H
Public health intervention wheel
3 important elements: population based, contains 3 levels of practice (community, systems, and individual/family), and identifies/defines 17 public health interventions 17 interventions (definitions of each on pg 15) Surveillance, disease and other health event investigation, outreach, screening, case finding, referral & follow up, case management, delegated functions, health teaching, counseling, consultation, collaboration, coalition building, community building, advocacy, social marketing, policy development and enforcement
Edward Jenner
Discovered smallpox vaccine
Public health efforts focus on prevention and promotion of population health. The local level of the health care system provides direct services to community members through community and personal health services. An example of a health service that targets the larger community, rather than individuals, is (Select all that apply.)
a mobile immunization clinic. condemning or repairing unsafe housing. airing a weekly public service announcement to remind women to do breast self-examination.
The use of theory in population-focused community health nursing encourages (Select all that apply.)
a proactive approach to care. development of population-focused programs.
Health Promotion
any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health motivated by the desire to increase well-being and reach the best possible health potential ex: health screening elementary school children (hearing, vision, BP, etc), veggie fair/farmers market for the community
Health Protection
behaviors one engages in w/ specific intent to prevent disease, detect disease in the early stages, or to maximize health w/in the constraints of the disease Ex: immunizations, cervical cancer screening (pap smear)
Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to
improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident.
Contemplation
intend to start the healthy behavior in the foreseeable future (w/in the next 6 mos). recognize their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both may still feel ambivalent toward changing their behavior.
Population-focused care
interventions aimed at health promotion and disease prevention that shape communities overall health status
Aggregate
is a community composed of people who have common characteristics Catholic community: religious Native American: ethnic School children: characteristic
Science of public health
scientific foundation of public health that brings together other sciences including environmental science, epidemiology, biostatistics, biomedical sciences, and social/behavioral science
Modifiable risk factors: can take actions to change
smoking/tobacco/drug use, diet, sedentary lifestyle/lack of exercise, activities, etc tobacco is the leading cause of preventable death
Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2015), community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing
sociocultural issues
Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by
supporting political activities to improve social and environmental conditions of immigrant families
Risk
the probability that a specific event will occur in a given time an exposure that is associated w/ a disease something that increases a person's chances of developing disease
Top 3 upstream determinants/challenges
#1 economics (poverty) #2 political (lawmakers) #3 environmental factors
Clara Barton
Civil War; distributed supplies & care to wounded soldiers Founded American Red Cross
Evaluation
Evaluation includes reflecting on each previous stage to determine strengths and weaknesses. Process evaluation, also called formative evaluation, would allow one to change the project while it is being implemented.
Macro: society or social economic factors influencing health status
Ex: removing the lead from the water, changing the water source, providing everyone w/ water filters Involves upstream thinking
Which theory is based on the assumption that individual needs and related activities are the focus of nursing care?
Orem's self-care deficit theory
Aggregate
Subgroups/subpopulations with some common characteristics or concerns
Joseph Lister
Surgeon who introduced new ideas of cleanliness in the 1800s; sterile technique
Edwin Chadwick
Used science for social improvement; 1834 Poor Law Amendment Act in England
Nonmodifiable: cannot be changed
age, sex, genetics
Receiving immunizations, regular health screenings, and physical examinations is an example of
health protection.
It has been estimated that individual behaviors and environmental factors are responsible for what percentage of all premature deaths in the United States?
50%
The Nature of Community
A community of common interest is one that has common activities and goals A community of solution is one when people have a common problem that unites them Geographic community can encompass less formalized areas that lack official geopolitical boundaries Social system: relationships that community members form with one another
Which is an example of "community health nursing" rather than "community-based nursing"?
An RN reviewing school clinic records to determine which children are not up to date on their immunizations
Other Sources of Health Data
By comparing baseline data, the nurse can construct benchmarks to gauge the achievement of program objectives. Epidemiological data are also important for documentation of a program's long-term effectiveness. The National Center for Health Statistics compiles annual National Health Survey data. It also publishes reports on prevalence of disability, illness, and other health-related variables. It tracks trends by nation, state, and year. The state health department records, state department of vital statistics, and the Centers for Disease Control and Prevention will not provide all of the data that the nurse is trying to find.
Census Data:
Census information is collected every 10 years by the US Census Bureau to describe the population characteristics of the nation. The value of the Census Bureau data is in clarifying the distribution of age, sex, race, and ethnicity of the community, which may also suggest health needs. The Census Bureau does not collect data on mortality and morbidity.
Community
Collection of people who interact w/ one another and whose common interests/characteristic form the basis for a sense of unity and belonging Geopolitical communities: defined/formed by natural and/or manmade boundaries and include cities, countries, states, and nations Phenomenological communities: people share a group perspective or identity based on culture, values, history, interests, and goals (Ex: schools, churches, social networks) Community of solution: collection of people who form group specifically to address a common need or concern
Major Features of a Community
Community health nurses focus care on health needs of aggregates; however, individuals, families, and groups are important parts of aggregates. Appropriate nursing care and health promotion planned for aggregates affect individuals and vice versa. Use of the nursing process is one part of health planning for the community. Geography or physical location may define communities. Census tracts subdivide larger communities. The US Census Bureau uses them for data collections and population assessment. Geographic location strongly influences the nature of health problems
Local level health services
Community health services: include protecting public from hazards like polluted water and air, tainted food, and unsafe housing Personal health services: immunizations, family planning services, well-infant care, STD tx
Social health
Connotes community vitality and is the result of positive interaction among groups w/in the community, with an emphasis on health promotion and illness prevention Ex: community groups sponsoring food banks to help alleviate probs of hunger & nutrition
Lemuel Shattuck
Created fundamental public health doc about unsanitary conditions causing poor health in America Began recording health statistics which led to an increase in life expectancy
Florence Nightingale
Crimean War; documented successes of saving lives and health systems Prevented needless illness & death Opened first SON, St. Thomas Hospital SON Rathbone then hired her grads & opened own SON in UK
William Rathbone
Developed district nursing in England (after hiring home nurse for fam member) Expanded services to sick/poor people w/ Nightingale
Health Planning Model
Differs from the customary nursing process applied to the care of an individual. The nurse decides which aggregate to focus on and then carefully defines that aggregate. Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but only those services that each participant needs.
Levels
Downstream- immediate health needs Interventions: changing effects of the cause (ensure chronic disease prevention are even accessible to low income people) Midstream- intermediary determinants (what someone is doing in their personal life; smoking, unhealthy eating, etc) Interventions: changing the causes (help pts get resources they need to live healthier) Upstream- structural determinants (3 determinants) Interventions: diminishing causes-of-the-cause (advocate for policies that support living wage; ex: seatbelt and helmet laws)
Downstream thinking
Downstream: more focused on treating disease rather than preventing it; requires more effort and reduces the health of the people Ex: downstream focus would be performing bariatric surgery on an obese pt, whereas upstream thinking would be preventing obesity by promoting health food choices and offering exercise programs to public
Intervention
During the intervention step of the Health Planning Model, the nurse must prepare for unforeseen problems or complications and consider alternatives to meet the client's needs. Although implementation should follow the plan, the nurse must also prepare for unexpected problems. If the project fails, it is crucial to analyze what went wrong so it can be avoided in the future. Planning for the unexpected and unplanned events is the best response as it encompasses a variety of things that may go wrong. Interventions are seldom successful unless the aggregate has input into determination of need, its priority, and appropriateness of the intervention. Interventions should be included from a range of strategies, including mass media (public service announcements, radio, television, billboards), general information dissemination (e.g., pamphlets, DVDs, CDs, posters), electronic information dissemination (e.g., websites, blogs, tweets, video stream), and public forums (e.g., town meetings, focus groups, discussion groups). Intervention levels apply to aggregates, communities, or individuals.
Planning
During the planning step, the nurse determines which problems or needs require intervention and identifies the desired outcomes or ultimate goals of the interventions. The nurse must validate the practicality of any planned intervention. This can best be accomplished by examining if there are adequate resources for the project. Interest of other staff members, support from administration, and the nurse's time and energy should all be considered, but are irrelevant if there are not enough resources to implement the project.
Secondary
Early detection and prompt intervention during period of early disease pathogenesis Implemented after problem has begun but before S&S appear Ex: mammography, BP screening, scoliosis screening, pap smears
Micro: individual pt
Ex: treating individuals impacted by the Flint Water Crisis
Community health
Extends realm of public health to include organized health efforts at community level through both government and private efforts.
A major limitation of the Health Belief Model is that the burden of action related to health behaviors is exclusively on the aggregate.
FALSE A major limitation of the Health Belief Model is that the burden of responsibility for health behaviors is on the individual client.
John Snow
Father of public health Cholera epidemic in Europe 1854- argued disease was not inhaled but ingested through mouth Led to discovery of contaminated well pumps (on Broad Street). Once they removed the pump handle the epidemic disappeared
Which nurse leader formulated the first theory-based conceptual model for nursing care?
Florence Nightingale
Pender's Health Promotion Model
Focuses on helping people achieve higher levels of well-being Encourages health professionals to provide positive resources to help patients achieve behavior specific changes The goal is not helping patients prevent illness but to look at ways to pursue better health or ideal health Assumptions Individuals strive to control their own behavior Individuals work to improve themselves and their environment Health professionals influence individual's behavior Self-initiated change of individual and environmental characteristics is essential to changing behavior.
Lillian Wald
Founder of public health nursing House on Henry Street/Henry Street Settlement Saw many poor immigrants on Lower East Side, NY and knew they deserve better care/living conditions Moved to Henry Street w/ Lillian Wald and established a nursing district People came to the nurses for health care that physicians weren't providing bc the people were unable to pay Wald provided services/home visits/education for a small fee Settlement's role was "one of helping people to help themselves" Led to formation of youth clubs, a juvenile program, sex edu for local schoolteachers, and support programs for immigrants Organization was later called Visiting Nurse Association of New York City
Population
Group of people w/ common personal or environmental characteristics
Mary Breckinridge
Improved the health of children Frontier nursing service (rode around on a horse through mountains) Determined healthcare must begin before birth
Nursing Diagnosis
Increased risk is the identified problem. The identification of the health problem represents a synthesis of all assessment data. Among the identified aggregate that will be the beneficiary of the nurse's action plan. The "related to" phrase describes the cause of the health problem and directs the focus of the intervention. As demonstrated is the evidence or support for the diagnosis. The health indicators are the supporting data.
thinking upstream
It is a conceptual model to assist the nurse in community health planning. It helps to focus the time, energy, and programmatic resources available to community health nursing clients. It focuses the nurse on long-term, "bigger picture" issues related to community health practice, such as social justice or power.
The Community as Client
It is essential that community health nurses understand and are comfortable with the concept of "community as client" before participating in health care planning. When focusing on the individual or family, nurses must remember that these clients are members of a larger population group or community, and environmental factors influence them
community assessment
It provides information about the community's current health status, needs and issues. A community assessment gives organizations comprehensive information about a community's current health status, needs and issues. This information can help develop a community health improvement plan by justifying how and where resources should be allocated to best meet community needs.
Health Belief Model
Kurt Lewin Behavior is based on current dynamics confronting the individual rather than prior experience Based on an individual's perception of current situation Perceived seriousness - what will happen to me Perceived susceptibility - will this happen to me Perceived benefits of treatment - will I not get the condition Perceived barriers to treatment - what is preventing me from making this change Cues to action - what is happening to me Self-efficacy- can I do it
The belief that health deficits result from an imbalance between the population's health needs and its health-sustaining resources is the premise of which theory?
Milio's framework
A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include (Select all that apply.)
Morbidity mortality life expectancy cancer incidence rates
Health Planning Models in Public Health
Most interventions occur at the individual level and include all prevention levels. For most C/PHN time does not permit intervention at the suprasystem level. The suprasystem includes a variety of organizations and community resources which can positively or negatively impact a client's health. P= predisposing factors: The knowledge, attitudes, behavior, beliefs, and values before intervention that affect willingness to change R= reinforcing factors: The positive or negative effects of adopting new behavior (including social support) E= Enabling factors: The environment or community of an individual that facilitates or presents obstacles to change Successful programs rely on empowering citizens to make decisions about their care. Empowering citizens causes power to shift from health providers to community members. Many prefer to remain in positions of power rather than sharing. Client ideas must be included in the planning process in order to get them involved. Empowerment will lead the clients to change their lives.
Major upstream challenge is poverty
No money, No jobs, No quality childcare, Inferior schools, Unsafe neighborhoods, Unstable housing, Limited access to healthy food, Poor access to transportation, No access to healthcare The downstream effects of these upstream challenges Heart disease, Stroke, Diabetes, Respiratory conditions, obesity
Dorothea Dix
Observed poor health conditions in prisons w/ Rathbone Created a report to Massachusetts gov't leading to hospital for mentally ill, which improved their living conditions
Which "determinants of health" refers to factors that are experienced with the senses-things that can be seen, touched, heard, and smelled?
Physical environment
Providing population-based care... shift in thinking
Populations are not homogeneous; must address the needs of special subpopulations High-risk and vulnerable subpopulations must be identified early in the care delivery cycle Nonusers of services often become high-cost users; essential to develop outreach strategies Quality and cost of all health care services are linked together across the healthcare continuum
Public health nursing (PHN)
Practice of promoting and protecting the health of populations. Population-focused
Primary
Preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals Consists of 2 elements: general health promotion and specific protection Ex: encouraging regular exercise, promoting good nutrition, immunizations, seat belt use, water purification Main focus of PHN
Levels of prevention (table pg 8)
Primary, Secondary, Tertiary
Community health nursing
Process of delivering nursing care to improve the health of a community
Healthy Communities
Productive functioning of a community is its ability to respond effectively to changing dynamics and meet the needs of its members. Communities can have a unique perspective that differs from that of the C/PHN on what defines critical health quality. The members of the community will define what the issue is
Which entity strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities?
Public health system
Prevention vs Cure
Spending $$ on prevention is more beneficial and improves the health of the people more than spending money on cures Thinking upstream (prevent diseases rather try to find fixes for them) U.S. policy makers must become committed to achieving improved health outcomes for the poor and vulnerable populations.
Health
State of complete physical, mental, and social well-being and not just the absence of disease or illness. State which an individual or group is able to realize aspiration & satisfy needs and can change or cope w/ the environment. Seen as resource for everyday life, not the objective of living. A positive concept emphasizing social and personal resources and physical capacities.
Tertiary
Targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation Prevent health problems from getting worse, reduce effects of illness/injury, and restore individuals to optimal level of functioning Ex: insulin injection teaching, diabetic disease mng, referral for PT/OT for pt w/ spinal cord injury
A community health nurse explores a group of teenagers' beliefs about the seriousness of eating disorders and their related susceptibility. The nurse is applying principles from which theory?
The Health Belief Model
Assessing the Community: Sources of data
The easiest way to obtain an overview of the community is through a windshield survey by driving or walking throughout the area and making organized observations. Sometimes referred to as Shoe leather epidemiology it refers to establishing hypotheses about the community's health, strengths, and possible problems through the down-to-earth approach of traveling through the area, and observing and interacting with community members.
Diagnosing Health Problems
The identification of the health problem or risk represents a synthesis of all assessment data. Epidemiology involves the analysis of health data to discover the patterns of health and illness distribution in a population. It also involves conducting research to explain the nature of health problems and identify aggregates at increased risk.
Assessment
The nurse gathers information about the needs of the community during the assessment step. The nurse needs to interview key informants in the community to gather data about the health of the community. Successful programs rely on empowering citizens to make decisions about their care. Empowering citizens causes power to shift from health providers to community members. This sometimes causes problems as many health care providers prefer to remain in positions of power rather than sharing. Client ideas must be included in the planning process in order to get them involved. Empowerment will lead the clients to change their lives.
Needs Assessment
The nurse must understand the community's perspective on health status, the services used or required, and their concerns. Official data do not capture this type of information. Data collected directly from an aggregate may be more insightful and accurate.
community assessment
The nurse partners with the community members to identify the community's problems and come up with solutions to improve the community's health by developing upstream solutions. To do this one needs to define the community and describe its characteristics. The comprehensive assessment data is essential for developing effective primary prevention interventions. This gathering of data is one of the core public health functions
Vital Statistics
The official registration records of births, deaths, marriages, divorces, and adoptions form the basis of data in vital statistics. When compared with previous years, vital statistics provide indicators of population growth or reduction.
Upstream thinking
Upstream: examining the origins of disease, nurses identify social, political, environmental, and economic factors that often lead to poor health options for both individuals and populations. Refocus the efforts of nurses "upstream," where the real problem lies
Healthy People 2020
Vision: a society where all people live long, healthy lives Goals Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development and healthy behaviors across all life stages Determinants of health Physical environment- biggest influence "zip code" Social environment Individual behavior Biology and genetics Health services Leading health indicators Access to health services, clinical preventive services, environmental quality, injury & violence, maternal/infant/child health, mental health, nutrition/physical activity/obesity, oral health, reproductive/sexual health, social determinants, substance abuse, tobacco use Each can affect the health of individuals and communities and can be correlated w/ leading causes of morbidity and mortality
The CDC defines community assessment as
a health assessment that identifies key health needs and issues using a systematic/comprehensive data collection and analysis.
Disease prevention activities protect people from disease and the effects of disease. An example of primary disease prevention is
administering vaccines to children before kindergarten.
Transtheoretical Model
an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health-related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.
Public health
art and science of preventing disease, prolong life and promoting health organized community efforts to benefit each citizen. Mission: social justice; entitles all people to basic necessities, such as adequate income and health protection, and accepts collective burdens to make it possible. Assumes its society's responsibility to meet basic needs of the people --> leads to greater need for public funding of prevention efforts to enhance health.
A microscopic approach to the community health problem of childhood obesity would focus on
asking an obese child and his or her parent(s) to complete a 24-hour food diary.
The community health nurse is teaching a prenatal class and includes the societal cost of fetal alcohol syndrome in one of the educational sessions. The nurse is demonstrating an understanding of
critical theoretical perspective.
Precontemplation
do not intend to take action in the foreseeable future (w/in the next 6 mos) often unaware their behavior is problematic or produces negative consequences People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior
Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a
food bank in a local church.
Using theory to guide community health nursing practice serves to (Select all that apply.)
guide data collection and interpretation in a clear and organized manner. improve community health nursing practice. focus the student on factors that are critical to understanding the situation.
Termination
have no desire to return to unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs
Action
have recently changed their behavior (w/in last 6 mos) and intend to keep moving forward with that behavior change may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.
Maintenance
have sustained their behavior change for a while (more than 6 mos) and intend to maintain the behavior change going forward. work to prevent relapse to earlier stages
Community assessment
is the process of identifying the strengths, assets, needs and challenges of a specified community. Assets refer to the skills, talents and abilities of individuals as well as the resources that local institutions contribute to the community.
Primary concern of C/PHN
is to improve the health of the community. C/PHN use all the principles and skills of public health practice which involves using demographic and epidemiological methods to assess the community's health and diagnosis its health needs. In doing this it is also important to ensure that the majority of people receive the maximum benefit.
Risk reduction
proactive process enables individuals to react to actual or potential threats to health
Risk communication
process of informing public regarding threats affected by perceptions, process, and actions
Preparation (Determination)
ready to take action w/in the next 30 days start to take small steps toward the behavior change, and believe changing their behavior can lead to a healthier life
community-based nursing
refers to setting and practice of the nursing role. Focus primary at family and individual levels