NURS 473 EXAM 1
Tertiary prevention
-Facilitating support group for stroke survivors -Teaching asthma self-management to children with asthma -Case management of care coordination for people with cancer -Rehab programs -End of life care
Guiding principles of health literacy
1. Ensure public health information and services are appropriate, actionable, and easy to understand and use. 2. Involve representatives from your target audiences in planning, implementing, disseminating, and evaluating health information and services. 3. Develop key partnerships to help facilitate change, influence behavior and generate interest in health literacy. 4. Support changes to improve public health professionals' health literacy skills.
How to determine prevention levels
1. Identify the health problem, the population at risk for the problem and the natural history of the health problem 2. Determine which stage in the natural history of the health problem the intervention aims to intervene for the population 3. Finally, link the stage in the natural history of the health problem to the level of prevention
Ten Great Public Health Achievements
1. Immunizations 2. Improvements in motor vehicle safety 3. Workplace safety 4. Control of infectious diseases 5. Decline in deaths from heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of water 10. Tobacco as a health hazard
Lilian Wald
1893 - arrived at Lower East side of NYC during a bad depression - gave patients ice, sterilized milk, meds, meals, and referrals to hospitals. Were also able to provide jobs. Worked a lot with immigrants 1895 - opened Henry Street Nurses' Settlement with other nurses, activists, lawyers, union organizers, and social reformers 1917 - nurses visited sick people in their homes 1933 - Wald managed 265 nurses who cared for 100,000 patients. Provided needed healthcare for the poor that was not available anywhere else
Nursing diagnosis
A statement that synthesizes assessment data A diagnosis is a label that both describes a situation (or state) and implies an etiology (cause) A nursing diagnosis limits the diagnosis process to those diagnoses that represent human responses to actual or potential health problems that nurses are licensed to treat Clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community and provides the basis for selection of a nursing intervention Provides basis for selection of nursing interventions to achieve desired outcomes
Health policy
A subset of public policy Health policy refers to decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society An explicit health policy can achieve several things: it defines a vision for the future which in turn helps establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people Health police includes laws to promote the health of citizens. Health policy is established in many ways: legislation, rules, regulations, and institutional mission and goals. Health policies determine what services are paid for and by whom, who is eligible to receive care, and who qualifies for financial assistance Examples: Medicare, Medicaid, ACA
Health policy development
Agenda setting: problems are defined and issues are raised. Gatekeepers filter out those which will be given attention by either executive or the legislative branches Formulation: Analysis and politics determines how the agenda item is translated into an authoritative decision: a law, rule or regulation, administrative order, or resolution Alternative policy proposals: put forth, claiming to inject rationality and technical analysis within the process. Policy analysts bring these alternatives to the attention of political decision makers with their recommendations. The policy prescription is chosen among the alternatives, including the no-action option. This is usually accomplished by building the support of a majority. What is produced here is a binding decision or series of decisions by elected or appointed officials who are not necessarily experts but who are presumably accountable to the public. Implementation: the authorized policy must be administered and enforced by an agency of government. The agency must take instructions as stated in the policy, but will probably be called upon to provide missing pieces and to make judgements as to intent, goals, timetables, program design, and reporting methods. The agency's mission may be well defined or poorly understood, but the field of action has shifted. Budgeting: financial resources must be brought to bear within an ongoing annual stream of cycles. Budget decisions are generally made with partial information and by changes from year to year which are only slightly different from the year before, a process called incrementalism. In recent years, budget constraints have significantly elevated budget considerations in importance within the policy cycle. Budget items are highly competitive but essential for policy delivery. Evaluation: the impacts of the policy may be assessed. If goals exist, the effectiveness of the policy and its components can be determined. Side effects must also be discovered and reckoned. The output of evaluation may be no change, minor modification, overhaul, or even (but rarely) termination. The feedback provided by evaluation is injected back into the agenda-setting stage, thus closing the loop of the cycle.
U.S. healthcare compared to other countries
Americans currently pay about twice as much per capita on healthcare as our peers do in other advanced nations, yet our healthcare outcomes are no better Healthcare costs skyrocket after age 70 in the US, while other countries see a slight incline if that We have the lowest health system performance and the highest healthcare spending Australia, Netherlands, and UK are doing the best U.S. ranked last on performance overall, ranked last on the Access, Administrative Efficiency, Equity, and Healthcare Outcomes domains. U.S. healthcare is an outlier
Public health nursing evidence based practice (EBPHN)
An approach to public healthcare practice in which public health nurse is aware of the evidence in support of his or her clinical practice, and the strength of that evidence According to ANA, nurses must use evidence-based principles. EBP is infused throughout the standards Standards of professional performance state that nurses must use best current evidence to guide practice Uses the highest quality of knowledge in providing care to produce the greatest impact on a population's health status and healthcare Includes: knowledge and research, clinical expertise and judgement, input from community members and other stakeholders
After community assessment
Analyze the data Formulate a community nursing diagnosis Plan/implement an intervention for the community Evaluate the intervention
Organizational policy
Applies to groups that have similar interests Examples: League of Women Voters, NSNSA, ANA
How to care for populations
Apply the nursing process: Find information using analysis and create priorities of care. Formulate nursing diagnosis.
ANA Standards of Public Health Nursing
Assessment Population and diagnosis Outcomes identification Planning Implementation -Coordination of care -Health teaching and health promotion -Consultation -Prescriptive authority and treatment not applicable -Applies public health laws, regulations, and policies Evaluation Professional performance: Ethics Educations Evidence-based practice and research Quality of practice Communication Leadership Collaboration Professional practice evaluation Resource utilization Environmental health
CAP assessment
Assessment: CORE: demographics, ethnicity/culture, values & beliefs Subsystems: physical environment, education, health and social services, economics, etc. Quantitative: Pima Maps, American Community Survey, Internet sites of assets in or nearby the community Qualitative: windshield survey and key informants
Appraising media quality
Authoritative: indicate qualifiactions of authors Complentarity: info supports, not replaces, patient-doctor relationship Privacy: respects privacy of personal data submitted to the site by visitor Attribution: cites the sources of published info Justifiability: site backs up claims relating to benefits and performance Transparency: accessible presentation, accurate email contact Financial disclosure: identify funding sources Advertising policy: clearly distinguish advertising from editorial content
NAAL literacy levels
Below basic: Adults at the below basic level have only the most elementary literacy skills. These skills range from being non- literate in English to being able to locate easily identifiable information in short, commonplace prose text. An adult at the below basic literacy level might be able to locate and circle the date of a medical appointment on a hospital appointment slip. Basic: Adults at the basic level have the skills necessary to perform simple, everyday activities such as reading and understanding information in short, commonplace texts. An adult at the basic literacy level might be able to state two reasons a person with no symptoms of a disease should be tested for the disease, based on information in a clearly written pamphlet. Intermediate: Adults at the intermediate level have the literacy skills necessary to perform moderately challenging activities, such as summarizing written text, determining cause and effect and making simple inferences. An adult with intermediate literacy skills might be able to determine a healthy weight range for a person of a specified height, on the basis of a graph that relates height and weight to body mass. index. Proficient: Adults at the proficient literacy level have the skills to perform complex activities, such as integrating, synthesizing and analyzing multiple pieces of information. An adult at the proficient level might find the information required to define a medical term by searching through a document. 12% of population
Determinants of health
Biology and genetics Individual behavior Social factors: -Social determinants -Physical determinants: built and natural environment Access to health services Policymaking: smoking laws, etc.
Experimental design
Can help answer questions: did program make a difference, have health behaviors, knowledge, attitudes changed The design requires random assignment to a control group and an experimental group Difficult to implement due to ethical, political, and community health reasons. However, the method remains the best to evaluate impact of a program Pretest-posttest one group design: applied to one group Pretest-posttest two group design: experimental and control group Usefulness to evaluation: appropriate for impact (short-term) results. It can also provide outcome data
Participatory observation
Collect data through personal involvement with a group of people or community
Planning actions
Community health goals: develop a good goal Program activities: actions necessary to attain goal Learning objectives: development of SMART objectives Collaboration: work toward consensus. Be a role model Resources, constraints and revised plans: identify resources and be clear about constraints Record meeting notes/progress for sharing with partners
Community engagement and policy alignment
Community ownership of the program/intervention will help ensure that the program will be sustained. The program should be connected to some overarching policy or plan (HP 2020, Pima County Health Needs Assessment, addressing an organizations strategic priority)
Social determinants of health
Conditions in the environment where people live, work, worship, play, etc. Affects a wide range of health functioning and quality of life outcomes and risks. May limit opportunities for good health choices Economic stability: poverty, employment, food insecurity, housing instability Education: high school grad, higher education, language and literacy, early childhood education and development Social and community context: social cohesion, civic participation, discrimination, incarceration Neighborhood and built environment: access to foods that support healthy eating patterns, quality of housing, crime and violence, environmental conditions
Cost-benefit analysis
Consequences or benefits of a program are valued in terms of dollars All measures costs and benefits are based on dollars
Criticalappraisalofevidenece
Core competency for meeting ANA standards Evaluating the research for its quality and applicability to healthcare decision-making (purpose, setting, sample) What has been done? How did it work and how can I use it? How does the purpose of the research compare to my goals? How similar is the setting and populations? How big was the sample? Assessing the strength of scientific evidence with ranking systems: Known as levels of evidence. Most based on research designs. Stronger the level of evidence, greater probability that application of evidence will be effective Many rating taxonomies exist
The core
Demographics: age, race, sex, ethnicity (can be ancestry, family composition, marital status) Health indicators: birth, death, and morbidity, health behaviors Culture and religion Health beliefs and practices Values Can be gathered from either informatics or qualitative info gathered from interviews
Public health core functions and essential services
Describe the public health activities that all public health organizations should undertake. Working definition for practice of public health. Serve as a basis for local health departments accreditation standards Core function 1: ASSESSMENT - collecting and analyzing info about health problems Essential service 1: *monitor health* status to identify community health problems Essential service 2: *diagnose and investigate* health problems and health hazards in the community Core function 2: POLICY DEVELOPMENT - consult stakeholders to decide appropriate interventions Essential service 3: *inform, educate, and empower* people about health issues Essential service 4: *mobilize community partnerships* to identify and solve health problems Essential service 5: *develop policies* and plans that support individual and community health efforts Core function 3: ASSURANCE - making sure necessary services are provided to reach agreed upon goals Essential service 6: *enforce laws* and regulations Essential service 7: *link* people to needed personal health services and assure healthcare Essential service 8: *assure a competent public health and personal healthcare workforce* Essential service 9: *evaluate* effectiveness, accessibility, and quality of personal and population-based health services Essential service 10: *research* for new insights and innovative solutions to health problems
SMART objectives
Describes results to be achieved and the manner in which results will be achieved. They represent annual mileposts to be achieved relevant to achieving corresponding goals and strategies CDC criteria: SMART and relates to a single result and is clearly written
Populations at risk of inadequate health literacy
Did not obtain health info over the Internet Did not graduate high school Disabled Did not speak English before school No medical insurance Hispanic adults Age 65+ Black adults Adults reporting poor health
Hospitals and population health nursing
Disaster planning Occupations health and wellness programs Infection control Affordable care act: focus on wellness, treat the health of patient populations, increase access to care, community health needs assessment
Sharing or dissemination of findings
Dissemination is the process of communicating the procedures or the lessons learned from an evaluation to relevant audiences in a timely, unbiased, and consistent fashion Like other elements of the evaluation, the reporting strategy should be discussed in advance with intended users and other stakeholders. Planning effective communications also requires considering the timing, style, tone, message source, vehicle, and format of information products Regardless of how communications are constructed, the goal for dissemination is to achieve full disclosure and impartial reporting
Cost-effectiveness analysis
Does not place a dollar value on either the consequences or the cost of a project Other outcomes such as a decrease in unhealthy behavior is measured (i.e. decreased teen suicide)
Community nursing diagnosis
Does not use "as evidenced by" when the nursing diagnosis "at risk" however in the community setting we are looking at prevention as the focus - therefore the at risk and as evidenced by is included in the community nursing diagnosis. Community responses need to reflect aggregates (groups of people) in the community experiencing the problem. For N473: Risk of (health issue) Among (who, community) Related to (etiology... cause of health issue) As demonstrated (evidenced) by (data or interview)
EBPHN vs EBP
EBPHN is more often based on quasi-experimental and observational rather than experimental designs Has a smaller volume of evidence Has outcomes which are longer Impacts team rather than individual decision-making
Education
Educational status Schools and colleges Libraries Child care centers Ed and literacy programs
American Community Survey
Every 10 years, Congress authorizes funds to conduct a national census of the U.S. ACS is a nationwide, continuous survey designed to provide communities with reliable and timely demographic, housing, social, and economic data every year. Collects info throughout the decade rather than once every 10 years. Many parties have access to it. Data is released in the year directly after the year in which they are collected Main function of decennial is to provide counts of people. ACS collects continuous data, while decennial only collects over a couple of months
Ecological studies
Examine relationship between exposure and disease with population-level data rather than individual level data. Relationship between poverty and diabetes
Economics
Financial statistics: income, unemployment rate, poverty rates, home values. Availability and conditions of businesses in community
Levels of prevention and health intervention
Focus on health not on the activities of the program How to stay focused on health is to stay focused on risk - what we are trying to prevent Interventions and prevention: identify the health problem, population at risk for the problem and the stage of natural history of the health problem Determine which stage in the natural history of the health problem the intervention aims to intervene for in the population Link the stage in the natural history to the level of prevention Ensure linkage to overarching police, strategy, etc. (HP 2020, Pima Health Needs Assessment)
Focus groups
Form of research where data is collected from a group of people answering questions and interacting with each other
Kinds of communities
Geographic boundaries: census tracts, neighborhoods Face to face: places of work and school Online: Facebook, online classes Of concern: PTAs, political groups Of special interest: church groups, sports teams, clubs, frats/sororities Resource community: support groups Of identifiable need: people living in public housing or shelter Not just a place where people live
Assessment
Getting to know and understand the community (the people, relationships with agencies, organizations, institutions, and the physical environment) Identifying strengths (resources and protective factors) and clarifying stressors (needs, problems, concerns, and risk factors) Data collection: Data gathering: existing data, quantitative and qualitative (demographics, crime stats) Data generation: collecting of new info - usually qualitative. Includes observation about the people and the community. Investigating knowledge, beliefs, values, perceptions
Secondary prevention examples
Goal is to detect and/or treat early to prevent permanent disability -Screening for TB and providing therapy for latent TB -Blood pressure screening and referral of those with elevated readings for further evaluation and treatment -Teaching the lay public to recognize symptoms of stroke and take action -Teaching breast self-exam -Teaching first aid
Public policy
Government policies that affect the whole population Policy is defined as a plan or course of action, as a government, political party, or business, intended to influence and determine decisions, actions, and other matters The development of policy includes the choices that a society, organization, or group makes regarding their goals and priorities, including how they allocate resources The policy formed reflects the values, beliefs, and attitudes of those who are designing the policy Examples: civil rights, environmental laws
Institutional policy
Governs worksites. Applies to groups that have similar interests. Examples: U of A, Banner-UMC, Raytheon
Consequences of limited health literacy
Have difficulty taking meds appropriately and interpreting labels and health messages Have higher rates of hospitalization, emergency care visits, and lower rates of flu immunization Have less health knowledge and comprehension of health information Are more likely to report their health as poor In particular, seniors' limited health literacy is associated with worse health status and quality of life and early mortality Community level: Misunderstandings about public health warnings about food safety Missed opportunities for services, such as free vaccines and preventive screenings Lack of preparation for emergencies, such as severe weather, bioterrorism, and evacuations Missed warnings regarding environmental health and safety, such as contaminated water
Single payer system
Healthcare system in which one entity - a single player - collects all healthcare fees and pays for all healthcare costs. Proponents of a single-payer system argue that because there are fewer entities involved in the healthcare system, the system can avoid an enormous amount of administrative waste. Instead, all healthcare providers in a single-payer system would bill one entity for their services. Within a single-payer system, all citizens would receive high-quality, comprehensive medical care PLUS the freedom to choose providers. Paperwork would be dramatically reduced with the elimination of bills, co-pays and deductibles.
Good goals
Help establish the overall direction for and focus of a program, define the scope of what the program should achieve, and serve as the foundation for developing program objectives Describe the overall mission or purpose of the program Are broad statements of program purpose that describe the expected long-term effects of a program Declarative: provides complete sentence that describes a program outcome Jargon-free: uses language that most people in the field outside of your agency can understand Short: uses few words Concise: gets the complete idea of your goal acorss as simply and briefly as possible leaving out unnecessary detail Easily understood: uses language that is clear Positive terms: frames the outcomes in positive terms or in terms of a decrease in risk behaviors or health outcomes. Avoids use of double negatives Framework strategies and objectives: provides a framework so that the strategies and objectives are stepping stones to make progress to achieve goals Steps: 1. Specify a health problem (obesity, asthma, AIDS) or health risk behavior (inadequate physical activity, poor diet, tobacco use) 2. Identify the target population that will be changed as a result of a successful project
Planned change
In Lewin's stages of planned change: there is discussion about forces that "unfreeze" (driving forces) and forces that "refreeze" (restraining forces). These "freezing" and "refreezing" forces can also be thought of as CAP model strengths and stressors. Constraints can be in the area of staff, budget, space, etc. but constraints can also be cultural issues, political concerns, community readiness, and numerous other restraining factors hindering change Unfreezing: at risk population becomes aware of the problem - problem diagnosed and solutions identified Moving: change actually occurs, the problem is clarified, and the program is planned and begins Refreezing: when the idea is established and continues to be influential and then the accomplished changes become integrated into the values of the client system
Data generation methods
Key informant interviews Participant observation - supports building partnerships Windshield survey Written surveys Focus groups
Levels of evidence
Level I: evidence from a systematic review or meta-analysis of all relevant RCTs or EB clinical practice guidelines based on systematic reviews of RCTs Level II: evidence obtained from at least one well-designed RTC Level III: evidence obtained from well-designed controlled trials without randomization Level IV: evidence from well-designed case control studies Level V: evidence from systematic reviews of descriptive and qualititative studies Level VI: evidence from a single descriptive or qualitative study Level VII: evidence from the opinion of authorities and/or reports of expert committees
Communication
Looks at how information is accessed and shared in the community Radio and TV Newspapers, newsletters, and flyers Billboards and bulletin boards Languages used Internet access and use
Case study evaluation
Looks inside the program to determine adequacy to meet stated needs Observation and interviews: selective perception (can lead to bias from evaluator), interactiveness (effect of being evaluated on those being observed) Nominal group: based on notion that people within the program are most knowledgable - structured group meetings Delphi technique: two-step questionnaire process Usefulness to evaluation: questions of relevance and progress can be addressed
Key features of ACA
Major provisions include: Expand access to insurance coverage: expand Medicaid to cover people below 133% of federal poverty guidelines. Crate insurance exchanges where people can purchase insurance and, if they have low incomes, receive federal dollars to help pay for the insurance. Increase consumer protections: prohibit lifetime monetary caps on insurance coverage and limit the use of annual caps. Prohibit insurance plans from excluding coverage for children with pre-existing conditions Emphasize prevention and wellness Improve quality and system performance Expand the health workforce Curb rising healthcare costs Since ACA was passed, 16.4 million people have become covered by insurance. Increases the cost of the federal and state governments by enacting Medicaid expansion - Medicaid can now include people above the poverty level. Government covers 100% of the cost for a certain amount of time and then reduces to 90% of the cost of the program. Low income children will always be covered under the CHIP program.
Data gathering sources
Maps Organizations' records and reports Meeting minutes Community resources manuals, brochures, and flyers Grant applications Newspapers and newsletters Census data and vital stats Internet resources: U.S. Census Geographic information system technology (GIS) City, county and state government sites Websites for local organizations and institutions
Monitoring process
Measures the difference between the program plans and what actually happened Focuses on the sequence of activities: how the program was implemented, who implemented which part, when were the program components implemented, monitoring charts (need inputs, process, and outputs) Usefulness: to tell if programs are on schedule and within budget, good for process evaluation, helpful with evaluating cost-efficiency
Public health
Organized measures (public or private) to prevent disease, promote health, and prolong quality of life among the population as a whole. It is a multidisciplinary specialty Public health nursing: practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. Emphasizes primary prevention. Clients can be individuals and families, but the focus, priority, and target of care is the population. Settings: health departments, other governmental organizations, non-profit health and social service agencies, work sites, schools, community health centers, faith-based organizations, international organizations and hospitals
Healthy people 2020
Overarching goals: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages
Recreation
Parks and playgrounds Paths and trails Gyms/recreation centers Theaters, bowling alleys, video game parlors Shopping malls Spectator sports
Health policy debate surrounding the ACA repeal and replace
Patient Protection and ACA requires most individuals to maintain health insurance coverage or potentially pay a penalty for noncompliance. Most are required to maintain minimum essential coverage for themselves or their dependents. May receive federal funding if qualified. Those who do not follow this will be penalized and the penalty increases every year.
Community
People and the relationships that emerge among them as they develop and use in common some agencies and institutions and a physical environment A group, population or cluster of people with at least one common characteristic, such as geographic location, occupation, ethnicity, or housing condition People do not need to know each other to be a community
Total population health
Perspective of health, field of study, and practice specialty Population can be geographical or other groups such as employees, ethnic groups, disabled personas, or prisoners Focuses on health outcomes of a group of individuals, including the distribution of such outcomes within a group. Includes patterns of health determinants and policies and interventions that link these two In its broadest sense, it is identical to a broad definition of public health Population health management or population health medicine: when the population is based on a disease or health problem
Politics and government
Political/government boundaries and representatives Voting statistics Political activity Residential groups
Race and ethnicity
Population-based data on race and ethnicity is gathered from self-reports, so people are categorized into the groups they identify with There are huge inconsistencies in how organizations gather data about ethnicity/race
Basic models for program evaluation
Process: evaluation Are we doing what we said we would do? Info to collect: site response, recipient response, practitioner response Effectiveness - impact (short-term evaluation) Concerned with the immediate impact of a program on a target group (knowledge, attitudes, perceptions, etc.) Info to collect: knowledge, attitudes, perceptions, skills beliefs, etc. Most evaluations will use this method Outcome: long-term outcomes evaluation Where we find out if the changes had a lasting and real effect Info to collect: incidence and prevalence of risk factors, etc.
Health and social services
Programs, organizations, and institutions that provide health and social services to the community core. Health services include acute care, urgent care, outpatient, LTC, home health, etc. Social services provide food, shelter, clothing, counseling, advocacy, case management, and assistance with daily living
Social policy
Promotes the welfare of the public Examples: social security, temporary assistance for needy families, child labor laws
Safety and transportation
Protective services: fire and police, disaster planning Crime and other hazards Transportation: private, public, road/sidewalk conditions Bikeways
True experimental design
RCTs have this design and are golden standard for evaluating cause and effect Experimental group that receives a treatment or intervention (the independent variable) introduced or manipulated by the researchers, and a control group that receives standard care. People are randomly assigned to their groups
Priorities of care table
Rate stressors by categories Identified in Pima County's Health needs assessment Community expression of interest in addressing problem Nursing students' ability to address problem Availability of resources relevant for addressing problem Severity of outcomes without effort to address problem Then state the applicable HP 2020 determinant of health category Then state an idea for a nursing intervention Then add up all the scores to see which one has the highest priority
Primary prevention examples
Reducing risk factors General health promotion: nutrition, hygiene, exercise Specific health promotion: seat belts, fluoride in water, immunizations Screening for risk factors
Quasi-experimental
Research without randomization OR may not have a control group
Nurses affecting health policy
Reviewing the history of AZ, viewing the maps, scanning the Pima County Health Assessment may give you an idea about some health policy iniitatives It is also important to know the ANA Code of Ethics: obligation to participate in institutional and legislative efforts to promote health and meet national health objectives Steps of a professional nurse: learn the legislative process, stay informed on current issues, identify government representatives, be an active constituent, and speak out.
Participatory action research
Self reflective inquiry that researchers and participants undertake together to improve the health of the community
CAP model
Similar to the nursing process, but it is cyclic with evaluation feeding back into ongoing assessment
Socialized medicine system
Socialized medicine is a system in which the government owns the means of providing medicine. Britain is an example of socialized system, as, in America, the Veterans Health Administration. In a socialized system, the government employs the doctors and nurses, builds and owns the hospitals, and bargains for and purchases the technology
Mixed method design
Some studies may use more than one design/method and so the evidence generated may fall into more than one level
Meta-analysis
Specific method of statistical synthesis used in some systematic reviews, in which the results form several studied are quantitatively combined and summarized
Natural history of a disease
Stage of susceptibility: risk but no disease. *Primary prevention*: targets a disease before onset Stage of early subclinical disease: pathological changes after onset of disease. *Secondary prevention*: targets an asymptomatic disease in order to detect and treat early enough to cure or prevent disability Stage of clinical disease: after onset of signs and symptoms. Usual time of diagnosis. Also *secondary prevention* Stage of recovery or disability: *tertiary prevention*: targets an established and usually permanent health problem
Health policy cycle
Step 1. Problem recognition and definition (assessment): recognizing the problem and defining the problem Step 2. Policy formulation (diagnosis): determine what type of policy is required and who has jurisdiction over the problem. Write a proposal and lobby for passage Step 3. Policy adoption (planning): rules and regulations formulated Step 4. Budgeting and policy implementation (implementation): allocation of resources and public education about the new policy improvement Step 5. Policy evaluation (evaluation): evaluate utilizing appropriate evaluation tools/measures
Analysis of assessment data
Summarize: each subsystem. Could also include areas within census tract that are different. Not all census tracts are the same throughout. Compare: to other communities. Compare census to Pima county Draw inferences: synthesize what you know about the community. What does the data mean? Will identify community strengths and stressors and highlight potential POCs. The inferences form the basis for the community nursing diagnosis. Community involvement is an important step in establishing and maintaining partnerships. Validating the priorities of care is imperative. What is important to you may not be important to the community. Participation and collaboration cannot be underestimated. Success of intervention will depend on community acceptance and involvement. As nurses, we have an ethical obligation for inclusion.
Systematic review
Summary of evidence typically conducted by an expert or expert panel on a particular topic, that uses a rigorous process to minimize bias for identifying, appraising and synthesizing research findings to answer a specific clinical question and draw conclusions about the data gathered. Includes a specific unanswerable question, an explicit and repeatable process and clearly identified criteria for studies to be included and excluded
Public Health Interventions
Surveillance: describes and monitors events through data collection and analysis to plan interventions (P) Disease and health event investigation: gathers and analyzes data regarding threats to health of populations (P) Outreach: locates populations at risk and provides info about the concern and what can be done about it (P) Screening: identifies individuals with unrecognized health risk or asymptomatic disease (P) Referral and follow up: assists individuals and communities to identify and obtain necessary resources in order to resolve problems (I, C, S) Case management: optimizes self-care capabilities of individuals and families and the ability to coordinate and provide services (I, C, S) Delegated functions: direct care tasks that an RN carries out under the authority of a practitioner under law (I, C, S) Health teaching: communicates facts, ideas, and skills that change knowledge and beliefs (I, C, S) Counseling: interpersonal relationship that allows them to increase their capacity to self-care and cope. Engages them at an emotional level (I, C, S) Consultation: seeks information and generates solutions to perceived problems or issues through interactive problem solving (I, C, S) Collaboration: commits two or more persons to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health (I, C, S) Coalition building: promotes and develops alliances among organizations for a common purpose. Builds linkages, solves problems, enhances leaderships (I, C, S) Community organizing: helps community groups to identify common problems or goals, mobilize resources, and develop strategies for reaching the set goals (P) 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 (P) Social marketing: utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors and practices of the population (P) Policy development and enforcement: places health issues in decision-makers agendas, acquires plan of resolution, and determines needed resources. Results in laws, regulation, ordinances, and policies (P)
Resources for PHNEBP
The American Journal of Public Health CDC - Behavioral Risk Factor Surveillance System and Youth Risk Behavior Surveillance System The community guide Healthy People The journal of community health nursing Partners in information access for the public health workforce Public Health Nursing (peer reviewed journal) Sandy Kramer AHSL librarian
Appropriateness of evaluation method
The approach chosen needs to fit the question(s) you wish to answer Four key points need to be considered when deciding which method of data collection to use: What resources are available for the evaluation task? Is the method sensitive to the respondents/participants? How credible will your evaluation be as a result of the method chosen? What is the importance of the data to be collected and to whom?
Health literacy
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Factors that affect how people understand health info: communication skills of public health professionals, level of complexity and novelty of the health information, cultural and linguistic stability of health information, public health infrastructure that facilitates and supports healthy behaviors Individual factors that affect health literacy: individual knowledge and skills, along with past experiences and other demographic, cultural, and environmental factors
Evaluation
The final step in the nursing process, but is linked to the first step of assessment and re-assessment of nursing interventions. Changes are appraised and progress is documented Steps in evaluation: These steps are taken early in the planning process: Engage stakeholders, describe the program, focus the evaluation design These steps are during the intervention and afterwards: Gather credible evidence, justify conclusions, ensure use and share lessons learned Need to know what will be evaluated, what criteria will be used to judge program performance, what standards of performance on the criteria must be reached for the program to be successful, what evidence will indicate performance on the criteria relative to the standards, and what conclusions about program performance are justified based on the available evidence
Case-control and cohort studies
These studies are considered observational or non-experimental Case-control: researchers select a group of people with an outcome of interest and another group without that outcome. Try to find key differences. Cannot determine cause and effect Cohort study: cohort is broken into groups based on exposure. The groups are followed over a period of time to determine health outcomes
Pima County Health Needs Prioritization
Top 4: Anxiety and depression spectrum disorders Substance abuse and dependency Injuries and accidents Diabetes Others CV disease and culturally appropriate services (tied) Oral/dental health Financial health Home environment as tied to health outcomes Access to early intervention, degenerative diseases, direct care workforce, health literacy (tied) LGBT health
Social media main ideas
Types of media including social media and how they can be used to promote health at the primary, secondary, and tertiary levels Advantages and barriers to using social media to teach health topics NAAL literacy levels Identify factors that influence health literacy Recognize those populations at greatest risk for limited health literacy Explain the consequences of limited health literacy
HP 2020 health communication goals
Use health communication strategies and health information technology to improve population health outcomes and health care quality, and to achieve health equity Health communication is important because: Improves healthcarequality and safety Increases efficiency of healthcare and public health service delivery Improve the public health information infrastructure Supports care in the community and at home Facilitates clinical and consumer decision-making Builds health skills and knowledge Mass-reach health communication caused a decrease in the prevalence of tobacco use, increased cessation and use of available services such as quit lines, and a decreased initiation of tobacco use among young people
Strategies to improve health literacy
Use plain language. Use culturally and linguistically appropriate messages. Design messages that are participatory and user-centered. Evaluate the effectiveness of communications. Engage regularly with the communities who are targeted by the communication. Consider the current literacy level of the intended audience, and design messages based on that level.
Surveys
Usually completed by self-administered questionnaires Usually performed for impact (short-term outcome) evaluation Reliability and validity: need to be concerned that what is being asked is repeatable or reproducible (reliability). Need to be sure that the questions measures the claims that need to be measures (validity) Usefulness to evaluation: relevance (need for proposed or existing program) and progress
Cross-sectional studies
Usually surveys or questionnaires. Can be quantitative or qualitative
Choosing an evaluation focus
Usually, questions of evaluation focus on areas of: Relevancy: usually for already existing programs which may have outlived their relevancy. Is there a need for the program? Progress: are program activities following the intended plan? Cost-efficiency: measures/evaluates whether results of a program could have been obtained less expensively through another approach Effectiveness: (impact) (summative; short-term outcomes). Were program objectives met? Outcome: (long-term outcomes). Did the program meet its goal?
Evidence
Verifiable knowledge on which to base belief and action
Health media
Web 1.0: written or video information on the Internet - traditional concept of internet use Web 2.0: resources that allow user interaction and may be user created (social media) eHealth: electronic form of health information mHealth: health information available in mobile phone 80% of adults and 90% of teens have access to Internet People use social media for news now in this order: Facebook, YouTube, Twitter, Google Plus, LinkedIn, reddit, Instagram, Myspace, Tumblr People not using media: adults over 55, people who speak Spanish primarily, people with a household income under $30,000, adults who do not have a high school degree, people with disabilities (i.e. vision or hearing)
Insurance (market-based) system
What the US has now The private insurance system's main techniques for holding down costs are practicing risk selection, limiting the services considered, constraining payments to providers, and shifting costs to patients. But given the system's fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated in response to profit opportunities rather than medical need, many attainable efficiencies are not achieved, unnecessary medical care is provided for profit, administrative expenses are high, and enormous sums are squandered in efforts to game the system. The result is a blend of overtreatment and undertreatment - and escalating costs. Researches calculate that between one fifth and one third of medical outlays do nothing to improve health Basically, the U.S. sucks at healthcare compared to other countries. We spend by the far the most money and have shitty quality/longevity of life
Physical environment
What you can see, hear, touch, feel, smell. Can include boundaries, age, condition and type of housing, buildings and lots, location, size, population density, layout, general overview, and geography Best generated through windshield survey
