POP FInal

Breastfeeding

"Breastfeeding is a natural and beneficial source of nutrition and provides the healthiest start for an infant. In addition to the nutritional benefits, breastfeeding promotes a unique and emotional connection between mother and baby." ~AAP recommends ~Exclusive breastfeeding for first 6 months ~Breastfeeding in combination with introduction of complementary foods until at least 12 months ~Continuation of breastfeeding for as long as mutually desired by mother and baby ~2011Surgeon General's Call to Action to Support Breastfeeding ~Actions aimed at increasing society support ~Nurses, other professionals, and support groups

Ms. L is being treated for depression. Which of the following statements by her indicates a need for further education?

"My medication will cure me of my depression."

Quality care: to err is human- building a safer health system

(IOM, 1999) focused on safety within the health care delivery system

Quality care: crossing the quality chasm

(IOM, 2001) focused on developing a new health care system for the twenty-first century, one that improves care

Quality care: who will keep the public healthy

(IOM, 2003) brought public health into the forefront by focusing on issues including globalization, rapid travel, scientific and technological advances, and demographic changes >In-depth exploration of educational needs for improved public health >Need for appropriately prepared public health professionals >New content areas for public health professionals: >Informatics, genomics, communication, cultural competence, community-based anticipatory research, global health, policy and law, and public health ethics >Old content areas for public health professionals: >Epidemiology, biostatistics, environmental health, health services administration, and social and behavioral science

Quality care: priority areas for national action

(IOM, 2003) identified priority areas that should be addressed to improve quality >Patient and family engagement >Population health >Safety >Care coordination >Palliative care >Overuse >Access >Health systems infrastructure capabilities

physiological changes of aging

- Occur in all body systems - Rate and degree of changes are highly individualized Influenced by - Genetic factors - Diet - Exercise - The environment - Health status - Stress - Lifestyle choices - And many other elements

monitor medication use

- Older adults consume more than one third of all Rx drugs, as well as many OTC drugs and "folk" remedies. - Age-related changes influence the effects of drugs. - Polypharmacy may lead to drug interactions and dangerous adverse reactions. - Most emergency hospitalizations for adverse drug events are caused by a few commonly used medications. - Closely monitor medication use in homes to ensure safety. - Older adults should be educated about potential adverse reactions, including drug-drug and drug-food interactions.

end of life issues

- Patient Self-Determination Act (PSDA) - Federal law enacted in 1990 - Requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess advance directives. - Living wills - Durable power of attorney - DNR (do-not-resuscitate) order

encourage physical activity and fitness

- Physical activity ... - Improves functional status - Reduces blood pressure and cholesterol - Decreases insulin resistance - Prevents obesity - Strengthens bones - Reduces falls - Walking is one of best forms of exercise. - Barriers: Pain, fatigue, lack of access to safe areas, impairment in sensory function and mobility

psychosocial issues and role changes affecting seniors

- Retirement - Relocation - Widowhood - Loss of family and friends - Possibly raising their grandchildren

Role of the community health nurse in women's health

-direct care -educator -counselor -researcher

Environmental health is..

. all the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors. ... encompasses the assessment and control of those environmental factors that can potentially affect health. ... targeted toward preventing disease and creating health-supportive environments.

How to Calculate rates

1. All of the events being measured should be included in the numerator. 2. Everyone included in the denominator should be at risk for the event in the numerator. 3. A specific period of time for the observations must be clearly indicated. 4. A rate is a fraction or a proportion; therefore, it is necessary to multiply by a base, usually a multiple of 10, to make the rates understandable. This removes the decimal points and makes the comparison of rates easier to interpret.

Community-Based Mental Health Care Initiatives

1. Americans understand that mental health is essential to overall health. 2. Mental health care is consumer and family driven. 3. Disparities in mental health services are eliminated. 4. Early mental health screening, assessment, and referral to services are common practice. 5. Excellent mental health care is delivered, and research is accelerated. 6. Technology is used to access mental health care and information.

Community assessment components: people

1. Demographic: distribution, mobility, density, census data 2. Biological factors: health and disease status, genetics, race, age, gender, causes of death 3. Social factors: occupation, activities, marital status, education, income, crime rates, recreation, industry 4. Cultural Factors: ethnohistory, hierarchy and roles, language, religion and spirituality, values, customs, norms

Which of the following statements describes the social construct paradigm for disability (as opposed to the medical model)?

1. It focuses on the modification of attitudinal, architectural, sensory, and economic barriers in the environment.

Community assessment components: place or environment

1. Physical Factors: geography, terrain, type of community, location of health services, housing, animal control 2. Environmental Factors: geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants

Factors that contribute to homelessness

1. Shortage of Affordable Housing Housing is considered affordable when it costs the resident 30% or less of their total income. There has been a dramatic increase of persons who pay half or more on rent. HUD offers assistance to low income families. The demand for this assistance has far exceeded the supply. 2. Income Insufficiency Average poverty threshold was 23,021 for a family of four in 2011, 44% of the poor were living below half of their threshold. The federal minimum wage is 7.25/hr. In many areas, wages need to be 3-5 times higher than this to afford the available housing. Much of a person's income is spent on rent leaving little for all the other necessities of life. 3. Inadequacy of supportive services

Standards of Practice for culturally competent nursing care

1. Social Justice 2. Critical Reflection 3. Knowledge of Cultures 4. Culturally Competent Practice 5. Cultural Competence in Health Care Systems and Organizations 6. Patient Advocacy and Empowerment 7. Multicultural Workforce 8. Education and Training in Culturally Competent Care 9. Cross-Cultural Communication 10. Cross-Cultural Leadership 11. Policy Development 12. Evidence-Based Practice and Research

Factors to consider when determining the health of a community

1. Status: epidemiological data, client satisfaction, mental health, crime rates 2. Structure: presence of health care facilities, service types and patterns of use, demographic data 3. Process: relationships, communication, commitment to and participation in health

Current HHS Strategic Plan

1. Transform health care 2. Advance scientific knowledge and innovation 3. Advance health, safety, and well-being of the American people 4. Increase efficiency, transparency, and accountability of HHS 5. Strengthen the nation's health and human services infrastructure and workforce

Key principles of public health nursing

1. emphasize primary prevention 2. work to achieve the greatest good for the largest number of people 3. recognize that the client is a partner in health 4. use resources to promote the best outcome.

2. Define and discuss the focus of public health.

1. public health is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort. ~public health efforts focus on prevention and promotion of population health at the federal, state, and local levels through the provision of community health and personal health services

In which era were people with mental disabilities labeled as "feebleminded" because they could not reach the minimum educational level?

19th century

Rural residents in the United States compose more than __% of the nation's poor.

50

Analytic epidemiology: experimental design

> Also called a Randomized Clinical Trial (RCT) >Subjects assigned to experimental or control group >Apply experimental methods to test treatment and prevention strategies >Ethical considerations with human subject rights review >Also useful for investigating chronic disease prevention

Primary Prevention

> Prevention of problems before they occur > Health promotion and health protection

Cultural Perspectives and Healthy People 2020

>Developed a set of national health targets...eliminating racial and ethnic disparities in health >Embraced and focused on ways to close the gaps in health outcomes >Focused on disparities among racial and ethnic minorities, women, youth, older adults, people of low income and education, and people with disabiliti

Analytic Epidemiology

>Examine complex relationships among the many determinants of disease >Investigation of the causes of disease, or etiology > Investigates the causes of disease by determining why a disease rate is lower in one population group than in another

Agent of disease: etiologic factors

>Nutritive elements >Excesses, deficiencies >Chemical agents >Poisons, allergens >Physical agents >Ionizing radiation, mechanical >Infectious agents >Metazoa, protozoa, bacteria, fungi, rickettsia, viruses

Health care providers

>Provider organizations >Any organization that provides health care to the community >Health care professionals >The interprofessional health care team >Professionals and nonprofessionals >Nontraditional health care providers >Complementary and alternative therapies

Management of Health Problems in culturally diverse populations

>Providing health information and education >Delivering and financing health services >Developing health professionals from minority groups >Enhancing cooperative efforts with the nonfederal sector >Promoting a research agenda on minority health issues

Immigration to the United States

>Since 1991, more than 13 million legal immigrants >In 2010, almost 40 million foreign-born individuals in the United States (12.9% of population) from: >Latin America 53.1% >Asia 28.2% >Europe 12.1% >Other regions 9%

Descriptive epidemiology

>Study of the amount and distribution of disease >Used by public health professionals >Identified patterns frequently indicate possible causes of disease >Focuses on the amount and distribution of health and health problems within a population

Areas of environmental health: built environment: water quality

>The availability, volume, mineral content levels, toxic chemical pollution, and pathogenic microorganism levels >The balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance ~Contamination of drinking supply by human waste ~Oil spills in the world's waterways ~Pesticide or herbicide infiltration of ground water ~Aquifer contamination by industrial pollutants- kill algae but also pollute water ~Heavy metal poisoning of fish and eating them

Environmental health

>The purpose of environmental health is to ensure the conditions of human health and provide healthy environments for people to live, work, and play. >Accomplished through... >Risk assessment >Prevention >Intervention

Community Based care

A myriad of services provided outside the walls of an institution ➢ Home health and hospice care, occupation health programs, community mental health programs, ambulatory care services, school health programs, faith-based care, elder services (adult day care) Community participation in decisions about health care services Focus on all three levels of prevention An understanding that the hospital is no longer the exclusive health care provider

Health Disparities

AHCRQ (2005) reveals that: >Cancer mortality rates are 35% higher in African Americans than in whites. >African Americans with diabetes are seven times more likely to have amputations and develop renal failure than are whites with diabetes. >30% of Hispanics and 20% of African Americans lack a usual source of health care (compared with less than 16% of whites). >Hispanic children are nearly three times as likely as non-Hispanic white children to have no usual source of health care. >African Americans (16%) and Hispanic Americans (13%) are more likely to rely on hospitals or clinics for health care than are whites (8%).

What group of homeless individuals is known for their involvement in survival sex?

Adolescents

Health and social services to promote the health of women

Affordable Care Act (ACA) of 2010 Protection from being denied coverage by insurance companies Protection from being charged more for health care services because of their gender Preventive care without copays including: Well-women visits with screening and counseling for gestational diabetes, HPV, STIs, HIV, contraception, and domestic violence Breastfeeding counseling support and supplies Medicaid (1965) A federal- and state-funded health insurance program for the poor Expanded under ACA to persons under 65 with an income below 133% of poverty level Largest source of funding for people with limited income, regardless of age eligibility Five broad coverage groups: Children, pregnant women, adults in families with dependent children, individuals with disabilities, individuals 65 years or older Women's health services Provide primary health care needs, as well as reproductive and maternity care services including: Eating disorders All forms of abuse Disease prevention, including smoking cessation Health promotion focusing on nutrition, exercise, and stress management The National Women's Health Network is a strong advocate for women's concerns.

How to assess a community: secondary and primary statistics

After looking at this secondary data online primary data needs collected from actual members of the community.

The biomedical model

Agent --> Outcome --Classic, one dimensional model --Works well for infectious diseases Many health conditions result from multiple influences. Any particular influence contributing to these health conditions cannot be considered out of context.

Based on the Department of Housing and Urban Development (HUD) definitions of homelessness, which one of the following individuals would be considered homeless?

An individual who spends most nights at public or private places not designed for regular sleeping accommodations

Age-adjusted rates or standardization of rates

Another method of reducing bias when there is a difference between the age distribution of two populations

3. Examine innovative and effective teaching and learning strategies that exemplify community-centered health education for the individual, family, or aggregate.

As health educators, community health nurses must realize that cultural and social definitions of health differ. In addition, the nurse must understand that individuals and communities must take responsibility for their own health.

humanistic theory

Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest

Thinking upstream-concepts applied to rural health

Attack community-based problems at their roots Emphasize the "doing" aspects of health Maximize the use of informal networks

Areas of environmental health: built environment: food, safety, and waster management

Availability, accessibility, and relative costs of healthy food free from contamination of harmful herbicides, pesticides, and bacteria ~Malnutrition ~Bacterial food poisoning ~Food adulteration ~Disrupted food chains by ecosystem destruction ~Carcinogenic chemical food additives

People with Disabilities 7

Barriers can be transportation, costs, appointment challenges, insurance issues...many PWD have many services needs such as prescriptions, therapies, devices, cares, etc. The costs can be unaffordable, even to those with insurance or those in middle to upper middle class. Caring for a child with a disability can have all these challenges and more with finding appropriate care Disparities are caused by ... ➢ Differences in access to care ➢ Provider biases ➢ Poor provider-patient communication ➢ Poor health literacy Persons with disabilities experience ... ➢ Higher rates of chronic illness ➢ Increased risks for medical, physical, social, emotional, and/or spiritual secondary issues People with intellectual disabilities are ➢ Undervalued and disadvantaged

Mr. H is a patient in the primary care center where you work as a staff nurse. He tells you that he is currently participating in a stress management program. You know that this is a form of which of the following?

Behavioral therapy

male-female health paradox

Biological factors Genetics, effects of sex hormones, and physiological differences Influenced by genetics, hormones, and environment Socialization Men enculturate their sons to believe that risking personal injury demonstrates masculinity. Men are more likely to change health behaviors when supported by female family members. Orientation toward illness and prevention Stereotypical view of men as strong and invulnerable is incongruent with health promotion. Men lack the somatic awareness and are less likely to interpret symptoms as indicators of illness. Men may have a desire to rationalize symptoms and deny their susceptibility to disease, thus delaying treatment. Data collection on health behaviors may not be accurate: Males are less likely than females to participate in the data collection process. Social pressure for males to be less expressive (suppress their emotions) may help explain gender differences in reporting health behaviors.

why do people age

Biological theories Events that occur randomly and accumulate over time (stochastic theories) Predetermined aging (nonstochastic theories) Psychosocial theories: how one experiences late life (behavioristic) Disengagement theory—withdrawal, decreased interaction Activity theory—remaining active and involved is necessary to maintain life satisfaction Continuity theory—continue through life as in previous years

How to assess a community: vital statistics

Births, deaths, marriages, divorces, adoptions- shows growth or reduction- also shows causes of death and birth info such as if it was a teen, cesarean etc.

Community health program planning, development and management: Implementation

Carry out the plan --> initiate interventions to achieve goals and objectives according to program plan. Monitor the intervention process and the response of the community in terms of values, needs and perceptions

Emergency Preparedness in Rural Communities

Challenges in rural areas: ➢ Resource limitation • Human, financial, and social capital ➢ Separation and remoteness • Longer response times ➢ Low population density • Impacts funding ➢ Communication • Warning systems often absent or neglected in remote areas; burden on individuals

People with Disabilities 13

Children and disability- is imperative that community health nurses use their expertise in listening to parents voice concerns about their child. Addressing concerns and working with the family towards goals , not merely reassurance , regarding a concerned parent.

People with Disabilities 10

Children with disabilities can be at an increased risk for bullying or teasing in school, whether this is an apparent or hidden disabilities. This can add to the already challenging condition. Depression, anxiety, health complaints and decreased academic achievements are among the effects of bullying.

aging is a natural process that affects all living organisms

Chronological age The young-old (ages 65-74) The middle-old (ages 75-84) The old-old (ages 85 and older) The elite-old (more than 100 years old) Functional age Functional ability and the ability to perform activities of daily living (ADLs) A better measure of age than chronological age

Based on the common illnesses and risky health behaviors among farmers, the community health nurse should implement which of the following health promotion activities?

Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families.

Community health program planning, development and management: assessment

Collect data about the community and its members --> complete a needs assessment and identify community strengths and weaknesses. Assess the availability of community resources. List potential sources for program funding. Evaluate secondary health data

Intervention Wheel: red section --> Collaboration

Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health.

Intervention Wheel: blue section --> health teaching

Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

3. Analyze three factors that contribute to homelessness Ch 22

Contributing factors to homelessness are complex and varied. They include poverty, changes in the labor market (i.e., shift to a service-based economy and a labor market that demands an educated workforce), lack of affordable housing, deinstitutionalization of persons with mental illness, and heavy use of alcohol and illicit drugs (particularly crack cocaine).

nutrition checklist for seniors: warning signs of poor nutrition health

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eed assistance in self-care E lder years (>80 years old)

Quality

Data should be appraised from research to measure whether bias is minimal. ~quality care is promoted through licensure and credentialing of health care providers, adherence to facility policies, professional development and compliance with legal guidelines.

Health Problems for Migrant Workers

Dental disease Tuberculosis Chronic conditions Stress, anxiety, and other mental health concerns Leukemia Iron deficiency anemia Stomach, uterine, and cervical cancers Lack of prenatal care Higher infant mortality rates STIs, HIV/AID

What official national organization provides financial housing assistance to low-income families?

Department of Housing and Urban Development (HUD)

Mr. S was recently hospitalized for a stroke. While in the hospital, he was also diagnosed with diabetes. As his nurse, you know he is at risk for which of the following?

Depression

Data Collection: windshield survey

Descriptive approach that assesses several community components by driving through a community Strengths: Provides a descriptive overview of a community Limitations: Need for a driver so the nurse can visualize and document the community elements ~May be time-consuming ~Results based only on visualization and does not include input from community members

Data Collection: informant interviews

Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants Strengths: Minimal cost ~Participants serving as future supporters ~Offer insight into beliefs and attitudes of community members ~Reading/writing of participants not required ~Personal interaction may elicit more detailed responses Limitations: Built-in bias ~Meeting time and place

Data Collection: focus groups

Directed talk with a representative sample Strengths: Possibility of participants being potential supporters ~Provides insight into community supports ~Reading/writing of participants not required Limitations: Possible discussion of irrelevant issues ~Challenging to get participants ~Requires strong facilitator ~Difficult to ensure that sample is truly representative of the overall community ~Time-consuming to transcribe discussion

People with Disabilities 4

Disabilities can be outwardly visible and apparent such as someone in a wheelchair or less obvious such as a person with hearing loss or Autism. Learning disabilities and other unapparent disabilities to the outside view maybe termed as hidden disabilities.

People with Disabilities 11

Disability harassment is a prohibited behavior under section 504 and title II of the Americans with Disabilities Act.

Relative risk ration

Divide the incidence rate of disease in the exposed population by the incidence rate of disease in the nonexposed population.

Important cohort studies

Doctor Study (Health of men, 36 years worth of data, Harvard University) Nurses Study (Health of women, @122,000 nurses, 42 years worth of data, Harvard University) The Crimson Study (Health in older ages, 236 Harvard sophomores, 80 years of data, Harvard University) Framingham Study (Heart disease, over 14,000 people across 3 generations, 70 years worth of data, Harvard University) Alameda County Study (Social networks and health, 7000 people, 10 years worth of data, University of California at Berkeley)

People with Disabilities 3

Each person is very unique and has their own experience, goals and knowledge- PWD cannot be lumped into one group.

Ecological studies VS. Case studies

Ecological: correlation analysis of population data Case studies: involve an in-depth analysis of an individual, group or social institution

1. Compare and contrast definitions of health from a public health nursing perspective.

Elements commonly used to compare and contrast the public health nursing definitions of HEALTH address the inclusion or exclusion of physical, mental, emotional, and spiritual realms; concepts of wholeness or well-being; perception of health; and social aspects of role functioning

Intervention Wheel: blue section --> counseling

Establishes an interpersonal relationship intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual.

Attributable risk

Estimate of the disease burden in a population

Informal Care Systems

Evolve from self-reliance and self-help traits of rural residents Include people who have assumed the role of caregiver based on their individual qualities, life situations, or social roles Provide direct help, advice, or information Need to identify and combine informal services with formal systems

Community health program planning, development and management: Evaluation

Examine the success of the interventions --> evaluate strengths and weaknesses of the program. Determine achievement of desired outcomes. Recommend and implement modifications to better meet the needs of the community

Community-oriented nursing

FOCUS OF CARE: aggregates, communities, population (public health). Can include at-risk or unserved individuals and families PRIMARY GOAL: health promotion and disease prevention NURSING ACTIVITIES: usually indirect (program management). Can include direct care of at-risk individuals and populations

Community-based nursing

FOCUS OF CARE: individuals and families PRIMARY GOAL: management of acute or chronic conditions NURSING ACTIVITIES: direct (one-on-one). illness care: management of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (school, camps, prisons)

Agent defined

Factor necessary to cause the disease in a susceptible host (see exceptional chart on page 72). An agent can be: Biological- Physical- Chemical- Nutritional- Psychological-

Distributive justice

Fair distribution of the benefits and burden in society is based on the needs and contributions of its members

You work in a community clinic that specializes in pediatric mental health. Joy, age 12 years, has been diagnosed with depression. You know a major risk factor for depression in childhood is which of the following?

Family history of depression

People with Disabilities 1

First- Stop and think- what would it be like to live with a disability? What if one of my loved ones was affected by a disability? What would it be like to live and work in my community and environment with a disability?

Private subsytems

Focus on the individual ~nonprofit ~profit >Models of services >Solo practice >Single specialty group practice >Multispecialty group practice >Integrated health maintenance model >Community health center >Voluntary or nonofficial agencies

Community health program planning, development and management: strategies and barriers

HELPFUL STRATEGIES: ~thorough assessment, accurate interpretation of data, collaboration with community partners, effective outreach and communication patterns, sufficient resources, logical planning, skilled leadership BARRIERS: ~inadequate assessment, inadequate or misconstrued data, no involvement with community partners, impaired communication, inadequate resources, lack of planning, poor leadership

Rural Health Care Delivery System

Health care provider shortages ➢ Rural shortages likely to become worse ➢ Need to "grow their own" ➢ Telemedicine Managed care in the rural environment ➢ Possible benefits: • Potential to lower primary care costs • Improve the quality of care • Help stabilize the local rural health care system ➢ Risks • Probable high start-up and administrative costs • Volatile effect of large, urban-based, for-profit managed care companies

Healthy People 2020 and Homelessness

Healthy people 2020 Social determinants of health to be considered are poverty, employment status, access to employment, housing stability, access to health services and access to primary care. ■ New goal: to "Create social and physical environments that promote good health for all" ■ New topic area: Social Determinates of Health (SDH) ■ Five broad dimensions of SDH are defined within Healthy People 2020 as: 1. Economic Stability 2. Education 3. Social and Community Context 4. Health and Health Care 5. Neighborhood and Built Environment

Precursors of death frequently not addressed by the present health care system for men

Heart disease and stroke Hypercholesterolemia Hypertension Diabetes mellitus Obesity Type A personality Family history Lack of exercise Cigarette smoking Cancer Sunlight Radiation Occupational hazards Water pollution Air pollution Dietary patterns Alcohol Heredity Certain medical conditions

2. Examine the nurse's role in community education within a sociopolitical and cultural context.

Helpful tips for effective teaching and learning strategies include determining what the patient wants to know and assessing the reading skill of the patient.

Intervention Wheel: red section --> Community organizing

Helps community groups identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set.

Intervention Wheel: green section --> referral and follow up

Helps individuals, families, groups, organizations, and/or communities identify and access necessary resources to prevent or resolve problems or concerns.

"I PREPARE" environmental exposure history mnemonic

I - Investigate potential exposures P - Present work R - Residence E - Environmental concerns P - Past work A - Activities R - Referrals and Resources E - Educate

Intervention Wheel: purple section -->Screening

Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations.

Community health program planning, development and management: Diagnosis

Identify and prioritize health needs of the community --> analyze data to determine health needs. work with community members, local health professionals and administrators to develop priorities and establish outcomes.

long term and short term goals

Identifying long term goals and short term goals is an important step in health education planning portion of the nursing process. These can be on an individual, family and community level. See the box on pg 145-146 for examples

Epidemiological calculations

Incidence: number of new cases in the population at a specific time divided by population total multiplied by 1,000= ____per 1,000 Prevalence: Number of existing cases in the population at a specific time divided by population total multiplied times 1,000= ____per 1,000

Health Disparities related to persons

Income and Poverty ➢ One of the most important indicators of the health and well-being of all Americans, regardless of where they live. ➢ Regional differences—highest in the South ➢ Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites ➢ Family composition—female-headed families have highest rates ➢ Children—among the poorest citizens in rural America Health risk, injury, and death ➢ Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use Risk factors ➢ Age, education, gender, race, ethnicity, language, and culture Education and employment Occupational health risks Perceptions of health (gender, race, ethnicity)

how to write a risk nursing diagnosis

Increased risk of...(disease)....among...(population)...related to......(cause)...as demonstrated in...(health indicator)........

Respect for autonomy

Individuals select those actions that fulfill their goals

Upstream thinking

Is used to focus on interventions that promote health or prevent illness, as opposed to medical treatment models that focus on care after an individual becomes ill.

Which of the following statements is true concerning the Individuals with Disabilities Education Act (IDEA)?

It provides federal funding through state-administered programs from preschool through secondary education for children with disabilities. .

Major indicators of health: mortality rates

LIFE EXPECTANCY: for americans is at an all-time high ~Mortality rates -Cardiovascular disease (CVD) continues to be the number one overall killer of women. -Cancer rates are increasing because of lifestyle choices, environmental carcinogens, and increase in life expectancy. -Diabetes mellitus causes the premature death of many women and is a risk factor for CVD. -Gaps exist in the availability and quality of reproductive health care services globally.

social learning theory

Links information to beliefs and values to change or shift the learners' expectations

barriers to health care for men

Little effort has been made to create a male-specific health care climate Access to care Focused on maintaining an effective workforce Financial support for curative—not preventive—care Reluctance to take time off from work for care Lack of health promotion Disease prevention and health promotion not often reflected in a man's perception of health Focus on disease cure in the present health care system

Intervention Wheel: purple section --> Case finding

Locates individuals and families with identified risk factors and connects them with resources.

You are working in a mental health facility as a nurse. You are involved with patients who have varied diagnoses. One of your patient's family members asks what biological problem causes all of these people to have mental illness. You respond that most experts believe which of the following?

Many factors cause the problem Information from studies to date is insufficient to establish a definitive biological cause for mental illness. Scholars have concluded that mental disorders are multifactorial, complex physiological phenomena

Tertiary preventions

Maximization of recovery after an injury or illness (rehabilitation) ~nutrition counseling for management of Crohn's disease ~physical and occupational therapy ~support groups

mens use of medical care

Men do not engage in health protective behaviors at frequently as women. Most men do not have routine check-ups, including screenings. Men seek ambulatory care less often than women. Men delay medical treatment à are sicker when they do seek health care à therefore they require more intensive medical care. Men tend to have longer lengths of stay in the hospital than women.

Mental illnesses adversely affect achievement of social justice. Which of the following statements related to marginalization of some populations because of mental illness is FALSE?

Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups.

Nonmaleficence

No harm is done when applying standards of care

Data Collection: participant observation

Observation of formal or informal community activities Strengths: indication of community priorities, environmental profile, and identification of power structures Limitations: Bias ~Time-consuming ~Inability to ask questions of participants

Health Disparities among rural americans

Only 10% of U.S. physicians practice in rural areas Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings) More often assess their health as fair or poor More disability days resulting from acute conditions More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates Higher number of unintentional injuries

Intervention Wheel: Yellow section --> Policy development and enforcement

Places health issues on decision-makers' agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies.

Intervention Wheel: Yellow section --> advocacy

Plead someone's cause or act on someone's behalf, with focus on developing the capacity of the community, system, and individual or family to plead their own cause or act on their own behalf.

People with Disabilities 15

Policy and Disability ~Individuals with Disabilities Education Act ensures a free public education to children with disabilities based on their needs in the least restrictive setting preschool through secondary ~Americans with Disabilities Act Landmark civil rights legislation- prohibits discrimination against PWD in everyday activities. This meant equal opportunities for employment , transportation, public accommodations, public services and telecommunications. ~Gaps- PWD are less likely to be employed, have lower income, education, access to transportation.....equates most likely to live in poverty compared to someone without a disability. PWD also more likely to have chronic health conditions

A community health nurse is reviewing the results of SIPP (Survey of Income and Program Participation) used by the U.S. Census Bureau to collect disability data. Which of the following will the nurse find classified as an instrumental activity of daily living?

Preparing meals

People with Disabilities 12

Prevalence - 56.7 million people (ages 5 and up ) in the US with a disability Of those 56 million, 38 million are considered to have a severe disability About 15% of households have at least one child with a special health care need 1 in 88 children are on the autism spectrum 5 times more boys than girls- many of these children have ongoing behavioral, emotional or developmental conditions Disability affects one out of 5 Americans

primary prevention measures for men

Provide health education and screening in the workplace Participate in interest groups and research focused on men's health Encourage interest in physical fitness and lifestyle changes Include the male perception of health in policy formation

tertiary prevention measures for men

Provide rehabilitation with sex role and lifestyle considerations Provide counseling on lifestyle, role changes, and job retraining. Give men permission to express emotions. Adapt goal setting to meet men's needs. Keep time away from work to a minimum. Develop new concepts of community care Provide specific services for men; adapt care to meet needs of male population in the community.

major legislation affecting women's health services

Public Health Service Act (1982) Provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery. Includes the Family Planning Public Service Act Title VII of the Civil Rights Act of 1964 Prevents discrimination based on sex, race, color, religion, or national origin Amended to also include pregnancy and childbirth Sexual harassment is violation of Civil Rights Act Social Security Act Provides monthly retirement and disability benefits to workers and survivor benefits to families Occupational Safety and Health Act (OSHA) Enacted in 1970 Ensures safe and healthful working conditions Family and Medical Leave Act (FMLA) Enacted in 1993 Provides 12 weeks of unpaid leave each year for family and medical reasons

Longevity and mortality in men

Rates of longevity are increasing for both men and women. Gender disparity for life expectancy and mortality has decreased, but mortality rates for men remain higher than those for women. Factors influencing mortality rates include race or ethnic origin, socioeconomic status, and education. Males continue to be at risk for death resulting from unintentional injury and homicide.

Tony, age 16 years, comes to see you, the school nurse, with complaints of abdominal pain. You note that Tony exhibits signs and symptoms of depression, states he wishes he did not wake up today, and exhibits signs of anxiety. You would do which of the following?

Refer him immediately for evaluation.

Rural Health Research

Research agendas must address: ➢ The capacity of rural public health to manage improvements in health ➢ Information technology capacity in rural communities ➢ Developing and monitoring performance standards in rural public health ➢ Developing leadership and public health workforce capacity within rural public health ➢ Interaction and integration of community health systems, managed care, and public health in rural America

research in women's health

Research efforts to include women in studies have grown; not based only on male subjects NIH Office of Research on Women's Health (ORWH) established in 1990 Many topics examined based on special task force recommendations Research on financing and delivery of health services for women

Mr. T has been admitted to the mental health floor for evaluation. You, the nurse, note that he has displayed hallucinations, disorganized thinking and speech, and bizarre behavior. He has a flat affect, lack of energy, and poor attention. You know that these are symptoms of what disorder?

Schizophrenia

Intervention Wheel: blue section --> Consultation

Seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, and family or individual.

Services for homeless

Some of the services need to prevent homelessness include job placement assistance, housing assistance, mental health services, Chronic disease management, substance abuse treatment, income assistance- just to name a few. There is a lack of these resources One thing that needs to be available to all persons is access to affordable health care 25% of those with an income below $25,000 had no health insurance.

Data Collection: surveys

Specific questions asked in written format Strengths: Data collected on client population and problems ~Random sampling ~Available as written or online format ~Contact with participants not required Limitations: Low response rate ~Expensive ~Time-consuming ~Possibility of the collection of superficial data ~Requires reading/writing abilities of participants

People with Disabilities 17

Strategies for the nurse 1. do not assume anything 2. Adopt the client's perspective 3. Listen and learn from the client; gather data from the perspective of the client and family 4. Care for the client and the family, not the disability 5. Be well informed about community resources 6. Become a powerful advocate 7. Look at the person and family as unique 8. Collaborate in health care planning with the individual or family

Systems thinking

Studies how an individual, or unit, interacts with other organizations or systems. Systems thinking is useful in examining cause and effect relationships.

Intervention Wheel: purple section --> surveillance

Surveillance: describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing and evaluating public health interventions

Measurement of Disability

Survey of Income and Program Participation (SIPP) ➢ Functional activities ➢ Activities of daily living (ADLs) ➢ Instrumental activities of daily living (IADLs) American Community Survey (ACS) ➢ Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment) Other organizations also collect disability data

Intervention Wheel: purple section -->Disease and other health event investigation:

Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures.

secondary prevention measures for men

Tailor health care clinics to men's needs Provide screening services for men Dental examination: Yearly Eye examination: Every 3 to 5 years Blood pressure check: Every 2 years Blood cholesterol check for men aged 53 years and older Prostate examination: Every year after age 50; blacks every year after age 40 Colorectal screening: Every 3 to 5 years Tobacco use and cessation information every year One-time screening for abdominal aortic aneurysm for men 65 years old if the male has smoked

People with Disabilities 2

Terminology- PWD- people with disabilities Thought to be the largest minority group in America. Some do's and don'ts when interacting with PWD. Don't- Be afraid of joking, be afraid to ask questions, focus on differences, lean on or move the persons wheelchair, assume a blind person know who is speaking to them, grab the arm of a blind person, repeat loudly what you want to say, pet a service dog. Do- treat everyone with respect as with any social or professional relationship, recognize educating others helps remover barriers so asking questions is ok, seek out similarities and interests, respect a wheelchair as a part of a person personal space, speak to individuals at eye level, inform the person who you are talking to is present and say goodbye when you are leaving, let the person take your arm instead, face the person you are speaking to, speak distinctly and slightly more slowly, do not interrupt the service dogs work.

5. Outline a systematic process for developing culturally and literacy relevant health education materials, messages, media, and programs.

The "Framework for Developing Health Communications" is recommended to create a variety of health education messages and programs.

Behavioral risk factor and surveillance survey (National, state and county data)

The Behavioral Risk Factor Surveillance System (BRFSS) --state-based program --gathers information on risk factors among Illinois adults 18 years of age (non-institutionalized) and older through monthly telephone surveys. Established in 1984 as a collaboration between the U.S. Centers for Disease Control and Prevention (CDC) and state health departments, the BRFSS has grown to be the primary source of information on behaviors and conditions related to the leading causes of death for adults in the general population.

Areas of environmental health: built environment: healthy homes

The availability, safety, structural strength, cleanliness, and location of shelter, and indoor air quality ~Homelessness-availability of a healthy home ~Rodent and insect infestation ~Poisoning from lead-based paint ~Sick building syndrome- could be caused by meth, pipes, mold ~Unsafe neighborhoods- this could be do they feel safe enough to go outside and get groceries or exercise

Areas of environmental health: built environment

The connection between people, communities, and their surrounding environments that affects health behaviors and habits, interpersonal relationships, cultural values, and customs ~Drunk driving ~Second-hand smoke ~Noise exposure ~Urban crowding ~Technological hazards

Waste management

The handling of waste materials resulting from industry, municipal processes, and human consumption as well as efforts to minimize waste production ~Use of nonbiodegradable plastics ~Poorly designed solid waste dumps ~Inadequate sewage systems ~Transport and storage of hazardous waste ~Illegal industrial dumping ~Nuclear facility emissions ~Radioactive hazardous wastes ~Radon gas seepage in homes and schools- second largest cause of lung cancer ~Nuclear testing ~Excessive exposure to x-rays

Rural Populations

The largest rural population in history of United States is now. 75% of counties are classified as rural; they contain only 20% of the U.S. population Number/size of rural counties are highest ... ➢ in the South (35%) ➢ in the Midwest and West (23%) ➢ in the Northeast (19%) Census data ➢ 20% of nation's children under 18 ➢ 15% of nation's elderly ➢ More than 50% of nation's poor Economic base is shifting ➢ Agriculture is the "food and fiber system" ➢ All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included ➢ Poverty in rural areas greater than in urban areas Poverty continues to be greater in rural America than in urban areas. Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas. Greater diversity among residents: a country of immigrants historically and today. Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care

Which of these statements is true regarding income insufficiency in the United States?

The poverty rate increased between 2007 and 2010.

Areas of environmental health: built environment: outdoor air quality

The purity of the air and the presence of air pollution ~Gaseous pollutants ~Greenhouse effect ~Destruction of the ozone layer ~Aerial spraying of herbicides and pesticides ~Acid rain

Prevalence Pot

The relationship between incidence and prevalence >Incidence >Recovery >Death

Which statement regarding the impact of managed care on rural public health departments is true?

The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement.

1. Discuss definitions of health.

The way health is defined has shifted from a focus on the curative model, to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health. > Health is viewed not only as an important goal, but at a resource for living

important characteristics of adult learners

They need to know why they need to learn something, want to be self directed, draw from life experience, must be ready to learn, the problem must be in the "now", motivated

Federal health agencies

U.S. Department of Health and Human Services (USDHHS) funded by taxes. Consists of the many agencies.

other issues in women's health

Unintentional injury or accidents Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States. Disabilities resulting from acute and chronic conditions Women have fewer disabilities than men because they tend to report their symptoms earlier and receive necessary treatment.

Data Collection: secondary data

Use of existing data (death statistics; birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem Strengths: Database of prior concerns/needs of population ~Ability to trend health issues over time Limitations: Possibility that data may not represent current situation ~Can be time-consuming

Intervention Wheel: Yellow section --> Social marketing

Uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest.

wellness vs. good health

Wellness is different than "good health." Wellness exists at one end of a continuum with illness at the other end. Health promotion programs focus on helping individuals to maintain their wellness, prevent illness, and manage any chronic illnesses that the individual may have. Preventive health services are valuable in improving the individual's health status to maximum wellness potential.

Doing a self-assessment

What comes to mind when you think of someone with a disability? Picture yourself as a person with a disability. Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability. Think about living in a family affected by disability. What is the experience of living with disability within your community?

According to the vulnerability index, the individual at highest risk for death is:

a 60-year-old person who has been homeless for 9 months.

The U.S. Department of Education defines a homeless child as:

a child abandoned in a hospital.

ratio

a fraction that represents the relationship between two numbers

Aggregate

a group of people with common characteristics

Accreditation: joint commission

accredits hospitals, home care agencies, long-term care facilities, and ambulatory care centers

Accreditation: American Healthcare commission

accredits managed care organizations (MCO)

Accreditation: National committee for quality assurance (NCQA)

accredits managed care organizations and insurers and uses the health plan effectiveness data and information set (HEDIS) to collect data about more than 90% of health care plans to measure performance and consumer satisfaction

cultural brokering

advocating, mediating, negotiating, and intervening between the client's culture and health care culture on behalf of the client

cultural preservation

allowing preservation of the client's traditional values

Adolescent health issues: violence

among youth is a multifaceted problem

Community health program planning, development and management: preplanning

brainstorm ideas --> gain entry into the community and establish trust. Obtain community awareness, support, and involvement. Coordinate collaborations that have similar interests in addressing identified problems

Childhood health issues: environmental concerns

can be found in air, water, and from toxic exposure to chemicals

environmental risks: air pollution

carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke

How to assess a community: focus groups

carefully selected participants a nurse selects from a specific aggregate- may get more insight about a specific aggregate than a survey or open forum. This type of data collection may also lay the groundwork for community participation and planning.

Age-specific rates

characterize a particular age-group in the population and usually consider deaths and births. Determining the rate for specific subgroups of a population and using a denominator that reflects only that subgroup remove age bias

Environment defined

conditions that influence the interaction of the agent and host

U.S. department of health and human services (HHS)

created healthy people 2020 which serves as a foundation for efforts throughout the HHS to create a healthier nation ~1979 Surgeon General's Report, Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention ~Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation ~Healthy People 2000: National Health Promotion and Disease Prevention Objectives ~Healthy People 2010: Objectives for Improving Health ~Healthy People 2020: Improving the Health of Americans

International council of nurses (ICN)

five core values: 1. visionary leadership 2. inclusiveness 3. flexibility 4. partnership 5. achievement promotes ethical nursing practice throughout the world

Pender's Health Promotion model #2

focuses on 8 questions or reasons why individuals engage in health actions.

environmental risks: contamination

food and food products with bacteria, pesticides, radiation and medication (growth hormones or antibiotics)

human health

human health and its influence on every aspect of life are central to the global agenda

The Brown family is being evicted from their home and will be moving into a homeless shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition, the Brown family is:

in imminent risk of homelessness.

Population-focused nursing

includes assessing to determine needs, intervening to protect and promote health, and preventing disease within a specific population (individuals at risk for hypertension, individuals without health insurance, individuals with a specific knowledge deficit)

The Social Environment

includes one's interactions with other individuals in the community as well as interaction with law enforcement, faith communities, and government agencies

cultural awareness

includes self-awareness of ones own cultural background, biases and differences. culturally aware nurses are: ~more likely to explore cultural variations among clients ~Better able to understand how personal beliefs impact client care ~Able to recognize that the meaning of health differs with each culture.

Environmental control

indicates the belief in how the environment affects the individual ~individuals who believe that the environment can be mastered to affect health status will actively engage in health promotion, disease prevention and treatment

Self-pay

individuals are responsible for payment of charges not covered by a third party. some clinics offer sliding scale payment where the rate of payment is based on the individual income.

Risks to children

no preventive health care and immunizations --> preventable diseases or chronic conditions in life

3. Discuss determinates of health and indicators of health and illness from a population perspective

o Make a person healthily or not healthy 1. Individual behaviors •This is modifiable with things such as opportunity and education oEX: eating health, not smoking, exercise 2. Health services •Preventative services and access to healthcare •Ex: rural area vs. inner city 3. Social environment •Poverty vs. wealth 4. Environmental factors •Places with a lot of pollution a house with mold etc. 5. Biology and genetics 6. Policies and interventions

Tobacco use

o Smoking is the most important preventable cause of death in the U.S according to the CDC

Vulnerable populations

o These include individuals who are subject to issues such as: • Violence, substance use disorders, mental health issues/illnesses, poverty and homelessness, rural residency, migrant employment, veteran status, disability, low income, difficulty accessing health care, poor self-esteem, young or advanced age, chronic stress, environmental factors

Recognizing potential abuse/neglect

o Unexplained injury o Unusual fear of the nurse and others o Injuries/wounds not mentioned in history o Fractures, including older healed fractures o Presence of injuries/wounds/fractures in various stages of healing o Subdural hematomas o Trauma o genitalia o Malnourished or dehydration

recognizing potential older adult abuse

o Unexplained or repeated physical injuries o Physical neglect and unmet basic needs o Rejection of assistance by caregiver o Financial mismanagement o Withdrawal and passivity o Depression

Community partnership

occurs when community members, agencies, and businesses actively participate in the process of health promotion and disease prevention critical to the accomplishment of health promotion and disease prevention strategies

Adolescent health issues: teen childbearing and parenting

often have long-term negative consequences for both child and mother

Community

one must look at the who (aggregates of persons) where (physical location/boundaries) why (social systems , relationships of aggregates that perform community functions)

assessing the relevancy of health materials

pg 145

Helpful tips for effective teaching

pg. 143

Primary Prevention of disease

prevention of the initial occurrence of disease or injury ~EXAMPLES: nutrition education, family planning, smoking cessation education, prenatal classes, providing immunizations

Goals of Community health nursing

promote, preserve, and maintain health of populations by the delivery of health services to individuals, families, and groups in order to influence "community health". Promoting health and preventing disease

Medicaid

provides health care coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability

cultural assessment

provides information to the health care provider about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors

One strategy for the community health nurse in caring for people with disabilities is becoming a powerful advocate. This involves:

providing information but allowing the person to make the decision.

reality

review pg. 122 and 123

Establishing causality: biological plausibility

the data must make biological sense and represent a coherent explanation for the relationship

Establishing causality: specificity

the exposure variable must be necessary and sufficient to cause disease; there is only one causal factor

Organizations

the health care system in the US is influenced by both federal and private organizations

The greatest promise for improving health outcomes for rural residents is:

the increase in distribution of technology, providing more education and health services.

Quantity

the number of studies, participants, or strength of effect

Rate

the primary measurement used to describe the occurrence of a state of health in a specific group of people in a given time period

relative risk ratio

the ratio of the incidence rate in the exposed group and the incidence rate in the non-exposed group

consistancy

whether the results are repeatable

In contrast to people who live in urban areas, rural residents frequently describe their health by their ability to:

work and be productive.

International organizations: united nations international children's fund (UNICEF)

works for children's survival, development, and protection by developing and implementing community-based programs with well-documented achievements in child health, nutrition, education, water, sanitation and women's rights

Which of the following are appropriate when working with people with disabilities? Select all that apply.

~ Asking a wheelchair-dependent person if he or she needs help and how you can assist. ~ Sitting or kneeling at eye level whenever possible when talking with someone who is wheelchair dependent. ~Speaking distinctly and a little slowly to someone who is hearing impaired.

Major indicators of health: morbidity rates

~More women than men are hospitalized each year in the United States. ~Women are more likely than men to be disabled from chronic conditions. ~Women are more likely than men to have surgery; many surgeries relate to reproductive health. ~The most frequently occurring interruption in women's mental health relates to depression.

International health care delivery systems

~Much to learn from one another. ~Research and development must be relevant to infectious diseases that affect the poor. ~Need to systematically generate an information base. ~Need to consider determinants of health. ~Use population-based approaches to address access, cost, efficiency, and effectiveness. ~Collaborate to solve the problems of health care delivery systems. ~Market- and population-based approaches need to learn from each other. ~Effective health care delivery systems must: ~Increase access and efficiency. ~Improve health status through health promotion and disease prevention. ~Eliminate health disparities. ~Protect individuals, families, and communities from financial loss caused by catastrophic illness.

Risks to mother --> risks to baby

~Not in optimal health --> Poor pregnancy outcome ~Uncontrolled medical conditions --> Low birth weight with serious medical conditions ~Exposure to drug, alcohol, tobacco, poor nutrition --> Chronic conditions that affect health and well-being ~Unsafe environment (secondhand smoke, lead-based paint) --> ~Chronic conditions throughout childhood and maybe adolescence/adulthood

Philadelphia 1976

~Nurse reported two cases of severe respiratory illness, one of which had been fatal ~Both people had attended the annual American Legion Convention ~Between July 26 and August 2, 18 conventioneers had died ~Led to the discovery of the gram-negative pathogen, Legionnella pneumophila

health in the global community

~Population characteristics ~Environmental factors ~Patterns of health and disease ~International agencies and organizations ~International health care delivery systems ~The CHN's role in the global community ~Research in international health

Preterm birth and low birth weight

~Preterm: birth before 37 weeks of gestation ~LBW: infant born less than 5.5 pounds -important predictors of infant health -greater risk of death than full term -greater risk of mental and physical disabilities *cerebral palsy *visual problems (retinopathy of prematurity) *feeding problems *hearing loss *developmental delays

Factors affecting child and adolescent health

~Significant factors in overall well-being: -Parents' or caregivers' income, education, and stability -Security and safety of the home -Nutritional and environmental issues -Health care access and use ~Specific issues: -Poverty -Racial and ethnic disparities -Health care use

2. Describe biological, social, and political factors associated with mental illness. Ch 24

• Biological factors associated with mental illness include genetic factors, neurotransmission, and brain structural and functioning abnormalities. • Social factors can contribute to the etiology of mental illness. • Political factors can dramatically influence how mental disorders are managed.

ch 19 learning focus: 1

• Biological theories of aging address how cells age and what triggers the aging process

ch 19 learning focus: 5

• Common health and illness concerns generally stem from issues of chronic illness or medication use.

2. Examine prominent health problems among women of all age groups (i.e., from adolescence to old age).

• Issues related to reproductive health include family planning, pregnancy and nutrition, and infertility and diseases of the reproductive tract. • Nurses are advocates and activists for women's health through their involvement in health policy making. • Medical treatment for women was generally based on research in which the subjects were exclusively male, but the establishment of the Office of Research on Women's Health has introduced a 20-year research agenda focused on women's health issues.

1. Identify the major indicators of women's health.

• Major indicators of women's health include life expectancy, mortality rate, and morbidity rate.

Ch 14 learning focus: 5

• Many current efforts to improve health focus on altering individual behavior but social, economic, and political changes to improve the environment may also be required in order to improve the health of individuals and communities.

Present-Day Community Mental Health Reform

• Mental Health Reform works toward monitoring federal legislation, administration activity, and public education initiatives. • Makes community mental health a national priority by establishing early access, recovery, and high quality in mental health services as standards • Medicalization of Mental Illness • Brain Neuroimaging, Genetics, and Hope for New Treatments

1. Explain the concepts of community mental health and discuss the importance of community mental health promotion in special populations. Ch 24

• Mental health refers not only to the absence of mental disorders but also to the ability of an individual to negotiate daily challenges and social interactions of life without experiencing cognitive, emotional, or behavioral dysfunction, violence, fear, or intellectual inadequacy. • Mental illness refers to maladaptive responses to distress and an inability to mobilize resources.

Agricultural Workers

• Migrant and seasonal workers have the poorest health of any aggregate in the country, and the least access to affordable care • They are high risk for accident and injury on the job • Higher rates of acute and chronic respiratory illness • At risk for acute pesticide poisoning - s/s headache, nausea, diaphoresis, vomiting- can also cause neurological symptoms and more serious breathing difficulty / bronchospasm ➢ Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension • Barriers to health in migrant workers- language, unaware of services, short stays and frequent relocation, trust issues, economics, fear of losing their job or deportation • Needs- preventative care, dental care, prenatal care, child health care, vaccinations • Solutions to needs of the seasonal or migrant worker- Mobile clinics, interpreters on site, multiple services available at once to take care of social as well as health needs, evening hours, transportation to non-mobile clinics

Bipolar Disorder

• Mood disorder that presents with changes in mood from depression to mania. • May co-occur with hallucinations and delusions. • Management of bipolar disorder must be ongoing and involve close monitoring. • Treatment generally involves use of mood stabilizing medication, often in combination with antipsychotic and antidepressant therapy.

ch 19 learning focus: 3

• Normal physiological aging changes are influenced by genetic factors, diet, exercise, the environment, health status, stress, lifestyle choices, and many other elements.

Ch 14 learning focus: 6

• Nurses must ask questions and assist community members in determining how the environmental problems affect their lives.

Eating Disorders

• Often triggered by developmental milestones (e.g., puberty, first sexual contact) or another crisis (e.g., death of a loved one, ridicule over weight, starting college) • Primarily affect females • Bulimia nervosa (binge eating) • Anorexia nervosa (obsessed with fear of fat and with losing weight) • Treatment: long-term nutrition counseling, psychotherapy, and behavior modification

ch 19 learning focus: 2

• Older adults must cope with psychosocial and role changes such as retirement, relocation, widowhood, loss of family and friends, and possibly raising their grandchildren.

2. Discuss barriers on the health of rural aggregates and the impact those have on the population. Ch 23

• Personal barriers to health care among rural residents include lower income levels, higher unemployment, and higher poverty rates than those of urban dwellers.

Teaching focus 6

• Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted. > Number of health events in a specified period > Population in same area in same specified period > Proportion multiplied by a constant (k) >For example, the rate can be the number of cases of a disease occurring for every 1000, 10,000 or 100,000 people in the population >Can make meaningful comparisons

Suicide

• Risk factors—IS PATH WARM? • Previous suicide attempts, mental illness, substance abuse, barriers to accessing mental health treatment • Protective factors • Appropriate mental health care, easy access to treatment, community support, and continuing support from medical and mental health providers • Warning signs of suicide • Question those at risk in terms of thoughts, plans, lethality, means, and intent. Warning signs of suicide I - Ideation S - Substance abuse P - Purposelessness A - Anxiety T - Trapped H - Hopelessness W - Withdrawal A - Anger R - Recklessness M - Mood changes

4. Describe the characteristics of rural community health nursing practice. Ch 23

• Rural nurses practice professional nursing within the physical and sociocultural context of sparsely populated communities and include aspects of maternity, pediatric, medical and surgical, and emergency nursing.

Migrant Health

• Seasonal and migrant workers are employed in farming. • Employment occurs during the time period required for caring for and harvesting crops. • Migrant workers make a temporary home during employment at a specific location, and can be paying for their family to live in a different, permanent home at the same time. • Agricultural workers are not covered under common labor laws (Fair Labor Standards Acts, Occupational Safety and Health Administration protections). • Minors 12 years old and older are not covered under the Child Labor Act and can work alongside family members, even under hazardous conditions • The Migrant Health Act provides funding for migrant health centers across the U.S., which serve about one-fifth of the migrant worker population. • Most migrant farmworkers do not speak English as a first language, and can face barriers of discrimination or ineligibility for services. • Undocumented workers might not seek services due to fear of deportation. • The nurse should use cultural competence to design care for individuals and groups of seasonal and migrant workers.

Learning focus ch 13: 2

• Sociocultural factors that influence health care include family characteristics, values and norms, nutritional practices, developmental considerations, communication patterns, and health-related beliefs and practices.

Teaching focus 2

• The wheel model considers the multiplicity of host and environmental interactions that have developed and the fact that understanding of disease has progressed.

Definition of Homeless Student

■ McKinney-Vento Homeless Education Assistance Improvements Act of 2001 ensures that each child and each homeless youth has equal access to the same free, appropriate public education, including a public preschool education, as provided to other children and youths. ■ Includes children and youth who are: - Sharing the housing of other persons (frequently referred to as "doubling up") - Abandoned in hospitals - Awaiting foster care placement

Model of Justice- Homelessness

■ Social justice system - Belief that all people are equally entitled to key ends (e.g., access to health care and minimum standards of income) - Says all members of society must accept collective burdens to provide a fair distribution of these ends - A foundational aspect of public health - Supports upstream thinking

Quality care: leadership by example

(IOM, 2003) was a report requested by Congress that examined the federal government's quality enhancement processes

Quality care: health professions education

(IOM, 2003), the education of all health professionals is viewed as a bridge to quality care. >Provide patient-centered care >Work in interdisciplinary teams >Employ evidence-based practice >Apply quality improvement >Utilize informatics

Quality care: keeping patients safe-transforming the work environment

(IOM, 2004) addressed critical quality and safety issues with a focus on nursing care and nurses >Focused on nurses in acute care and the work environment for safer patient care >Also looked at nursing shortage, health care errors, patient safety risk factors, nurse's role in quality improvement, and work environment threats to patient safety

Sleep and Health and Health Promotion activities

> Sleep is an essential component of chronic disease prevention and health promotion > Requirements change with age and life circumstances > Regulated by waking time and circadian rhythms > Hormones during sleep affect memory, blood pressure, and kidney function. Health Promotion activities > Sleep assessment is important >Identify disorders that may affect daily activities >Keep sleep log >Practice sleep hygiene >Establish environment that promotes sleep >Avoid food and activities that interfere with sleep

Analytic epidemiology: cross-sectional studies

> Sometimes called prevalence or correlational studies > Examine relationships between potential causal factors and disease at a specific time > Impossible to make causal inferences

Public health system: state level

> State health departments >Responsible for the health of their citizens >Central authorities in the public health care system >Dependent on federal level for guidance and resources >Establish own state laws

Critical issues in health care delivery: health care reform

> The Clinton Health Reform Initiative > Patient Protection and Affordable Care Act of 2010

Alcohol consumption and health

> Third leading lifestyle-related cause of death for the nation > Short-term use causes acute risks > Long-term effects have major impact on health and social issues > Influenced by legal drinking age ># 1 used and abused drug among U.S. youth Health promotion activities > Prevent underage drinking > Assist with enforcement of legal drinking age > Identify individuals and groups at risk of abuse and dependence > Educate adults and youth on dangers of alcohol > Requires a community-wide effort to address the problem on several fronts

Public health system: federal level

> U.S. Department of Health and Human Services > Surgeon General and numerous other agencies > Targets general population, special populations, and international health > IOM Report, HHS in the 21st Century: Charting a New Course for a Healthier America (2008), recommended transformation of system

Use of epidemiology: health services

> Used to describe the distribution of disease and its determinants in populations > Study population health care delivery > Evaluate use of community health services

Future of Public Health questions

> What services? >Who has access? >Who pays? >How is it delivered? >What is the role of government?

Critical issues in health care delivery: globalization and international health

> World has no real boundaries > CDC active in responding to preparedness and international travel > WHO fosters collaborative global initiatives >ICN gives nursing perspective

Risk Reduction

> is a proactive process > enables individuals to react to actual or potential threats to their health

Risk communication

> is the process of informing the public regarding threats > is affected by perceptions, process, and actions

Applying epidemiologic principles in nursing practice

>Assessment of health needs and assets ~Individual assessment ~Community assessment ~Using assessment data for planning and implementing interventions ~Promoting healthy lifestyles ~Preventing and controlling outbreaks ~Contributing to a safe and healthy environment ~Evaluating the effectiveness of health services

Culturological assessment

>Brief history of ethnic and racial origins of the cultural group with which the client identifies >Values orientation >Cultural sanctions and restrictions >Communication >Health-related beliefs and practices >Nutrition >Socioeconomic considerations >Organizations providing cultural support >Educational background >Religious affiliation >Cultural aspects of disease incidence >Biocultural variations >Developmental considerations

Role of the community health nurse

>Conduct a "culturological" assessment. >Conduct a cultural self-assessment. >Seek knowledge about local cultures. >Recognize political issues of culturally diverse groups. >Provide culturally competent care. >Recognize culturally based health problems.

Analytic epidemiology: observational studies

>Descriptive purposes >Etiology of disease >No manipulation by investigator

Providing health information and education

>Developing programs to increase public awareness about health problems. >Plan health information campaigns: >Be sensitive to cultural factors. >Involve community leaders. >Acknowledge existing cultural beliefs and practices. >Involve families, churches, employers, and community organizations as support systems. >Use lay volunteers to organize community support networks. >Client education should be interpersonal; carefully use credible printed materials and audiovisuals.

development of epidemiology as a science

>Early attempts at understanding the reasons for disease were primarily a direct result of trial and error observations of individual people. ~John Graunt and the Bills of Mortality (1662) ~William Farr, Registrar General (1840s) ~John Snow and the Broad Street Pump (1854 and page 71) ~Florence Nightingale, Nurse and Epidemiologist (1854)

Cornerstones of Public health nursing

>Focus on health of entire population >Reflect communities' priorities and needs >Establish caring relationships >Remain grounded in social justice >Provide care for the whole person >Promote health based on epidemiological evidence (evidence-based practice) >Collaborate with community resources

Federally sponsored initiatives to improve health of minority groups

>HRSA Health Disparity Collaboratives (HDC) >Racial and Ethnic Approaches to Community Health (REACH 2010) >National Breast and Cervical Cancer Early Detection Program (NBCCEDP) >Ryan White Comprehensive AIDS Resources Emergency (CARE) Act B >National Center on Minority Health and Health Disparities (NCMHD)

Benefits of an environmental health history

>Increased awareness of environmental/ occupational factors >Improved timelines and accuracy of diagnosis >Prevents disease and aggravation of conditions >Identifies potential work-related environmental hazards and/or environmental hazards in and around clients' homes

Diversity among nurses

>Minorities are generally underrepresented by nursing workforce (HRSA, 2009): >White/non-Hispanic 81.8% >African American 4.2% >Hispanic 1.7% >Asian and Pacific Islander 3.1% >Native American and Alaska >Native 0.3% >Minority groups tend to be geographically distributed in the United States.

Resources for Minority health

>U.S. Department of Health and Human Services and Public Health Service >Office of Minority Health >Disadvantaged Minority Health Improvement Act of 1990 >Indian Health Service >Indian Self-Determination Act of 1975 >National Institutes of Health >National Center on Minority Health and Health Disparities (NCMHD)

Environmental health: using a critical theory approach

>Uses "thinking upstream" framework. >Raises questions about oppressive situations. >Involves community members in the definition and solution of problems. >Facilitates interventions that reduce health-damaging effects of environments. >Asks critical questions about clients' work and home environments to help discern the contributions of specific hazards to health.

Which of the following would be considered a long-term disabling condition in which the person must learn to incorporate the modifications required for living into daily living and identity?

A cardiovascular accident (CVA) with paralysis to the right side of the body

Community health diagnosis

A community health diagnosis consists of 4 parts- identification of health risk or problem, the affected aggregate, the cause and the supporting evidence.

Health disparities related to place

A downward spiral may exist: ➢ people leave à services are lost à tax base becomes insufficient à fewer services are provided à long distances to get health care à jobs become scarce and more people leave à the cycle continues Access to health care (#1 priority) Fewer primary care physicians General health services lacking Health insurance coverage ... ➢ Varies according to race and ethnicity; age and residence (rural or urban) ➢ Influences health patterns ➢ May create financial barriers to health care

What is a healthy community

A healthy, productive community has the ability to respond to change in dynamics in order to meet the members needs. The dynamics of a community are always going to change. The subsystems in a community need to function to meet these changing needs.

Quality care: the future of nursing leading change, advancing health

(IOM, 2011) focuses on the nursing profession and how it might fit into the change process 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

Host Factors-Intrinsic factors

(Susceptibility, or Response to Agent) >Genetic >Age >Sex >Ethnic group >Physiological state >Prior immunological experience >Active/, passive >Intercurrent or preexisting disease >Human behavior

Health Indicators

(mortality rates, disease prevalence, levels of physical activity, obesity, tobacco or other substance use) describe the health status of a community and serve as targets for the improvement of a community's health

7. Prepare an appropriate and meaningful teaching plan and evaluation criteria for the individual, family, and/or group.

Nurses should analyze the program and health message for effectiveness and track the mechanisms using process evaluation.

6. Relate and apply factors that enhance the suitability of health education materials, messages, media, and programs for an intended audience.

Nurses should evaluate health materials for format-layout, type, verbal content, visuals content, and aesthetic quality before the materials are disseminated to individuals, families, or the general public.

People with Disabilities 8

Differentiating illness and disability- nurses have to remember that these often are or can be separate. An illness is not necessarily related to the disability or vice versa. Be careful to not put PWD into the "sick role" but always ask the client if they want assistance, clarify goals with the person or family, that way, as a nurse you know the best way to help. Listen, collaborate with the person and family, make plans and goals that meets the person's wants and needs...empower the person and family by collaborating with them. Promotion of self-determination fosters personal values and preferences.

Intervention Wheel: green section --> delegated functions

Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law.

WHO International Classification of Functioning, Disability, and Health

Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level). An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level). A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level).

People with Disabilities 5

Primary prevention are those actions that involve the manifestations of the disability itself. Examples include prenatal care and immunizations for mothers and newborns ~Secondary prevention focuses on preventing secondary conditions that are related to the disability such as obesity prevention in someone with impaired mobility. ~Tertiary prevention focuses on preventing a functional limitation from progressing into a disability. An example is a customized education plan for someone who has learning disabilities.

reproductive health concerns

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

What is the purpose of the Homeless Information Management System (HIMS)?

Obtains national data on homeless individuals

Levels of prevention for women's health

Primary prevention Recognize risk for disease and target health care behaviors to reduce risk Never smoking, following a nutritious diet, safe sex practice, avoiding drugs, limiting alcohol consumption, and staying physically active Secondary prevention Routine screening for cervical cancer, STIs, breast self-exams, and mammograms Tertiary prevention Education and resource utilization

Attack rate

a disease or condition is endemic when there is a moderate, ongoing occurrence in a given location ~EPIDEMIC: occurs when the rate of disease exceeds the usual (endemic) level of the condition in a defined population ~PANDEMIC: condition occurs when an epidemic occurs in multiple countries or continents ATTACK RATE: number of people exposed to a specific agent who develop the disease divided by the total number of people exposed

Which model supports upstream thinking with the purpose to improve homelessness through reduction of structural conditions contributing to homelessness?

Social justice

Mission of public health

Social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible

Proportionate mortality ratio

method also describes mortality. It represents the percentage of death resulting from a specific cause relative to deaths from all causes. It is often helpful in identifying areas in which public health programs might make significant contributions to reducing deaths. In some situations , a high PMR may reflect a low overall mortality or reduced number of deaths resulting from other causes. Therefor PMR requires consideration in the context of the mortality experience of the population

International organizations: united nations (UN)

provides the means to resolve global conflicts and formulates policies that affect all nations. regardless of size, wealth, or political system, all member nations have an equal vote in the decision-making process. UN decisions reflect world opinion and the moral authority of the community of nations

Establishing causality: strength of association

rates of morbidity or mortality must be higher in the exposed group than in the non-exposed group.

analytical study design: case-control studies

also known as retrospective studies, work backward from the effect to the suspected cause ("bread and butter" design for epidemiology) >Subjects are selected on the basis of the presence or absence of the disease or outcome in question—one group of people (case-subjects) with the health problem and another group without the health problem (controls) >The relationship between exposure and outcome in a case-control study is quantified by calculating the odds ratio (OR). The OR is an estimate of RR that is interpreted in the same manner as RR.

Total quality management (TQM)

an approach that seeks to improve quality and performance which meets or exceeds expectations

Continuous quality Improvement (CQI)

an approach to quality management that emphasizes the organization and its processes and systems and uses objective data to analyze and improve processes ~Effectiveness: providing services to those who will benefit ~Timeliness: reducing waits and harmful delays in providing and receiving care ~Client-centered: ensuring client values guide decision-making ~Equity: Providing equal care without discriminating against gender, race, sexual orientation, or socioeconomic status ~Safety: avoiding injuries to clients from the care intended to help them ~Efficiency: avoiding waste in supplies, ideas, or energy

Critical issues in health care delivery: consumer advocacy and client rights

an important health care issue that individual states and the federal government have been addressing through legislation ~client/consumer-centered health care

Establishing causality: dose-response relationship

an increased exposure to the risk factor causes a concomitant increase in disease rate.

epidemic

an outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population

cultural needs

are as important as physical and psychological needs. The nurse should avoid imposing personal cultural values on the client, as well as ethnocentrism and stereotyping in the provision of care

Determinants of Health

are factors that influence the client's health. These include nutrition, stress, education, the environment, finances, and social status/stigma (prejudice)

Behaviors

are one's response to internal stimuli (hunger) and to external conditions (hot weather). Behaviors interact with one's biology in a common relationship with one influencing the other.

Modifiable risk factors

are those factors over which we have control such as smoking, drinking, or leading an active lifestyle

Analytical study design: cross sectional studies

are those in which a sample of persons from a population is enrolled and their exposures and health outcomes are measured simultaneously.

Non-modifiable risk factors

are those over which we have little or no control such as age, gender, and genetic history

How to assess a community: community forum

asking specific questions in an open forum community setting

cultural repatterning

assisting the client to modify cultural practices that are not beneficial to the client's health

Ms. W, 18 years old, presents at a community clinic describing vague complaints. She explains that she recently dropped out of high school and is having trouble keeping a job. She notes that she has difficulty concentrating and has used drugs (i.e., marijuana and alcohol) when riding motorcycles with friends. When conducting the initial assessment, the RN should include questions and tools that would screen for:

attention-deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

Health belief model #2

fist developed in order to explain why people did not participate in health education programs to prevent TB. Key components of the HBM are perceived susceptibility , perceived severity, perceived benefits, perceived barriers, self efficacy and cues to action- personal threat is the motivating factor

Health beliefs and practices: biomedical belief

focus on identifying a cause for every effect on the body; that the body functions like a machine. this is the basis for the united states health system and is science-based

public health subsytems

focus on the population >"promote the general welfare of its citizens." ~federal programs ~state programs ~local programs >Mandated by the U.S. Constitution >Federal policies and practices influence local and state governments >Coordination of services under Department of Health and Human Services

Nongovernmental organizations (NGOs): Bill and Melinda gates foundation

focuses on reducing extreme poverty, improving health, and increasing public library access. ~In africa it has a profound effect on improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria

Nongovernmental organizations (NGOs): carter center

formed by the president and first lady Carter. three objectives 1. to prevent and resolve conflicts 2. to enhance freedom and democracy 3. improve health

Childhood health issues: children with special health care needs

frequently need multiple health care services

Adolescent health issues: the use of tobacco, alcohol, and drugs

has serious and long-lasting consequences for adolescents and society

1. Describe the goals of health education within the community setting.

health education refers to "any combination of learning experiences designed to facilitate voluntary actions conducive to health that people can take on their own, individually or collectively, as citizens looking after their own health or as decision makers looking after the health of others and the common good of the community."

Community assessment components: social systems

health systems, economic systems/factors, education systems, religious systems, welfare systems, political systems, recreation systems/factors, legal systems, communication systems/factors, transportation systems, resources and services

Medicare

individuals must be older than 65 years and receiving social security, have been receiving disability benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare

International organizations: world health organization (WHO)

international health agency of the United nations. WHO directs and coordinates international health efforts, producing and disseminating global health standards and guidelines, helping countries to address public health issues, and supporting health research

International organizations: pan american health organization (PAHO)

international public health agency working to improve the health and living standards of the americas.

Affective domain

involves a change in attitude and development of values; for example a client expresses acceptance of having a colostomy and maintains self-esteem

Psychomotor domain

involves the performance of a skill; for example, the community nurse teaches a client how to self-administer insulin

Evidence-Based practice

involves using best practices, expert opinions, and client preferences to change the delivery of client care. The goal is to improve client outcomes ~The nurse must consider several factors when applying evidence to practice: cost, benefit to the client, client satisfaction, safety, and client specific factors such as culture and demographics

Childhood health issues: childhood immunizations

is a benchmark of child health

Community assessment

is a comprehensive approach that emphasizes the community as a client, with one goal of providing benefit to the people of the area as a whole, rather than to individuals.

Health Risk Assessment

is a comprehensive way of assessing health risk and is a helpful tool to determine health promotion interventions

Community

is a group of people and institutions that share geographic, civic, and or social parameters. communities vary in their characteristics and health needs.

Childhood health issues: childhood obesity

is a health crisis; it can lead to numerous health problems

Education

is a key role in population health nursing. These education efforts need to be practical, relevant, and fit the lives and learning needs of the intended population. People learn better in a community setting , rather than a hospital or healthcare setting. It is more comfortable and provides less distraction.

surveillance

is a mechanism for the ongoing collection of community health information. monitoring for changes in disease frequency is essential to effective and responsive public health programs.

Accreditations: consumer assessment of healthcare providers and systems (CAHPS) and agency for healthcare research and quality (AHRQ)

is a survey and reporting tool administered by the AHRQ. It collects data and reports on consumer experience with specific aspects of their health plans. This type of survey provides data that help purchasers of plans compare and contrast plans

Epidemiological process

is a systematic method of targeting a specific health need with the goal of improving health. epidemiology provides a broad understanding of the spread, transmission and incidence of disease and injury.

Risk Assessment

is a systematic way of distinguishing the risks posed by potentially harmful exposures

Childhood health issues: child maltreatment

is an indicator of children's physical and emotional health status

Adolescent health issues: sexual activity

is often unprotected and can result in pregnancy and STIs

Cultural competence

is respecting and understanding the values and beliefs of a certain cultural group so that one can function effectively in caring for members of that cultural group.

Childhood health issues: accidental injury

is the leading cause of death in children ages 1-14

Host

is the living being that an agent or the environment influences ~Susceptible host: age, gender, genetics, ethnicity, immunological status, physiological state, occupation

Host defined

is the person that may be acted upon by the agent

Agent

is the physical, infectious, or chemical factor that causes the disease ~Chemical agents: drugs, toxins ~Physical agent: noise, temperature ~Infectious Agent: viruses, bacteria

Acculturation

is the process of merging with or adopting the traits of a different culture. adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system

Environment

is the setting or surrounding that sustains the host. ~Physical environment: geography, water/food supply, presence of reservoirs/vectors ~Social environment: access to health care, high-risk working conditions, poverty

Epidemiology

is the study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection

The physical environment

is those things which are tasted, smelled, felt, heard, and seen

International organizations: world bank

is to improve the health status of individuals living in areas that lack economic development

How to assess a community: key informant interviews

knowledgeable long term residents, officials or health workers are all examples of potential key informants in a community

The number one health concern identified by the majority of rural health care leaders is:

lack of health insurance.

environmental risks: toxins

lead, pesticides, mercury, solvents, asbestos, and radon

Health beliefs and practices: magico-religious beliefs

link health to supernatural forces, or good and evil. this includes belief in faith healing used by some christian religions, or voodoo and witchcraft practices used in caribbean nations

Public health nursing: Assurance

making sure adequate health care personnel and services are accessible, especially to those who might not normally have them. ~enforce laws and regulations that protect health and ensure safety ~Link people to needed personal health services and ensure the provision of health care when otherwise unavailable ~Ensure a competent public health and personal health care workforce ~Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Beneficence

maximize benefits and minimize risks

How to assess a community: surveys

may elicit responses from a wider variety of community members

Screening

the purpose is to identify risk factors and disease in their earliest stages. screening is usually a secondary prevention activity because indications of disease appear AFTER a pathological change has occurred

Critical issues in health care delivery: coordination and access to care

the social justice foundation of public health is yet to be realized because many inequalities in access to health care still exist

Epidemiology is...

the study of the distribution and determinants of health and disease in human populations....the principal science of public health a. used as a research methodology to study states of health and illness, and b. used as a body of knowledge that results from the study of a specific state of health or illness

People with Disabilities 18

~Adjustment to the disability occurs in 4 phases Ostrich, special designation, normalization and self actualization. 1. Ostrich: when parents do not deny a disability but also do not fully realize its impact 2. Special designation: when parents begin to realize their child has a special need and seek help 3. Normalization: when parents try to make the differences between their child and children without disabilities less apparent and may actually request a reduction in services 4. Self actualization: when parents view being different as not better or worse, just different, and support their child in learning about his or her disability, along with ow to be a self- advocate

environmental risks: water pollution

wastes, erosion after mining or timbering, and run-off from chemicals added to the soil

Public health policy in the United States is influenced by two types of justice, market justice and social justice. Examples of market justice include which of the following?

~All people are entitled to the status they create for themselves. ~All people are entitled to happiness if they put forth enough effort. ~All people are entitled to the income they work for.

Advantages of case control studies

~Allow for the examination of multiple exposures for a single outcome ~Are suitable for studying rare diseases and those with long latency periods ~Require fewer case-subjects ~Are generally quicker and less expensive to conduct than cohort studies, making them well suited for an outbreak investigation

Safe to sleep campaign recommendations

~Always place baby on back to sleep for naps and night ~Place baby on firm surface with fitted sheet ~Not in adult bed, couch, or chair alone or with adults ~Keep soft objects, toys, and loose bedding out of sleep area ~Do not smoke during pregnancy ~Do not allow smoking around baby ~Do not let baby get too hot during sleep ~Follow vaccine and health check-up recommendations ~Avoid advertised SIDS products ~Get regular health care during pregnancy - National Institute of Child Health & Human Development: Safe sleep for your

community health nurses role for improving child and adolescent health

~An advocate for improved individual and community responses to children's needs. ~A researcher for effective strategies to serve women and children. ~A participant in publicly funded programs. ~A promoter of social interventions that enhance the living situations of high-risk families. ~A partner with other professionals to improve service collaboration and coordination. ~Understand the legal and ethical implications of decision making.

Critical community health nursing practice

~Approach environmental health at the population level ~Take a stand; advocate for change ~Ask critical questions ~Facilitate community involvement ~Form coalitions ~Using collective strategies

U.S infant mortality

~Attributable to public health measures and improved standards of living -improved sanitation -clean milk supply -immunizations -nutritious food -enhances access to maternal health care ~Technological advances also contributed -E.G -Synthetic lung surfactant

Advocacy

~Clients are autonomous beings who have the right to make decisions affecting their own health and welfare ~clients have the right to expect a nurse-client relationship that is based on trust, collaboration, and shared respect ~Clients are responsible for their own health ~it is the nurse's responsibility to advocate for resources or services that meet the client's health care needs.

Health promotion strategies for women

~Collaboration and an interdisciplinary approach are necessary to meet the health care needs of women. ~Women should receive services that promote health and detect disease at an early stage. ~Many women seek information that will allow them to be in control of their own health. ~Women desire to become more knowledgeable about their own health. ~Health promotion for low-income, underserved women may differ from that for middle-class women. ~Knowledge deficits about one's own health prevail among women regardless of socioeconomic or educational level.

Strategies to improve child and adolescent health

~Collect/analyze data tracking well-being of children and adolescents. ~Establish goals and set measurable objectives using Healthy People 2020. ~Implement health promotion and disease prevention strategies. ~More significant and cost-effective for children than other age groups. ~Utilize public health programs targeted to children and adolescents.

Milio's Framework for Prevention

~Complements the health belief model. ~Emphasizes change at the community level. ~Identifies relationship between health deficits and availability of health-promoting resources. ~Theorizes that behavior changes within a large number of people can ultimately lead to social change.

Mortality rates

~Crude mortality rate: overall death rate ~Cause-specific rate, case fatality rate: deaths from a specific cause ~infant mortality ratio, age-specific rate: deaths at specific times across the lifespan Crude mortality rate: number of deaths divided by population total multiplied by 1,000= ____per 1,000 Infant mortality rate: number of infant deaths before 1 year of age in a year divided by number of live births in the same year multiplied by 1,000= ___per 1,000

Sudden unexplained infant death

~Definition of SUID -Less than 1 year of age -Occurs suddenly and unexpectedly -Cause of death not immediately obvious before investigation -Half of SUID are SIDS ~Definition of SIDS -Death cannot be explained after a thorough investigation, including autopsy, examining death scene, and review of clinical history ~Back to Sleep campaign (1994) -Heighten awareness of the safety of positioning infants on their backs for sleep -SIDS death declined by >50% ~Safe to Sleep campaign (2010) -Included other actions to reduce risks of other sleep-related causes of death (e.g., suffocation)

Prenatal care

~Early and regular prenatal care enhances chance of a healthy, full-term baby. ~Health education and counseling ~Risk identification ~Monitoring and treatment of symptoms ~Referral to health, nutrition, social services ~Medicaid, WIC, food stamps, smoking cessation services, housing, child care, job training, substance abuse treatment, domestic violence screening and counseling

Emerging issues in environmental health

~Environmental public health infrastructure ~Natural disasters ~Global climate change ~Ozone depletion ~Fossil fuel burning ~Marine dumping ~Active land mine abandonment in war-torn areas ~Destruction of tropical rain forests

Environmental factors

~Environmental stressors ~Directly assault human health ~Damage society's goods and services ~Affect quality of life (QOL) ~Interfere with the ecological balance ~Natural disasters, terrorism, and war affect all of the above ~The field of environmental health and sustainable development has exploded since 1990.

Millenium Development goals (United nations 2000, 2006)

~Eradicate extreme hunger and poverty ~Achieve universal primary education ~Promote gender equality, and empower women ~Reduce child mortality ~Improve maternal health ~Combat HIV/AIDS, malaria, and other infectious diseases ~Ensure environmental sustainability ~Develop global partnerships

Principles guiding community health nursing

~Ethics ~Advocacy ~Evidence-based practice ~Quality ~Professional collaboration and communication

Role for nurses in the environment

~Facilitate public participation in measures to improve the environment. ~Perform individual and population risk assessments. ~Implement risk communication. ~Conduct epidemiological investigations. ~Participate in policy development

"Health for all by year 2000" WHO goal 1978

~Goal framed at the Alma-Ata conference in the Soviet Union in 1978; now extended to 2010 again without attainment ~Concept of primary health care ~Health as a fundamental human right for individuals, families, and communities ~Unacceptability of the gross inequalities in health status ~Importance of community involvement ~Active role for all sectors

Preconception health

~Half of all pregnancies are unintended. ~Impact on developing fetal organ systems by: *Healthy maternal weight and good nutrition *Tending to chronic maternal diseases *Being up-to-date on vaccinations *Avoiding environmental toxins *Decreasing stress and eliminating abusive relationships *Avoiding illicit drugs, tobacco, and alcohol ~Preconception counseling as a prevention strategy: -Effective contraception to avoid unintended pregnancies and pregnancy spacing -Recommend intake of folic acid daily -Encourage healthy lifestyle modifications ~Prenatal care ~Prenatal substance use

Public health programs targeted to children and adolescents

~Health Care Coverage Programs -Affordable Care Act -Medicaid and CHIP -EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) ~Direct Health Care delivery programs -Maternal and Child Health Block Grant (Title V) -Community & Migrant Health Centers program -School-Based Health Centers -WIC

Social factors affecting women's health

~Health care access ~Education and work ~Employment and wages ~Working women and home life ~Family configuration and marital status

Long term implications of a child's health

~Health habits adopted by children and youth profoundly influence their potential to lead healthy, productive lives. ~The physical and emotional health of a child plays a pivotal role in the overall development and well-being of the entire family. ~Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential.

NCHS: leading causes of death (2016)

~Heart disease: 633,842 ~Cancer: 595,930 ~Chronic lower respiratory diseases: 155,041 ~Accidents (unintentional injuries): 146,571 ~Stroke (cerebrovascular diseases): 140,323 ~Alzheimer's disease: 110,561 ~Diabetes: 79,535 ~Influenza and ~Pneumonia: 57,062 ~Nephritis, nephrotic syndrome, and nephrosis: 49,959 ~(Intentional Self-Harm) Suicide: 44,193

Nightingale's Environmental Theory

~Highlights the relationship between an individual's environment and health ~Depicts health as a continuum ~Emphasizes preventive care

Wheel Model of Human- Environment Interaction

~Host (human) genetic core > Biological environment > Social environment > Physical environment

Health History questions

~Housing: What is the physical condition, age or location of the residence?, Is it located near a school, day care, or work site? ~Are lighting, ventilation, and heating/cooling systems adequate ~What are the occupations of household members (current and past, longest held jobs)? ~Are there any recent home remodeling activities, such as the installation of new carpet or furniture or refinishing of furniture? ~Has there been any lead exposure in old paint, crafts, leaded pottery, or dishes? `

Infant mortality

~Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status. ~Infant mortality is related to several factors: -Maternal health -Medical care quality and access -Socioeconomic conditions -Public health practices

Common acute illnesses in women

~Urinary tract infection and dysuria ~Diseases of the reproductive tract -Vaginitis, vulvovaginitis, pelvic inflammatory disease (PID), and toxic shock syndrome (TSS) ~Chronic diseases -Coronary vascular disease (CVD) and metabolic syndrome, hypertension, diabetes, arthritis, osteoporosis, and cancer (breast, lung, gynecological) ~Mental disorders and stress

cultural assessment parameters

~ethnic background ~religious preferences ~family structure ~language and literacy needs ~communication needs ~education ~cultural values ~food patterns ~health practices ~use of folk or spiritual healers and alternative healing techniques

Important elements of the affordable care act

~extending eligibility for dependents to remain on parent's insurance until age 26 ~prohibiting health plans from denying benefits for preexisting coverage to children under age 19 ~banning lifetime limits on benefit coverage ~covering preventative care services

International community assessment model

~health ~spirituality ~environment ~communication ~education ~government ~family support ~technology ~safety ~transportation ~economics ~recreation

Critical issues in health care delivery: managed care

refers to any method of health care delivery designed to reduce unnecessary use of services, improve cost containment or cost-effectiveness, and ensure high-quality care. currently the predominant force in health care delivery Health maintenance organizations (HMOs): comprehensive care is provided to members by a set of designated providers Preferred provider organizations (PPO): predetermined rates are set for services delivered to members; financial incentives are in place to promote use of PPO providers Medical savings account: untaxed money is put in an account for use of medical expenses

Risk

refers to the probability of an adverse event EX: likelihood that healthy people exposed to a specific factor will acquire a specific disease

Health beliefs and practices: naturalistic beliefs

relate the individual as part of nature or creation. an imbalance in nature is believed to cause disease. this is the basis of eastern or Chinese medicine. several other cultures, such as the Mexican culture, follow the hot-cold theory of balance in relation to health and illness that accompanies this belief framework

causality

relationship between two variables in which the presence or absence of one variable (the "cause") determines the presence or absence of the other (the "effect")

Culturally competent community health nursing

requires that the nurse understand... >Lifestyle >Value system >Health and illness behaviors of diverse individuals, families, groups, and communities

Mortality Rates

routinely collected birth and death rates.

Functioning subsystems include:

safety, education, health services, communication, economics

periodic change

seasonal or cyclic fluctuations in time surrounding health problems

Barriers to health care

~inadequate health care insurance ~inability to pay for health care services ~language barrier ~cultural barrier ~lack of health care providers in a community ~geographic isolation ~social isolation ~lack of communication tools (telephone) ~lack of personal or public transportation to health care facilities ~inconvenient hours ~attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds ~eligibility requirements for state/federal assistance programs

Benefits of professional communication

~increased adherence to prescribed treatment plan ~reduced admissions to acute care ~reduced cost of care ~shared decision-making with client and family ~reduced medication errors

Public health

~refers to the efforts organized by society to protect, promote, and restore the people's health >Concerned with a healthy population >Concerned with a healthy environment >Scope is broad >Encompasses activities that promote good health >Organized into multiple levels (federal, state, local) >Provides services for those unable to obtain health care without assistance > Establishes laws, rules, and regulations to protect the public

A community health nurse is concerned about reducing the fatal injuries to America's rural children. To address this problem, the nurse organizes a community of solution (see Chapter 1). For this group, it would be important to have representatives from all of the following groups or organizations:

~the Department of Public Highway and Safety. ~emergency department staff (both doctors and nurses) from local hospitals. ~teachers and coaches from area schools. ~city or county government.

National health care goals- increases

~use of alternative modes of transportation for work ~number of days that beaches are open and safe for swimming ~recycling of municipal solid waste ~testing for presence of lead-based pain in pre-1978 housing ~monitoring for diseases or conditions caused by environmental hazards ~homes with radon mitigation (those at risk) and radon-reducing features ~schools with policies/practices to promote health/safety ~presence/use of information systems related to environmental health

influences on global health

~wars and political unrest ~natural and man-made disasters ~limited resources and structure in lesser-developed nations ~international travel (increases spread of disease) ~sanitation practices ~climate change ~maternal health ~nutrition

Intervention studies (experimental studies)

—epidemiologic investigation designed to test a hypothesized relationship by modifying an identified factor in a population. >Preventive trial—study where the investigator provides a specific preventive measure to the group under study and follows the group to determine the effects of the intervention (compared to a control group) >Therapeutic trial—clinical trial where the investigator provides a specific treatment (therapy) to the group under study and follows the group to determine the effects of the treatment (compared to a control group)

Ch 15 learning focus: 3

• "Health for All by the Year 2000" was a global declaration from an international conference at Alma-Ata in 1978 deeming primary health care a right essential to attaining health for all.

ADHD and ADD

• ADHD: attention deficit hyperactivity disorder • ADD: attention deficit disorder • Usually appear before age 7 and often accompanied by related problems (e.g., learning disability, anxiety, and depression) • Three major characteristics are inattention, hyperactivity, and impulsivity. • Symptoms are typically managed with a combination of behavior therapy, emotional counseling, and practical support.

ch 19 learning focus: 4

• Although people are living longer, many older adults have chronic illnesses that interfere with the quality of their lives.

Effects of disabilities

• Cost of chronic management • Decreased employment rates • Decreased household income and increased poverty rates • Decreased opportunity for physical activity • Isolation and possible self-image issues • Possible altered roles of family members • Increased risk for abuse • Possible inability to live independently • Presence of comorbidities

Pesticide Exposure

• Pesticide exposure is a significant problem among farm workers. • SUBJECTIVE FINDINGS: • Headache, dizziness, dyspnea, nausea, abdominal cramps, poor concentration, eye irritation • OBJECTIVE FINDINGS: • Confusion, irritability, muscle weakness and twitching, nasopharyngeal irritation, vomiting, rash • COMPLICATIONS: • Long-term exposure is linked to cancer, reproductive problems, Parkinson's disease, liver damage, and behavioral issues. Impaired fetal development can occur among pregnant women exposed to pesticides, even from secondary exposure (contaminated clothing from a family member).

3. Discuss the individual and societal costs of poor child health status.

• Poor child health status is associated with lack of prenatal care, lead poisoning, and maternal drug use.

2. Describe social determinants of child and adolescent health.

• Poverty, teen pregnancy, poor education, low income, and lack of social support all contribute to poor health status

Strategies for preventing homelessness and assisting individuals who are homeless

• Prevent individuals and families from becoming homeless by assisting them in eliminating factors that can contribute to homelessness. • Refer those who have underlying mental health disorders to therapy and counseling. • Enhance parenting skills that can prevent young people from feeling the need to run away. • Assist homeless clients in locating temporary shelter. • Assist clients in finding ways to meet long-term shelter needs. • If homeless shelters are not provided in the community, work with government officials to develop shelter programs.

Teaching focus 7

• Primary prevention relies on epidemiological information to indicate those behaviors that are protective and thus will not contribute to an increase in disease and those that are associated with risk. > health promotion and specific prevention

2. Describe psychosocial issues related to aging.

• Psychosocial theories of aging examine how one experiences late life

Learning focus ch 13: 1

• Racial and cultural diversity creates differences in the formation of values, family characteristics, socioeconomic status, education, religion, nutritional practices, and communication.

Teaching focus 5

• Rates are used to interpret raw data and for comparisons between aggregates and communities. Rates are expressed as proportions or fractions and can be used to compare rates of the aggregate being studied with similar aggregates in other areas.

1. Describe features of the health care system and population characteristics common to rural aggregates. Ch 23

• Residents of rural communities have health patterns and problems related to demographic and geographic patterns (i.e., age, gender, occupation, race and ethnicity, availability of health information, preventive and illness services, sewage and water systems, and transportation).

2. Describe physiological and psychosocial factors that have an impact on men's health status.

• Social and psychological factors impacting men's health status include occupational hazards, unemployment, and massive advertising campaigns that use gender and gender roles to sell alcohol and tobacco together with men's reluctance to seek preventive and health services. • Physiological factors impacting on men's health status include men's higher levels of stored iron, the death of men's brain cells at a faster rate than women's, and a weaker immune system.

2. Identify sources of information about a community's health.

• Sources of data for assessing a community's health include the following: windshield surveys, census data, vital statistics, National Center for Health statistics, and local, regional, and state government reports.

4. Discuss key federal legislation applicable to people with disabilities.

• Three key pieces of federal legislation were enacted that have had a dramatic impact on persons with disabilities. They are the Individuals with Disabilities Education Act, the Americans with Disabilities Act, and the Ticket to Work and Work Incentives Improvement Act.

3. Discuss the relationship of risk to health and health promotion activities.

• Tobacco and health risk o Leading cause of preventable death o Most common in less educated populations and those living below poverty level o Most common form of chemical dependence o Tobacco in all forms is harmful • Health promotion activities o Look for teachable moments o Assess client's tobacco use o Explore willingness to quit o Refer to cessation programs o Encourage attempts to quit

Developmental theory

Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge

assess nutritional status

- Poor nutrition in older adults is common. - Obesity in adults over 70 years and older has been increasing. - Normal physiological changes related to aging affect nutritional status. - Income, functional status, medications, social isolation, transportation, and dependence on others affect nutrition as well. - Recommend myplate.gov for assessment of eating patterns.

Nurses can help parents and family members adjust to a child with a disability by:

establishing a partnership between the parent and health care team.

Preterm birth and low birth weight factors

*Minority status *Chronic stress *Maternal age of <17 years and >35 years *Chronic health problems of mother *Lack of prenatal care *Multiple births *Certain problems with the uterus or cervix *Low socioeconomic status *Unhealthy maternal habits *Induced labor and elective C-section births

Host factors- Environmental Factors -extrinsic factors

*influence existence of the agent, exposure, or susceptibility to agent* > Physical environment > Biological environment >Human populations, flora, fauna > Socioeconomic environment >Occupation, urbanization and economic development, disruption

recommended screenings and exams for health promotion and disease prevention for all older women

- Breast self-exam: Monthly - Clinical breast exam: Annually - Mammogram: Every 1 to 2 years if age 40 or older - Check with HCP if 74 years+ - Pelvic exam and Pap smear: Annually - Check with HCP about discontinuation at 65 or older with three consecutive negatives exams and no abnormal in previous 10 years and not otherwise at risk - Digital rectal exam: Annually with pelvic exam - Bone density: Once after menopause - More often if at risk

monitor for chronic illnesses

- Chronic disease is the leading cause of death among persons 65 years and older. - The prevalence of chronic disease increases with aging; many older adults have at least two chronic conditions. - The most common conditions are arthritis, hypertension, and diabetes. - Chronic illness is a major cause of disability and may cause limitations with activities of daily living (ADLs and IADLs).

recommended screenings and exams for health promotion and disease prevention for all older adults

- Complete physical: Annually - Blood pressure: Annually - More often if hypertensive or at risk - Blood glucose: Annually - More often if diabetic or at risk - Serum cholesterol: Every 5 years - More often if at risk - Fecal occult blood test: Annually - Sigmoidoscopy: Every 3 to 5 years OR - Colonoscopy: Every 10 years - More often if high risk - Visual acuity and glaucoma screening: Annually - Dental exam: Annually for those with teeth; cleaning every 6 months (every 2 years for denture wearers) - Hearing test: Every 2 to 5 years

recommended screenings and exams for health promotion and disease prevention for all older men

- Digital rectal exam and prostate exam: Annually - Prostate-specific antigen (PSA) blood test: Annually

end-of-life issues

- Discuss and educate patients about end-of-life issues. - Inform other members of the health care team about advance directives. - Make sure that the document is visible and accessible in the patient's chart. - Encourage patients to discuss their wishes with their family. - Encourage patients to discuss with physician so it becomes part of medical record.

recommended health practices

- Encourage recommended health care screenings and examinations. - Encourage physical activity and fitness. - Evaluate the nutritional status and needs of older adults. - Monitor chronic illnesses. - Monitor medication use. - Monitor and accommodate sensory impairments.

elder safety and security needs

- Falls - Traumatic brain injury (TBI) - Driver safety - Residential fire-related injuries - Cold and heat stress disorders - Elder abuse - Crime - Psychosocial disorders - Anxiety disorders - Depression - Substance abuse - Suicide - Alzheimer's disease

spirituality

- Involves "finding core meaning in life, responding to meaning, and being in relationship with God/Other" (Manning, 2013) - Spirituality has health benefits—resilience - Nurses should address spiritual needs and concerns as part of holistic care. - Interventions include nurses' presence, active listening, caring touch, reminiscence, prayer, hope, nonjudgmental attitude, facilitation of religious practices, referral to spiritual care experts.

alzheimer's disease

- Slowly progressive brain disorder: begins with mild memory loss; progresses through stages to total incapacitation and eventually death. - Diagnosing is difficult; often reached after all other conditions ruled out. - Assessment tools include: - Mini-Cog, MIS, and GPCOG - Clock drawing - No cure and limited treatment options are available. - Behavioral and physical changes create many challenges for caregivers. - Management strategies include: - Appropriate use of available treatment options - Management of coexisting conditions - Coordination of care among professionals and caregivers - Participation in activities and adult day care programs - Support groups and support services

immunizations for older adults

- Tetanus, diphtheria, pertussis: Every 10 years - Influenza (flu) vaccine: Annually - Pneumonia vaccine: Once after age 65 - Ask physician about booster every 5 years - Hepatitis A and B: For those at risk - Herpes zoster (shingles): One-time dose - Varicella: If evidence of lack of immunity and significant risk for exposure

monitor and accommodate sensory impairments

- Visual impairment impacts social abilities, depression, falls, and communication. - Cataracts, macular degeneration, diabetic retinopathy, and glaucoma - Hearing loss one of most common conditions affecting older adults. - Presbycusis and tinnitus - Dental problems are neglected because of inadequate dental care, limited mobility and transportation, poor nutrition, myths, lack of finances and reimbursement. - Incontinence affects quality of life and is a symptom of underlying problems.

adult learners

- learn better in a facilitative, nonrestricted and nonstructural environment

Pender's Health Promotion Model

- similar to health belief model - does NOT consider health risk as a factor that provokes change - examines factors that affect individual actions to promote and protect health ~personal factors (biological, psychological, sociocultural), behaviors, abilities, and characteristics associated with the action ~Attitudes of others, and competing demands and preferences

Analytic epidemiology:: retrospective studies

> Compare individuals with a particular condition or disease with those who do not have the disease > Data collection extends back in time

Tertiary Prevention of Disease

> Correction and prevention of deterioration of a disease state > Limitation of disability and rehabilitation

Diet and Health and health promotion activities

> Diet—one of most modifiable risk factors > Imbalance of caloric intake and physical activity > Complex interplay among metabolism, genetics, behavior, environment, culture, and socioeconomic status > Geographic areas, age, ethnicity all influence weight Health Promotion Activities > Special populations have different nutritional needs > Educate clients about: > Balancing caloric intake and physical activity > Servings vs. portion control > Eating away from home affects "portion distortion" > Using social media and mobile applications to help

Secondary Prevention of disease

> Early detection and intervention > Early diagnosis and treatment

Ecosocial Approach

> Emphasize the role of evolving macro-level socioenvironmental factors along with microbiological process in understanding health and illness (Smith & Lincoln, 2011) >Challenges the more individually focused risk factor approach to understanding disease origins

Steps in Risk Assessment

> Hazard identification > Risk description > Exposure assessment > Risk estimation

Morbidity Rates

> Incidence rates: measure of the probability that people without a certain condition will develop that condition over a period of time > New cases or conditions >Attack rate >Number of new cases of those exposed to the disease >Prevalence rates >All cases of a specific disease or condition at a given time

Activities that promote health and prevent disease

> Include screening for disease and immunizations

Use of epidemiology: nurses must apply findings in practice

> Incorporate results into prevention programs for communities and at-risk populations > Extend application into major health policy decisions >Community health nurses should exercise "social responsibility" in applying epidemiological findings, but this will require the active involvement of the consumer.  >Community health nurses collaborating with community members can combine epidemiological knowledge and aggregate-level strategies to affect change on the broadest scale.

Public health system: local health department

> Local health departments (LHD) >Responsible for direct delivery of public health services and protection of the health of citizens >Not all communities have LHDs >Responsible for: >Community health services >Environmental health services >Personal health services >Mental health services

Analytic epidemiology: prospective studies

> Monitor a group of disease-free individuals to determine if and when disease occurs > Cohort shares a common experience within a defined time period >Monitors cohort for disease development

Person-Place-Time Model

> Person: "Who" factors, such as demographic characteristics, health, and disease status >Place: "Where" factors, such as geographic location, climate and environmental conditions, political and social environment >Time: "When" factors, such as times of day, week, or month and secular trends over months and year

Physical activity and Health and Health promotion activities

> Physical activity serves both health promotion and disease prevention purposes > Leisure activities are influenced by level of education, gender, age, economic level, geography > One's environment plays a significant role in activity level Health Promotion Activities > Support and develop "walkable" neighborhoods and cities > Determine recommended exercise levels for individuals

Risk factor

> Refers to the specific exposure factor > Often external to the individual

Faith Communities and Parish Nursing

A strong sense of community, family life, and religious faith Integrating nursing expertise and faith-based knowledge to provide holistic care to members of congregations Involved in case management and coordination of services Collaboration with other organizations to extend limited rural community health resources

demographic characteristics

Americans are living longer than ever before and the older population will continue to grow. Older population is becoming more diverse. Number of seniors differs by geographic location. Older women outnumber older men. Older men are more likely than older women to be married. Educational attainment has increased among older adults. - Older women are more than twice as likely as older men to live alone. - Older adults want to live in their own home for as long as possible—"age in place." - Alternative housing options are available with services to help seniors. - With aging, a good percentage of income is spent on health care. - The proportion of the older population living in poverty has decreased but is affected by gender, marital status, race, and ethnicity.

Characteristics of Disability

Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person's ability to carry out a major life activity. ➢ Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria. Physical disabilities Sensory disabilities Intellectual disabilities Serious emotional disturbances Learning disabilities Significant chemical and environmental sensitivities Health problems

The landmark civil rights legislation that uses the authority of the federal government to guarantee equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications is the:

Americans with Disabilities Act (ADA). The ADA is landmark civil rights legislation that provides a clear and comprehensive mandate against discrimination toward people with disabilities in everyday activities. The IDEA addresses the educational needs of children with disabilities. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work. The Civil Rights Act prohibits discrimination based on race, ethnicity, religion, and sex.DIF: Cognitive level: KnowledgeREF: Page 414

Telemedicine

An alternative cost effective way to provide access to care to those with limited ability. This involves two way real time communication with patients and providers. • Cost-effective alternative to face-to-face care • Telehealth includes telephones, fax machines, email, and remote monitoring • Telemedicine permits two-way, real-time, interactive communication between patient and provider

Establishing causality: temporally correct relationship

exposure to the causal factor must occur before the effect, or disease

Which of the following statements best describes the demographics of rural America?

Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy.

Nurses

Determine a community's health by examining the degree to which the community's collective health needs are identified and met

Community health program planning, development and management: Planning

Develop interventions to meet identified outcomes --> identify who will assume responsibility for each intervention. Plan a logical sequence for interventions by establishing a timetable

Public health nursing: policy development

Developing laws and practices to promote the health of a population based on scientific evidence ~inform, educate, and empower people about health issues ~mobilize community partnerships to identify and solve health problems ~develop policies and plans that support individual and community health efforts.

Secondary Prevention

Early detection and treatment of disease with the goal of limiting severity and adverse effects ~EXAMPLES: community assessments, disease surveillance, screenings

International organizations: CDC

Protecting the health and safety of all americans and for providing essential human services. prevent and control infectious and chronic disease, injuries, workplace hazards, disabilities and environmental health threats ~founded to help control malaria

Morbidity in mens health

Men tend to perceive themselves to be in better health than do women. Women are more likely to be ill, whereas men are at greater risk for death. Incidence rate for acute and chronic conditions is higher for women than for men; injuries are higher for men than women. Women have higher morbidity rates than men, but men have higher morbidity and mortality rates for conditions that are the leading causes of death.

1. Discuss various definitions of homelessness. Ch 22

Homeless refers to an individual who lacks a fixed, regular, and adequate nighttime residence or who has a primary nighttime residency that is either a shelter or an institution that provides a temporary residence or a public or private place not ordinarily used for sleeping.

People with Disabilities 14

IEP individualized education plan- specific to child with a disability - using a team approach and variety of resources to meet developmental milestones and educational needs. Progress should be monitored to see that goals are met and changes should be made accordingly. Parents have a right to request a change in this plan.

Tertiary prevention

INDIVIDUAL ●Refer homeowners to lead abatement resources. ●Educate clients who have asthma about environmental triggers. COMMUNITY ●Become active in consumer and health related organizations and legislation related to environmental health issues. ●Support cleanup of toxic waste sites and removal of other hazards.

Secondary prevention

INDIVIDUAL ●Survey for health conditions that can be related to environmental and occupational exposures. ●Obtain environmental health histories of individuals. ●Monitor workers for levels of chemical exposures at job sites. ●Screen children 6 months to 5 years old for blood lead levels. COMMUNITY ●Survey for health conditions that can be related to environmental and occupational exposures. ●Assess neighborhoods, schools, work sites, and the community for environmental hazards

primary prevention

INDIVIDUAL: Educate individuals to reduce environmental hazards. COMMUNITY ●Educate groups to reduce environmental hazards. ●Advocate for safe air and water. ●Support programs for waste reduction and recycling. ●Advocate for waste reduction and effective waste management.

Community Mental Health

Important events that changed mental health in the US- 1963 JFK signed the Community Mental health Act- closing and deinstitutionalizing the mentally ill, this was due in part of the opening of Community mental health centers, designed to give comprehensive treatment and allow integration of people with mental health needs into society. De institutionalization began in 1965, decreasing the number of patients in state facilities from 559,000 to 154,000 from 1965 to 1980. Often these patients did not receive adequate services. This helped grow the homeless population.

Goal of population health nursing

Improving the health of the community is the goal of population health nursing. In order to accomplish this goal the nurse must define and assess the community to diagnose health needs. The client is the community, so program planning has to maximize benefit to the majority of people. The nursing process is used in this process and the nurse partners with community members to identify issues and develop solutions.

Population trends

In 1970 >Minority groups were 16% of population By 2010 >Minority groups increased to 36% of population By 2025 >More than half of all children will be minorities By 2050 >More than 54% of total population will be minorities >First time in U.S. history that minorities will make up a majority of the population By 2060, projected demographic trends: >White 44% >Hispanic 30% >African American 15% >Asian 9% >American Indians & Alaska Natives 2%

Recommendation for the Nurse

Listen to parental concerns ➢ "Something is not right" ➢ Establishes an important bond with parents ➢ Nurse can serve as an intermediary Regularly assess for key developmental milestones ➢ Compare with predicted values ➢ Work with team of resource providers on IEP Be cognizant of disability within the context of culture and aging

Historical perspective of epidemiology

Investigations of disease pattern in the community; comparing people who had disease or who remained healthy

Cognitive domain

Involves knowledge and the development of intellectual skills; for example a client discusses how sodium intake will affect blood pressure

Epidemiological triangle

Involves the study of the relationships among an agent, host, and environment. Their interaction determines the development and cessation of communicable diseases, as they form a web of causality, which increases or decreases the risk of disease.

Health Protection

Is motivated by a desire to avoid disease, to detect disease early, or to achieve one's best functional status within the confines of disease

Health Promotion

Is motivated by a desire to increase well-being and to reach one's best health potential

Biology

Is one's individual genetic makeup, age, gender, family history, and disease history

Risk

Is the probability that an event will occur. A risk factor is an exposure that is associated with disease

2. Identify demographic characteristics of the homeless population and subpopulations. Ch 22

Lack of a permanent mailing address, problems with distance and transportation, and lack of money all contribute to problems of access to health care for homeless populations ■ More men than women ■ Women head up more single families ■ Younger than general population ■ Minorities were overrepresented ■ Disability rate twice that of all families ■ Veterans were primarily male • Adults who are unemployed, earn low wages, or are migrant workers • Female heads of households • Families with children (fastest-growing segment) • People who have a mental illness (large segment) • Veterans • People who have substance use disorders • Unaccompanied youth • Adolescent runaways (high incidence of lesbian, gay, bisexual, and transgender [LGBT] adolescents) • Intimate partner abuse survivors • People who have HIV or AIDS • Older adults who have no place to go and no support system

Literacy and health

Literacy level is an important factor in health program planning, low literacy is a nationwide issue. Literacy is generically defined as the ability to read at a fifth grade level. Health literacy on the other hand is the empowerment to access and understand health information and utilizing available services. The negative health impact of low literacy and or low health literacy can be massive. Assessing basic literacy can be done informally by a community health nurse by casually asking "do you enjoy reading" "what do you read" Nurses could also give the patient a few moments to read information, then ask questions about the material. A way to test health literacy informally is to simply ask if the person fills out important documents alone or prefers to have help. There are many official tools that test literacy and health literacy as well.

Intervention Wheel: purple section --> Outreach

Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained.

Breastfeeding advantages

Mother: -Lower risk of breast and ovarian cancer -Lower risk of postpartum depression -Lower risk of type 2 diabetes -Saves money on formula Baby: -Cells, hormones, and antibodies in breast milk -Lower risk of asthma -Lower risk of obesity -Lower risk of diabetes -Lower risk of SIDS -Fewer illnesses

Community health nurses

Must assess their clients' health risks at each encounter, assessing both positive and negative factors

According to the ICF (International Classification of Functioning, Disability, and Health), which of the following would be classified as a disability?

Need to use a powered wheelchair

Prevalence Rate

Number of existing cases divided by total population multiplied by 1000

Morbidity Rates: incidence rate calculation

Number of new cases_in given time period Population at risk in  same time period multiplied by 1000 75/4000-250=0.02 0.02 x 1,000= 20 per 1000 per time period

Home care and hospice

Nurse case management and development of local resources ➢ Often hospital based in rural areas ➢ Use county extension services as a bridge for outreach services ➢ Improve home care for these patients and provide support for their families ➢ A partnership between the public health nurse and county extension service could provide support, as well as information groups and caregiving classes, for the important informal provider network.

How to assess a community: windshield survey

Nurse gains understanding of the layout, geography, location of services, businesses, industry, and possibly locate environmental concerns. The nurse can also observe people within the community.

Medicalization issues

Nurse's interaction with PWD and families ➢ Approach on an eye-to-eye level ➢ Listen to understand ➢ Collaborate with the person/family ➢ Make plans and goals that meet the other's needs and draw on strengths and improve weaknesses ➢ Empower and affirm the worth and knowledge of the person/family with a disability ➢ Promote self-determination and allow choices

Data Collection: community forum

Open public meeting Strengths: Opportunity form community input Minimal cost Limitations: Difficulty finding a convenient time and place ~Potential to drift from the issue ~Challenging to get adequate participation ~Possibility that a less vocal person may be reluctant to speak

Intervention Wheel: green section --> Case management

Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.

Office of research on women's health

Overarching themes for research: Developmental, psychological, spiritual, and physiological factors effect on lifespan Female determinants' (such as genetics and gender expectations) effect on health Health disparities and diversity Diseases and conditions affecting women Career development and advancement of women in the sciences

Windshield survey components

PEOPLE: who is on the street, what is their general appearance, what are they doing, what is their origin, is there any evidence of substance abuse PLACE: ~boundaries: where is the community located, what are the boundaries, are there natural boundaries ~location of health services: where are the major health facilities located ~natural environment ~Man-made environment HOUSING: is the housing acceptable quality, how old are the homes, are there single or multifamily dwellings SOCIAL SYSTEMS: are there ample schools, are there parks, places of worship, recreation centers, grocery stores, is public protection evident

Migrant health prevention

PRIMARY • Educate regarding measures to reduce exposure to pesticides (hand washing after working, washing food picked from fields before consumption, changing clothes after work). • Teach regarding accident prevention measures. • Provide prenatal care. • Mobilize preventive services (dental, immunizations) SECONDARY • Create testing programs for tuberculosis and prenatal diagnostic testing. • Implement screening programs for- • Pesticide exposure • Skin cancer • Chronic preventable diseases • Communicable diseases • Anemia (children) TERTIARY Treat for manifestations of pesticide exposure. ●Mobilize primary care and emergency services. ●Promote rehabilitation following work-related musculoskeletal injuries. ●Educate clients who have diabetes mellitus or anemia regarding appropriate nutrition

Mental health Prevention

PRIMARY • Provide education to populations regarding mental health issues. • Teach stress-reduction techniques. • Implement parenting classes. • Organize bereavement support groups. • Promote protective factors (coping abilities) and risk factor reduction. SECONDARY • Screen to detect mental health disorders. • Work directly with at-risk individuals, families, and groups through formation of a therapeutic relationship. • Conduct crisis intervention TERTIARY • Perform medication monitoring. • Provide mental health interventions. • Make referrals to various groups of professionals, including support groups. • Maintain the client's level of function to prevent relapse or frequent rehospitalization. • Identify behavioral, environmental, and biological triggers that can lead to relapse. • Assist the client in planning a regular lifestyle and minimizing sources of stress. • Educate the client and family regarding medication adverse effects and potential interactions

People with Disabilities 9

PWD have been abused, segregated, and disrespected as humans throughout history. The deinstitutionalization movement in the 60's and 70's stimulated community based independent living centers for PWD. Care in institutions have improved in the twentieth century.

People with Disabilities 16

Parenting, family response to a child with a disability ~Affects all family members. Redefining parental roles, expectations and image of the child, marital partners, members of culture and society are all redefined. Grieving the loss of the idealized child is expected. Likely caregiver role strain will be experienced, often straining relationships, can result in divorce. Nurses can help the family adjust by educating based on readiness to learn, referrals to case managers, support groups, empowering the parents to make decision on the child's behalf and establishing a strong partnership between the parent and the health care team. ~A PERSON LIVING WITH A DISABILITY IS THE EXPERT ON KNOWING WHAT WORKS BEST FOR THEIR BODY. Collaboration and care planning needs to take place between the nurse and the client.

individual assessment

Part of a nursing assessment involves the identification of risk factors and an understanding of the natural history of diseases: constructs developed by epidemiologists. Nurses, in their care of individual clients, have the potential to link environmental exposure to illness and disease.

Agricultural workers are at high risk for occupational injuries and illnesses. To reduce the most common cause of fatalities among youth on farms, which of the following is the most important strategy for the community nurse to implement?

Partnering with the county extension agent to offer tractor safety classes

mens health care needs

Permission to have concerns about health and talk openly to others about them Support for the consideration of gender role and lifestyle influences on their physical and mental health Attention from professionals regarding factors that may result in illness or influence a man's expression of illness, including such things as occupational factors, leisure patterns, and interpersonal relationships Information about how their bodies function, what is normal, what is abnormal, what action to take, and the role of proper nutrition and exercise Self-care: testicular and genital self-exams Physical exam and history-taking that include sexual and reproductive health and illness across the lifespan Treatment for problems of couples, such as interpersonal problems, infertility, family planning, sexual concerns, and STDs Help with fathering (i.e., being included as a parent in child care) Help with fathering as a single parent, particularly with a child of the opposite sex, in addressing the child's sexual development and concerns Recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change Adjustment of the health care system to men's occupational constraints regarding time and location of health care sources Financial ways to obtain these goals

Areas of environmental health: built environment: work-related exposures

Poor working conditions that result in potential injury or illness ~Asbestosis ~Asthma ~Lung cancer ~Agricultural accidents

Public health nursing

Population focused and involves a combination of nursing knowledge along with social and public health sciences

Defining Rural Populations

Population size ➢ Rural = towns with population of less than 2500 or in open country [farm/nonfarm] Density ➢ Rural = fewer than 45 persons per square mile ➢ Frontier = less than 6 people per square mile Differ in complex geographical, social, and economic areas Disparities include key indicators of health: ➢ Employment ➢ Income ➢ Education ➢ Health insurance ➢ Mortality ➢ Morbidity ➢ Access to care

Characteristics of Rural Nursing

Positive aspects ➢ Ability to provide holistic care ➢ Know everyone well ➢ Develop close relationships with the community and with coworkers ➢ Enjoy rural lifestyle ➢ Autonomy and professional status ➢ Being valued by the agency and community Negative aspects ➢ Professional isolation • Assist clients with identifying and applying for assistance programs. • Use cultural competence when planning interventions. • Establish trusting partnerships with key individuals in the community. • Use existing relational ties between residents to foster community outreach initiatives.

Impact on Community Health Nursing

Principles of change that focus on quality, access, and cost... >The need for patient-centered care >The need for stronger primary care services >The need to deliver more care in the community >The need for seamless, coordinated care >The need for reconceptualized roles for health professionals >The need for interprofessional collaboration

Priority needs

Priorities needs can be set by the nurse according to what the community finds important. Each community or aggregate will be unique.

Community health diagnoses

Problems identified by community assessments Usually written: "RISK OF low birth weight AMONG adolescents who are pregnant in the downtown district RELATED TO low income, lack of availability of nutritious food, and tobacco use as evidenced by lack of secure housing, food bank use, increased rates of unemployment, and smoking among pregnant adolescents"

Legislation and Programs Affecting Rural Public Health

Programs that augment health care facilities and services ➢ Community Health Centers (CHC) program ➢ Migrant Health Clinic (MHC) program and the Migrant Health Program (MHP) ➢ Medicare's Rural Hospital Flexibility (RHF) grant program ➢ Primary care cooperative agreements

Intervention Wheel: red section --> Coalition building

Promotes and develops alliances among organizations or constituencies for a common purpose.

Rural Public Health Departments

Public health nurses are often the core providers of public health services in rural areas. ➢ Collaboration of services is key—need to develop partnerships with other heath provider agencies. ➢ Environmental health, maternal and child health, and communicable disease control are the three highest-priority programs.

People with Disabilities 6

Quality of life issues- overcoming of environmental and social barriers to attain needed services can be some of the biggest challenge for PWD and their families.

National health care goals-reductions

REDUCTIONS ~toxic air emissions ~waterborne disease outbreaks ~per capita domestic water use ~blood lead levels in children ~pesticide exposures requiring visits to health care facility ~indoor allergen levels ~US homes wit lead-based paint or related hazards ~exposure to chemicals and pollutants ~risk posed by hazardous sites ~number of new schools near highways ~global burden of disease due to environmental concerns

Culture and socioeconomic factors

Socioeconomic status (SES) is a composite of the economic status of a family or unrelated individuals based on: >Income >Wealth >Occupation >Educational attainment >Power >Poverty guidelines >Determined by comparing pretax cash income with the poverty threshold adjusted for family size and composition issued annually by USDHHS. >The U.S. Census Bureau (2012) reported that the poverty rate in 2011 was 15% >African American population—27.6% >Asian population—12.3% >Hispanic population—25.3% >Children under 6 years—24.5% >Distribution of resources >Upper, middle, and lower classes >Total family income, occupation, and educational level >Age, sex, material possessions, health status, family name, location of residence, family composition, amount of land owned, religion, race, and ethnicity >A disproportionate number of individuals from the racially and ethnically diverse subgroups are members of the lower socioeconomic class >Outcome of social stratification is social inequality Education >Perhaps the single most important factor in SES. >Child's educational development affected more by differences in levels of formal schooling than by cultural differences or economic indices.

Teaching focus 3

• The web of causation model is another model that considers the host and environmental interactions and the complexity of their relationships.

Cognitive theory

Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors

nurses responsibilities with mens health

Use gender-specific interview techniques to obtain the most accurate health history. Be aware of personal gender bias in data collection. Be aware of the accuracy and interpretation of secondary sources of information. Help men learn how to provide support to the caregiver or to develop a caregiver role. Acknowledge that gender-linked behaviors increase risks: Lifestyle factors (e.g., use of tobacco, substance abuse, poor preventive health habits and stress, lack of emotional channels) Men's unwillingness to seek preventive care Men's unwillingness to seek health care when a symptom arises

critical theory

Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors

Other community voluntary services

Women's organizations Promote voluntary involvement with community; many others have made women's health a major item on their agenda. Networking Help women advance careers, improve lifestyles, and increase income and success. Crisis hotline services Provide counseling to battered women, battering parents, rape victims, those considering suicide, and those with multiple needs.

point prevalence

a prevalence rate that indicates the existence of a condition at a specific point in time

period prevalence

a prevalence rate that indicates the existence of a condition during an interval of time, often a year

What is listeria? Where is it commonly found in nature? Why is it a public health problem?

a type of bacterium which infects humans and other warm-blooded animals through contaminated food.

Establishing causality: cause and effect relationship

definitively establishing causality particularly in chronic disease is a challenge. there are 6 criteria below that establish the existence of a cause and effect relationship.

social organization

describes the significance of individual members of a family or the family as a whole. ~a single family member who is not the client might be the decision maker in the family; an individual might forgo her own health care needs for the sake of the good of the family

time orientation

describes whether an individual places more value on the past, the present or the future

Mental disorders

o Affective disorders • Bipolar disorders, major depressive disorder o Anxiety disorders • Obsessive compulsive, panic, phobias, PTSD o Schizophrenia o Dementia o Conduct disorders o Personality disorders

Caring for clients who experience violence

o Build trust and confidence with a client o Focus on the client rather than the situation o Assess for immediate danger o Provide emergency care as needed o Work with the client to develop a plan for safety o Make needed referrals for community services and legal option

National Strategy for Suicide Prevention

o Create supportive environments for individuals, families and communities o Enhance community and preventative services o Promote the availability of timely tx and support services o Improve suicide prevention surveillance collection, research and evaluation • IS PATH WARM- mnemonic to screen and recognize warning signs- prevention of suicide

Individual risk factors for violence

o History of being abused or exposure to violence o Low self-esteem o Fear and distrust of others o Poor self-control o Inadequate social skills o Minimal social support o Immature motivation for marriage or childbearing o Weak coping skills

Types of violence within communities

o Homicide o Assault • Males are more likely than females to be assaulted • Youths are at a significantly increased risk o Rape • Most incidences of rape are spousal or acquaintance rape o Suicide • Highest among ages 45-64 • Males are more likely to complete suicide • White people are more likely o Abuse o Economic maltreatment

National health goals

o Increasing the number of people who have a routine primary care provider o Increasing the number of people who have health insurance o Reducing the number of people who are unable to access or have a delay in accessing health care services and prescribed medications o Reducing the number of people who have disabilities who report physical barriers to accessing health and wellness

Migrant and seasonal farm workers constitute a high-risk population due to their low income and migratory status. These workers lack adequate access to preventive services. The most important role of the rural community health nurse in meeting the health care needs of this vulnerable population is to:

serve as an advocate working to gain health care access for these farm workers.

Analytical study design: cohort studies

sometimes referred to as prospective studies, are longitudinal studies, which monitor subjects over time to find associations between risk factors and health outcomes. Calculate relative risks as the statistical outcome of the study.

Crude rates

summarize the occurrence of births, mortality, or diseases in the general population i.e. crude birth rates

cultural accommodation

supporting and facilitating the client's use of cultural practices that are beneficial to the client's health

Critical issues in health care delivery: information technology

telehealth: is growing, which means that clients can receive care via technology EMR: electronic medical records Social media: has become a more common source of information and could be used to share information about community health, including health promotion and prevention

after collecting the data:

the work of identifying health problems begins

Critical issues in health care delivery: disparity in health care delivery

this is related to the number of uninsured and underinsured, but it is also more than that. potential causes of disparities in health care include bias and stereotyping

Type of rates: incidence density

use of a person-time denominator in the calculation of rates; a person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year)

Behavioral theroy

use of reinforcement methods to change learners' behaviors

Ecological Model

used as a guide in population health to examine the determinants of health for a population, and for targeting interventions to multiple factors that affect health. It includes the following components ~Individual traits (age, gender, biological, mental, and behavioral factors) ~Social, family and community relationships ~Occupational and home environments ~Overall conditions creased by local, state, national, and worldwide forces and trends

Public health nursing: assessment

using systematic methods to monitor the health of a population ~monitor health status to identify community health problems ~Diagnose and investigate health problems and health hazards in the community

Establishing causality: consistency with other studies

varying types of studies in other populations must observe similar associations. Numerous studies using different designs have repeatedly supported the relationship between smoking and heart disease

How to assess a community: census data

very helpful (does not include health data), but shows ages, race, ethnicity, and can be the start of what to look for next in a specific geographical location

Population characteristics

~Large populations create pressures ~Goal is to improve quality of life (QOL) ~Health promotion ~Effective health care delivery systems ~Enhancement of the environmental infrastructure ~World population distribution is uneven ~More than 50% live in China, India, United States, and Indonesia; 30% are children; 8% are over 60 ~Life expectancy varies significantly in different countries. ~Japan 86 years, Zambia 43 years ~As the world population grows, a global trend toward urbanization occurs. ~Live closer together and migrate to urban areas for employment ~Increased living density and global travel threatens health of general population by environmental factors

Infant mortality statistics

~Leading causes of infant death in the United States (almost 60% of all infant deaths) -Congenital defects -Disorders relating to short gestation and low birth weight -Sudden infant death syndrome (SIDS) -Maternal complications of pregnancy -Accidents such as suffocation ~United States ranks 27th in infant mortality among industrialized nations

Patterns of health and disease

~Lifestyles, health and cultural beliefs, infrastructure, economics, and politics affect existing illnesses and society's commitment to prevention. ~Disease patterns vary throughout the world. ~in the US there is a lot of eradicated disease because of vaccines but this is not the case around the world ~Racial, ethnic, and access disparities exist within and between countries.

Mr. B has been diagnosed with a severe mental illness. The nurse may expect Mr. B to exhibit which of the following?

~Low self-esteem ~ Difficulty forming relationships

EBP Management of Mental Disorders

~Psychotropic or Psychotherapeutic medications • Medications treat symptoms; they do not cure mental illness • Nurse needs to be up-to-date on medications: ~Psychotherapy • A process of discovery that helps alleviate troubling emotional symptoms and returns individuals to a healthy life • Involves use of professional, therapeutic relationships and the application of psychotherapy theories and best practices • Changes a client's attitudes, feelings, beliefs, defenses, personality, and behavior • Individual, family, couple, group therapy • Play, cognitive, behavioral therapy

Health Belief Model

~Purpose is to predict or explain behaviors ~Assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease ~Emphasizes change at the INDIVIDUAL LEVEL ~Describes the likelihood of taking an action to avoid disease based on the following: ~perceived susceptibility, seriousness, and thread of a disease ~Modifying factors (demographics, knowledge level) ~Cues to action (media campaigns, disease effect on family/friends, recommendations from health care professionals) ~Perceived benefit minus perceived barriers to taking action

Role of the community health nurse in international health care

~Seek to ensure the attainment of health for all in a cost-effective, efficient, accessible health care system. ~Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation. ~Coordinate work with other health care personnel and community leaders as well as local and global community leaders. ~Utilize changes in the health environment to form the basis for the nursing role. >Primary health care ~Essential services that support a healthy life. ~Involves access, availability, service delivery, community participation, and the citizen's right to health care. ~First line or point-of-access medical and nursing care controlled by providers and focused on the individual. ~May not be the norm as needs of the group outweigh the needs of the individual. ~All nurses in the world must understand and learn from one another. Nurses are health care's most valuable assets. ~Community public health nurses can improve access to care for the most vulnerable and hard-to-reach groups in any country. ~The future demands evidence-based learning, engagement, service, and growth in information technology and local and global health policy.

Research in International Health

~Since 1990, international nursing research has focused predominantly on: ~Student and faculty educational exchange programs ~Diverse clinical experiences ~The international development of home care or transition from hospital to home >WHO Collaborating Centers contributed to a partnership for educational programming, clinical practice, and research for graduate students in primary health care nursing and community health

3. Compare and contrast short- and long-term, health-related, disabling conditions.

~Temporary disability ~Permanent disability from accident or disease ~Disability from progressive decline of a chronic illness The onset of a disability is unique as well. This may be something that happened at birth, a gradual onset, with aging or a sudden unexpected event, such as a trauma or accident. Think of how this adaptation would be different for the person and the family.

Ethics

~The Public Health Code of Ethics identifies the ethical practice of public health nursing ~Ethical considerations include preventing harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity and providing confidentiality, competency, trustworthiness, and advocacy. ~Clients rights: the right to information disclosure, privacy, informed consent, information confidentiality, and participation in treatment decisions

Impact on Pregnancy on a child's health

~The health of the mother before during and after pregnancy has a direct impact on the health and well-being of her children. ~A comprehensive approach is needed to... -Identify and treat potential risks -Overcome barriers to good health before, between, and beyond pregnancy -Protect and promote the health of women and children -Ensure the health of future generations

Prenatal substance use

~The use of tobacco, alcohol, or illicit drugs in any combination is dangerous to a woman's health and worsens infant health and development outcomes. ~Smoking is one of the most preventable causes of infant morbidity and mortality ~Alcohol can lead to ~FAS ~Drugs can cause permanent harm to an unborn baby

Disadvantages of case control studies

~They are not appropriate for studying rare exposures. ~They are subject to bias because of the method used to select controls. ~They do not allow the direct measure of the incidence of disease.

Ch 14 learning focus: 2

• Consequences of environmental hazards may be general or specific and may be immediate, long-range, or transgenerational.

Ch 14 learning focus: 1

• Areas of environmental health and related hazards of concern to community health nurses include living patterns, work risks, atmospheric quality, water quality, housing, food quality, waste control, radiation risks, and violence risks.

4. Apply the nursing process to women's health concerns across all levels of prevention.

• Assessment of women's health needs should be comprehensive and include physical, psychological, social, and spiritual areas. • Analysis and diagnosis should be based on assessment data and include review of the available health services.

Learning focus: 3

• At the local level, public health agencies are responsible for direct delivery of health care.

Learning focus: 2

• At the state level, public health organizations vary greatly from state to state, largely depending on the geographic size of the state and the population.

3. Identify barriers to adequate health care for women.

• Barriers to adequate health care for women include socioeconomic problems, inadequate education, racial and ethnic discrimination, or language barriers.

3. Discuss barriers to improving men's health.

• Barriers to improving men's health include the lack of health care specialists in men's health and men's own orientation toward illness and prevention.

2. Describe historical attitudes and perspectives surrounding disability that have contributed to devaluation and disempowerment of people with disabilities.

• Beginning in the 1990s, media images of the disabled became more positive. Emphasis has been on inclusion, normalization, and deinstitutionalization of people with disabilities, and people with disabilities are increasingly being seen as "normal."

Anxiety Disorders

• Characterized by feelings of severe anxiety • Generalized anxiety disorder • Panic disorder • Phobias • Obsessive-compulsive disorder (OCD) • Posttraumatic stress disorder (PTSD) • May be attributed to genetic makeup and life experiences of the individual. • Treatment varies with disorder. • Support from family and friends beneficial.

Ch 15 learning focus: 4

• Community health nurses seek to ensure the attainment of the goal of health for all through their involvement in research, community assessment, planning, implementation, management, evaluation, health care services delivery, and participation in health policy development and legislation.

Challenges in the community -mental health

• Complex patient comorbidity • Lack of resources • Competent mental health professional workforce and law enforcement • Physical facility inadequacies • Stigma of mental illness • A community's mental health is a reflection of community as a whole. • Mental illness is a significant public health problem affecting not only the person with mental illness, but also his or her families, friends, schoolmates, workmates, and others.

Definitions, prevalence and characteristics of homelessness

• Counting the homeless and defining who is actually considered homeless is a daunting task. Keeping this in mind, we really only have a rough estimate of the homeless in America. Those who are sheltered are easier to account for, but there are many, many more hidden - physically or living in cars, doubled up with other families or in abandoned buildings. • The estimate is 633,782 total homeless- but the number is thought to be much higher • Among sheltered homeless adults (not in a family) 72% are men and 28% women, the majority of these were between ages 31 and 61 • Other than individuals, the government also looks specifically at families and Veterans ■ Point-In-Time (PIT) count of sheltered homeless people on a single night in late January of every year and submit this data to HUD—use data to prepare an Annual Homeless Assessment Report (AHAR) ■ Department of Education includes youth and families for services through Education for Homeless Children and Youth (ECHY) program ■ Conference of Mayors' Hunger & Homelessness Survey gathers data for their cities each year

Multidimensional Roles of the Community Mental Health Nurse

• Court representative • Educator • Researcher • Collaborator • Consultant • Case manager • Content expert • Administrator • Activist • Politician • Advocate • Initiator • Evaluator • Grant writer • Practitioner • Coordinator

Deinstitutionalization

• Courts' actions • Limited involuntary institutionalization • Set minimum standards for care in institutions • Insufficient community resources • Inadequate housing • Insufficient supported employment • Insufficient community mental health professional workforce • Few community mental health care services • Funding did not follow the change in policy

Learning focus: 6

• Critical health care issues include impact of managed care, delivery of quality health care, fraud and abuse, impact of information technology, consumerism and clients' rights, coordination and access to health care, disparity in health care delivery, and health care reform.

Ch 14 learning focus: 3

• Critical theory involves asking critical questions regarding the source of actual and potential threats to health observed in a community.

Learning focus ch13: 3

• Cultural aspects that influence nursing care for minority and culturally diverse groups should be assessed and data included when planning care.

1. Discuss the major dimensions of a community.

• Dimensions describing communities include an aggregate of people, a location in space and time, and a social system.

Identification of Mental Disorders

• Early identification, appropriate treatment, and rehabilitation can reduce duration and disability and decrease possibility of relapse. • Direct questioning • Observations • Use of standardized assessment tools or questionnaires

4. Examine the importance of community engagement for impacting health disparities.

• Education begins with establishing an atmosphere conducive to learning, whereby a therapeutic trusting relationship forms the foundation for a healing relationship.

Ch 15 learning focus: 1

• Enormous population growth presents a threat to the health and the economy of many nations.

5. Identify uses for epidemiological data at each step of the nursing process.

• Epidemiological studies support program planning by establishing the effectiveness of certain interventions and their specificity for different aggregates.

4. Discuss factors that promote men's health.

• Factors that promote men's health include more research into men's health and men's own increasing interest in physical fitness and adopting healthier lifestyle patterns.

3. Identify factors that place farmers and migrant workers at risk for illness and accidents. Ch 23

• Farmers and their families have been found to have excess risk for conditions associated with hearing loss, respiratory illness, nonfatal accidents, and chemical hazards. • Limited availability and accessibility of formal health care resources, combined with self-reliance and self-help of rural residents, have resulted in the development of strong informal care and social support networks in rural communities.

Other Issues for Migrant Workers

• Food insecurity • Inconsistent income with yearly cycles of unemployment. • Poor and unsanitary working and housing conditions • Exposure to environmental pesticides • Less access to dental, mental health, and pharmacy services • Inability to afford care • Reduced availability of services (distance, transportation, hours of service, lack of health record tracking) • Language barriers and cultural aspects of health care • Discrimination • Immigration status (fear that seeking services will lead to deportation)

Teaching focus 8

• For secondary prevention epidemiological data and clinical trials play crucial roles in disease identification.

Teaching focus 9

• For tertiary prevention epidemiological studies suggest optimal strategies in the care of patients with chronic advanced disease.

6. Describe the purpose of Healthy People 2020 and give examples of the topic areas that encompass the national health objectives.

• Healthy People 2020 has two broad goals: (1) to increase quality and years of healthy life and (2) to eliminate health disparities.

Health Status of Rural Residents

• Higher infant and maternal morbidity rates • Higher rates of diabetes mellitus • Higher rates of obesity • Less likely to meet physical activity recommendations • Higher rates of suicide • Increased trauma/injuries from lightning; farm machinery; drowning and boating; and snowmobile, all-terrain vehicle, and motorcycle crashes • Increased occupational-associated risks (agriculture, fishing, mining, and construction are the most • dangerous industries) • Less likely to seek preventive care

Health Status and Homeless Populations

• Homeless adults suffer at rates higher than the general populations from- Acute Illness- respiratory infections and trauma. Chronic illnesses- Hypertension, musculoskeletal, GI disorders, Asthma, COPD, seizures and poor dentation. Other diseases such as serious mental illness and substance abuse occur more frequently as well. The overall morbidity and mortality rates are higher also. • Women- Higher rates of pregnancy, preterm and low birth weight babies. Compared to homeless men, women report having higher rates of stressful life events, foster care, domestic violence and hospitalization for psychiatric problems. Violence can often be a cause of homelessness in women. Once a woman is homeless, she is at much higher risk to be the victim of violence or assault. • Families- Children in homeless families have higher rates of asthma, iron deficiency anemia, obesity, mental health problems, developmental delays and behavior issues- as well as a higher risk for educational/ school issues such as lower test scores, repeating grades and bullying. • Youth- All youth are at risk for STD's, substance use and abuse, depression and suicide, but homeless youth have higher rates than the general population. Other problems occurring more in homeless youth include skin problems, anemia, unintentional injury and physical and sexual abuse. Those homeless youth at an especially high risk are those who are pregnant, identify as LGTBQ, and engage in prostitution or "survival sex" and those with a history of foster care. • Chronically homeless suffer often from severe mental and substance abuse disorders.

4. Identify major health problems among various homeless aggregates. Ch 22

• Homeless children experience more immunization delays, upper respiratory tract and ear infections, asthma, skin disorders, diarrhea, anemia, and hunger. They also experience high rates of mental health problems and developmental delays as well as depression, anxiety, and withdrawal. • Homeless men experience higher rates of acute physical health problems such as respiratory infections, trauma, and skin disorders. • Homeless women have health problems that typically cluster around problems of substance use and abuse, mental illness, history of violence, and childhood risks.

Healthy People 2020 mental illness objectives

• Improvements in Suicide, Adolescent Suicide attempts, Eating Disorders, Major depressive episodes • Treatment expansions in - mental health tx and screening in primary care facilities, Tx for children with mental health disorders, Juvenile justice facility screening, employment for persons with serious mental illness, tx for co-occurring substance abuse and mental illness, mental health services for homeless

Ch 15 learning focus: 2

• In developed countries, where infections are better controlled and where people have longer life expectancies, primary causes of mortality are related to chronic diseases.

Factors that affect Mental Health

• Individual coping abilities • Stressful life events (exposure to violence, disasters) • Social events (recent divorce, separation, unemployment, bereavement) • Chronic health problems • Stigma associated with seeking mental health services

Ch 15 learning focus: 5

• Internationally, the nursing role is becoming less traditional and more diverse, but nurses in all countries coordinate their work with other health care personnel and community leaders.

4. Discuss public programs and prevention strategies targeted to children's health.

• Medicaid has increased eligibility for pregnant women, infants, and children so that more individuals are receiving services.

Depression

• Most frequently diagnosed and one of the most disabling mental illnesses in the United States • Includes major depressive disorder, dysthymic disorder, and bipolar • Often co-occurs with serious physical disorders (heart attack, stroke, diabetes, and cancer) • Health education includes risk factors identification, as well as how and when to obtain treatment • Children and adolescents also suffer with depression. Treatment includes pharmacological therapy, psychotherapy, behavior therapy, electroconvulsive therapy, or a combination of these

Nursing in the Rural Community

• Nursing shortage in rural areas, declining school enrollment, increased population of elderly- all make for a more critical need. Rural nurses earn less than urban nurses. A grow their own strategy is in place in some rural areas to encourage and support local citizens to pursues nursing and work in the area after completion of school. People who study nursing locally are more apt to remain in the area. • Positives to being a rural nurse- ability to really get to know your patients, provide holistic care, more autonomy and intensity of purpose, challenging

Health and social issues in the rural population

• Obesity • Sedentary lifestyle • Tobacco use- higher rates of tobacco use in rural men and women • Unintentional injury- higher rates related to more dangerous occupations and high risk behaviors, lack of emergency services- esp. for trauma ~Lack of access to emergency care due to : low population density, large, isolated, or inaccessible areas, severe weather, poor roads, lower density of telephone/communication methods • Mental illness- higher suicide rates, fewer mental health services (75% of counties do not have a psychiatrist, 95% do not have a child psychiatrist) stigma attached to mental illness and seeking out help for services • Suicide- is the second leading cause of death in rural areas, sometimes being 800% higher than the national average in certain areas, Alaska being the highest • Access to Care- un or underinsured, few doctors and nurses, especially family practice, closure of hospitals, long distances to receive care, emergency care access may be more than an hour or two away, barriers in mobility and transportation, Only 10% of physicians in the U.S. practice in rural settings. • Poverty- few job options, lower education levels, lower income levels. Higher poverty rates in rural areas when compared to urban areas • Preventative / primary care- prevention screening less likely to occur, few primary care doctors, fewer options for clinics and hospitals, un or underinsured • High risk behaviors- lower use of seat belts, more tobacco use, driving longer distances on poor road conditions, more use of ATV's , much higher rates of unintentional injury overall • Education- lower education levels overall, lack of educational opportunities, poverty creates a barrier

7. Discuss community/public health nursing practice in terms of public health's core functions and essential services.

• The three primary core functions of public health are assessment, policy development, and assurance.

5. Explain the difference between public/community health nursing practice and community-based nursing practice.

• The American Nurses Association definition of public health nursing focuses on care to individuals, families, and groups within a community, while the American Public Health Association definition focuses on care to the community as a whole. > Public Heath Nursing is the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort > Community Health Nursing: extends the realm of public health to include organized health efforts at the community level through both government and private efforts. Care is directed to individuals, families, and groups.

Learning focus: 1

• The Department of Health and Human Services is the main organizational body of the public health care system at the federal level.

Primary Functions of Public Health

• The Institute of Medicine has identified three primary functions of public health: assessment, assurance, and policy development.

8. Discuss community/public health nursing interventions as explained by the Intervention Wheel.

• The Intervention Wheel contains three important elements: (1) It is population-based; (2) it contains three levels of practice (community, systems, and individual/family); (3) it identifies and defines 17 public health interventions.

Rural and Migrant Health

• The Midwest is second next to the South in Rural population density. 50% of the poor in America live in a rural area. Rural America is a diverse population. • Some areas in the south and west are growing in population, but many rural areas are seeing a decline in younger people, due to a lack of employment opportunities. In these areas, this leaves an increasingly aging and isolated population. Aging in place, immigration of older persons into rural areas and migration of younger persons to urban areas puts a lot of stress on communities that already struggle to provide adequate health care, transportation and housing to the residents.

4. Formulate community and aggregate diagnoses.

• The community and aggregate diagnosis consists of four components: the identification of the health problem or risk, the affected aggregate or community, the etiological or causal statement, and the evidence or support for the diagnosis.

5. Apply knowledge of child and adolescent health needs in planning appropriate, comprehensive care at the individual, family, and community levels.

• The community health nurse should combine knowledge of major indicators of child health, social factors that contribute to declining health status, and public programs designed to address problems of health care.

Learning focus ch 13: 4

• The community health nurse should include a cultural assessment when gathering data and applying the nursing process to transcultural nursing.

Epidemiological triangle

• The epidemiological triangle analyzes the relationship between agent, host, and environment.

Learning Focus 1 Ch 24

• The history of community mental health has included the Age of Confinement, mental health reform, medicalization of mental illness, deinstitutionalization, and Decade of the Brain.

1. Identify major indicators of child and adolescent health status.

• The major indicators of child and adolescent health status are infant mortality, accidental injuries, violence, and "new morbidities of youth".

1. Identify the major indicators of men's health status.

• The major indicators of men's health status are rates of longevity, mortality, and morbidity.

1. Differentiate between medical model and social construct definitions for disability.

• The medical model prescribes interventions designed to remedy or ameliorate functional limitations of the person who is seen as ill. • In the social construct paradigm, disability is the result of failure of the social environment to adjust to the needs of persons with disabilities.

Schizophrenia

• The most common psychotic disorder • Positive symptoms include hallucinations, delusions, disorganized thinking and speech, and bizarre behaviors • Negative symptoms include flat affect, poor attention, lack of motivation, apathy, lack of pleasure, and lack of energy • Increased risk for alcohol use, depression, suicide, and diabetes • Treatment is intensive—often with hospitalization (initially), antipsychotic meds, and psychotherapy

4. Describe some of the most common types of mental illnesses encountered in community settings. Ch 24

• The most common types of mental illnesses are depression, schizophrenia, anxiety disorders, eating disorders, and attention deficit hyperactivity disorder.

Teaching focus 4

• The person-place-time model categorizes the relationships of factors contributing to disease.

Learning focus 2 ch24

• The primary roles of mental health nurses in the community are educator, activist, practitioner, and coordinator.

Learning focus: 4

• The private health care subsystem focuses on care to individuals by nonprofit and for profit sectors and personal care physicians.

Learning focus: 5

• The public subsystem is concerned with the health of populations and the provision of a healthy environment and is composed of programs at the federal, state, and local levels of government.

3. Describe the process of conducting a community assessment.

• The steps of a community assessment include the identification of issues of concern via the interview of key community informants, synthesizing assessment data into diagnostic statements about the community's health in the form of a community diagnosis, and the planning phase in which plans for the intervention and its evaluation are proposed.

4. List the three levels of prevention and give examples of each.

• The three levels of prevention widely recognized in public health are primary, secondary, and tertiary.

Veterans Suicide and PTSD

• Two models of community based mental health are the ACT program and the Crisis Intervention Team • The ACT model pg483 moves the traditional 24 hour mental health care to a community setting that is highly individualized, supportive, has mobile crisis intervention, medication, hospitalization, education and skill training for families and patients. • The Crisis Intervention team is an advocacy and training program that partners mental health professionals, advocates and law enforcement. This provides a safe and educated approach to a mental health crisis by specially training and collaborating community members in handling crisis safely.

Health Issues of Homeless Populations

• Upper respiratory disorders • Tuberculosis • Skin disorders (athlete's foot) and infestations (scabies,lice) • Substance use disorders • HIV/AIDS • Trauma • Mental health disorders • Dental caries • Hypothermia and heat-related illnesses • Malnutrition

Ch 14 learning focus: 4

• Vulnerable aggregates are those who are less able to protect themselves from pollution, inadequate housing, toxic poisoning, unsafe products, and other hazards.

HUD legal definitions in the United States

■ Category 1. Literally Homeless. Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided ■ Category 2. Imminent Risk of Homeless. Individuals and families who will imminently lose their primary nighttime residence ■ Category 3. Homeless Under Other Federal Statutes. Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition ■ Category 4. Fleeing/Attempting to Flee Domestic Violence (DV). Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

Recent Efforts to Count Homeless

■ Homeless Information Management System (HMIS) - Directed by Congress to gather homeless data ■ Continuum of Care (CoC) concept - One-night point-in-time (PIT) count - Annual estimate based on reports of service use - A "snapshot" picture of the homeless population ■ National Alliance to End Homelessness (NAEH) and Housing and Urban Development (HUD) ■ U.S. Conference of Mayors