Community Health
Macroeconomic theory
focuses on aggregate behaviors, economic growth, and employment
Essentials of Community Nursing
Determinants of health - client or environmental factors which influence client health (nutrition, social support, stress, education, finances, transportation, housing, biology/genetics, personal health practices) Health indicators - health status of a community and serve as targets for improvement of community health (mortality rates, disease prevalence, levels of physical activity, obesity, tobacco/substance use) Nurses - determine community health by examining the degree of community collective health needs are identified and met Community - a group of people/institutions sharing geographic, civic, and/or social parameters (vary in characteristics and health needs)
Respond To School Crisis and Disasters
Develop a crisis plan. Act as a first responder or triage the injured. Participate in the drills. Counsel and debrief.
Occupational Safety And Health Act of 1970: Occupational Health and Safety Administration (OSHA)
Develops and enforces workplace health regulations to protect the safety and health of workers. Provides education to employers about workplace health and safety.
Aggregate
In public health, this term represents individual units brought together into a whole or a sum of those individuals. In public health science, the term aggregate often refers to the unit of analysis, that is, at what level the health-care provider analyzes and reports data
Poverty Threshold
Is a yearly determination of a standard of living below which a family has the lack of goods and services commonly taken for granted by mainstream society.
Elder maltreatment
Is any abuse and neglect of persons aged 60 and older by a caregiver or another person in a relationship involving an expectation of trust. Forms of elder maltreatment include:
Racism
Is defined as "A belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race."
Stigma
Is defined by the online Merriam-Webster dictionary as "a mark of shame or discredit".48 Stigmatized individuals either possess, or are believed to possess, some attribute that is not valued in a particular social context.
Vulnerability
Is the degree to which an individual, population, or organization is unable to anticipate, cope with, resist, and recover from the impact of disease and disasters. Vulnerability is not exclusively tied to social status.
Attributable Risk
Is the measure of the proportion of the cases or injuries that would be eliminated if a risk factor was not present. It is calculated using the population attributable risk (PAR), which is based on the strength of the risk factor and the prevalence of the risk factor in the population.
Primary Prevention
Teaching good nutrition and knowledge of health hazards, and providing information on immunizations and use of protective equipment.
The Changing Diversity in the Older Adult Population
The number of white older adults is projected to decrease by 10% and all other ethnic/racial groups will increase, with 42% of older adults being members of a minority population by 2050. The number of persons of Hispanic origin aged 65 years or older will nearly double from 31.4 million in 2010 to 71 million in 2050. Conducting a cultural assessment and maintaining cultural competency is an essential skill for nurses working with older adult populations.
The free radical theory
The observation that older adults are more prone to the damaging effects of free radicals, that is, molecules with unpaired electrons because older adults have lower levels of protectant free-radical scavengers such as vitamins A, C, and niacin.
upstream thinking
used to focus on interventions that promotes health or prevent illness Nursing theory provides the basis for care of the community and family
Secondary Prevention
Access all children, faculty, and staff during emergencies. Provide emergency care (first aid, early defibrillation with AED, CPR). Headaches Stomach pain, diarrhea Anxiety over being separated from parents Minor injuries (cuts or bruises) that occur at school Assess all children, faculty, and staff during emergencies. Provide emergency care (first side, early defibrillation with AED, CPR). Create emergency plans for all children who have a potential for anaphylactic reactions or other health problems that could result in an emergency situation. Maintain inventory of emergency supply equipment and secure medications.
1978
Public Health Service developed
Life span
The measure of a life from birth to death.
Healthy People 2020 stated that the impact of social and physical determinants of health
"determinants affect a wide range of health, functioning, and quality of life outcomes." They provided a number of examples. As noted earlier, Healthy People 2030's foundational principles include "Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy" The goal is to create interventions that change outcomes and decrease racial and ethnic disparities. The five purposes of the model are to: 1. Provide policy makers and others concerned with health disparities a better appreciation of the issues 2. Better understand the interrelationship of all the variables 3. Provide a research format and direction for data input 4. Give building blocks to the community stakeholders so they can contribute input and improve structure 5. Improve the systematic planning of data collection, interventions, and evaluation.
Four stages:
(1) susceptibility (2) the sub-clinical phase after exposure when pathological changes are occurring without the person being aware of them also sometimes referred to as the incubation period for CDs and latency period for noncommunicable illness (3) clinical disease with the development of symptoms (4) the resolution phase in which the final outcomes are cure, disability, or death.
Gerontology
The study of the effects of time on human development or the study of the aging process
Ten Keys to Healthy Aging
1. Controlling hypertension 2. Stopping smoking 3. Screening for cancer 4. Keeping current on immunizations 5. Regulating blood glucose 6. Lowering cholesterol 7. Being physically active 8. Preventing bone loss and muscle weakness 9. Maintaining social contact 10. Combating depression
Health is influenced at several levels (Ecological Model):
1. Individuals 2. Families 3. Communities 4. Organizations 5. Social systems 6. There are multiple determinants of health. 7. A population and environmental approach is critical. 8. Linkages and relationships among the levels are important. 9. Multiple strategies by multiple sectors are needed to achieve desired outcomes
10 essential services of public health
1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public health and personal health-care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems
6 social determinants of health
1. economic stability 2. neighborhood and physical environment 3. education 4. food 5. community and social context 6. health care system
Zosters: RZV or ZVL
50 yr or 60 yr and older Get two doses of RZV at age 50 years or older (preferred) or one dose of ZVL at age 60 years or older, even if the individual had shingles before
Pneumococcal vaccines: PCV13 and PPSV23
65 yr and older Get one dose of PCV13 and at least one dose of PPSV23 depending on age and health condition
Oldest-old
95 and older
Occupational Health
: all work environments have Associated risks. Healthcare in the workplace seeks to both promote health and prevent occupational illnesses and injury. Throughout Improvement and maintenance of Health, Workplace expenditures are decreased by less sick time used for workers compensation claims, and decrease the use of group health coverage. Nurses function in numerous roles within workplace settings and are challenged to provide cost-effective and high-quality care. In this effort, it is essential for the occupational health nurse to develop Partnerships with workplace Administration, industrial hygienists, safety specialists, Occupational Medicine Physicians, human resource departments, Union representatives, and health insurance agencies. The occupational health nurse Works to promote a healthy work environment to Foster to health and safety of workers. Assessing risk for work-related illnesses and injury Planning and delivering health and safety services in the workplace Collaborating with Community Healthcare Providers Facilitating how promotion activities that lead to a more productive Workforce This autonomous speciality entails making independent nursing judgements when providing care to the workforce aggregate.
Continuing Care Retirement Communities
A CCRC is defined as a community that provides housing and health care across the continuum from independent living, to assisted living, to skilled nursing care.
Naturally Occurring Retirement Community
A NORC is defined as a community that provides: Residential housing with supports Transportation for appointments and shopping Individual assessment of those at risk, followed by referral and follow-up of service Coordination of nonprofessional services Closed or vertical NORCs are geographically confined, such as apartment buildings or complexes The open or horizontal form of NORC refers to one- and two-family homes in age-integrated neighborhoods.
Families
A family consists of individuals who identify themselves as family members and have an interdependent relationship that provides emotional, financial, and/or physical support. There are numerous structures and forms families can choose to take. Home visits provide community health nurses with the opportunity to observe the home environment and to identify barriers and supports to health-risk reduction.
Social Gradient
A gradient in health that runs from top to bottom of the socioeconomic spectrum. This is a global phenomenon, seen in low-, middle-, and high-income countries. The social gradient in health means that health inequities affect everyone."
National Institute For Occupational Safety And Health (NIOSH)
A part of the centers for disease control and prevention, it focuses on identification of workplace hazards and research for prevention of work-related injury and illness. Provides education to safety and health professionals about workplace safety.
Gender fluid
A person who does not identify with a single fixed gender and expresses a fluid or unfixed gender identity.
Gay
A person who is emotionally, romantically, or sexually attracted to members of the same gender.
Genderqueer
A term for people who reject notions of static categories of gender and embrace a fluidity of gender identity and often, although not always, sexual orientation.
Queer
A term people often use to express fluid identities and orientations. Often used interchangeably with "LGBTQ."
Cisgender
A term used to describe someone whose gender identity aligns with the sex assigned to them at birth.
Lesbian
A woman who is emotionally, romantically, or sexually attracted to other women.
A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following information should the nurse determine when conducting a work site survey? A. Work practices of employees B. Past exposure to specific agents C. Past jobs of individual employees D. Length of time working in current role
ANS: A. Work practices of employees
A nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health department to provide? (Select all that apply) A. Managing the Women, Infants, and Children program B. Providing education to achieve community health goals C. Coordinating directives from state personnel D. Reporting communicable diseases to the CDC E. Licensing of registered nurses
ANS: B. Providing education to achieve community health goals C. Coordinating directives from state personnel
A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? A. Placing posters with images of appropriate hand hygiene near restrooms B. Routinely checking students for pediculosis throughout the school year C. Implementing age‑appropriate injury prevention programs for each grade level D. Working with a dietitian to determine carbohydrate counts for students who have diabetes mellitus
ANS: B. Routinely checking students for pediculosis throughout the school year
A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following situations as an example of community-based nursing (Select all that apply) A. A home health nurse performing wound care for a client who is immobile B. An occupational health nurse providing classes on body mechanics at a local industrial plant C. A school nurse teaching a student who has asthma about medications D. A parish nurse teaching a class on low-sodium cooking techniques E. A mental health nurse discussing stress management techniques with a support group
ANS: A. A home health nurse performing wound care for a client who is immobile C. A school nurse teaching a student who has asthma about medications
A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following factors are influenced by an individual's culture? (Select all that apply) A. Nutritional practices B. Family structure C. Health care interactions D. Biological variations E. Views about illness
ANS: A. Nutritional practices B. Family structure C. Health care interactions E. Views about illness
Public Health Science
ANS: is the scientific foundation of public health practice and brings together other sciences including environmental science, epidemiology, biostatistics, biomedical sciences, and the social and behavioral sciences
A nurse is using I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following questions should the nurse ask when assessing for "A" in the mnemonic? A. "What do you like to do for fun?" B. "What year was your residence built?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"
ANS: A. "What do you like to do for fun?"
A nurse is advocating for local leaders to place a newly-approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. Fidelity C. Respect for autonomy D. Veracity
ANS: A. Distributive justice
An occupational health nurse is consulting with senior management of a local industrial facility. When discussing work‑related illness and injury, the nurse should include which of the following factors as physical agents? (Select all that apply.) A. Noise B. Age C. Lighting D. Viruses E. Stress
ANS: A. Noise AND C. Lighting
A nurse is preparing a list of important topics to discuss with young adults who are seen at the clinic. Which of the following topics should the nurse plan to address with this aggregate? A. Preconception counseling B. Managing the common cold C. Detecting congenital abnormalities D. Accessing Medicare benefits
ANS: A. Preconception counseling
A public health nurse is planning interventions for children in the community. Which of the following topics should the nurse choose to target a major concern for school-aged children? A. Skin cancer detection B. Access to health care C. STI prevention D. Cholesterol screening
ANS: B. Access to health care
A nurse is caring for a client who is from a different culture than the nurse. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the client's perception of their current health status B. Gather data about the client's cultural beliefs C. Determine how the client's culture can affect the effectiveness of nursing actions D. Gather information about previous client interactions with the health care system
ANS: B. Gather data about the client's cultural beliefs
A public health nurse is planning an in-service on older adult health. Which of the following information should the nurse include? A. The percentage of older adults in the population is decreasing. B. The proportion of older adults who live alone is increasing. C. Older adults take on-half of all prescription medications. D. Older adults have a decreased recovery time following injury.
ANS: B. The proportion of older adults who live alone is increasing.
A nurse is completing an ecomap as part of a family assessment. Which of the following questions should the nurse plan to ask to gather appropriate data? A. "Do you have a family history of heart disease?" B. "What kind of foods does your family eat?" C. "Is your family involved in any community organizations?" D. "How does your family cultural beliefs influence your health values?"
ANS: C. "Is your family involved in any community organizations?"
A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning? A. Direct caregiver B. Consultant C. Case manager D. Counselor
ANS: C. Case manager
A public health nurse is reviewing the outcomes of an exercise program at various locations. Which of the following aspects of care does this finding evaluate? A. Timeliness B. Client-centered C. Equity D. Safety
ANS: C. Equity
A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? A. Performing a home safety check at the client's house B. Teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. Implementing a program to notify individuals exposed to a communicable disease
ANS: C. Providing influenza immunizations to employees at a local preschool
A nurse is talking to a client who asks for additional information about hospice. Which of the following statements should the nurse make? A. "Clients who require skilled nursing care at home qualify for hospice care." B. "One function of hospice is to provide teaching to clients about life‑sustaining measures." C. "Hospice assists clients to develop the skills needed to care for themselves independently." D. "A component of hospice care is to control the client's manifestations."
ANS: D. "A component of hospice care is to control the client's manifestations."
A home health nurse is planning care for a client following a stroke. The nurse plans to interview each member of the family to see how they might help the client progress toward recovery. The nurse is using which of the following approaches to family health? A. Family as a component of society B. Family as a system C. Family as a client D. Family as context
ANS: D. Family as context
A public health nurse is planning several initiatives for a city. Which of the following interventions should the nurse include as part of public health assurance? A. Meeting with city officials to propose changes to health laws B. Partnering with a laboratory company to provide free HIV screening for the public C. Reviewing data for incidence of influenza over a 25 year span D. Providing medical facilities with information accidental injury rates
ANS: Partnering with a laboratory company to provide free HIV screening for the public
During the past 100 years, as the lifespan of populations has increased, the prevalence of NCD (Chapter 9), also referred to as chronic diseases, increased, creating a growing burden of non-communicable chronic disease in the United States and across the world.
According to the WHO, in contrast to CDs, NCDs are defined as disease that are not passed from person to person, they have a long duration and usually a slow progression. There are four main categories of NCDs: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Tertiary prevention can reduce the burden of chronic diseases
Lesbian, Gay, Bisexual, Transgender, Queer
According to the WHO, persons who do not conform to established gender norms often face stigma, discriminatory practices, and/or social exclusion. This can adversely affect health through increased susceptibility to diseases as well as their mental and physical health. It can also result in decreased access to health services, all of which can result in poorer health outcomes.
Conveying Cultural Sensitivity
Address client's by their last names, unless the client gives the nurse permission to use other names Use culturally sensitive language Find out what the clients known about their health problems and treatments, and determine the client's intent to adhere to the prescribed treatment plan Do not make assumptions about the client Provide health teaching materials in the client's primary language and at the recommended readability level
Healthy People 2030 Framework and Health Disparities
Addressing health disparities in the U.S. continues to be a priority in HP 2030. There are seven foundation principles for HP 2030 that guide the development of HP 2030 topics and objectives including: "Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy."17 There are five overarching goals including: "Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all".
The third component consists of 17 public health interventions
Advocacy pleads someone's cause or act on someone's behalf, with a focus on developing the community, system, individual, or family's capacity to plead their own cause or act on their own behalf. Case finding locates individuals and families with identified risk factors and connects them with resources. Case management optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Coalition building promotes and develops alliances among organizations or constituencies for a common purpose. It builds linkages, solves problems, and/or enhances local leadership to address health concerns. Collaboration commits two or more people or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. (Henneman, Lee, & Cohen. [1995]. Collaboration: A concept analysis. Journal of Advanced Nursing, 21, 103-109.) Community organizing helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set. (Minkler, M. [Ed.]. [1997]. Community organizing and community building for health [p 30]. New Brunswick, NJ: Rutgers University Press.) Delegated functions are direct care tasks that a registered professional nurse carries out under the authority of a health-care practitioner as allowed by law. Delegated functions also include any direct care tasks that a professional registered nurse entrusts to other appropriate personnel to perform. Consultation seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, family, or an individual. The community, system, family, or individual selects and acts on the option best meeting the circumstances. Counseling establishes an interpersonal relationship with the community, a system, the family, or an individual intended to increase or enhance their capacity for self-care and coping. Counseling engages the community, a system, family, or an individual at an emotional level. 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. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. (Adapted from American Nurses Association [2010]. Nursing's social policy statement: The essence of the profession. [2010]. Silver Springs, MD; American Nurses Publishing.) 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. Policy development places health issues on decision makers' agendas, acquires a plan of resolution, and determines needed resources. Policy development results in laws, rules and regulations, ordinances, and policies. Policy enforcement compels others to comply with the laws, rules, regulations, ordinances, and policies created in conjunction with policy development. (Minnesota Department of Health, Division of Community Health Services, Public Health Section. [2001]. Public health interventions: Applications for public health nursing practice. Retrieved from http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf.). Referral and follow-up assist individuals, families, groups, organizations, and/or communities to identify and access necessary resources to prevent or resolve problems or concerns. Screening identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations. 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. 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 (Centers for Disease Control and Prevention. [2012]. CDC's vision for public health surveillance in the 21st century. Morbidity and Mortality Weekly Report, S61).
Cultural Brokering
Advocating, mediating, negotiating, and intervening between the client's culture and health care culture on behalf of the client.
Determinants of Aging and Health
Aging: the process of becoming chronologically and biologically older Important indicators of age are physical health, psychological well-being, socioeconomic factors, functional abilities, and social relations.
Recommended services for older adults:
Alcohol misuse screening and counseling Aspirin use Blood pressure screening Cervical cancer screening Depression screening Obesity screening and counseling Zoster vaccination
Disparities
Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent among populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, SES, and geographic location all contribute to an individual's ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups.
Secondary Homelessness
Includes those who are staying in a temporary form of housing because they have nowhere else to go—those living with friends or family, or in shelters.
Dementia and Alzheimer's Disease: Impact on the Older Adult Population
Alzheimer's disease and related dementias (ADRD) are the sixth leading cause of death for all adults in the U.S. and the fifth leading cause of death in people over the age of 64. It is the most common form of dementia. Other dementia diagnoses include vascular dementia, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia. Prevention Primary prevention of AD and other types of dementia is challenging because there is no clear evidence that specific interventions actually prevent AD or cognitive decline. Secondary prevention through memory screening programs has helped to identify those people in the early stages. Centers for Disease Control and Prevention's Healthy Brain Initiative The Healthy Brain Initiative: Specific actions are highlighted and addressed in four domains of public health: educate and empower the nation, develop policy and mobilize partnerships, assure a competent workforce, and monitor and evaluate.
Palliative Care
An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
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
Exposure To Hazards
An occupational health history provides the framework for a nurse to begin to assess a worker for possible exposure to health hazards. To goal to identify agents and host factors that place the work at risk, identify ways to eliminate or minimize exposure, and prevent potential health problems. Information elicited should include the following. Current and past jobs. Current and past exposure to specific agents and any relationship of current manifestations to work activities. Any precipitating factors (underlying illness, previous injuries, healthy or unhealthy habits.)
Transgender
An umbrella term for people whose gender identity and/or expression is different from cultural and social expectations based on the sex they were assigned at birth.
Poverty Guidelines
Are another federal measure. These guidelines simplify the poverty thresholds and are used for administrative purposes such as determining who is eligible for federal programs aimed at aiding those living in poverty.
Public Health Nurses
Are employed at federal, state and local levels. The overall purpose of public health is to impact the health of the populations through disease prevention, health promotion, and actions that protect population health.
Social Determinants of Health
Are factors within a community or defined location that affect individual health. Neighborhood and built environment Social and community context Economic stability Health and healthcare Education It is important to assess cultural beliefs and practices when developing a plan of care
Social Determinants Of Health
Are the social and environmental conditions in which people live and work. These social determinants include neighborhood and the built environment, economic stability, education, social and community context, and health and health care.
Health Education
As learning aimed at acquiring information and skills related to making health decisions. The WHO defines health education as any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes.
Primary Prevention
Assess the knowledge base regarding health issues. Teach health practices. Teach health promotion practices. Hand hygiene and tooth brushing Healthy food choices Injury prevention, including seat belt use and bike, fire and water safety Substance use prevention Immunizations Disease prevention Assess the immunization status of all children. Maintain current records of required immunizations.
Cultural Preservation
Assisting the client to maintain traditional values and practices
Cultural Repatterning
Assisting the client to modify cultural practices that are not beneficial to the client's health
Facilitating Safety Policies
Assisting with the development of policies and procedures for staff in the event of fire, disaster, or injury. This is particularly important for schools where the nurse is present full-time.
A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. "I don't drive, and my son is only available to take me places in the mornings." B."I can't take off during the day, and the local after-hours clinic is no longer on operation." C. "Only one doctor in my town is a designated provider by my health maintenance organization." D."I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."
B."I can't take off during the day, and the local after-hours clinic is no longer on operation."
Prevention of Communicable Diseases in Older Adults
Based on the epidemiology triangle, public health interventions for preventing communicable diseases in older adults, for the most part, focus on primary prevention through vaccination. This includes vaccination for prevention of pneumonia and shingles.
Private Funding
Based on using a case management approach with a specific group of providers in an attempt to contain the cost of care
Theories of Education: behaviorism, cognitivism, constructivism, and humanism
Behaviorism is the theory of classical conditioning The focus is only on the observed behavior change and not on the mental activity The cognitive framework focuses more strongly on inner mental activity Constructivism is a learning theory that reflects on our own experiences. We actively construct our own world as we increase our experience and knowledge It is a process that builds knowledge within our own unique framework Humanism learning uses feelings and relationships, encouraging the development of personal actions to fulfill one's potential and achieve self-actualization. It is self-directed learning, examining personal motivation and goals This is also a theory of adult learning
Agent Factors
Biological Agents: viruses, bacteria, fungi, blood-borne, airborne pathogens. Chemical Agents: Asbestos, smoke. Mechanical Agents: musculoskeletal or other straints from repetitive motions, poor workstation-worker fit, lifting heavy loads. Physical Agents: temperature extremes, vibrations, noise, radiation, lighting. Psychological agents: threats to psychological or social well-being resulting in work-related stress, burnout, violence.
Circle Model Of Spiritual Care
C: Caring I: Intuition R: Respect for religious beliefs and practices. C: Caution L: Listening E: Emotional Support
Community Education
Children Anticipatory guidance Breastfeeding Sleeping positions Nutrition Physical activity Substance use disorders Dental hygiene and health Skin protection Injury prevention including car, fire, water safety; helmet use; poison control; CPR training Adolescents Anticipatory guidance Substance use disorders Sexual behavior Nutrition, especially calcium intake for female clients Physical activity Skin protection Injury prevention including car, fire, and firearm safety
Health Concerns and Leading Causes of Death
Children Perinatal conditions and congenital anomalies Sudden infant death syndrome (SIDS) Motor vehicle and other unintentional injuries Adolescents Motor vehicle and other unintentional injuries Homicide Suicide Screening and Preventative Services Children Height and weight Vision and hearing Dental health At birth: hemoglobinopathy, phenylalanine level, T4, TSH Immunization status (check the centers for disease control and preventive (CDC) website for current administration schedules.) Lead exposure Cholesterol and triglyceride levels Adolescents Height and weight Vision and hearing Dental health Rubella serology and immunization history Substance use disorders, including tobacco Immunization status Mental health screenings Cholesterol and triglyceride levels
National Health Goals
Children Reductions in Dental caries Obesity Infant mortality Exposure to secondhand smoke Increases in Newborn blood spot screening and follow-up testing Access to a medical home Schools that require health education Childhood immunizations Use of child safety restraints Physical activity The number of infants who are breastfed Adolescents: Reductions in Violent crimes Use of alcohol Deaths related to motor vehicle crashes Increases in Schools with a breakfast program Participation in extracurricular activities Wellness checkups Physical activity
STEPS OF THE OMAHA SYSTEM
Collecting and assessing data. Stating the problem. Identifying an admission problem rating using a problem classification scheme. Planning and intervening. Rewriting problems during the span of care delivery and at discharge. Evaluating the end problem outcome.
Community Education
Community resources and programs Healthy meals and snacks, nutritional supplements Exercise Dental health Injury prevention Care and fire safety Fall prevention Abuse and mistreatment Medication safety
Milio's Framework for Prevention
Complements the health belief model Identifies relationship between health deficits and availability of health resources Theorizes that behavior changes within a large number of people can ultimately lead to social change
Health maintenance organizations (HMOs)
Comprehensive care is provided to members by a set of designated providers
Cultural Humility
Conversely, acknowledges that the understanding of the multitude of diverse cultures in the world today may be too big a task. An understanding that self-awareness about one's own culture is an ongoing process, and an acknowledgment that we must approach others as equals, with respect for their prevailing beliefs and cultural norms
Emerging issues for improving the health of older adults include efforts to
Coordinate care Help older adults manage their own care Establish quality measures Identify minimum levels of training for people who care for older adults Research and analyze appropriate training to equip providers with the tools they need to meet the needs of older adults
Tertiary Homelessness
Includes those who rent single rooms on a long-term basis without security of a fixed or permanent residence.
Cultural Competence
Cultural competence is a skill the nurse develops in learning to respect individual dignity and preferences, as well as acknowledging cultural differences.
Social Capital
Defined by Lin in 1999 in terms of resources available to individuals and communities based on membership in social networks 21, is another factor to consider when examining underlying factors contributing to disparity in health outcomes.
Social Justice
Defined by the Merriam-Webster dictionary as "a state or doctrine of egalitarianism."23 In other words, because health disparities represent a lack of equality in health outcomes among groups, it is important to adopt a doctrine of social justice related to health and to strive to promote equal opportunities to maximize the health of individuals and communities.
Health Inequity
Describes avoidable gaps in health outcomes. For example, persons with type 2 diabetes who cannot afford the cost of medication and therefore are unable to take it as ordered will experience higher A1C levels and experience more adverse outcomes.
Ageism
Describes bias toward older adults based on stereotypes. Ageism, like racism and sexism, is a way of judging or categorizing people and not allowing them to be individuals with unique ways of living their lives. It is a set of beliefs, attitudes, norms, and values used to justify age-based prejudice and discrimination.
The cross-linkage or connective tissue theory
Describes the chemical reactions that create strong bonds among molecular structures that are normally separate, particularly in collagen, elastin, and ground substance. Increased numbers of cross-links in collagen yield stiffness and loss of resilience.
Social Organization
Describes the significance of individual members of a family or the family as a whole. Social organization often affects how decisions are made within a family or group.
Questions To Ask Older Adults
Does the client have food in the house to eat? Is there help with household activities? Does the client live alone? Who is the client support system? Is the client able to set up and dispense their own Medication? Does the client have access to healthcare
Secondary Prevention
Early detection and treatment of disease with the goals of limiting severity and adverse effects Screenings Community assessments Genetic disorders/ metabolic deficiencies in newborns Control of outbreaks of communicable diseases Cancer, Hypertension, DM,Hypercholesterolemia,TB
Psychosocial Theories of Aging
Early theorists offered the observation that older adults tend to disengage from pursuits and roles that they enjoyed in earlier life and suggested that this process was a mutual withdrawal of the individual from society. This process of disengagement was accepted and actually desired by older adults, and that it was a natural and universal feature of a long life. Older adults who resisted withdrawal and remained active and engaged in life were observed to age more optimally. The more active they were, the greater satisfaction they expressed with the quality of their lives. Perhaps strongest of all is the theory that people are basically consistent throughout their lives, and their personalities remain constant through the passing years.
Nurses can evaluate quality by examining aspects of care
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, socioeconomic status Safety- avoiding injuries to clients from the care intended to help them Efficiency - avoiding waste in supplies, ideas, energy
Key Principles of Public Health Nursing
Emphasize primary prevention Work to achieve the greatest good for the largest number of people Recognize that the client is a partner in health Use resources wisely to promote the best outcomes
Three Core Functions
Encompassing the purpose of health public as defined by the Health and Medicine Division (HMD) in 1988 are
Family Health Risk Appraisal Environmental Risk
Enomaps are used to identify family interactions with other groups and organizations. Information about the family's support network and social risk is gathered.
Sustainable Development Goals (A little different from e-book)
Eradicating hunger and extreme poverty Making primary education available worldwide Promoting empowerment of women and gender equality Promoting a sustainable use of ecosystems, including forests and oceans Developing global partnerships and promoting equality Promoting individual well-being and healthy lives Ensuring sustainable water, energy, and sanitation Promoting economic growth, industrialization, and innovation Making safe human settlements and cities Combating the effects of climate change Promoting peaceful, just societies
Article 27
Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts, and to share in scientific advancement and its benefits. 2. Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary, or artistic production of which he is the author.
Article 25
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control. 2. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
Family as a context
Focuses on an individual first, and the family next Used to promote the health and recovery of an individual, using the family as a resource for service and support
Health Education
Inclusion of health concepts in course of study for children in pre-K through grade 12.
Article 26
Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit. 2. Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace. 3. Parents have a prior right to choose the kind of education that shall be given to their children.
Article 24
Everyone has the right to rest and leisure, including reasonable limitations of working hours and periodic holidays with pay.
Article 23
Everyone has the right to work, to free choice of employment, to just and favorable conditions of work, and to protection against unemployment. 2. Everyone, without any discrimination, has the right to equal pay for equal work. 3. Everyone who works has the right to just and favorable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection. 4. Everyone has the right to form and to join trade unions for the protection of his interests.
Article 22
Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international cooperation and in accordance with the organization and resources of each State, of the economic, social, and cultural rights indispensable for his dignity and the free development of his personality., as a member of society, has the right to social security and is entitled to realization, through national effort and international cooperation and in accordance with the organization and resources of each State, of the economic, social, and cultural rights indispensable for his dignity and the free development of his personality.
Family as a client
Examines the family unit functioning first, then individual needs next Used to see how the family health is impacted by each individual's reaction to a health event
Health Disparity
Exists when "a health outcome is seen to a greater or lesser extent between populations.
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 benefits coverage Covering preventative care services
Injury and Violence That Pose the Greatest Threat to Older Adults in the United States
Falls Older adult drivers Elder abuse and maltreatment Residential fire Sexual abuse Suicide
Crisis and Traditions
Family crisis occurs when a family is not able to cope with an event. The family's resources are inadequate for the demands of the situation. Traditions are times of risk for families Traditions include birth or adoption of a child, death of a family member, child moving out of the home, marriage of a child, major illness, divorce, and loss of the main family income. These traditions require family to change behaviors, make new decisions, reallocate family roles, learn new skills, and learn to use new resources.
Health Concerns and Leading Causes of Death
Females Reproductive health Childbearing Menopause Preconception counseling Malignant neoplasm (breast, cervix, ovaries) Males Unintentional injuries Erectile dysfunction Malignant neoplasm (prostate, testes)
Biomedical beliefs
Focus on identifying a cause for every effect on the body, that the body functions like a machine Basis for the way the majority of medical facilities in the US function and is based on identifying a biophysical cause and treatment for health problems
Environmental Prevention
Focuses on health protection by improving the safety of the environment such as fluoridating water, banning smoking in public places, enacting laws against drunk driving, enforcing clean air acts, and building green spaces for recreation.
Forensics
Forensic nurses care for perpetrators of injury as well as victims of sexual assault, substance use related injuries, human trafficking, physical abuse, gang violence, disaster, and accidental injuries.
The Reach Program
Funds tribes, universities, and community-based organizations to develop and implement health programs aimed at reducing health disparities.
Family Health Risk Appraisal Biological Health Risk Assessment
Genograms are used to gather basic information about the family, relationships within the family, and health and illness patterns. Genomics involves the study of genetic information and how it is influenced and expressed. Providers can use genomic information to identify specific individual risks and provide appropriate prevention. Repetitions of disease with a genetic component (cancer, heart disease, diabetes mellitus) can be identified.
United Nations Sustainable Development Goals (SDGs)
Goal 1. End poverty in all its forms everywhere. Goal 2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. Goal 3. Ensure healthy lives and promote well-being for all at all ages. Goal 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Goal 5. Achieve gender equality and empower all women and girls. Goal 6. Ensure availability and sustainable management of water and sanitation for all. Goal 7. Ensure access to affordable, reliable, sustainable, and modern energy for all. Goal 8. Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all. Goal 9. Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation. Goal 10. Reduce inequality within and among countries. Goal 11. Make cities and human settlements inclusive, safe, resilient, and sustainable. Goal 12. Ensure sustainable consumption and production patterns. Goal 13. Take urgent action to combat climate change and its impacts.* Goal 14. Conserve and sustainably use the oceans, seas, and marine resources for sustainable development. Goal 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and biodiversity loss. Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels. Goal 17. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development.
Healthy People Topics Relevant to Health Planning for Older Adults
Goal: Improve the health, function, and quality of life of older adults. Overview: Older adults are among the fastest growing age groups, and the first baby boomers turned 65 in 2011. More than 37 million people in this group will manage more than one chronic condition by 2030. Chronic conditions can lower quality of life in older adults and can be leading causes of death in this population. HP 2020 Midcourse Review: Of the 19 objectives for this topic area, 2 were developmental and 15 were measurable. For 3 of the measurable objectives, the target was met or exceeded, and 1 was improving. For 3, there was little or no detectable change, and 5 were getting worse. Three of the objectives had baseline data only.
Aggregate
Groups that have a common characteristic. Aggregates or target populations can be defined based on special interests or geographic locations.
Vulnerable Populations
Have been identified based on race, ethnicity, age, gender, sexual orientation, history of incarceration, socioeconomic status (SES), exposure to violence and war (Chapter 12), and lack of a permanent residence.
Healthy People 2030
Health and well-being of the population and communities are essential to a fully functioning, equitable society. Achieving the full potential for health and well-being for all provides valuable benefits to society, including lower health-care costs and more prosperous and engaged individuals and communities. Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy. Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. Promoting and achieving the nation's health and well-being is a shared responsibility distributed among all stakeholders at the national, state, and local levels, including the public, profit, and not-for-profit sectors. Working to attain the full potential for health and well-being of the population is a component of decision making and policy formulation across all sectors. Investing to maximize health and well-being for the nation is a critical and efficient use of resources.
Number of deaths for top 10 leading causes of death, 2017
Heart disease: 635,260 Cancer: 598,038 Accidents (unintentional injuries): 161,374 Chronic lower respiratory diseases: 154,596 Stroke (cerebrovascular diseases): 142,142 Alzheimer's disease: 116,103 Diabetes: 80,058 Influenza and pneumonia: 51,537 Nephritis, nephrotic syndrome, and nephrosis: 50,046 Intentional self-harm (suicide): 44,965
Screening and Preventative Services
Height and weight Dental health Blood pressure Cholesterol (ages 45 to 65 years) Fecal occult blood test/sigmoidoscopy (50 years and older) Immunization status Diabetes mellitus HIV Skin cancer Females Pap test Mammograms and clinical breast exam Rubella serology and vaccination history (childbearing years) Males Digital rectal examination Prostate-specific antigen testing
Client Education
Home Health nurses provide follow-up care after an acute Hospital stay they must educate the client and the family regarding complications or adverse reactions: These instructions can include when to contact the agency, emergency room, or provider. Information and resources for families and clients can provide support in dealing with illnesses. Providing education encourages clients to be independent and involved in their own care. It also allows families to be involved in the care and decision-making regarding their family members.
Hospice
Hospice Care focuses on enhancing the quality of life throughout the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. Clients can receive hospice care in a variety of settings, including the home, hospice centers, hospitals, and long-term care settings. Hospice Care is a comprehensive care delivery system for clients who are terminally ill. Further medical care aimed towards a cure is stopped. The focus becomes relief of pain and suffering, as well as enhancing quality of life. The hospice nurse provides care for the client and the client's entire family. Hospice Care includes skill, Direct Services, and indirect character coordination. Hospice Care uses an interprofessional approach. Controlling manifestations of medical problems and dying processes is a priority. The provider directs Hospice Care Services, which are then managed by the nurse. Volunteers are used for non-medical care. Post mortem bereavement services are offered for the family. Helping the family transition from an expectation of recovery to acceptance of death is an important aspect of providing hospice care. The hospice nurse can continue to work with the family for up to one year following the death of the client.
Assess Children For Evidence Of Mental Illness, suicide, and Violence
Identify children's risk.
Androgynous
Identifying and/or presenting as neither distinguishably masculine nor feminine. Bisexual: A person emotionally, romantically, or sexually attracted to more than one sex, gender, or gender identity although not necessarily simultaneously, in the same way, or to the same degree.
Secondary Prevention
Identifying workplace hazards, early detection through health surveillance and screening, of further limitations.
Benefit of Doubt
If there is evidence that the client is making a reasoned choice, the worker has a responsibility to see that the benefit of doubt is in his or her favor.
The first component is the population basis of all interventions
Illustrates that the focus of all interventions is population health
Immigrants, Migrants, Refugees, and Asylees
Immigrants: as defined by the Merriam-Webster dictionary is a person who comes to a country to take up permanent residence. Illegal alien: is a term sometimes used to describe those who enter a country without proper permission and with the intent of becoming permanent residents. Migrant worker: is used to describe those who move from place to place to get work and who often work in another country that is not their own. Migrant workers are at greater risk for experiencing modern slavery. Modern slavery includes the selling of people in public markets; women forced into marriage to provide labor; and forced work inside factories or fishing boats where salaries are withheld, or under threats of violence, that is, labor extracted through force, coercion, or threats. Migrant agricultural worker: is a person employed in agricultural work of a seasonal or other temporary nature who is required to be absent overnight from his or her permanent place of residence. Refugees: A refugee is someone who fled his or her home and country owing to "a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group, or political opinion", according to the United Nations 1951 Refugee Convention. Many refugees are in exile to escape the effects of natural or human-made disasters. Asylum seekers: say they are refugees and have fled their homes as refugees do, but their claim to refugee status is not yet definitively evaluated in the country to which they fled.
An aging America
In 2015, the U.S. Census Bureau estimated that 14.9% (47.8 million) of the U.S. population was 65years old or older. By 2050, the estimated number of persons aged 65 or older will be 83.3 million, and 60% of these Americans will be over the age 74. On average, those who are presently 65 years of age will now live another 18 years, and those aged 85 years will live into their early 90s. This phenomenon is referred to as population aging, which is a shift in the distribution of a country's population toward older ages. This puts a strain on pension funds and the demand for health-care services. What accounts for the population aging in the United States? Improvement in the environment Less threatening diseases due to antibiotics and other medications Improvements in sanitation, diagnostic advantages, the application of technology, and improved prenatal and obstetrical care Baby boomers: those members of the U.S. population born between 1945 and 1964
Susceptibility
In assessing risk for work-related illness and injury, the nurse should keep in mind the following factors affecting susceptibility to illness and injury.
Barriers to healthcare
Inadequate health care insurance Inability to pay for health care services Language barriers Cultural barriers Lack of health care providers in the community Geographic isolation Social isolation Lack of communication tools (telephones) 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
Determinants Of Health
Include a range of personal, social, economic, and environmental factors.
Primary Homelessness
Includes everyone who is living without adequate shelter—those living in vehicles, surviving on the streets, staying in parks, or squatting in abandoned buildings.
Incarcerated Population
Includes persons living under the jurisdiction of state or federal prisons, and in the custody of local jails.
Correctional Population
Includes the incarcerated population as well as persons living in the community while supervised on probation or parole.
Risk Factors for Perpetration
Individual Level Current diagnosis of mental illness Current abuse of alcohol High levels of hostility Poor or inadequate preparation or training for caregiving responsibilities Assumption of caregiving responsibilities at an early age Inadequate coping skills Exposure to maltreatment as a child Relationship Level High financial and emotional dependence upon a vulnerable elder Past experience of disruptive behavior Lack of social support Lack of formal support Community Level Formal services, such as respite care for those providing care to elders, are limited, inaccessible, or unavailable Societal Level A culture where: There is high tolerance and acceptance of aggressive behavior Health-care personnel, guardians, and other agents are given greater freedom in routine care provision and decision making Family members are expected to care for elders without seeking help from others Persons are encouraged to endure suffering or remain silent regarding their pains There are negative beliefs about aging and elders.
The second component consists of the three levels of care: individual/family, community, and systems.
Individual level practice focuses on knowledge, attitudes, practices, beliefs, and behaviors of individuals. Community-level practice is focused on changing norms, attitudes, practices, awareness, and behaviors. Systems-level practice is concerned with policies, laws, organization, and power structures within communities.
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.
Behavioral Risk
Information is gathered about the family's health behavior, including health values, health habits, and health risk perceptions.
Internally Displaced Persons
Internally Displaced Persons (IDPs) are people who have not crossed an international border but have moved to a different region than the one they call home within their own country.
Organizations
International health organizations World Health Organization (WHO) Federal health agencies Veterans Health Administration US Department of Health & Human Services Funded through federal taxes Administration for Children and Families (ACF) Administration for Community Living (ACL) Centers for Medicare and Medicaid Services (CMS) Agency for Healthcare Research and Quality (AHRQ) Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry (ATSDR) Food and Drug Administration (FDA) Health Resources and Service Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) Substance Abuse and Mental Health Services Administration (SAMHSA)
Primary prevention
Interventions are conducted to prevent development of disease or injury in those who are currently healthy. Vaccinations Banning smoking
Indicated Prevention
Interventions are provided to populations with a high probability of developing disease. Weight-loss program for adolescents who are obese and are showing signs of hyperglycemia but who have not been diagnosed with type 2 diabetes. The difference is that the individuals included in the intervention have already been identified as being at greater risk for the disease whereas in secondary prevention the effort is to identify those with the disease among an apparently healthy population.
Marginalization
Is a social process through which a person or group is on the periphery of society based on identity, associations, experiences, or environment. To marginalize someone is to treat the person as though she is of little or no consequence or is unimportant.
Behavioral Prevention
Often focused on health promotion strategies, is aimed at changing individual behavior such as exercise promotion, smoking cessation, or responsible drinking.
What are older adults at risk for?
Older Adults Are At Particular Risk For Falls!
Aging and the Workforce
Older adults are staying in the workforce for a number of reasons: The economic recession of 2008 to 2010 reduced the savings of older adults Desire to feel productive A need for social interaction The wish for something to do
Characteristics of Healthy Families
Members communicate well and listen to each other There is affirmation and support for all members Members teach respect for others There is a sense of trust Members play and share humor together Members interact with one another Members participate in leisure activities together Members share a religious foundation Privacy of individuals is respected There is a shared sense of responsibility There are traditions and rituals Members seek help for their problems
Missionary Nurse
Missionary nursing seeks to promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe. These nurses can be career missionaries, or can serve as short-term, volunteer or part-time missionaries. Cultural and language barriers often affect the provision of care. Collaboration within the community is essential in meeting goals.
Nurses Working In Public Health Support The 10 Essential Public Health Services
Monitoring community health and solving problems. Diagnosing and investing health risks Providing education and empowerment regarding health issues Facilitating community partnerships Developing community health plans and policies Enforcing health regulations Promoting access to health care and services Assuring a competent healthcare workforce Evaluating personal and population-based health services Researching solutions for health problems Specific tasks the nurse might be engaged include the following Intervening to protecting the natural environment Identifying problems for populations at risk Collecting vital statistics and analyzing the impact Providing specific health services to populations in alignment with laws and goals Managing communicable disease through prevention, screening and treatment Scheduling wellness, screening, and immunization clinics Supervising and ensuring the competency of staff Legislating for policy implementation and revision Partnering with community health agencies Gathering statistics through surveillance, investigations and monitoring vital statistics Fostering emergency preparedness
Family as a component of society
Monitors how families interact with other institutions in a community (schools, medical facilities, congregations) Used to study and implement population-focused interventions (such as immunization campaigns for a disadvantaged population)
OMAHA SYSTEM MODEL
Nurses caring for individuals, families, and communities under home health and hospice care often used the omaha system model to implement the Nursing process. The framework is also used in many electronic health-record systems
Community Health
Nurses provide health care services to Clients where they reside. This includes traditional homes, assisted living facilities, and nursing homes.
Responsibilities
Occupational health nurses' roles and responsibilities include the following
Physical abuse
Occurs when an elder is injured (e.g., scratched, bitten, slapped, pushed, hit, burned, etc.), assaulted, or threatened with a weapon (e.g., knife, gun, or other object), or inappropriately restrained.
Discrimination
Occurs when one group gives unjust or prejudicial treatment to another group based on his or her race, ethnicity, gender, SES, or other group membership.
Parish Nurse
Parish nurses promote the health and wellness of populations of faith communities. The population often includes church members and individuals and groups in the geographical community. Parish nurses work closely with pastoral care staff, professional health care members, and lay volunteers to provide a holistic approach to healing (body, mind and spirit).
Tertiary Prevention: Assess Children Who Have Disabilities
Participate in developing the individual education plan (IEP) for children who have disabilities. Work with a child/family to develop and achieve long-term outcomes. Assess children who have long-term health needs at school. Provide care for children who have chronic disorders, including asthma, diabetes mellitus and cystic fibrosis.
Medication Interactions
Pharmacokinetic interaction, wherein alcohol interferes with the body's ability to metabolize the medications Pharmacodynamic interaction, wherein alcohol enhances the effects of the medication.
Community Health Nurses
Practice in diverse settings. They practice as home health nurses, hospice nurses, occupational health nurses, faith community nurses, school nurses, and forensic nurses.
6 distinct stages
Precontemplation - individual is unaware of the need to change Contemplation - individual considers change, and weighs the benefits with costs Preparation - individual plans to take action Action Maintenance - individual implements actions to continue the behavior Termination - conscious efforts to continue the leaht behavior are no longer needed (individual is consistent) **Most clients do not reach this stage**
Preferred provider organization (PPOs)
Predetermined rates are set for services delivered to members; financial incentives are in place to promote use of PPO providers
Health Belief Model
Predict or explain health behaviors Assumes that preventive health actions are taken primarily for the purpose of avoiding disease Emphasizes change at the individual level Describes likelihood of taking an action to avoid disease based on: Perceived susceptibility, seriousness, and threat of disease Modifying factors (demographics, knowledge level) Cutes to action (media campaigns, disease effect on family/friends, recommendations from health care professionals) Perceived benefits minus perceived barriers to taking action
Health Promotion For Staff
Promoting activities that encourage health promotion and disease prevention behaviors among the school's faculty and staff.
Facilitation Of Family/Community Involvement
Promoting collaboration between the school, parents/caregivers, community resources.
Physical Education
Promoting physical activity in school.
WHO Components of Palliative Care
Provides relief from pain and other distressing symptoms Affirms life and regards dying as a normal process Intends neither to hasten or postpone death Integrates the psychological and spiritual aspects of patient care Offers a support system to help patients live as actively as possible until death Offers a support system to help the family cope during the patient's illness and in their own bereavement Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated Will enhance quality of life and may also positively influence the course of illness Is applicable early in the course of illness in conjunction with other therapies intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications A key issue in end-of-life decisions is the cultural perspective of the patient and family making the decision.
Natural History Of Disease
Provides the foundation for the public health frameworks currently in use, especially the most widely used framework of primary, secondary, and tertiary prevention. Depicts the continuum of disease from the disease-free state to resolution
Nutrition Services
Providing access to meals that accommodate the health and nutrition needs of all children.
Health Services
Providing health services in school by qualified professionals (nurse, physicians, dentist, allied health professionals).
Counseling, Psychological, And Social Services
Providing services that improve the mental, emotional, and social health of students, as well as the overall school.
Healthy People 2020 Public Health Infrastructure
Public health infrastructure is fundamental to the provision and execution of public health services at all levels. A strong infrastructure provides the capacity to prepare for and respond to both acute (emergency) and chronic (ongoing) threats to the nation's health. Infrastructure is the foundation for planning, delivering, and evaluating public health. Public health infrastructure includes three key components that enable a public health organization at the federal, tribal, state, or local level to deliver public health services. These components are: A capable and qualified workforce Up-to-date data and information systems Public health agencies capable of assessing and responding to public health needs These components are necessary to fulfill the previously discussed 10 Essential Public Health Services
Health Protection
Puts the emphasis on increasing the person's ability to protect against disease. Ex. vaccination outreach program (health protection, risk reduction program) First intervention promotes healthy behavior and the second increases the ability of the immune system to protect against a communicable agent, thus reducing risk.
Promotion Of A Healthy And Safe School Environment
Reducing illicit drug and tobacco use and violence in schools.
Tertiary Prevention
Reducing the limitations of disability and promoting rehabilitation following health alterations Maximize recovery (rehab) Case Management Support Groups Exercise Physical/Occupational Therapy Nutrition Counseling
National Health Goals
Reduction in The proportion of older adults who have moderate to severe functional limitations Hospitalizations due to heart failure Inappropriate medication use by older adults who have a disability Hospitalizations due to pressure injuries Emergency department visits due to falls Increases in Use of clinical prevention services Use of the "Welcome to Medicare" benefit Information to the public regarding elder abuse, neglect, exploitation Physical activity among those who have reduced physical or cognitive function Access to diabetes self-management benefits Health care professionals who have geriatric certifications
National health care goals
Reductions Toxic air emissions Waterborne disease outbreaks Per capita domestic water use Blood lead levels in children Pesticide exposures requiring visits to a health care facility Indoor allergen levels US homes with lead-based paint or related hazards Exposure to chemicals and pollutants Risks posed by hazardous sites Number of new schools near highways Global burden of disease due to environmental concerns Increases Use of alternative modes of transportation for work Number of days that beaches are open and safe for swimming Recycling a municipal solid waste Testing for presence of lead based paint 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 and safety Presence/ use of information systems related to environmental health Global health initiatives can be used to improve health status worldwide, and to promote equity in treatment Health for All in the 21st Century (HFA21) outlines goals to promote productivity through adequate healthcare services around the globe
National Health Goals
Reductions in Barriers to access Allergens within the hom Families that are unable to have a child or maintain a pregnancy Passive smoke exposure Household hunger Intimate partner violence Increase in Positive parenting Health education provided by an agency (Head Start, school system, college, places of employment, health departments) Home testing for radon Health Insurance coverage Individuals who have a usual primary care provider
Perform Screening For Early Detection Of Disease And Initiate
Referrals As Appropriate. Vision and Hearing Height and Weight Oral Health Scoliosis Infestions (lice) General Physical Examination
Community
Refers to a group of individuals living within the same geographical area, such as a town or a neighborhood, or a group of individuals who share some other common denominator, such as ethnicity or religious orientation. In contrast to aggregates and population, individuals within the community recognize their membership in the community based on social interaction and establishment of ties to other members in the community, and often join collective decision making.
Population
Refers to a larger group whose members may or may not interact with one another but who share at least one characteristic such as age, gender, ethnicity, residence, or a shared health issue such as HIV/AIDS or breast cancer. The common denominator or shared characteristic may or may not be a shared geography or other link recognized by the individuals within that population. For example, people with type 2 diabetes admitted to a hospital form a population but do not share a specific culture or place of residence and may not recognize themselves as part of this population. In many situations, the terms aggregate and population are used interchangeably
Prevention
Refers to stopping something from happening.
Structural Discrimination
Refers to the policies of dominant race/ethnic/gender institutions and the behavior of the individuals who implement these policies and control these institutions, which are race/ethnic/gender neutral in intent but which have a differential and/or harmful effect on minority race/ethnic/gender groups.
Health Prevention
Refers to the prevention not only of disease and injury but also to the slowing of the progression of the disease. It also refers to the prevention of the sequel of diseases and injury, such as the prevention of blindness related to type 1 diabetes. Health prevention is accomplished through the institution of public health policies, health programs, and practices with the goal of improving the health of populations, thus reducing the risk for disease, injury, and subsequent disability and/or premature death.
Diversity
Reflects the fact that groups and individuals are not all the same but differ in relation to culture, ethnicity, and race.
Health Gradient
Reflects the relationship between health and income at the population level with health gradually improving as income improves.
Naturalistic beliefs
Relate the individual as a part of nature or creation. An imbalance in nature is believed to cause disease. Eastern or Chinese medicine Mexican culture: hot-cold theory of balance
Protective Factors for Elder Maltreatment
Relationship Level Having numerous, strong relationships with people of varying social status Community Level Coordination of resources and services among community agencies and organizations that serve the older population and their caregivers Higher levels of community cohesion and a strong sense of community or community identity Higher levels of community functionality and greater collective efficacy
Nightingale's Environmental Theory
Relationship between an individual's environment and health Depicts health as a continuum Emphasizes preventive care
Downstream Approach
Represents actions taken after disease or injury has occurred. Micro approach with a focus on illness care Ex. Obesity: With a downstream approach, a health-care provider may focus primarily on nutritional health teaching based on nutritional patterns, portions, and choices without taking into consideration the environmental factors influencing choices within a community. If there are no supermarkets within a community, it is difficult to make healthy choices.
Application of Ethical Principles to Community Health Nursing
Respect for autonomy - individuals selce those actions that fulfill their goals Nonmaleficence - no harm is done when applying standards of care Beneficence - maximize possible benefits and minimize possible harms Distributive justice - fair distribution of the benefits and burden in society is based on the needs and contributions of its members
Tertiary Prevention
Restoration of health through rehabilitation strategies and limited-duty programs.
Returnees
Returnees are former refugees who return to their own countries or regions of origin after time in exile. Returnees need continuous support and reintegration assistance to ensure that they can rebuild their lives at home.
School Nurse
School nursing encompasses many roles. Case Manager: Coordinates comprehensive services for children who have complex health needs. Community Outreach: Strives to meet the needs of all school-age children by cooperative planning and collaboration between the education system and other community agencies. Consultant: Assists students, families, and personnel in information gathering and decision-making about a variety of health needs and resources. Counselor: Supports students on a wide variety of health needs. Can provide grief counseling. Direct Caregiver: Provides nursing care to ill or injured children at school Health Educator: Helps prepare children, families, school personnel, and the community to make well-informed health decisions. Researcher: Contributes to the base of knowledge for school health and education needs.
Interventions and Services for Persons Experiencing Homelessness
Shelter: Housing is the biggest need of the homeless. Simply providing housing can improve the health of the homeless and reduce the number of hospital visits and hospital admissions. Food: When families and individuals live in poverty, they frequently have to make impossible choices between paying the rent, buying food, or buying essential medications. Health Care: Steps are being taken to help address some of the barriers the homeless face in trying to attain health care, especially access to health care. Policy: The housing-first model promotes providing immediate housing with supportive services and is gaining traction nationally.
Precaution Adoption Process Model
Similar to TTM/SOC model Stage of being unengaged regarding an issue between the stages of being unaware and contemplating action Does not include termination stage
Pender's Health Promotion Model
Similar to the 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, self efficacy Feelings, benefits, and characteristics associated with the action Attitude of others, and competing demands and preferences
Skilled Services Of A HomeHealth Nurse:
Skilled assessment Wound care Laboratory drawers Medication education and administration Parenteral nutrition IV fluids and medication Central line care Urinary catheter insertion and maintenance Coordination, delegation, and supervision of various other participants and Health Services.
Vulnerability At The Population Level
Social determinants of health, including economic determinants, environmental determinants, social capital, and health system determinants, are associated with the degree of vulnerability experienced by different populations. Thus, individual risk factors combine with community and population factors to influence the vulnerability of at-risk groups. These at-risk groups who experience vulnerability due to challenges related to the social determinants of health include those: Experiencing Homelessness Migrants Immigrants Asylees Those With A History Of Incarceration Members Of Lesbian, Gay, Bisexual, Transgender, Queer (Lgbtq+) Community. Developmental Stages Also Contribute To Vulnerability For Older Adults And Children
Geriatrics
Specialized medical care of older adults
Public health nursing scope and practice 6 standards of practice:
Standard 1. ASSESSMENT - The PHN collects comprehensive data pertinent to the health status of populations. Standard 2. DIAGNOSIS - The PHN analyzes the assessment data to determine the diagnoses or issues. Standard 3. OUTCOMES IDENTIFICATION - The PHN identifies expected outcomes for a plan specific to the population or situation. Standard 4. PLANNING - The PHN develops a plan that prescribes strategies and alternatives to attain expected outcomes. Standard 5. IMPLEMENTATION - The PHN implements the identified plan. Standard 5A. COORDINATION OF CARE - The PHN coordinates care delivery. Standard 5B. HEALTH TEACHING AND HEALTH PROMOTION - The PHN employs multiple strategies to promote health and a safe environment. Standard 5C. CONSULTATION - The PHN provides consultation to influence the identified plan, enhance the abilities of others, and effect change. Standard 5D. PRESCRIPTIVE AUTHORITY - The advanced practice registered nurse practicing in the public health setting uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations. Standard 5E. REGULATORY ACTIVITIES - The PHN participates in applications of public health laws, regulations, and policies. Standard 6. EVALUATION - The PHN evaluates progress toward attainment of outcomes.
11 standards of professional performance
Standard 7. ETHICS - The PHN practices ethically. Standard 8. EDUCATION - The PHN attains knowledge and competence that reflect current nursing practice. Standard 9. EVIDENCE-BASED PRACTICE AND RESEARCH - The PHN integrates evidence and research findings into practice. Standard 10. QUALITY OF PRACTICE - The PHN contributes to quality nursing practice. Standard 11. COMMUNICATION - The PHN communicates effectively in a variety of formats in all areas of practice. Standard 12. LEADERSHIP - The PHN demonstrates leadership in the professional practice setting and the profession. Standard 13. COLLABORATION - The PHN collaborates with the population, and others in the conduct of nursing practice. Standard 14. PROFESSIONAL PRACTICE EVALUATION - The PHN evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. Standard 15. RESOURCE UTILIZATION - The PHN utilizes appropriate resources to plan and provide nursing and public health services that are safe, effective, and financially responsible. Standard 16. ENVIRONMENTAL HEALTH - The PHN practices in an environmentally safe, fair, and just manner. Standard 17. ADVOCACY - The PHN advocates for the protection of the health, safety, and rights of the population.
State Health Agencies
State departments of health: obtain funding from state legislature and federal public health agencies. Women, Infants, and Children (WIC) Children's Health Insurance Program (CHIP) State boards of nursing Local health department Receives funds from the state level to implement community level programs Funded through local taxes with support from federal and state funds
Stateless Persons
Stateless persons do not have a recognized nationality and do not belong to any country. Statelessness situations are usually caused by discrimination against certain groups. Their lack of identification—a citizenship certificate—can exclude them from access to important government services, including health care, education, or employment.
Clinical prevention
Strategies are those that use a one-to-one delivery method between the healthcare provider and the patient, and usually occur in traditional health-care settings. These can include health protection activities such as vaccinations, as well as screening, and early detection of disease.
Family as a system
Studies how interactions among family members affect the whole family function Used to promote family health by directing interventions toward the way family members interact with each other
Cultural Accommodation
Supporting and facilitating the client's use of cultural practices that are beneficial to the client's health
Universal Declaration of Human Rights
The Universal Declaration of Human Rights, adopted by the General Assembly of the United Nations in 1948, continues to provide the underlying framework for equity in health at the WHO and down through national- and state-level approaches to improving health equity. The Declaration consists of 30 articles that serve as a standard of achievement for all nations to measure compliance with human rights and fundamental freedoms.
Knowles identified six suppositions for adult learning
The adult needs to know why he or she is learning something. The adult's own experiences are an important part of the learning process. Adults need to participate in the planning and evaluation of their learning. Adults learn better if the information has immediate relevance. Adults like problem-centered approaches to learning. Adults respond better to internal rather than to external motivation.
National Advisory Committee On Occupational Safety And Health (NACOSH)
The advisory committee is made up of 12 members representing labor, occupational health, safety professions, and the general public. The committee's purpose is to advise the secretaries of labor and health and human services on policies and programs that affect occupational safety and health.
Aging in Place
The aging-in-place approach includes implementation of community-based programs that include health promotion, prevention of disease, improvement of functioning, and enhancement of quality of life in older adults while maintaining them in their homes. Barriers to aging in place include funding for home modifications, availability of needed services, and consumer awareness.
Substance Use in Older Adults
The baby boomer cohort has a higher rate of substance use compared with other cohorts.
Biological Theories of Aging
The biological theories of aging regard the body as a collection of cells and materials subject to mechanical or architectural failure as they grow. Biological breakdown with aging may result from genes, such as when harmful genes "turn on" and become active in later life. Aging occurs as a result of the accumulation of errors in protein synthesis over time, leading to impared cell function Aging is related to mutations that occur when cells are exposed to environmental factors, such as radiation or chemicals; this exposure causes the DNA to be damaged and altered.
Freedom Over Safety
The client has a right to choose to live at risk of harm, providing she or he is capable of making that choice, harms no one else, and does not commit a crime.
Self-Determination
The client has a right to personal choices and decisions until a time that she or he delegates, or the court grants, the responsibility to someone else.
Confidentiality
The client has a right to privacy and secrecy.
Participation in Decision Making
The client has a right to receive information to make informed decisions and to participate in all decision making affecting his or her circumstances to the extent able.
Least Restrictive Alternative
The client has a right to service alternatives that maximize choice and minimize lifestyle disruption.
8 principles of public health:
The client or unit of care is the population. The primary obligation is to achieve the greatest good for the greatest number of people or population as a whole. The processes used by PHNs include working with the client as an equal partner. PRIMARY prevention is the priority in selecting appropriate activities. Public health nursing focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive. A PHN is obligated to actively identify and reach out to all who might benefit from a specific activity or service. Use of available resources must be optimal to assure the best overall improvement in the health of the population. Collaboration with a variety of other professions, populations, organizations, and other stakeholder groups is the most effective way to promote and protect the health of the people (pg.15)
Who is old?
The commonly accepted definition of older adult is a person aged 65 or older. The age 65 was chosen because, in high income countries, most persons are eligible for retirement benefits at this age. Chronological age may not accurately reflect a similar biological age of persons living in a low-income country compared with someone the same age living in a high-income country. People who live in low-income countries age faster because of inadequate nutrition, exposure to communicable diseases, and poorer living conditions. The aging process is a product not only of chronological age but also of biological age. The quality and length of life depends on factors that improve the biological response to growth and development experienced across the life span. These factors include not only individual health habits embraced in youth and followed across the life span, but also the environment in which an individual lives.
Faith Community
The faith community nurse works with individuals, families, and faith communities who share common faith traditions. Most religions have practices that are important to health and healing, and many follow specific practices when caring for an ill or dying member.
Criteria for screening programs:
The first criterion is to be certain that the screening test has high specificity and sensitivity. The next important criterion is that the test needs to be simple to administer, inexpensive, safe, rapid, and acceptable to patients. The next criterion is that the disease be sufficiently serious to warrant screening. The next criterion addresses the issue of whether the treatment for disease is easier and more effective when the disease is detected early. Another criterion for implementing a screening program is to determine whether the prevalence of a disease is high in the population to be screened. The final and ethically the most important criterion is that resources are available for referral for diagnostic evaluation and possible treatment.
Steps of culture data collection
The first step of the culture assessment is collection of self-identifying data about the client's ethnic background, religious preference, family structure, food patterns, and health practices. Next, the nurse should pose questions that address the client's perceptions of their health needs. The final step of the data collection process is identification of how cultural factors can affect the effectiveness of nursing interventions.
Adults
The genetic makeup of each sex can increase the risk for certain diseases. The environment is an influence, with societal and cultural expectations for gender influencing the risk of disease, and whether interventions for prevention and treatment of disease are valued. Most of the major health concerns for adults are related to chronic conditions, rather than infectious diseases.
LIVING ENVIRONMENT
The home health nurse must evaluate the living environment for safety, paying close attention to a non-secure rugs, electrical outlets, and extension cords; the use of oxygen; low-lighting; the need for safety devices in the bathroom; and other potential environmental hazards.
There are three emerging issues for the baby boomer generation and older adults related to communicable diseases.
The increase in human immunodeficiency virus (HIV) infection Sexually transmitted infections (STIs) The increased prevalence of chronic hepatitis C (HCV) in those over 50.
Asexual
The lack of a sexual attraction or desire for other people.
Rectangularization of aging
The population trend toward increased numbers of healthy years before decline, or more exactly, a reduction in variability of the age of death.
Life expectancy
The probable number of years a person will live based on the birth and mortality statistics of the population. The fact that we are living longer has had a direct impact on public health, allocation of health resources, and demand for nursing services.
Health Promotion
The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions. Ex. institution of an exercise program in an elementary school Health promotion often focuses on interventions aimed at helping patients increase healthy behaviors, such as a healthy diet and exercise, and reduce unhealthy behaviors, such as tobacco use or at-risk alcohol use.
Noncommunicable Diseases
The risk for developing an NCD increases over the life span because of genetics, the physiology of aging, health behaviors, and the environment. In addition to vaccination, primary prevention models focus on reduction of behavioral risk factors associated with obesity and hypertension. These include improving nutrition, increasing physical activity, and social support.
Assess Children To Detect Child Abuse Or Neglect
The school nurse is required by state law to officially report all suspected cases of child abuse/neglect.
Maintenance of the Family
The worker has a responsibility to deal with the maltreatment as a family problem, if the perpetrator is a family member, and to try to find the necessary family services to resolve the problem.
Primacy of the Adult
The worker has a responsibility to serve the client, not the community's, family members', or landlord's concerns.
Do No Harm
The worker has a responsibility to take no action that places the client at greater risk of harm.
Avoidance of Blame
The worker has a responsibility to understand the origins of any maltreatment and to commit no action that would antagonize the perpetrator and so reduce the chances of terminating the maltreatment.
Transtheoretical (TTM) of Stages of Chance (SOC) Model
Theorizes that changes occurs over time, in 6 distinct stages
Communicable Disease
There are three main reasons for increased vulnerability to communicable diseases in the older adult: Decreased immunity Existence of comorbid illness Undernutrition
Five Talking Points on Health Literacy:
These brief talking points may be helpful if you need to tell someone quickly what health literacy is and why it is important. Add in talking points relevant to your organization. Nine out of 10 adults struggle to understand and use health information when it is unfamiliar, complex, or jargon-filled. Limited health literacy costs the health-care system money and results in higher than necessary morbidity and mortality. Health literacy can be improved if we practice clear communication strategies and techniques. Clear communication means using familiar concepts, words, numbers, and images presented in ways that make sense to the people who need the information. Testing information with the audience before it is released and asking for feedback are the best ways to know if we are communicating clearly. We need to test and ask for feedback every time information is released to the general public.
Centenarians
Those over the age of 100
Super centenarians
Those who live to be 110
Environmental risks
Toxins: lead, pesticides, mercury, solvents, asbestos, and radon Air pollution: carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke Water pollution: wastes, erosion after mining or timbering, and run-off from chemicals added to the soil Contamination: food and food products with bacteria, pesticides, radiation, and medication (growth hormones or antibiotics)
Medical savings account
Untaxed money is put in an account for use for medical expenses
Late onset at-risk substance
Use is defined as at-risk substance use that began later in life, often triggered by a sentinel event such as loss of a spouse or partner.
Eight indicators that provide a baseline of data through which to monitor progress in ensuring that recommended services reach this key population:
Vaccinations that protect against influenza Vaccinations that protect against pneumococcal disease Screening for early detection of breast cancer Screening for colorectal cancer Screening for diabetes Screening for lipid disorders Screening for osteoporosis Counseling service for smoking cessation
Health beliefs and practices
Whatever an individual believes is the cause of impaired health will affect actions the individual will take to treat or prevent disease
Poverty
When household income falls below the economic threshold considered to be adequate to support the number of persons in the household, the members of that household are considered to be living in poverty.
Interpreter
When it is difficult for a the nurse or client to understand the other's language. Family member use for interpretation is not advised The interpreter should not be from the same community
Self-Neglect
Which is defined as "inability, due to physical or mental impairment or diminished capacity, to perform essential self-care," accounts for a majority of elderly maltreatment cases reported to Adult Protective Services (APS).
Universal Health Literacy Precautions:
Which translates into providing patients with information both oral and written that is understandable and easily accessible to persons across all education levels. Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized. Making the office environment and healthcare system easier to navigate. Supporting patients' efforts to improve their health.
Host Factors
Worker characteristics (job inexperience, age, pregnancy)
Social Determinants Of Health
according to the WHO "... are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries."
Old-old
ages between 85 and 95
Family caregivers
are defined as "an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation."
Falls
are the most common form of unintentional injury and one of the leading causes of injury and death in the older population.
Formal caregivers
are volunteers or paid caregivers associated with a service system.
Primary Prevention
prevention of the initial occurrence of disease or injury Education Immunizations Prenatal classes Family planning/sex education Communicable disease prevention
Time Orientation
describes whether an individual focuses more on the past, present, or future
I PREPARE
determines current and past environmental exposures Investigate: potential exposures Present work: exposures, use of personal protective equipment, location of safety data sheets (SDSs), hazardous materials brought home from work on clothing, trends Residence: age of home, heating, recent remodeling, chemical storage, water Environmental concerns: air, water, soil, industries in the neighborhood, waste site or landfill nearby Past work: exposures, farm work, military, volunteer, seasonal, length of work Activites: hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines Referrals and resources: Environmental Protection Agency, Agency for Toxic Substances & Disease Registry, Association of Occupational and Environmental Clinics, SDS, OSHA, local health department, environmental agency, poison control Educate: risk reduction, prevention, follow-up
Microeconomic theory
examines individual preference and finances, and how those actions affect cost of care and resource distribution
Upstream Approach
focuses on eliminating the factors that increase risk to a population's health. Macro approach to addressing health Ex. Obesity: An upstream approach to obesity might include interventions focused on agriculture subsidies, transportation policies, and urban zoning. It might also involve interventions restricting television advertising of food to children, creating national nutrition standards for meals served in childcare settings, or working with the private sector to introduce healthier options in restaurants and local markets
Assessment
focuses on the systematic collection, analysis, and monitoring of health problems and needs.
Globalization
the process of increasing economic, political, and social independence and integration as capital, goods, persons, concepts, images, ideas, and values cross state boundaries
Hospice Care
has been under the domain of community health care, because the goal is to provide care to persons at the end of life within the community setting. It is usually defined as the provision of care to persons who have less than six months to live, the goal of which is to provide care and comfort not cure or treatment. Common descriptions of the preferred circumstances of death include being free of pain and suffering, being in the company of loved ones, and being in one's own home.
Public Health
has contributed significantly to the health of the nation over the past century, it is often difficult to define. C.E.A.Winslow: "The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and for the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity." Winslow's definition: reflects what public health is, the scientific basis of public health, and what it does, and it remains relevant to this day.
Secondary Prevention interventions
include those aimed at early detection and initiation of treatment for disease, thus reducing disease-associated morbidity and mortality. Screenings
Environmental control
indicates the belief in how the environment affects the individual.
Universal Prevention
intervention is one that is applicable to the whole population and is not based on individual risk. The intervention is aimed at the general population. Intervention aimed at the general population Anti-smoking campaigns, drinking and driving campaigns
Selective Prevention
interventions are aimed at a subset of the population that has an increased level of risk for developing disease. Can be based on demographic variables such as age, gender, and race Interventions include efforts to screen women for breast cancer who have a known family history of breast cancer, or providing community education programs to prevent lead poisoning in older urban neighborhoods.
Socioeconomic Status (SES)
is a composite measure of the interrelated concepts of income, education, and occupation.
Cultural competency
is a core aspect of care for healthcare providers. Traditionally defined as the attitudes, knowledge, and skills the health-care provider uses to provide quality care to culturally diverse populations. Requires an understanding and capacity to provide care in a diverse environment. Implies an endpoint of acquired knowledge related to the culture of others.
Social Capital
is a term that has numerous definitions in the literature. The central point of social capital is the benefits that occur through social networks. One example is that persons often secure a job based on whom they know rather than what they know. Social capital usually refers to a person's or a community's capacity to obtain support from the social connections available to the person or community. Social capital resides in the quantity and quality of interpersonal ties among people and communities.
Prevalence Pot
is a way of depicting the total number of cases of the disease in the population that takes into account issues related to duration of the disease and the incidence of the disease.
Sexual abuse or abusive sexual contact
is any sexual contact against an elder's will. This includes acts in which the elder is unable to understand the act or is unable to communicate. Abusive sexual contact is defined as intentional touching (either directly or through the clothing), of the genitalia, anus, groin, breast, mouth, inner thigh, or buttocks.
caregiver
is anyone who assists someone else who is incapacitated in some way and needs help.
Prevalence
is basically the number of total cases of disease (numerator) divided by the total number of people in the population (denominator) and reflects the total number of cases of a disease in a given population.
Population Health
is comprised of the definition for population (a mass of people that make up a definable unit to which measurements pertain) and health (the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity) and requires an understanding of all the factors listed in the ecological model that contribute to the health of a population.
Health literacy
is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
prevented Fraction
is defined as a measure of what can actually be achieved in a community setting.
Reliability
is defined as the ability of the instrument to give consistent results on repeated trials.
Specificity
is defined as the ability of the screening test to give a negative finding when the person truly does not have the disease, or true negative.
Sensitivity
is defined as the ability of the screening test to give a positive finding when the person truly has the disease, or true positive.
Validity
is defined as the degree to which the instrument measures what it is supposed to measure.
Andragogy
is similar but is specifically the art and science of helping adults learn using the correct strategies.
Pedagogy (pedagogical learning)
is the correct use of teaching strategies to provide the best learning.
Neglect
is the failure or refusal of a caregiver or other responsible person to provide for an elder's basic physical, emotional, or social needs; in other words, it is a failure to protect them from harm. Examples include not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments.
Public health nursing
is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. A specialty practice within nursing and public health. Focuses on improving population health by emphasizing prevention and attending to multiple determinants of health. Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice. A multi-level view of health, public health nursing action occurs through community applications of theory, evidence, and a commitment to health equity. Guided by the ANA Public Health Nursing: Scope and Standards of Practice and the Quad Council of Public Health Nursing Organizations' Core Competencies for Public Health Nurses
Screening
is the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures that can be applied rapidly to sort out those with a high probability of having the disease from a large group of apparently well people. Screening for possible disease has the potential to reduce disease-related morbidity and mortality but has serious ethical issues that must be addressed.
Tertiary Prevention
is the prevention of disability and premature death and, when indicated, the initiation of rehabilitation for those diagnosed with the disease. Interventions aimed at preventing secondary complications related to disease
Abandonment
is the willful desertion of an elderly person by a caregiver or other responsible person.
The goal of a primary health care system
is to make health care available in close proximity to people who need it, and to ensure that it be comprehensive with flexible cost to accommodate the income variations of the individuals who use those services.
Financial abuse or exploitation
is unauthorized or improper use of resources of an elder for personal benefit, profit, or gain. Examples include forgery, misuse or theft of money or possessions, use of coercion or deception to surrender finances or property, or improper use of guardianship or power of attorney.
Four health at-risk behaviors
lack of exercise or physical activity, poor nutrition tobacco use drinking too much alcohol are underlying causes for illness and premature death.
Magico-religious beliefs
link health to supernatural forces, or good and evil. Belief in faith healing used by some christian religions Voodoo and witchcraft practices used in caribbean nations Biological variations in health: can be linked to genetic ties from biological relatives
Systems Thinking
studies how an individual or unit interacts with other organizations or systems Useful in examining cause and effect relationships
Population Focused Care
nurses need a basic knowledge of the different scientific disciplines that make up public health science. When nurses assess a community and/or a population, they use their knowledge of epidemiology and biostatistics to help identify priority health issues at the population level. Some terms relevant to a discussion of public health:
Early 1800s
nursing care in homes implemented
Psychological or emotional abuse
occurs when an elder experiences trauma after exposure to threatening acts or coercive tactics. Examples include humiliation or embarrassment, controlling behavior (e.g., prohibiting or limiting access to transportation, telephone, money or other resources), social isolation, disregarding or trivializing needs, or damaging or destroying property.
Ecological Determinants
of health include "... potable water and sanitation, affordable and clean energy, climate action, life below water, and life on land."
community health nursing
population focused approach to planning, delivering, and evaluating nursing care Promotes the health and welfare of clients across the lifespan and from diverse population Clear understanding 0f foundations of community health nursing, the principles guiding community health nursing, and health and disease promotion
Culture 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 Prior to collecting information about a client's culture, the nurse should perform a self-assessment
Risk Reduction
refers to actions taken to reduce adverse outcomes such as the use of a condom to reduce the risk of transmission of a communicable disease (CD).
Policy development
refers to using scientific knowledge to develop comprehensive public health policies
Early onset at-risk substance use
reflects older adults who have a history of regular alcohol consumption above the recommended limits or problem drug use that began early in their adult lives
Assurance
relates to assuring constituents that public health agencies provide services necessary to achieve agreed-upon goals
Environmental health
relates to the quality of the air, water, land, and other surroundings with which people come into contact.
Core end-stage indicators
that characterize the terminal phase of a chronic NCD include physical decline, weight loss, multiple comorbidities, a serum albumin of less than 2.5 g/dL, and ADL dependence.
Homelessness
the U.S. government has a two-part definition of homelessness. Definition 1: One who lacks a fixed, regular, and adequate nighttime residence Definition 2: One who lives in a supervised shelter or institution designed for temporary residence, or one who lives in a place that is not normally used as accommodation for people.
Culture
the customary beliefs, social forms, and material traits of a racial, religious, or social group; also: the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.
Dependence ration
the proportion of dependents (those aged 0 to 14 years plus those 65 years of age and older) per every 100 members of the population aged 65 and older per every 100 members of the population aged 15 to 64.
Aged dependency ratio
the ratio of the number of persons age 65 and older per every 100 members of the population aged 15 to 64. Factors that may improve the age dependency ratio include the increased age of full retirement for Social Security benefits for baby boomers from 65 to 67 and the graying of the U.S. workforce.
Top four risk factors for preventable death in the United States
tobacco use, improper diet, physical inactivity, and alcohol use—relate to behaviors.
Intervention Wheel
which illustrates how PHNs can improve the health of the individuals, families, communities, and systems.
