NUR 471 Quiz 1
4 basic environmental principle
#1-Everything is connected to everything else #2-Everything must go somewhere #3-Nature knows best #4-There is no such thing as a free lunch
Family as a component of society
- Family is seen as one of many institutions in society, along with health, education, religious, or financial institutions - The family as a whole interacts with other institutions to receive, exchange, or give services and communicate
Family as System
- Focus is on the family as client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts - Simultaneously focuses on individual members and the family as whole at the same time. The interactions between family members become the target for nursing interventions
Secondary Prevention for Older Adults
-Education on preventive measures and positive health behaviors
Family as Context
-Focus that is placed on the individual first and the family second -The family as context serves as either a resource or a stressor to individual health and illness
Family as Client
-The family is first, and individuals are second -The family is seen as the sum of individual family members -The focus is concentrated on each individual as he or she affects the family as a whole
What are major family health risks & family risk appraisal? (3)
-biological & age-related risks -environmental risks -behavioral risks
Family Health Risk Appraisal (6)
-genetics -age -biological characteristics -personal health habits -lifestyle -environment
Structural-Functional/Bioecological Systems Theory (2)
-how environments & systems outside the family influence the development of the child -4 systems can affect family development & adaptation
Community Health (3)
-identification of needs -protection & improvement of collective health within a GEOGRAPHICALLY DEFINED area -school district, zip code
What is the effect of radon? (3)
-injures tracheal-bronchial cells -lung cancer -2nd leading cause of lung cancer
What are the characteristics of collaboration & partnership? (5)
-shared goals -mutual participation -maximize use of resources -clear responsibilities -set boundaries
Interactional/Family Systems Theory (4)
-stability is maintained through adaptation to internal & external stresses -stresses created by changes -individual is viewed as participating in a whole family -families are viewed from a system & suprasystem approach
Lead Poisoning - Screening (3)
-targeted to kids in poverty, single parent families, & pre-1950's homes -child: blood lead levels ≥ 5 ug/dl -adult: ≥ 5 ug/dl
Developmental/Family Developmental & Life Cycle Theory (2)
-understands normal predicted stresses that families experience as they change & transition over time -stresses are based on the age of the oldest child
theoretical foundations that inform family nursing practice
1. Family system theory. 2. Family Developmental and Life Cycle Theory, and 3. Bioecological Theory.
Public Health Core Functions relation to environmental health
1.Assessment -Monitoring health status -The diagnosis and investigation of health hazards into the community 2.Assurance -The enforcement of policy 3.Advocacy/Policy development -Provides guidance through the essential community services -Engages scientists to analyze and develop policies to ensure health based upon sound evidence
EDUCATOR
= health teacher; plan for community-wide impact
COLLABORATOR
= multidisciplinary collegiality(cooperation among colleagues) /leadership approach
MANAGER
= plan & organize to meet clients needs; direct/lead client, controlling/evaluating progress. Case management= assessment, planning, & coordinating
Concept of community
Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging
Tertiary Prevention for Older Adults
Follow-up and rehabilitation Health issues: Alzheimer's disease, arthritis, cancer, depression, diabetes, cardiovascular disease, and osteoporosis
Levels of contracting
Formal - All parties negotiating a written contract by mutual agreement, signing the agreement, and sometimes having it witnessed or notarized Informal - Some form of verbal agreement about relatively clear-cut purposes and tasks
enviromental health
Freedom from illness or injury related to exposure to toxic agents and other potentially dangerous environmental conditions.
Primary Prevention for Older Adults
Health education; follow-through of sound personal health practices; recommended routine screenings and appropriate immunizations (see Display 24.2) Nutrition, oral health, exercise, and safety needs Economic security needs Psychosocial needs: coping with multiple losses, maintaining independence, social interaction, companionship, and purpose Spirituality, advance directives, hospice, palliative care, and preparing for death
Empathetic listening
Listening with the intent to understand how the speaker feels and their ideas Empathy: identifying with a persons emotions and situation; even if not in agreement with them Sympathy: feelings of pity and sorrow for someone else's misfortune. Be interested in your client Being culturally sensitive, have good eye contact and body language Minimize distractions Invite the client to expand on his or her thoughts
Sending skills
Nonverbal: more unconscious and learned implicitly Dress Facial expressions Eye contact (oculesics) Gestures Time management (chronemics) Silence Space (proxemics) • Touch (haptics) • Senses (sensorics) • Tone • Intonation (paralanguage) Verbal: speaking and writing Keep messages honest and uncomplicated Use few words Ask for feedback
#2. Everything has to go somewhere-EXPOSURE CONTROL
Once waste products are generated, they must be disposed of through: -Incineration •Products such as ash and emissions must be disposed of -Water discharge •Products must be treated so dose not high enough for harm -Landfilling or burial in the soil •Liners, pumps and monitors must be put in place to avoid seepage into groundwater or air
Describe the national and global health status of older adults.
Overview: - Growth in number and proportion of older adults living in the United States; projected to reach almost 20% of population by 2030 - Increased demands on public health system, medical and social services, and health care delivery - Chronic disease contributing to disability, diminished quality of life, and increased health care costs Globally: - Number of adults over age 65 expected to reach 1.4 billion by 2050; those over age 80 years growing faster than any other group
Community Health Nursing Characteristics - 4) Primary Prevention
PRIORITY
Characteristics of contacting
Partnership and mutuality • Commitment • Format: Responsibilities,Timeline • Negotiation
Functions of the family
Providing affection Providing security and acceptance Instilling identity and satisfaction Promoting affiliation Providing socialization
Interpersonal skills
Showing respect- Empathizing: Empathetic listening - Developing trust and rapport
Characteristics all families have in common
Small social system, Moves through stages, Own values and rules, Structure, has certain basic functions
Principles of effective community nursing practice
Standards of practice = AACN "essential" seven. Standards of care = Scope and standards Management essential to all nursing roles = process, assessment, planning, implementation, evaluation Essential behaviors = decision making, transferring information, relationship building
Community Health Nursing Characteristics - 8) Collaboration
With a variety of other professions, populations, organizations, and entities is the MOST effective way to promote and protect the health of people
Three types of communtiy
- Geographic - city, town , neighborhood - Common interest - church, professional organization - Community of solution - group of people who come together to solve a problem that affects all of them (medical trade, water control)
Key functions in public settings
- Health populations, community needs/priorities - Caring relationship Grounded in cultural sensitivity, compassion, social justice, belief in worth of all - epidemiological evidence to promote health - Individual/collaborative strategies to achieve results
Community Health Nurse - Roles (7)
-CLINICIAN -EDUCATOR -ADVOCATE -MANAGER -COLLABORATOR -LEADER/CHANGE AGENT -RESEARCHER
What childhood s/sx would you see in a child with lead poisoning from d/t HIGH LEVEL exposure? (4)
-CNS damage -convulsions -coma -paralysis
Roles within framework of public health functions: ASSURANCE? (5)
-ENFORCE laws & regulations that protect health & ensure safety -LINK people to needed personal health services & assure the provision of health care when otherwise unavailable -ASSURE competent public & personal health care workforces -EVALUATE effectiveness, accessibility, & quality of personal/population-based health services -RESEARCH new insights & innovative solutions to health problems
Lead Poisoning - Childhood S/sx (6)
-HA -irritability -weakness -abd pain -vomiting -constiptation
I-PREPARE (8)
-I = investigate potential sources -P = present work -R = residence -E = environmental concerns -P = past work -A = activities/hobbies/health practices -R = referrals & resources -E = educate
Roles within framework of public health functions: POLICY DEVELOPMENT? (3)
-INFORM, EDUCATE, & IMPOWER people about health issues -MOBILIZE community partnerships & action to identify/solve health problems -DEVELOP POLICIES & PLANS that support individual & community health efforts
How does radon enter homes? (2)
-INHALED = cracks in floors/walls -INGESTED = contaminated private well water
Roles within framework of public health functions: ASSESSMENT? (2)
-MONITOR health status to identify & solve community health problems -DX & INVESTIGATE health problems & health hazards in community
Hospice - Characteristics of RN Practice (7)
-RN = central to interdisciplinary team -collaborate w/doctors -rotation through 24/7 to assure continuous availability to phone & visits for emergent problems -similar to home health nurse, but added expertise in relieving physical & emotional suffering -speak the truth & encourage choices -strengthening the family -comforting spiritual practice & letting go
What are 5 barriers to effective communication in community health nursing?
-SELECTIVE PERCEPTION (interpret through own perception) -LANGUAGE BARRIERS (interpret meaning of words differently) -FILTERING INFO (manipulation of info by sender to influence the receiver's response) -EMOTIONAL INFLUENCE (how a person feels at time a message is sent/received influences its meaning) -LANGUAGE OF NURSING (-RNs w/unique vocab may not be understood by pt, family, & community members-use of scientific terms/jargon by some health professionals can be confusing)
Skills necessary for PHN/CHN practice
-SPECIAL SKILLS = assessment, policy development, assurance -COLLABORATES W/OTHER INSTITUTIONS = schools, parishes, occupational health
What are the 3 core PUBLIC HEALTH FUCNTIONS basic to community health nursing?
-assessment -policy development/advocacy -assurance
Public Health Functions - Assurance
-availability of resources of necessary services throughout the community -once it's a law/regulation, we make sure services are available in a community to the ones who need it most in most cost-effective way
Indoor Air Pollution - 2nd Hand Smoke - EFFECTS (3)
-carcinogenic -COPD -asthma
Lead Poisoning - Treatment (2)
-chelating agents -they facilitate urinary excretion of lead
Indoor Air Pollution - Radon (3)
-colorless/odorless gas -product of uranium decay -7% of US homes have high levels
Tertiary Prevention (3)
-decrease extent & severity of health problems to its lowest possible level to minimize disability & restore/preserve function -prevents ADDITIONAL complications of an event that's ALREADY happened -EX = MI pts do cardiac rehab
Radon Poisoning - Intervention (4)
-decrease smoking -don't sleep in basement -increase time outdoors -circulate outdoor air into home
Secondary Prevention (4)
-efforts to detect & treat EXISTING disease -activities gear toward high risk groups -how diseases are treated -EX = screenings (b/c not done on everyone), education for diabetic pts to prevent complications r/t disease
What are the 2 main components of community health practice?
-health promotion -disease prevention
What settings do community health nurses practice in? (7)
-homes -ambulatory services -schools -occupational health -residential institutions -faith communities -community at large (domestic & international)
What conditions must be met in order to receive hospice care through Medicare? (3)
-hospice doctor AND regular doctor certify terminally ill -accept palliative care instead of care to CURE illness -statement is signed choosing hospice care instead of other Medicare-covered benefits to tx terminal illness & related conditions
Insect & Rodent Control - RN's Role (6)
-increasing awareness of threat -remaining alert to evidence of insects/rodents -educating persons -notifying proper authorities -surveying communities -influencing policy makers
Lead Poisoning - Effect (3)
-interferes w/RBC production = anemia, neurotoxicity -can be stored in bones for 20-30 years -can be mobilized from bone in illness, stressful conditions, & pregnancy
Insect & Rodent Control - Effects (4)
-irritation/discomfort -direct threat to health via attack -contamination of food -vectors for disease transmission (mosquitoes, flies, ticks, roaches, fleas, rats, mice, & ground squirrels)
Primary Prevention (3)
-keep illness or injury FROM HAPPENING -education -EX = immunizations (b/c everyone SHOULD be receiving), hand washing.
Lead Poisoning - Sources (5)
-lead-based paints -drinking water via lead pipes -lead-contaminated soil/air -pottery glazes -folk remedies
Home Health - Characteristics of RN Practice (4)
-locating & getting through the door (making connection) -promoting self-management -detecting -collaborating, mobilizing, strengthening, teaching, & solving problems
Work Exposures
-manufacturers, labs, etc. (paint, reagents, etc.) -cleaning solutions = bleach, solvents -pharmacologic agents = RNs, pharmacists, etc. (i.e. oncology RNs)
What childhood s/sx would you see in a child with lead poisoning from d/t LOW LEVEL exposure? (3)
-mental retardation/behavior problems -hyperactivity -growth retardation
What are the 7 parts of the communication process?
-message -sender = verbal & nonverbal communication -receiver = active or reflective listening; observe behaviors -encoder = how we phrase things -channel = how message is delivered -decoding = receiver's responsibility -feedback loop
What conditions must be met in order for Medicare to FULLY pay for home health care? (4)
-must be homebound -doctor must certify that you need 1+ professional services -must be under plan of care established & regularly reviewed by doctor -home health agency has to be approved by Medicare
Indoor Air Pollution - 2nd Hand Smoke - INTERVENTION (2)
-policies to prohibit smoking in public places, cars, worksites, restaurants, & bars -smoking cessation programs
How's community health different from public health? (2)
-public = broader, makes sure EVERYONE has what they need to stay & be healthy -community = GEOGRAPHICALLY defined
What are potential home exposures? (5)
-radon -tobacco smoke -carbon monoxide -lead -insect/rodent
Public Health Functions - Assessment
-regular collection, analysis, & sharing of info about health conditions, risks, & resources in community -EX = data collection, analysis, papers
Lead Poisoning - Adult S/sx (5)
-reproductive problems -increased BP -digestive/nervos DO's -decreased memory/concentration -decreased joint/muscle function
Radon Poisoning - Prevention (4)
-seal cracks -force ventilation -vent radon gas to outside -radon detector
Lead Poisoning - Prevention (2)
-test for presence of lead in all homes build BEFORE 1978 (when the sale of lead-based paint was banned) -lead abatement = remove all lead-based paint, clean up all dust
Public Health Functions - Policy Development/Advocacy
-use of assessment data to develop policy & direct resources toward those policies -take in info & use it to inform how we vote/engage legislators -how we help write policies
Insect & Rodent Control - Government's Role (5)
-vector surveys -research -control -community awareness -pest control programs
Community Health Nursing Characteristics - 3) Processes Used
-working w/pt as EQUAL partner -collaborate w/pts, clients, & community members -create healthy environments
Process of contracting
1. Assessment: explore needs 2. Nursing diagnosis/goal setting 3. Plan/intervention: explore resources; develop a plan; divide responsibilities; agree on time frame 4. Evaluation: evaluation; renegotiation or termination
• Describe the nurse's role in assessment and intervention of environmental hazards at the primary, secondary and tertiary levels of prevention.
1.Complete an environmental health history 2.Recognize potential environmental hazards and illnesses 3.Make appropriate referrals for conditions with probable environmental causes 4.Provide information to clients and communities.Primary: Education —dose, frequency, route of exposure, environmental pathways, toxicity, health effects, screening frequency Secondary: Screening —for exposure Tertiary: Treatment —ongoing health screening programs for those exposed to toxins with delayed effects, counseling, assessment of capabilities
ADVOCATE
= act on behalf of client, support client self determination/independence, make system responsive/relevant to client needs advocates must be assertive, take risks, communicate & negotiate well, identify & obtain resources for pt
Leader/Change agent
= action as the change agent
-CLINICIAN
= provides care; focuses on holism, health promotion, & prevention while using expanded skills
Disease Prevention/prevention of health problems
Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment
Roles of a public health nurse
Assess: community data, trends, epidemiology, population growth data for planning services, and environmental risks Diagnose: identification of priorities, application of information and observation of changes, and emergence of new issues Plan and implement: collaborative interventions, education, and advocates to influence change Evaluate: programs and interventions, rates, and research involvement
Roles within framework of public health functions (3)
Assessment = clinician, educator, manager. Policy development = clinician, educator, manager, collaborator. Assurance = clinician, educator, manager, collaborator, change agent, advocate, researcher.
Benefits of Empathetic Listening
Better Care Greater patient satisfaction Higher levels of hope Increased patient trust and ratings of clinical competence Better health Improved medication adherence Reduced pain Reduced mortality Fewer disease complications Improved immune function Decreased health care utilization & costs
Community health nursing
Collaboration and interdisciplinary teamwork - health department, community based clinics, work sites, ambulatory clinics, schools, urgent care
Barriers to effective collaboration
Communication barriers Miscommunication Stereotypes Perception of unequal power and authority Apprehension about sharing information Inflexibility and uneasiness Failure to develop a common purpose Structural factors: inadequate time, resources, or agency support
How the Environment Influences the Health of the Community
Ecology is the study of the interactions and relationships between living organisms and their environments. Ecosystems are dynamic communities that no organism including humans can exist outside of. The scientific study of ecosystems provides an understanding of the relationship between humans and the environment and why knowledge of environmental health is so important for nurses.
Health Promotion
Efforts that seek to move people closer to optimal well-being or higher levels of wellness. 1. increased span of healthy life 2. Reduce health disparities 3. Achieve access preventive services
#1-Everything is connected to everything else
Exposure pathway assessment 1.Source of harm/ contamination 2.Exposure media—air, soil, water, food -> transmission 3.Receptor population (humans in pathway) 4.Exposure route—ingestion, inhalation, dermal absorption Exposure point—human contact w/ contaminant 5.Dose of contaminate (amount/duration/frequency) Each of the 5 elements must be present in sufficient quantity for harm to occur
State and federal programs that support families
Family medical leave act - allows for job safety in event of medical leave TANF and SS Medicare/medicaid - insurance Affordable care act - aid for those underinsured or uninsured
Public health nursing
Focus expanded to heal and welfare of general public - Lillian Wald started public health nursing term. - Margaret Sanger started comstock act, birth control info, planned parenthood - NLNE - VNA/FNS (mary breckinridge)
Upstream Focus
John McKinley in 1979, "A Case for Focusing Upstream" -Identifies root causes of disease and manufacturers of illness. -It considers socioeconomic factors and also the environmental origins of disease and health problems. Public health nurses are often the "sentinels of surveillance" who detect unusual illness patterns and respond to environmental emergencies in work and community settings
Value of Contracting
Partnership developed, with agreement about purpose of relationship and conditions under which it will be carried out Results: - Self-health promotion and increased motivation - Focus on unique needs - Client participation in decision making - Clients' autonomy and self-esteem enhanced with learning self-care - More efficient and cost-effective nursing service
#4. There is no such thing as a free lunch-Today's solution may be tomorrow's problem
Past creates present problems and what we don't know Examples: -Garbage that went into streets was moved to unlined landfills -Gas tanks were buried underground because they were unsightly -Lawn chemicals -Other?
4 settings of PHN/CHN practices
Public, Private, Home Health, Hospice.
Core communication skills
Sending skills Receiving skills Interpersonal skills
Receiving skills:
V=Verbal; NV=Nonverbal - Active or reflective listening: work to discover what the client means • Sitting forward (NV)• Sustaining eye contact (NV)• Nodding the head (BE CAREFUL) (NV)• Asking occasional questions for clarification (V)• Paraphrasing to reflect back what you have heard (V) • Avoid daydreaming or formulating responses - Observing behaviors
Becoming a community/public health nurse
academic prep = BSN professional development = continuing educaiton programs/units Certifications = BSN + 5 yrs experience (CPH)
Community Health Nursing Characteristics - 2) Primary Obligation
achieve greatest good for greatest number of people/population as whole
Public health
activities that society undertakes to assure the conditions in which people can be healthy
public health nursing
community based and most importantly it is population focused
Early home care nursing
focus of care to reduce suffering and promote healing - religious/charitable groups St. Vincent poor law - sisters of charity - Florence nightingale + mary seacole
District Nurisng
focus to provide 1st rate nursing to sick @ home. - Visiting nurses - care of individuals
Community Health Nursing Characteristics - 7) Key Element
optimal use of available resources to assure best overall improvement in health of population
Three levels of Prevention
primary, secondary, tertiary
Community Health Nursing Characteristics - 1) Population
pt or unity of care
Community Health Nursing Characteristics - 5) Strategies
selected to create healthy environmental, social, & economic conditions in which population may thrive
Indoor Air Pollution - 2nd Hand Smoke - SOURCE
smoking tobacco in home, car, or other enclosed spaces
RESEARCHER
systematic investigation, collection, & analysis of data for solving problems; EB findings to community settings
Community Health Nursing Characteristics - 6) Other obligation
to actively reach out to ALL who might benefit from a specific activity
#3. Nature knows best
•Cannot decrease the dose (exposure) through air or water by: -Examples: •Moving garbage to water •Building taller smoke stacks •Initially it seemed the capacity of water and air to accommodate waste products was limitless "...any major man-made change in a natural system is likely to be detrimental to that system."-Barry Commoner
