service.

The nurse who was responsible for organizing relief efforts for soldiers during the U.S. Civil War and who was the founder of the American Red Cross was a.) Lavinia Dock. b.) Clara Barton. c.) Sojourner Truth. d.) Mary Breckenridge.

a.) cultural stereotyping. The tendency to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they behave is called cultural stereotyping. Culture-bound syndrome is a condition that is culturally defined. Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture. Ethnocentrism is a person's tendency to view his or her own way of life as the most desirable, acceptable, or best and tendency to act in a superior manner toward individuals from another culture.

The phrase "All Chinese people like rice" is an example of a.) cultural stereotyping. b.) culture-bound syndrome. c.) cultural imposition. d.) ethnocentrism.

a.) Advocate b.) Consultant d.) Collaborator e.) Mediator In general, the physician is considered to be the diagnostician. All of the other roles are appropriate for community health nurses, and all require knowledge and skills related to health education.

There are many ways the community health nurse can be engaged in health education in the community. Which are frequent roles or activities that the nurse can be expected to fulfill? (Select all that apply.) a.) Advocate b.) Consultant c.) Diagnostician d.) Collaborator e.) Mediator

-Never assume always ask -The minority is becoming the majority --More health disparities with minority --Why- minorities are traditionally more lower socioeconomic class, less resources, less trust as the healthcare system as a whole (use them for research), -Cultural universal- something that happens in most cultures --Ex: weddings -Cultural specific- something a certain culture does --Wedding, bind hands together -Ask what their preferences are, accommodate on what we can and if not negotiate and talk to them, preserve and maintain their culture, respect them, know slide #7!!! -Cultural aspect- understand their orientation- recognize what is important to the people you are working with --Ex: present oriented- they can come in when they are available --Ex: future oriented focused on their future and not now -Family is what they say it is -Look at min 35 on voice memo and write down those numbers -federal one $13,590 if they make less than that they fall below the poverty line. $4,720 is one individual -Ways to improve community practice- communicate with them to see what they think the issue is, find organization to improve minority health, -Communicate cross culturally- look into the different cultures, don't make any generalizations or stereotypes, learn their language, gain trust, interpreter

Things she said in SI about Chapter 13: Cultural Diversity and Community Health?

Peacekeeping: Refers to those periods between wars or military actions Peacekeeping Missions: Refers to special assignments whose mission is to keep peace or stability Unique Health Risks: Exposures, Traumatic Experiences, Peacekeeping deployment

VA Guest Speaker: Peacekeeping Missions?

-They might not all be visible disabilities visible vs invisible -American with disability act 1990 give people more rights- we wanted them to have access to everything --Some people are predisposed for disabilities -Public assistance SSI and SSDI government programs to help people with disabilities -Disabilities can be temporary not always permanent --Ex: of temporary disability would be like broken leg or broken arm -Nursing intervention slide important! We need to do appropriate health screenings, monitor for proper weight, special transportation? -Tailoring the needs to the patient. Don't assume someone can or can not do something -Safety plans in place for people with impairments

Things she said in SI about Chapter 21: Populations Affected by Disabilities?

-Each war comes with its own medical issues -WW1- trauma, boots on the ground, hand to hand combat, radiation came from pacific hiroshima bomb, -WW2: Look at scotts powerpoint for health concerns to each war -Korean war- cold injuries, lose fingers and toes -Vietnam - agent orange (round up), weather exposure hot, ---Agent orange exposure- cancer , lung problems, diabetes, fetal development issues, -Middle east- TBI, burn pits, burning oil fields, --TBI- neuro deficients, PTSD --Burn pits- years later may get skin rashes, nausea, vomiting, headaches -Purpose of the VA- veterans can have access to medical care -Service connected disability- a disease or injury that was incurred or aggravated as a result of during active duty????!!!! -Veterans health administration know this!!! -Know veteran healthy risk- military sexual truama!!!! -Veteran suicide- highest in males, firearms use, they account for 18% of all deaths by suicide -Ask if they served in the military not if they are a veteran

Things she said in SI about Chapter 22: Veterans Health?

-They have very limited resources -So we can give them things to get them stay healthy or clean they don't have resources to keep up with it -Difficult to find, not very welcoming, difficult to count them -More likely to commit crime which gives them a record which makes it harder for them to get help -Contribution to homelessness- inadequate and scarce support services, no affordable housing, insufficient funds to meet basic needs -Chronic homeless- high risk for death if homeless 6 or months -Prevention of homelessness is biggest thing -HUD

Things she said in SI about Chapter 23: Homeless Populations?

-Keep in mind literacy levels 4-6th grade -Need to figure out what the community needs as a whole, by scheduling meetings, contacting them, pamphlet, social media -Do they have access to social media? Do they all speak english? -People wanna see themselves so let the community group review it. -Empowerment- the community needs to want to be involved to make decisions -How do we enhance communication- teach back, ask questions, develop trust -Adult learners- like less structure, group learning -Children like structure when learning -They need to want to learn: if there is nothing in it for them

Things she said in SI about Chapter 8: Health Education?

False 4th-6th grade

True or False? Educational materially should be written at or below an 8th grade reading level.

b.) cohabitation. Cohabitation is defined as a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage. A nuclear family is composed of a husband, wife, and their immediate children. Internal and external structure of a family refer to the family and their relationships within the immediate family and the extended family.

Two unrelated heterosexual adults that share a housing unit with their three children is an example of a.) nuclear family. b.) cohabitation. c.) internal structure. d.) external structure.

-Learner in active role -Knowledge from the group more powerful than info from educator -Looks are social and political aspects of health problems -Problem solving education- allows active participants and ongoing dialogue and encourages learners to be critical of and reflective about health issues -Involves not only education but also activism on the part of the educator -Solicit feedback from focus groups

Understand Freire's approach to health education?

Attack community-based problems at their roots Emphasize the "doing" aspects of health -Help people continue doing things they value Maximize the use of informal networks -Go to a diner and buy a table of coffee so you can sit down with them and talk to them. Get the word out

Upstream Interventions- Objective 6 for Rural Health?

Unique Health Risks: Infectious disease, Cold/heat injuries, High altitude illness, Environmental hazards, Blast injuries, Vision loss, Connective tissue injuries, Lower back injuries, TBI/Spinal cord, PTSD, High divorce rate, Substance abuse

VA Guest Speaker: Afghanistan and Iraq?

-Multiple deployments -Adjustment disorder -Reintegration back into society -High suicide rates (attempts included) -Military sexual trauma

VA Guest Speaker: Caring for our newest veterans?

-10th leading cause of death in the US -Females attempt suicide at a rate three times more likely than males -Males are four times more likely to succeed at suicide -17.6 veterans die by suicide every day

VA Guest Speaker: Caring for suicidal ideations population?

-Modern body armor has increased the survival rate among troops who experience an explosive ordnance in combat, and medical advances further increase the likelihood that a soldier will survive the loss of a limb. -The majority of the 11,879 amputation surgeries performed in 2016, however, were not combat related. Rather, the main etiology was diabetes and peripheral vascular disease, with a 78% incidence of diabetes in veterans undergoing surgery in 2016. -Besides the obvious physical impairment affecting activities of daily living (ADLs), body image issues from limb amputations or disfigurement may create multiple social and employment barriers

Veteran Health Risks: Amputation​?

Physical stress, heavy loads, long hours, inability to show weakness etc. -Often comorbid w/ PTSD or TBI. -PTSD associated muscle tension can exacerbate

Veteran Health Risks: Chronic pain​?

-Though most veterans successfully transition into civilian life, there are many who struggle, eventually becoming homeless. -Most homeless veterans live in urban areas and have mental health and/or substance abuse disorders. Veterans become homeless due to a number of factors. In addition to the complex set of factors influencing all homelessness—a shortage of affordable housing, lack of a livable income, and access to health care—a large number of displaced and at-risk veterans live with lingering effects of PTSD and substance abuse, which are compounded by a lack of family and social support networks. -Additionally, military occupations and training are not always transferable to the civilian workforce, placing some veterans at a disadvantage when competing for employment. -Homelessness and criminal justice system involvement can be a vicious cycle, with the impact of one problem increasing the risk of the other. Many behaviors associated with homelessness such as trespassing, loitering, and petty theft are criminalized. Incarceration, in turn, often leads to barriers to obtaining housing and reintegrating into society.

Veteran Health Risks: Homelessness?

-Physical assault of a sexual nature​ -Battery of a sexual nature​ -Sexual harassment that occurred while the veteran was serving on active duty Risk Factors and Characteristics of Veterans Experiencing MST: • Female • Younger (18-29 years of age) • Racial ethnic minority • Unemployed • Single/divorced • Enlisted • Navy veteran

Veteran Health Risks: Military sexual trauma (MST)​?

-Many veterans have been exposed to various levels and types of noise. This can include sound from gunfire, machinery, explosives, rockets, and heavy weapons. Others have been exposed to loud engines from tanks, large machinery, and aircraft. -This exposure can lead to hearing loss and tinnitus.

Veteran Health Risks: Noise​?

-A veteran's particular service branch, time period of service, and activities in which the individual was engaged may have contributed to exposure to a number of other potentially harmful toxins or substances. -These include exposure to asbestos, lead, industrial solvents, and other harmful chemicals. Symptoms and subsequent problems or complications might develop years later and be very hard to determine.

Veteran Health Risks: Occupational hazard exposures?

2 or more injuries sustained in same incident, affects multiple body parts & results in various kinds of impairment

Veteran Health Risks: Polytrauma​?

-Anxiety attacks, hallucinations, nightmares, irritability, sleeplessness, and cardiovascular and gastrointestinal disorders. -Sx usually begin within 3 months of incident and all must be experienced for @ least a month (reimagining, avoiding, 2 reactivity sx, 2 cognition/mood sx)

Veteran Health Risks: Posttraumatic stress disorder (PTSD)​?

-Some veterans are particularly at risk from diseases caused by ionizing radiation exposure. This exposure was of particular concern among those who participated in nuclear weapons testing or who served near Hiroshima and Nagasaki after the bombings—later known as atomic veterans. -Complications of prolonged or intense exposure to even low levels of radiation can lead to many types of cancer. It is also associated with other diseases such as thyroid and parathyroid disease, cataracts, and nervous system disorders.

Veteran Health Risks: Radiation​?

Pattern of use that results in marked distress and/or impairment -More than 2 out of 10 veterans w/ PTSD have SUD

Veteran Health Risks: Substance use disorder​?

-Highest in males 18-29 and males >75 -An average of 20 veterans die by suicide EACH DAY (decreasing) -Veterans account for 18% of ALL deaths by suicide -Approximately 65% of all veteran suicides were those age 50 and older -Approximately 67% involved a firearm -Those who experience MST 2-4x more likely to report suicidal thoughts/behaviors

Veteran Health Risks: Suicide?

Disruption of brain function caused by external mechanical force, blunt force etc. -HA, Tinnitus, sleep disorders, irritability, memory problems, mood/anxiety disorders, chronic pain, suicidality, dizziness/balance issues

Veteran Health Risks: Traumatic brain injury (TBI)​?

d.) PTSD Although problems with alcohol or other drugs affect veterans at about the same rates as the general population, there is a strong relationship between SUD and PTSD: more than 2 of 10 veterans with PTSD also have SUD.

Veterans with a substance use disorder (SUD) are most likely to suffer from a.) TBI b.) MST c.) VHA d.) PTSD

Chronically homeless—high risk for death if homeless 6 or more months or with one or more of:​ (Decide who is at risk for death so these would be the people that would get help first) -More than three hospitalizations or ED visits in a year​ -More than three ED visits in the previous 3 months​ -60 years of age or older​ -Cirrhosis of the liver​ -End-stage renal disease​ -History of frostbite, immersion foot, or hypothermia​ -HIV/AIDS​ -Co-occurring psychiatric, SUD, and chronic medical conditions. Healthcare: Federally Qualified Health Centers (FQHC) and FQHC Look-A-Likes & Health Care for the Homeless

Vulnerability index for Homelessness?

-Pay -Safety: --Personal Protective Equipment --Penalties for assaulting healthcare workers --Safe Working Environment -Client Access to Care -Cost of Care- you and your clients -Nurses should be part of the process not the problem!

WIIFM- Why do nurses need to know about policy and politics?

-We are all apart of a family -We care for individuals that are a part of a family -We live in a community filled with families

WIIFM- Why is understanding "Family" important?

-Members interact with one another -Establish priorities -Healthy families affirm, support, and respect each other -Shared responsibility for family function -Teaches family and societal values and beliefs and shares a spiritual core -Help others within the family and outside the family -Sense of play and humor and share leisure time. -Cope with stress and crisis and grow as a result of positive coping

What do Healthy Families do?

c.) Young women Young homeless women may become involved in survival sex because they need money to meet subsistence needs, hence the term survival sex.

What group of homeless individuals is known for their involvement in survival sex? a.) Young adult gay men b.) Middle-aged women c.) Young women d.) Elderly men

Can withhold payments from agencies that don't give quality care. -CMS is the federal agency that administers the Medicare and Medicaid programs -Example: patient gets hospital acquired infection insurance won't pay

What is Centers for Medicare and Medicaid Services (CMS) 2001?

Community members take on the power to enact change -Consider cultural strengths

What is Community empowerment?

Context: what is the place like? -Characteristics of place- geography, political, social and economic institutions --Hills impact people with geography --Political- may not have the structure or industry -Access to Care: more physicians in urban areas vs rural areas --Makes it difficult for people in rural area because they might not have transportation to these urban areas for health care -Health Insurance: Rural area might not have insurance Composition: what is the place made up of? —what kind of people? -Characteristics of groups of people- age, education, income (lower income in rural area), ethnicity and health behaviors (suicide rates higher) -Income and Poverty -Health Risk, Injury and Death: --Higher risk for injury and death due to the jobs they do (Factories) --Farmers at a higher risk for skin cancer --Lot of rural people commute for work which increases their chance of vehicle crashes --Response time in rural area is slower, smaller hospitals -Ethnicity: --Might not have access to resources or be treated as outsiders -Gender: --Life expectancy is higher in rural areas -Education and Employment -Occupational Health Risks -Vulnerable Groups- Young and Old: --Lack of resources for these groups Understand both to apply the nursing process- assessment, planning, intervene and evaluate public health issues

What is Context and Composition in regards to Rural Health?

Interaction and interdependence of families as biological and social beings within an environment -Using this framework the CHN would assess the family as a system within the context of its environment. Microsystem- immediate environment Exosystem- may affect individual indirectly Mesosystem- links between microsystems and exosystems Macrosystem- indirect influence -Media, exposure to war Chronosystem- what happens over time For example: -Investigated parent-health care provider discussions of family and community health risks during well-child examinations. Additionally, they studied the gaps between the issues discussed by the practitioner and the information the parent desired. On the basis of the results of the National Survey of Early Childhood Health, health topics for discussion were identified, including family financial difficulties, the presence of a support partner, parent's emotional support, alcohol and/or drug use in the home, cigarette smoking in the home, the parent's physical health, and community violence. Cigarette smoking was discussed nearly 80% of the time, and alcohol and drug use was discussed 45% of the time; however, community violence was discussed less than 10% of the time, and financial needs 12%. The results indicate the need for better communication and education between health care providers and clients.

What is Ecological framework?

Protect privacy, improves portability of insurance and restrictions on covering pre existing conditions -Very difficult for people to get their bills paid -Restricted health insurance coverages on max per year??

What is HIPAA 1996?

Choose your theory based on setting/population -Stimulus-Response Conditioning- stimulus leads to response -Humanistic- help people help themselves, use self-directing behavior -Cognitive- people think, feel, learn and solve problems -Social Learning- Behavior explains and enhances learning though efficacy, outcome expectation and incentives

What is Learning Theory?

-Influence health care --Monitoring, production, provision, and financing of health care services. -Influence corporations, employers, insurers, nursing schools, hospitals. Long term care and clinics. Private sector versus public sector: -Private: business management, economics --Based on economic and market trends --Example: private insurance anything not government -Public: social justice, reactive, shift with political changes --Funded by taxpayer dollars --There are not many public sector hospitals anymore --Focus on social justice, greatest number of people get the things they need --Reactive not proactive; slow to respond because have a lot of hoops to jump through regarding the federal government --Example: public health dept, VA: anything funded by federal government

What is Public health policy?

Income, wealth, occupation, education level -Way to measure inequalities -Poverty- extent to which someone does without resources -$13,590 for one person and an additional $4,720 for every other person

What is Socioeconomic Status (SES)?

With the structural-functional conceptual framework approach, the family is viewed according to its structure, or the parts of the system, and according to its functions, or how the family fulfills its roles. Internal Structure: -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 (e.g., spouse, parental, and interest) through which the family carries out its functions -Boundary, 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- work, health, and welfare Context: refers to the background or situation relevant to an event or personality in which the family system is nested -Ethnicity -Race -Social class -Religion -Environment Instrumental Functioning: refers to routine activities of daily living (e.g., elimination, sleeping, eating, giving insulin injections) (Box 20.1). This area takes on important meaning for the family when one member of the family becomes ill or disabled, is unable to carry out daily functions, and must rely on other members of the family for assistance. For example, an older adult may need assistance getting into the bathtub, or a child may need to have medications measured and administered. Examples: -Activities of Daily Living -Do family members require assistance? Expressive Functioning: -Emotional communication -Verbal communication -Nonverbal communication -Circular communication -Problem Solving -Roles -Influence -Beliefs -Alliances and coalitions

What is Structural-Functional Conceptual Framework?

Allows veterans to see advanced practice nurses -Increases access to care because more people to see veterans

What is VA healthcare system 2016?

Divides into Dept of Health and Human Services and Department of Education

What is the Department of Health, Education, and Welfare (HEW) 1980?

Nurses use the family life cycle to determine family strengths and weaknesses Family Life Cycle: 1.) Leaving home 2.) Beginning family through marriage or commitment as a couple relationship 3.) Parenting the first child 4.) Living with adolescent(s) 5.) Launching family (youngest child leaves home) 6.) Middle-aged family (remaining marital dyad to retirement) 7.) Aging family (from retirement to death of both spouses) -To assess the family, the CHN must comprehend these phases and the struggles that families experience while going through them. -Wright and Leahey called attention to the need to distinguish between "family development" and "family life cycle." They stated that the former is the individual, unique path that a family goes through, whereas the latter is the typical path many families go through.

What is the Developmental Theory?

Expressive Functioning: -Emotional communication: Is the family able to express a range of emotions, including happiness, sadness, and anger? -Verbal communication: focuses on the meaning of words. Do messages have clear meanings rather than distorted meanings? Wright and Leahey gave the example of masked criticism when a father states to his child, "Children who cry when they get needles are babies." -Nonverbal communication: which includes sounds, gestures, eye contact, touch, or inaction. An example is a husband remaining silent and staring out the window while his wife is talking to him. -Circular communication: is commonly observed between dyads in families. A common example is the blaming, nagging wife and the guilty, withdrawn husband. -Problem Solving: refers to how the family solves problems. Who identifies problems? Someone inside or outside the family? What kinds of problems are solved? What patterns are used to solve and evaluate tried solutions? -Roles: refers to established patterns of behavior for family members. Roles may be developed, delegated, negotiated, and renegotiated within the family. It takes other family members to keep a person in a particular role. Formal roles, with which the larger community agrees, may come into conflict with roles set by family members and influenced by religious, cultural, and other belief systems. -Influence: refers to methods used to affect the behavior of another. Instrumental influence is the use of reinforcement via objects or privileges (e.g., money or use of technology tools). Psychological influence is the influence of behavior through the use of communication or feelings. Corporeal control is the use of body contact (e.g., hugging and spanking). -Beliefs: refer to assumptions, ideas, and opinions that are held by family members and the family as a whole. Beliefs shape the way families react to chronic or life-threatening illness. For example, if a family of a person with colon cancer believes in alternative treatments, then acupuncture may be a viable option. -Alliances and coalitions: are important within the family. What dyads or triads appear to occur repeatedly in the family? Who starts arguments between dyads? Who stops arguments or fighting between dyads? Is there evidence of mother and father against child? When does this change to parent and child against the other parent? The balance and intensity of relationships between subsystems within the family are important. Questions may be asked regarding the permeability of the boundary. Does it cross generations?

What is the Expressive Functioning portion of the Structural-Functional Conceptual Framework?

I. Launching: single young adult leaves home -A.) Coming to terms with the family of origin -B.) Development of intimate relationships with peers -C.) Establishment of self: career and finances II. Marriage: joining of families -A.) Formation of identity as a couple -B.) Inclusion of spouse in realignment of relationships with extended families -C.) Parenthood: making decisions III. Families with young children -A.) Integration of children into family unit -B.) Adjustment of tasks: child rearing, financial, and household -C.) Accommodation of new parenting and grandparenting roles IV. Families with adolescents -A.) Development of increasing autonomy for adolescents -B.) Midlife reexamination of marital and career issues -C.) Initial shift toward concern for the older generation V. Families as launching centers -A.) Establishment of independent identities for parents and grown children -B.) Renegotiation of marital relationship -C.) Readjustment of relationships to include in-laws and grandchildren -D.) Dealing with disabilities and death of older generation VI. Aging families -A.) Maintenance of couple and individual functioning while adapting to the aging process -B.) Support role of middle generation -C.) Support and autonomy of older generation -D.) Preparation for own death and dealing with the loss of spouse and/or siblings and other peers

What is the Family Life Cycle: Stages and Tasks of Middle-Class North American Family Life Cycle?

-Increased income to FDA -Reauthorized user fees for FDA -Pharmacies or any private sectors had to get approval from FDA and had to pay a fee to get the approval

What is the Food and Drug Administration Safety and Innovation Act-2012?

a.) lineal relationship. Lineal relationships involve a client seeking assistance from another family member and allowing a relative to make important decisions related to health matters. A collateral relationship's focus is primarily on group goals, and family orientation is important. A cultural relationship is characterized by tolerance and respect. Individual relationships refer to personal autonomy and independence. Individual goals dominate, and group goals become secondary.

When making health-related decisions, clients from different cultural backgrounds depend on relationships. One type of relationship involves the client seeking assistance from other members of the family and allowing a relative to make decisions about important health-related issues. This relationship is a(n) a.) lineal relationship. b.) collateral relationship. c.) cultural relationship. d.) individual relationship.

Explains family Interaction between units (systems) Suprasystem- external influence -The larger system of which the family is a part, such as the larger environment or the community (e.g., churches, schools, clubs, businesses, neighborhood organizations, and gangs). System- Family -"A goal-directed unit made up of interdependent, interacting parts which endure over a period of time". A family system is not concrete. It is made up of suprasystems and subsystems and must be viewed in a hierarchy of systems. The system under study at any given time is called the focal, or target, system. In this chapter, the family system is the focal system. Subsystems: Smaller unit within the family, such as the relationship between spouses, parent and child, sibling and sibling, or extended family. Examples: parent-child subsystem marital subsystem sibling-sibling subsystem. -General systems theory is a way to explain how the family as a unit interacts with larger units outside the family and with smaller units inside the family. -The family may be affected by any disrupting force acting on a system outside the family (i.e., suprasystem) or on a system within the family (i.e., subsystem). -Adding that systems theory provides direction for understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.

What is the General systems theory?

In response to critical nursing shortage. -Funds for increased enrollments at nursing schools

What is the Nursing Investment Act 2003?

Was a very comprehensive attempt to improve access to care by providing health insurance to most of the nation's uninsured -Improved access to care for all citizens in our country (since we don't have universal healthcare) -Lower premiums -Changed thresholds for people to be eligible for medicaid

What is the Patient Protection and Affordable Care Act (ACA)- 2010?

Family members may seek social support outside of the family Social support is feeling connected through relationships Social network is connected groups Helps explain health-related issues such as obesity and sexually transmitted infections (STIs) Social media is a form of social networking -Reason that social media is so heavily used to communicate medical information

What is the Social Network framework?

Creates Medicaid (State and based on income) and Medicare (Federal)

What is the Social Security Act 1965?

-Family processes and how they influence development -Depiction of ecological/transactional model -Understanding beliefs and values of family as an institution and other institutions is important to take social action -The family as an institution, along with other institutions (e.g., religious, educational, recreational, or governmental), is culturally anchored (i.e., each holds a distinct set of beliefs and values about the nature of the world and human existence). An awareness of culture (e.g., beliefs and values) as it is expressed in each system is important (i.e., as it is expressed in mainstream U.S. values versus the value patterns of the family). Example: -Used a transactional model to explore the relationship between parental marital distress and adolescent emotional adjustment. In a 6-year prospective study of 531 parent-adolescent dyads, they found such a relationship, especially for late adolescent and young adult girls and less so for males. The findings suggest that "girls' greater sensitivity to interpersonal problems may be reciprocal and that the parental marriage is still associated with adjustment for girls in late adolescence and early adulthood".

What is the Transactional Model?

b.) Cultural negotiation Cultural negotiation refers to the process in which messages, instructions, and belief systems are manipulated, linked, or processed between the professional and lay models of health problems and preferred treatment. In each act, the nurse gives attention to eliciting the client's views regarding a health-related experience (e.g., pregnancy, complications of pregnancy, or illness of an infant). Cultural diversity is a multifaceted and complex concept that refers to the differences among people, especially those related to values, attitudes, beliefs, norms, behaviors, customs, and ways of living. Cultural competence is respecting and understanding the values and beliefs of a certain cultural group so that one can function effectively in caring for members of that cultural group. Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture.

What is the process used when conceptual differences, which impact the provision of health care, exist between the client and the nurse? a.) Cultural diversity b.) Cultural negotiation c.) Cultural competence d.) Cultural imposition

b.) Obtains national data on homeless individuals The intent of the HIMS is to obtain national data, including the number of and demographic information on the homeless population. Providing means to feed homeless people, serving as a screening tool to obtain any history of criminal activity, and providing homeless individuals with educational materials are not functions of the HIMS.

What is the purpose of the Homeless Information Management System (HIMS)? a.) Provides means to feed homeless people b.) Obtains national data on homeless individuals c.) Serves as a screening tool to obtain any history of criminal activity d.) Provides homeless individuals with educational materials

d.) Department of Housing and Urban Development (HUD) HUD, in cooperation with state and local governments and nonprofit housing organizations, operates programs that provide financial housing assistance to low-income families. The WHO is an organization that is concerned with international public health. FEANTSA is a European organization that works to prevent and alleviate poverty and homelessness in Europe. The Robert Wood Johnson Foundation provides funding for nursing education.

What official national organization provides financial housing assistance to low-income families? a.) World Health Organization (WHO) b.) Federation of National Organizations Working with the Homeless (FEANTSA) c.) Robert Wood Johnson Foundation d.) Department of Housing and Urban Development (HUD)

-Family is what they say it is -Informed consent: next of kin -Strategies we use to move from individual to family level- home visits so you can see more of how they live and how they work together -Genogram- shows us how people are connected and structure -Family health tree is based off genogram- lays out cause of death -Ecomap- map of our family unit and things that surrounds us and how were linked or not linked -If something is affecting multiple families figure out what's going on- we need to address it

What she talked about during SI for Chapter 20- Family Health?

C. Below $27,750 $13,590 for individual and $4,720 for everyone else

What was the poverty guideline for a family of four in the United States in 2022? A. Below $13,590 B. Below $18,310 C. Below $27,750 D. Below $37,190

c.) The Hill-Burton Act The Hill-Burton Act of 1946 provided grants to states for the construction of new hospitals, targeting low income and rural areas. The McCarren-Ferguson Act gave states the right to regulate health insurance plans. The Health Amendments Act authorizes funds for registered nurse education in administration, supervision, or teaching. The Tax Equity and Fiscal Responsibility Act established the prospective payment system for Medicare.

Which act, established in the 1940s, provided grants to states for the purpose of new construction of health care institutions? a.) The McCarren-Ferguson Act b.) The Health Amendments Act c.) The Hill-Burton Act d.) The Tax Equity and Fiscal Responsibility Act

a.) Asking a wheelchair-dependent person if he or she needs help and how you can assist. c.) Sitting or kneeling at eye level whenever possible when talking with someone who is wheelchair dependent. d.) Speaking distinctly and a little slowly to someone who is hearing impaired. When working with a blind person, unless the person is quite familiar with everyone present, it is helpful to identify the people present and who is talking during a conversation. Service dogs should not be interrupted when they are working. The other choices are all appropriate ways of interacting with people with disabilities.

Which are appropriate when working with people with disabilities? (Select all that apply.) a.) Asking a wheelchair-dependent person if he or she needs help and how you can assist. b.) Assuming that a person who is blind knows who is speaking or who is present; otherwise, you might embarrass the individual. c.) Sitting or kneeling at eye level whenever possible when talking with someone who is wheelchair dependent. d.) Speaking distinctly and a little slowly to someone who is hearing impaired. e.) Petting a service dog and complimenting him on what a good boy he is.

a.) Communication is appropriate and clear. b.) Support and respect are evident and appreciated. d.) Common beliefs and values are shared. e.) Members play and share leisure time appropriately. Healthy or energized families communicate, support, teach values, share a religious core, have flexible roles and power, engage in family decision making, foster responsibility and service to family and community, have a sense of humor and play, and grow from problem solving.

Which characteristics are demonstrated by healthy or energized families? (Select all that apply.) a.) Communication is appropriate and clear. b.) Support and respect are evident and appreciated. c.) Roles are static and change only in times of crisis. d.) Common beliefs and values are shared. e.) Members play and share leisure time appropriately.

a.) Serving in active duty for 24 consecutive months d.) Being separated under any condition other than dishonorable Veterans are eligible for VA benefits when they fulfill two requirements related to service and separation. 1) Service: they must have served in active duty for 24 consecutive months or for a full period of call (Reserves and Guard) and 2) Separation: they must have been separated under any condition other than dishonorable.

Which criteria is required in order for veterans to receive U.S. Department of Veterans Affairs(VA)benefits? (Select all that apply.) a.) Serving in active duty for 24 consecutive months b.) Serving for a half period of call in the Reserves c.) Committing to the Guard for 12 months d.) Being separated under any condition other than dishonorable e.) Being deployed overseas for 6 months

d.) Two or more persons living together who share common interests Current families are diverse in composition and relationships and vary in reasons for living together. Formerly, families were defined by how closely they resembled the "nuclear family" of parents and children, but this is no longer the case. "Family" means any person or persons who play a significant role in an individual's life.

Which description does not reflect a current definition of family? a.) A social unit interacting with the larger society b.) Individuals living together related by kinship, marriage, or choice c.) Mother, father, and children interacting with extended family d.) Two or more persons living together who share common interests

c.) Freire The concept of empowerment can be traced back to Paulo Freire, a Brazilian educator in the 1950s. He promoted a problem-solving approach to education. Freire's approach supported activism on the part of the educator.

Which educator is credited with developing the concept of empowerment and included activism on the part of the educator as a teaching methodology? a.) Bandura b.) Pender c.) Freire d.) Burris

c.) A bill must succeed through the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. The bill must succeed through both legislative bodies, the House of Representatives and the Senate. The Supreme Court is not involved in creating legislation. A bill goes before a committee before going to either legislative body.

Which is the correct process a bill must take before final approval by the president? a.) A bill must succeed through one of the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. b.) A bill must go through discussion by the Supreme Court and then be submitted for final approval by the president. c.) A bill must succeed through the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. d.) A bill must be approved by the House and Senate and then go before a committee before being submitted for final approval by the president.

A.) Develop Trust

Which is the highest priority for a community health nurse when educating a new client group? A.) Develop Trust B.) Provide Content C.) Distribute pamphlets D.) Answer Questions

a.) Social justice The social justice model seeks to reduce the structural conditions contributing to homelessness through collective action, thus supporting upstream thinking.

Which model supports upstream thinking with the purpose to improve homelessness through reduction of structural conditions contributing to homelessness? a.) Social justice b.) Market justice c.) Physical justice d.)Mental justice

a.) The poverty rate from 2010 to 2015 did not differ statistically. The poverty rate increased did not change statistically from 2010 to 2015. The median income in 2015 was $53,889. The economy and related issues are the most common reasons for unemployment. Working at minimum wage places a person below the poverty line.

Which of these statements is true regarding income insufficiency in the United States? a.) The poverty rate from 2010 to 2015 did not differ statistically. b.) People who make minimum wage would not be categorized as impoverished. c.) Alcoholism is the major reason for lack of employment. d.) The median household income in 2015 was around $40,000.

B.) The commonalities of values, norms, and life patterns that are held in all cultures Rationale- A culture Universal is something held in most cultures. It is commonalities in all cultures

Which statement best defines Leininger's term "culture universal"? A.) The preference to be cared far by someone from their own cultural group for maximum ease and comfort B.) The commonalities of values, norms, and life patterns that are held in all cultures C.) The particular values, beliefs, and patterning of behavior that Is universal within a particular culture D.) The health care roles, norms, and behaviors that are involved when illness or injury occurs

a.) Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy, with agriculture-related employment representing 5% of the gross domestic product (GDP) and farms representing 1% of the GDP. Changes in rural demographics include a shift in the economic base from agriculture to industry, as well as more diversity as the number of rural Hispanics increases. Additionally, there has been a rise in negative health outcomes for rural residents; obesity, smoking, and drug use are more prevalent in rural America than in urban America.

Which statement best describes the demographics of rural America? a.) Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy. b.) There has been a shift in the economic base of rural America as more communities are dependent on income generated from mining and construction. c.) There has been a decline in diversity in rural America, with more Hispanics and youth moving to urban areas rather than rural communities and small towns. d.) There are more positive health behaviors (e.g., less smoking, obesity, and drug use) among residents of rural America when compared with urban America.

C.) It is difficult for nurses to agree on what changes are needed Rationale: Multiple nursing professional organizations make it difficult to have a collective voice to enact change. Nursing is a respected profession. Nurses are percelved as leaders in health care. Nurse can collaborate as needed.

Which statement best describes why nurses are not more effective in creating political change? A.) Nursing as a profession is not respected by politicians B.) Nurses are not perceived as leaders in health care C.) It is difficult for nurses to agree on what changes are needed D.) Creating change is hard since nurses do not know how to collaborate

a.) It focuses on the interaction between features of a person's body and features of the society in which the person lives. Because disability is conceptualized as the inability to perform important life functions, it becomes a product of interaction between health status and the demands of one's physical and social environment. The other options are characteristics of the medical model.

Which statement describes the social construct paradigm for disability (as opposed to the medical model)? a.) It focuses on the interaction between features of a person's body and features of the society in which the person lives. b.) It discourages full citizenship for people with disabilities. c.) Health professionals prescribe interventions to remedy functional limitations of the ill person. d.) It focuses on problems and solutions related to the individual.

c.) It ensures a free public education from preschool through secondary education for children with disabilities. This is the only true statement regarding IDEA. IDEA ensures free appropriate public education in the least restrictive setting. The IEP is developed by parents, student, and professionals. The other option concerns the TWWIIA.

Which statement is true concerning the Individuals with Disabilities Education Act (IDEA)? a.) It is designed to ensure a free, appropriate public education in the most restrictive setting. b.) An IEP (Individualized Education Program) for a child is developed solely by the school professionals. c.) It ensures a free public education from preschool through secondary education for children with disabilities. d.) It removes guidelines that typically result in the termination of Medicaid and Medicare benefits for people with disabilities who return to work.

c.) MST is associated with diabetes. A number of health conditions are more prevalent among women with a history of sexual trauma, including sexually transmitted infections, diabetes, obesity, arthritis, irritable bowel syndrome, hypertension, and eating disorders. MST is reported by 32.4% of female vetrans and only 4.6% of male veterans. It is estimated that in one of seven women who report MST, the trauma was perpetrated by an intimate partner. Among veterans seeking treatment for PTSD, sexual trauma has been associated with more severe PTSD than any other type of trauma, including combat trauma.

Which statement regarding military sexual trauma (MST) is true? a.) MST is more common among male veterans. b.) MST is always perpetrated by a stranger. c.) MST is associated with diabetes. d.) MST is associated with mild PTSD.

c.) The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement. The evolution of managed care into rural environments has limited the safety-net role of some local health departments to provide primary care by preventing fee-for-service reimbursement and contracting care to networks of providers or organizations. This is especially true for Medicaid managed care, which serves that same population of people that are traditionally served with primary care services through local public health departments. Medicaid's importance for rural areas is likely to grow as broader health care developments, such as declining inpatient use of rural hospitals and reductions in Medicare reimbursement, provoke more interest in using the Medicaid system to support threatened rural infrastructure. Consequently, the administration of the Medicaid program will increasingly seek the cost savings promised by managed care, and the role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement.

Which statement regarding the impact of managed care on rural public health departments is true? a.) Managed care has expanded the safety-net role of many local health departments by funding primary care services. b.) Medicaid's importance for rural areas is likely to decrease. c.) The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement. d.) Medicaid programs will continue to serve the rural communities on a fee-for-service basis.

d.) A cardiovascular accident (CVA) with paralysis to the right side of the body Those with a temporary disability have a very different experience from those who are permanently disabled. Although they may experience the frustrations of the disability, they do not fully enter the world of people with disabilities because they know they will soon reenter society as able bodied. In contrast, those who develop a permanent disability (e.g., as in a CVA) must learn to incorporate the modifications required for living into their daily living and identity.

Which would be considered a long-term disabling condition in which the person must learn to incorporate the modifications required for living into daily living and identity? a.) A sprained ankle requiring the use of crutches b.) A total knee replacement surgery requiring the use of a walker after surgery c.) A car accident with a broken arm requiring surgery d.) A cardiovascular accident (CVA) with paralysis to the right side of the body

c.) "Is it OK if I speak in English?" Determining the meaning of health, health practices, and habits and usual health practices of the client will help the nurse provide culturally sensitive care that will be accepted by the client. "Is it OK if I speak in English?" does not address health.

While caring for a client from a different culture, the community health nurse must assess the client's health-related beliefs. All of the following questions would be appropriate and would elicit the desired information except a.) "Are there certain foods you eat when you are sick?" b.) "When do you know you are sick enough to visit a health care provider?" c.) "Is it OK if I speak in English?" d.) "What does health mean to you?"

a.) The client is quiet and compliant, asking few questions. c.) The client may avert his or her eyes during the conversation. e.) The client may provide the nurse with the answers he or she thinks the nurse wants to hear. Asian and Native American clients are likely to appear quiet and compliant. Asian, Native American, Indochinese, Arab, and Appalachian clients may consider direct eye contact impolite or aggressive, and they may avert their own eyes during the conversation. Asian clients may provide the nurse with the answers they think the nurse wants to hear. The nurse must be aware that this behavior does not mean that the client or family understands his or her instructions and they will not necessarily be compliant in future health behavior.

While caring for a client from an Asian culture, the community health nurse might expect which behaviors? (Select all that apply.) a.) The client is quiet and compliant, asking few questions. b.) The client asks many questions related to the health problem and the nurse's instructions. c.) The client may avert his or her eyes during the conversation. d.) Folk healers and complementary health care providers may also be present. e.) The client may provide the nurse with the answers he or she thinks the nurse wants to hear.

• Any "dysfunction" (e.g., separation, disease, or injury) that affects one or more family members probably affects other family members and the family as a whole --Example of dysfunction: if the main person who brings in the money for the family has a stroke its going to affect the whole family because they aren't bringing in the money after the stroke • The wellness of the family is highly dependent on the role of the family in every aspect of health care, from prevention to rehabilitation. • The level of wellness of the whole family can be raised through care that reduces lifestyle and environmental risks by emphasizing "health promotion, 'self-care,' health education, and family counseling" --Ex: Quit smoking • Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. • A clear understanding of the functioning of the individual can be gained only when the individual is assessed within the larger context of the family. --Ex: Violent patient but then family lets you know that the patient actually has dementia • The family as a vital support system to the individual member needs to be incorporated into treatment plans. --Family is part of the treatment plan --No one smokes in the house; Family goes on a leisurely walk once a week

Why is Family Health Important?

The family is a critical resource: The importance of the family in providing care for its members has already been established. In this caregiver role, the family can also improve individual members' health through health promotion and wellness activities. Dysfunction (illness, injury, separation) that affects one or more family members will affect the members and unit as a whole: Also referred to as the ripple effect, changes in one member cause changes in the entire family unit. The nurse must assess each individual and the family unit. Case finding is another reason to work with families: As the nurse assesses an individual and family, he or she may identify a health problem that necessitates identifying risks for the entire family. Improving nursing care: The nurse can provide better and more holistic care by understanding the family and its members.

Why is Family Nursing Important?