Public Health Exam 1
School nursing associations
https://www.nasn.org/home http://missourischoolnurses.org/ http://slssna.com/
Where are we today???
https://www.youtube.com/watch?v=QFrqTFRy-LU
About 1% of the world's population suffers from
schizophrenia Epidemiology = symptoms of schizophrenia typically first appear in late adolescence or young adulthood and persist throughout a person's life, causing significant impairment in all aspects of a person's psychosocial functioning
Early intervention programs for first-episode psychosis
specialized teams of professionals whose primary goal is to maintain the individual's current level of educational and vocational functioning through early treatment
Role of public health nurse - direct services
-Care giver -Case manager/coordinator -Advocate -Educator -Counselor -Collaborator -Information broker
Common health concerns
-Drugs and alcohol -Smoking -Sexual behavior and teenage pregnancy -Sexually transmitted infections -Nutrition -Violence -Cyberbullying
Healthy People 2020 Goals
-Eliminate preventable disease, disability, injury, and premature death -Achieve health equity, eliminate disparities, and improve the health of all groups -Create social and physical environments that promote good health for all -Promote healthy development and healthy behaviors across every stage of life
Eight domains of Public Health Nursing Practice
-Analytic assessment skills -Policy development and program planning skills -Communication skills -Cultural competency skills -Community dimensions of practice skills -Basic public health science skills -Financial planning and management skills -Leadership and systems thinking skills
The nursing process in faith community nursing
-Assessment and diagnosis -Interventions and outcomes
Lillian Wald PHN founder in U.S.
-Began PHN, linking medical care to the poor -Began the first Public School Nursing Service -Created Federal Children's Bureau -Brought nursing into higher education -BSN ideal minimal educational level for PHN (BSN has PHN in curriculum)
Principles of hospice care
-Care -Patient and family -Team approach -Address of loss, grief, and bereavement -Anticipatory mourning
Principles of Public Health Nursing (ANA)
-Client is the population -Greatest good for greatest number -Client is equal partner -Primary prevention is priority focus -Create conditions in which populations thrive -Active outreach -Aim toward best overall improvement -Collaboration with others
Role of public health nurse - population-based services
-Coalition builder -Change agent -Policy advocate -Culture broker -Case finder -Researcher
Patient/client-centered care
-Cultural traditions -Personal preferences -Values -Families -Lifestyles
Caring for patients at the end of life
-Death itself -Thoughts of a long or painful death -Facing death alone -Dying in a nursing home, hospital, or rest home -Loss of body control, such as bowel or bladder incontinence -Not being able to make decisions concerning care -Loss of consciousness -Financial costs and becoming a burden on others -Dying before having a chance to put personal affairs in order
Nursing care when death is imminent
-Decisions about level of care -Comfort measures only -Advance directives -Artificial nutrition and hydration -CPR or DNR? -Euthanasia and physician-assisted suicide
Three major changes in health care in the 21st century
-Development of patient/client centered care -Increased use of technology -Increased personal responsibility for health
Areas essential to the preparation of specialists in public health
-Epidemiology -Biostatistics -Nursing theory -Management theory -Change theory -Economics -Politics -Public health administration -Community assessment -Program planning and evaluation -Interventions at the aggregate level -Research -History and issues in public health
Schizophrenia
-Epidemiology -Early intervention programs for first-episode psychosis -Primary prevention programs -Enhancing treatment adherence in schizophrenia -Role of community mental health teams in treatment of schizophrenia
History of faith community nursing
-Faith community nursing is a fairly recent concept; however, in ancient times, families and religious communities served as a primary source of health and illness care -Religious groups and monasteries established the first hospitals -Granger Westberg, a Lutheran Minister and hospital chaplain, began "parish nursing" in the 1980s
Education for faith-based nursing
-Faith-based nurses are often educated for the role in continuing education programs -The Westburg Institute has developed a curriculum that can be delivered in a continuing education format or through a more formal academic program for college credit https://westberginstitute.org/ -The curriculum for all participants is developed at the baccalaureate level, even though many faith community nurses have diplomas or associate degree preparation
Faith-based nurse scope and standards of practice
-Faith-based nurses function by virtue of their license to practice nursing -Faith-based nurse functions more independently
Principles of public health
-Focus on the aggregate (big groups of people) -Promote prevention -Encourage community organization -Practice ethical theory for the greater good -Model leadership in health -Use epidemiologic knowledge and methods to guide us through our decisions in our evidence-based practice
Criteria for population based PHN practice
-Guided by assessment of population health status -Focuses on entire population with similar concerns or characteristics -Considers broad determinants of health such as income, nutrition, housing, employment, etc -Considers all levels of prevention -Considers all levels of practice (individual, family, community, and systems)
Public health combines concepts of
-Health promotion and disease prevention -Is interdisciplinary (we all work together) -To improve and enhance quality of life -Includes physical, mental, and environmental health -Is based on the science of epidemiology
Challenges for community and Public Health Nursing in the 21st century
-Helping eliminate health disparities in underserved populations -Demonstrating cultural competence -Planning for community change -Contributing to a safe and healthy environment -Responding to emergencies, disasters, bioterrorism -Responding to the global environment
Assessment (core function)
-Identifying community needs and monitoring indices of health -Determines presence and extent of a problem -Collect, assemble, analyze, and make data available (methods to collect include surveillance, needs assessments, focused groups, interviews)
Personal responsibility for health
-Increased personal responsibility for health by preventing or modifying unhealthy behavior -Review own medical record -Life style = diet, weight control, exercise, avoid tobacco and recreational drug use -Educate self on medical conditions
Roles of the faith-based nurse
-Integrator of faith and health -Personal health counselor -Health educator -Health advocate -Referral agent -Coordinator of volunteers (food pantry, BP screening, etc.) -Accessing and developing support groups
First visiting nurses associations established in US was in
1885 -Purpose was to restore, promote health, and prevention of disease, poor people Lillian Wald: -Public health founder (1893) -Nurses' Settlement House/slums of New York -Henry Street Settlement (rewatch video on CoursePoint)
Declaration of Alma-Ata
1978 World Health Organization -That health is a fundamental human right and attainment of health is a most important world-wide social goal
The precipitous in autism - a public health crisis
-Long-term outcomes of children with autism are improved with early identification and treatment -Screening tools for autism have been developed, but most are for use in toddlers and not in infants -Screening for prodromal symptoms in infancy; some of the more debilitating features of the disorder might be mitigated with early intervention and treatment
Medicare hospice benefits
-Medicare Part A eligible -Less than 6 months or less to live -Sign for hospice care -Medicare-approved program
Enhancement of treatment adherence in schizphrenia
-Nonadherence to medication is the most common factor associated with relapse and recurrence of psychotic symptoms -Nursing interventions to enhance medication adherence applicable to those with chronic mental illness
Benefits of Health Information Technology
-Patient centered -Improved coordination of care -Support for evidence-based care -Reduced error -Expand access to affordable care -Improved overall health outcomes -Public health -Increased prevention of disease and disability -Earlier detection of infectious disease outbreaks -Improved tracking of chronic disease management -More accurate assessments of the disease and disability
Nursing and patients with chronic disease
-Patient- and family-centered care -Ethical behavior and consumer rights -Clinical excellence and safety -Inclusion and access -Organizational excellence -Workforce excellence -Standards -Compliance with laws and regulations -Stewardship and accountability -Performance measurement
Psychological first aid
-Populations traumatized by disasters -Populations at risk for psychological trauma -Psychological first aid is recommended to help support survivors and first responders to natural and intentional disasters
What does public health help with?
-Prevents epidemics and the spread of disease -Protects against environmental hazards -Prevent injuries -Promotes and encourages healthy behavior -Responds to disaster and assists in recovery
School nurse as a child advocate
-Provide education and communication necessary to ensure that the student's health and educational needs are met -Implement strategies to reduce disruptions in the student's school activities -Communicate with families and healthcare providers as authorized -Ensure the student receives prescribed medications and treatments and that staff who interact with the student on a regular basis are knowledgeable about these needs -Provide a safe and healthy school environment to promote learning
Assurance (core function)
-Relies on the first two core functions -Turns strategies (from policy development) into programs Involves: -Enforcing laws about health and safety -Linking people to needed services -Assuring a competent workforce -Evaluating quality of services
Attention-deficit/hyperactivity disorders and emotional disorders in children
The main characteristics that help healthcare practitioners, including school nurses, differentiate ADHD from bipolar disorder are the pervasiveness of the symptoms and the predominant symptoms
Role of community mental health teams in treatment of schizophrenia
-Respite services, day treatment facilities, and sheltered workshops are a few of the outpatient services that help alleviate the daily burden of care for families -To address these shortcomings in the delivery of care, community mental health teams coordinate both the psychosocial and the psychopharmacological needs
Since the passage of PL 94-142 in 1975, school nurses provide more complex care for conditions such as
-Seizures -Asthma -Cardiac conditions -Cystic fibrosis -Quadriplegia -Diabetes -Life-threatening allergies
Death in America
-Stages in the dying process -Specialized care at the end of life
The uniqueness of Faith Communities
-Strong relationship with the clergy -Faith community is it's own community
Role and responsibilities of the community mental health practitioner
-Teacher -Clinician -Advocate https://www.apna.org/i4a/pages/index.cfm?pageid=1
Scope of mental illness
-There is no difference in lifetime prevalence rates of major mental illness between developed and developing countries -The projected lifetime risk of developing a major mental illness is highest in countries where the population is subject to sustained violence
At the end of the first lecture, you should be able to answer the following:
-What are the major changes in health care in the 21st century? -What is community-based nursing practice? -What is community health nursing? -What is public health? -What is an aggregate? -What are the goals of Healthy People 2020? Describe the historical significance of HP -What is health information technology and how does it benefit nurses and patients? -What are the great public health achievements in the US in the 20th century? -What is the significance of the following groups: ACHNE, ANA, APHA, and ASTDN? -Know the significance of Clara Barton, Dorothea Dix, Lemuel Shattuck, and Lillian Wald -What are the core functions of the role of the government? Example of each core function? -What are the levels of the American Public Health System? Provide examples
Issues and challenges in public health nursing
-Workforce shortage for all nurses -Budget constraints for agencies -Recruit and retain public health work force -Insufficient number of baccalaureate level nurses -Less than competitive salaries
Core competencies for public health professionals
1. Analysis and assessment 2. Policy development and program planning 3. Communication 4. Cultural competency 5. Community dimensions of practice 6. Basic public health sciences (epidemiology, biostatistics) 7. Financial planning and management 8. Leadership and systems thinking
Three core functions of government in health care & goals
1. Assesses health care problems 2. Intervenes by developing relevant health care policy that provides access to services 3. Ensures that services that are delivered and outcomes are achieved -Patient Protection and Affordable Care Act (PPACA) Goals: -Provide affordable health insurance coverage -Improve access to primary care -Lower costs
Parish nursing
A specialty practice of nursing having RN's contribute to the health and wholeness of people in the context of a faith community -The parish nurse is part of the ministry staff of the congregation and serves the illness needs of individual people, families, and the entire faith community
Models of Faith Community Practice
A variety of faith-based nursing models exist Congregation-based model = a faith-based nurse serving a particular faith community by virtue of a contract or job description; supports the concept of faith-based nurse who can be paid or serve as a volunteer Institution-based model = the faith community nurse serves a health system with assignment to particular congregational settings; in this model, the parish or faith-based nurse serves as liaison and helps plan and coordinate care, particularly at times of transition
Health care changes in the 21st century
Access Cost Quality Social determinants of health = social conditions in which people live and work Health care disparities = gaps in health care experienced by one population compared with another
Legislation for Parity (equality) in Mental Health Insurance Benefits
All health insurance coverage, including deductibles, copays, coinsurance, and out-of-pocket expenses, as well as all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits, will be the same regardless of health need or diagnosis
Secondary prevention
Detects disease early to minimize problems -Early detection, early prevention -Screening (planned effort to identify and minimize disease and injury) -Maximizing health and wellness through strategies that are set in place at the early and active chronic stages of pathogenesis of illness and injury
Three core functions of public health
Assessment = collect and analyze unbiased info on the community Policy development = support health promotion and protection Assurance = enforce laws that support health and safety
PHN role in core functions?
Assessment = needs assessments, data collection, surveillance Policy Development = group presentations, work with politicians, community groups, teams to develop programs Assurance = referrals, providing services, workforce supervision, quality assurance
Spiritual care
Care of the human spirit that may include dealing with the meaning of health, illness or loss, relationships with God and others, and which has the goal of peace
Community health nursing
Community-oriented nursing = use of systematic process to deliver care to individuals, families, and community groups with a focus on promoting, preserving, protecting, and maintaining health Community-based nursing = minor acute and chronic care that is comprehensive and coordinated where people work, live, or attend school; illness care provided outside the acute care setting **School nurses practice both of these = when in their office and seeing students come in daily for illness/injury, they might also be managing other chronic diseases of kids in the school (community-based) & the school nurse might keep records on how many students they saw in their office over the course of that month or how many medications they gave, or look at the trends over time with some of the injuries such as the inflatables at PE times (community-oriented)
Community and public health nursing today
Competencies = Quad Council of Public Health Nursing Organizations (determines how public health nursing applies the 8 core competencies) Scope and Standards of Practice (set by ANA) Education = entry generalist requires a baccalaureate degree; Specialist Masters prepared nurse does research Certification for specialty practice
Health information technology
Comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner -Home monitoring devices (Telehealth) -Electronic Health Record -Rapidly advancing forms of technology are dramatically improving lives -An average of 32 medical devices are approved each year
Local level public health systems (primary revenue is property tax at local level)
County health departments, City health department, regional health departments Most public health services provided at local level: -Vary widely in services offered -Most common are communicable disease, environmental health, and child health -Direct care focus versus population focus (can be providing both but from various perspectives)
Youth Risk Behavior Surveillance Survey (YRBSS)
Data from the YRBSS, a biannual report of the common risk behaviors influencing the health of our nation's youth, can be used by the school nurse as a tool for monitoring trends both locally and nationally https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
Trends affecting the Health Care System
Demographics: -Aging population -Nursing shortage (aging faculty, limited clinical sites, classroom space, clinical preceptors) Technology: -Telehealth -EMR/HER Global influences
Federal level public health systems (where most of the money is --> comes from income tax)
Department of Health and Human Services (DHHS) = two Operating Divisions -Public Health Service Operating Division -Human Services Operating Division Department of Justice Environmental Protection Agency Department of Homeland Security U.S. Marshalls
Mood and anxiety disorders
Epidemiology = social factors & biological theories of depression and anxiety Nursing interventions
Faith community nursing
Equivalent to parish nursing; used in settings in which the word "parish" may have no meaning or association -This broader term is the preferred term, but many original documents used "parish nursing" as the title for the role
Nursing in faith communities
Faith community nursing provides the following support: -Health promotion -Health screening -Health teaching -Care for individual people and groups associated with the congregation
True or False? Health care disparities are social conditions in which people live and work
False --> this is social determinants of health
Deinstitutionalization
The phenomenon of allowing patients leave care in large, complex health care systems in order to receive care in neighborhoods and communities on an outpatient basis
Individuals with Disabilities Education Act (IDEA)
Federal law enacted in 1990 and reauthorized in 1997, designed to protect the rights of students with disabilities by ensuring that everyone receives a free, appropriate public education, regardless of ability -IDEA strives to grant equal access to students with disabilities and to provide additional special education services and procedural safeguards
Hospital or acute care
Focus on individual, patient, and family
Public or community health
Focus on individuals, families, communities, home environment, population of people
What influences the incidence of mental illness?
Genetic, biological, and environmental risk factors -Mental health and, conversely, mental illness are concepts bound by culture -Understanding of what connotes mental health is shaped by social norms that evolve from generation to generation
Practice settings for PHN
Governmental agencies: -Health departments -Schools -Correctional facilities & jails -Rural health clinics Non-governmental agencies: -Community Health Centers -Nurse managed clinics -Homeless services -Workplaces - Occupational health -Faith-based organizations
Role of the school nurse
Health assessment Health promotion and assessment of school health needs: -Data from the Youth Risk Behavior Surveillance Survey (YRBSS can be used by the school nurse as a tool for monitoring trends both locally and nationally) -There are online clearinghouses of school-based, evidence-based programs for the prevention of common health risk behaviors
Tertiary prevention
Keeps existing problems from getting worse -Long term management or treatment of chronic diseases (quality of life) -Maximizing health and wellness through strategies that are set in place at the palliation and end-stage of disease and injury trajectories
Mental health definition
No universally accepted definition of mental health; for practical purposes, widely accepted parameters for what behaviors connote psychopathology must be used to measure -Incidence -Morbidity -Mortality
Public health nursing in Missouri
PHN's first recognized by the state nurses' association in 1914 Early PHN activities: -Sanitation -Managing epidemics -School nursing -Child welfare
Community-based treatment of the mentally ill gained momentum as World War II veterans returned home exhibiting the symptoms of
PTSD -By the early 1960s, a scathing report by the Joint Commission on Mental Health and Illness about conditions in state-supported psychiatric hospitals prompted the adoption of the Community Mental Health Center -Aided by advances in the development of pharmacologic treatment of the mentally ill, the numbers of patients treated in state mental hospitals precipitously declined -Since deinstitutionalization began, there has been an outcry of frustration from nurses in the community about the lack of supportive services to meet the needs of people with chronic mental illness (can send them to outpatient treatment in community where they can get treated)
Public health nursing
Population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire country --> The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences (APHA) -Useful characteristics = focusing on populations who live in a community, emphasize prevention, have concern for interface between health status of population and environment
The main focus of public health
Prevention -Think Upstream (prevention) -Seek source of problem for more effective prevention
Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
Program mandated by a federal law passed in 1969, which required that children and adolescents younger than 21 years of age have access to the periodic screenings -Hearing, vision, height & weight screenings, etc.
Primary prevention
Promotes health and prevents disease -Immunizations, health education classes, using seat belts -Maximizing health and wellness through strategies that are set in place before illness or injury is present
Department of Health and Human Services
Public Health Services Operating Division --> role is to support knowledge development, establish nationwide objectives, provide technical assistance, provide tax funds, and assure actions and services throughout various organizations -Centers for Disease Control and Prevention (CDC) -United States Public Health Service (USPHS) -Food & Drug Administration (FDA) -National Institutes of Health (NIH) -Health Resources and Services (HRSA) Agency for Healthcare Research and Quality (AHRQ) -Indian Health Service (IHS)
Hospice care
Services that are reasonable and necessary for the comfort and management of a terminal illness; these may include the following: -Physician services -Nursing care -Physical therapy, occupational therapy, and speech-language pathology services -Medical social services -Hospice aide services -Homemaker services -Medical supplies, including drugs and biologicals and medical appliances -Counseling, including dietary counseling, counseling about care of the terminally ill client, and bereavement counseling -Short-term inpatient care for respite care while caregiver is out of town, pain control, and symptom management
School health nursing
Specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students
State level public health systems (power is derived from 10th amendment --> primary source of revenue is from income sales tax)
State Board of Health = Missouri Department of Health and Senior Services (DHSS) Core responsibilities: -Assessment of health needs -Assure legal base for health activities -Establish statewide health objective -Assure health services -Support local health services
What is an example of thinking upstream?
Teaching classes on methods to control the spread of the H1N1 flu virus to prevent an outbreak -Trying to prevent by addressing problems and intervening early Downstream = addressing problems that are already there, trying to mitigate them without looking at what is causing them
The future of school health: The Community School Model
The future of school nursing is providing a prevention framework that links the community and the school -Collaborative design that uses the resources of a community to provide structured preventive services such as after-school programs, parent outreach, crisis intervention, and school-based health centers where they get their primary care at school
Public Health Systems
US government has responsibility to promote & protect health at the federal, state, and local levels -Provides services that benefit the social welfare of citizens
Policy development (core function)
Uses info from the assessment to design programs, develop public policy, and develop strategies to reduce risk and improve health Integrates: -Leadership role -Partnerships with other agencies -Evidence-based decision-making
Ethical considerations of faith commmunities
Values, cultural practices, and faith are a part of health -The body, mind, and spirit of community members are a primary focus of nursing in faith communities
Americans with Disabilities Act (ADA)
Wide-ranging federal legislation enacted in 1990 that is intended to make American society more accessible to people with disabilities
Congregation
an organized group of people who share: -Religious beliefs -Customs -Practices The congregation has an internal governance structure and may be: -Independent -Affiliated to local or national denominations
Funding for public health has
decreased -WHILE population based services have increased **Prevention **Community-oriented care **Continuity **Nurses role
The unemployed, the poor, and the homeless all report higher levels of
depression, anxiety, schizophrenia, and substance abuse than the general population -The number of mentally ill clients who are homeless has steadily increased in the US as state governments embarked on a systematic plan to "deinstitutionalize" the mentally ill
Leading cause of disability worldwide
psychiatric disorders