N404 populations and community health exam 1
The top 12 causes of death in the world, in order of prevalence:
1. Ischemic heart disease. 2. Cerebrovascular disease. 3. Chronic obstructive pulmonary disease. 4. Lower respiratory infections. 5. Lung cancer. 6. HIV/AIDS. 7. Diarrheal diseases. 8. Road injury. 9. Diabetes mellitus. 10. Tuberculosis. 11. Malaria. 12. Cirrhosis
Public Health
"activities that undertakes to assure the conditions in which people can be healthy"
Community Health
"identification of needs and the protection and improvement of collective health within a geographically defined area (Community)"
Global Health
"the health of populations in a global context. Priority is on improving health and achieving equity in health for all people worldwide."
Recommended actions that could help to address the shortage:
1. Advocating for strengthening nursing and midwifery leadership at all levels of the WHO and in state, local, and national governmental organizations responsible for health policy. 2. Support policies for the ethical recruitment and retention of nurses/midwives. 3. Implement policies to promote safe and just working environments for nurses. 4. Strengthen professional nursing organizations and interorganizational communication and collaboration to promote policies and funding priorities to support critical global health workforce needs. 5. Partner with health-related nongovernmental organizations to address global health care and nursing workforce needs. 6. Promote policies and standards to ensure that nursing educational curricula incorporate concerns for global citizenship and political participation in a substantial way.
10 facts about the state of global health:
1. Around 7 million children under the age of five die each year. 2. Cardiovascular diseases are the leading causes of death in the world. 3. HIV AIDS is the leading cause of adult death in Africa. 4. Population aging is contributing to the rising cancer and heart disease. 5. Lung cancer is the most common cause of death from cancer. 6. Complications of pregnancy account from us 15% of deaths in women of reproductive age worldwide. 7. Mental disorders such as depression are among the 20 leading causes of disability worldwide. 8. Hearing loss, vision problems, and mental disorders are the most common causes of disability. 9. Nearly 3500 people die from road traffic crashes every day. 10. Undernutrition is the most underlying cause of death for at least one third of all children under the age of five.
Global health and globalization:
A landmark report that highlighted America's vital interest in global health defined global health as health issues that transcend national boundaries and may be best addressed by cooperative actions.
Define aggregate:
A mass or grouping of distinct individuals who are loosely associated with one another. It is a broader term that encompasses many different size groups. Both communities and populations are types of aggregates. Community health nurses may work with aggregates such as pregnant and parenting teens, elderly adults with diabetes, or gay men with HIV/AIDS. Most Facility RNs work with individuals. Because of public health nursing's focus on communities, aggregates, and families, new nursing and healthcare delivery systems may be developed that are more gainful and effective in preventing health problems that later require more expensive hospitalizations.
a nurse is using the I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following questions should the nurse ask when assessing for "A" in the mnemonic? A. "What do you like to do for fun?" B. "What year was your residence built?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"
A. "What do you like to do for fun?"
a nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. the nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. fidelity C. respect for autonomy D. veracity
A. Distributive justice
A correctional nurse is working with an inmate who has a chronic health condition. When providing care for this inmate, which interventions would the nurse most likely implement? (select all that apply.) A. Monitor inmates response to medication. B. Provide the inmate with information about exercise. C. Provide mental health counseling. D. Schedule and perform tests such as MRIs and ultrasounds. E. Administer medications.
A. Monitor inmates response to medication. B. Provide the inmate with information about exercise. E. Administer medications.
A correctional nurse is working at the secondary level of prevention to address HIV in the prison environment. Which activities are associated with secondary prevention of HIV? (Select all that apply.) A. Offer HIV testing to inmates who are experiencing symptoms. B. Teach inmates on how HIV is transmitted and provide condoms on request to inmates. C. Administer an HIV test to all new inmates. D. Administer medications to treat symptomatic HIV.
A. Offer HIV testing to inmates who are experiencing symptoms. C. Administer an HIV test to all new inmates.
A correctional nurse frequently works with inmates who have addictions to alcohol and drugs. Which of the following activities are most appropriate for a correctional nurse to implement with these inmates? A. Providing drug education. B. Utilizing withdrawal protocols C. Referring inmates to appropriate programs and agencies D. Providing intensive weekly drug counseling E. Arresting inmates who are caught with drugs or alcohol
A. Providing drug education. B. Utilizing withdrawal protocols C. Referring inmates to appropriate programs and agencies
a newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following information should the nurse determine when conducting a work site survey? A. Work practices of employees B. Past exposure to specific agents C. Past jobs of individual employees D. Length of time working in current role
A. Work practices of employees
Choose the option that correctly completes the following sentence: Depriving incarcerated individuals of appropriate medical attention: A. may be considered cruel and unusual punishment, which is a violation of the Eighth Amendment to the U.S. Constitution. B. can be acceptable if the crime of the inmate is offensive to the nurse. C. is often necessary due to the challenges of providing health care in correctional settings. D. is a common, reflexive bias among correctional nurses.
A. may be considered cruel and unusual punishment, which is a violation of the Eighth Amendment to the U.S. Constitution.
an occupational health nurse is consulting with senior management of a local industrial facility. When discussing work‑related illness and injury, the nurse should include which of the following factors as physical agents? (Select all that apply.) A. noise B. age C. Lighting D. Viruses E. Stress
A. noise C. Lighting
a nurse is preparing an educational program on cultural perspectives in nursing. the nurse should include that which of the following factors are influenced by an individual's culture? (select all that apply.) A. nutritional practices B.Family structure C. Health care interactions D. Biological variations E. Views about illness
A. nutritional practices B.Family structure C. Health care interactions E. Views about illness
Components of Community Health Practice
ALL EFFORTS THAT SEEK TO MOVE PEOPLE CLOSER TO OPTIMAL WELL-BEING OR HIGHER LEVELS OF WELLNESS 1. INCREASE THE SPAN OF HEALTHY LIFE FOR ALL CITIZENS 2. REDUCE HEALTH DISPARITIES AMONG POPULATION GROUPS 3. ACHIEVE ACCESS TO PREVENTIVE SERVICES FOR EVERYONE 4. PREVENTION OF HEALTH PROBLEMS •ANTICIPATING AND AVERTING PROBLEMS OR DISCOVERING THEM AS EARLY AS POSSIBLE TO MINIMIZE POTENTIAL DISABILITY AND IMPAIRMENT
a nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. "I don't drive, and my son is only available to take me places in the mornings." B. "I can't take off during the day, and the local after‑hours clinic is no longer in operation." C. "only one doctor in my town is a designated provider by my health maintenance organization." D. "I would like to schedule an appointment with the local doctor in my town who speaks spanish and english."
B. "I can't take off during the day, and the local after‑hours clinic is no longer in operation."
a nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the client's perception of his current health status. B. gather data about the client's cultural beliefs. C. Determine how the client's culture can affect the effectiveness of nursing actions. D. gather information about previous client interactions with the health care system
B. Gather data about the clients cultural beliefs
Which of the following correctional settings sees the highest rates of suicide? A. State prisons B. Local jails C. Federal prisons D. Private prisons
B. Local jails
a nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health department to provide? (select all that apply.) A. managing the Women, Infants, and children program B. Providing education to achieve community health goals C. coordinating directives from state personnel D. reporting communicable diseases to the CDC E. licensing of registered nurses
B. Providing education to achieve community health goals C. coordinating directives from state personnel
Which of the following regarding the health of the current prison population is not a statistical trend? A. The rate of Type II Diabetes Mellitus is rising. B. The rate of HIV/Aids is rising. C. The rate of heart conditions is stable or slightly rising. D. The rate of arthritic conditions is stable or slightly rising.
B. The rate of HIV/Aids is rising.
Factors Influencing Community Health Nursing in the 21st Century
Health Care "Reform" stemmed from 5 factors: High rate of underinsured, unsustainable health care spending, lack of prevention focus, poor health outcomes, and health disparities. Demographics: age and increasing ethnic diversity by 2040, 1 in five Americans will be 65+ Globalization: market that brings together capital, technology, and information across borders
a school nurse is planning health promotion and disease prevention activities for the upcoming school year. in which of the following situations is the nurse planning a secondary prevention strategy? A. Placing posters with images of appropriate hand hygiene near restrooms B. routinely checking students for pediculosis throughout the school year C. implementing age‑appropriate injury prevention programs for each grade level D. Working with a dietitian to determine carbohydrate counts for students who have diabetes mellitus
B. routinely checking students for pediculosis throughout the school year
a school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. in which of the following roles is the nurse functioning? A. direct caregiver B. consultant C. case manager D. counselor
C. Case manager
The lead correctional nurse in a facility is working to develop a continuing education program for the other correctional nurses who work in the facility. Which topic would be the most appropriate to include in the program? A. Education about discharge planning for inmates. B. Education about the treatment of unusual chronic diseases. C. Education about working with older inmates with chronic diseases. D. Education about the nutritional needs of the inmates.
C. Education about working with older inmates with chronic diseases.
Which of the following is the most common chronic medical condition among the prison population? A. HIV/Aids B. TB C. Hypertension D. Type II Diabetes Mellitus
C. Hypertension
A correctional nurse is a guest speaker at a gathering of community/public health nurses who are considering a career in correctional nursing. As part of her presentation, she discusses the history of correctional nursing. How would the nurse describe the historic view of correctional nursing? A. Prisons were clean, safe environments for the incarcerated. B. Healthcare was readily available to the inmates as needed. C. Inmates were viewed as not deserving of care paid for by public dollars. D. The emphasis was on rehabilitation of inmates, not punishment.
C. Inmates were viewed as not deserving of care paid for by public dollars.
a community health nurse is implementing health programs with several populations in the local area. in which of the following situations is the nurse using primary prevention? A. Performing a home safety check at a client's home B. teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. implementing a program to notify individuals exposed to a communicable disease
C. Providing influenza immunizations to employees at a local preschool
a nurse is preparing an education program on disease transmission for employees at a local day care facility. when discussing the epidemiological triangle, the nurse should include which of the following factors as agents? (select all that apply.) A. resource availability B. ethnicity C. toxins D.Bacteria E. altered immunity
C. Toxins D. Bacteria
a nurse is talking to a client who asks for additional information about hospice. Which of the following statements should the nurse make? A. "clients who require skilled nursing care at home qualify for hospice care." B. "One function of hospice is to provide teaching to clients about life‑sustaining measures." C. "Hospice assists clients to develop the skills needed to care for themselves independently." D. "a component of hospice care is to control the client's manifestations."
D. "a component of hospice care is to control the client's manifestations."
What would a correctional nurse expect to find when reviewing demographics of the incarcerated population? A. There is an equal distribution of inmates from across socioeconomic backgrounds. B. A greater proportion of female inmates are black as compared to white or hispanic. C. Inmates are incarcerated for committing minor crimes more often than violent crimes. D. About one-half of federal prison inmates are incarcerated for drug offenses.
D. About one-half of federal prison inmates are incarcerated for drug offenses.
a nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. which of the following learning strategies should the nurse include for clients who are auditory learners? A. showing informational videos B. Providing equipment to practice hands‑on skills C. supplying outlines for note‑taking D. facilitating small group discussions
D. Facilitating small group discussions
Globalization positive effects:
Diffusion of ideas, technologies, and other innovations such as the availability of safe water, medications, and treatments. The expansion of trade has resulted in increased living standards for many, especially women. Another positive effect is the emerging global stewardship that has been influenced by international and global exchanges. This leads to the growing recognition of common threats and opportunities.
Other Opportunities for Nurses to Contribute to Global Health and the Goal of Health for All:
In addition to using information and communication technologies to facilitate global partnership and collaboration, 4 additional opportunities for nurses to make a difference are: Supporting primary healthcare initiatives, Helping to address challenges associated with the global nursing shortage in international nurse migration, Promoting global health equity through leadership and involvement in health policy development, And participating in international exchanges and collaborations.
Globalization negative effects:
Include increased crowding in urban areas, increase health problems such as obesity and chronic disease, faster transmission of infectious diseases associated with increased global travel, and so-called microbial hitchhikers. Yet another is the growing disparities between the haves and have-nots.
Infectious diseases:
Infectious diseases: the HIV/AIDS pandemic has a devastating effect in many countries. In 2011 there were 34 million people living with the HIV. There are wide variations in the HIV infection rate globally. In sub-Saharan Africa nearly 5% of adults are infected and this accounts for 69% of adults living with HIV, and 90% of children infected with HIV world-wide. Emerging infections include those caused by newly evolved strains of pathogens. Examples are multiple drug resistant tuberculosis, staph aureus infections, or chloroquine resistant malaria, and now, newly found infections such as SARS. There were 335 global infectious diseases reported as an emergence from 1940 to 2004. 22.8% of which were vector borne, and the incidence of these diseases are in response to climate anomalies that occurred during the 90s. This lends support to the hypothesis that global warming and climate change may lead to the emergence these types of diseases.
Threats to Global Public Health Security and Health Diplomacy:
Today it is essential that countries work together to minimize risks from disease outbreaks and health hazards related to such factors as natural disasters, infectious disease outbreaks, bioterrorism incidents, or other emergencies. The healthy people 2020 document includes a global health goal to improve public health and strengthen US national security through global disease detection, response, prevention, and control strategies. It is important for every nurse to be familiar with their local community plans for dealing with potential threats. Nurses will often be the key first responders to any health threats.
Climate change:
While that continues to be debated, it is likely there will be shifts and patterns of disease in the coming decades that are at least partly attributable to climate change. There are several ways climate change my influence health outcomes, including changes in intensity of extreme heat waves, floods, and droughts; changes in air pollutants and allergens, alterations in ecosystems like water and food supplies that in turn influence the incidence of infectious disease as well as nutritional status, and population displacement due to rising sea levels. The potential health effects of climate change are worse for the elderly and other vulnerable groups who will be at greatest risk for exposure to catastrophic weather events such as hurricanes and extreme heat, increased flooding that results in food and water shortages and that could lead to mass migration, or environmental refugees, regional tension and conflict; or persons affected by disasters and economic problems due to ecosystem and climate changes will be vulnerable to mental health stress, and many vector borne diseases may become more frequent and widespread.
a nurse manager at a community agency is developing an orientation program for newly hired nurses. when discussing the differences between community‑based and community‑oriented nursing, the nurse should include which of the following situations as an example of community‑based nursing? (select all that apply.) a. a home health nurse performing wound care for a client who is immobile B. an occupational health nurse providing classes on body mechanics at a local industrial plant C. a school nurse teaching a student who has asthma about medications D. a parish nurse teaching a class on low‑sodium cooking techniques E. a mental health nurse discussing stress management techniques with a support group
a. a home health nurse performing wound care for a client who is immobile C. a school nurse teaching a student who has asthma about medications
Public health nursing
nursing that is community based and, most importantly, it is population focused.
Amish Health Considerations
•A Christian church that accepts the basic tenets of Christian faith. Members are free to join or leave at will. •Many use modern medical services. Others turn to alternative treatment options: folk remedies, homeopathy, vitamins, reflexology, herbal teas. More open to the mysteries of divine providence. •There are no explicit religious prohibitions against certain types of medicine. •There are many different kinds of Amish groups, each with it's own dress styles, carriages, occupations, and rules about technology, decided by their church. •Less inclined to seek heroic measures, or intervene when their elderly face terminal illness. •May seek special clinics that offer treatments not authorized in the US - in Mexico and elsewhere.
Culture
•Culture is acquired knowledge. •Culture is a patterned behavioral response. •Cultural diversity (cultural plurality): Is a variety of cultural patterns coexisting within a designated geographic area
Community Health Nursing
•FIELD OF NURSING WITH A SHIFT FROM INDIVIDUAL TO AGGREGATE •COMBINES NURSING SCIENCE WITH PUBLIC HEALTH SCIENCE •COMMUNITY BASED AND POPULATION FOCUSED •PUBLIC HEALTH SCIENCES AND NURSING THEORY •FOCUS ON POPULATION-LEVEL OUTCOMES •EMPHASIS ON PREVENTION
Transcultural Nursing Principles
•First, develop cultural self-awareness. •Then cultivate cultural sensitivity. •Assess the client's culture. •Show respect and patience while learning about other cultures. •Examine culturally derived health practices.
Hispanic Health Considerations
•Heart disease, diabetes, cancer, stroke, obesity, TB, alcohol abuse, and unintentional injuries. •High birth rate. •Catholicism is dominant religion, along with magico-religious practices. •May believe illness is will of god and a form of castigo. •Belief that witchcraft and the evil eye are supernatural causes of illness. •Males considered superior. •Patriarchal Family alignment.
Asian American Health Considerations
•Higher infant mortality •Father is family dominant. Lineage carried through male line •Dignity/Honor is extremely important •Mental Illness may be hidden. •Many believe in yin and yang, and qi. •May trust in spiritual healer over western medicine
Black or African American Health Considerations
•Higher susceptibility to certain diseases. •Many single parent households. •Large extended family networks •Strong church affiliations •Community social organizations •May have skin issues. •May hold traditional African beliefs. •A black client may not be African American.
Jehovah's Witness Health Consideration
•Jehovah's Witnesses strive to adhere to the form of Christianity that Jesus taught and that his apostles practiced. •Jehovah's Witnesses often help when disaster strikes. •Jehovah's Witnesses accept medicine and medical treatment. Some treatments conflict with Bible principles, though, and they reject those. •Funeral practices follow the model of the manner in which Jesus was buried.
Arab or Muslim Health Considerations
•Largely Christian or Muslim. •Traditional medicine still practiced over western medicine. •Sharaf or Honor is important in a family. •Cleanliness is paramount and ritualistic. •The left hand is used for cleaning genitals, the right hand for eating, hand shaking, and other hygienic uses. •Nurses assigned to Muslim patients should be the same sex as the client. •Only women discuss pregnancy, menstruation, child birth, family planning, etc. •Pregnancy can be complicated by genital mutilation.
Characteristics of Culture
•Learned •Integrated •Shared •Mostly tacit •Dynamic
Alaskan - Aleutian - American Indian Health Considerations
•Native Americans prefer traditional healing practices and folk medicine over western medicine. •Beliefs about health reflect living in total harmony with nature. •Use purification rituals. •Highest Ranking Health Problems: Alcoholism 5x higher than the national average. (lower physiological tolerance), TB 5x higher, DM II 2 x higher, Obesity/Overweight, Intentional/Unintentional Injuries.
Community health nurses
•SCHOOL NURSES •PUBLIC HEALTH NURSES •HOME HEALTH NURSES •HOSPICE NURSES •CORRECTIONS NURSES •OCCUPATIONAL HEALTH NURSES •GERIATRIC NURSES •MOBILE HEALTH NURSES •TELE HEALTH NURSES •RN CASE MANAGERS •NURSE EDUCATORS •PARRISH OR FAITH BASED NURSES •A COMMUNITY HEALTH NURSE IS A NURSE WHO WORKS IN A POSITION OF HEALTH CARE OUTSIDE AN ACUTE CARE FACILITY.
Ethnocultural Health Practices
•World community •Biomedical view •Magico-religious view •Holistic view: Mind - Body - Soul •Homeopathy •Folk medicine and home remedies •Herbalism •Prescription and over-the-counter drugs •Complementary therapies and self-care practices •Diet therapies (cancer diets, juice diets, fasting) •Gastrointestinal treatments (coffee enemas, high colonic enemas) •Balance and exercise activities (t'ai-chi, yoga) •Sensory exposure (aromatherapy, music therapy, light therapy) •Therapeutic manipulation (acupuncture, acupressure, reflexology)
What is Community Health?
▪CH is a field of nursing where the community is your client. ▪Primary obligation is to achieve the greatest good for the greatest number of people. ▪Nurses go out into the community to see clients, instead of clients coming in to see nurses. ▪CH is Assessing, Policy Development, and Assurance. ▪Primary prevention is the priority. ▪An understanding that risk factors for illness or injury can be individual or population based.
Settings for Community Health Nurses
▪Homes ▪Ambulatory service ▪Schools ▪Occupational health ▪Residential institutions ▪Faith communities ▪Community at large (domestic and international) ▪Mobile Health ▪Correctional Facilities
