NUR 440 Exam 2

Millennium Development Goals (United Nations, 2000, 2006)

Target date of 2015 1. Eradicate extreme hunger and poverty 2. Achieve universal primary education 3. Promote gender equality, and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other infectious diseases 7. Ensure environmental sustainability 8. Develop global partnerships

Bill & Melinda Gates Foundation

1. "Everyone should care about these problems and, if we can show a path, I think they will get involved so that the rate of progress can be far more rapid than it's been in the past."

Hurricane Maria September 20, 2017 -Vulnerability -Environment -Direct and Indirect casualties

1. Natural disaster -Mass Casualty For days, there were few workers from the Federal Emergency Management Agency or troops to help organize and distribute supplies. And most of the fuel delivered as part of the relief effort was stuck in San Juan because roads weren't passable and truck drivers couldn't get to work. That means that even the highest-priority facilities — namely, the island's 69 hospitals — haven't been able to operate at full capacity. 2. About 100 people died in the three days after the storm in the Lajas region, twice the typical rate, according to a local funeral director. Some of those , directly related to a shortage of medical supplies. "We don't know if they didn't have enough medicine, or oxygen — all of them were without electricity after the hurricane," said funeral director Francisco Velez. And, tragically, as Carmen Yulín Cruz, mayor of Puerto Rico's capital San Juan, asserted in an impassioned plea, people may still be dying because the relief effort has been moving so slowly. "I am begging, begging anyone who can hear us to save us from dying," she said. "If anybody out there is listening to us, we are dying, and you are killing us with the inefficiency." 3. This also had *indirect casualties* - this area is where many supplies needed for hospitals are manufactured. As a direct result of this hurrincaine there is a nationwide shortage of Normal saline and multiple medications including morphine, diluadid, reglan and my personal favorite Tordol. Causing acutual problems that relate directly to us. 4. Tom Gallagher, CEO of the American Radio Relay League (ARRL. Stalwart volunteers for ARRL, a national association for ham radio enthusiasts, are providing real-time dispatches from the Caribbean. A tactical team of 50 bilingual hams, recruited by the Connecticut-based ARRL, will be deploying to Puerto Rico for three weeks to assist the American Red Cross. Their primary objective will be submitting survivor information to agency's Safe and Well system, which lets people know their loved ones are safe. 5. Ham radio is an older technology, archaic by some modern standards, but highly customizable. Hobbyists must pass a test to obtain a license, so the term "amateur" is something of a misnomer. As of 2015, there were 726,275 hams in the US, and six million worldwide. 6. Vulnerability: age, pre-existing health problems, degree of mobility, emotional stability. Many poor and elderly they had no where to go- many elderly stranded 7. ENVIR/TYPE: (phys, chem, bio & social factors) phys factors (time, food available, functioning utilities); contaminated water, loss of family, no safe structures, aging power grid 8. TIME/PROX: e.g., warning before a tornado or hurricane;, warnings ignored before Johnstown, warnings heeded before Hurricane Patricia/ The Christmas Tsunami happened during tourist season 9. INDIV PERCEP/RESP: sometimes after people have a stronger reaction than prior to.

Health Delivery Strategies for Women

1. Offer opportunities to promote health and detect disease at an early stage. 2. Many women seek information that will allow them to be in control of their own health. -giving info on support groups, classes, offering screenings 3. Women desire to become more knowledgeable about their own health. 4. Health promotion for low-income, underserved women may differ from that for middle-class women. -caring for low income underserved vs high income involves a very different approach -high income wants expert, low income wants to feel connection with someone in lower class -low income wants to learn in community setting, don't want to go to hospital or travel far -someone who is relatable and not talking down -higher income more likely to go to classes, self help groups, books to read

forensic nursing

1. application of the nursing process to public or legal proceedings, and the application of forensic health care in the scientific investigation of trauma and/or death related to abuse, violence, criminal activity, liability, and accidents

correctional nursing

1. specialized subset of forensic nursing

sexual assault nurse examiner (SANE)

1. specially trained registered nurse who applies the nursing process during forensic examinations to victims or perpetrators of sexual assault

globalization

1. the process of increasing social and economic dependence and integration as capital, goods, persons, concepts, images, ideas, and values cross boundaries (increasing interdependence between countries)

Application of the Nursing Process -for individuals within the family, the family as a whole, and the family's aggregate

Fundamental approach to a family interview/visit: 1. Self knowledge of previous life experiences and values 2. Gather: -Referral information -Assessment forms -Intervention tools (screening materials, supplies) 3. Be flexible

OASIS

Outcome and Assessment Information Set (OASIS) 1. Form/data set that determines Medicare pay rate and measures outcomes of adult home care patients to monitor outcome-based quality improvement. 2. Includes sociodemographic, environmental, support system, health status, and functional status attributes of an adult patient. 3. Mandatory for all Medicare and Medicaid patients receiving skilled care.

Why is Home Health Utilization on the Rise in the US?

1. Aging population 2. Lower costs associated with home health care 3. Insurer support for home health services -Medicare coverage - considers home health an alternative to institutionalization 4. trying to avoid treating pts just when sick -preventing exacerbations

Educational Preparation for a Home Health Nurse

1. BSN and QSEN competencies -Autonomy and Critical thinking skills! -BSN preferred due to being more autonomous -ability to assess patient's family and community as well 2. Home care nurse serves as case manager -Ability to manage an interdisciplinary team 3. Nursing Process & Health Planning Process

Nursing Strategies based on Systems Theory

1. *Assess* system, subsystems, suprasystem -Identify their Internal structure --Family composition, gender, rank order, functional subsystem, and boundaries (does mom or dad make rules) -Identify their external structure --Extended family and larger systems (work, health, welfare) --Context: ethnicity, race, social class, religion, environment 2. Interview families to assess response to events & identify health needs 3. Consider how the family reflects needs/gaps in the suprasystem 4. Identify resources (other subsystems within the suprasystem) to support the family 5. Address needs & gaps through advocacy, community health planning, or health policy 6. Expand family capacity by working with family subsystems

Hospice Care

1. *Definition:* focuses on caring for people facing a terminal illness -Care shifts from curative to comfort -life expectancy less than 6 mo but doesn't have to be 6 mo actually -getting pt away from stress of appts, chemo, med side effects—> enjoy final days 2. Patient criteria for hospice care? 3. *Goal:* Each patient will die pain free and with dignity, while providing ongoing family support

Emergencies vs Disasters

1. *Emergencies* are events that can be managed by agencies, communities, families, or individuals using their own resources 2. "A *disaster* is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources." -But a disaster event, depending on the characteristics of the disaster, may be beyond the ability of the community to respond and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community, both for management of resulting issues and for recovery. -*Mass casualty* - 100+ individuals, overwhelms available emergency medical services, facilities and resources -*Multiple casualty* - 2 to 99 individuals injured 3. Casualties include -*direct victim*: the individual affected -*indirect victims*: family, friend, or first responder of the victim -*displaced persons*: individuals who have to *evacuate* their homes, schools, businesses as a result of the disaster -*refugees*: individuals who have fled their homes as a result of famine, drought, natural disaster or civil unrest. This is more permanent.

Definitions & Purpose of the family?

1. *Multiple definitions* -Census Bureau: 2 or more people (1 is householder) related by birth, marriage, or adoption, residing in the same housing unit legally -Any person who plays a significant role in an individual's life (HRC, 2017) -Social unit interacting within the larger society -Group by marriage, parenthood or procreation -Network of personal commitment -Group of people related biologically, emotionally 2. *Purpose:* To meet the needs of the individual and society; to provide a "buffer", and be the first teacher

Home Health Services May Also Include

1. *Skilled nursing care (provided by RNs)* 2. Supportive social services (PT, OT, ST) 3. Social workers 4. Home health aides -bathing, feeding 5. Respite care -caregiver/nurse gives caregiver a break to get groceries, go to church, etc. 6. Adult day care 7. Intermediate skilled extended care facilities 8. Assisted living facilities 9. *Telephone support nursing services* -nurse works remotely, saves pt from coming in, ex. diabetic (discuss diet and sugars), regularly scheduled calls to assess condition 10. *Telehealth*

Disaster Management

1. A collaborative interdisciplinary team effort is needed between a network of agencies and individuals. 2. Develop a disaster plan. -Communities can respond more quickly, more effectively, and with less confusion. -Ensures that resources are available. -Delineates roles and responsibilities of all personnel and agencies, both official and unofficial.

Home Healthcare: Definition

1. A system of healthcare and social services provided in the home to help them through an illness/injury 2. *Examples of Nursing Care Provided in Home?* -wound care, G tube care, administering feedings, trache and vent care, case management, education, cardiovascular/respiratory assessments, vital signs, IV therapy, chronic illness-> hospital for exacerbation-> instructions to maintain condition of chronic disease as to not end up in hospital 3. *Goal:* allow patients to get better in their own homes to regain independence 4. hospitals, public health departments, school districts, hospice agencies have home care nurses 5. can be any age/disease, acute (help w breastfeeding) or chronic

Other Barriers to Healthcare Impacting Men

1. Access to care: -Time and location of services -proximity to work place, convenience 2. Financial considerations -better than they used to be w lower copays, covered annual physicals 3. Communication style/lack of "health" communication

International Agencies & Organizations

1. Bill and Melinda Gates Foundation 2. UNICEF (United Nations International Children's Fund) -works for children's survival, development, and protection by developing and implementing community-based programs with well-documented achievements in child's health, nutrition, education, water, sanitation, and women's rights 3. World Bank -provides low-interest loans/grants to developing countries for education, health initiatives such as education of health care providers, disease prevention and control, infrastructure, agriculture, communications, environmental protection, and economic and institutional development 4. CDC (Centers for Disease Control and Prevention) -forefront of public health efforts to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats and to protect the health of international travelers through advisories and immunization and vaccine recommendations 5. ICN (International Council of Nurses) 6. U.S. Dept of Health and Human Services

What diseases are PREVALENT among MEN? (pg. 347)

1. Cardiovascular disease -men have no estrogen protection (cholesterol may present at younger age) 2. Cancers -Types? -lung, skin, prostate, colon cancer 3, Unintentional injuries -Why? 4. Diabetes 5. Obesity 6. Causes of death vary most by RACE -top 3-5 of what is impacting men and women

What diseases are PREVALENT among WOMEN?

1. Cardiovascular disease -Women are more likely than men to die from their first myocardial infarction. -Why? -women at high risk to die from heart attack d/t different s/s (overlooking jaw/shoulder pain), estrogen, fatigue—> more non specific, smaller arteries-> more likely to clog, more likely to have other co morbidities (diabetes) -estrogen is very cardiac protectant (keeps cholesterol levels down, no high bp—> post menopause need to be screened) 2. Cancer Types? -breast, lung (causes most deaths), skin (#1), ovarian, cervical, endometrial 3. Diabetes -effects almost 9% of population (hispanics, latinos, african americans more at risks than caucasian) 4. Mental health -depression 2-3x more common in women then men (at least reported) -men are more successful in attempting suicide due to using more lethal means, but women attempt more

Bioterrorism Agents/Diseases (pg. 592)

1. Category A pathogens are highest risk -Easily disseminated or transmitted from person to person -High mortality -Easily cause panic and social disruption -require special action for public health preparedness -examples: Bacillus anthracis (anthrax) Clostridium botulinum toxin (botulism) Yersinia pestis (plague) Variola major (smallpox) and other related pox viruses Francisella tularensis (tularemia) Filoviruses Ebola Marburg 2. Category B pathogens - second highest priority -They are moderately easy to disseminate -Result in moderate morbidity rates and low mortality rates -examples Staphylococcus enterotoxin B (SEB) Typhus fever (Rickettsia prowazekii) Food- and waterborne pathogens Bacteria Diarrheagenic E.coli Pathogenic Vibrios Shigella species Salmonella Listeria monocytogenes Campylobacter jejuni Yersinia enterocolitica Viruses Hepatitis A Protozoa Giardia lamblia Microsporidia Mosquito-borne encephalitis viruses West Nile virus (WNV) 3. Category C pathogens - third highest priority -Could be engineered for mass dissemination in the future because of availablity -examples Hanta virus Tickborne diseases Yellow fever virus Influenza virus Other Rickettsias Rabies virus Tuberculosis, including drug-resistant TB 4. Another new threat is the use of antimicrobial resistant organisms* -Research on mechanisms of antimicrobial resistance -Studies of the emergence and/or spread of antimicrobial resistance genes within pathogen populations -Studies of the emergence and/or spread of antimicrobial-resistant pathogens in human populations -Research on therapeutic approaches that target resistance mechanisms -Modification of existing antimicrobials to overcome emergent resistance -Antimicrobial research, as related to engineered threats and naturally occurring drug-resistant pathogens, focused on development of broad-spectrum antimicrobials

Who Pays?

1. Certified vs. Non-Certified Agencies -just about everyone is certified -non-certified may not have skilled nurses (private duty nurses) -non-certified not under medicare/caid 2. Medicare Requirements for Home Care: -Individual over 65 or disabled -Homebound and under the care of a physician -Requires medically necessary skilled nursing care or therapy services 2. Medicaid benefits through CMS 3. Private health insurance -Requires pre-certification for services 4. Reimbursement requires physician authorization and periodic plan of care reviews -home care nurse has to collaborate w insurance company to see how many visits are permitted (private health insurance) -medicaid can have home health services up to 60 days then needs to be reevaluated by physician

Weapons of Mass Destruction

1. Chemical agents- cause death or serious bodily injury through release, of toxic chemicals. 2. Biological agents- any weapon involving a disease organism 3. Radioactive agents- designed to release radiation or radioactivity at a level dangerous to human life

Two record breakers, two different outcomes. -Scope -Predictability -Timing

1. Christmas Tsunami 2004 -Natural disaster Mass casualty -The 2004 Christmas tsunami in Indonenesa occurred during the holidays when many people were on vacation in that area. ( est. 167,799 dead, inc. 9000 European tourists -Scope: of this destruction was huge, -Predictability - none -Timing warnings heeded before Hurricane Patricia/ The Christmas Tsunami happened during tourist season, made casualties high 2. Hurricane Patricia 2015 -Natural disaster Multiple casualty -Scope: Patricia, the strongest hurricane ever recorded at sea, reached a record 215 mph as it roared toward the west coast of Mexico in October 2015 ( Nat. Hurricane Center Mar.10, 2016). It's the strongest wind speed ever measured in a hurricane in the Western Hemisphere -Predictability: Lots of warning, time to prepare, Evacuation was successful in getting most of the people out before the storm struck -Timing: Sparsely populated area, off season so few tourists. Only 6 casualties because of this

Roles and Responsibilities of Home Health Nurse cont.

1. Collaborate with other disciplines, providers 2. Supervise ancillary staff and caregivers 3. Serve as a patient advocate 4. Promote continuity of care 5. Evidence-Based Practice

Roles of the Hospice Nurse

1. HOLISTIC Nursing Process -Assessment: --Comprehensive health history, spiritual assessment, mental status, functional abilities, regular pain assessments -Plan/Implement: --Strong focus on effective therapies (pharmacologic and non-pharmacologic) for symptom management 2. Caring for the family/caregivers -Through dying process, and after death of loved one 3. Member of a team 4. Cultural competence related to death and dying -Assess pt's and family's beliefs and practices -reminding caregiver its okay if cannot handle everything, normal to need help, cannot do anything wrong

International Health Care Delivery Systems

1. DevelopED and developING health care delivery systems are VERY different. Depends on: location, education, technology, resources (financial/other) 2. Much to learn from each other. 3. Research and development must be relevant to infectious diseases of the poor. 4. Collaborate to solve the problems of health care delivery systems. -spend money on prevention instead of ICU who will not survive 5. Market-based vs. population- based health care systems -market-based: (U.S.) treats health care as a market commodity focusing on curative medicine rather than preventative medicine bc doing so creates more capital -population based: focuses on health promotion and disease prevention and new nursing degrees such as DNP in order to address system access, quality, efficiency, effectiveness, and value-based care 6. NP role

Roles of the Community Health Nurse in Women's and Men's Health

1. Direct care provider 2. Educator 3. Counselor

Patterns of Health and Disease

1. Disease patterns and primary causes of mortality vary throughout the world: racial, ethnic, and access disparities 2. DevelopED countries: chronic diseases: CVD, resp, CA 3. DevelopING: Infections: AIDS, TB, malaria, hep B, Rheumatic heart disease, parasitic infections, Dengue fever (transmitted by mosquitos) 4. Public health interventions can reduce mortality by 50% 5. Immunizations, Control mosquitos, tobacco control

Working with families: Interviews

1. During the interview, think about the family as a system within the larger social system 2. Introduce self, explain purpose of visit, address client by name and title, use integrity 3. Therapeutic conversation - Listening; recognizing that everything that is said matters 4. Each encounter has a healing potential

Clinical Example

1. E.B is a 78-year-old elderly women, living in an assisted living facility in Pennsylvania. She has two living relatives, a sister and brother-in-law, who she used to live with years ago, but their relationship is estranged because the brother in law sexually assaulted her. Until 10 years ago, E.B. was a live-in aide to an elderly women, Esther. E.B. provided daily ADLs for Esther and cared for her in her final days of advanced dementia. After Esther passed away, Esther's daughter and son helped E.B. move to the setting she lives in now. With E.B.'s consent, Esther's daughter also became her power of attorney. E.B.'s source of income is a check sent to her on the first day of the month by social security. Due to E.B.'s declining health, her money is managed by Esther's children. They cash the check and help E.B. to pay her bill to the assisted living facility. You are the nurse caring for E.B. 2. Who is E.B.'s family? -Esther's children -family is whoever pt says they are, their support

Role of the CHN in International Health Care

1. Ensure the attainment of health for all in a cost-effective health care system. 2. Involvement in: -research, leadership -community assessment -planning and implementation -management, evaluation -education -health services delivery -emergency response -health policy -legislation

Disparities and Social Issues Impacting Men's Health

1. Few men's health specialists 2. Biological factors -No estrogen production. Increased cholesterol 3. Gender socialization -Avoidance of being labeled as "sick" or "weak" -put emphasis on men being assertive, riskier 4. Reluctance to see preventive care and treatment 5. Delayed use/less use of healthcare services 6. More frequent use of emergency services

Other Specialized Home Health Programs

1. For patients who require continuous skilled care -Beneficial to the patient's health -Less costly than hospitalization 2. Family or caregiver support determine success. -ultimate goal is for caregiver to accomplish what you are doing on their own 3. Examples of high-tech services: -Daily infusions of TPN or antibiotic therapy -Pediatric services for children with chronic health problems -Follow-up for premature infants at risk for complications -Ventilator therapy -Home dialysis programs

The Role of Caregivers in Home Health Care

1. Formal vs. Informal -formal caregiver: nurse, professional/paraprofessional, usually compensated -informal: family members, volunteers 2. Assess the skills of the family member present 3. Educate the caregiver -Procedures for providing care -Signs and symptoms of exacerbations 4. *Goal:* Provide the caregiver with skills necessary to care for the patient successfully in the home without RN intervention -family member may have a stigma and may not want to be involved 5. What to do if no caregiver present? -Depend on your resources!

Assessment Tools to Guide Care

1. Genogram -A tool that helps the nurse outline the family's structure -if cannot understand relationships -include at least 3 generations -can also record health histories to determine genetic histories 2. Family health tree -Family's medical and health histories -causes of death -mental health issues 3. Ecomap -Depicts a family's linkages to their suprasystems -to supports in community and how they interact w them

Examples of Health Promotion for Women in the Community

1. Go Red Campaign -heart health 2. Primary care and women's health care the community -educational info based on women's health needs 3. Crisis Hotlines: Suicide or Domestic Violence -to provide counseling, also do work for men

World Health Organization: "Health for All by the Year 2000" (WHO Goal, 1978)

1. Goal: to achieve "a level of health that would enable all of the world's people to lead a socially and economically productive life" instituted at the Alma-Ata conference, 1978 2. 7 elements of primary health care: health education re disease prevention and cure, proper food supply and nutrition, adequate supply of safe drinking water and sanitation, maternal and child health care, immunizations, control of endemic diseases and provision of essential drugs

Patterns of Health and Disease cont.

1. HIV/AIDS -HIV increasing w people moving towards cities 2. Malaria -rates falling due to vaccinations, prevention 3. Tobacco

Service Learning

1. Hands on learning, Volunteering 2. Academic Service-Learning is a concrete expression of Neumann University's mission as a Catholic University in the Franciscan tradition. 3. Service-Learning provides students with an opportunity to make real world connections to course content and serve community partners in the process. Structured opportunities to reflect on the experiences allow students to see the benefits to all parties, and many students report they are transformed by the experiences.

Disparities and Social Issues Impacting Women's Health

1. Health care access 2. Lack of reproductive education over the lifespan -might not have had sex ed yet in school-> prenatal care is huge 3. Education and work -esp hard for single women 4. Wage inequalities 5. Multiple roles between career and caregiving -single moms are poorest aggregate

Environmental Factors

1. Health is threatened by environmental factors and disease 2. Environmental stressors- Air, water, & land pollution -Directly assault human health -Damage society's goods and services -Affect QOL -Interfere with the ecological balance 3. 36% of the world's population lack access to sanitation, 768 million people regularly go without adequate drinking water 4. Natural disasters, terrorism, and war

Healthcare Delivery Strategies

1. Health promotion education -Start at a young age, continue through adulthood -Use at every patient encounter 2. Books, magazines 3. Self-help groups for men, women 4. Organizations 5. Gender-specific strategies

Facts about Morbidity among Women

1. Higher morbidity rates, especially for debilitating and chronic diseases 2. More use of health services 3. More hospitalizations and surgeries 4. More reported depression, stress 5. More domestic violence -domestic violence largest cause of injury to women between 15-44 6. More disabilities 7. morbidity: diseases 8. women are sicker than men with diseases

Roles and Responsibilities of Home Health Nurse

1. Holistic focus on patient and caregiver needs 2. Assess patient-family interactions -Understand systems theory -role that patient plays in family, support systems, relationships 3. Provide education and interventions for family and patient -ready for d/c when caregiver can take over nurse's role 4. Nursing actions according to plan of care -Provide and monitor care -thinking about d/c right away, set goals first visit and take baby steps each visit toward goals 5. Identify need for referrals & resources -Assess available resources -The patient and family's interactions with community

Infection Control

1. Home Care nurses travel from home to home 2. Infection control is critical! 3. In addition to hand-washing, protect equipment 4. Keep bags zipped, etc.

Some Examples of Home Health Nursing Roles

1. Home health agency RNs -Assist patients with transition home from hospital -Provide wound care, tube feeds, trach care, IV therapy 2. Hospital-based Home Health RNs -Patient follow-up -Patients experiencing exacerbations 3. Public health RNs -Follow patients with communicable diseases -TB-> once sent home need nurse sent out to ensure pt is taking meds

Defining "Homebound"

1. Homebound ≠ Bedbound 2. Patient is considered homebound if they cannot leave home without "considerable or taxing effort" -advanced cancer and neutropenic, hip fx 3. Examples: -Requires the aid of supportive devices (wheelchair or walker) -Requires the use of special transportation -Needs the assistance of another person -Has a condition that leaving the home is medically contraindicated -Symptoms of the disease process (such as pain, SOB or confusion) worsen when leaving the home 4. The patient can leave home for medical treatment (such as chemotherapy or dialysis) or for receiving therapeutic and psychosocial treatment (such as through a certified adult day care program). 5. May leave home for a non-medical absence as long as the absence is short and infrequent. -Examples: church, hair salon, family event, etc. -doesn't have to be home at all times

Characteristics of Disasters (pg. 595)

1. How does *frequency* affect the preparation of citizens? -how often a disaster occurs. -Some disasters occur relatively often in certain parts of the world. Examples are hurricanes, which occur with variable frequency between the months of June and November in the northern hemisphere, and earthquakes, which occur periodically throughout the world. Terrorism was relatively rare until late in the 20th century and we were not prepared for 911. 2. What disasters are *predictable*? -meteorologist have helped us predict disasters, e.g. floods, hurricanes. Some are not preventable, fires, explosions 3. What is *preventability/ mitigation*? -action taken before a disaster. Prim prevention, assess for potential dangers, develop disaster plans, conduct drills 4. What is *imminence*? -In terms of speed of onset, warning available, duration of impact phase. the tsunami struck quick with no warning. -Warning - event will occur within the next 24 hrs. -Watch - the event is imminent. Take precautions now. 5. What impacts *scope, and number of casualties*? -The scope of a disaster indicates the range of its effect. -The scope is described in terms of both the geographic area involved and the number of individuals affected, injured, or killed. Even if an event is large, proper preparation can limit it's scope -From a health care perspective, the location, type, and timing of a disaster event are predictors of the types of injuries and illnesses that might occur. -Vulnerable populations --age, pre-existing health problems, degree of mobility, emotional stability. - Hurricane Katrina (New Orleans) - many elderly stranded -Environmental factors --(phys, chem, bio & social factors) phys factors (time, food available, functioning utilities); contaminated water, loss of family -Warning time --e.g., warning before a tornado or hurricane; PTSD after 9/11 - NO warning before 9/11, warnings ignored before Johnstown, warnings heeded before Hurricane Patricia/The Christmas Tsunami happened during tourist season -Individual perception and response --sometimes after people have a stronger reaction than prior to. 6. What is the *intensity*? -the ability of the disaster to cause damage or injury -there are scales to measure intensity and predicted level of destruction. -Category 5 tornado, what does that mean to you??

Local Disasters

1. Man Made Multiple Casualty - Jan. 30 - Feb. 6 - 1975 - Twenty six of the forty-four people aboard the Corinthos lost their lives as a result of the collision, explosion, and fire. Although the Edgar M. Queeny also caught fire, no fatalities were reported on that vessel. This was the catalyst to start the CCMC burn Center. It was started in 1973 as a small center and expanded to a regional center after this fire. This illustrates one of the principles of disaster planning by involving and *taking stock of all available resources*. Got foam from the foam manufacturer in West Chester. 2. Man Made Multiple Casualty - Wade Dump - Feb. 2, 1978 - thought to be a tire disposal site, it was later found to be a illegal toxic dump site. 30 firefighter have since died of cancer related to walking in the toxic waste that night. This was the reason that the *Superfund legislation was started*

Springfield Mall Shooting 10/30/85 -3 people killed 7 injured

1. Man Made Multiple Casualty -Halloween 1985 - Springfield Mall - Sylvia Seegrist on October 30, 1985 opened fire at a Springfield, Pennsylvania shopping mall, killing three people and wounding seven others before being disarmed by a Volunteer Firefighter/EMT who was shopping at the mall. The individuals killed included two men and a two-year-old boy.[1] She was 25 years old and had been diagnosed as suffering from paranoid schizophrenia 10 years earlier. Having been committed and discharged several times, her case stimulated discussion about the state's authority to commit possibly dangerous people versus individual rights. 2. Seegrist's behavior was so disconcerting that clerks at a local K-Mart told her they had no rifles in stock when she tried to purchase one from them. She eventually purchased a gun at another store,[5] and on October 30, 1985 she went to the mall. Seegrist exited her Datsun B-210, retrieved the weapon she had purchased, and then fired at a man approximately 30 yards from where she stood. The man was not hit and having seen the vehicle his would-be killer arrived in, flattened one of the Datsun's tires to prevent an escape in that vehicle. John Laufer, who did not realize Sylvia was firing real bullets, disarmed her as she walked up to him and tried to raise her gun to shoot him. Laufer forced her to a nearby store while he waited for the arrival of mall security. The first guard that responded asked her why she had just done what she did; her reply was "My family makes me nervous".[6] 3. Seegrist's actions helped spur the state government to form a legislative task force, in order to address better ways to care for the mentally ill in the community.[11][12] Seegrist's mother also urged legislators to make changes to the state mental health laws.[13][14] In response to the December 2012 school shooting at Sandy Hook Elementary School in Newtown, Connecticut, Seegrist's mother Ruth told The Philly Post, "You know, it's ironic that people who are irrational are expected under the law to get help on their own. There needs to be something in the law that compels a troubled person to be diagnosed by a psychiatrist. In the 1950s, we were institutionalizing people who weren't mentally ill. You could institutionalize someone who was just unruly. We've gone from one extreme to the other."[15]

Disaster Nursing: Natural and Manmade Disasters

1. Hurricanes, tornadoes, floods, wildfires, and industrial accidents occur yearly in some parts of the United States. Further, in recent years, terrorist attacks have become more common. 2. The bombings of the World Trade Center in New York City in 1991 and the bombing of the Alfred P. Murrah Federal Building in 1995 occurred over two decades ago, but the combined terrorist attacks on the twin towers of the World Trade Center in New York City, the Pentagon in Washington, DC, the plane hijacking and crash in Pennsylvania on Sept. 11, 2001, and more recent events such as the Sandy Hook shooting, the Boston Marathon bombings in 2013 the Las Vegas shooting on October 1st, 2017, and the Parkland Florida school shooting in Feb. of 2018, indicate that the potential is ever present. Every year I update this lecture and I hope that I won't have a new mass shooting to talk about but usually I do. 3. Since September 11th we tend to think of terrorist attacks as acts instigated by religious extremist groups but we sometimes forget they are by lone people such as the 1985 Halloween shooting at the Springfield Mall or some of the incidents listed above.. Attacks occur all over the world on an almost daily basis, and concerns about potential terrorist attacks have increased the focus on what needs to be done in terms of prevention/mitigation, preparedness, response, and recovery—not only in the event of terrorist attacks but also in the event of disasters of all kind 4. Because of the recognition of the need to be prepared, the Joint Comission, CMS, and state boards of nursing are putting a new emphasis on disaster education for nurses. It is now part of the NCLEX exam.

Social and Structural Constraints

1. Identify what prevents families from receiving needed health care or achieving a state of health 2. Often based on social and economic causes -Literacy, education, employment -Distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers)

Sept. 11, 2001

1. Impact of Terrorism 2. National Institutes of Health (NIH) developed a bioterrorism research program 3. Development of a quality health surveillance program 4. Department of Homeland Security was started Sept. 22, 2001 -Eleven days after the September 11, 2001, terrorist attacks, Pennsylvania Governor Tom Ridge was appointed as the first Director of the Office of Homeland Security in the White House. The office oversaw and coordinated a comprehensive national strategy to safeguard the country against terrorism and respond to any future attacks. -With the passage of the Homeland Security Act by Congress in November 2002, the Department of Homeland Security formally came into being as a stand-alone, Cabinet-level department to further coordinate and unify national homeland security efforts, opening its doors on March 1, 2003. -Improved public health preparedness for bioterrorism 5. This was the largest act of terrorism in this country, maybe even the world up to this point, 6. This act of terrorism changed the way we think about and plan for disasters of this magnitude

Hospice Nursing Care

1. Improves end-of-life care for the terminally ill 2. Occurs in a variety of settings -Hospitals -Nursing homes -Patient homes, etc.

Characteristics of a healthy family

1. Interaction and communication 2. Can establish priorities 3. Respect and affirm members 4. Flexible and responsive 5. Teach societal and family values 6. Foster responsibility and service to others 7. Play, share leisure time, and laugh together 8. Able to cope with stress and crisis 9. Know when to get help

Examples of Health Promotion for Men in the Community

1. Jefferson Men's Health Program 2. Men's Health Month 3. urologist serves as PCP and submits for referrals

Nursing's Role in a WMD Attack (pg. 596)

1. Know the signs and symptoms of biological, chemical, radiation, and nuclear exposure 2. Know the guidelines for early detection of biochemical terrorist attacks. 3. Treat and control the spread of biological and chemical agents 4. For a biological or chemical attack the process can be different. Usually 911 is not called and it is the providers in the hospital - often the ED who first realize that something is going on. It is important to understand the signs of a possible attack and know what to do in the event of one. Remember often you are the first responder in this case. -* Naturally occurring Smallpox has been eradicated. The last know case of naturally occuring smallpox was diagnosed on Oct. 26, 1977 in Somalia. The only smallpox bacteria in existence is stored at the CDC in the US and at a government lab in Russia. So if there is even 1 case of smallpox it would be investigated as bioterrorism.

Governmental Responsibilities

1. Local government (first responders) -Responsible for the safety and welfare of its citizens. 2. State government (Office of Emergency Management) -Involved when a disaster overwhelms the local community's resources. 3. Federal government focuses on protecting the American people and their homeland -DHS - multiple departments (US department of homeland security) -FEMA - became part of DHS in 2003 (federal emergency management agency) -CDC -NDMS (national disaster medical system): federally coordinated healthcare system and partnership of the Departments of Health and Human Services, Homeland Security, Defense, and Veterans Affairs. 4. Non- Governmental Organization -American Red Cross (ARC)

Las Vegas Shooting Oct.1 2017

1. Man Made Mass casualty - terrorism. At least 59 people were killed and more than 500 others injured after a gunman opened fire Sunday Oct. 1, 2017 at a country music festival across the street from the Mandalay Bay Resort and Casino on the Las Vegas Strip, authorities said. 2. Kevin Menes MD -Flow is king. Destroy the choke points to allow patients to flow to definitive care. -By organizing patients into clear physical zones, they were able to avoid wasting time writing too many tags. That's precious time that could be spent with resuscitations. -The Orange tag in triage allowed Menes's team to focus on the most critically wounded while keeping a very close eye on those who were badly wounded but would soon crash. -Don't have enough ventilators? Pair patients of similar size, double the tidal volume, and use Y tubing to ventilate two patients on one vent. -Mentally rehearse difficult scenarios ahead of time. This can be just as valuable as actual practice. Think through what you will do if/when your current plan of action fails. -Not enough monitors? Place all patients in line of sight, and use clinical judgment to find the crashing patients.

Eddystone Munitions Plant Explosion April 10, 1917 -133 Killed - many more injured

1. Mass Casualty - Local Terrorism - 133 killed 200 seriously injured and another 300 with minor injuries- Prior to the Oklahoma City bombing this was the largest act of terrorism on American soil. 2. In 1917 the Eddystone Ammunition Plant, located outside of Chester, was one of the busiest munitions factories in the country. On Monday, April 10th at about 9:55 a.m., just days after the U.S. had entered the war, "F" Building of the plant was torn apart by a trio of explosions. One hundred and thirty-three persons, mostly girls, lost their lives in the explosion. The calls for help went out to firefighters, ambulances and doctors throughout the area. *One hundred PMC cadets rushed to the scene*. Almost immediately the cadets began to calm the crowds and restore order. With rifles, the cadets forced back the crowds, which tried to fight their way into the plant yard. They remained on duty for more than five hours and proved of real assistance. The Chester City and Crozer hospitals quickly became filled and the Sixth Regiment Armory in Chester was turned into a temporary hospital..." *Boy Scouts* were used to take the injured to hospitals by stretcher 3. Residents of this city immediately after the appeal for "help" was flashed here, rushed to the plant in motor trucks and automobiles and donated their services in carrying the wounded to the hospitals. Guards from the Remington Arms, Baldwin Locomotive Works and other nearby big industries have sent their guards to watch over the damaged shrapnel plant and help to battle the flames that is threatening the entire plant. 4. Heads of the ammunition works telephoned Chief of Police Vance a few minutes after ten o'clock appealing for assistance and earnestly requesting that the fire companies and all the doctors possible be rushed to the scene. A few minutes later every fire fighter in the city responded to the call and hurried to the borough. Doctors immediately upon hearing the news hurried to the plant and joined in rendering medical assistance to the injured men scattered over the plant. 5. Motor trucks were put into service and injured men were rushed to the Chester and Crozer Hospitals while the police patrol and *private owned automobiles* rushed dead men to the morgue.Fire companies from all boroughs between Eddystone and Philadelphia joined forces with the local fire fighters near the noon hour in battling the flames. Hundreds of residents of this city are giving valuable service to the ground in caring for the wounded. Help from Philadelphia was summoned.The injured are also being cared for in the tabernacle. 6. The unidentified dead were buried at a mass funeral service in Chester Rural Cemetery. The service was held on April 13 at 11:00 a.m. An estimated 12,000 people attended the funeral service. The Eddystone Ammunition Company paid for all the funeral services. In less then two weeks the company was back to work. The mystery of the explosion was never solved. Investigators later felt that the Russian, Leon Trotsky, had the plant sabotaged to prevent the shells from reaching the new government, which was democratic. 7. *Resources* - Boy Scouts, PMC cadets, Guards from close by industry. Sound the alarm bell and all available medical personnel came (know your resources**)

Oregon 1986 Bioterrorism Attack Salmonella - 751 people sickened. No fatalities

1. Mass Casualty Bioterror attack- The 1984 Rajneeshee bioterror attack was the food poisoning of 751 individuals in The Dalles, Oregon, through the deliberate contamination of salad bars at ten local restaurants with salmonella. A leading group of followers of Bhagwan Shree Rajneesh) had hoped to incapacitate the voting population of the city so that their own candidates would win the 1984 Wasco County elections.[2] The incident was the first and single largest bioterrorist attack in United States history.[3][4] The attack is one of only two confirmed terrorist uses of biological weapons to harm humans since 1945, the other being the 2001 anthrax attacks across the USA.[5] 2. As a result of the attack, 751 people contracted salmonellosis, 45 of whom were hospitalized. There were no fatalities. Although an initial investigation by the Oregon Public Health Division and the Centers for Disease Control did not rule out deliberate contamination, the agents and fact of contamination were only discovered a year later. 3. The commune leadership planned to sicken and incapacitate voters in The Dalles, where most of the voters resided, to sway the election.[14] Approximately twelve people were involved in the plots to employ biological agents, and at least eleven were involved in the planning process.[11] No more than four appear to have been involved in development at the Rajneeshpuram medical laboratory; not all of those were necessarily aware of the objectives their work served.[11] At least eight individuals were involved with the distribution of the bacteria.[11] 4. The main planners of the attack included Sheela Silverman (Ma Anand Sheela), Rajneesh's chief lieutenant, and Diane Yvonne Onang (Ma Anand Puja), a nurse practitioner and secretary-treasurer of the Rajneesh Medical Corporation.[11][15] They purchased salmonella bacteria from a medical supply company in Seattle, Washington, and staff cultured it in labs located inside the commune.[11] They contaminated the produce at the salad bars as a "trial run".[12][16] The group also tried to introduce pathogens into The Dalles' water system.[11] If successful, they planned to use the same techniques closer to Election Day.[12]

Johnstown Flood May 31, 1889- 2209 dead -Preventability/ Mitigation -Scope

1. Mass casualty - Na-tech The Johnstown Flood (locally, the Great Flood of 1889) occurred on May 31, 1889, after the catastrophic failure of the South Fork Dam on the Little Conemaugh River 14 miles (23 km) upstream of the town of Johnstown, Pennsylvania. The dam broke after several days of extremely heavy rainfall, unleashing 20 million tons of water (18 million cubic meters) from the reservoir known as Lake Conemaugh..,[2] The flood killed 2,209 people 2. Preventability- Army Corp of Engineers warned for years that a major rainfall could cause that dam to break and the warnings went unheeded. When it happened there was no time to get out. 3. Scope: highly populated area, large dam 4. The American Red Cross, led by Clara Barton and with 50 volunteers, undertook a major disaster relief effort. ] Barton arrived on June 5, 1889, to lead the group's first major disaster relief effort; she did not leave for more than 5 months. She and many other volunteers worked tirelessly. Location of the South Fork Reservoir at Johnstown Flood National Memorial, Penn. 5. Frank Shomo, the last known survivor of the 1889 flood, died March 20, 1997, at the age of 108.

weapons of mass destruction Sarin gas attack (pg. 592)

1. Mass casualty - bioterrorism 1995- predates 9/11 and there was little interest in the US because we thought " that can't happen here"- 7 killed , 4000 injured. Most of the injuries were mild but those sheer numbers inspire panic and that is the most deadly of all.

May 15, 2015 Amtrak Regional Train Crash Philadelphia -6 Dead and Over 200 Injured"

1. Mass casualty - man made 2015 2. Predictability - not predicted 3. Preventability- speed controllers on trains - slated to be installed on all trains but not done 4. Mitigation - Not as bad as it could have been because of so many resources ( medical care) nearby. Still the system was overwhelmed

Mexican Earthquake September 19, 2017 -Timing -Mitigation -Preventability

1. Mass casualty event- natural disaster- The death toll from the earthquake on Sept. 19 2017 in central Mexico killed 333. This was a 7.1 magnitude earthquake 2. Think about the *time* of the day. It occurred just after school started. IF this happened during off school hours, the effects may have been *mitigated* It was later found that many of the buildings were older and not built up to modern code. This may have *prevented* some deaths

Facts about Morbidity among Men

1. Men tend to perceive themselves to be in better health than do women. -old school thought: health seen as a commodity, only for anything that gets in the way of work/ADLs -medical tx may interfere w work, don't want to be perceived as sick/weak 2. Higher morbidity rates for conditions that lead to death 3. Women are more likely to be ill, whereas men are at greater risk for death. 4. Admitted "sicker" to hospitals -Delay medical treatment then are sicker when they do seek health care, therefore they require more intensive medical care.

Hurricane Florence Sept. 16- 18 2018 -Scope -Perception

1. Natural Disaster - Multiple Casualty - Sep 18, 2018 2. Scope- heavy rain and very slow moving hurricane - not much wind damage but because it hung around so long there was significant flooding 3. Perception - many people didn't evacuate because they thought it would not be a big deal. . 51 people died in the Carolinas from Hurricane Florence, which caused widespread flooding and set rain records in many areas of North Carolina. The storm surge continued to flood North Carolina for 2 weeks after the storm.

types of disasters (pg. 591)

1. Natural disasters -hurricanes, tornadoes, flash floods, blizzards, typhoons, volcanic eruptions 2. Man-made disasters -chemical & biological terrorism (bomb), transportation accidents, food & water contamination, fires and explosions, building collapse. 3. Combination disasters -NA-TECH (natural/technological) disaster: a natural disaster that creates or results in a widespread technological problem -a blizzard that knocks out power lines, a flood that causes a dam or levee to break

Research in International Health

1. Nursing research has focused on: -Student and faculty educational exchange programs -Diverse clinical experiences -The international development of home care or transition from hospital to home 2. WHO collaborating centers in nursing provide a framework for research, education, and service delivery partnerships. 3. Sigma Theta Tau international-Nursing Honor Society

Reproductive Health Concerns

1. Nutrition -Includes total life nutritional experience 2. Dysmenorrhea -painful menstruation 3. Family planning -Includes fertility control and infertility -Need multiple safe options designed to meet the individual needs of all women 4. STIs, HIV, and AIDS -Women need age-appropriate STI prevention, education, and counseling. -Worldwide, AIDS is a leading cause of death among young women.

Types of Home Health Agencies

1. Official -operated by gov (county health departments), funded by taxpayers, medicare/medicaid, private insurances 2. Non-Profit -tax exempt, do not pay fed taxes, individual home health agencies or through hospitals 3. Proprietary -for profit companies (majority), chain companies, run like a business, not tax exempt 4. Hospital-Based -hospital programs, take their own discharged pts from their hospital, helps whole health system save money on high risk pts 5. Agencies differ in their financial structures, organizational structures, governing boards, and populations served. -framework and what funding they receive

Palliative Care vs. Hospice Care

1. PALLIATIVE CARE -Focuses on relief of the pain, stress, other debilitating symptoms of serious illness -*Is NOT dependent on prognosis* -Can be delivered simultaneously with curative treatment -No time limit on length of palliative care -cancer (undergoing chemo, radiation), not dependent on life expectancy, can be on throughout course of tx 2. HOSPICE CARE -Always provides palliative care, but... -*Focuses on end of life care* -For patients who no longer seek curative treatment -Designed for patients with life expectancy <6 months -chemo no longer being pursued

Patient Rights & Responsibilities

1. Patients can refuse homecare or change their mind 2. Contracts and Care plan goals are developed to clarify roles of informal caregivers and patients 3. Advance Directives, Durable Power of Attorney for healthcare, or Living Will documents

Population Characteristics

1. Population in 1804=1 billion, 2025=8 billion 2. 99% of growth occurs in resource poor countries 3. Large populations create pressures for food and health care 4. Creates pressure of feeding everyone and results in malnutrition, disease or death 5. If adequate food, overcrowding leads to pollution, stress, disease and violence 6. 50% of world's population are in China, India, US, & Indonesia 7. Life expectancy varies significantly in different countries and overall population distribution is uneven 8. As the world population grows, a global trend toward urbanization occurs

Working with families

1. Potential Problems -Individuals only provide one view of a situation; try to interview at least 2 members of a family -Sometimes, it is necessary to interview all family members Examples: chronic disease, newborn visits; illness resulting in significant change of family patterns

How do changing family characteristics influence nursing practice?

1. Potential need for resources & interventions 2. "Ripple effect" - Any dysfunction affects everyone and the unit as a whole -if someone becomes ill, not just effecting pt 3. Case-finding -taking care of pt and find someone else who needs care, screening for genetic risks 4. Improving nursing care from a holistic perspective 5. The focus on keeping patients at home

Components of a Home Visit

1. Referral 2. Initial contact - usually phone 3. Environmental assessment -Neighborhood -Home 4. Communication & relationships

Pain Control & Symptom Management

1. Regular pain assessments 2. Administer meds in doses sufficient to keep patient free of pain; on a regular schedule -Address Breakthrough pain -morphine, tyelonyl usually given regularly -long acting and then something for break through pain 3. Educate on Addiction vs. Tolerance -family members get worried about giving too much-> addiction -addiction: psychological -tolerance: physiologically need more, no longer responding same way, not causing negative consequences 4. Other symptoms: -GI symptoms (reduced appetite, n/v, constipation) -Fatigue

Acts of Terrorism

1. Terrorism is -"the unlawful use of force and or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives." (FBI, 2013) -"is premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents." 2. International terrorism involves the territory or the citizens of more than one country 3. Threats of terrorism: -Assassinations -Kidnappings -Hijackings -Bomb scares and bombings -Computer-based attacks -Chemical, biological, nuclear, radiological weapons

Florence Nightingale

1. The environmental factors affect different patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or her needs 2. The ten major concepts of the Environment Theory, also identified as Nightingale's Canons, are: -Ventilation and warming -Light and noise (visiting hours) -Cleanliness of the area -Health of houses -Bed and bedding -Personal cleanliness -Variety -Offering hope and advice -Food -Observation

Why Is It Important for the Nurse to Work with Families?

1. The family is a critical resource! 2. Helps the nurse understand the patient within context of the family 3. Benefits the patient 4. Benefits society, as a whole

Working with families

1. Therapeutic questions -What does the family expect from the visit? -What are the challenges of the family? -What are the concerns or problems? -Who will share information about the family history? 2. Commend and build on family strengths - always point out family strengths with the family

Home Healthcare: Purpose

1. To allow individuals remain at home -providing care that would otherwise be offered in hospital setting 2. To encourage *cost containment* due to prospective payment system (PPS) and diagnostic-related groups (DRGs) -medicare will only pay for set amount for diabetic pt-> easy to run up tab in hospital, permit a number of visits in the home 3. *Focus:* -Care of ill patients, with health promotion and disease prevention interventions -Family -Resources --connecting pt to community resources and educating them on resources 4. can be ordered by physicians, other states NPs, case managers—> often done at time of d/c

Changing characteristics of the family

1. Traditional, nuclear family -getting married later -different races marrying 2. Cohabitation -boyfriend and girlfriend living together and not married , or roommates, sometimes resembles a marriage (can be kids) 3. Single parenting 4. Multigenerational -living with parents and grandparents 5. Grandparent-headed families -grandparent taking care of child's child, suicide/drug abuse in parent of child 6. Same sex parents 7. Blended families -brady bunch, husband and wife have kids of their own and get together

Other Common Acute Illnesses in Women

1. Urinary tract infection and dysuria 2. Diseases of the reproductive tract -Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID) -STI or different infection 3. Chronic diseases -Coronary vascular disease (CVD) and metabolic syndrome, hypertension, diabetes, arthritis, osteoporosis, and cancer (breast, lung, gynecological) 4. Mental disorders and stress

Health Delivery Strategies for Men (pg. 355)

1. Use *gender-specific interview techniques* to obtain the most accurate health history. -Caution with secondary sources of information. -Permission to have concerns about health and talk openly to others about them -intervening with occasional close ended questions can be helpful -secondary sources: family member who is along for visit (being aware of accuracy and interpretation), ask pt for permission 2. Offer screenings or education at the workplace, malls, barbershops, etc. -physicians training barbers about health promotion 3. Consider impact of illness on occupational factors, leisure patterns, and interpersonal/sexual relationships 4. *Educational needs* for how their bodies function, what is normal/abnormal, actions to take, and the role of proper nutrition and exercise

Conducting a Home Visit

1. Visit preparation -Review the referral form -Contact the client 2. Initial telephone contact -Obtain permission to visit -Set mutually acceptable time for visit -"Nurse is a guest in the client's home" -If no telephone, use drop-in visit as first contact 3. The visit -Conduct an environmental assessment --windshield survey: curb appeal (not taken care of), how close pharmacy, grocery store, neighborhood they live in -Create a comfortable atmosphere for communication -Initiate a conversation that builds trust 4. Documentation -Assessment data and interventions for all visits -Document care plan in chart (tedious) -Homebound status required for reimbursement 5. Utilize the nursing process -Gather subjective assessment data -Complete a physical assessment -Identify nursing diagnosis and develop a nursing care plan for the client and family -Establish mutually agreed-on goals that are realistic and achievable for the client and family -Clearly delineate client and nurse's roles -Implement nursing interventions as needed -Make appropriate and necessary referrals (meals on wheels, support groups, can advocate for PT) 6. Ending the visit -Set dates for subsequent visits -Reinforce information provided 7. Evaluating the visits -Evaluate progress toward goals -Modify plans if needed -Discontinue care when goals are achieved -may only be 30-60 mins per visit

Clinical Example

1. You are a home health nurse called to visit a patient, Mary, who suffered a broken pelvis and was just discharged from a rehab facility. Mary works as a secretary for a pharmaceutical company. She is a 45-year-old woman diagnosed with pre-hypertension and pre-diabetes. She is 5'3 and weighs 155 lbs. Her family history indicates that her mother died following a heart attack at the age of 66. Her father has dementia and lives in a nursing home about 15 minutes from her home. Mary is worried about how she will manage around the house with a walker. She also wants to get back to work. She says she is also worried about missing her usual visits to her father. 2. Mary's husband Al, is 53, a veteran, and is a mechanic who owns a motorcycle repair shop. Al is a smoker. He says he works hard all week and usually likes to sit and watch TV on the weekends. In good weather, he'll sometimes take motorcycle trips with his buddies. He says the best way to stay healthy is to keep "the heck away from doctors; if it ain't broke, don't fix it!" 3. Their daughter, Stefanie, is 21, 4 months pregnant, and has just moved back home after ending a relationship with an abusive boyfriend. Stefanie works part time as a waitress at the local Applebee's. According to Al," Stefanie is a good kid, but she could help her mother a little more around the house". Mary says, "Stefanie is going through a rough patch, and she needs to take it easy since she's pregnant". Stefanie isn't present for your visit. 4. where they live is supra system nutritionist, PT

Clinical Example

1. You are caring for a 8 year old child with newly diagnosed Type 1 Diabetes. 2. How will this chronic illness affect: -Family patterns? nutrition, shopping, new schedule for checking sugars -Fears? hypo/hyper glycemia in parents, fear of needles in pt -Emotional responses? -Family expectations? -Primary caregiver? 3. Chronic illness injects change into various areas of family life

Medicolegal Death Investigator

1. conducted to clarify the sudden, unexpected, and often nonnatural circumstances in which death occurred

clinical forensic nurse examiner

1. deliver care to living patients who are involved with the legal system, and their services may include several subspecialties

nurse's role in the correctional setting

1. health care triage 2. assessment of medical and psychiatric health 3. ethical issues- refusal of tx by pts 4. nurse's educational requirements for forensic nursing -registered nurse and attend a specific program

Pan American Health Organization (PAHO)

1. international public health agency with nearly a century of experience in working to improve the health and living standards of Americas 2. serves as the regional office of WHO

factors affecting health and wellness in the correctional setting

1. maintaining a safe environment -no nursing care in a correctional environment requires a nurse to be locked in an enclosed environment with an inmate 2. chronic and communicable diseases -of continuous concern are HIV, hepatitis, and tuberculosis -the rate of these and other communicable diseases among the incarcerated population is associated with high-risk behaviors, including current and previous drug use, unprotected sexual intercourse, and tattooing 3. women's health -routine gynecological exams are not consistently apart of health screening for women upon entry into a correctional facility or a routine part of ongoing health care 4. adolescents in prison -juveniles in adult correctional facilities are 36x more likely than the adult population and more likely than juveniles in the juvenile center to commit suicide 5. mental health issues -nurses should also be aware that once released from imprisonment, these individuals are at substantial risk of mental illness relapse and reinstitutionalization

Definitions of Health

1. women -Historical - reproductive function (can women be in home) -Current - holistic; interactions between social factors, habits, and physiology 2. men -Historical - ability to work -Current - holistic; interaction between biological, social, and behavioral factors

Community Health Nurse Roles

Examples of Prevention 1. Primary -Women: nutrition, immunizations (HPV), self breast exam education, STI prevention education, preconception planning education -Men: importance of exercise, decreasing risky behaviors (hard hats at work), nutrition, immunizations 2. Secondary -Women: pap smear, mammograms, colonoscopy, BP, labs -Men: prostate screening, eye/dental exams 3. Tertiary -Women: support groups r/t diagnosis (heart disease, diabetes) -Men: