nur 412 unit 1 / lecture 1: Epidemiology of Population-based Care/Introduction to Community Health Nursing
Public health ******
"activities that society undertakes to assure the conditions in which people can be healthy" PH, as a specialty of nursing practice, seeks to provide organizational structure, a broad set of resources, and the collaborative activities needed to accomplish the goal of an optimally healthy community ****** we broaden our view from a focus on the individual to families, aggregates, communities, and populations... ---> community is the recipient of care, health is the product PH is concerned with the interchange between population groups and their total environment and with the impact of that interchange of health ---> broadened beyond focusing on individuals, family as ancillary to focusing on families, aggregates, communities, populations great deal of evidence that shows health and illness are community (not just individual) issues - HIV/AIDS - TB - CVD - antibiotic resistance - terrorism - pollution many different professionals work in community health - PH - government - city planners - social workers - epidemiologists - politicians - law enforcement ---> the nurse is an integral member
Community health ******
"identification of needs and the protection and improvement of collective health within a geographically defined area"
Prison community
* living under same laws and regulations *
Group of farmers
* shared common interests * if you're a farmer, you worry about crops
Professional nurses
* shared goal = to care and help others * ex. ANA
Members of Mothers Against Drunk Driving
* shared goals * goal of getting people to stop driving drunk to prevent death of children
Citizens of a town
* you have common rights and privileges in the town * if you can't buy beer on Sunday at noon, no one can do that
Tiny village in Appalachia
*shared everything * share church, store, hospital, etc.
THE Essential Public Health Services operationalize the core functions
1. UNDERSTAND THE PROBLEM 2. PREPARE TO ADDRESS THE PROBLEM 3. ACT TO SOLVE OR PREVENT THE PROBLEM ---> Core functions were operationalized in 10 essential PH services delineated by the PH Functions Steering Committee led to the development of core competencies for PH professionals performing these functions core competencies reflect 8 domains of PH practice ---> Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Ensure competent public and personal health care workforces. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. CHN - not necessary that you provide all of these services - may work in collaboration with others - important to recognize respective roles/working towards same goal
Primary prevention
A nurse teaches the importance of folic acid to a group of pregnant women. This is considered which level of preventive care? Primary prevention Secondary prevention Tertiary prevention Quaternary prevention
Assurance
A population health nurse has identified an increase incidence in cases of myocardial infarction in her community in the last year. He/she is working on an initiative to improve the population's access to primary care clinics so that services like screenings for hypertension and hyperlipidemia can be more easily procured. The essence of this initiative falls under which core function of public health? Assessment Policy development Assurance Quality Improvement
Promote quality of life, healthy development and health behaviors across all life stages.
A population health nurse has made a personal goal of working to educate pregnant women about having healthy pregnancies and proper care of newborns. This example aligns most appropriately with which of the goals of Healthy People 2020? 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 health behaviors across all life stages.
Primary prevention
A population health nurse is working to distribute clean syringes to drug abusing sex workers. This is an example of which of the following? Secondary prevention Tertiary prevention Primary prevention Quaternary prevention
Acute Care Nursing & Public Health Nursing
Acute care nursing - care of solitary patients - primarily illness end of health continuum - promote health, get them better to go home and do ADLs Public health nursing - care encompasses a much wider vista - primary charge to prevent health problems - promote higher levels of health Client as equal partner - promote autonomy - encourage belief/understanding that health is their responsibility (must value action before acting)
PHN AS ADVOCATE, MANAGER, & COLLABORATOR
Advocate - pleader of the client's cause or actor on behalf of the client - support the client's self-determination and independence - make the system responsive and relevant to the client's needs - formulate policy ---> advocates must: - be assertive - take risks - communicate and negotiate well - identify and obtain resources for the client Manager - administrative direction of goals ---> plan, coordinate, lead, control, and evaluate - participative approach with community -> community mobilization Collaborator - joint working with others - schools, health agencies, health departments, etc. multidisciplinary collegiality and leadership
Promotion of health
All efforts that seek to move people closer to optimal wellbeing or higher levels of wellness Three-pronged effort 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 National health promotion goals - Healthy People 2030 - primary emphasis is achieving health equity and eliminating disparities among segments of the population by addressing the determinants that influence health **************** promotion of health is recognized as one of the most important components of public health and community health practice (most effective) goal = to raise levels of wellness - activities designed to foster a healthy lifestyle and develop a state of good health in the population (HP 2020 Goals) - includes many forms of health education (dangers of drug use, demo healthy behaviors) in the community HP - encompasses the development and management of preventive health care services that are responsive to community health needs - VISION = a society in which all people live long, healthy lives goals and desired outcomes for population health in the US have been operationalized in several sets of national objectives ---> HP2020...now an interactive website of data and info - HP began in 1979 w report from Surgeon General - HP 2020 released in 2010 with 600 objectives and 42 topical areas Health determinants as defined by HP 2020 - the range of personal, social, economic, and environmental factors that influence health status - include policy making, social factors, health services, individual behavior, and biology and genetics population health care is designed to improve overall health status of the public through modification of factors that influence health either negatively or positively national objectives guide design of care delivery systems and serve as a means for evaluating the effectiveness of pop health care
Prevention of health problems NEED TO KNOW THIS SLIDE ****************************** (slide 66) KNOW THESE DEFINITIONS ********************
Anticipating and averting problems or discovering them as early as possible to minimize potential disability & impairment Three levels: Primary - efforts to keep illness or injury from occurring Secondary - efforts to detect and treat existing disease before it is symptomatic Tertiary - reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function health assessment of individuals, families, and communities is an important part of all three levels of preventive practice - health status must be determined to anticipate problems and select appropriate preventive measures - CONTEXT matters
Competent communities facilitate healthy living
Collaborate effectively in identifying the problems and needs of the community. Achieve a working consensus on goals and priorities. - not everyone has to agree, but majority do Agree on ways and means to implement the agreed-on goals. Collaborate effectively in the required actions.
some notes on BIG GEMS
Behaviors - habits, lifestyle, smoking, drinking, obesity Infections - disease Genetics - ex. Cholesterol can be super high if this is in your genetic makeup Geography - ex. Rural places can only have 1 place to go; ex. Santa Barbara is all mountains, so the wind blows and fungus from the soil is brought up - immunosuppressed people are more likely to get fungal infection in lungs; pollution
Policy development
City ordinances that designate indoor smoking as illegal are an example of which core function of public health? Health promotion Assessment Assurance Policy development
1. Socioeconomic Factors
Clean water & sanitation projects
PHN AS CLINICIAN & EDUCATOR
Clinician - care provider - focus on holism, health promotion, and prevention while using expanded skills Educator - health teacher - role model - social marketing - plan for community-wide impact
CH Nursing roles
Clinician Educator Advocate Manager Collaborator Leader Researcher
4. Clinical Interventions
Diabetes management project
2. Changing the context to make the healthy choice the default
Eliminating supersized beverages
Qualities of a healthy community
Equity (lack of disparities) Strong economy and employment opportunities (lack of poverty) Education Health care & preventive health services A stable, sustainable ecosystem & environment Inclusive, equitable, & broad community participation Employ environmental strategies Engage multisector participation The capacity to assess & address their own health concerns Collaboration between partners Housing/Shelter Civic engagement Healthy public policy Access to healthy food Safety Opportunities for active living Transportation Empowered population Healthy child development Use data to guide & measure efforts
1. Socioeconomic Factors
Eradicating poverty
CH nursing characteristics (notes from her midterm powerpoint)
Field of nursing with a shift from individual to aggregate Conceptualizing the population as a unit separate from its members Focus on population-level outcomes Assess people in context (relationships) or population as a whole Actively reach out to all who might benefit "Upstream" investment in strategies ---> priority of preventive, protective, and health-promoting strategies over curative strategies Processes used include: - working with the client as an equal partner - mechanisms for public participation in health improvement - reducing disparities within the population Application of multiple strategies - attention to determinants of health and their interactions - creation of new evidence-based strategies are necessary to assure the best overall improvement in the health of the population - assess people in context Interprofessional collaboration = avoids fragmentation or gaps, ineffective solutions Recognizing that responsibility for population health is shared by many segments of society that must work collaboratively to achieve health Tertiary care uses up the greatest % of our healthcare dollars (less for primary, secondary) Evidence-based decision making - decision making based on scientific evidence of health status, health determinants, and effectiveness of interventions - demonstrated accountability for health outcomes
Primary prevention strategy
Fluoridation of water would be an example of a population-level: Primary prevention strategy Secondary prevention strategy Tertiary prevention strategy Quaternary prevention strategy
Types of communities
Geographic - city, town, neighborhood Common interest - church, professional organization, people with mastectomies Community of solution - group of people who come together to solve a problem that affects all of them ...in all cases, a collection of people chose to interact with one another because of common interests, characteristics, or goals ex. nurse employed by county would focus on county, but nurse employed by state health department would focus on all areas
Individual based nursing ******
Grounded in a relationship of caring Focuses on individual good (the patient) Restoration of health and function Manage resources at hand Take care of clients who come to them Commitment to individual patient
Population based nursing ****
Grounded in social justice Focuses on the greater good Health promotion and disease prevention Utilizes and organizes community resources Seek out clients in need - go into the community - address needs of peeps like homeless **** Commitment to the community as a whole
So, what are we prioritizing in HP 2030?
Healthy People prioritizes the issues that affect the health of the U.S. population collaboration of private and public organizations to set evidence-based national objectives aimed at improving the health of the population 1200 objectives across 42 topical areas ---> objectives focus on specific conditions and broader issues such as health disparities, access to care, dissemination of health-related info, strengthening of public health services, and addressing determinants ***** we may see more success if we focus energies at social determinants There are two types of Objectives: - measurable = include the current national baseline status of a health issue derived from existing reliable data sources, as well as the target for achievement by 2020 - developmental = no baseline data available and are targeted for development of national data collection systems and processes
Healthy People 2030 Overarching Goals THE GOALS ARE HIGHLIGHTED ******************** (slide 63)
High-quality, longer lives free of preventable disease, disability, injury, and premature death Health equity, eliminate disparities, and improve the health of all groups Social and physical environments that promote good health for all Quality of life, healthy development, and healthy behaviors across all life stages ----> This effort aims to improve the health of American citizens by establishing objectives & benchmarks that can be monitored over time (guidance). There have been Healthy People objectives for 2000, 2010, & now for 2020. Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Community characteristics of health have been described by the CDC as health-related quality of life indicators. - early descriptions included such things as rates of poverty and unemployment, levels of high school education, severe work disability, mortality rates, and the proportion of adolescent births
Settings for CHN Practice
Homes Ambulatory service Schools Occupational health Residential institutions Faith communities Government or private health agencies
Healthy People 2030 emphasizes population health in its mission **************
Identify nationwide health improvement priorities Increase public awareness and understanding of the determinants of health, disease, and disability and opportunities for progress Provide measurable objectives and goals that are applicable at the national, state, and local levels Engage multiple sectors to take actions to strengthen policies and improve evidence-based practices Identify critical research, evaluation, and data collection needs
The Concept of 'Health' know these definitions *************
Illness - the state of being relatively unhealthy Health ************* - a holistic state of well-being including soundness of mind, body, and spirit - not merely the absence of disease or infirmity ---> which includes: Wellness - health and the capacity to develop a person's potential, leading to a fulfilling and productive life - a relative state society suggests a polarizing either/or way of thinking about health, but: - wellness is relative, not absolute - illness is a state of being relatively unhealthy WHO's definition of health - a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity community health practitioners place a big emphasis on wellness - it includes the definition of health, but incorporates more... quality of life pre-requisites for health (WHO) - peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, equity Wellness - capacity = think Maslow's hierarchy of needs; measured in terms of quality of life - health is greatly affected by behaviors and environment - health is a state of being and must be approached holistically ---> physical, emotional status, status of home, family, work ---> community = physical, psychological, spiritual, SES factors consumers and providers often define health and wellness in different ways to clarify the concept for nurses who are considering CH practice, the distinguishing features of health are briefly characterized here; implications can be examined...
1. Socioeconomic Factors
Improving housing options
PHN AS LEADER & RESEARCHER
Leadership role - coalition building = process by which parties (individuals, organizations, or nations) come together to form a coalition - action as a change agent Researcher - systematic investigation, collection, and analysis of data for solving problems - evidence-based findings to community settings case finding and surveillance ---> Research process: - identify an area of interest. - specify the research question or statement. - review the literature. - identify a conceptual framework. - select a research design. - collect and analyze data. - interpret the results. - communicate the findings.
5. Counseling and Education
Nutritional consultation
Healthy People 2030
Our national health priorities are outlined and measured using __________________
Populations & Aggregates
Population - all people occupying an area or all of those who share one or more characteristics - people don't necessarily interact with one another or share a sense of belonging Aggregate - a mass or grouping of individuals considered as a whole who are loosely associated with one another - broader term
Key Components of Community Health Practice
Promotion of health Prevention of health problems
Community & Public Health Important to understand *****
Public health - "activities that society undertakes to assure the conditions in which people can be healthy" - broad set of resources - ex. Tobacco-free Florida - TB = can't live in the community; need to quarantine until you get your meds -> direct observational therapy (DOT) is needed if people refuse = public health issue Public health nursing - nursing that is community-based and, most importantly, population-focused - promotion, protection, and preservation of public health Community health - "identification of needs and the protection and improvement of collective health within a geographically defined area" Community health and Public health share many features - both are organized community efforts aimed at the promotion, protection, and preservation of the public's health - PH is historically associated with primarily with government entities (fed, state, local health agencies) that tackle a wide range of health issues - private health efforts and organizations (ACS, ALA) work towards solving selected health problems...which augments public efforts - Community health encompasses both approaches and works collaboratively with all...CH practice focuses on specific, designated communities; is part of the larger PH effort
3. Long-lasting, protective interventions
Receiving the flu vaccine
CH Nursing Characteristics (continued)
Shift from individual to aggregate Combines nursing science with public health science - community-based & population-focused - public health sciences & nursing theory Focus on population-level outcomes Emphasis on primary prevention ******** - ex. immunizations - ex. alter risk behaviors - ex. target certain neighborhoods = put up signs about STDs, condoms, testing - cuz there are many disparities with regard to sex behaviors
Key Categories of Social Determinants of Health IMPORTANT TO KNOW **************
Social Economic Status: ~~~~ Education - if you're more educated, it's more likely that you'll eat better, do pre-screening treatments like colonoscopy after 50, get dental hygiene ~~~~ Work + Income - you can afford better food and have access to preventative care - income helps you meet basic needs of Maslow's hierarchy - higher life expectancy if you work and have an income Social status - has influence on the other factors Social support - gay Hispanic middle aged men with no support had more sexual risk behaviors - very important - doesn't have to be from the family - you get lots of support from friends, coworkers, religious organizations Place + Housing - somewhere to live that is safe - ex. living in Miami with no AC - infection risk is higher - if sent home with wound care to home with no AC, that's a problem - rural - how far is the nearest facility? - advantage to rural is farming their own healthy food - ex. Cockroaches and asbestos in apartment - makes asthma worse, leading to pneumonia Transportation - people need to get places, which improves accessibility Food - McDonald's can feed a family of 4 very cheaply - farmer's market with fresh foods is expensive - need less expensive food if you're poor, which probably won't be very nutritious Access to health services - may not have access - rural - 1 hospital does it all and might not have everything that's necessary Culture + Religion - influences our behavior - acceptable to be a certain way or do certain things - Hispanics - sometimes when very ill and into Santeria, may do home remedies that won't help or will hurt them - Haitians will douche with botanics when their vaginas have issues, which will prob hurt them - colic when born - Hispanic mom made Dr. V smash and boil a plant -> she later read an article that said that this plant is toxic to babies Stress - doesn't help, only hurts - if a person is racially targeted - always worried and stressed
some factors that impact health
Socioeconomic status Education levels Environment Gender identity Culture - some don't go to the doctor until it's too late
Health involves both subjective & objective dimensions...
Subjective - how people feel Objective - how well people can function in their environment - observable - indicators of health: A man dresses and feeds himself and goes to work. A family nourishes its members through a supportive emotional climate despite financial exigencies A community provides adequate resources and services for its members. ----> Actions are motivated by values
Secondary prevention
The community health nurse is conducting screening for hearing defects at a local health fair. This is an example of: Primary prevention Secondary prevention Tertiary prevention Quaternary prevention
Public Health Nursing Aims To:
Understand the complex relationship between people/groups/social systems and health Use that understanding to improve population health
CH Nursing characteristics (Page 22) NEED TO KNOW ************** community health nursing - able to reach and help more people - use lots of evidence-based stuff - use optimal resources available
Unit of care/Client - population Primary obligation - greatest good for the greatest number of people Healthcare Priority - primary prevention ********** Process - clients are equal partners Strategies - creating healthy environmental, social, and economic conditions in which populations may thrive Collaboration - with professions, populations, organizations, and entities to most effectively promote and protect public health Resources - optimal use of available resources assures best overall improvement Methods - develop a means for measuring and analyzing community health problems and intervention effectiveness
Health Impact Pyramid
VERY IMPORTANT ****************** downward = increasing population impact upward = increasing individual effort needed Similar to Maslow but this is the public health model On a continuum - the bottom of the pyramid is what affects the most people - the top affects the least amount of people Most important to reach majority of people = socioeconomic factors **** - has the biggest population impact Most individual effort needed = counseling and education **** - has the biggest individual impact RDA - example of making default decisions healthy - hasn't reached everybody, so not on bottom of pyramid
Population based vs. Individual based nursing
VERY IMPORTANT NEED TO KNOW THE DIFFERENCES ***************** - know the characteristics of each slide 31
A. Teaching safe sex practices to teenagers
Which activity would reflect a community health nurse working at the primary prevention level? A. Teaching safe sex practices to teenagers B. Performing adult hypertension screening C. Encouraging women to do breast self-examination D. Helping with a postmastectomy exercise program
C. Providing skin testing for tuberculosis (PPD) to the homeless
Which is an example of secondary prevention? A. Planning an educational program on healthy lifestyles B. Discussing healthy menu planning with diabetic clients C. Providing skin testing for tuberculosis (PPD) to the homeless D. Transporting clients to Alcoholics Anonymous (AA) meetings
A population health nurse makes home health visits to investigate toxic exposures from a nearby park
Which of the following examples of essential public health services falls within the core function of assessment? A community forum is held to educate community members about a local Zika outbreak A population health nurse makes home health visits to investigate toxic exposures from a nearby park The state health department opens new satellite clinics to increase access to care in rural counties A population health nurse works with a local health agency to develop a new policy proposal
Changing the Context to make individuals' default decision healthy
second to bottom of health impact pyramid examples of ways to address this: - fluoridation - smoke-free laws - tobacco tax ex. putting fluoride in the water - not everyone has access to clean drinking water - will buy bottled water instead which doesn't have fluoride
Reporting a new case of cancer to the national cancer registry
Which of the following examples represents the core function of assessment? Reporting a new case of cancer to the national cancer registry Advocating for more stringent regulations on nutrition labels Providing health education classes to inmates with chronic conditions Training healthcare providers to counsel community members on healthy behaviors
Health promotion
Which of the following is NOT a core function of public health? Health promotion Assessment Assurance Policy Development
It is grounded in social justice
Which of the following is a characteristic of community health nursing? It is grounded in social justice It focuses on individuals It aims at restoring health and function It manages resources at hand
It is a group of people that have common interests that bind them together
Which of the following is true regarding communities of common interest? It is a group of people who come together to solve a problem It is a group of people that lives in the same geographic area It is a group of people that have common interests that bind them together It is a group of people that does not necessarily interact with one another
Health Disparity (unsupportive determinants of health are linked to a wide variety of diseases and unequitable disadvantages)
a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
Community Health nursing takes nursing to a whole new level
a synthesis of nursing knowledge and practice and the science and practice of public health to affect determinants that influence the health of population groups ****** community health is focused more on populations and groups combines nursing science with public health science - community-based and population-focused - public health sciences and nursing theory community health nursing adds public health knowledge and skills that address the needs and problems of communities and aggregates and focuses care on communities and vulnerable populations public health nursing is grounded in both public health science and nursing science, which makes its philosophical orientation and the nature of its practice unique it has been recognized as a subspecialty of both fields recognition of this specialty field continues with a greater awareness of the important contributions made by community health nursing to improve the health of the public
Assurance
availability of necessary services throughout the community ex. school health nurse, nurse in community center, enforcing laws that regulate smoke detectors/enforcing smoke detectors to give assurance of fire being alerted connecting to other quality health services - examples = home health nurse, PT, etc. benchmark institutions to determine best options availability of necessary services throughout the community link people to needed services and assure the provision of health care when otherwise unavailable assure a competent public and personal health care workforce mobilize community partners to identify and solve health problems conduct research into innovative solutions for health problems enforce laws and regulations that protect health and ensure safety ---> LISTED AS POLICY DEVELOPMENT IN TEXTBOOK evaluate the effectiveness, accessibility, and quality of personal and population-based health services ---> LISTED AS ASSESSMENT
Determinants of health - BIG GEMS
behavior infections genetics geography environment medical care socio-economic-cultural
Socioeconomic Factors
bottom of health impact pyramid the bottom is the most important part to help the most people ****** the least amount of individual effort needed examples of socioeconomic factors that can be addressed - poverty - education - housing - inequality ways to address socioeconomic factors: - reduce poverty - increase education - have housing for all - reduce inequities
Geographic community
city, town, neighborhood geographic boundaries - may vary in size, but have certain identifiable characteristics - ex. age, sex ratios - ex. communication networks - ex. facilities - ex. government institutions ---> many of these cities lie within a county/state a single part of a city can be treated as a community - cities are broken down in to census tracts, or neighborhoods it is helpful to delineate geographic areas because it allows for a clear target for analysis of health needs **** - basis for identifying and addressing problems - available data, easier to reach intended audience with education and media campaigns larger scale, global community - many health problems impact us on this level, so it is important to view the world this way
Concept of 'Community' Need to understand the examples ********
collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging humans are social creatures - we live our lives in the company of others - we can belong to many communities at once the community where we live/work can have a profound influence on our collective health and well-being - ex. obesity in US vs Guatemala/Tanzania. Stunting ---> from beginning, attempt to create healthier communities (ex. smoking and MSA, asthma and poverty, obesity and nutrition standards/toys in meals/advertising) Citizens of a town - * you have common rights and privileges in the town * - if you can't buy beer on Sunday at noon, no one can do that Group of farmers - * shared common interests * - if you're a farmer, you worry about crops Prison community - * living under same laws and regulations * Tiny village in Appalachia - *shared everything * - share church, store, hospital, etc. Members of Mothers Against Drunk Driving - * shared goals * - goal of getting people to stop driving drunk to prevent death of children Professional nurses - * shared goal = to care and help others * - ex. ANA
Continuous and Episodic Health Care Needs
continuous needs ~~~ developmental events - assistance with providing a toddler-proof home or establishing positive toilet-training techniques - help in effectively dealing with the progressive emancipation of preteens and teenagers - anticipatory guidance for reducing and managing the stress associated with retirement - help coping with the death of an aged parent episodic needs - birth of an infant with Down's syndrome - a head injury incurred from an automobile crash - a diagnosis of HIV/AIDS, tuberculosis, or another communicable disease
Core Public Health Functions: THE PROCESS OF PREVENTION NEED TO KNOW THIS SLIDE **************
core functions form the foundation for public health practice and public health nursing activities - foundational to all roles - directs PHN work - functions are applied at all levels - individuals, families, communities Assessment - systematic collection, analysis, and sharing of information about health conditions, risks, and resources in a community - ex. looking at morbidity and mortality rates of community - gather and analyze info Policy Development - use of assessment data to develop policy and direct resources toward those policies - ex. meet with community leaders to develop policies like speed bumps so people don't get run over, lights to prevent accidents, roundabouts Assurance - availability of necessary services throughout the community - ex. school health nurse, nurse in community center, enforcing laws that regulate smoke detectors/enforcing smoke detectors to give assurance of fire being alerted If law already exists, it's assurance If you're creating the law, it's policy development
Secondary prevention
efforts to detect and treat existing disease before it is symptomatic ex. - colonoscopy - mammogram - hearing and vision tests involves efforts to detect and treat existing health problems at the earliest possible stage, when disease or impairment is already present example screenings - HTN - cholesterol - BSE - mammograms - paps - TB skin test - testing of water or soil samples for contaminants and hazardous chemicals - to watch for early signs of child abuse attempts to discover a health problem at a point when intervention may lead to its control or eradication
Primary prevention
efforts to keep illness or injury from occurring ex. - immunizations - fluoridation - nutrition campaigns - smoking cessation campaigns applied to a generally healthy population and precedes disease or dysfunction examples - childhood vaccinations - encouraging elderly to install/use safety devices to prevent falls - teaching young adults healthy lifestyle behaviors, so that they can make them habitual behaviors for themselves and their children - working through a local health department in consultation with a school district to help control and prevent communicable diseases such as rubella, poliomyelitis, or varicella by providing regular immunization programs and vaccine oversight involves anticipatory planning and action on the part of community health professionals, who must project themselves into the future, envision potential needs and problems, and then design programs to counteract them so they never occur
Common interest community
ex. church, professional organization, people with mastectomies collection of people (despite location) can have common interests that bind them as members examples - nurses in a professional organization - disabled mobilized to improve the built environment - victims of domestic violence - environmental protection common interest is a mobilizing force for action ex. MADD - established the federal legal minimum drinking age - established the standard blood alcohol levels of 0.08% - defended sobriety checks in front of SCOTUS - responsible for 30 year low in alcohol-related traffic deaths
The Human Genome Project
genomics the identification and plotting of human genes and the study of the interaction of genes with each other and the environment
Community of solution
group of people who come together to solve a problem that affects all of them varies with nature of the problem, size of area affected, number of resources needed to address problem can be a conduit of change when admin/political barriers get in the way ex. water pollution problem may involve several counties whose agencies and people must work together to control upstream water supply, industrial waste disposal, and city water treatment ex. schools collaborating with law enforcement and health agencies, legislators, policy makers to study patterns of substance abuse among students & design possible interventions ex. groups formed to address HIV/AIDS, obesity, clinical CVD prevention in rural areas (Heartbeat Connections)
Confusion over the meaning of "CH nursing" arises when defined only in terms of where it is practiced.
health care services have shifted from the hospital to the community many nurses in other specialties now practice in the community ex. home health care, community mental health, geriatric nursing, long-term care, and occupational health although CHNs today practice in the same or similar settings, the difference lies in applying the PH principles to large groups and communities of people—or having a population focus ---> requires a shift in focus—from individuals to a broader focus on aggregates and populations
Alma-Ata Declaration, 1978
healthcare should be available for all - 1978 - disparities were realized officially - objective was health for all people of all nations
We are constantly interacting with & influenced by our surroundings
individual - age - income, education - attitudes, beliefs - trauma - mental health history relationship - family - peers - partner - other social networks community - neighborhoods - schools - workplace - social or religious organizations societal - social and cultural norms - policy
The Health Impact Pyramid IMPORTANT TO KNOW - HAVE TO PLACE ON THE TIERS ****** - KNOW THE EXAMPLES AND ONES FROM THE BOOK
is a useful framework for identifying the ways in which we can support communities 1. Socioeconomic Factors - bottom - the most important part of the pyramid to help the most people ****** 2. Changing the Context to make individuals' default decision healthy - second to bottom 3. Long-Lasting, Protective Interventions - third to bottom 4. Clinical Interventions - second from top 5. Counseling and Education - top - most individual effort needed ****
Public health nursing ******
nursing that is community-based and, most importantly, population-focused
There are WAY TOO MANY health disparities impacting vulnerable populations
noncommunicable disease: Coronary heart disease - Black men and women more likely to die of heart disease and stroke Colorectal cancer screening - as education and income increase, screening rates increase - usually need education and income for this - procedure, day or so off of work to prep and do it - not everyone can take 2-3 days off of work environmental health: Air pollution - racial/ethnic minority groups are more likely to live in the most polluted urban areas and experience a larger impact Motor vehicle crashes - men of all races/ethnicities are 2-3x more likely to die in crashes than women - death rates are 2x as high among American Indians/Alaska Natives communicable disease: HIV/AIDS - racial (Black & American Indian/Alaska Native) & sexual minorities (MSM) experience disproportionately high rates of HIV diagnosis Influenza vaccination - whites aged 65 years and older have consistently higher rates of vaccination coverage
Pharmacogenomics
permits the design of drugs tailored to a person's genetic makeup or to a targeted disease
primary goal of Healthy People 2030
primary emphasis is achieving health equity and eliminating disparities among segments of the population by addressing the determinants the influence health ****************
Tertiary prevention
reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function ex. - HIV medication or counseling with regard to safe sex - bariatric surgery requiring nutritional counseling prior to getting cut open already have disease examples - rehab after stroke to reduce impairment - post-mastectomy exercise programs to restore functioning - early treatment and management of diabetes to reduce problems or slow their progress individuals involved have an existing illness or disability whose impact on their lives is lessened through tertiary prevention in broader community health practice, tertiary prevention is used to minimize the effects of an existing unhealthy community condition ---> examples of such prevention are: - insisting that businesses provide wheelchair access - warning urban residents about the dangers of a chemical spill - recalling a contaminated food or drug product when a community experiences a disaster such as an earthquake, a fire, a hurricane, or even a terrorist attack, preventing injuries among the survivors and volunteers during rescue is another example of tertiary prevention—eliminating additional injury to those already experiencing a tragedy.
Clinical Interventions
second from top of health impact pyramid examples - medicine for high BP - medicine for diabetes
Assessment
systematic collection, analysis, and sharing of information about health conditions, risks, and resources in a community ex. looking at morbidity and mortality rates of community gather and analyze info identify the health needs of the population to make informed decisions ex. - birth/death rates - prevalence/incidence - accidents/injury, diseases, etc. monitor health status to identify health problems - via interviews, surveys, public records (available online!), research findings (requires trust = access) diagnose and investigate health problems and hazards in the community
Wellness
the capacity to develop a person's potential, leading to a fulfilling and productive life
a good tip
you should define a community before targeting them to help
wellness-illness continuum
the level (degree) of illness increases as one moves toward total disability or death the level of wellness increases as one moves toward optimal health society suggests a polarizing way of thinking about health - but wellness is relative, not absolute, while illness is a state of being relatively unhealthy ****** the continuum can apply to individuals, families, communities there are many levels and degrees of wellness and illness - a 75 year old who is active and functioning at an optimal level of wellness is robust - a 75 year old with end-stage renal disease is frail - someone recovering from pneumonia may be mildly ill - a teenage boy with functional limitations because of episodic depression may be described as mildly well community health practice ranges across the entire health spectrum - it always works to improve the degree of health in individuals, families, groups, and communities **** - in particular, community health practice emphasizes the promotion and preservation of wellness and the prevention of illness or disability (by thinking of health relatively, as a matter of degree) scope of nursing practice can be broadened to focus on preventing illness or disability as well as promoting wellness - traditionally, most health care has focused on treatment of acute and chronic conditions at the illness end of the continuum - gradually, the emphasis is shifting to focus on the wellness end of the continuum, as outlined in the government document, Healthy People 2020, which emphasizes that individual health is linked to community health health can be subjective or objective - how people feel vs how well they can function in their environment health care needs can be: - continuous = toddler-proof home, coping with death, dealing with stress of retirement or - episodic = one-time, unexpected, negative-health event such as the birth of infant with Down syndrome, head injury from car crash, communicable disease
Epigenetics
the study of human gene activity changes not involving alterations in DNA that can be passed from one generation to the next
Long-Lasting, Protective Interventions
third to bottom of health impact pyramid examples - vaccines - smoking cessation - colonoscopy
Counseling and Education
top of health impact pyramid the most amount of individual effort needed smallest amount of people impacted examples - eat healthy and exercise
false A community of solution is a group of people who come together to solve a problem that affects all of them
true or false: A community of solution is based on its location.
Policy Development
use of assessment data to develop policy and direct resources toward those policies ex. meet with community leaders to develop policies like speed bumps so people don't get run over, lights to prevent accidents, roundabouts develop policies and plans that support health - enhanced by assessment data ensure legislation and laws are promotive of public health - that policies are being enforced - ex. ACA - legislation to promote public health
