exam 1 N402

Name a serious disease linked to radon gas

Radon causes an estimated 21,000 lung cancer deaths in the United States every year. It is the second leading cause of lung cancer, after active smoking, and the leading cause among nonsmokers (EPA, 2013f). Nine federal agencies are currently working on an initiative to reduce radon exposures and illnesses (EPA, 2013d). Carbon monoxide is an odorless, colorless, toxic gas. It can cause mild flulike effects such as headaches, dizziness, disorientation, nausea, and fatigue at lower levels of exposure and death at higher levels (EPA, 2012d). Molds, dust, and secondhand smoke exposure can often exacerbate asthma symptoms.

State the actions a nurse should take in planning an appropriate community intervention; i.e. how that community would be empowered. (chap 7)

19. BOX 7.1 Health Planning Project Objectives I. Assessment A. Specify the aggregate level for study (e.g., group, population group, or organization). Identify and provide a general orientation to the aggregate (e.g., characteristics of the aggregate system, suprasystem, and subsystems). Include the reasons for selecting this aggregate and the method for gaining entry. A. Describe specific characteristics of the aggregate. 1. Sociodemographic characteristics: Including age, sex, race or ethnic group, religion, educational background and level, occupation, income, and marital status. 2. Health status: Work or school attendance, disease categories, mortality, health care use, and population growth and population pressure measurements (e.g., rates of birth and death, divorce, unemployment, and drug and alcohol abuse). Select indicators appropriate for the chosen aggregate. 3. Suprasystem influences: Existing health services to improve aggregate health and the existing or potential positive and negative impact of other community-level social system variables on the aggregate. Identify the data collection methods. B. Provide relevant information from the literature review, especially in terms of the characteristics, problems, or needs within this type of aggregate. Compare the health status of the aggregate with that of similar aggregates, the community, the state, and the nation. C. Identify the specific aggregate's health problems and needs on the basis of comparative data collection analysis and interpretation and literature review. Include input from clients regarding their need perceptions. Give priorities to health problems and needs, and indicate how to determine these priorities. II. Planning A. Select one health problem or need, and identify the ultimate goal of intervention. Identify specific, measurable objectives as mutually agreed on by the student and aggregate. B. Describe the alternative interventions that are necessary to accomplish the objectives. Consider interventions at each system level where appropriate (e.g., aggregate/target system, suprasystem, and subsystems). Select and validate the intervention(s) with the highest probability of success. Interventions may use existing resources, or they may require the development of new resources. III. Intervention A. Implement at least one level of planned intervention when possible. B. If intervention was not implemented, provide reasons. IV. Evaluation A. Evaluate the plan, objectives, and outcomes of the intervention(s). Include the aggregate's evaluation of the project. Evaluation should consider the process, product, appropriateness, and effectiveness. B. Make recommendations for further action based on the evaluation, and communicate them to the appropriate individuals or system levels. Discuss implications for community health nursing. An essential component of health planning is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the assessment, planning, implementation, and evaluation steps of this process. Community organization reinforces one of the field's underlying premises, as outlined by Nyswander (1956): "Start where the people are." Moreover, Labonte (1994) stated that the community is the engine of health promotion and a vehicle of empowerment. He describes five spheres of an empowerment model that focus on the following levels of social organization: interpersonal (personal empowerment), intragroup (smallgroup development), intergroup (community collaboration), interorganizational (coalition building), and political action. Paying attention to collective efforts and support of community involvement and empowerment, rather than focusing on individual efforts, will help ensure that the outcomes reflect the needs of the community and truly make a difference in people's lives. Labonte's (1994) multilevel empowerment model allows us to consider both macro-level and micro-level forces that combine to create both health and disease. Therefore it seems that both micro and macro viewpoints on health education provide nurses with multiple opportunities for intervention across a broad continuum. In summary, health education activities that have an "upstream" focus examine the underlying causes of health inequalities through multilevel education and research. This allows nurses to be informed by a critical social perspective from education, anthropology, and public health and through community-based participatory research

11. Define community, community health nursing, and community-based nursing

Community: a group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and/or goals. Public health is the Science and Art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort Community health extends the realm of public health to include organized health efforts at the community level through both government and private efforts. Community health nursing as "the synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations" Community-based nursing practice refers to "application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system". Community-based nursing is setting specific, and the emphasis is on acute and chronic care and includes such practice areas as home health nursing and nursing in outpatient or ambulatory settings.

Florence Nightingale and practices of her time

Contributing to the health of British soldiers during the Crimean War and establishing nursing education In 1854, Nightingale responded to distressing accounts of a lack of care for wounded soldiers during the Crimean War. Upon their arrival, the nurses learned that the British army's methods for treating the sick and wounded had created conditions that resulted in extraordinarily high death rates among soldiers. Indeed, one of Nightingale's greatest achievements was improving the management of these ill and wounded soldiers Nightingale found that allocated supplies were bound in bureaucratic red tape; for example, supplies were "sent to the wrong ports or were buried under munitions and could not be got" Nightingale realized that her most forceful argument would be statistical in nature. She reorganized the methods of keeping statistics and was the first to use shaded and colored coxcomb graphs of wedges, circles, and squares to illustrate the preventable deaths of soldiers. Nightingale compared the deaths of soldiers in hospitals during the Crimean War with the average annual mortality in Manchester and with the deaths of soldiers in military hospitals in and near London at the time Nightingale discovered that each hospital kept incomparable data and that many hospitals used various names and classifications for diseases. She noted that these differences prevented the collection of similar statistics from larger geographic areas. These statistics would create a regional health-illness profile and allow for comparison with other regions.

Community as Partner/ community assessment, empowerment

State the purpose of the Community as Partner model in community assessment. The Community-as-Partner Model begins with assessment. The concept of assessment is represented by the 'assessment wheel'. The center of the wheel is the community core. This represents the people of the community. The areas surrounding the community core are the eight subsystems of the community. The community core (people in the community) is influenced by the eight subsystems and the eight subsystems are influenced by the community core. Sometimes the influences are positive, sometimes they are negative. The relationship between the community core, the subsystems and the environment are illustrated by the solid and broken lines in the figure and will be discussed in further detail in the following slides. Each community and aggregate presumably will have a unique perspective on critical health qualities. Indeed, a community or aggregate may have divergent definitions of health, differing even from that of the community health nurse. Nevertheless, nurses and health professionals work with communities in developing effective solutions that are acceptable to residents. Building a community's capacity to address future problems is often referred to as developing community competence. The nurse assesses the community's commitment to a healthy future, the ability to foster open communication and to elicit broad participation in problem identification and resolution, the active involvement of structures such as a health department that can assist a community with health issues, and the extent to which members have successfully worked together on past problems. This information provides the nurse with an indication of the community's strengths and potential for developing long-term solutions to identified problems.

13. Define incidence and prevalence. Understand what influences the "prevalence pot" (i.e. length of an illness)

The two principal types of morbidity rates, or rates of illness, in public health are incidence rates and prevalence rates. Incidence rates describe the occurrence of new cases of a disease (e.g., tuberculosis, influenza) or condition (e.g., teen pregnancy) in a community over a given period relative to the size of the population at risk for that disease or condition during that same period. The denominator consists of only those at risk for the disease or condition; therefore known cases or those not susceptible (e.g., those immunized against a disease) are subtracted from the total population The incidence rate may be the most sensitive indicator of the changing health of a community because it captures the fluctuations of disease in a population. Although incidence rates are valuable for monitoring trends in chronic disease, they are particularly useful for detecting shortterm changes in acute disease—such as those that occur with influenza or measles—in which the duration of the disease is typically short. A prevalence rate is the number of all cases of a specific disease or condition (e.g., deafness) in a population at a given point in time relative to the population at the same point in time: When prevalence rates describe the number of people with the disease at a specific point in time, they are sometimes called point prevalences. For this reason, cross-sectional studies frequently use them. Period prevalences represent the number of existing cases during a specified period or interval of time and include old cases and new cases that appear within the same period. Prevalence rates are influenced by the number of people who experience a particular condition (i.e., incidence) and the duration of the condition. A nurse can derive the prevalence rate (P) by multiplying incidence (I) by duration (D): (P = I × D). An increase in the incidence rate or the duration of a disease increases the prevalence rate of a disease. With the advent of life-prolonging therapies (e.g., insulin for treatment of type 1 diabetes and antiretroviral drugs for treatment of HIV), the prevalence of a disease may increase without a change in the incidence rate. Those who survive a chronic disease without cure remain in the "prevalence pot" (Fig. 5.4). For conditions such as cataracts, surgical removal of the cataracts permits many people to recover and thereby move out of the prevalence pot. Although the incidence has not necessarily changed, the reduced duration of the disease (because of surgery) lowers the prevalence rate of cataracts in the population.

Writing Objectives State the components of a written process objective

Development of goals and objectives is essential. The goal is generally where the nurse wants to be, and the objectives are the steps needed to get there. Measurable objectives are the specific measures used to determine whether the nurse is successful in achieving the goal. The objectives are instructions about what the nurse wants the population to be able to do. In writing the objectives, the nurse should use verbs and include specific conditions (how well or how many) that describe to what degree the population will be able to demonstrate mastery of the task. Because the objectives are specific and can be quantified, they may be used to measure outcomes. Objectives may also be referred to as behavioral objectives or outcomes because they describe observable behavior rather than knowledge. An example of the goals and measurable objectives for a city with a high rate of childhood obesity is shown in GOAL Reduce the rate of childhood obesity in the city of New Bedford. OBJECTIVES 1. The percentage of children whose body weight exceeds the 98th percentile for age and height will be reduced to 5%. 2. All the children will be invited to join a 5, 2, 1 program: • Five fruits and vegetables per day • Two-hour limit on screen time (TV, video games, and computer) per day • One hour of physical activity per day 3. The food pyramid will be taught to all school nurses and health educators by the end of the school year. 4. The food pyramid will be presented and distributed to parents at all the summer health fairs.

State the importance of nursing knowledge of a community in providing care (chap 7)

Steps in the Health Planning Model Assessment Meet with group leaders of aggregate to clarify mutual expectations Determine sociodemographic characteristics Interview a key informant Consider both positive and negative factors Compare the aggregate with the "norm" Research potential problems Identify health problems and needs Prioritize the identified problems and needs to create an effective plan Assessment Describe your population - specific targeted population - then assess demographics and further information. Assessment of the health issue - specific to your targeted population with epidemiological searches. Assess your targeted population in relation to the 8 subsystems of Anderson & McFarland 4 needs assessments: Expressed needs: Demand for services and the market behavior of the targeted population Normative needs: Lack, deficit, or inadequacy of services determined by health professionals Perceived needs: Wants and desires expressed by audience Relative needs: Gap showing health disparities between advantaged and disadvantaged population Diagnosis Assessment data analysis: Analyze parts of the assessment while also linking them together. Setting stage for diagnosis. Diagnosis RT some factors identified in your assessment AEB the actual statistics Planning Determine the intervention levels: Subsystem, aggregate system, and/or suprasystem Plan interventions for each system level: Primary, secondary, or tertiary levels of prevention Validate the practicality of the planned interventions according to available resources: Personal, aggregate, and suprasystem

State potential influences of the "built environment".

The built environment consists of the connections among people, communities, and their surrounding environments that affect health behaviors and habits, interpersonal relationships, cultural values, and customs. There is growing evidence that the built environment directly and indirectly affects health outcomes and disease rates. One review of the literature found that neighborhoods that are more walkable are associated with increased physical activity, increased social capital, lower overweight, lower reports of depression, and less reported alcohol abuse. Social capital refers to networks and the associated norms and expected collective benefits derived from cooperation between individuals and groups. Structural characteristics of the built environment, such as street condition, neighborhood deterioration, and the proportion of parks and playgrounds, affect levels of physical activity and obesity found that women are more likely to increase physical activity if they live in a walkable community compared with men, indicating safety to be an attributing factor. Simply put, having a safe, intact place to walk may encourage exercise among adults. Page 544

macroscopic approach

A macroscopic approach to lead exposure may incorporate the following activities: examining trends in the prevalence of lead poisoning over time, estimating the percentage of older homes in a neighborhood that may contain lead pipes or leadbased paint surfaces, and locating industrial sources of lead emissions. These efforts usually involve the collaborative efforts of nurses from school, occupational, government, and community settings. Macroscopic Approach • Examines interfamily and intercommunity themes in health and illness • Delineates factors in the population that perpetuate the development of illness or foster the development of health • Emphasizes social, economic, and environmental precursors of illness • Nursing interventions may include modifying social or environmental variables (i.e., working to remove care barriers and improving sanitation • or living conditions) • May involve social or political action

How to calculate common rates for conditions in the population

Attack rate: Number of new cases among those exposed to the disease Incidence Rate: (Number of new cases in given time period) x 100 / Population at risk in same time period Prevalence Rate: Number of existing cases x1000 / Total Population Proportionate mortality rate: › # deaths from specific cause in a year X100 / all deaths in that year Cause specific rate: › # deaths from cause A in a year X100,000 / mid-year population Case fatality = # dead from disease / # of people with the disease Births per 1000 women, categorized according to a specific composition of mothers in the population: (1) Crude birth rate: number of live births per 1000 of population. (2) General fertility rate: number of live births per 1000 women between the ages of 15 and 44 years. (3) Age-specific fertility rate: number of births to women of a particular age (called cohorts). (4) Total fertility rate: Average number of children a woman would bear during her lifetime, assuming her childbearing conforms to her age-specific fertility rate every year of her childbearing years (typically, age 15 to 44). (5) Completed fertility rate: number of children actually born per woman in a cohort of women up to the end of their childbearing years (typically, age 44). Crude rates are vulnerable to bias Infant mortality › Infant deaths X1000 / # of live births Neonatal mortality › # neonatal deaths (to 28 days) in yr X 1000 / # of live births in a years Maternal mortality › Maternal deaths during preg X100,000 / # of live births (not all pregnancies) Crude rates summarize the occurrence of births (i.e., crude birth rate), mortality (i.e., crude death rates), or diseases (i.e., crude disease rates) in the general population Age-specific rates characterize a particular age group in the population and usually consider deaths and births Age adjustment or standardization of rates is another method of reducing bias when there is a difference between the age distributions of two populations. The nurse uses either the direct method or the indirect standardization method The proportionate mortality ratio (PMR) method also describes mortality. It represents the percentage of deaths resulting from a specific cause relative to deaths from all causes

2 sources for statistical data on health concerns

Census, The National Center for Health Statistics (NCHS)

Lillian Wald contribute to public health nursing

Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by supporting political activities to improve social and environmental conditions of immigrant families.

Describe potential and actual results of global warming

Effects of environmental risks may also be indirect, such as in the case of global warming. Global warming is the gradual increase in the average temperature of Earth's near-surface air and oceans since the mid-twentieth century and its projected continuation. Rising global temperatures may enhance the quantity and distribution of parasites, insects, and other disease vectors, potentially increasing the prevalence of a variety of infectious diseases. For example, global warming contributed to the entry and propagation of the West Nile virus in the United States and is suspected in facilitating the rapid spread of the Zika virus. Higher air and water temperatures facilitate the spread of vectorborne diseases transmitted by mosquitoes (e.g., West Nile virus). As a result, 2012 saw more cases of West Nile virus infection (5387) than any year since 2003, with a higher proportion of deaths; however, between 2012 and 2015 there has been an annual consecutive reduction in both the number of cases and deaths related to West Nile Virus.

Endemic, epidemic, pandemic

Endemic Diseases that are always present in a population (e.g., colds and pneumonia) Epidemic Diseases that are not always present in a population but flare up on occasion (e.g., diphtheria and measles) Pandemic: The existence of disease in a large proportion of the population: a global epidemic (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome, and annual outbreaks of influenza type A)

Multiple choice questions

Evolve Chap 1 Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2015), community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing: sociocultural issues Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a: food bank in a local church It has been estimated that individual behaviors and environmental factors are responsible for what percentage of all premature deaths in the United States? 50% Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by: supporting political activities to improve social and environmental conditions of immigrant families Disease prevention activities protect people from disease and the effects of disease. An example of primary disease prevention is: administering vaccines to children before kindergarten. Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to: improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident Which is an example of "community health nursing" rather than "community-based nursing"?: An RN reviewing school clinic records to determine which children are not up to date on their immunizations Which entity strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities?: Public health system A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include (Select all that apply.): morbidity, mortality, life expectancy, cancer incidence rates. Public health efforts focus on prevention and promotion of population health. The local level of the health care system provides direct services to community members through community and personal health services. An example of a health service that targets the larger community, rather than individuals, is (Select all that apply.): a mobile immunization clinic, condemning or repairing unsafe housing, airing a weekly public service announcement to remind women to do breast self-examination. Chap 2 In which historical age would people have had an increased risk for contracting salmonella, anthrax, Q fever, or tuberculosis from the proximity of domesticated animals and herds?: Settled village stage During the Renaissance period, much was learned about health and disease. The Elizabethan Poor Law was enacted during this time to: make local parishes responsible for caring for the poor in the community. Edwin Chadwick's Report on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain greatly contributed to the development of the: General Board of Health for England. What discovery by Edward Jenner resulted in one of the greatest medical advances of the 18th century?: The development of the smallpox vaccination that resulted in immunity after inoculation with the cowpox virus Lemuel Shattuck, a Boston bookseller with an interest in public health, published the 1850 book Report of the Massachusetts Sanitary Commission. Which was not a recommendation of the report?: Introducing modern family planning methods in the United States The first visiting nurse in the United States was: Francis Root. Modern community health nursing requires the nurse to __________, which empowers people to understand and address their health issues and disease.: practice from a population focus . Which was not a public health service provided by the Romans?: Housing for the indigent population When nonindustrial cultures adopt Western customs and transition into urban environments, Western diseases begin to appear. Epidemiologic studies suggest that common risk factors that contribute these health conditions include: (Select all that apply.): changes in diet., environmental alterations, increased population density, occupational hazards. Lillian Wald and Mary Brewster's Henry Street Settlement was a model of modern health care. Which services were provided to people living in the Lower East Side of New York City by the Henry Street Settlement nurses? (Select all that apply.): Home visits to ill mothers and children, School health services, Industrial health services to local workers, Support programs for immigrants. Chapter 3 Which statement is not true about the "thinking upstream" model of community health nursing practice?: It focuses the nurse on short-term, individual-based nursing interventions. A microscopic approach to the community health problem of childhood obesity would focus on: asking an obese child and his or her parent(s) to complete a 24-hour food diary. Which theory is based on the assumption that individual needs and related activities are the focus of nursing care?: Orem's self-care deficit theory A community health nurse explores a group of teenagers' beliefs about the seriousness of eating disorders and their related susceptibility. The nurse is applying principles from which theory?: The Health Belief Model The belief that health deficits result from an imbalance between the population's health needs and its health-sustaining resources is the premise of which theory? Milio's framework The community health nurse is teaching a prenatal class and includes the societal cost of fetal alcohol syndrome in one of the educational sessions. The nurse is demonstrating an understanding of: critical theoretical perspective. Which nurse leader formulated the first theory-based conceptual model for nursing care?: Florence Nightingale Using theory to guide community health nursing practice serves to (Select all that apply.): guide data collection and interpretation in a clear and organized manner, improve community health nursing practice, focus the student on factors that are critical to understanding the situation. The use of theory in population-focused community health nursing encourages (Select all that apply.): a proactive approach to care, development of population-focused programs. A major limitation of the Health Belief Model is that the burden of action related to health behaviors is exclusively on the aggregate: False Chap 5 The nurse working in the community is aware that there are different models for studying the epidemiology of a health condition in a population. One model of investigation of the interrelationships and characteristics of disease is the epidemiological triangle. This model analyzes what three elements?: Agent, host, and environment When chronic disease became a more important cause of death in developed countries, different epidemiologic models were developed to study the many factors involved in the development of these health conditions. Which is an example of such a model?: Web of causation In the 1850s, a researcher studied a cholera epidemic among people living in different sections of London. The researcher who used epidemiologic methods to study the epidemic and used rates as an epidemiologic tool was: John Snow. A community health nurse participating in planning programs for the coming year considers incidence rates to better understand the needs of the community. Which statement below is the most accurate explanation of incidence rates?: New cases of a disease or condition in a community over a period of time are included in incidence rates. An epidemic is occurring in a public health nurse's community, and the nurse is working with the epidemiologist and other health professionals seeking to identify the causative agent. What phrase best describes such efforts?: Analytic epidemiology A community nurse is reviewing health statistics to gain a better understanding of a population's health needs. Crude rates are available for several health occurrences. What statement accurately describes crude rates?: In calculating a crude rate, the average population size may be used as denominator. The percentage of deaths resulting from a specific cause provides the nurse with information about areas in which public health programs might make significant contributions in reducing deaths. Select the statistic often used for this purpose: Proportionate mortality rate The health literature accessed by the community health nurse often addresses the probability of an adverse event. What term refers to the likelihood that healthy people exposed to a specific factor will experience a specific health condition?: Risk Through epidemiologic investigations, effective prevention measures are often identified. When the nurse is engaged in providing prevention for the community before disease has developed, the prevention activities meet the definition for what level of prevention?: Primary The public health nurse is working with a specific population and is preparing to participate in a descriptive epidemiology study. Which of the statements apply to descriptive epidemiology? (Select all that apply.): Descriptive epidemiology seeks to answer questions about the amount of disease in a given population, Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population Chap 6 One dimension of a community, which looks at personal characteristics and risks of a group, is called: aggregate of people Which group is an example of a community of solution?: A group concerned with reducing teenage suicides. Which source of information about a community's health would give the community health nurse information about births, deaths, and marriages and aid in providing indicators of population growth or reduction?: Vital statistics A community health nurse in the assessment phase of the nursing process conducted research to identify the distribution pattern of breast cancer within a population and the associated risk factors. This is called: epidemiology. One of the first steps in community assessment may involve the community health nurse driving or walking through an area and making observations about such things as environmental layout and location of agencies, hospitals, industries, and so forth. This is called a(n): windshield survey. Which method of gathering data is most effective for remote and vulnerable segments of a community and for those communities with underdeveloped opinions? Focus groups When writing a community diagnosis, the community health nurse notes that the "among" phrase: specifies the aggregate that will benefit from the nurse's plan. Identify the etiologic or causal statement component of the following community diagnosis: "There is an increased risk for undetected testicular cancer among young men related to insufficient knowledge about the disease and the methods for preventing and detecting it at an early stage as demonstrated by high rates of late initiation of treatment.": Insufficient knowledge about the disease and methods of prevention Epidemiologic data can be useful in the planning phase of the community assessment process because they: help construct benchmarks to gauge achievement of program objectives. The steps in the community assessment process for community health nurses are (Select all that apply.): writing a community diagnosis, evaluating the outcomes, collecting assessment data, planning community interventions Chap 7 A community health nurse working as a school health nurse conducted a community assessment and determined that the focus of programs and health education for the academic year should address the problem of childhood obesity. In planning, it is important for the nurse to allow time for individual nursing assessment and education for children who are overweight or obese and to plan classroom education programs. The nurse is demonstrating an understanding of which important community health nursing concept?: Aggregate health care What legislation resulted in increased consumer involvement in the U.S. health care system and a review of the allocation of health care resources?: National Health Planning and Resources Development Act A community health nurse is using the Health Planning Model to improve a client's health. The nurse prepares for unexpected problems or complications in the client's care. This attention to unexpected problems takes place during which step?: Intervention Before participating in health care planning, a community health nurse must understand the concept of: community as client. The community health nurse understands that a client's health can be negatively or positively affected by his or her suprasystem. Which correctly describes a client's suprasystem? The suprasystem includes: all resources available for use by the client, including health-related and non-health-related resources Systems theory provides a framework that includes interventions that are possible at the three levels of prevention. The level of prevention that includes early diagnosis is: secondary prevention Public service announcements, dissemination of pamphlets, and focus groups are examples of measures that can be used by the community health nurse. These are also known as: nursing interventions Which of following factors is not necessary to consider when determining priorities for health problem interventions?: The nurse's preferences The rationale behind the Affordable Care Act was to: put individuals, families, and small business owners in control of their health care. The Affordable Care Act of 2010 included several elements that involve health planning. These elements include (Select all that apply.): Reducing premium costs for millions of working families and small businesses, Capping out-of-pocket expenses, Prohibiting denial of coverage because of a preexisting condition, Covering the cost of preventive care Chap 14 How would a community health nurse use Executive Order 12898?: Recognize that it would help achieve environmental justice. Using critical theory when exploring issues of environmental health ultimately allows the nurse to: alter the precursors of poor health Which intervention would be the most appropriate to implement for a community that has a high risk for environmental health hazards?: Involve citizens in decision-making processes about proposed activities that could pose an environmental threat A public health nurse is surveying a population of coal miners. Which question would elicit information about related risk to a miner's children?: "How close do you live to your workplace?" Approaching health at the aggregate level is the initiative of which agency or document": Healthy People 2020 When building a collective strategy by framing an environmental problem, the community health nurse should ask which question?: Who is affected by the problem? A primary role of the community health nurse in facilitating community participation and partnership is: educating about environmental health hazards When assisting specific aggregates, which should be included in the community health nurse's outcomes?: Helping people learn from their own experiences and analyzing the world with the intention to change it An emergency department nurse assesses a 25-year-old patient with tachycardia, headache, and nausea. The patient denies drug use, heart problems, and smoking. She works from her house and states that everyone in her house has had the "flu" but that she is the only one who has not been feeling better. The nurse notices that the patient lives in the historic section of the town. What environmental hazard should the nurse be primarily concerned about?: Housing quality A community health nurse would include which in her assessment of environmental health? (Select all that apply.): Work-related exposures, Atmospheric quality, Radiation risks

Compare and contrast the epidemiologic triangle with the wheel model

Epidemiology Triangle: analyze three elements: agent, host, & environment. Examples of Agent of disease: causal factors nutritive elements (excesses, deficiencies), chemical agents (poisons, allergens), physical agents (ionizing radiation, mechanical), infectious agents (metazoa, protozoa, bacteria, fungi, viruses, rickettsia). Host Factors of disease (susceptibility, or response to agent): Ex. chickenpox affect older adults more severely than younger kids genetic, age, sex, ethnic group, physiological state, prior immunological experience (active/passive), intercurrent or preexisting disease, human behavior. Environmental factors of disease (extrinsic factors) influence existence of the agent, exposure, or susceptibility to agent: Ex. physical environment (climate, air, water, geology), biological/ecological environment (human populations, flora, fauna), socioeconomic environment (occupation, urbanization, and economic development, disruption) Wheel Model of Human-Environment Interaction: Multiple-causation rather than single-causation disease theory. Useful for analyzing complex chronic conditions with a GENETIC link. Ex: HTN, diabetes, obesity, cancers. Genetics is at the core and surrounding it is social environment, physical environment, and biological. Depending on the disease, one of these may have a more dominant environment.

Meaning of "thinking upstream", and important factors for focus

Examining the root causes of poor health; actions focus on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world Factors: Demographic variables (age, sex, race, ethnicity), sociopsychological variables (personality, social class, peer, reference group pressure), structural variables (knowledge about dz & prior contact with the dz)

Healthy people 2020

Healthy People 2000 built on the first surgeon general's report. Healthy People 2000 contained the following broad goals 1. Increase the span of healthy life for Americans. 2. Reduce health disparities among Americans. 3. Achieve access to preventive services for all Americans. The purpose of Healthy People 2000 was to provide direction for individuals wanting to change personal behaviors and to improve health in communities through health promotion policies Healthy People 2010 listed two broad goals: Goal 1: Increase quality and years of healthy life. Goal 2: Eliminate health disparities The first goal moved beyond the idea of increasing life expectancy to incorporate the concept of health-related quality of life (HRQOL). This concept of health includes aspects of physical and mental health and their determinants and measures functional status, participation, and well-being. Practitioners should incorporate these objectives into programs, events, and publications whenever possible and should use them as a framework to promote healthy cities and communities. Selected relevant objectives are presented throughout this book to acquaint future community health nurses with the scope of the Healthy People 2020 initiative and to enhance awareness of current health indicators and national goals

9. Describe the actions of John Snow and their significance

In 1854, when an English physician, anesthetist, and epidemiologist named John Snow demonstrated that cholera was transmissible through contaminated water. In a large population afflicted with cholera, he shut down the community's water resource by removing the pump handle from a well on Broad Street and carefully documented changes as the number of cholera cases fell dramatically While exploring the cholera epidemics in London in 1855, Dr. John Snow collected data about social and physical environmental conditions that might favor disease development. He specifically examined the contamination of local water systems. Snow also gathered information about people who became ill—their living patterns, water sources, socioeconomic characteristics, and health status. A comprehensive database helped him develop a theory about the possible cause of the epidemic. Snow suspected that a single biological agent was responsible for the cholera infection, although the organism, Vibrio cholerae, had yet to be discovered. He compared the death rates among individuals using one water well with those among people using a different water source. His findings suggested an association between cholera and water quality

Lillian Wald's

Lillian Wald's political activism and vision were shaped by feminist values. Working in the early 1900s, she recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Wald appeared frequently at the White House to participate in the development of national and international policy.

Assumptions of the Health Belief Model

The HBM is based on the assumption that the major determinant of preventive health behavior is disease avoidance. The concept of disease avoidance includes perceived susceptibility to disease "X," perceived seriousness of disease "X," modifying factors, cues to action, perceived benefits minus perceived barriers to preventive health action, perceived threat of disease "X," and the likelihood of taking a recommended health action. Disease "X" represents a particular disorder that a health action may prevent. It is important to note that actions that relate to breast cancer will be different from those relating to measles. For example, in breast cancer, a cue to action may involve a public service advertisement encouraging women to make an appointment for a mammogram. However, for measles, a cue to action may be news of a measles outbreak in a neighboring town.

7. Describe historical public health measures.

The following sections briefly trace the evolution of organized public health and highlight the periods of prerecorded historical times (i.e., before 5000 BCE), classical times (i.e., 3000 to 200 BCE), the Middle Ages (i.e., 500 to 1500 CE), the Renaissance (i.e., fifteenth, sixteenth, and seventeenth centuries), the eighteenth century, the nineteenth century, and into the present day Florence Nightingale was the first nurse to exert political pressure on a government. In the 1850s Nightingale was asked to establish the first nurse corps to tend the soldiers in the Crimea War. She transformed military health and knew the value of data in influencing policy. She was a leader who knew how to use the support of followers, colleagues, and policy makers. As discussed in Chapter 2, Nightingale collected and analyzed data about health services and outcomes, an activity that now is a critical element of public health. Sojourner Truth beginning in the 1840s became an ardent and eloquent advocate for abolishing slavery and supporting women's rights. Her work helped transform the racist and sexist policies that limited the health and well-being of African Americans and women. She fought for human rights and lobbied for federal funds to train nurses and physicians. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. In 1882, she successfully persuaded Congress to ratify the Treaty of Geneva, which allowed the Red Cross to perform humanitarian efforts in times of peace. This organization has had a lasting influence on national and international policies. Lavinia Dock was a prolific writer and political activist. She waged a campaign for legislation to allow nurses to control the nursing profession instead of physicians. In 1893, with the assistance of Isabel Hampton Robb and Mary Adelaide Nutting, she founded the politically active American Society of Superintendents of Training Schools for Nurses, which later became the National League for Nursing. She was also active in the suffrage movement, advocating that nurses support the woman's right to vote. Lillian Wald's political activism and vision were shaped by feminist values. Working in the early 1900s, she recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Wald appeared frequently at the White House to participate in the development of national and international policy. Mary Breckenridge worked to develop nursing in rural Kentucky in the 1920s, establishing the Frontier Nursing Service. Susie Walking Bear Yellowtail was a Native American nurse who walked from reservation to reservation, working to improve health services for this population from the 1930s to 1960s. She also established the Native American Nurses Association. Florence Wald was a nursing leader in establishing hospice care in the United States— modeled after similar services offered in the United Kingdom—in the 1970s. Dr. Ruth Watson Lubic is a nurse-midwife who crusaded for freestanding birth centers in this country, being influential in the opening of New York City's first birthing center in 1975. After developing the birth center model through the Maternity Center Association in New York City, Dr. Lubic expanded the model to Washington, DC, where the infant mortality rate was twice the national average. In 1993, Lubic was awarded the MacArthur Fellowship Grant and, in 2001, the National Academy of Medicine's Lienhard Award

Microscopic approach

The individual patient is the microscopic focus, Whereas society or social economic factors influencing health status are the macroscopic focus When the individual is the focus, the micro focus contains the health problem of interest (e.g., pediatric exposure to lead compounds). In this context, a microscopic approach to assessment would focus exclusively on individual children with lead poisoning. Nursing interventions would focus on the identification and treatment of the child and family. However, the nurse can broaden his or her view of this problem by addressing removal of lead sources in the home and by examining interpersonal and intercommunity factors that perpetuate lead poisoning on a national scale. Microscopic Approach • Examines individual, and sometimes family, responses to health and illness • Often emphasizes behavioral responses to an individual's illness or lifestyle patterns • Nursing interventions are often aimed at modifying an individual's behavior by changing his or her perceptions or belief system

food desert

There are significant disparities in access to healthy and fresh food supplies, with poor minority families being more likely to live in a food desert—a neighborhood with little to no access to healthy foods

The factors in a person's life that are most likely to influence health status.

These include physical (structure/function), social, role, mental (emotional and intellectual), and general perceptions of health status. Health status: Work or school attendance, disease categories, mortality, health care use, and population growth and population pressure measurements (e.g., rates of birth and death, divorce, unemployment, and drug and alcohol abuse).

Describe primary, secondary, and tertiary prevention levels

When interventions occur before disease development, they are called primary prevention. Primary prevention relies on epidemiological information to indicate those behaviors that are protective, or those that will not contribute to an increase in disease, and those that are associated with increased risk. Those actions that are general in nature and designed to foster healthful lifestyles and a safe environment are called health promotion. Actions aimed at reducing the risk of specific diseases are called specific protection. For example, numerous research studies have confirmed that regular exercise is an important health promotion activity that has positive effects on general physical and mental health. Immunizations exemplify specific protection measures that reduce the incidence of particular diseases. Secondary prevention occurs after pathogenesis. Those measures designed to detect disease at its earliest stage, namely screening and physical examinations that are aimed at early diagnosis, are secondary prevention. Interventions that provide for early treatment and cure of disease are also in this category. Again, epidemiological data and clinical trials determining effective treatments are crucial in disease identification. Mammography, guaiac testing of feces, and the treatment of infections and dental caries are all examples of secondary prevention. Tertiary prevention focuses on limitation of disability and the rehabilitation of those with irreversible diseases such as diabetes and spinal cord injury. Epidemiological studies examine risk factors affecting function and suggest optimal strategies in the care of patients with chronic advanced disease.

IPREPARE mnemonic as a tool for taking an environmental health history

• I - INVESTIGATE potential exposures (when in contact with something, when at home or work) • P - PRESENT WORK (what exposed to, MSDS location, PPE, coworkers with health problems) • R - RESIDENCE (age, location, heating type, stored chemicals, drinking water source • E - ENVIRONMENTAL concerns (concerns about air, water, soil in neighborhood; industries / farms / landfill / waste-site nearby) • P - PAST WORK *****(experience, longest work period, military, farm, seasonal or volunteer work)****** IMPORTANT***** • A - ACTIVITIES (hobbies, burn / solder / melt, garden / fish / hunt, eat what is grown or hunted, alternative healing) • R - REFERRALS & RESOURCES • E - EDUCATE (materials available to client, plan for follow up)