Nursing 420 Exam 3

Quality improvement

- Community Assessment-Community Health Improvement Plans (CHA/CHIP): To monitor the outcomes of health agency services over a 3-5-year plan. Long-term approach to address public health problems. Results in improved agency care delivery, coordination, performance. Helps to achieve accreditation. - Population Health Management (PHM): A model of care that addresses individuals' health needs at all points along the continuum of care, including in the community setting, through participation, engagement and targeted interventions for a defined population. Goal is to address health disparities with cost-effective, customized interventions. - Mobilizing for action through planning and partnerships (MAPP)

Guiding principles

1. In planning for mass casualty event, the aim should be to keep health care system functioning and to deliver acceptable quality of care to preserve as many lives as possible 2. Planning a health and medical response to a mass casualty event must be comprehensive, community-based and coordinated at the regional or national level 3. There must be an adequate legal framework for providing health and medical care in a mass casualty event 4. The rights of individuals must be protected to the extent possible and reasonable under the circumstances 5. Clear communication with the public is essential before during and after a mass casualty event ◦ Public acceptance of event or situation that deviates from standard practice 6. Post event clean up poses high risk for additional injuries/illness - often lacks oversight and organization

Vaccinations for MokeyPox

2 shot series; PEP and PrEP; longer onset to protection, 2-4 weeks; provided to jurisdictions and federal entities Jynneos vaccine injection: prevention; EUA; 2 intradermal injections 4 weeks apart; max protection 2 weeks after dose; 0.1 ID as effective at 0.2 IM; prioritized for high-risk individuals and safe in HIV and persons with atopic dermatitis (different from previous smallpox vaccine) ACAM2000: FDA approved; lots of contraindications- cardiac, eye disease on topical steroids, immunosuppressed, atopic dermatitis or other exfoliative diseases, pregnancy, HIV Vaccine Immune Globulin (VIGIV): FDA licensed for treatment of vaccinia vaccination complications; no data- unknown effectiveness in MPX; may consider in severe cases of PEP TPOXX Tecovirimat: FDA approved for smallpox for adults and pediatrics; no studies in MPX; minor side effects; oral or injectable; CDC holds EA protocols Cidofovid (Vistide): FDA approved for CMV retinitis in AIDS patients; data not available but effective against OPV in vitro and animal trials; CDC holds EA for use in OPV (including MPX); may be considered for severe disease; renal toxicity RISK Brincidofovir (CMD001, TEmbrexa): FDA treatment approved for adults, children, and neonates; data not available; not as much renal toxicity

Web of causality

A 2-dimensional casual web that considers multiple levels of factors that affect health and disease Diseases are not distributed randomly but are due to several factors Looks like a spider web What might be the "spider?"- those larger factors and contexts that influence or create the casual web itself Poverty, discrimination, and other social determinants

Bioterrorism

A bioterrorism attack is the deliberate release of viruses, bacteria, or other agents used to cause illness or death in people, animals, or plants Many of these agents can be found in nature and can be spread through the air, water, or food

Community diagnosis

A clear statement of the health problem and the causal reasons or theories for the health problem Guides the community team's thinking in how to design the program and decide what components are necessary

Health care setting

A disaster is any situation that produces an immediate patient load grater than the ED has the capacity of handling without additional resources; disasters are classified as external or internal - incident command system - medical command physician - triage officer - media liaison

Mobilizing for acton through planning and partnerships (MAPP)

A framework for conducting community assessment Aims to help communities apply strategic thinking to prioritize PH issues and identify resources to address them Consists of 4 different assessments - community themes and strengths assessment - local public health system assessment - community health status assessment - forces of change assessment Elements of MAPP model include generating shared visions and common values, developing a framework for long-range planning. Assess community themes & strengths: Key informant interviews, surveys, focus groups that assess the strengths & problems within the community - from community members' perspective. Community health status: Identify priority community health & quality of life issues - involves gathering primary and secondary data related to the problem(s) Local public health system focuses on organizations that contribute to the public's health in the community Forces of change: Focuses on identifying forces such as laws, technology, or funding that affect the context in which the community & its public health system operate. Examples of PH interventions at the individual and community levels are Women, Infants & Children (WIC), school health programming, and immunization campaigns.

Logic model

A logic model is a graphic depiction (road map) that presents the shared relationships among the resources, activities, outputs, outcomes, and impact for your program It depicts the relationship between your program's activities and its intended results A logic model can focus on any. level of a program: the entire organization or one department or program The first step in the CDC Framework approach to program evaluation is to engage the stakeholders. Stakeholders are people or organizations that are invested in the program, are interested in the results of the evaluation, and/or have a stake in what will be done with the results of the evaluation. Representing their needs and interests throughout the process is fundamental to good program evaluation. Some key terms used in logic models, although not all are employed in any given model: Inputs: The resources needed to implement the activities Activities: What the program and its staff do with those resources Outputs: Tangible products, capacities, or deliverables that result from the activities Outcomes: Changes that occur in other people or conditions because of the activities and outputs Impacts: long-term outcomes Moderators: Factors that are out of control of the program but may help or hinder achievement of the outcomes

Mortality rate

A measure of deaths

Prevelance

A measure of existing disease in a population at a particular time

Morbidity rate

A measure of illness severity

Rate

A measure of the frequency of a health event in different populations at certain periods

Incidence

A measure that reflects the number of new cases or events in a population at risk during a specific time periods

Outbreak investigation

A systematic epidemiological investigation can: - determine if there is a sudden increase in the incidence of a CD - define what constitutes a case - determine the severity of the outbreak- Case Fatality Rate (CFR) - map out the epidemic curve - generate a hypothesis - conduct case finding - determine common source of exposure - identify source of transmission on take action - isolate source - how best to break the cycle Examples of disease prevention interventions: - Alerting the public to an ongoing risk to reduce further exposure (lead in neighborhood soil where people like to garden). - Providing treatment to those exposed if warranted (post rabies exposure prophylaxis). - Identifying contacts to prevent a secondary outbreak if warranted (contact tracing for STIs and for Covid-19).

Zoonoses

A zoonosis is an infection transmitted from a vertebrate animal to a human under natural conditions Means of transmission include animal bites (bats and rabies), inhalation (rodent excrement and hantavirus), ingestion (milk and listeriosis), direct contact (rabbit carcasses and tublaremia), and insects Rabies (hydrophobia): highest case fatality rate of any known human infections, essentially 100%; best protection remains vaccinating domestic animals (dogs, cats, cattle, and horses)

ASPR

ASPR leads the nation's medical and public health preparedness for, response to, and recovery from disasters and public health emergencies; ASPR collaborates with hospitals, healthcare coalitions, biotech firms, community members, state, local, tribal, and territorial governments, and other partners across the country to improve readiness and response capabilities Public health emergency medical countermeasures enterprise (PHEMCE): interagency body that review and recommends countermeasures for ASPR to focus on ASPR's health care readiness programs provides a coordinated, national approach to preparing health care systems to surge and overcome other complex challenges associated with disaster health care

Key components of health program planning

Active involvement of the community as a partner Skill and time to do a competent assessment Shared conclusions with the partners of the needed interventions Actual program planning, interventions, and evaluation Social justice: human rights and equity

Psychological impacts on providers

Acute event impact ID of staff not coping Include mental health providers in team Creative breaks Staff communication with family Surveillance of high-risk staff Impact of inability to help given constraints on care Forceful removal from duties CISM essential

Disaster planning

Addresses problems posed by various events Broad in scope Addresses collaboration Mutual aid agreements: agencies, organizations

Planning process

Adequate disaster preparedness and response is essential - delivery of life-saving interventions - optimization of population health outcomes Step 1: form a team Step 2: understand the situation Step 3: determine the goals and objectives Step 4: plan development Step 5: plan preparation review and approval Step 6: plan implementation and maintenance

Advocacy and ethics definitions, codes, standards

Advocacy: the application of information and resources (including finances, effort, and votes) to effect systemic changes that shape the way people in a community live; the act of pleading for or supporting a course of action on behalf of a person, group, or community. •Public health nurses have a moral mandate to establish ethical standards when advocating for health care policy. •Political action is the way you try to fulfill your ethical responsibilities to clients •Work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all (equity and social justice).

The affordable care act

Affordable care act (2010): Meant to reduce health disparities by increasing access to health insurance so that people could better access healthcare services. •Healthcare equity is a form of social justice. •. The law helps young adults stay on their parents' insurance until age 26, does not allow insurance companies to drop people because they have a diagnosis requiring expensive care, and helps others to be able to get the care they need with insurance coverage for their needs. •Some may think that the Affordable Care Act, which is supposed to help improve the health care we receive, has not benefited them personally. It may be so that some have not seen direct changes, however, several things have changed in health care because of this law.

Review, transmission of communicable diseases

Agent, host, and environment Modes of transmission Disease development Disease spectrum Vectors Fomites Transmission - The method through which the agent leaves its reservoir and enters its host (Water, food, air, vectors, unprotected sexual contact, or penetrating wounds) Vectors are usually insects that carry the disease from the reservoir to humans Inanimate objects that can carry disease, such as a contaminated doorknob, are called fomites.

Disaster planning: prevention (mitigation and protection)

All-hazards mitigation (prevention): reducing risks to people and property from natural hazards before they occur Prevention against natural disasters - structural measures: protecting buildings and infrastructure; threats include forces of wind and water - nonstructural measures: land development restrictions Prevention against human-made disasters - heightened inspections - improved surveillance and security operations - public health and agricultural surveillance and testing - immunizations - isolation - quarantine - halting of chemical, biological, radiological, nuclear, and explosive (CBRNE) threats

Agents of bioterrorism

Anthrax Smallpox Plague Tularemia

Ethics and the core functions of public health nursing

Assessment - competency in research, measurement, analysis, and dissemination techniques - beneficence and nonmaleficence - virtue ethics- importance of integrity Policy development - achieve public good - service to others over service to self - what is ethical is also good policy - moral leadership Assurance - all persons should receive essential personal health services - providers should be competent to provide care and be available - distributive/social justice

Steps to health program management

Assessment, planning, implementation, evaluation Assessment includes gathering primary and secondary data. Primary data is how the community subbjectively perceives the community health need. Sources of primary data include surveys and focus groups. Secondary data is objective information - immunization uptake rates, disease rates in a community, birth records, mortality records. Primary and secondary data can be collected again after your program or intervention is complete, to evaluate if goals were met.

Death processes

Backlog May not be able to accommodate cultural expectations toward death and handling of bodies Temporary morgue Difficultly identifying dead or confirm death May have difficulty finding and notifying next of kin Burial and cremation services may be overwhelmed Standards for completeness and timeliness of death certificates may need to be lifted temporarily

Epidemiology

Basic science of public health Study of distribution and determinants of disease in populations Includes communicable and chronic diseases, mental health, occupational health and injuries Epidemiology has been defined as "the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems." Determinants of health events are the factors and characteristics that influence how and why outbreaks occur.

Anthrax

Caused by Bacillus anthracis bacteria found in soil Incubation period 1-6 days (up to 60 days) Inhalation anthrax is not spread person to person Skin (cutaneous) Digestive (GI) Lungs*** (inhalation) Death can occur within 24 hours Quarantine not necessary No treatment in early stages: death approaches 100%

Category A

Characteristics - easily disseminated or transmitted person to person - high mortality or major public health Impact - may cause panic or social disruption - requires special public health action Agents: anthrax, botulism, pneumonic, plague, smallpox, tularemia, viral, hemorrhagic, fevers, ebola, marburg

Category B

Characteristics - moderately easy to disseminate - moderate morbidity and low mortality - requires specific enhancement of diagnostic capacity and enhanced?????? Agents: brucellosis, C. perfringens toxin, glanders, Q fever, ricin toxin, staph enterotoxin B, water or food agents

Category C

Characteristics - high availability - ease of availability and production - potential for high morbidity, mortality, and public health event Agents: yellow fever virus, influenza virus, TB (including drug resistant TB), rabies virus, SARS, Chikungunya virus, tickborne (hemorrhagic fever viruses, encephalitis complex flaviviruses)

Authority to activate the use of altered standard of health and medical care

Circumstances should be defined Clarification to who can make the call and at what level (site, community, region, state, or federal) Under what legal, statutory authority Identify who assumes responsibility for directing emergency actions Clarify relationship of autonomous institutions to the incident management system

Creating objectives

Clarify the goal Design an outcome measurement Keep the program focused on the intended intervention Measurable, time-limited, action-oriented Include who will achieve what, by how much, by when HP 2030: - goal: increase local PH departments that have deployed a community health improvement plan - objective: by 2030, increase the percent of PH agencies who have CHIP (measure: % of increased enrollment in CHIP)

Experimental studies

Clinical trials: research issue is commonly the efficacy of a medical treatment for disease Community trials: the issue is often health promotion and disease prevention rather than treatment of existing disease

Analytic epidemiology

Cohort studies Case-control studies Cross-sectional studies Ecologic studies Ecologic fallacy Analytical epidemiology searches for the determinants of the patterns observed—the how and why. The key feature of analytic epidemiology is a comparison group, where a study compares specific health status features between an affected or at risk group versus a control/comparison group. Ecologic fallacies are associations observed at the group level that may not hold true for the individuals who make up the groups, or associations that actually exist may be masked in the grouped data. An ecologic fallacy is like making a causal assumption that is not correct or does not apply to the people you are concerned with. "Correlation is not causation". To avoid ecology fallacies, apply a higher level of research.

Program management

Community health program planning is population focused, promotes health equity, empowers communities and advocates for social justice Planned to meet the needs of specific individuals, groups, communities Examples: home health, Immunization programs, family planning programs, school health programs, occupational health and safety, environmental health, community programs directed at preventing specific health conditions A program will fail if the community is not interested. Key informant interviews are a good tool in community assessment, because they help to identify what issues are important to community members.

Applications of epidemiology in nursing

Community-oriented epidemiology: involves observation, data collection, consultation, and interpretation Popular epidemiology: a form of epidemiology in which lay people This lends itself to evidence-based practice in nursing. A nurse epidemiologist investigates trends in groups or aggregates and studies the occurrence of diseases and injuries. The information is gathered from census data, vital statistics, and reportable disease records. Nurse epidemiologists identify people or populations at high risk; monitor the progress of diseases; specify areas of health care need; determine priorities, size, and scope of programs; and evaluate their impact. They generally do not provide direct patient care, but serve as a resource and plan educational programs. They also publish results of studies and statistical analysis of morbidity and mortality. Lillian Mood is a public health nurse with more than 20 years of experience in South Carolina working with communities to detect and explain the causes of illness and disability. In describing her involvement with specific communities, Mood noted that the contact often began with a telephone call of concern about a planned or existing industrial facility or a firsthand observation of illness, expressed in lay terms as "too many cases of cancer," "several people have had miscarriages," or "more respiratory problems." The citizen's reasoning behind these observations is that "If I am seeing more health problems in my community, I ask what they have in common. The common factor may be where we live. So it must be the air or the water." This is basic epidemiologic thinking, not irrational fear. Citizens try to make sense of what they are seeing, and they want professional help to unravel the pattern of illness.

Case management

Coordination of services across healthcare specialties and community health services Improve quality of care, efficiency of services Cost containment Must know community resources, be a good communicator Case management plans: standards of client care, standards of nursing practice, clinical guidelines using evidence-based practice; adaptation to each client's unique situation is key Evaluation: if goals were not met, change the plan

Financial issues

Cost to provide care in traditional, alterate settings, and pre-hospital care settings Creating alternative care site in schools, neighborhoods, centers, and hotels Training providers (advance and just in time) Staging drills Repairing physical plant Tracking cost Supply procurement

Partnerships in disasters

Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA) Department of Health and Human Services Centers for Disease Control and Prevention Public Health System (PHS) American Red Cross (ARC)/International Red Cross Other local, state, and federal agencies Community partners

Program planning

Describe the problem Formulate the plan Conceptualize the problem Detail the plan Evaluate the plan Ultimate goal: Ensure that health care services are acceptable, equal, effective, and efficient When considering the outcomes of a planned intervention, a nurse should measure short-term, long-term, and unexpected/unintended outcomes. Evidence based practice is used in developing the rationale for the program. Implementation involves knowing what resources are needed and how the program will be delivered. For example, If there was an outbreak of Hepatitis A in a community, a pathogen that is transferred through the fecal-oral route by way of contaminated food, water and touched surfaces, the priority strategy that the public health nurse would share with community members would be the importance of washing hands.

Epidemiological approaches

Descriptive epidemiology seeks to describe the distribution of health-related states and events in terms of person, place, and time - Example of descriptive epidemiology - illustrating the current prevalence of ebola virus is Western Africa Analytic epidemiology focuses on investigation of causes and associations - Example of analytic epidemiology - when you are investigating the cause of an outbreak of vomiting and diarrhea after a large banquet and you test the food eaten - focuses on the determinants of health-related states and events. Ecologic approach is the broad consideration of many levels of potential determinants from different sources (systems approach) Distribution describes who has the disease; where and when it occurs Epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition

Major roles of nurse in disasters

Determine magnitude of the event Define health needs of the affected groups Establish priorities and objectives Identify actual and potential public health problems Determine resources needed to respond to the needs identified Collaborate with other professional disciplines, governmental and non-governmental agencies Maintain a unified chain of command Communication

Health people 2030: disasters

Disaster incidents have an effect on almost every objective Disasters play a direct role in the objectives related to the following: - environmental health - food safety - global health - health related quality of life and well-being - immunization and infectious disease - injury and violence prevention - mental health and mental disorders - occupational safety and health - preparedness (new since 2020) - public health infrastructure

Triage

Efforts need to focus on maximizing number of lives saves - identify cause, protect staff and limit exposure - identify and treat those with a critical need and most likely to survive - ED may be reserved for immediate-need patients - ambulatory patients delivered to alternate care sites - needs of current patients will become part of resource allocation

Epidemiologic triangle

Environment- Host- Agent This model was originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases. Changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person's risk for disease. The triad consists of an external agent, a susceptible host, and an environment that brings the host and agent together. In this model, disease results from the interaction between the agent and the susceptible host in an environment that supports transmission of the agent from a source to that host. Agent originally referred to an infectious microorganism or pathogen: a virus, bacterium, parasite, or other microbe. Host refers to the human who can get the disease. Opportunities for exposure are often influenced by behaviors such as sexual practices, hygiene, and other personal choices as well as by age and sex. Environment refers to extrinsic factors that affect the agent and the opportunity for exposure. Environmental factors include physical factors such as geology and climate, biologic factors such as insects that transmit the agent, and socioeconomic factors such as crowding, sanitation, and the availability of health services. Environment: conditions external to the host and agent associated with the transmission of the agent Reservoir: where the agent resides Human Animal Water, food, air, or soil Change in any one of these may cause disease transmission

Immunization programs

Essential service Protects the population from communicable disease International travel vaccine administration Post-rabies exposure prophylaxis Mandated by schools to varying degrees across the country Immunizations integrated in public health clinical services If an outbreak occurs, the local health department is responsible for mass immunizations Coordination of vaccine supplies, rates of immunizations given regionally, statewide immunization registries to document, and free immunization clinics Goal: equitable access

Why do we plan for disasters?

Everything seems to go a little better when we plan Adds organizations and structure to a chaotic scenario Plans often exist but does not mean that it is perfect, but it is continuous

Smallpox

Exist in laboratory stockpiles 2 clinical forms - variola major - variola minor Incubation period 7-17 days Diagnosis: presence of virus, antigen, nucleic material, or immunoglobulin in clinical specimens (blood and/or vesicles)

FEMA

FEMA's mission is helping people before, during, and after disasters, and our guiding principles help us achieve it FEMA's employees are commited to serving our country before, during and after disasters; every day more than 20,000 emergency managers work to make our nation safer, stronger, and more prepared Established national terrorism advisory system: - threat alert: elevated or imminent threat - FEMA published in-depth guide for citizen: Are you Ready?

Roles of federal public health agencies

Federal: develop regulations that implement policies formulated by Congress and provide a significant amount of funding to state and territorial health agencies to: •Provide public health services •Survey the nation's health status and health needs •Set practice standards •Provide expertise that facilitates evidence-based practices •Coordinate public health activities that cross state lines •Support health services research

Response

First level: first responders - mobilization of local responders: fire department, law enforcement, public health, and emergency services - National Response Framework (NRF): emergency support functions (ESFs) - National Incident Management System (NIMS) - response to biological incidents: biodefense programs- BioWatch, BioSense, Project BioShield, Cities Readiness Initiative, Strategic National Stockpile (SNS) Actual implementation of the plan Activities used to address the event Focuses on emergency relief: saving lives, first aid, minimizing and restoring damaged systems, care and basic life requirements to victims (food, water, shelter)

Role of the public health nurse in disasters

First responder Epidemiology and ongoing surveillance Rapid needs assessment Disaster communication Disaster response ethics Sheltering

Recovery (look at PP)

Focuses on stabilization Returning community to pre-impact status- make it better Rehabilitation Reconstruction Epidemiological surveillance is needed

Formative and summative evaluation

Formation evaluation: for the purpose of assessing whether objectives are being met or planned activities are completed; begins with an assessment of the need for a program and is ongoing as the program is happening; allows for changes to be made - examples: ongoing feedback and recommendations from clients, behavior observations, teach-back at each step of procedure Summative evaluation: to assess program outcomes or as a follow-up of the results of the program activities and usually occurs when a program is completed; includes evaluation of objectives and goals - examples: demonstration of effective wound self-care, wound healing. Decreased rates of child obesity in a school district; higher immunization rates

Nursing process and case management

From Stanhope, p. 275 Stanhope p. 281: Primary prevention: exchange information, increase health literacy, instruct on accessing healthcare system, engage in health education Secondary prevention: case finding, using healthcare data to identify health problems, assessments and interventions that promote health Tertiary prevention: monitor and adjust the use of prescription medications and adherence to treatment to reduce the risk of complications

What is a disaster?

Generally: an occurrence causing widespread destruction and distress; a catastrophe Mass casualty event: a catastrophic event that overwhelms local resources; multiple resources (federal and state) are necessary to handle the crisis

Prevention and control of communicable diseases

Goal: reduce prevalence and prevention Role of nurses - immunizations - surveillance - teaching controls - prevention - screening and treatment Multisystem approach to control to correct imbalance between human host and environment

Changing care expectations and practices during a disaster

Health care organization have to be prepared to respond to acts of terrorism and public health emergencies Most plans assume care according to established standard of care A mass casualty event could compromise these plans Adjustments in standards will ensure care will save as many lives as possible

Herd immunity

Herd immunity is the resistance of a group of people to an attack of disease to which a large proportion of the members of the group are immune The immunity of a population to an agent depends upon having a large enough portion of the population immune (by vaccine or past infection) to prevent the spread of disease to persons in the population who do not have immunity The threshold of immunity depends upon the percentage** of the population that must be immune to achieve heard immunity to a specific agent

MonkeyPox

Historical outbreaks: 2003- outbreak traced to imported prarie dogs 2011- travel from Africa 2021- travel from Africa Recent outbreak: 7-16 May- 2022 3 unlinked cases in the UK 19 May- first US case of MonkeyPox late May- CDC set up program mid to late May June- CDC set up EOC 30861 US cases 54 US deaths >90000 cases worldwide Symptoms: febrile prodrome 2-5 days before rash (not always recognized or not always occurring); fever; headache; respiratory symptoms; lymphadenopathy Characteristics/rash: Texas resident shared on Instagram (Silver Steele name) photos since little was known about monkey pox. He sent them to the CDC so they could share. Similar to smallpox with centrifugal distribution Progresses from Macule-> Papule ->vesicle-> pustule-> crust -> desquamation Deep-seated firm well circumscribed with ventral umbilication Single state of development to a given site of the body Rash is often present on palms and soles Genital and perianal areas Lesions do not always disseminate to most sites of the body Number of lesions is lower 21 days clears up Lower GI general issues Rectal bleeding Conjunctivitis Historical additional complications: bronchopneumonia, dehydration, GI disruption, secondary infections, sepsis, encephalitis, ocular infection and corneal scarring, skin scarring, death (11% in unvaccinated) Treatment: many cases are mild and self-limiting (nonfatal); prognosis depends on poor vaccine status, health status, concurrent illness, comorbidities; early 2000 panic smallpox vaccine, there may be some residual immunity; no current approved treatment for MPX; however antiviral and vaccines developed for smallpox can be used (antiviral Tecoviramir) Prevention: vaccinating high risk individuals and those in contact via contact tracing; indications; high risk- immunocompromised, pediatrics, history of atrophic dermatitis or exfoliative skin disorders pregnant or breast feeding, one of more complications (cellulitis, gastroenteritis, pneumonia) Responder protection: consider contact and droplet (not airborne) highly infectious- N95, face shield, gown, gloves; limit aerosol generating procedures; thorough cleaning between patient use Isolation: strict isolation beyond COVID, do not share anythi

Ways to handle moral distress

Identify the type(s) of situations that lead to distress Communicate that concern to your manager and examine ways to work toward addressing the stressor Seek support from colleagues Seek support from ethics committees, social workers, and pastoral care, among others Be proactive and express one's voice on matters that are ethically concerning

Host factors

Immunity is resistance to disease Resistance is the ability of the host to withstand infection and it may involve natural (inborn) or acquired (from disease or vaccination immunity) Susceptibility is the likelihood of a human's risk of disease due to exposure to the disease agent

Inhalation anthrax stages

Incubation 1-7 days Inititially mimics cold or flu Brief period of improvement (hours) Rapid progression to severe respiratory distress Treatment after exposure- breathing in spores - Cipro 500mg BID for 60 days - Doxycycline 100mg BID for 60 days - vaccine available for military

Parasitic diseases

Intestinal parasitic infections are a greater concern in devleoping countries Pinworm most common infection in US, usually in schools, institutions, where overcrowding occurs Parasitic opportunistic infections are more frequent or severe in immunocompromised Control and prevention; early diagnosis, improved hygiene and vector control, education and environmental improvements Parasites are organisms that depend on a host to survive. Endoparasites, those that live within the body, are classified into four major groups: nematodes (roundworms), cestodes (tapeworms), trematodes (flukes), and protozoa (single-celled animals).

Core epidemiological functions explained

Investigative functions: used to identify and describe the distribution and determinants of health-related states and events, as well of the efficacy, effectiveness, and efficiency of health intervention and health services Identifying risk factors for health-related stated and events: causes of health-related stated and events Evaluating health interventions, and programs for efficacy, effectiveness, efficiency, cost Policy: address the role of epidemiological work in informing health policy and all levels Linkages: emphasizes the important of linkages across professions, organizations, governments, and other necessary parties

Areas requiring adjustment

Liability of providers functioning with inadequate resources Certification and licensing Scope of practice Institutional autonomy Facility standards Patient privacy and confidentiality Documentation of care Property seizures Quarantine and mass immunization

Governmental responsibilities with disasters

Local government (first responders): responsible for the safety and welfare of its citizens State government (Office of Emergency Management): involved when a disaster overwhelms the local community's resources Federal government (ASPR: Administration for strategic Preparedness and Response): a single department focusing on protecting the American people

Roles of local public health agencies

Local: Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community •Goal: to safeguard the public's health and to improve the community's health status - Example: A nurse is working at a local health department would likely be providing leadership in planning community health screenings, disseminate health information, provide essential public health services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community.

Descriptive epidemiology

Long-term patterns of morbidity or mortality rates (over years or decades) are called secular trends Secular trends may reflect changes in social behavior or health practices Personal characteristics Place based characteristics Time based (temporal) characteristics Descriptive epidemiology provides a picture of how things are or have been—the who, where, and when of disease patterns. Personal characteristics of interest in epidemiology include race, ethnicity, sex, age, education, occupation, income (and related socioeconomic status), and marital status. Place based characteristics are geographic: how does the rate of disease differ from place to place (e.g., with local environment)? Time based considerations: Is there an increase or decrease in the frequency of the disease over time? Are other temporal (and spatial) patterns evident? Temporal patterns of interest to epidemiologists relate to epidemics at singular or certain points in time, cyclical patterns (seasonal), and event-related clusters (such as a food borne illness event after a banquet). Secular trends may relate to an increase of substance abuse that occurred during pandemic lockdowns, or vaccination lapses that happened when people were afraid to take their children for baby shots during lockdowns. Long-term patterns of morbidity or mortality rates (i.e., over years or decades) are called secular trends. Secular trends may reflect changes in social behavior or health practices. One temporal and spatial pattern of disease distribution is the point epidemic. In addition to secular trends and point epidemics, there are also cyclical time patterns of disease. One common type of cyclical variation is the seasonal fluctuation seen in a number of infectious illnesses. A fourth type of temporal pattern is non simultaneous, event-related clusters. These are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.

Diseases of travelers

Malaria Foodborne and waterborne disease Diarrheal disease Individuals traveling outside the United States need to be aware of and take precautions against potential diseases to which they may be exposed. Which diseases and what precautions depend on the individual's health status, the travel destination, and the reason for and the length of travel. Persons who plan to travel in remote regions for an extended period may need to consider rare diseases and take special precautions that would not apply to the average traveler. On return from visiting exotic places, travelers may bring back with them an unplanned souvenir in the form of disease. Therefore, in a presenting client, it is important to ask about a history of travel.

Milestones in quality

Managed care organization Core competencies of public health nursing (2010) Several nursing organizations, which compromise the Quad Council for Public Health Nursing, have taken the charge to strengthen nursing practice in the community Quad Council renamed to Council of Public Health Nursing Organizations The Council on linkages between academia and public health practices has worked to advance academic and practice collaboration to ensure a well-trained, competent workforce and a strong, evidence-based public health infrastructure

Types of disasters

Manmade: accidental, deliberate, chemical, biological, radiological, nuclear, explosives Natural: earthquake, tornado, floods, hurricanes, blizzards, wildfires, tsunamis, nuclear, temperature extremes

Treatment decisions

May be based on clinical judgment with the lack of advanced technology May not be made by specialist Best use of available medications, supplies, resources Chronic care resources may be diverted

Documentation

May be impossible to maintain Regression to paper system from electronic May not be able to obtain informed consent May not be able to document care provided Verbal handoffs important Tracking of patients can be a challenge

Equipment and supplies

May be rationed Disposable supplies may be reused If something breaks may not have ability to repair Supplies could be contaminated

Case study: Measles vaccination campaign in New York

Measles is an airborne virus. A rash appears within a week of infection, symptoms appear average 14 days. Cough, sore throat, conjunctivitis. The sick are contagious from four days before, to four days after the rash starts. Rash with high fevers that can cause infertility, pneumonia, immune problems in later years, hearing problems, death. Herd immunity requires 96% of people in a community to be immunized in order to protect the unimmune from infection. This disease has been controlled by state laws mandating vaccinations for school entry. Religious exemptions, enabling avoidance of school vaccine regulation due to conflicts with faith, had been increasing in NYS. Lowered vaccine coverage raises the risk of a disease outbreak. New York schools require two measles vaccinations for K - 12 students. Community health problem assessment and diagnosis - traditional culture; new ideas are prone to rejection, preserving the community and relationships within it

Mitigation

Measures taken to reduce harmful effects Prevention Occurs before incident Adjust the plan as needed

NIMS: National Incident Management System

NIMS is a comprehensive, national approach to incident management that is applicable at all jurisdictional levels and across functional disciplines It is intended to: - be applicable across a full spectrum of potential incidents, hazards, and impacts, regardless of size, location, or complexity - improve coordination and cooperation between public and private entities in a variety of incident management activities - provide a common standard for overall incident management

Community preparedness

National Health Security Strategy (NHSS) Disaster and mass casualty exercises - the National Exercise Program (NEP) - Homeland Security Exercise and Evaluation Program - Federal Emergency Management Agency (FEMA)

Strategic national stockpile

National repository of medicine and medical supplies Supplies (push packages) can be sent anywhere in the country within 12 hours Each state has plans to receive and distribute SNS resources

Natural vs acquired immunity

Natural immunity (innate resistance) vs acquired immunity (disease resistance from having a disease or vaccination)

Scope of practice

Nurses may function as physicians Physicians may function outside their specialty Credentialing may be on an emergency or temporary basis EMS could treat patients and not transport

Health policy and advocacy intro

Nurses who select the community as their area of practice must be especially aware of the impact of government, law, and health policy on nursing, health, and the communities in which they practice Government, law, and political action change over time and influence the health care system

Disaster management and emergency preparedness

Nursing and disaster - respond quickly - clinically competend to provide safe, appropriate, individual and population-based care In disasters, nurses tend to be - first receivers of injured victims - first responders to render emergency aid and triage

Communicable disease and nursing practice (conclusion)

Nursing practice includes doing your part to prevent the spread of communicable disease Preventative measures: personal protective equipment, proper cleaning of equipment, preventing transmission to coworkers, self, and other patients Understand communicable diseases at individual and population levels Public and community health nurses are on the front lines of communicable disease management

How disasters affect communities

One health and interconnectedness Stress reactions in individuals - exacerbation of a chronic disease - older adult's reactions dependent on health, independence, income, and so on - regressive behaviors in children

Smallpox disease course

One of the first symptoms is usually a high fever Next a rash... first on the tongue and in the mouth: highly contagious stage Rash develops into sores and spreads to all parts of the body within 24 hours (starts on face) **Sores become fluid-filled raised bumps, with an indentation, may resemble a belly button: the most distinguishing feature Contagious until scabs have disappeared- usually 3 weeks

Case study: planning and implementation

Over 20,000 contacts were identified Contacts referred for postexposure prophylaxis with MMR vaccine, immune globulin, and/or home quarantine Unvaccinated children identified with the use of the Citywide Immunization Registry DoH personnel used this information to contact patients/parents about getting MMR vaccination Schools/daycares in affected neighborhoods were notified that all children without MMR vaccination or proof of measles immunity were to be prohibited form attending Health department leaders coordinated community meetings. Notices about vaccine safety were distributed by hand by health department outreach. An emergency order, which required MMR vaccination or proof of measles immunity for all persons living, working, or going to school in the four affected Williamsburg ZIP Code areas, was issued on April 9, 2019.17 A total of 232 summonses were issued by the Department of Health to individual persons for not adhering to the emergency order. Schools and daycares that did not adhere to vaccine requirements were subject to fines, closure, or both. Community members protested these measures, initiated lawsuits, and started hiding the presence of measles as family members became sick. NYS Governor eliminated the religious exemption for school vaccine requirements, but parents sought out medical exemptions instead (most did not meet criteria). Rabbis and other religious leaders spoke out in support of vaccination, but anti-vaccination fears were deeply embedded within the community.

Program goals

Overall aim A broad statement of the impact expected by implementing a program A statement of outcome rather than activity Usually only a few goals for a program Should be realistic, achievable, and sustainable

Principles of the ethical practice of public health

PH institutions should protect the confidentiality of information gathered PH should achieve community health in a way that respects the rights of individuals in the community PH should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources are accessible to all PH programs should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community PH institutions should engage in collaborations that build the public's trust

Roles in mitigation

Participate in mass immunization programs Surveillance and early detection Education and public health initiatives What can be done to help the infrastructure to survive/respond to any hazard?

Delays in care

Patients may be backlogged Surgeries may be delayed Radiology and laboratory services may be rationed Non-emergent care may not be given: patients turned away; EMS reprioritizing responses and transportation (zone care triage) Primary care space for clinic may become alternate care site or staff reassigned and appointments cancelled

Performance monitoring and guidelines

Performance monitoring: a process of selecting community indicators that measure the process and outcomes of a health improvement intervention strategy; indicators can be assessed to determine intervention effectiveness or agency performance Guidelines: protocols of recommended practice developed by governmental and health care agencies and professional organizations

Horizontal transmission

Person-to-person Four routes - direct/indirect: such as sexual contact- direct; clothing, toys, and the like- indirect - common vehicle: infected host to susceptible host; via food, water, body

Preparedness

Personal preparedness - disaster kits for home, workplace, and care - disaster plan Professional preparedness - National Disaster Medical System (NDMS); Disaster Medical Assistance Team (DMAT) - Medical Reserve Corps (MRC) - Community Emergency Response Team (CERT) Community preparedness Proactive planning efforts Evaluating potential vulnerabilities Warning/looking for indicators: location, timing, magnitude

Impact of a disaster on the community

Population affected - pediatric (childcare, etc) - special needs - indigent -- displacement, medications, special equipment Economic impact Social/human impact Impact of the media Resource availability Infrastructure status Long term impact

Role of public health departments and the public health nurse

Population assessment Assurance of a well-coordinated system of health promotion and healthcares services Policy development to support the health of the community Vital statistics, environmental sanitation, health department laboratory services, maternal/child healthcare and surveillance, public health education (PSAs) Essential services are provided with interventions at individual, community, and systems levels of care Public Health Core Functions: Assurance, Policy, Assessment Example: Interventions for reducing tobacco use: - Individual - counseling a pregnant woman in tobacco cessation methods - Community - group education in tobacco cessation for teens - Systems - advocating for tobacco tax increases to decrease motivation to use it

Disaster preparedness

Prevention Mitigation Preparedness Response Recovery

Levels of prevention in epidemiology

Primary prevention: refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Interventions at this level of prevention are aimed at individuals and groups who are susceptible to disease but are not currently symptomatic. Example: Counseling clients about low-fat diet and regular physical exercise. Secondary prevention encompasses interventions designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. For example: treadmill stress test, mammogram. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. For example: cardiac rehabilitation.

MAPP example

Problem: infant mortality Mobilize community partnerships: a MAPP committee was formed Action: community assessments were done by committees: data collected and funding sought Planning/partnership: high infant mortality found to be higher among African Americans in the community than among others Programs built to improve access to prenatal care, birth weight, and reduce teen pregnancy, tobacco use among pregnant women and girls Rate of infant mortality was increasing in a community. A MAPP committee was formed including community members, nurses, healthcare providers, elected officials, pregnant and teen mothers. Community assessments were done by committees: Data collected from community members about maternal care, maternal care implementation in the area, vital statistics, survey data. Funding was sought to build necessary programs for maternal care High infant mortality found to be higher among African Americans in the community than among others. Programs were built to improve access to maternal and infant care specific to this population found to be at high risk Result: The MAPP committee achieved funding to establish a Nurse-Family Partnership community health program with nurse home visits for low-income, first-time mothers to address the essential service of linking people to needed PH services as well as assuring the provision of these healthcare services. Evidence-based practice: Research supports the nurse-family partnership model as an effective framework to ensure high-quality programs and services in local communities.

Policy and advocacy terms to know

Public health policy impacts nursing practice. State nurse practice acts fall under the umbrella of public health policy because they are designed to protect the public as the recipients of nursing care. A nurse's scope of practice is included in public health policy. For the nurses, public health policy affects their personal lives as well as their professional role of advocacy. Changing public health policy does fall within the scope of nursing practice in that nurses are responsible for identifying, interpreting, and implementing public health laws, regulations, and policies. Policy refers to laws & regulations. Public policies influence the lives of citizens. Health policies have the goal of improving a health outcome for people. Although taxes are not regularly thought of as public health policy, the policy of exempting employer-sponsored health benefits from income and payroll taxes has influenced employers to offer health benefits in lieu of increased salaries. Bill - pend

Communicable disease spectrum

Public health's responsibility, local to global surveillance of diseases - Epidemic: significant increase in a disease - Endemic: numbers of diseases within a population - Pandemic: outbreaks around the globe In disease development, exposure to an infectious agent does not always lead to an infection and vice versa. Depends upon the immunity and resistance of the host. - Infection: the entry, development, and multiplication of the infectious agent in the susceptible host - Disease: possible outcomes of infection; may indicate physiologic dysfunction or pathologic reaction - Incubation period: time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease - Communicable period: interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person

Healthcare improvement in the community

Quality of healthcare has been difficult to evaluate in the US because there are different definitions of quality of care and it is hard to get same kinds of data to compare from different healthcare sites Improving quality can help provide better care, effective interventions, save lives, reduce costs, improve client confidence in health care delivery Focus is on finding problems in the system, not blaming individuals

Quality improvement

Quality: defined by the client as the improvement in health status, by the organizations and providers as accurate interventions and the skill of the provider Quality health care: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality in public health: the degree to which policies, programs, services, and research for the population increase desired health outcomes and conditions in which the population can be healthy

Evaluation, interpretation, action

Regular intervals for evaluation should be established within the agency and periodic reports written so performance improvement efforts can be analyzed, and problems identified Course of action should be based on their performance, cost, timeliness Take action Follow up and evaluation of actions taken must occur for performance improvement

Legal and regulatory issues

Relevant laws: Emergency Medical Treatment and Active labor Act (EMTALA) Health Insurance Portability and Accountability Act (HIPAA) Federal Volunteer Protection Act Good Samaritan Act Medical and health care regulations 80 hr work week for medical residents OSHA and workplace regulations Building codes Publicly funded health insurance Human subject research laws Use and licensure of drugs and devices

Nurse's role in a disaster

Remember why you chose the nursing profession? To care for others in their times of need Our role as registered nurses is to understand your scope of practice We will be called upon to care for the wounded, but also care for the mentally unstable patients as well

Foodborne and waterborne diseases

Role of safe food preparation Salmonellosis Escherichia coli Waterborne disease outbreaks and pathogens

Vaccine-preventable diseases

Routine childhood immunization schedule Measles: an acute, highly contagious disease that, although considered a childhood illness, may be seen in the United States in adolescents and young adults. Outbreaks in the United States highlight the ongoing risk of measles importation from other countries by people who travel. Rubella: (German measles) virus causes a mild febrile disease with enlarged lymph nodes and a fine, pink rash that is often difficult to distinguish from measles or scarlet fever. In contrast to measles, rubella is only a moderately contagious illness. In 1941, the link between maternal rubella and poor pregnancy outcomes was recognized and the disease suddenly assumed major public health significance. Pertussis: (whooping cough) begins as a mild upper respiratory tract infection progressing to an irritating cough that within 1 to 2 weeks may become paroxysmal (a series of repeated violent coughs). Because of its cyclical nature, there are periodic outbreaks of pertussis. Influenza: this viral respiratory tract infection often hard for people to distinguish from the common cold or other respiratory diseases - key: Flu shot campaigns with symptom awareness

Sources of data

Routinely collected data: census data, vital records (birth and death certificates) Surveillance data as carried out by the Centers for Disease Control and Prevention (CDC) Data collected for other purposes: medical, insurance, health department records Epidemiologic data: primary data from sources such as surveys and interviews; secondary data research findings and government dashboards

Laws specific to nursing practice

Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers (Nurse Practice Act, Licensure) Failure to follow scope of practice and licensure can result in professional negligence (or malpractice): an act (or a failure to act) that leads to injury of a client Public health policy impacts nursing practice

Ethical issues and dilemmas related to diverse cultures, values, and beliefs

Situations in which ethnic diversity can be judged in relationship to cultural standards: •Situations that place persons at direct risk of harm, whether psychological or physical •Situations in which cultural standards conflict with professional standards •Situations where the greater community's values are jeopardized by values of a small culture within that community •Situations where community customs may cause mild offense or annoyance to other communities, but no major problems

Smallpox vs Chickenpox

Smallpox: fever 2-4 days before rash; rash- pocks at same stage; development is slow; distribution- more pocks on arms and legs; palms and soles is usually present; usually 1 in 10 die Chickenpox: fever at the same time as rash; pocks in several stages; rapid development; more pocks on body; usually absent on palms and soles; death is very uncommon

SMART objectives

Specific: indicates who (priority population) and what (action or activity); contains an action verb Measurable: outlines how much change is expected and how that change will be measured Achievable: can be realistically accomplished given current resources and constraints Realistic: addresses the scope of the health program and proposes reasonable programmatic steps toward goals Timeline: provides a timeline for meeting objectives

Inadequate staff

Staff may be scarce Some equipment may not be used without trained staff to operate them Staff may not have access to facility if they do not preplan Concern for family needs versus work requirements Staff could be directly affected (ill)

Roles of state public health agencies

State: responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health •Distribute federal and state funds to local public health agencies to implement programs at the community level •Examples of programs: communicable disease programs, maternal and child health programs; chronic disease prevention programs; injury prevention programs •State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health; they do not provide essential public health programs to the community.

Core epidemiological functions

Surveillance: provides information for action: it identifies disease trends and patterns, enables resource priorities to be decided, and lead to the planning of health programs as well as evaluation methods Field investigations Analytic studies Evaluation These investigative functions are used to identify and describe the distribution and determinants of health-related states and events, as well of the efficacy, effectiveness, and efficiency of health intervention and health services Efficacy is about the outcomes of an intervention or program under "ideal" conditions, such as studying outcome in a research study, efficacy only measures the outcomes in the people who participate in the program Effectiveness is about the outcomes in "real world" settings, such as when a program is implemented in a community or a clinical setting Core epidemiological functions primarily address the investigative, research, and evaluative functions that have long been the focus of epidemiologic work. Used to describe the distribution and determinants of health-related states and events, as well of the effectiveness and efficiency of health interventions and services. Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of health data to help guide public health decision making and action. This happens through the collection and evaluation of morbidity and mortality reports and other relevant health information, the dissemination of these data, and their interpretation for public health decision making

Program evaluation

Systematic collection of information about activities, outputs, and outcomes to enhance a program and its effectiveness Provides feedback about how the activity design worked, cost effectiveness, and if the interventions worked, if the timeline was appropriate, if the program should be expanded or used in another location The type of evaluation to be used should be chosen early on, because it needs to effectively measure the outcomes you hope to improve

Nursing (Blima's) interventions

Taught parents how to evaluate research Addressed their beliefs: that everyone is out to get them, that everyone wants to make money off of them Addressed multigenerational trauma Shared statistics communicable disease consequences Ensured meetings with compliant with community needs (held in primary language, separate meetings for men and women) Started a text-based chat group Provided evidence-based answers to texted questions Communicated respectfully and with empathy Held small group sessions for ultra-Orthodox women and colleagues from the Orthodox Jewish Nurses Association - perceived benefits and severity was reached with her message

Breaking the chain of infection

The cycle of transmission for a specific pathogen provides needed information on the type of intervention that could break the chain of infection Interventions can be aimed at any point in the cycle of transmission

Roles of local, state, and federal public health agencies

The majority of local, state, and federal agencies are involved in: •Collecting and analyzing vital statistics •Providing health education and information to the population served •Receiving reports about and investigating and controlling communicable diseases •Protecting the environment to reduce the risk to health •Providing some health services to particular populations at risk or with limited access to care •Planning for and responding to natural and human-made disasters and emergencies •Identifying public health problems for at-risk and high-risk populations •Conducting community assessments to identify community assets and gaps •Partnering with other organizations to develop and implement responses to identified public health concerns

Risk

The probability that an event will occur within a specified periods

Ethics

The work of nurses in public health involves ethical activities. •Nurses struggle with the rights of individuals and families versus the rights of local groups within a community. •Ethical issue examples: COVID-19 pandemic; Medication access; Vaccination •Struggling with these social justice issues can lead to moral distress - can be hard to know the right thing to do. •Basing your actions on ethical principles is a part of clinical decision making and practice

Tuberculosis

The world health organization's aim is to have a 90% reduction in TB deaths and 80% reduction in TB incidence The rate of decline must accelerate by 4%-5% annually to achieve the end of TB by 2020 The national goal to eliminate TB (less than 0.1 case per 100,000 population) has not been met Transmission via airborne droplets. Common symptoms: Cough, fever, fatigue, hemoptysis, chest pains, weight loss. WHO reports 12 million cases in 2012 and 1.3 million deaths due to TB (WHO, 2013) (Multidrug-resistant TB and Extremely drug-resistant TB) In United States, half of new cases are in New York, Florida, Texas, and California. Previously, purified protein derivative (PPD) test used for initial screening. Followed by chest x-ray for persons with positive skin reaction and pulmonary symptoms. Prompt treatment with multiple antimicrobial drugs. Treatment failure may be due to lack of client adherence, which can result in drug resistance. U.S. drug regimens include isoniazid and sometimes rifampin.

Vector-borne diseases

Tick-borne diseases Lyme disease: usually occurs in the summer in rural and suburban areas of the northeast, mid-atlantic, and north-central states, particularly Wisconsin and Minnesota Rocky Mountain Spotted Fever: most commonly occurs in the southeast, Oklahoma, Kansas, and Missouri Vector-borne diseases refer to illnesses for which the infectious agent is transmitted by a carrier, or vector, usually an arthropod (mosquito, tick, fly), either biologically or mechanically. With biological transmission, the vector is necessary for the developmental stage of the infectious agent. Examples include the mosquitoes that carry West Nile virus and the fleas that transmit plague. Prevention and control are key controls

Emerging infectious disease

Today, improvements in technology and transportation have brought people closer together Eliminated geographical barriers to transmission of disease (ex: deforestation, climate change) Increase in emerging and reemerging communicable diseases: Zika, Ebola, Disease Resistance TB, Polio Smallpox has been eradicated and some communicable diseases are close to eradication: Polio Dracunculiasis (Guinea Worm) What emerging communicable disease has been in the news this year? It's related to smallpox? Other communicable diseases are reemerging in drug resistant forms: Malaria Tuberculosis Bacterial pneumonias

Health care-associated infections

Transmitted or developed within a hospital or other health care setting Transmitted between clients, health care workers, visitors MRSA (Methicillin Resistant Staphylococcus Aureus)

Sexually transmitted diseases

Transmitted through contact and exchange of bodily fluids; preventable with use barrier protection More than 25 infectious agents Harmful effects: reproductive health problems, fetal and perinatal health problems, cancer (HPV), associated with the sexual transmission of HIV infection There are 3 notifiable STIs that have federally funded control programs: Chlamydia, Gonorrhea, and Syphilis Chlamydia and Gonorrhea: associted with pelvic inflammatory disease and can be passed from mother to the infant during delivery Syphilis: four stages- can be cured during the 1st stage; can be passed from mother to the infant during pregnancy or delivery The number of new cases (the incidence) of STDs, such as gonorrhea, herpes simplex virus, human papillomavirus (HPV), and chlamydia continues to increase. Chlamydia is the most commonly reported infectious disease. Gonorrhea is the second most common. Because of the impact of STDs on long-term health and the emergence of eight new STDs since 1980, continued attention to their prevention and treatment is vital. Main risk factor: unprotected sexual contact Disparities based on: Gender Ethnicity Sexual orientation Socioeconomic factors Underreporting of S T I's in nonpublic health-care settings Access to care

Smallpox treatment and prevention

Treatment: no proven treatment; supportive therapy- IV fluids, analgesics/antipyretic, antibiotics for secondary infections (Cidofovir) Prevention: vaccine; isolation/decontamination- droplet and airborne precautions for 17 days after a person's exposure, isolation/quarantine while individual is infected, considered infectious until scabs fall off- scabs contain live virus

PHN roles and responsibilities

Vaccinations Prenatal care Medication administration for STIs and TB Home visits for high-risk community members Establish relationships with individuals and community groups Recognize social determinants that affect health Disease control such as Tuberculosis management, Hepatitis A TB management: •Symptoms - night sweats, weight loss, poor appetite, persistent cough. •Drug-resistant TB has complicated and prolonged the fight to eradicate this disease (due to non-adherence). Highly contagious, associated with social determinants such as poverty, crowded living situations (dorms, prisons), alcohol/substance abuse, arrival from another country with high rates of TB infection. •Contact those who have been exposed to a positive case. They will need TB testing. •Treatment requires directly observed therapy for several months to ensure adherence or medication electronic monitoring system that tracks the openings of the pill bottle, phone, email or text reminders. •Public health nurses may contribute to investigations that locate where the TB cases are concentrated, and organize outreach services to those community members (testing, information, arrangement of prophylactic treatment as needed) If there is an outbreak of Hepatitis A in a community what is the most important information that the public needs to know from you to prevent transmission? Washing hands - HepA is transmitted fecal-oral route. Contaminated surfaces, food, and water are touched. Handwashing is the most effective way to prevent transmission. Emerging or re-emerging infections/diseases concerns: Drug resistant variants, diseases that have started to infect humans, climate change, globalization/international travel

Modes of transportation

Vertical transmission is the passing of the infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Horizontal transmission is the person-to-person spread of infection through one or more of the following four routes: direct/indirect contact, common vehicle, airborne, or vector-borne. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, blood, serum, saliva, or plasma. Vectors are arthropods, such as ticks and mosquitoes, or other invertebrates, such as snails, that transmit the infectious agent by biting or depositing the infective material near the host.

Approaches to quality improvement

Voluntary approaches •Credentialing - competence recognition •Accreditation - organization regulation compliance •Certification - skills recognition •Charter - institutional status to give degrees •Recognition - cross-institutional credentialing •Academic degrees Required approaches •Licensure - individual •Accreditation - regulation compliance for agency reimbursement •Certification - achievement qualifying for professional practice •Academic degrees - required to enter professions These approaches exist to assure QI in healthcare. The voluntary approach involves a large governing or official body's evaluation of a person's or an agency's ability to meet criteria or standards through processes like accreditation or certification. Required approaches to QI are methods used to manage a specific health care delivery system in an attempt to deliver care with outcomes that are acceptable to the consumer such as state licensure of a health department , licensing of health care providers, like boards of nursing,

Psychological stress of disaster workers

Workers at risk for stress reactions May not recognize the need for self-care Symptoms may signal need for stress management assistance ANA well-being initiative

Public health advocacy

•Advocacy is the process of actively engaging in activities to change health policies and improve the health of populations. •Example of health policy advocacy: The lawmakers, healthcare professionals, and civic leaders who worked together for many years advocating for the affordable care act to become law.

Nursing ethical principals

•Autonomy= The ability to implement and carry out patient care goals by using your knowledge and skills. Examples: Your professional decision making, and carrying out nursing responsibilities as appropriate to your nursing role. •Beneficence= Making sure that the patients' best interests are considered while you work for the benefit of those in your care. Examples: Comfort to a hospice patient, helping a patient learn how to self-manage their insulin, self-checking your personal biases so they do not negatively impact your care. •Nonmaleficence= To do no harm. To provide safe, effective, and quality care. Examples: Holding the administration of a medication when you assess signs of an adverse reaction to it, assessing the safety of a home healthcare client's home environment, to provide quality care that is not influenced by personal biases. •Fidelity= Keeping your commitment to provide consistent delivery of interventions so that all clients receive appropriate information

Documentation

•Documentation is essential to the evaluation of quality care in any organization •Healthcare organization records determined by state departments of health •Public health agency records predict population trends, identify community health needs, determine program budgets (infant mortality, chronic disease prevalence, life expectancy) •Public health agency records can provide a picture of the overall health and healthcare status of a community, population, country.

Ethical decision making

•Ethical dilemmas: Moral problems when the right thing to do is unclear. Example: Allocating limited resources among needy populations. •Ethical decision making: the part of ethics that focuses on the process of how ethical decisions are made •Example: Keeping patient confidentiality •When is it ok to breech client confidentiality? Only if the nurse suspects abuse. Then, who do you breech confidentiality to? Supervisor, child protective services, adult protective services, etc. •The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position. A nurse can only legally breech confidentiality when there is concern for harm to the patient or others.

The nurse's role in the policy process

•Nurses need to be involved in the policy process and understand the importance of involvement in nursing to the clients they serve •For most professional nurses, action is the policy arena comes most easily and naturally through participation in nursing organizations, such as the State Nurses Association, Association of Community Health Nursing Educators (ACHNE), or the Association of Public Health Nurses (APHN). •Nursing advocacy is important! Government and policy have a large impact on nursing and health. •Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care. You also need to know how people can access services so you can help. •Example: A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance.

Governmental role in US health care

•US Department of Health and Human Services (USDHHS) is the federal agency that has a strong influence on public health activities at state and local levels. •The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS. •Over time, wars, economic instability, and political differences between parties all shaped the government's role because these events change government priorities.

The law and health care

•Your state board of nursing governs your nursing license. •State boards of nursing govern each state's Nurse Practice Act which determines your scope of practice. •North Carolina is a "compact state." Nursing licensure compact is an agreement between states that allows nurses to have one compact state nursing license that gives them the ability to practice in other states that are part of the agreement. States may have differing application details such as finger printing.