NURS 3600 Exam #2

What is the Web of Causation Model?

-Focuses on the *interaction* among *factors* predisposing to illness. -A way of looking at the *multiple factors* and how they *interact/lead* to (cause) a particular *outcome*. -"One thing led to another..."

What is public insurance? Plan examples?

-Funded through *tax dollars*, whether *federally* or through the *state*. -Some examples of types of plans: >*MEDICARE*: funded and administered by the *federal government*; comes from *taxes* paid into the *Social Security System* by U.S. workers; *same* across states. >*MEDICAID*: funded by *states* and the *federal government* provides about *58%* of funding for basic Medicaid programs; *varies* by state.

How does the Socio-Ecological Model relate to health promotion/teaching?

-Health education *alone* is *not as effective* as addressing the problem at *MULTIPLE LEVELS* - achieves change. -By applying the *socio-ecological model*, we can change the *built environment* and *laws*, conduct *community organizing*, and *social marketing* to promote change. -For example, *individual* and *society* levels related to mother-in-law and the *smoking law change* for air travel. -For example, only *18.4%* received the vaccine for H1N1, the other *65%* related it to SEM (e.g., individual issue, no money, no time).

What are the responsibilities of the state level subsystem?

-Helps *federal* and *local governments* to address health issues. -*Financing* and *delivery* of *services* (r/t Medicaid). -Guarantee essential *health services*. -*Support local service* capacity.

What is analytic epidemiology?

-Includes *how* and *why*; goes *beyond description* and gets at the *CAUSES* or *INFLUENCERS* (*DETERMINANTS*) of the disease patterns. -*Factors* exposures, *behaviors*, *contexts*. -*Individual*, *relational*, *social*, *environmental* aspects.

What is descriptive epidemiology?

-Includes *what*, *who*, *where*, and *when*; *describes* but does not go beyond. -*Person-Place-Time Model*: >*Person*: age, gender, SES, health status. >*Place*: geographic location, environment, political, social. >*Time*: day, week, month, and trends. -The "*epi curve*" can be used to *compare* common issues year over year and look for *changes* in patterns that can signal a need to *adjust plans* and *interventions*.

What is iNcidence?

-Measures *NEW* illnesses in a population; *month-to-month* basis or *week-to-week* for certain diseases. -Provides *assessment* about the status of, and the risk association with particular illnesses.

What is prevAlence?

-Measures chronic illness in a population; *ALWAYS* present during a *period of time* (e.g., the prevalence of heart disease ranges between 150/100,000 and 155/100,000). -Helps *plan* for health services, resources, and facilities.

What is mortality?

-Number of *deaths* that may have occurred (crude [any], age-specific, disease-specific). -The *Morbidity* and *Mortality Weekly Report* is published by the CDC (*LINK*).

What is the Epidemiological Triangle/Triad?

-Puts *three aspects* of a disease or event into perspective; there are always *multiple factors* involved/*INTERCONNECTION*: 1) *Causative agent*: may be a vector (transmit agent) or specific agents (e.g., bacteria, viruses, parasites, etc.). 2) *Susceptible person/host*: the individual that has the issue ("Who has the flu, COVID-19, TB?"). 3) *Environment*: where the issue occurred, ways to change the environment and decrease risk ("Where did this occur?").

Describe the health-oriented perspective:

-Recognizes *HUMAN COMPLEXITIES*. -*HOLISTIC*. -Interactions with the *environment*. -*UPSTREAM THINKING* (focus is on health, goal is improving and maintaining).

What does prevention mean?

-Specific protections at *3 levels* (i.e., primary, secondary, and tertiary). -Actions to reduce the threat of *SPECIFIC* diseases and injuries.

What is epidemiology?

-Study of *OCCURRENCE* and *DISTRIBUTION* (through data analysis or display) of *HEALTH-RELATED STATES* or events in specified populations. -Study of *DETERMINANTS* of such states, and *APPLICATION* of knowledge to control the health problem. -*Includes* things like sporadic/intermittent diseases, chronic diseases, violence, mental health, and positive health states.

What is universal health care?

-The *GOVERNMENT* either owns *all* health facilities and *employs* the providers. Or, the government is the *ONLY* insurance, and *everyone* has it (e.g., Canada and UK). The phrase "*Medicare for All*" refers to universal health care. -*U.S. DOES NOT HAVE UNIVERSAL HEALTHCARE*. Instead, we have both *private* and *public insurance*: >*Private insurance*: employer or individual purchased insurance. >*Public insurance*: Medicare, Medicaid, CHIP (expanded form of Medicaid for children), Tri-Care (for active duty + retired military).

What is a premium?

-The *charge* for owning the *insurance* (paid monthly). -*Employers* pay *part* of the costs of the monthly premiums and *employees* usually pay a *smaller portion*.

What are retrospective plans?

-The *service* is *provided*, the *provider bills* the *insurance company* and *waits* to be *paid*. -The *insurance company determines* the *amount* to pay based on its policies and agreements with providers (no control). -They may *cover some things* and *not others*. They may pay a certain percentage of the overall bill.

What is speciFicity?

-The ability of the test to identify persons who *do not have* the disease (*TRUE NEGATIVES*). -If a test is *highly specific*, it will ignore almost everything *except potential examples* of the disease.

What is sensiTiviTy?

-The ability of the test to identify persons who *have the disease* (*TRUE POSITIVES*). -If a test is *highly sensitive*, it will find even the *smallest indication* of disease. -The test will "*find*" almost all of the "*needles in the haystack*."

What are prospective plans?

-The biggest example of this is *Medicare*. -Based on *nationwide health care data* about average lengths of stay for specific diagnoses, Medicare established formulas that determine payment amounts "*in advance*." -For example, Medicare beneficiary admitted with exacerbation of *COPD*, hospital knows *how much reimbursement* they will receive from Medicare, and this will be the *total* no matter how long patient stays (5 or 20 days). -*HOSPITALS ARE NOT ALLOWED TO BILL THE PATIENT IF COSTS EXCEED REIMBURSEMENT AMOUNTS* (except for standard deductibles).

What is dual eligibility?

-When an individual qualifies for both *Medicare* and *Medicaid*. -*Medicare* always is *PRIMARY* coverage: Medicare will pay *first* and pay the *larger amount* of the bill. *Medicaid* will then pay a *smaller portion*. -If an individual has *both*, they *do not* have to buy *Part B* of *Medicare* - *Medicaid* will help cover.

What are two types of epidemiological investigations?

1) *Descriptive Epidemiology* 2) *Analytic Epidemiology*

Describe Paulo Freire's ideas on community empowerment:

-*Community members* take on the *power* to *create change*. -Based on a community's *STRENGTHS* and *ASSETS*, empower them to *continue* to *improve health* even after a *program has ended* or the "*helpers*" have *left* the area (e.g., service trips). -"*Start where the people are.*"

What are current challenges in controlling disease (pt. II)?

-*Cultural factors* -*Return* of *older diseases* (e.g., Pertussis) -*Drug resistance* -*Diagnosis challenges* -*Global issues* (i.e., travel, lack of supplies, political issues)

What are teaching tips for public health nursing?

-*Use your resources*: saves time (if something already exists, you may be able to use that), but be sure it's *APPROPRIATE*. -*Evidence-based practice resources*: community guide to preventative services and the CDC.

If it's a two-person family, and the program's qualifying limit is 200% of the FPL, what is the highest the family's income can be?

$12,880 + $4540 = $17,420 X 2 = *$34,840*

The community health nurse was planning health education including validation of learning. What method could be used for validation?

*A. Return demonstration.* B. Asking if the group learned. C. Documenting attendance. D. Providing a certificate.

What is a beneficiary?

*Anyone covered* by an *insurance program*, gets the "*benefit*" of the *coverage*.

What are Diagnostically Related Groups (DRGs)?

*Equates* to a *dollar figure* for every possible *diagnosis* an individual could be hospitalized for (e.g., MI = "$100,000").

What is a pandemic?

*Spread* across *multiple countries/continents* (e.g., COVID-19).

What is an epidemic?

*Spread* over a *population*, *large area* or *region* (e.g., obesity in the United States).

What questions are incorporated into epidemiological investigation?

-"*What* is the outcome?" -"*Who* is affected?" -"*Where* are those affected?" -"*When* have the events occurred?" -"*How* did this occur?" -"*Why* are some affected more than others?"

What is tuberculosis?

-*1/3* of world population infected. -*Leading infectious case* of *death* worldwide, the formation of *granulomas*. -*At-risk populations*: always consider travel, consider the risk of crowded conditions (e.g., prison, senior community, homeless shelter).

What increases cost of health care in the U.S.?

-*Access* -*Historical payment systems*: "fee for service" -*Unnecessary use of services* (based on the fear of lawsuits) -*Preference* -*LACK OF PREVENTIVE CARE* (U.S. wants to spend money on more tangible things) -*LIFESTYLE/HEALTH BEHAVIORS* -*Technological advances* (expensive) -*Aging of society*

How do most vaccines work?

-*Antigen* introduced. -*Imitate* an infection in the body. -Immune system produces *T-lymphocytes* and *antibodies*. -*Imitation* infection *ends*. -"*Memory*" *T-lymphocytes* and *B-lymphocytes* remain to *fight future infections*.

What does the case definition include? What is the harm with calling something a case without confirmation?

-*Clinical information*: symptoms (probable cause), laboratory verification (*CONFIRMED CASE*). -*High risk populations*: children <5, adults >65, pregnant women, people with weak immune systems. -Can *waste money* and *resources* and create *panic*.

What are the responsibilities of the private health care subsystem?

-*Clinics*, *physicians*, *hospitals*. -*FEDERALLY QUALIFIED HEALTH CENTERS* (FQHC). -*Voluntary agencies* (non-government, philanthropic funds/donations, operated + managed as businesses): >Organ/body structures: *AHA* >Specific diseases: *ACS*, *ADA* >Special groups: *March of Dimes* >Phases of health: *Planned Parenthood*

What is influenza? Influenza vaccine?

-*Definition*: a contagious *RESPIRATORY SYSTEM* illness caused by influenza viruses that infect the nose, throat, and lungs; may lead to death in *at-risk populations*. -*Influenza vaccine*: multiple strains, timing (August-May), side effects (means vaccine is working), routes (nasal [18-49], high dose [65+], intradermal [18-64]).

What is pertussis? Pertussis vaccine?

-*Definition*: a highly contagious respiratory tract infection that is easily preventible by vaccine. -*S/sx*: cough lasting two weeks, *INSPIRATORY WHOOP* (take in a huge gulp of air after coughing severely), post-tussive vomiting. -*Lab*: PCR (swab) and culture (+) for B. pertussis. -*Tetanus*, *Diphtheria*, and *Pertussis vaccine*: >DTaP, DT: children <7, 5 dose series. >Tdap: older children and adults; ages 11-18, 19 and older, expectant moms with first pregnancy. >Td: booster, every 10 years or post-exposure for tetanus. -*Upper-case* (full strength), *lower-case* (reduced), "*a*" (acellular/only part of pertussis organism).

What is measles? Measles vaccine?

-*Definition*: a viral infection that is serious for small children but is easily preventible by a vaccine; outbreaks in high schools and colleges. -*S/sx*: generalized maculopapular *RASH*, fever 101F, cough, coryza (runny nose), or conjunctivitis. -*Labs*: + serologic test for measles IgM. -*Measles*, *Mumps*, and *Rubella vaccine* (MMR). -*Interventions*: can be tracked via *INDEX CASE* (first person to have disease), geographic mapping, surveillance, disease investigation.

What programs use the poverty line to determine eligibility? What programs do not?

-*Do use*: Head Start, the Supplemental Nutrition Assistance Program (SNAP), and the National School Lunch Program. -*Do not*: cash public assistance programs (e.g., Temporary Assistance for Needy Families and Supplemental Security Income).

Why is it important for nurses to understand the U.S. health care system and the programs that fall under?

-*Finances* and the *structure* of health care system affect all of our lives, *personally*, *professionally*, and *financially*. -*Professional* aspects: >*PROGRAM FUNDING* and healthcare costs. >Determining client *ELIGIBILITY* for services (*ADVOCACY* - knowing how to obtain resources for clients). >Ensuring *ACCESS* to care. >*IMPROVING* the health care system.

Describe the Affordable Care Act (ACA-2010):

-*GOAL*: greatly increase the number of *insured citizens*. -Most *citizens* must have *health insurance* and *most employers* must offer *affordable coverage* (i.e., providing benefits to full- + part-time employees, changing eligibility). >*Medicaid expansion*. >*Insurance exchanges* to *purchase insurance*. >*Subsidies* to assists with *premiums*. >*Tax penalties* for *not taking insurance* if eligible (now eliminated - young workers used to report whether they accepted insurance). -*Essential benefits package*. -Focus on *PREVENTION* and *WELLNESS*. -*Community assessments* by *hospital* (had a better understanding of its community and its needs).

What are the responsibilities of the federal level subsystem?

-*General population*: >Public protection, environment, food safety, air travel. >Funding to states. >Standardize public health policy. -*Special populations*: Native Americans and Veterans. -*International health* (protection + economic interests).

What theories are individual-focused (health promotion)?

-*Health Belief Model* (Pender's Health Promotion Model, sociological) -*TTM/Stages of Change* (i.e., lifestyle modification)

Describe health literacy, literacy resources, and tools:

-*Health Literacy* (HL): skills needed to *access*, *understand*, and *use basic health information*. -*Low health literacy* is linked to *negative outcomes*. -University of Maryland Health Literacy Resources (*LINK*): provides *links* to *resources* on *health literacy* in the United States and *guides* for clear health communication. -Assessment tool examples: >Vital Sign for Health Literacy (*LINK*): screening tool that *identifies patients* at *risk* for *low health literacy* (i.e., given a nutrition label and then asked 6 questions). >AHRQ Toolshed (*LINK*): developed *four tools* to measure an *aspect* of *health literacy*—individuals' *reading comprehension* in a medical context. -Need to *validate learning* (w/ return demonstration).

What are concepts of infection and disease occurrence?

-*INFECTION*: having the organism in your *body*, it has *entered* and begun *multiplying*. -*DISEASE*: *pathophysiological response* to the organism. -*Confirmed case*: some kind of *proof* that confirms *actual* presence of a disease (e.g., lab test). -*Replication* and *transmission*: disease *cannot be transmitted* until it has reached a particular level of *replication* (a.k.a. "shredding"). -*Carriers*: someone who *has* the *infection* in their body and *can pass* it to someone else, but *doesn't* have the *active disease* themselves.

What is morbidity?

-*Incidence* and *prevalence* of disease occurrences. -The *Morbidity* and *Mortality Weekly Report* is published by the CDC (*LINK*).

What are the stages of infection?

-*Latent*: hidden, no signs and symptoms. -*Incubation*: time from *exposure* and *becoming infected* to the time that *symptoms are showing*. -*COMMUNICABLE*: time from becoming *infected* to the time of *being able* to *pass* the disease (may happen before symptoms show). -*Active*: signs and symptoms are *apparent*.

What are Federally Qualified Health Centers (FQHC)?

-*Low-cost* clinics, community-based; provides *primary* and *preventive* care (e.g., medical, oral, and mental). -Clients are seen *regardless* of their *ability* to pay and *without insurance*; usually there is a *$5 charge*. -Considered a *SAFETY NET* program, receive money from *federal government* but not controlled, overseen by *community board*.

What are examples of adult screening tests?

-*Mammography*: C (women 40-49; 2015) and B (women 50-74). -*Colorectal cancer*: A (adults 50-75) and B (adults 76-85). -*Pap smear*: A; *Blood pressure*: A; *Cholesterol/lipids*: A.

What are characteristics of a disease?

-*Mode of action*: transmission/passing of organism. -*Infectivity*: how *easily* the organism can *invade* the body. -*Pathogenicity*: how *easily* the organism *creates disease*. -*Virulence*: how *likely* the disease causes *severe results*. For example, *tuberculosis* has *low infectivity* and *pathogenicity* but *high virulence* (if not properly tx).

What is the importance of vaccine information statements?

-*Vaccine Information Statement* (VIS) includes: >Vaccine *benefits* and *adverse events*. >Available in *>30 languages* (patients should be provided with appropriate language). >Required by *law*.

What is motivational interviewing? What does OARS stand for?

-*Motivational interviewing*: an effective way to open a conversation with a *learner* and *prepare* them for a *long-term relationship* that will assist them to manage their health; can utilize the *OARS* acronym: 1) *O*pen-ended questions: allows conversation to take-off. 2) *A*ffirmations: letting them know that you understand them. 3) *R*eflection: or reflect w/ them on what they said, active listening. 4) *S*ummaries: what the discussion was about, decisions.

What is surveillance (PHN WHEEL)?

-*Ongoing*; predetermined and systematic investigation into aspects of health that *could potentially* become issues (e.g., safe water, level of flu in community). -Through surveillance, *information* is *available* that helps with *long-term planning* and *intervention* to maintain *safe status*.

What are examples of federal agencies and departments that focus on health (pt. II)?

-*Other federal departments* with *health functions*: >*Department of Agriculture* (oversees the WIC program - supplemental nutrition and other services for pregnant women, infants, and children) >*Department of Defense* (health of military d/t need for military readiness) >*Department of Labor* (oversees OSHA - employee injury, safety, regulations, and protection) >*Department of Justice* (prison systems, the SANE nurse designation) >*Environmental Protection Agency* (EPA)

What are some attempts to control costs of health care?

-*Prospective payment systems*: provides incentives for efficiency, DRGs acute care, HHRGs Home Care. -*Controlling utilization*: primary care provider as "*GATEKEEPER*" (hold-back to control costs), managed care plans preauthorization requirements. -*Addressing* the *social determinants* (e.g., Aurora [*LINK*] committing $50 million to help the disadvantaged, accomplished by hiring/training people, increase minimum wage).

What is screening?

-*Purpose*: identify *RISK FACTORS* and *diseases* in their *earliest stages*; *NOT DIAGNOSTIC*. -Generally, *not episodic illnesses* (i.e., the flu) but rather *chronic disease/conditions* (e.g., breast cancer, HTN). -*PRESUMPTIVE* (positive but not confirmatory) identification of disease, requires *further testing* (e.g., biopsy, cultures, swabs). -Timely *referral* and *follow-up* (r/t PHN WHEEL). -*Early* detection and treatment is *beneficial*. -*Considerations for screening*: >Must be *cost-effective* and *acceptable*. >*RISK* of screen vs. *BENEFIT*. >Example: *prostate screening* (*LINK* - screening can be harmful if no rationale or benefit to screening).

What is Medicare (Title XVIII)? Qualifications?

-*Qualifications*: *65+* and *worked long enough* and *paid* into *Social Security* system (10 years), *disabled adults* who have *not yet* reached *65+*, persons with *End-Stage Renal Disease* (ESRD), *disabled <22* and was *never able* to work. >*PART A* (AUTOMATIC): hospitalization, home health, hospice; automatically receive Part A, *DO NOT* pay a premium. >*PART B* (BUY IT): out-patient and physicians; you can *BUY* Part B, monthly premium based on *income* (lowest $150). Do not have to buy it. >*PART C* (CHOOSE IT): *ALTERNATIVE* to Part A and B; different types of plans and insurance companies that will appeal to some. >*PART D* (DRUG PLAN): Rx coverage; a benefit d/t rising costs of drugs and seniors difficulty affording medications; you can *BUY* Part D.

What is Medicaid (Title XIX)? Qualifications?

-*Qualifications*: covers *poor older adults*, *blind*, *disabled*, *dependent children* by *income*; *BASED FIRST ON FAMILY SIZE AND INCOME*! -Funded jointly by *states* and *federal government*. -U.S. government established the *required services* that must be covered by *each state*. -Also, states can choose to cover *other things* based on needs and budget (if state does not cover required services, government can stop providing federal funds).

What is the Transtheoretical Model (TTM)?

-*STAGES OF CHANGE*, similar to an *assessment tool* (helps determine where an individual is on a continuum). 1) *Pre-contemplation*: when individuals aren't really thinking about things (e.g., teens and unprotected sex). 2) *Contemplation*: thinking about things but just a thought, nothing has been done. 2) *Preparation*: individuals are getting ready to do something (e.g., teens getting information, buying condoms). 4) *Action*: individuals do something and take that big step. 5) *Maintenance*: becoming used to action, becomes a habit/routine (e.g., teens having protected sex). 6) *Termination*: not exactly possible, action is ingrained in individuals that it becomes a part of them/life. -Relates to the *Change Theory* (unfreezing, changing, and refereezing).

Describe federal regulations acts (pt. I):

-*Social Security Act and Amendments* (SSA) (1935, 1965): established *MEDICARE* (Title XVIII) and *MEDICAID* (Title XIX). -*Hill-Burton Act* (1946): federal money for hospital construction in rural areas; increased emphasis on acute care. -*Omnibus Budget and Reconciliation Acts* (1981, 1987, 1989, and 1990): focus on *OUTCOME MEASURES* to determine *quality* (i.e., how often patients return, birth outcomes).

What theories are community/population-focused (health promotion)?

-*Social-Ecological Model* -*Empowerment Model*

How are infectious/communicable diseases controlled and prevented?

-*Surveillance*: who, when, where, what. -*Data* and *notification*: The Nationally Notifiable Infectious Conditions List (*LINK* - states collaborate with CDC to determine which diseases are on the list; states voluntarily report diseases to the CDC). -*Immunizations*: allows for the development of *antibodies*.

Describe federal regulations acts (pt. II):

-*Tax Equity and Fiscal Responsibility Act* (TEFRA) (1982): prospective payment system (PPS) for Medicare (Acute care = DRG system). -*The State Child Health Improvement Act* (SCHIP) (1997; 2009): provides insurance for children and families who cannot afford health insurance (r/t Medicaid). -*Medicare Modernization Act* (2003): provides seniors and disabled w/ some Rx drug benefit coverage.

What are examples of other screening tests?

-*Tuberculosis Skin Testing* (TST): HR populations. -*Scoliosis*: *I* (used to be recommended). -*Prostate-specific antigen* (PSA): C (55-69) and D (70+).

What are examples of federal agencies and departments that focus on health (pt. I)?

-*United States Department of Health and Human Services* (USDHHS): >*National Institutes of Health* (NIH - research) >*Indian Health Services* >*Centers for Medicare and Medicaid Services* (CMS - oversees Medicare and Medicaid, policies and funding) >*Health Resources and Services Administration* (HRSA - ensures adequate training of health professionals, scholarship money for MSN programs) >*Centers for Disease Control and Prevention* (CDC)

What are current challenges in controlling disease (pt. I)?

-*Vaccine failure*: >*Primary* (no response to initial vaccine or cold chain) versus *secondary* (waning of the immunity) >"*Cold chain*" (maintenance of proper temperature for vaccinations is broken) >*Waning* (immunity gets smaller and goes away) -*Lapses* of immunizations -*Mutations* -*New diseases*

What are examples of diseases transmitted via the respiratory route?

-*Varicella* -*Diphtheria* -*Pertussis* -*MMR* -*TB* -*Influenza*

Describe state funded health insurance in Wisconsin:

-*WI Medicaid* priorities: elderly, blind, disabled. -*Badger Care Plus*: health care coverage for *low-income* residents: >Household income up to 300% FPL: *pregnant women*. >Household income up to 300% FPL: *children </=19*. >Household income up to 200% FPL: *adults*.

What is risk pooling?

-A *group* of individuals whose *medical costs* are *combined* to *calculate premiums*. -Pooling risks together allows the *higher costs* of the *less healthy* to be *offset* by the relatively *lower costs* of the *healthy* (e.g., healthy and acute/chronic illnesses).

Describe the disease-oriented perspective:

-Absence of *DISEASE*. -*Objective* view. -*FOCUS ON REPAIR*.

What is the importance of immunization schedules?

-Accessed via the *CDC WEBSITE*; recommendations made by *WHO*, *AAP*, and *ACIP*. -*0* through *6 years*; *7* through *18 years*. -*Catch-up schedule*: for a child *behind* on immunizations, give immunizations within the *shortest* but appropriate time frame (e.g., when window is 6-12 months, go with 6 months). -*Adult immunization schedule*: for adults with medical and other indications.

What is the Guide to Clinical Preventive Services U.S. Preventive Services Task Force (USPSTF - *LINK*)?

-An *online guide* that lists *screening tests* and *analyzes* their *benefits* and makes *recommendations* for their use. -*Letters* are used to indicate the *recommendation level* for that test: >*A*: recommends, net benefit is *substantial*. >*B*: recommends, net benefit is *moderate*. >*C*: recommends *against routine* use of service. >*D*: recommends *against* the *service.* >*I*: *insufficient* to assess benefit vs. harm.

What are major points about infectious/communicable diseases and their relation to population health and nurse's role?

-Communicable disease *prevention* and *control programs* must move beyond drug treatment. -*Health promotion* and *education* to change individual and community behavior must be emphasized. -Close cooperation with other members of the *interprofessional team*. -*Mobilizing community participation* to implement successful programs.

What are the responsibilities of the local level subsystem?

-Conduct *required community assessments*. -*Programs*: immunizations, CD prevention, risk assessment, MCH, environmental health, lab services, mental health, STI/STD. -*Board of health*. -Funding from *state* and *federal taxes*.

Describe the importance of health education materials:

-Consider *format* of materials. -Assess materials *relevance*, appropriate *audience*, *appeal*, and *reading level*. -Reading level can be assessed through the following: >SMOG (*LINK*): takes a sample of writing and determines *reading level* and *grade level* of text. >"Simply Put" (CDC - *LINK*): a guide for creating *easy-to-understand* materials.

What is the importance of learning in health promotion/teaching?

-Consider that people *learn* in *different ways* (i.e., hands-on, reading, listening). -*Age* and *developmental level* must be considered. -*Factors* that may affect learning: culture, fears, physical problems.

What is the Natural History of Any Human Disease Model?

-Determining *what's going on* with a *disease* and *how* the *actions* to address it relate to the *timeframe* of a *disease*. -*Doing something* - but doing the *right thing* at the *right time* in relationship to the way *diseases develop*. >*Prepathogenesis period*: appropriate interventions include *health promotion* and *specific protection* (*PRIMARY PREVENTION*). >*Period of pathogenesis*: appropriate interventions include *early dx and prompt tx* and *disability limitation* (*SECONDARY PREVENTION*) or *rehabilitation* (*TERTIARY PREVENTION*).

What is the Socio-Ecological Model?

-Dynamic system, *community* as *client*: *individual*, *interpersonal*, *organizational*, *community*, *society*. -Use the model to *GO BEYOND SIMPLE EDUCATION*! -Determine *actions* at the *various levels* that will augment education: >*Laws* - societal level because it tends to involve national laws/policies. >*Family involvement* - interpersonal level because it surrounds the individual, acts as a network for a person. >*Environmental changes* - community level because its associated with a larger group (e.g., neighborhoods, workplaces).

What are the Federal Poverty Guidelines (FPG)? How is it calculated?

-Established *annually* by the *federal government*; used as a *basis* for *qualifying* for *low-income health insurance* and *programs*. -If *income* is *below* some percentage of FPG and a program accepts people with *incomes below* that level, then *income qualifies* for the *program* (+ other criteria). -R/t *ANNUAL INCOME* and *FAMILY SIZE*; 2021: *1 person* = *$12,880*, *add $4540/additional person* in family.

What is private insurance? Plan examples?

-First established in *1930s*; often referred to as *managed care plans* because the *insurance company* has a *process* in place to "*manage*" care delivery. -Some examples of types of plans: >*Preferred Provider Organization* (PPO): the plan will only pay for specialty services if the *PCP* (Primary Care Provider/Gatekeeper) *refers* the client to a specialist; self-referrals are not usually covered. >*Health Maintenance Organization* (HMO): the *insurance coverage* is part of the *entire system*; the system manages the *hospital*, *additional services*, and *insurance coverage*; *providers* work for the HMO; there is often a focus on *wellness* (e.g., Kaiser Permanente).

What is the Health Belief Model?

-Focus is on *BEHAVIOR* and *MOTIVATION*. -Found that *information alone* is rarely enough to motivate one to act, must know *what* and *how* to do it, should relate to *individual's needs*. 1) *Individual perceptions* (POWERFUL): perceived susceptibility, severity, benefits (of preventative action), and *BARRIERS* (to prevent action). For example, being influenced to wear a motorcycle helmet after friend gets injured. 2) *Modifying factors*: demographic and sociopsychological variables (i.e., change environment, get family involved), perceived threat, *CUES TO ACTION* (information, reminders, persuasive communication, experience). 3) *Likelihood of action*: likelihood of taking recommended preventative health *ACTION*.

What are the types of immunity?

1) *NATURAL*: we develop immunity ourselves by *having* the disease. -*Active*: by having the disease we develop *antibodies*. -*Passive*: through the *placenta*, antibodies received from the *mother*. 2) *ARTIFICIAL*: we develop immunity after receiving a *vaccine* or *immunoglobulin*. -*Active*: we develop our own *antibodies* after receiving *vaccine*. -*Passive*: we receive *antibodies* from someone else. 3) *HERD*: if approximately *80%* of a "group" is *vaccinated*, others are *protected *; only involves groups in close proximity.

What is a deductible?

A *standard amount* that a *beneficiary must pay* themselves *per year before* their *insurance* starts to pay the bills.

What is an outbreak?

A *sudden spike* in cases compared to the average (e.g., Typhoid Mary Outbreak).

Why are theories important?

A working knowledge of theory is important in understanding *why people act* as they do and *why they may* or *may not* follow advice given to them by *medical professionals*.

What level of prevention is involved if a school nurse advocates for increasing the tobacco tax? And...What level of practice is it (Using the SEM)?

A. Secondary/community. B. Tertiary/individual. *C. Primary/society.* D. Tertiary/interpersonal.

Nurses at the Health Department Clinic use cues to action. What are they doing?

A. Teaching healthy diets. B. Warning clients of dangers of the flu. C. Conducting health assessments. *D. Sending reminder cards when annual mammograms are due.*

Which example best demonstrates a connection between the determinants of health and health promotion?

A. Using SMOG to evaluate teaching materials. *B. Improving walkability to school for school children.* C. Social marketing to reach large numbers of people. D. Advocacy for research to improve cholesterol lowering drugs.

What is investigation (PHN WHEEL)?

Used when a *THREAT* exists. Something appears to be *going on* but must be *analyzed* further to *understand* and *correct*.

What are epidemiological measures?

Always a *NUMBER/RATE*, not an intervention.

What is the "Near Poor" concept?

An individual's *income* is *above* the *poverty level*, but income is still *too low* to *buy insurance* = fall into gaps!

What does promotion mean?

Positive actions such as *EDUCATION FOR HEALTHY LIVING* and promotion of favorable environmental conditions.

What is an example of safety and quality concerns related to health care?

Some hospitals may try to get patients out *as early* as possible. This leads to "*no point of return*" or "*diminishing results*", hospitals are *not paid* if patient comes back.

What is an endemic?

The *amount* of a disease that *routinely exists* in an *area* (e.g., Malaria in Africa).

What is a government subsidy?

The *federal government* would "*subsidize*" (provide money for) a person's payments for *insurance* based on *income*.

What are third-party payers?

The *insurance companies* (help cover most of the costs). The *beneficiary* is the *first party*, and the *provider* is the *second party*.

What do retrospective and prospective plans refer to?

The *timing* that a determination is made regarding *how much* an *insurance company* will *pay* to a *provider*.

What is multi-causation?

There will *always* be *multiple factors* behind an infection/disease; whether *agent*, *host*, and/or *environment*.

Why do nurses implement health teaching, prevention, and promotion?

To *CHANGE* and *INFLUENCE* behaviors and to *IMPROVE* health.