Week 1: Community Nursing and Cultural Influences
currently what degree is required to work as a public health nurse?
§Master's degree required for specialization in PHN ( §Then eligible to sit for certification exam) §BSN graduate has basic preparation to function as a staff PHN.
Médecins Sans Frontières Doctors Without Borders
§Provides life-saving medical and technical assistance to people affected by natural or man-made disasters and armed conflict. Field staff deliver direct care in more than 60 countries, often in very difficult conditions.
Healthy People 2020 Goals
§Reduce health disparities among Americans; to eliminate not just reduce by 2010 §Now the goal expanded by 2020 to achieve health equity, eliminate disparities, and improve the health of all groups?
What is culture awareness?
§The self-examination and in-depth exploration of one's own beliefs and values as they influence behavior
United Nations Children's Fund
§UN agency that advocates for children in the areas of nutrition, environment, education, gender equity, health, and public policy.
World Health Organization
§UN-affiliated intergovernmental agency responsible for shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends.
School Nursing in America
§Works with school-aged children in the educational setting §Have experience in mental health, school policy and law, and must be comfortable working with children §Work with teachers, administrators, and parents §Students' social well-being and anti-bullying measures
What are Risk Factors for Health across Countries ?
•HIV/AIDS, Alcohol, tobacco, obesity, lack of physical activity. •Very low-income countries - adequate food, sanitation, safe drinking water, and vector-bourne diseases are primary concerns
some examples of technological trends
•Telehealth •Electronic health record (EHR)
Forces shaping global health and nursing
policy and national economics population trends environmental factors Access to technology
§Levels of Prevention
primary, secondary and tertiary
§Assessment refer to
systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community.
§Policy Development refers to
the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.
Specialists in public health nursing are defined as
those who are prepared at the graduate level, with either a master's or doctoral degree, "with a focus in the public health sciences"
What is health literacy?
§Capacity to obtain and use health information
eight categories of competency, which include:
(1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking.
Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy:
(1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics.
§Assurance
-refers to the role of public health in ensuring that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them. Assurance also refers to making sure that a competent public health and personal health care workforce is available. Fielding (2009) subsequently made the case that assurance also should mean that public health officials should be involved in developing and monitoring the quality of services provided.
Eight Principles of Public Health Nursing
1)The client or "unit of care" is the population 2)The primary obligation is to achieve the greatest number of people or the population as a whole. 3)The process used by public health nurse include working with the client(s) as an equal partner. 4)Primary prevention is the priority in selecting appropriate activities. 5)Selecting strategies that create healthy environmental, social, and economic conditions in which population may thrive is the focus. 6)There is an obligation to actively reach out to all who might benefit from a specific activity or service. 7)Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice. 8)Collaboration with a variety of other professions, organization, and entities is the most effective way to promote and protect the health of the people
Essential Elements of Primary Health Care
1.Education concerning prevailing health problems and methods of prevention and control 2.Promotion of the food supply and proper nutrition 3.The provision of safe water and basic sanitation 4.Maternal and child health care, including family planning 5.Immunization against the major infectious disease 6.Prevention and control of locally endemic disease 7.Appropriate treatment of common disease and injuries Provision of essential drugs
§There are more than ..............federally funded community health centers throughout the country
1300
when was the United States PH created ?
1988 by the institute of medecine •Found the United State's PH system in disarray and concluded that, although there was widespread agreement about what the mission of PH should be, there was little consensus on how to translate that mission into action.
In 2012 total number of uninsured people in the US was
48 Million
Patient-centered care
: Recognizes the client or designee as the source of control and as a full partner in providing compassionate and coordinated care that is based on the preferences, values, and needs of the client
§A nurse is an emergency department is triaging clients following an exploration at a local factory. Which of the following clients should the nurse identify as the priority? § A.A client who has superficial burns to 10% of the abdomen B.A client who has tracheal deviation and shortness of breath C.A client who has agonal respirations and an open head injury D.A client who has a fracture of the humerus and a bleeding foot laceration
C
What was the major outcome of the committee's work?
Community Health Improvement Process (CHIP)
§A nurse is planning a primary prevention program for the older adults at a local community center. Which of the following information should the nurse include as a primary prevention setting? A.Increase intake of dietary fiber B.Have a hearing screening every 1 to 2 years C.Schedule annual fecal occult blood testing D.Use heat therapy to relieve joint stiffness
Correct A- Primary Prevention- Prevents Constipation B- Incorrect- Secondary -Detection of hearing loss C- Incorrect- Secondary - Detection of GI bleeding D-Incorrect- Tertiary- Management of an existing condition
§A home health nurse is planning care for a client who has type 2 diabetes mellitus. Which of the following interventions should the nurse include to address primary prevention for this client? A.Initiate a dietitian referral to teach the client about carbohydrate counting. B.Instruct the client to eat fatty fish twice weekly to prevent cardiovascular disease C.Schedule routine eye examination to detect diabetic retinopathy D.Teach the client's caregiver how to administer glucagon IM for hypoglycemia
Correct B-Primary Prevention- Fatty acids maintain blood lipid levels A- Incorrect- Tertiary Prevention-Diabetes Management C- Incorrect- Secondary Prevention- Screen for eyes complications D-Incorrect- Tertiary Prevention- Management of hypoglycemic episodes
The largest share of health care expenditures goes to pay for
Hospital physician are second
Evidence-based practice:
Integrates the best current clinical evidence with client and family preferences and values to provide optimal client care
Safety:
Minimizes the risk for harm to clients and provides through both system effectiveness and individual performance.
•Quality and Safety Education for Nurses (QSEN), a national initiative designed to transform nursing education: •
Patient-centered care •Teamwork and collaboration •Evidence-based practice •Quality improvement •Safety •Informatics
Teamwork and collaboration:
Refers to the ability to function effectively with nursing and interprofessional teams and to foster open communication, mutual respect, and shared decision making to provide quality client care.
§Tertiary Prevention-
Stopping deterioration in a patient, a relapse, or disability and dependence by anticipatory nursing and medical care. Example: The public health nurse develops a diabetes clinic in which nursing care including educational programs for nutrition and self-care are provides for a defined population of adults in a low-income housing unity of the community.
§Secondary Prevention-
Stopping the progress of disease by early detection and treatment, thus reducing prevalence and chronicity. Example: The public health nurse develops a program of toxin screening for migrant workers who may be exposed to pesticides and refers for treatment those who are found to be positive for high levels.
Informatics:
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
Quality improvement:
Uses data to monitor the outcomes of the care processes and uses improvement methods to design and test changes to continually improve quality and safety of health care systems.
§Primary Prevention-
Using general and specific measures in a population to promote health and prevent the development of disease (incidence) using specific measures to prevent disease in those who are predisposed to developing a particular condition. Example: The public health nurse develops a health education program for a population of school-age children that teaches them about the of smoking on health
What is the goal of Healthy People 2020?
a society in which all people live long, health lives
A nurse had the opportunity to work with Mary Breckinridge. Which of the following would the nurse most likely have assisted with? a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Teaching birth control measures to large numbers of women in the South
ANS: B Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement
A major provision of the Social Security Act of 1935 was the establishment of: a. the FNS to provide nursing service to rural communities. b. state and local community health services and training of personnel. c. district nursing to provide home health care to sick people. d. community-based settlement houses.
ANS: B Title VI of the Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of PHNs. Nurses completed educational programs in public health and funds were provided to assist states, counties, and medical districts in the establishment and maintenance of adequate health services.
A nurse is providing care to clients through the FNS. Which of the following clients would the nurse most likely have seen? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with measles
ANS: C The FNS nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. They would not have seen injured soldiers, males, or a child with measles.
A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-based
ANS: D Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the community as a whole. Community health nursing focuses on the health status of individuals and the effect of their health status on the community as a whole.
How would public health nursing change if more people became insured? A.More screening would be required. B.Community organizing would diminish. C.PHN would become more prevention oriented. D.Case management would become a larger part of PHN.
Answer is A. Screening frequently follows either surveillance or disease and health event investigation and is often preceded by outreach activities. Surveillance is often paired with disease and health event investigation, even though either can be implemented independently. Screening frequently follows either surveillance or disease and health event investigation and is often preceded by outreach activities in order to maximize the number of those at risk who actually get screened. Most often, screening leads to case finding, but this intervention can also be carried out independently.
Which was a leading cause of the rise in chronic illness deaths? A. National crude mortality rate B. Growth of an aging population C. Rise in communicable diseases D. Decrease in home nursing services
Answer is B. Growth of an aging population meant that people started living long enough to develop more chronic illnesses.
One goal of public health nursing is to focus most on... A. Tertiary health care B. Primary health care C. Population-based services D. Clinical preventive services
Answer is C. Screening frequently follows either surveillance or disease and health event investigation and is often preceded by outreach activities
Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. individuals. b. aggregates. c. communities. d. geographical regions.
B
Reasons for Focus on Free-Living Clients
Prevention has greatest impact on majority. Interface between health and environment Prevention practice most likely to flourish
§A community health nurse is providing teaching about health promotion to a group of adolescents. Which of the following topics is the most important for the nurse to include in an attempt to lower adolescent mortality rates? ● A.Underage smoking B.Safer sex practices C.Texting while driving D.Heart healthy diet
C
§A public health nurse is reviewing a protocol for management of H5N1 influenza during an outbreak. Which of the following interventions should the nurse identify as part of tertiary prevention. A.Provide two-step H5N1 immunization to high risk-individuals B.Teach individuals to recognize signs and manifestations of H5N1 infection C.Promote adequate hydration for clients experiencing an H5N1 infection D.Implement airborne and contact isolation for clients infected with H5N1 influenza
Correct C- Tertiary Prevention- Management of the disease A-Incorrect- Secondary Prevention- There is an outbreak already for these high risk individuals. The goal is to prevent the spread of the disease. Patients get first vaccine, then follow with a second one a few weeks later. B-Incorrect- Secondary Prevention- promotes rapid treatment and prevents progression of the disease D-Incorrect-Secondary Prevention- prevents further spread of the disease
§A faith community nurse is teaching the daughter of a client who has a terminal illness about her role as a member of the client's health care team. Which of the following statements by the daughter indicates an understanding of the teaching? § A."You will be able to access my mother's hospital medical records for us to review?" B."You will be able to give my mother pain medication?" C."You can submit invoices to Medicare to reimburse you for services." D."You will coordinate with volunteers who will come to help my mother?"
D
what characteristics distinguish public health nursing as a specialty:
It is population-focused. Primary emphasis is on populations whose members are free-living in the community as opposed to those who are institutionalized. • It is community-oriented. There is concern for the connection between the health status of the population and the environment in which the population lives (physical, biological, sociocultural). There is an imperative to work with members of the community to carry out core public health functions. • There is a health and preventive focus. The primary emphasis is on strategies for health promotion, health maintenance, and disease prevention, particularly primary and secondary prevention. • Interventions are made at the community or population level. Target populations are defined as those living in a particular geographic area or those who have particular characteristics in common and political processes are used as a major intervention strategy to affect public policy and achieve goals. • There is concern for the health of all members of the population/community, particularly vulnerable subpopulations.
What agency is most heavily involved with the health and welfare concerns of U.S. citizens?
The U.S. Department of Health and Human Services (USDHHS; or simply HHS)
§A home care nurse is visiting an older adult client and notes that unwashed dishes are pilled up and newspapers cover the front steps. Which of the following questions should the nurse to ask the client to determine if he is socially isolated? § A."Why haven't you bought in your newspapers?" B."Do you need help completing your housework?" C."How often do you have visitors come to see you?" D."Have you considered moving to an assisted living facility?"
c
§Social Security Act of 1935
§Funded opportunities for education and employment of PHNs §Funded assistance to states, counties, and medical districts in establishing adequate health services §Provided funds for research and investigation of disease
The largest share of health care expenditures goes to pay for hospital care, with physician services being the next largest item. The amount of money that has gone to pay for public health services is much lower than for the other categories of expenditures. Other significant drivers of the increasingly high cost of health care include prescription drugs, technology, and chronic and degenerative disease
true
§Community-Based Nursing
§Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school.
§Public Health Nursing
§Community-oriented nursing practice is a philosophy of nursing service delivery that involves the generalist or specialist public health and community health nurse.
In the future what degree might be required to work as a public health nurse
§Doctor of Nursing Practice (DNP) will likely be required for specialization in PHN. §Then eligible to sit for certification exam
WHO Millennium Declaration Goals
§Eradicate extreme hunger and poverty §Achieve universal primary care §Promote gender equality and empower women §Reduce child mortality §Improve maternal health §Combat HIV/AIDS, malaria, and other diseases §Ensure environmental sustainability §Develop a global partnership for development
Eight Principals of Public Health
•The client or "unit of care" is the population •The primary obligation is to achieve the greatest number of people or the population as a whole. •The process used by public health nurse include working with the client(s) as an equal partner. •Primary prevention is the priority in selecting appropriate activities •Selecting strategies that create healthy environmental, social, and economic conditions in which population may thrive is the focus. •There is an obligation to actively reach out to all who might benefit from a specific activity or service •Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice. •Collaboration with a variety of other professions, organization, and entities is the most effective way to promote and protect the health of the people
What are immigrants health care challenges ?
•Use of traditional healing practices unfamiliar to their health care providers •Providers' lack of knowledge of high-risk diseases in the specific immigrant groups