Population Health Exam 2 Objectives- Alycia
List the overarching goals of Healthy People 2020
1. Obtain high quality longer lives free of preventable disease, injury and premature death 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that create good health for all groups. 4. Promote quality of life, healthy development and healthy behavior across all stages of life
Define the profile of early age substance abuse and what interventions may be warranted.
- can be genetic or have environmental influences - developmental or peer influences pay a role - personality attributes associated with early -onset substance abuse include: poor impulse control, attention deficits, conduct disorders, general psychological dysregulation and high comorbidity of anxiety disorders, PTSDs, and major depression - accessories to substances continues to play a central role in initiation of substance abuse (higher prevalence in areas where Marijuana is legalized) Interventions: screening - CRAFFT, Parenting style should include high levels of engagement, supervision, appropriate discipline, and sustaining positive bonds + screen for family/social experiences that are associated with the use of alcohol like excessive consumption by family members and peers; education is important for adolescent, parents, teachers, and other adults + motivational interviewing by the nurse to assist the adolescent to set realistic goals, reinforce healthy behaviors and be nonjudgmental Regulations surrounding early substance abuse should be enforced (possession laws, drinking and driving law and minimum age laws)
During the community assessment, how can you use existing data to describe the community's strength and weaknesses, asset, and liabilities?
- collect demographic data from national, state, county, and city or town from the internet - collect local data from libraries, service organizations, municipal records, newspapers, phone books, and other local sources
How does divorce affect family development
- far-reaching effects for family members at every generational level in both nuclear and extended families -divorce is different when comparing a family without children as opposed to one with children; child and stage of development determines his or her perception of the change in marital relationship, and the resolution of any conflicts - the stage of the relationship between the married couple also determines the level of loss and bereavement (may have a "couple identity crisis" as shared financial investments and possessions are dissolved or feelings of a sense of unfinished business/sense of failure)
How does the process of changing occur?
- more successful when it is actively managed rather than allowed to happen haphazardly - not usually a linear process, with the exception of large paradigm shifts - requires an understanding of what needs to be changed, how the change will take place, and an idea of what the change will look like when the desired state has been achieved
How does the process of unfreezing occur?
- moves people away from denial or lack of awareness of the need to change to a stage of pre-planning or preparation for change - education about the extent of the problem and its consequences may begin the process of unfreezing - nurses can be change agents during this stage to help mobilize the community by helping to highlight discrepancies between current and desired community health status, or creating a sense of urgency about a health issue - create dissatisfaction with the current state and raise awareness of a need for change
What is an obesogenic environment? How would this be addressed?
- not just an issue of personal or family responsibility but one created by the environment that promotes or contributes to obesity - interventions should be directed at changing the environment to create conditions where healthy choices are the default or norm
Define the profile of college students and binge drinking as well as what interventions should be used
0.08% or above; environmental influence of attending college is a significant risk factor; rates of binge drinking vary by race, gender, and peer-group affiliation, suggesting that cultural and environmental influences are huge (first years, athletes, Greek, mandated students Binge drinking is associated with life altering health risks including: physical and sexual assault, alcohol poisoning, and alcohol-related deaths Interventions: alcohol screening standards at all universities; assess for quantity and frequency; prescriptions; brief counseling sessions to reduce the frequency and intensity of alcohol use; use motivational interviewing (establish trust, empathetic listener, instil hope and positive regard); sustained and coordinated effort among nurses in counseling services, health clinical, primary care, ERs to identify at risk behaviors; governmental law and school policies to reduce harmful incidents
What are the steps to a community assessment?
1. Establish a working group 2. Define the composition of the community 3. Identify the information that needs to be collected 4. Identify an organizing framework for collecting data 5. Use existing data to describe the community's strengths and weaknesses, assets, and liabilities 6. Gather new data as necessary 7. Analyze the data, looking for similarities, differences, and inconsistencies 8. Develop a profile of the community 9. Identify vulnerable populations, unmet needs, resources, and unique characteristics 10. Outline a plan for intervention based on findings 11. Prepare a report and disseminate it to others 12. Design, implement and evaluate a project based on findings
List the components of SMART objectives
1. Specific: what behaviors, knowledge, skill, change in health status indicators or outcome will result from the program? 2. Measurable: how will the outcome be measured? 3. Achievable: is it realistic to reach the desired outcome with the resources and time available to the program? 4. Relevant: is the objective related to the program's goals and activities? 5. Time-bound: when will the objective be achieved? - SMART objectives help in planning interventions and establishing measurement systems to evaluate programs and outcomes
List the 10 summary points of great concern related to demographic information and the needs of the LGBTQ people
1. The four different subgroups have unique needs; there is little demographic data tailored to each of the separate groups 2. Few population based studies have been conducted in LGBTQ groups, with the exception of HIV- related research 3. Specific questions on surveys related to sexual orientation 4. Recognition of same-sex heads of households has not alway been included in survey data 5. There is confusion regarding variability of expression of one's identity, behavior, and attraction 6. Cultural contexts vary across age and developmental staging about about "coming out of the closet"; some people may not feel comfortable with the word queer 7. Fluidity of gender and sexual identity changes over time 8. LGBT groups tend to experience more serious physical and mental health conditions, including interpersonal violence and substance additiction 9. Particular health concerns from a prevention perspective include obesity, injury, violence, and access to healthcare facilities 10. Health professionals are poised as confidants and trusted people to make significant preventive inroads at all levels if they approach LGBTQ groups informed with data.
What is an instrumental functioning assessment?
Assess if ADLs and IADLs are being met Assess routines, patterns, behaviors, and interactions related to those activities How family's current state of health and illness are impacting instrumental family functioning Who is responsible for certain tasks? How well are tasks performed? Is the division of labor fair and reasonable?
List the risk factors that cause concern for the safety of children during IPV?
1. Threats to kill the caretaker, children, or self; caretaker fears for the children's safety 2. A child was physically injured in an incident when the caretaker was the target. 3. A child was coerced to participate or witness the abuse of the caretaker 4. A weapon was used or threats were made to use a weapon, and the caretaker believed that there was intentional and ability to cause harm
Define subculture
A group sharing some practices, language, or other characteristics in common, within a larger society that does not share those characteristics
Explain ways a nurse and an institution can be culturally competent
A nurse will never know all cultures at one time but should have the following traits: - openness to others ideas and ways of life - respect, curiosity, patience, an self-awareness of one's own culture and culturally mediated ideas - humility to know that one can always learn more about a certain client's culture and that person as an individual Individual nurses must work toward cultural awareness and competence to help erase health disparities and power imbalances amongst groups Institutional policies should provide the framework and tools necessary for nurses to provide culturally competent care
Define withdrawal:
A reduction in prolonged substance use that results in problematic behavioral, physiologic, and cognitive changes; withdrawal causes significant impairment in social, occupational, and interpersonal functioning and is usually associated with an urge to read minister the substance to reduce symptoms
During the community assessment, how would one gather new data?
Community forums/town hall meetings that give a qualitative assessment to gain community opinions (who should be involved in the change) Focus groups Key informants (a person knowledgeable about specific aspects of a problem and the community's current and past attempts to address it — can include formal/informal leaders, or members of the community Participant observation (windshield) Surveys
define addiction
A term along with habituation, which the WHO recommends to be substituted with substance dependence; however, clients and practitioners communally use addiction
Define abuse of a disabled person
Abuse/neglect to person's with disabilities of physical, cognitive disabilities - appears that people with cognitive disabilities who have a desire to be accepted and "fit in" may acquiesce to behaviors that are not quite comfortable with because of fear of social isolation - often, a person with a disability is dependent on another, and that dependency prevents him or her from recognizing abuse and seeking help - event when a person with a disability reports a crime, they are often not believed (viewed as not credible)
What factors are involved in securing funding for community health intervention programs?
Accountability Sustainability Program replication
Define substance use disorder
Addiction to alcohol, illicit drugs, and non medical use of prescription medications
What is a force field analysis? What is the process, and what is the goal?
Also developed by Karl Lewin; change management technique that identifies factors within the community that are driving or reinforcing change in the desired direction or factors that are restraining or resisting change - identify what factors can be increased or decreased to allow the process of unfreezing to occur - identify what forces are not possible to change (political, structural, cultural, or financial constraints) - what the change to be realistic and achievable - allows you to select the most appropriate targets
Define child abuse
Any recent act, or failure to act, on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse, or exploitation; or an act or failure to act which presents an imminent risk of serious harm Neglect remains the highest form of maltreatment, followed by physical abuse, and then sexual abuse Nurses should still encourage the affected mother/father to express her family's immediate needs, seek support of a community domestic violence advocate, tell her about family services that meet their immediate needs, identify the family support system, assist in developing a safety plan, and consult with child protection experts/domestic violence providers Strongest protective factor int he lives of children who are exposed to domestic violence is support for the non offending parent
What aspects of culture can affect health and health care?
Attribution of illness - different cultural worldview s reflect different ideas about what causes illness Diet - choose foods or diet plans that correlate with the individual's culture (be aware of dietary restrictions and know some groups incorporate herbs/teas that related to the potential medicinal effects that should be noted with these combinations Communication (verbal, nonverbal, and style) - verbal: always communicate in a patient's fluent language, using a translator when needed that accommodates "cultural brokage"; Non-verbal: know the client's previous experiences to best care for them; style: communication can be linear or nonlinear) Time orientation: consider patient's time views when discussing medications; acknowledge a person's perception of time related to culture rather than using your own perception of time Roles: men, women, children, young adults, and elderly all have different roles in different cultures: in some cultures children are encouraged to speak for themselves while others expect children to be quite; in some cultures the prognosis should be discussed with the family prior to the patient and sometimes people who are sick make the decisions and in other cultures, the family should decide Religion: can affect health, illness, and treatment plans; prayers for some are viewed as advantageous; all religions have traditions and rituals around death that affect end of life issues Folk medicine: clients can be self-prescribing or going to folk healers; always ask what other nonpharmacolocial practices they are using just like with medications because they can have massive effects on treatments and additional prescribed meds
List and describe the factors that compound disease prevention and health promotion in the rural elderly
Availability: insufficient number and diversity of formal services and providers; lack of acceptable service and human service infrastructure Accessibility: shortages of adequate, appropriate, and affordable transportation; cultural and geographic isolation Affordability: poverty and inability to pay for services Awareness: low levels of information dissemination; literacy issues Adequacy: lack of service standards and evaluation; evidence-based practice compromised Acceptability: reluctance to ask for help Assessment: lack of basic information on what is needed using research rigor and analyses
What is an example of tertiary prevention activities related to IPV?
Caring for victims affected by, or currently experiencing violence; primary clinical care and follow up including attentive listening that is validating and nonjudgmental Discuss health effects of violence and provide information regarding the cycle of violence; provide risk factors associated with increased risk of homicide Referral to resources; provide them with options specific to their locale, provide safety planning, national hotline numbers Advocacy and quality of care following Recognize the warning signs and know how to ask about violence; know what legal options there are and social services
What are the three domains of family functioning in the Calgary Family Intervention model?
Cognitive; Affective; Behavioral
What is an underserved area
Complete area that is exhibiting health care personnel shortage and must recruit to retain health care workers - these people may or may not be part of an underserved population but the community as a whole is not getting enough resources
List and describe the types of community assessments
Comprehensive assessment: discover all relevant community health information (review existing data, in depth surveys from groups in community; interview key informants; often expensive and time consuming) Problem-oriented assessment: begins with a single problem; familiarization is not sufficient and a comprehensive assessment is not feasible; responsive to a particular need and contextual issues associated with the need Familiarization or windshield survey: observation of a community while driving a car or riding public transit to collect data for a community assessment (common starting place; studying data already available for a community; gathering first hand data - find health, social, and governmental services, become familiar with the residents and community workings, focus on the physical environment including education, safety and transportation, health and social services, communication, and recreation)
Define family systems theory
Comprised of subsystems (individual members) and part of a constant interaction with suprasystems in the external environment (neighborhood, community, and societal institutions) Family is defined as a system with continual interactions between its members and the environment The system as a whole is greater than its parts A change in one member of the family will affect all other members (each part contributes to a functioning whole)
What is the structural piece of the Calgary Family Assessment? What components are involved?
Comprised of the following components: Internal structure: family composition, gender and sexual orientation of the members, birth order of the children, and boundaries defined by the couple/parent and child/sibling External structure: extended family, social and community connections (school, work, religious, healthcare) Context: culture, race, social class, spirituality/religion, environment Identify key relationships within and outside the family (genograms and ecomaps)
What are the different types of family structures:
Concept of family has broadened and become more inclusive, and it extends beyond the two-parent traditional nuclear family (share common traits, but structural configurations differ Single-parent (due to divorce, widowhood, or birth outside of a marital relationship - half of all single mothers have never been married and most common marital status of a single parent father is divorced) Blended Cohabiting couples/families Gay and Lesbian families Homeless families
What is the purpose of data analysis in community assessment
Conclusions can be made Relationships that predict health status can be defined Look for similarities, differences, and inconsistencies to help diagnose the problem Determine if the assessment findings were valid and following diagnosis; address the problem now that we know the cause
Define institutional competence
Healthcare organizations must also strive to provide cultural competence awareness and seek to minimize structural hindrances to cultural openness and respect
Define formative evaluation
Ongoing evaluation during the project implementation (are we doing what we said we can do?) Revisions can take place during this process
How is a plan outlined for interventions based on the "diagnosis" of a community assessment?
Decide what the expected goals/outcomes are What interventions may be effective in achieving the desired outcomes? How should the program be evaluated/measured
Describe cohabiting couples and families
Decision to marry in the US is regarded as individual and personal Couples may choose to cohabit before marriage or instead of marriage 1/3rd of cohabiting, unmarried couples have children under 18 Families often form when couples in a group of people cohabit; they consider themselves a family as they form committed emotional bonds and share possessions/home ownership
During the community assessment, what entails "identifying the information that needs to be collected"?
Define the purpose of the assessment Define the setting and those who are part of the setting defines the context in which the plan can be developed Real or perceived needs to be addressed Determine what type of assessment needs to be conducted
Living in shelters or temporary facilities is associated with greater risks for what?
Depression, anxiety, sadness
What are genograms?
Diagram of a family constellation (at least 2 generations) Highlights family members' ages, gender, relationship, birth order, marital status, mortality Can include health status, education, and occupation Shows how interdependent family members are related Identifiy common traits as well as unique attributes
When you design, implement,and evaluate a project based on the findings, what should you be asking yourself?
Did we do what we said we would do?
Define tolerance
Diminished physical/psychological response to effects of alcohol or illicit substances. A person develops tolerance when he or she needs to use higher doses of alcohol or illicit substances to achieve the desired euphoric effect
Define cultural competence
Openness to and respect for other's ideas and ways of life; curiosity, patience, self-awareness of one's own culture and culturally mediated ideas
Describe the family life cycle phases for divorcing and remarrying
Divorce: working through the actual decision; planning for separation and change in family system; dealing with emotions (anger, sadness, guilt, fear); organizing (living arrangements, finances, custody issues, restructuring relationships) Post-divorce family: adjusting to a single-parent structure and some form of shared custody or visitation schedule are focal issues; develop respectful co-parenting relationships and processes is important (assists children to adjust to new living arrangement and family dynamics Remarriage: complexity and the formation of multiple new relationships and structural changes within the family system (need time and patience for new family membership, roles, functions, and boundaries)
What are the 3 properties of culture?
Dynamic, not static (changes over time; language can change; culture adapts to circumstances; individual people and families evolve with change in home life, illness, and migration to a new country) Shared, not private (all definitions of culture include the concept that culture is shared among groups of people; families and peers are the first source of cultural sharing; can happen any place people interact — social media, school, neighborhoods; individual people have cultural values, beliefs, and practices, but sharing them is the process of culture) Learned, not inherited (no one is born with culture; culture is first learned from parents and siblings, then from peers, teachers, neighbors, books, tv, and media; culture is brought in when they are raised, and it does not necessarily have anything to do with where they are born)
What is an example of primary prevention activities related to IPV/
Education must be persistent, constant, mulilingual, and culturally aware Must target potential victims and potential perpetrators Note that many victims and perpetrators of IPV differ in their opinions of what constitutes abuse Dependent on: prior exposures; cultural identification; family and peer opinions; education
What is the functional piece of the Calgary Family Assessment? what components are involved?
Emphasized interaction among family embers and how they behave with each other (focuses mostly on the present, but past can be relevant) Instrumental functioning versus expressive functioning
What are ecomaps
Outline the influence that other systems or groups have on families Vital connections like: Religion Work Education Culture Healthcare Social organizations and groups Helpful to identify social supports and show families whether resources are available to assist them
What is the developmental assessment as part of the Calgary Family Assessment?
Explores the evolving path the family goes through and the tasks needed to be addressed at key periods; Typical life-cycle events include: birth, child rearing, departure of children, retirement, death Sociocultural, economic, and other societal factors have increased the variety of family constellations and influenced family development and life cycle Family life is dynamic and progression through stages is not through; look at each family individually to assess the current stage and its current abilities to accomplish tasks and continue down its path; during transition, the roles change, and family life patterns do as well
Define the family developmental theory
Families all progress through typical stages; 8 stages 1st stage: young adult-typically in the early 20s and leaving home to start families and start a new career Next 4 stages: childbearing and child-rearing in heterosexual two-parent families 6th stage: parents launch their children in adulthood to begin the married and career lives Last 2 stages: middle aged and aged families with a focus on the empty nest, establishing inter generational relationships, retirement, coping with the loss of a spouse and living alone
Describe homeless families
Families with children comprise 35% of the homeless population Poverty contributes to homelessness as families struggle with incomes that are too low to pay for housing and other basic financial needs This may be due to: Lost job, eviction, overcrowding, catastrophic illness, unanticipated major bills, interpersonal violence, natural disaster
What is the expressive functioning assessment?
Family communication (both verbal and nonverbal) to understand how emotions are expressed Influenced by culture, socioeconomic status, and family history Determines how emotions are expressed,; are you observing a healthy range of emotions; are those emotions accepted and supported?; is emotional expression limited/suppressed Assess meanings and messages in verbal communications; are they clear? Are there concealed meanings or vague responses or frequent misunderstandings? Assess nonverbal communication: facial expression, body posture, gestures, do they support family interaction and function or are they detrimental
Over time how does the cycle of violence progress?
Frequency picks up, and the honeymoon phase gets shorter and shorter (sometimes being eliminated all together) The explosion phases get worse and more risky - may result in injury/maiming/death
What is sustainability in reference to securing funding for community health intervention programs?
Funding agencies expect programs to have a clear and convincing plan outlining how efforts started with grant funding will be continued after the grand ends; is there a commitment from participating agencies that they will maintain changes if the program is effective and produces desired results?
Describe the different types of communities.
Geopolitical: sharing geographic boundaries and governing structures (where they live; cities, towns, neighborhoods) Phenomenological: sharing common interests or beliefs or goals (can also be geopolitical, but the geography will be less defined Communities of solution: formed by a group of people to address common interests, beliefs, or needs (form in response to a common problem or threat like contaminated water or industrial air pollution)
After the data is analyzed in a community assessment and the profile is made of the community, how are the vulnerable populations identified?
Going back to the stakeholders, formal leaders, informal leaders to see if the profile is made is accurate and they agree what populations need to be addressed
List and describe the 3 stages of the cycle of violence
Honeymoon Period: apologies, promises, gifts Tension building: criticism, yelling, swearing, coercion, anger; victim may or may not know what is wrong; victim tries to remedy the situation and tries to prevent the situation from getting worse by taking responsibility for making the partner feel better and begins to set herself up to feel guilt when he eventually explodes Explosion: attacks and threats are either physical, emotional, or sexual; the reason for explosion is usually trivial or unknown leaving the victim confused and feeling helpless; victim may or may not fight back or may/may not try to escape the violence or call for help
Define summative evaluaiton
Immediate impact of a program or a target group
Explain the social determinants of health and how they contribute to the health status of a community
Include the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness; it is the complex interaction of social, economic, environmental, and behavioral factors that impact the health status of a community
During the community assessment, what entails establishing a working group?
Include the community members and institutions to achieve desired health outcomes for the community Can include coalitions, stakeholders, partners in the change process to improve community health status Get the opinion leaders on board with the changes you wish to make Discuss factors that contribute to the problem
Define elder abuse
Intentional actions that cause harm or create a serious risk of harm (whether or not it is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder; includes failure by the caregiver to satisfy the elder's basic needs or to protect the elder from harm
What are the sources to collect existing data, and what do those sources tell you?
Internet (demographic data - age, sex characteristics, racial/ethnic distribution) City hall archive/chamber of commerce (same info as with internet) Observation (same info as with internet Census: demographic data, household types, marital status State and county health department: number of births and deaths by age and leading causes of death and other vital statistics Personal contact/observation: values, beliefs of the community Telephone book: number of churches/religious buildings in a community
Define the profile of persons who inject drugs and name interventions
Interventions: syringe exchange programs (free sterile needles, safe disposal, overdose treatment and education, HIV/hepatitis testing, mental health services, SUD treatments)
Define culture
Knowledge, values, practices, customs, and beliefs of a group
During the community assessment, what entails defining the composition of the community?
Making it clear who is a member of the community and who is not Group of people sharing common interests, needs, resources, beliefs, and environment—an interrelated and interacting group of people Can be geopolitical, phenomenological, or a community of solution
What are the five leading principles to address during a family interview
Manners: common courtesies, such as the nurse introducing him/herself to the family, indicate a desire to connect with the family and to instill trust in family members Use of therapeutic conversation: when time is limited, purposeful and focused conversation helps build a relationship; nurses validate family concerns with their active listening (allow everyone present to voice observations, insights and concerns before offering how they could change the situation; plan goals and outcomes with the family; forge a partnership with the family's participation; collaborate with the family to set priorities) Ecomaps/genograms: these tools are invaluable, especially when family members are likely to be involved with the care of another member Use of therapeutic questions: asking family members questions helps them identify their expectations about care but also assign priorities to their most urgent needs Commendations acknowledging family strengths: informing families about the assets and resources they already gave possess leads them to view their situation differently and makes them more likely to move toward more effective problem solving
How must we as nurses modify the stages of the family developmental theory
Must be aware of the ever changing stages of life since these norms have now shifted - variations in the family structure and timing of family developmental tasks - time of leaving home, getting married, and having children has changed - stages are not as predictable and do not fit as well with changing structure of contemporary families - diversity of family norms should be respected and family health and well-being should be promoted for types of families
How does the process of refreezing occur?
New behaviors can be difficult to maintain until they become habitual - anticipate the support system that must be in place when a program ends so that positive changes in health are maintained (the community is key to sustainability; community members and stakeholders should have a sense of "ownership" of the process or program and feel engaged and empowered by the changes that are accomplished; les likely to occur if the change is imposed upon the population)
Homelessness impacts children in what ways?
Physical and mental health Education Sense of safety Overall development
Describe gay and lesbian families
Prevalence of marriage in the general population continues to decline, but same-sex marriage has increased substantially Same-sex marriage is legal in all 50 states, but an anti-LGBTQ discrimination and social stigma remains Some negative attitudes toward same-sex parenting continue to exist with opponents contending that the parents' sexual orientation is detrimental to children
During the community assessment, what does it mean to identify an organizing framework for collecting data?
Provide direction for the assessment as they highlight methods that were successful (Identification of community assets and know the capacity to create and implement change from within the population aggregate) What is the reason for conducting an assessment (gaining information to clarify if change needs to be made OR to empower those responsible for implementation that change) Use frameworks like the epidemiologic process, a community as a partner, or assets based approach to collecting data
What is accountability in reference to securing funding for community health intervention programs?
Regular follow-up about how the funds were used, details of program activities, and progress toward achieving program goals (making sure the change is occurring how we said it would—and that progress towards the end goal is being made)
Describe the behavioral domain of the Calgary Family intervention model
Related to action and doing and involves helping families change behaviors that may be detrimental to family functioning and promote behaviors that support health coping, adjustment, and family functioning; help members of the family act in a more caring manner and be more supportive of each other, improve family communication, and identifying improved methods in coordinating care/completing family activities - identify the family caregivers and provide caregiver education and support (educate on illness, training on caregiving tasks, observe interactions between the care recipient and caregivers, improve understanding of the caregiver role, performance of tasks, and care for the recipient - encourage self-care and respite for the family caregiver (available community services, teach components of self-care, and decrease caregiver burden and support their health and well-being - assist them family in developing helpful daily rituals and routines (assess previous routines and rituals, identify adjustments that are needed, and help them provide structure and organization that will decrease stress)
Describe the affective domain of the Calgary Family intervention model
Related to feelings and the need to reduce emotions that may be interfering with a family's ability to problem solve, cope, and heal, or the need to increase emotions that support family functioning within the illness experience; therapeutic communication should enhance emotional engagement in problem solving as well as feelings of closeness and affirmation within family relationships - acknowledge, validate, and normalize emotions (make a safe environment and facilitate conversation + reduce intense emotions that may be interfering with the family's ability to communicate and problem solve - encourage family members to share their unique experience with the illness or condition - establish emotional support to respond to family members' concerns and feelings (listen intently and observe for emotional support that the family is able to offer each other and identify emotional strengths that can support healthy coping)
Describe the cognitive domain of the Calgary Family Intervention model
Related to thinking and the need to gain new information and knowledge about a health problem affecting the family; change the way a family perceives its health problem to discover solutions - comment family and individual strengths by observing positive patterns of behavior; begin and end family conversations with commendations; promote families' positive self-view and self-efficacy while also fostering the relationship between nurse and family - offer information and opinions/new ideas and education on a specific health problem or risk using clear, relevant, understandable language; encourage family to respond to the information and opinions shared; educate to change the way the family thinks about the health problem and find new and effective solutions
What is done during the community assessment when the report is disseminated?
Report back tot he community constituents on the plan Explain what you think is the priority problem and make sure that your priority problem is also the priority problem for the community (are you on the same page?) If they do not think the problem you identify is a priority, any plan you implement will not be effective because the community is not motivated to change
What are the 5 crucial functions of a family as defined by the structural-functional theory?
Reproductive: addition of new members through procreation or adoption Affective: nurturant, love, and sense of belonging Socialization: transmission of culture, values, rules, social norms, and social identity Economic: production, consumption, and destruction of goods and services Healthcare: promotion and protection of health and well-being, coordination of care and health services
What is an example of secondary prevention activities related to IPV?
Screen women of childbearing age for IPV Inquiry with high-risk populations Routine assessments
What are the three types of evaluation in a family assessment
Structure-Process: organization of the visit and how it proceeded (were you organized/prepared? What distractions influenced the visit? What adjustments will you make for next time) - similar to formative evaluation of a community assessment Outcome: most important evaluation component; we want to know if the anticipated outcome was achieved and what made it possible; it may also be progression towards a goal in the form of of small changes over time in the family dynamics which are noted on a visit by visit basis (viewed cumulatively - similar to the summative evaluation) Self-evaluation: what aspect of your performance as the public health nurse facilitated the desired outcome during the home visit?; were you prepared? Did you gather enough data so you could be prepared to assist the family on the next visit? What would you do differently? What went right? What went wrong?
What is an underserved population?
Subgroup of the population that has a higher risk of developing health problems due to a greater exposure to health risks because of the marginalization in social status, acce to economic resources, age, or gender - groups not served equitably by public and private healthcare infrastructures because of lack of access, racism, sexism, homophobia, and fear of what they do not understand - underserved populations are vulnerable and other subgroups can include those with HIV/AIDS, PTSD, depression, and other mental illnesses - although you might live in an industrialized country such as the Us, many are not being cared for due to lack of assurance that the healthcare industry has trained professionals that are willing to help or have policies in place to help people with specific needs - typically have adverse outcomes from lack of healthcare
What is program replication if terms of securing funding for community health intervention programs?
The ability to reproduce a successful program with a different community or new population aggregate is a test of the strength of the design of an intervention; keep in mind that what may have succeeded in one population could reflect the community's readiness to change rather than the strength of the program
Define ethnocentrism
The assumption that others believe and behave as one's own culture does, or the belief that one's own culture is superior to others
Define the profile of older adult substance use and name interventions
The cohort with the greatest lifetime use and dependence with alcohol and drugs is now entering older adulthood Regular screening across all age cohorts Thorough health history/urine and blood toxicology; systematic assessment for symptoms suggestive of intoxication or withdrawal symptoms; misuse or excessive use of medication or non prescriptions can be related to education/senses/cognition Healthcare providers mistakenly attribute presenting signs to depression, dementia, delirium rather than substance abuse because there is a lack of awareness about the extent of substance use Education is needed to talk about the recommendations about acceptable levels of alcohol consumption decrease with age
What is a salutogenic environment? What is needed to make this happen?
The healthy choice is the default Ex: in schools, healthy food choices are the only ones available, and physical activity is incorporated into school curricula - need coordinated and comprehensive efforts by stakeholders, community leaders, multiple sectors, professional organizations, and leaders - Use Health Impact Assessment to make informed choices about improving health by evaluating the potential health effects of a plan before implementation; maximize positive health outcomes, minimize adverse health outcomes, and keep in mind the engagement of the community and stakeholders
What are levers of change and how/why are they used?
The purpose of using levers of change is to increase driving forces and to decrease restraining forces; Leverage points are identified in the force field analysis; you want to pick the change that makes the largest impact with the smallest effort - public policies such as tax increases on tobacco, alcohol/soft drinks can serve as policy levers to bring about change in community health status
Define substance use
The use of alcohol, illicit drugs, and non medical use of prescription medications
What is Lewin's model of change?
Three step process involving unfreezing, changing, and refreezing Unfreezing: necessary precursor to change which may occur through generational changes in beliefs/norms or through a paradigm shift Changing: transition through a dynamic process Refreezing: stabilizing once a change has occurred with the goal of sustaining the change in the community's systems, policies, and customs
Define cross-cultural nursing
Transcultural nursing; any nursing encounter in which the client and the nurse are from different cultures
Define family
Two or more persons who share emotional closeness and identify themselves as members of a family (people determine their status as a family) Concept of family is not static—it evolves over time with cultural influences and social changes Family boundaries are not limited to traditional definitions that imply genetic and legal definitions Family structure has been influenced by delayed marriage and child-bearing, increased divorce rates, remarriage rates, increased co-habitation, smaller family sized, grand parenting, and same sex marriage
Describe a blended family
Two single parents either marry or cohabitate and raise their children from previous relationships together Became more prevalent as more divorced or widowed people remarry Survey respondents show higher levels of commitment and obligation to biological parents, grown children, and siblings over those with stepparents, stepchildren, or step/half siblings
Describe upstream, mainstream, and downstream interventions. How do these interventions address change?
Upstream: at the societal, environmental, or policy level; focus on underlying causes of poor health and health disparities to achieve the greatest impact Mainstream: at the population or community level Downstream: at the individual level; do little to address the social or environmental determinants of population health and require continued and repeated efforts as new people continue to experience the relevant health problem - behavior needs to be institutionalized, normalized, and legally bound to have individual behavior change
What is the Calgary Family Assessment? Why was it developed? What are the assessment categories?
Used to understand and intervene with families to promote their health and soften their illness experiences, a detailed assessment needs to be completed This model was developed to assist nurses to perform an assessment in an organized and systematic manner Three assessment categories: structural, functional, and developmental — combine the elements needed to gain a multilayered understanding of the family components
Define family structural-functional theory
Views the family as a social system but emphasizes the organization or structure of the family and how the structure facilitates its functioning; structure refers to the ordered set of relationships among the parts and between family and other social systems The structure facilitates the achievement of the functions which serve both the individual family members, community, and society Society and cultural norms affect changes in the family structure; the time that nuclear or extended family spends with each other is not determine by distance but on family customs Family provides essential needs including food, shelter, and clothes
What type of family comprised the majority of homeless families? What are they at higher risk for?
Young, single mothers Greater risk of: illness/disability, substance use disorder, violence-related injuries; mental health problems
