community final

Innovations to Global Health Problems: Home Based Life Saving Skills (HBLSS)

1998 American College of Nurse-Midwives developed the HBLSS. HBLSS is a community program to reduce mother and infant mortality. Address high rates of home birth with traditional birth attendants by providing training by NMWs. Training, demonstration, skill development, manual, Take Action Cards are key factors.

Nursing Actions: Primary Prevention climate change

Become involved with political actions to develop strategies to minimize population exposure to potential and known environmental hazards. Educate community stakeholders on how to avoid environmental hazards (i.e. sunscreen, ear plugs, safety glasses, air quality awareness). Heat action plans, water safety plans Efforts to cover non peeling lead paint -In persons with elevated lead levels due to lead exposure from peeling paint chips or dust created by peeling paint, what level of prevention is the removal of lead from their environment? ----tertiary -Is all peeling paint a potential lead exposure hazard? Examples: Precautionary principle Potential: cell phones & brain cancer research, plastic food containers

Children's Health Vulnerability

Body systems are still rapidly developing Eat more, drink more, and breath more in proportion to their body size than adults Breathing zone is closer to the ground than adults Bodies may be less able to break down and excrete contaminants Behaviors can expose them to more contaminants, e.g. playing on the ground; putting objects and fingers in their mouths

Select Key Issues in Global Health

Communicable diseases - HIV/AIDS, TB Malaria NCDs - HD, Diabetes Maternal and child health Concerns over mental health issues Vaccines and immunizations Poor water, sanitation and hygiene issues Violence Mal-distribution of the healthcare work force

• Evaluate actions associated with the concept of environmental justice

Development, implementation, and enforcement of environmental laws, regulations and policies eX: pipeline, creating dump

Globalization due to:

Due to: Greater connections Information technology International travel Migration patterns

• Examine the exposure pathway to identify risk for exposure to an environmental toxin look @ pic

Exposure Pathway -- method by which people are exposed to an environmental contaminant that originates from a specific source Source of Contamination -what are the contaminants & where do they originate Environmental Media and Transport Mechanisms -the environmental medium that the contaminant is in helps determine who is exposed and how they are exposed -transport -- how the contaminant moves from the source to the point of exposure to people Point of Exposure -place where people come in contact with the contaminated medium Route of Exposure -how the contaminant enters the body Receptor Population -population of people likely to be exposed

Current trends in Environmental Health

Focus on the built environment where people live and work -Attributes that can promote or inhibit health Children's environmental health -Susceptibility and exposure Environmental justice movement focusing on place -Development, implementation, and enforcement of environmental laws, regulations and policies

Levels of Nursing Care

Individual health Community health Population health Public Health

The Healthy People 2020 environmental goals

Outdoor air quality Surface and ground water quality Toxic substances and hazardous wastes Homes and communities Infrastructure and surveillance Global environmental health

Role of Nursing in Policy

Role of nurses in policy forums and influential decision making bodies is limited in terms of global health - need to narrow the gap ICN committed to preparing nurses for management and leadership roles - Leadership for Change Program Do you know of nurses who are heavily involved in politics in the US?

Innovation: Helping Babies Breath (HBB) Program

Teaches those in the community the first steps of neonatal resuscitation in that first "Golden Minute" Key elements: Train community how to respond to a baby who is not breathing Focus on suctioning, if needed Hygiene Warmth Get help

Non Communicable Diseases (NCDs) Major Important NCDs

"Each year, 38 million people worldwide die from non-communicable diseases (NCDs), with three-quarters (28 million) of those deaths occurring among people living in low- and middle-income countries." *NCDs are often diseases of poverty (SDOH) * -Poor nutrition - food not as nutritious - have problems with undernutrition or obesity -Tobacco use - key contributor to NCDs - HD, Lung Disease, Cancer et al -Environmental issues - poor access to safe parks etc for exercise -Harmful use of alcohol -Limited access to good medicines and diagnostic testing leads to increased mortality from NCDs in certain countries CVD Diabetes Others

Maternal Health Major Focus of Global Efforts Newborn and Child Health Mental Health Water, Sanitation & Hygiene Issues

"Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered. The sheer scale of maternal health issues makes maternal well being and survival vital concerns." Lancet, 2016 Pregnant women have complications (or die) for a number of reasons including: Hemorrhage Pregnancy related hypertension Infection children: "5.6 million children under the age of 5 years died in 2016. This translates into 15 000 under-five deaths per day. More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions. Leading causes of death in children under-5 years are preterm birth complications, pneumonia, birth asphyxia, diarrhea and malaria. Children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high income countries." mental health: Mental health problems are causing a great amount of disability and human suffering. (Severe shortage of therapists to treat those in need) Many countries lack mental health infrastructure to meet the needs of its population. There is still often associated impact of stigma for seeking mental health care. According to a Harvard public health doctor and co-author of a 2016 Lancet article on mental health... "People with severe mental illness die before a heavy smoker, just to have a perspective on how serious this is..." Dr. Daniel Vigo Water, Sanitation & Hygiene Issues: "Ensuring access to safe water, sanitation, and hygiene (WASH) services plays an important role in safeguarding the health, well-being, and resilience of individuals and communities. WASH has the potential to prevent 6.3% of deaths and 9.1% of the disease burden in developing countries." -Lack of clean water and sanitation can lead to exposure to a variety of pathogens that can cause disease - especially diarrhea. Children and others can get dehydrated. -Oral rehydration salts. -Zinc

Global Health Defined Describe globalization and global health

"Health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people" (Kickbush, 2006). IOM (2009) definition: "the goal of improving health for all people in all nations by promoting wellness and eliminating avoidable diseases, disabilities, and deaths." The UN in 1948 noted: -"Everyone has the right to a standard of living adequate for the health and well-being of himself and his family." -Priority is to improve health equity for people around the globe. Health is seen as not being contained to a single geographic area. No standard agreed upon definition for global health - a number of definitions exist Want to promote wellness and eliminate disease, disability and death Public Health for the World - important to look at health of populations

Public Health Win! Vaccines and Immunizations

"Vaccines are one of the most cost-effective and successful public health solutions available. They save the lives of approximately 2.5 million children each year." This has been the focus of a number of funders for global health - like the Gates Foundation Rwanda has had recent success with vaccinations

• Explain the concept of self-efficacy

-how well one can execute courses of action required to deal with prospective situations -one's ability to succeed in specific situations or accomplish a task. -One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges Health-promotion & prevention, self-diagnosis, self-monitoring, self-medication and self-management are critical to successful outcomes ***important: believing in your own abilities, confidence**** Involves a partnership between consumers and providers: shared decision making Involves a complex and diverse set of skills influenced by integration of knowledge (health behavior & social determinants of health), attitudes and self-efficacy (confidence). Support means using tools and techniques that work

Key organizations involved in establishing health equity

1. Select Major US Global Health Program Areas -Presidents Emergency Plan for AIDS Relief (PEPFAR) (2003) -President's Malaria Initiative (PMI) (2005) -Global Fund to Fight AIDS, TB and Malaria 2. World Health Organization (WHO) Established after WWII to lead worldwide health activities A number of initiatives have been created by the WHO - a few are: -Global Alliance for Vaccines and Immunizations -Global TB Partnership -Global Fund on HIV/AIDS ----WHO is an important organization providing information and direction about issues that concern global health status 3. Alma-Ata Declaration 1978 World leaders gathered to talk about the importance of the issue of primary care for all Noted that governments are responsible for the health of their citizens Want everyone to be able to live a life that is socially and economically productive - primary health care is seen as the key

Response The best response plans use

: Implementation of the disaster plan. The best response plans use an incident command system, are routinely practiced and modified when improvements are needed.

Shelter Management of Care Determine elements to be included when teaching sheltering in place strategies--what things do you need (8)

Allocation of space, obtaining supplies and equipment, scheduling staff, reports & records, first aid, triage, prevention of disease, providing emotional support, communication, coordination, anticipation. Application of the nursing process -Assessment, Planning, Implementation, Evaluation Risk of evacuating may outweigh risk of sheltering in place. Community members should be educated to have available: -Non-perishable food for 3-5 days/person -First aid kit -5 day supply of necessary medications -Water - 1 gallon/person/day (extra if children/pets in the home) -Battery operated radio & replacement batteries -Flashlight & extra batteries -Extra blankets -Other: baby formula, diapers, pet supplies, -personal hygiene items

Major Roles of Nursing During Recovery

Assess for trends in the development of infectious diseases Participate in critical incident stress debriefing -Responders are exposed to traumatic situations. -Responders experience exhaustion and may not be aware of the impact of the experience on them nor be able to verbalize these feelings right after an incident. Monitor individual and family coping with the situation -Assess need for mental health and support services. Participate in evaluation meetings to analyze the response team's strength and weaknesses and submit a plan for future improvement.

Education for Sheltering in Place

Bring your family and pets inside. Lock doors, close windows, air vents and fireplace dampers. Turn off fans, air conditioning and forced air heating systems. Take your emergency supply kit unless you have reason to believe it has been contaminated. Go into an interior room with few windows, if possible. Seal all windows, doors and air vents with plastic sheeting and duct tape. Consider measuring and cutting the sheeting in advance to save time. Be prepared to improvise and use what you have on hand to seal gaps so that you create a barrier between yourself and any contamination. Local authorities may not immediately be able to provide information on what is happening and what you should do. However, you should watch TV, listen to the radio or check the Internet often for official news and instructions as they become available.

Major Roles of Nurses During Disasters (impact)

Communicate clearly, openly, and honestly using simple language. Maintain a unified chain of command Participate in a coordinated, multidisciplinary response. Rapid assessment of the situation and of nursing care needs. -Define health needs of the affected groups -Determine resources needed Triage and initiation of life-saving measures first. Provide safe and appropriate acute, shelter, and community-based care. Use of imagination and resourcefulness in dealing with potential lack of supplies, equipment and personnel. Evaluation of the environment and mitigation or removal of any health hazards. Identify actual and potential public health problems. Leadership in coordinating patient triage, care, and transport during time of crisis. Teaching, supervision, and utilization of auxiliary medical personnel and volunteers. Provision of understanding, compassion, and emotional support to victims and families.

• Explain the importance of ensuring a strong nursing workforce globally Global Nursing: Key Concepts

Consider SDH Consider individual/community, public health and population care Conduct research Enhance education in global health concepts Foster strong nursing leadership Advocate for individuals and groups Be active in policy change The world has less boundaries than it once did... Travel and trade have made it easy to be in a country in Africa one day and in the US the next. Disease can travel also. Health equity is a challenge for many stakeholders across the globe. Non communicable diseases (cardiac problems, mental illness) are becoming the leading cause of morbidity world wide. Depending on the region of the globe where people live, different health concerns may predominate. Nursing should be a strong leadership presence to promote health equity globally - organizations like STTI and ICN are are the forefront. Nurses deliver over 80% of health care in many regions of the world. Community nursing is the cornerstone of this care. Research has shown that interventions can be delivered by nurses to vastly improve outcomes for women and children - HBLSS, HBB, Family Nurse Partnership Model (FNP). Primary care is seen as paramount to helping people attain their healthiest lives. SDOH are at the root causes of individual and population health. A person's education, income, type of job et al determine overall health status. Sustainable Development Goals (SDGs) published by the UN help us focus on 17 key domains to help build a better future for all.

Violence: A Major Global Health Issue Low Income Countries More Impacted by Violence than Higher Income Countries physical sexual psycological deprivation/neglect

Definition: The World Health Organization defines violence as: "The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation." Violence is among the leading causes of death worldwide for people aged 15-44 years, especially males Much of the true cost is invisible, human grief and pain Do you think it is inevitable, part of the human condition?

The Nature of Disasters- disruption, loss, leading

Disruption of: Communication, transportation, utilities (gas, electricity, water, sewer). Loss of: Shelter, food, clean drinking water, medicine, medical care Leading to: Increased mortality, nutritional deficiency, environmental exposure, infectious disease, psychological stressors, etc.

Tertiary Prevention: Are we too late?

Eliminate hazards (i.e. mold, hazardous wastes) when people are asymptomatic. Help communities manage the long-term effects of conditions that are caused by environmental hazards. Work with inter-professional teams and community members by participating in political activity to change conditions/ influence lawmakers when health hazards are present and endanger a community.

emergencies v disasters

Emergencies: considered events that require a swift, intense response on the part of existing community resources. Disasters: often unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community. Predictability Controllability Speed of onset Length of forewarning Duration of impact Scope and intensity of impact

Preparedness (risk assessment)--Issues to consider

Evaluation of the community's propensity for disasters. Issues to consider include weather patterns, geographic location, industries in close proximity (e.g., nuclear power plant or chemical factory), availability of health and emergency services, evacuation plan, designated shelters (e.g, schools, concert halls, churches - places that can accommodate large numbers of people). Provide education on how to shelter in place.

Nursing Actions: Secondary Prevention

Examples: Conduct lead screenings of children and symptomatic individuals Screening for environmental conditions that trigger asthma in the school environment. Screening for environmental toxins in the workplace -Off-gassing in offices (new paint, carpet) -Closed air systems -Pesticides and petroleum in landscaping

• Interpret roles of government agencies to respond to a disaster FEMA OSHA EPA Department of Transportation CDC Red Cross

FEMA PA (Federal Emergency Management Agency's Public Assistance Grant Program): Core role: Assess and respond to disaster events in the United States. Provides assistance to state, tribal and local governments, and certain types of private nonprofit organizations so that communities can quickly respond to and recover from major disasters or emergencies. Executive Order of the President required to activate FEMA PA as a national emergency or major disaster. OSHA (Occupational Safety & Health Administration): emergency preparedness in the workplace. EPA (Environmental Protection Agency): Response and recovery of environmental disasters (e.g., oil spills, toxic substances). Department of Transportation: prepare for and manage the transportation recovery process following a major disaster. CDC: support state/city public health departments in disaster preparedness. Red Cross (Red Crescent in many countries): provide individual and family assistance to meet emergency needs such as food and shelter; handle inquiries from concerned family members outside the affected area; coordinate distribution of emergency relief services.

Global Nursing and Local Practice (GLOCAL)

Family Nurse Partnership Human trafficking Substance abuse Violence

climate change human exposures modulating influences: health effects

Human exposures: Regional weather changes Heat waves Extreme weather Temperature Precipitation modulating influences: Contamination pathways Transmission dynamics Agroecosystems, hydrology Socioeconomics, demographics Health effects: Temperature-related illness and death Extreme weather-related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent-borne diseases Effects of food and water shortages Effects of population displacement

Superfund Status What is an environmental health policy? How does environmental health policy evolve?

In the 1970s, the Love Canal and Valley of the Drums areas were identified as toxic waste dumps and were exposing people to the toxins in the soil and water, causing disease. In 1980, Congress passed the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) to provide the funds to clean up these sites. -Also known as Superfund A site's designation as a Superfund site means that the site is so contaminated that the Federal Government must take over to complete the job. -The site goes on the long list of sites needing to be cleaned. What is an environmental health policy? -Governmental laws, rules and regulations to prevent and reduce risks to the public from environmental influences. How does environmental health policy evolve? -In response to pressures from an environmentally conscious public Often implemented as a result of priorities of elected or appointed officials. Current concerns are the potential reversals of recent efforts to strengthen and expand policies and regulations.

• Classify barriers to effective chronic disease management

Ineffective application of acute care models for chronic disease Rushed practitioners not following evidence based practice Lack of care coordination & communication Lack of interdisciplinary health team to address complex needs in chronic disease Lack of active follow-up to ensure best outcomes Inadequate use of community resources In acute care models the pt. is a passive recipient of care; illness if often short-lived, and objective of care is cure & return to pre-illness state. In chronic care quality is assessed by how well patients follow treatment regiments, adopt recommended lifestyle changes, & achieve standards set forth in quality of care guidelines. Patients need to be active & equal partners in management of their disease. Social & economic issues are often barriers to treatment. Mobilization of community organizations may be able to help, e.g.: provide transportation to appointments; senior centers provide screening & health education services. physical: mobility, safety, disability, disease, cognition, insurance/access, cost psychological: depression, fear, motivaiton, denial, stress, self-esteem cognitive- dementia, education, literacy. mroals, language economic- poverty, insurance, medicaid, employment, cost, social/cultural- language, religion, norms, bias,, geography, social stigma Recall concepts from what you have learned about social determinants of health.

Communicable Disease - ID Threats

Infectious diseases do not respect international boundaries HIV/AIDS -2015 37.6 million people world wide are living with HIV -Young women and girls make up 50% of new infections TB

Analyze methods for reducing risk of adverse health outcomes from exposure to environmental conditions

Instruct individual to wear a respirator when stripping paint from an old house. Encourage farmers who work with pesticides to refrain from wearing their work boots into the house. Developing a school policy to establish waiting periods for school children to be off the playground following applications of fertilizers and herbicides and when air quality is poor Teach asthma management plans to reduce exposure to interior and exterior triggers

Innovations: Mental Health Lay Counselor Training

Key attributes: Lay counselors come from the same community as their "patients". Trained by professionals. Follow-up by reviewing charts and observation of lay counselors. Lay counselors are taught how to provide support. Provide active listening and make suggestions for improving mood.

• Interpret levels of disasters- level 1-3

Level I: Organization, agency or community is able to contain the event utilizing its own resources. Level II: Disaster requires assistance from external sources, but these can be obtained from nearby agencies. Level III: Disaster is of a magnitude that exceeds the capacity of the local community or region and requires assistance from state and/or federal level assets.

top 10 causes of death globally top 10 low income

MI stroke lower respiratory COPD lower respiratory diarrhoeal disease stroke MI

Some Important Emerging Global Health Threats

Mental health problems are causing a great amount of disability and human suffering Many countries lack mental health infrastructure to meet the needs of its population There is still often associated impact of stigma for seeking mental health care Substance abuse (tobacco, alcohol and illegal drug use) is problematic across many parts of the world - including in the US (ie. current opioid crisis) Emerging health threats are often being linked to resistance to antibiotics, new strains of drug resistant bacteria and non or poor adherence to medical treatment protocols Tobacco use is decreasing in developed countries, but increasing in developing countries (WHO, 2011) Males especially are at risk for health problems related to violence, traffic injuries and self-inflicted injuries - in top 10 disease burden for age group 15 to 44 year olds (WHO, 2011)

Health system strengthening Definition of an essential public health package Most health risks in next 20-30 years could be averted through:

Most health risks in next 20-30 years could be averted through -comprehensive assessments of climate risks to health and health systems -integrated environment and health surveillance -delivery of preventive and curative interventions for identified climate-sensitive public health concerns -preparedness and response to the public health consequences of extreme weather events -applied research -strengthening of human and institutional capacities and inter-sectoral coordination

• Determine appropriate advanced triage level based on type of injury

Multi-sectorial coordination system to maximize the use of existing resources, and provide prompt and appropriate care based on severity of injury/illness. Communication with medical providers critical to inform of agents involved (e.g., chemical, biological, radiological, firearms injuries, explosive/blast injuries). Accomplished through triage: -Helps to bring order and organization to a chaotic scene -Identifies and provides care to those in greatest need -Helps make difficult decisions easier -Assures that resources are used in the most effective manner

types of disasters

Natural: typhoons, hurricanes, tornados, snowstorms, heat waves, drought, earthquake, volcanic activity, landslides, surface collapse. Human-induced disasters: Technological disaster: danger associated with technological or industrial accidents, infrastructure failures, or human activities that result in loss of life or injury, property damage, environmental degradation, economic disruption. Examples: industrial pollution, nuclear release/radioactivity, toxic waste, oil spills. Environmental degradation: human activities that damage natural resources or adversely alter ecosystems. Examples: deforestation, land degradation, land, water and air pollution, climate change, ozone depletion. Terrorism/Bioterrorism: Deliberate use of violence (e.g., mass shootings, bombings, release of toxic chemicals, gases, biological agents) for the purpose of harming the population. LSI - Any Incident that has the capability of becoming a mass casualty event Pre-Planned event - Any event that has been planned for Mass Casualty Incident - Any incident that overwhelms typical response resources (Normally >5 injuries)

nursing- how to get policy Change for climate change

Nurse is acting from a primary prevention viewpoint to prevent or minimize the occurrence of an exposure. Stay knowledgeable Raise awareness Organize coalitions in the community to develop strategies for change and reduce resistance to change. Share resources and expertise to educate on action steps to eliminate, avoid or reduce exposure to environmental hazards.

Nursing Role: Environmental Health

Nurses draw on their strong science backgrounds and communication skills -Community involvement/public participation -Individual and population risk assessment -Epidemiologic investigations -Policy development I-PREPARE---what questions to ask to pts -Investigate Current & Potential Exposures -Present work/location for extended time -Residence -Environmental Concerns -Past work -Activities Actions -Referrals and Resources -Educate

• Appraise independent nursing roles in chronic disease management

Nurses: Facilitate an individual's management (self-care) of their illness & maximize their quality of life. Are members of the interdisciplinary team Coordinate care from multiple settings Perform holistic client assessments Teach & coach clients Engage clients at all levels of prevention Utilize effective communication: including motivational interviewing Involve client and caregivers in decision making Shift in health care toward involving client as an active partner

Nurses International Large Nursing Efforts to Improve Global Health

Open Access Curriculum -Philosophy: Nursing Education Equity -Downloaded in over 30 countries -Newest country interested is Uganda in Africa Telehealth My Safe Birth Score (US and Abroad) Community Focused Curriculum - technology enhanced curriculum GAPFON ICN WHO Centers -WHO collaborating center for Public Health Nursing and Midwifery in Public Health, England Rory Meyers College of Nursing research

Goals of Disaster Nursing

Overarching goal: achieve the best possible level of health for the people and the community involved in the disaster. Meet the immediate basic survival needs of the affected population (water, food, shelter, security). Identify potential for a secondary disaster. Appraise risks and resources in the environment. Correct inequalities in access to health or appropriate resources. Empower survivors to participate in and advocate for their own health and wellbeing. Respect cultural, lingual and religious diversity in individuals and families and to apply this principle to all health promotion activities.

• Evaluate goals and key elements for successful chronic disease management

PALLIATIVE CARE Controlling symptoms Coordinating care Reducing unnecessary tests and futile interventions, as appropriate to the goal of care as determined by the client. Ongoing conversations with the client and family: shared decision making. Five steps to setting goals -Explore the problem. What is your concern? -Clarify feelings and meaning. Are you feeling (sad, frustrated) because of ... ? -Develop a plan. Where would you like to be (3 months, 6 months) from now? What are your options? What are barriers? Who could help? -Commit to action. What are you going to do? When? How confident are you? -Experiment with and evaluate the plan. How will you know you have succeeded?

• Differentiate features of the patient-centered medical home

PCMH: The medical home is a model or philosophy for achieving primary care excellence so that care is received in the right place, at the right time, and in the right manner that best suits a patient's needs. features: Patient-centered Comprehensive Coordinated Accessible Committed to quality & safety Patient-centered: A partnership among practitioners, patients, and their loved ones ensure decisions respect patients needs and preferences, and that patients have the education/support they need to participate in their own care. Comprehensive: Care provider team is wholly accountable for the patient's physical & mental health needs, including health promotion, disease prevention, acute, and chronic care. Coordinated: Care is organized across all elements of the broader health care system including specialty care, hospitals, home health care, community services, and supports. Accessible: Patients are able to access services with shorter waiting times, after hours care, 24/7 electronic/telephone access, strong communication through health IT innovations. Committed to quality & safety: The health care team focuses on quality improvement The patient is at the center of care. Primary care team is focused on caring about and caring for the patient. Technology - patient can communicate with team through email, video chat, after-hour phone calls. Mobile apps and electronic health resources - health education messaging & personal health record.

Major Role of Nurses for Preparedness of disaster. Be knowledgeable of:

Participate in the development of community disaster plans. Participate in community risk assessment: -Initiate disaster prevention measures. -Prevention or removal of hazard. -Movement/relocation of at risk populations. -Public awareness campaigns. -Establishment of early warning systems. Perform disaster drills and table-top exercises. Identify educational and training needs. Develop evaluation plans for all components of Disaster Nursing Response. Educate community members on go-bags, shelters, and how to shelter in place. Be knowledgeable of: -Disaster plan at place of employment -Evacuation plan for the community -State & local offices of emergency management -Communication plan for emergencies

• Appraise negative impacts of chronic disease on an individual (9) and features of modern chronic diseases

Physical / mental suffering Impaired mobility; functional ability Substantially reduced quality of life Constraints on social and family life Loss of independence Inability to work Loss of income with concurrent high medical/pharmaceutical costs Isolation, shame, stigma, feelings of loss, fear of 'becoming a burden' Depression There is no cure. Goal is to reduce the disease burden. High co-morbidity rate. *Need for patient engagement* in self-care behaviors. Access to continuity of care still limited especially in relationship to social determinants of health. Most resources are still more directed toward acute care but this is changing----acute care is not preferable b/c you want to prevent it before it escalates

Health Effects of Disasters

Premature deaths, illnesses, and injuries in the affected community, often exceeding the capacity of the local health care system. May destroy the local health infrastructure. May create environmental imbalances, increasing the risk of communicable diseases and environmental hazards. May affect the psychological, emotional, and social wellbeing of the population - fear, anxiety, depression, panic, terror. May cause shortages or contamination of food and clean drinking water. May cause large population movements (refugees) creating a burden on other health care systems and communities. Strain on health providers managing the injured and deceased. Increased need to provide mental health services - "psychological first aide" for disaster victims and responders.

• Distinguish the standard phases of the disaster management continuum

Preparedness: identify all hazards proactive planning evaluate possible damage -> Mitigation: Take measures to limit damage, disability, and loss of life -Mitigation takes place before and after disasters. -> Response: Implementation of disaster plan proide emergency care restore communication and transportation -> Recovery: Stabilization Return to normal status -> Evaluation: Learn from the past Prepare for the future Pre-Impact: Initial phase. Warning is given at the first possible sign of danger to a community. Crucial in preventing loss of life and minimizing damage. This is the period when the emergency preparedness plan is put into effect and emergency centers are opened. Local health department coordinates PODs (points of distribution) for the post-impact phase. Impact: Phase where disaster actually occurs. Impact phase continues until the threat of further destruction has passed. Emergency operation center serves as center for communication and coordination of services. Affected population at this point is either in a shelter, or have sheltered in place. Post-Impact: Recovery and return of normal community order and functioning. Points of distribution (POD) are available for emergency supplies, food, water, and medications.

Advanced Triage

Principles: Do the greatest good for the greatest number Preservation of life takes precedence over preservation of limbs Class I (Emergent) - Red tag - Immediate response required -Victims with serious injuries that are life threatening but has a high probability of survival if immediate care is provided. -Examples: compromised airway, shock hemorrhage Class II (Urgent) - Yellow tag - Can delay up to 2 hours -Victims who are seriously injured and whose life is not immediately threatened. -Examples: Open fracture Class III (Non-urgent) - Green tag - Can delay more than 2 hours -"Walking wounded" - casualty requires medical attention after all higher priority patients have been evacuated. -Examples: Minor injuries, closed fracture, sprain, strain Class IV (Expectant) - Black tag - Dead or expected to die -Victims are so severely injured that they will die of their injuries, or are in a life-threatening medical crisis that they are unlikely to survive given the care available. -Examples: massive head injury, cardiac arrest, full-thickness burns

Recovery Evaluation

Recovery: Recovery of community and staff. Activities include restoring essential services, debris removal, care and shelter, provision of food, water, medications, damage assessments, funding assistance. Evaluation: Each step of the disaster event is reviewed. Following a thorough review of the strengths and weaknesses, a final report is prepared with recommendations for improving emergency response in the future. This is the foundation for evidence-based disaster response.

• Examine for risk of environmental health concerns for diverse populations

Risk Assessment determines likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of exposure to an environmental contaminant. Factors to consider -Strength of the "contaminant" -Duration of the exposure -Frequency of exposure -Systemic signs and symptoms -- bioavailability of the contaminant in the body is limited to technology to measure ----Note: Keep in mind that airborne pollutants can travel long distances

Simple Triage

S.T.A.R.T. - Simple Triage and Rapid Treatment: separates the injured into 4 groups: 0 - The deceased who are beyond help 1 - The injured who can be helped by immediate transportation 2 - The injured whose transport can be delayed 3 - Those with minor injuries - non-urgent injuries

What Constitutes a High Quality Referral or Quality Transition of Care? Describe the elements of quality transitional care

Safe-Planned and managed to prevent harm to patients from medical or administrative errors. Effective-Based on scientific knowledge, and executed well to maximize their benefit. Timely -Patients receive needed transitions and consultative services without unnecessary delays Patient- centered-Responsive to patient and family needs and preferences Efficient-Limited to necessary referrals, and avoids duplication of services. Equitable-The availability and quality of transitions and referrals should not vary by the personal characteristics of patients. Here emphasize patient/client centered care and inclusion of client's needs and preferences. Care Transition -"Admission" back to the community setting -Home care -Outpatient treatment clinics including palliative care -Hospice -Outpatient surgeries Quality Transitional Care -Facilitate the connection for clients between health care transitions in a complex health care system. Contrast making a referral with systems focused on quality transitional care referring to elements on previous slide. Also distinguishing between just making a referral and assurance of quality continuity of care.....illustrating this by case studies outlined on the next slide.

• Appraise potential toxins found in work environments (7)

Screening for environmental toxins in the workplace -Off-gassing in offices (new paint, carpet) -Closed air systems -Pesticides and petroleum in landscaping construction agriculture Top 3 greenhouse gases: Carbon dioxide Methane Nitrous oxide Water vapor (H2O) Carbon dioxide (CO2) Methane (CH4) Nitrous oxide (N2O) Ozone (O3) Chlorofluorocarbons (CFCs) Hydrofluorocarbons (incl. HCFCs and HFCs)

Traumatic Stress During Recovery Phase. PTSD 4 symptoms

Shock and denial common immediately after the incident. Depends on: -Degree of intensity and loss -Coping abilities -Stress situation prior to the disaster Post-traumatic Stress Disorder (4 symptoms): -Reliving the event -Avoiding situations that remind the individual of the event -Feeling numb -Feeling keyed up (also called hyper-arousal)

• Analyze stakeholders' roles to collaborate to address important global health issues World Health Organization (WHO)

Stakeholders may include: "Government -- not only the Ministry of Health or Department of Health, but also Finance, Treasury, Education, etc Non-governmental organisations and not-for-profit sector Community groups and civil society organisations Business and the private sector Political parties Local government Health insurance groups and other health care funders Donors and aid agencies, including global health initiatives UN agencies, including WHO Health workers 'organisations & health care providers' networks Patients and health service users"

Mitigation

Steps taken to lessen the impact of the disaster should one occur - can be risk reduction as well as recovery measures. Examples: Prevention - installing back-up generator power, use of sandbags to prevent flooding, taping windows to prevent breakage, stocking up on medications, food and bottled water. Recovery - assure availability of food, clean drinking water, measures to prevent communicable diseases. Preparedness: Mitigation is an effort to reduce the impact of identified risks from causing a greater disaster. Recovery: Mitigation also involves efforts to lessen the impact of a disaster by initiating measures to limit damage, disease, disability, and loss of life among members of a community.

Taking an Exposure History:

Suggestions for environmental health screenings to ask an adult: What kind of work do you do? How long on the job? Types of work exposures? Do you notice health problems: at work? at home? in the community? in specific locations? What is the age of your home? Characteristics of heating and ventilation? Do you live near an industrial site or landfill? Have you recently used pesticides, solvents, insecticides, or weed killers? What kinds of hobbies do you have? Has your workplace been treated recently for insects, weeds, or other pest problems? Increased use of pesticides etc. Bed bug spraying?

• Explain the focus of the Declaration of Alma-Ata

The Declaration of Alma Ata, issued on September 12, 1978, provides a moral vision for primary care that remains valuable today at a time of transformation of the specialty of family medicine. definition of health: a state of complete physical, mental, and social well-being and not merely the absence of disease - asserts a comprehensive definition of health that recognizes health as a fundamental *human right* -argues persuasively that gross inequalities in health status are politically, socially, and economically unacceptable - identifies primary health care as the key to improving health and reducing health status inequalities. -insists that health improvements must reach everyone. -suggests there may be new opportunities to bridge family medicine, public health, preventive medicine, and com mu n it y-based ca re to reach those in need of service -The values of Alma Ata can guide the specialty of family medicine to lead positive health system change through renewed collaboration, addressing inequalities, efficient use of resources and appropriate technology, and advocacy in the spirit of social justice.

Care coordination

The deliberate organization of patient care activities between two or more participants involved in a patient's care to facilitate the appropriate delivery of health care services. Patient centered medical home -accountability -patient support Community agencies, hospitals, ERs, meidcal specialists -> relationships, agreements, and connectivity to the PCMH -involved providers receive the info they need when they need it -practice knows the status of all referrals/transitions involving its panel -patients report receiving help in coordinating care ->>> high quality referrals and transitions Discuss client centered care and concept of patient centered medical homes as holistic approach involving clients/patients as partners.

• Classify the involvement of the United States role in regard to efforts to improve health in key regions of the world US role in global health: organization of USG (7)global health efforts Select Major US Global Health Program Areas

US role in global health: research and development international treaties/organizations technical assistance donor program operation partnering global health diplomacy organization of USG global health efforts: white house encompasses all -defense -USDA -treasury -labor -commerce -homeland security -MCC -peace corps -EPA USAID: global health bureau and other functional regional bureaus -feed the future -PMI -USAID NTD program State: office of hte secretary, GHD, OES, PRM, IO, GWI ambassadors -PEPFAR HHS: office off hte secretary OGA, ASH, ASPR -CDC -NIH -FDA -HRSA US engagement is carried out by multiple agencies, departments and Congressional committees. Presidents Emergency Plan for AIDS Relief (PEPFAR) (2003) President's Malaria Initiative (PMI) (2005) Global Fund to Fight AIDS, TB and Malaria

Nursing Education/Competencies Important to Global Health Care

What educational needs currently exist in order to meet the global health care needs of low resource countries? What competencies are needed by global health nurses? Would you feel equipped upon graduation to take a job in a low resource country as a nurse delivering care?

Climate change and health

Without effective responses, climate change will compromise: Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhea and heat stress. The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sanitation), is estimated to be between US$ 2-4 billion/year by 2030. Areas with weak health infrastructure - mostly in developing countries - will be the least able to cope without assistance to prepare and respond. Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health, particularly through reduced air pollution. Some expected impacts will be beneficial but most will be adverse. Expectations are mainly for changes in frequency or severity of familiar health risks

Workforce Migration (Brain Drain) Health Care Workforce Maldistribution

Workers move from low-income countries to regions where they can make more money. WHO notes that worldwide we are missing almost 4.3 million doctors, nurses, midwives, and others. High income countries may have 90 nurses and NMs per 10,000 people . Low income countries have how many NMs per 10,000? US + canada: 14% of the world population 10% of the world disease burden 37% of the global healthcare workforce Spends about 50% of world financial resources for health Africa: 11% of the world population 24% of the global disease burden 3% of the global healthcare workforce Spends less than 1% of the world's financial resources for health

• Explain the importance of primary care for all to ensure global equity

alma ata Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process Primary health care: 1.reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience; 2.addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly; 3.includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs; 4.involves, in addition to the health sector, all rel ated sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; 5.requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate; 6.should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; 7.relies, at local and referral levels, on health wor kers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community

• Using the Social-Ecological Model, differentiate responses to extreme weather events. A Description of Social Ecological Model (SEM) Levels: individual interpersonal community organizational policy/enabling environment what is it?

individual: -knowledge, attitude, behaviors Characteristics of an individual that influence behavior change, including knowledge, attitudes, behavior, self-efficacy, developmental history, gender, age, religious identity, racial/ethnic identity, sexual orientation, economic status, financial resources, values, goals, expectations, literacy, stigma, and others. interpersonal: -families, friends, social network • Formal (and informal) social networks and social support systems that can influence individual behaviors, including family, friends, peers, co-workers, religious networks, customs or traditions. community: -relationships between organizations • Relationships among organizations, institutions, and informational networks within defined boundaries, including the built environment (e.g., parks), village associations, community leaders, businesses, and transportation. organizational: -organizations and social institutions Organizations or social institutions with rules and regulations for operations that affect how, or how well, for example, services are provided to an individual or group. policy/enabling environment: -nation,s tate, local laws • Local, state, national and global laws and policies, including policies regarding the allocation of resources for health and access to healthcare services, restrictive policies (e.g., high fees or taxes for health services), or lack of policies that require/encourage certain healthy behaviors. The Social Ecological Model (SEM) is a theory-based framework for understanding the multifaceted and interactive effects of personal and environmental factors that determine behaviors, and for identifying behavioral and organizational leverage points and intermediaries for health promotion within organizations. The most effective approach to public health prevention and control uses a combination of interventions at all levels of the model.

Social Determinants of Health (SDOH) what are the social determinants of health? • Interpret the impact of the social determinants of health on the overall health of an individual, community or population

neighborhood and physical environment -Access to Healthy Foods (and price?) -Quality of Housing -Crime and Violence -Environmental Conditions Economic Stability -Poverty -Employment -Food Security -Housing Stability Education -High School Graduation -Enrollment in Higher Education -Language and Literacy -Early Childhood Education and Development Food: hunger access to healthy options Social and Community Context -Social Cohesion -Civic Participation -can they vote? Health and Health Care -Access to Health Care -Access to Primary Care -Health Literacy poor health outcomes: mortality, morbidity, life expectancy, health care expenditures, health status, functional limits -Social disadvantage is often linked to poorer health -Most affluent in society enjoy better health than the rest -Medical care alone is not enough to improve health or reduce disparities. Why? What else is needed? When inequities are high and community resources are low, poor health outcomes are made even more dramatic.

• Interpret the importance of the UN's Sustainable Development Goals (SDGs) as a framework to guide efforts to ensure (17)

no poverty no hunger good health and well being quality educaiton gender equality clean water and sanitation affordable clean energy decent work and economic growth industry, innovation and infratstructure reduced inequalities sustainable cities and communities responsible consumption and prodction climate action life below water life on land peace justice and strong institutions partnerships for the goals