Exam 3 Notes
Youth Risk Behavior Surveillance System (CDC)
9th to 12th grades. - survey collecting country wide information about adolescent health
Priority 1 Triage (Red Tag)
Casualty with treatable life-threatening injuries *IMMEDIATE* - opening airway, starts to breathe - breathing > 30 or < 10 - delayed capillary refill - absent radial pulse - bleeding needing controlled - does not follow instructions
Dept. of Housing and Urban Development (HUD) definition of homelessness
Category 1: Literally Homeless Category 2: Imminent Risk of Homeless Category 3: Homeless Under Other Federal Statutes Category 4: Fleeing/Attempting to Flee Domestic Violence (DV)
Global Health
Health problems, issues and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions
Rural Americans are at a greater risk of death from 5 leading causes than urban Americans...
Heart disease Cancer Unintentional injury Chronic Lower Respiratory Disease Stroke
Poor Health as a Cause of Homelessness
Injury or illness... → missing too much time from work. → exhausting sick leave or not being able to maintain a regular schedule or perform work functions. → no funds to pay for health care. → remaining ill. → difficult to regain employment. → no income from work → housing problem Poor health can lead to unemployment, poverty, and homelessness.
Combination disasters
NA-TECH (natural/technological) disaster: a natural disaster that creates or results in a widespread technological problem
Community-Based Mental Health Care: Crisis Intervention Teams
Partners with mental health consumers and family members, mental health professionals, and advocacy organizations.
Priority 2 Triage (Yellow Tag)
Patients with serious but not immediately life-threatening injuries *URGENT* - Did not move out, when asked - Airway OK - Breathing 11-29 - Capillary refill < 2 sec. and radial pulses present - Can follow instructions to move unaffected limb
Risk factors to the mother are....
Risks to the baby
Healthy School Environment
• Violence is a major public health problem. • Terrorism • School shootings
Global organizations
• WHO (World Health Organization) • PAHO (Pan American Health Organization) • UN (United Nations) • UNICEF (United Nations International Children's Fund) • World Bank • CDC (Centers for Disease Control and Prevention)
Nurse Attorney
• Educated in both the law and in nursing. • Often involved in malpractice cases • May be involved in licensure disciplinary action or agency oversight. • Serves as legal consultant. • Helps hold accountable poor practitioners who are dangerous to clients. • Meticulous practitioners who are wrongfully accused of negligence will be defended.
Clinical Forensic Nurse Examiner
• Emergency and Critical Care • Organ and Tissue Donation and Transplantation • Child Abuse and Neglect • Elder Mistreatment • Population with Disabilities
Mental Health and the Police
• Estimated that at least 20% of police calls for service involve a mental health or substance use crisis. • Since 2015, nearly a quarter of all people killed by police officers in America have had a known mental illness.
Forensic Nurse Death Investigator
• Evaluates the death scene from a holistic nursing perspective. o Possesses essential knowledge of anatomy, physiology, pharmacology, growth and development, physical examination, and health history interviewing techniques. • Might interpret the scene differently than professionals without medical or scientific knowledge.
Migrant and Seasonal Farmworker Health
• Migrant: migrate to find work • Seasonal: reside permanently in one place and work locally when farm labor is needed. • Vulnerable population • Community Health Nurses from a central link for services
Morbidity for men
• More men die of Covid than women. • Men tend to perceive themselves to be in better health than do women. • Common indicators of morbidity rate: o Incidence of acute illness o Prevalence of chronic conditions o Use of medical care
Legal Issues in Occupational Health
The occupational health nurse is professionally primarily accountable to workers and worker populations and to the employer, the profession, and self • The employee-nurse relationship • The employment capacity of the occupational health nurse • Any acts of negligence
Urban sprawl
The process of urban areas expanding outwards, usually in the form of suburbs, and developing over fertile agricultural land.
Outdoor air quality
The purity of the air and the presence of air pollution The Environmental Protection Agency (EPA) has classified six common air pollutants
Family and Community Involvement
The school nurse is a resource to the community; performs many roles: • Educator • Resource/leadership role • Consultant • Advocate Students who have parental support are more successful, experience less emotional distress, eat healthier, and are more actively engaged in learning.
Occupational Health Nursing
The specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment ...
Lack of inclusion of transgender people in most national surveillance systems means...
lack of tracking health problems for people who are transgender.
State government responsibilities
o Assist local officials with emergency plans. o Workshops and training courses o Advise and support local government.
Recovery Stage
o Begins when the danger from the disaster has passed. o All local, state, and federal agencies are present in the area. • Help victims rebuild their lives. • Restore public services. • Cleanup of damage and repair begins. • Evaluation and revision of the disaster plans • Understand the financial impact.
Disaster Nursing
o Disasters require nurses to navigate chaotic environments, often in makeshift facilities and with limited technology and medical supplies. Impacted areas may not have power or running water. Residents are likely scared and traumatized, so they can behave erratically and need tremendous emotional support. o Nurses must first align with disaster planning agencies to allow the agencies to assess nurses' skills and interests and assign them to response teams accordingly. • American Red Cross • National Disaster Medical Teams • Nurses Response Network (RNRN)
Community Responses to a Disaster
o Four phases: • Heroic phase — helping others. • Honeymoon phase — relive event and tell stories, express gratitude. • Disillusionment phase — feelings of despair and exhaustion • Reconstruction phase — rebuilding, return to normalcy. o Common reactions to a disaster • Posttraumatic stress disorder
Prevention Stage
o Identify potential disaster risks. • Create risk maps. o Educate citizens regarding what actions to take to prepare for disasters. • Individual, family, and community level o Develop a plan for meeting the potential disasters identified. ■ Create resource maps.
Preparedness/Planning Stage
o Individual and family preparedness • Training in first aid • Assembling a disaster emergency kit • Establishing a predetermined meeting place away from home • Making a family communication plan ■ Authority ■ Communication ■ Logistical ■ Evacuation and rescue
Local government responsibilities
o Prepare citizens for all kinds of emergencies and disasters. o Office of Emergency Management o Mock drills
Response Stage
o Response stage begins immediately after the disaster incident occurs. o May include: • Shelter in place • Evacuation • Search and rescue • Staging area • Disaster triage ■ Greatest good, for the greatest number, in the shortest time
Primary prevention — preventing occurrence of disaster or limiting consequences.
o Risk map — geographic map of area analyzed for potential disaster. o Resource map — geographic map outlines resources available if area affected by disaster.
Federal government responsibilities
o U.S. Department of Homeland Security ■ Prevent terrorism and ensures resilience to disasters. o The Federal Emergency Management Agency (FEMA) ■ Supports citizens and first responders to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. ■ Strengthened after Hurricane Katrina (2005)
Population Characteristics
• *Population growth presents a threat to health and the economy in many nations. (lack of resources, lack of infrastructure, overwhelm health system)* • 8 billion as of November 15th, 2022. • 9.7 billion by 2050 • Peak at 10.4 billion in the 2080s • Life expectancy varies significantly in different countries. • 56% of the deaths in Africa are because of communicable, maternal, perinatal, or nutritional conditions.
Improving the Health of People with Mobility Limitations and Intellectual/Developmental Disabilities through State-based Public Health Programs
• *The overall goal of this funding opportunity is to reduce health disparities experienced by adults with intellectual and developmental disabilities (IDD) and adults with mobility limitations (ML) in the U.S.* • State programs are funded to *link adults with IDD to preventive health care and health promotion programs in their community*
Violence
• Bullying • Teen dating violence • Homicide • Sexual abuse
Faith Community Nursing: Role in Health and Wellness
• Throughout history, churches provided care for the indigent and disenfranchised, meeting basic needs and basic health care. • Many religions have traditions and rituals related to health and healing. • Some religions give specific guidelines for ministering to ill, homebound, or dying members. • All major religions describe the relationship among health, healing, and wholeness. • Old Testament discusses Shalom, or God's desire for health and wholeness. • New Testament documents healing activities of Jesus, restoring health to people. • The Talmud describes the importance of maintaining physical health and vigor so that Jewish people will understand God's will in their lives. • Followers of Buddhism believe that health and healing are connected, and illness occurs when there is an imbalance between life and the environment.
Purpose of Home Health Services
• To allow individuals to remain at home. • To provide health care services that would otherwise be offered in a health care institution such as a hospital or nursing home setting. • To encourage cost containment through timely hospital discharges • To focus on the care of sick patients (skilled nursing care) with some expansion to include health promotion and disease prevention interventions.
Veteran Health Risks
• Traumatic brain injury (TBI) • Noise • Radiation • Amputation • Occupational hazard exposures • Posttraumatic stress disorder (PTSD) • Military sexual trauma (MST) - 1 in 3 women; 1 in 50 men • Polytrauma • Chronic pain • Substance use disorder (SUD) • Suicide
People Receiving Community Mental Health Services
• Typically have severe mental illness including schizophrenia, chronic depression, bipolar disorder or borderline personality disorder. • Most have been ill for a lengthy period of time. • Have suffered from a series of complex life problems such as poverty, homelessness, involvement in violent relationships, a history of child abuse, incidents of victimization through sexual or physical assault in adulthood, multiple periods of institutionalization, physical illness, and, sometimes, trouble with the law.
Theories That Explain Men's Health
- Biological factors - Socialization - Orientation toward illness and prevention - Reporting of health behaviors - Gender-linked behavior
Sources of Income for Seniors
- Social security - Earnings - Pension - Assets (good percentage of income is spent on health care)
Smoking is ....
... one of the most preventable causes of infant morbidity and mortality
Who is more likely to live in poverty? 0-5 year olds or 6-17 year olds?
0-5 year olds (15.5% compared to 13.9% of 6-17 year olds)
What was the documented % increase from 2010-2017 in the number of women with opioid-related diagnoses documented at delivery?
131% (Huge strain on the healthcare system for babies who have to withdrawal from these opioids after birth.)
What is the percentage of children are living in poverty (2019) for children 0-17?
14.4%
Sick Building Syndrome
A buildup of toxic compounds and pollutants in an airtight space; seen in newer buildings with good insulation and tight seals against air leaks
- Heat-related illnesses, hospital visits, and deaths will increase. - More carbon dioxide causes some plants to produce more pollen. - Increased levels of harmful algae and bacteria will threaten sources of drinking water
According to the Climate and Health Impacts Map, what is Ohio at risk for?
EPA
An independent federal agency established in the 1970s to coordinate programs aimed at reducing pollution and protecting the environment - very political
Food Safety
Availability, accessibility, and relative costs of healthy food free from contamination of - harmful herbicides - pesticides - bacteria
What race has the highest poverty rate for single mother households?
Black non-Hispanic children (41.5% compared to White at 27.9% and Hispanic children at 40.5%)
Role of the Community Health Nurse for Women
Direct care • Variety of settings Educator • Health education • Sensitive to cultural issues Counselor • Women's health • Reproductive health
Prenatal care
Early and regular _____ ___ enhances chance of a healthy, full-term baby
• Occupational toxic poisoning • Machine-operation hazards • Electrical hazards • Repetitive motion injuries - carpal tunnel seen in many people. • Carcinogenic particulate inhalation
Environmental health problems posed by work related exposures such as
True or false? Women are more likely to change their health behaviors when supported by male family members.
FALSE! Men are more likely to change health behaviors when supported by female family members
True or false? Do married households have a higher poverty rate compared to female-householder families?
False
True or false? White infants are twice as likely to die as black infants?
False (black infants are twice as likely to die as white infants)
Community health nurse interventions for obesity/overweight
Generate public awareness. Preventative efforts - healthy lifestyle, physical activity Design and implement policies and standards, in schools.
Distribution of the 10 leading causes of death among men in the United States in 2019
Heart disease, cancer, unintentional injuries, CLRD, stroke, diabetes, AD, suicide, chronic liver and cirrhosis, kidney disease, other No septicemia on this list, but it is on the women list.
Preterm Birth and Low Birth Weight (modifiable risk factors - on the exam!)
Minority status - decrease disparities of minorities, create programs for minority moms. Chronic stress - not having a choice and causing stress. Maternal age of <17 years and >35 years - sexual education, geriatric pregnancies, counseling to mitigate risk. Lack of prenatal care - clinics Low socioeconomic status - resources, policy, insurances Unhealthy maternal habits - education
How many Americans are overweight and obesity in the U.S.?
More than 60% of Americans
Risks to children
No preventive health care or immunizations -> preventable diseases or chronic conditions in life
Office of Research on Women's Health
Overarching themes for research • Developmental, psychological, spiritual, and physiological factors effect on lifespan • Female determinants' (such as genetics and gender expectations) effect on health • Health disparities and diversity • Diseases and conditions affecting women. • Career development and advancement of women in the sciences
OSHA
Requires any chemical manufacturer or distributor to provide safety data sheets that communicate hazards of chemical products. • Nurses can be sure workers are aware of and know where to access the safety data sheets relevant to their workplace.
Healthy Homes
The availability of shelter and its safety, structural strength, cleanliness, location, and indoor air quality Concerns with radon, carbon monoxide, molds and dusts, secondhand smoke, cooking vapors, lead paint, and rodents
The Built Environment
The connection between people, communities, and their surrounding environments that affects health behaviors and habits, interpersonal relationships, cultural values, and customs. influences a person's level of physical activity.
Waste Management
The handling of waste materials resulting from industry, municipal processes, and human consumption as well as efforts to minimize waste production
Other Issues in Women's Health
Unintentional injury or accidents Intimate partner violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States. Healthcare issues for women being decided by male lawmakers
AQI
Used to measure and report air quality in a specific area (color coded & numbers)
A. Air pollution B. Changes in vector ecology C. Increasing allergens D. Environmental degradation E. Water and food supply F. Water quality G. Severe weather H. Extreme heat
When considering climate change, which of the following are/will be factors in current and future health outcomes? Select all that apply. A. Air pollution B. Changes in vector ecology C. Increasing allergens D. Environmental degradation E. Water and food supply F. Water quality G. Severe weather H. Extreme heat
From 2000 to 2019 who has had the least decrease in poverty out of Black/Hispanic/White children?
White non-Hispanic children
Adolescent health issues
• *Risk-taking behaviors* • *Adolescent sexual activity* is often unprotected and can result in pregnancy and STIs. • *Violence* among youth is a multifaceted problem. • The use of *tobacco, alcohol, and drugs* has serious and long-lasting consequences for adolescents and society. (Addiction is a consequence to them and society.)
Senior Health Population
• 19% of the rural population is 65 years or older. • 15% in urban areas • The 65-and-older population grew by over a third (34.2% or 13,787,044) during the past decade, and by 3.2% (1,688,924) from 2018 to 2019.
Sexual risk behavior
• 38% of high school students had ever had sex (CDC, 2019) • 46% of sexually active students did not use a condom the last time they had sex - YIKES! • Teen childbearing - children of teens have lower school achievement. • Highest rates of teen pregnancies - NH American Indian/Alaska Native
Food Desert
• A neighborhood with little to no access to health foods • Low-income areas • Lack of accessibility is a major barrier to those in the community who are trying to live healthier lifestyles.
Health and Social Services to Promote the Health of Women
• ACA of 2010 -contraception • Medicaid (1965) - Pregnant women are eligible if they meet the poverty level guidelines for their state of residence • Women's health services
Social factors affecting women's health
• Access to Care • Education and Work • Employment and Wages
Sexual Health Education
• Across states, fewer than half of high schools (43%) and less than one-fifth of middle schools (18%) teach key CDC topics for sexual health education. • Promoting and implementing well-designed SHE programs positively impacts student health - students are more likely to: • Delay initiation of sexual intercourse • Have fewer sex partners. • Have fewer experiences of unprotected sex. • Increase their use of protection, specifically condoms. • Improve their academic performance. • According to the CDC, Abstinence only sexual health education is ineffective and unethical.
Environmental health
• All the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors. • Encompasses the assessment and control of those environmental factors that can potentially affect health. • CDC Center for Environmental Health
Community Agencies for older adults
• Alzheimer's Association Greater Cincinnati Chapter • Catholic Social Services of Southwest Ohio (+ Caregivers Assistance Network) • Cincinnati Area Senior Services - Evanston, Over the Rhine and Mt. Auburn Senior Centers • Council on Aging • Department of Insurance Medicaid Program Benefits Program
Community Health Nurse's Role with Children and Adolescents
• An *advocate* for improved individual and community responses to children's needs. • A *researcher* for effective strategies to serve women and children. • A *participant* in publicly funded programs. • A *promoter* of social interventions that enhance the living situations of high-risk families. • A *partner* with other professionals to improve service collaboration and coordination. • Understand the legal and ethical implications of decision making.
Community Nurse's Role for Seniors
• Assess older adults in the community. • Mutual planning for health • Case management • Knowledge of and connection to services available in the community • Design health promotion and disease prevention interventions to benefit older adults.
Water quality
• Balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance. • Availability, volume, mineral content levels, toxic chemical pollution, and pathogenic microorganism levels
Factors That Impede Men's Health
• Barriers to men's health • Little effort has been made to create a male-specific health care climate. • Mission orientation • Lack of health promotion
Areas of Environmental Health
• Built environment. • Work-related exposures • Outdoor air quality • Healthy homes • Water quality • Food, safety, and waste management • Waste management
Prerequisites for Good Health
• Clean air • Stable climate • Adequate water, sanitation, and hygiene • Safe use of chemicals • Protection from radiation • Healthy and safe workplaces • Sound agricultural practices. • Health-supportive cities and built environments. • Preserved nature.
Health Promotion Strategies for Women
• Collaboration and an interdisciplinary approach • Promote health and detect disease at an early stage. • Women desire to become more knowledgeable about their own health.
Strategies to Improve Child and Adolescent Health
• Collect/analyze data tracking well-being of children and adolescents. • Utilize Healthy People 2030 objectives. • Implement health promotion and disease prevention strategies. • Utilize public health programs targeted to children and adolescents.
Emerging Issues in Environmental Health
• Environmental public health infrastructure (need government funding to increase the quality of the infrastructure). • Natural disasters • Global climate change • Ozone depletion • Fossil fuel burning • Marine dumping (a lot of trash goes into the ocean) • Active land mine abandonment in war-torn areas • Destruction of tropical rain forests
Critical Theory Approach
• Environmental threats or factors that affect the safety and well-being of particular populations. • Threats that deprive them access to resources necessary to pursue health.
Health problems related to housing
• Fire hazards • Lack of accommodations for people with disabilities (spend to make these accommodations, never planning to have a disability when you buy a home.) • Illnesses caused by overcrowding, psychological effects of architectural design (lack of windows, shorter ceilings). • Injuries sustained from collapsed building structures. • Exposure to deaths from inadequate indoor heating and cooling (elderly, ill, pregnancy, smaller children).
Healthy People 2030 for Seniors
• Goal: Improve health and well-being for older adults. • Specific goals designed to promote healthy outcomes for older adults. • No general community-related objectives
Public Health Programs Targeted to Children and Adolescents
• Health Care Coverage Programs • Direct Health Care delivery programs
Legitimate nursing actions for critical theory approach
• Helping communities become more aware of the environmental effects on health. • Assisting the community in making the needed changes in their environment • Promoting collective action and strategies for change
Effects of Environmental Hazards
• High unemployment rates, drought, extensive smog cover • Housing needs for elderly who use walkers or canes. • Occupational risks of electrical line repair workers • Mentally incapacitating effects of elevated blood lead values in children Can be long-term, immediate, or intergenerational effects. Can have a direct relationship with cancers and chronic disease. Can also be indirect like global warming
Living Arrangements for Seniors
• Housing and residential services - prefer to age in place • Alternative housing options for older adults
Environmental health history can...
• Increased awareness of environmental health concerns • Improved timelines and accuracy of diagnosis • Prevention of disease and aggravation of conditions • Identification of potential environmental hazards
Longevity and Mortality
• Life expectancy for males - 75.1 in 2020, down from 76.3 in 2019. Women are at 80. • 70 years for men globally • United States lags behind other countries in premature mortality rates for males (a measure of unfulfilled life expectancy). • Males at higher risk for death resulting from unintentional injury, suicide, and homicide.
Food Safety Concerns
• Malnutrition • Bacterial food poisoning • Food adulteration • Disrupted food chains by ecosystem destruction. • Carcinogenic chemical food additives
Use of Medical Care for Men
• Men do not engage in health protective behaviors as frequently as women. • Most men do not have routine check-ups, including screenings. • Men seek ambulatory care less often than women; men delay medical TX. • Sicker when they do seek health care, requiring more intensive medical care. • Men tend to have longer lengths of stay in the hospital than women.
Morbidity rate for women
• More women than men are hospitalized each year in the United States. • Women are more likely than men to be disabled from chronic conditions. • Women are more likely than men to have surgery; many surgeries relate to reproductive health. • The most frequently occurring interruption in women's mental health relates to depression.
Risk factors to the mother
• Not in optimal health -> Poor pregnancy outcome • Uncontrolled medical conditions -> Low birth weight with serious medical conditions • Exposure to drug, alcohol, tobacco, poor nutrition -> Chronic conditions that affect health and well-being. • Unsafe environment (secondhand smoke, lead-based paint) -> Chronic conditions throughout childhood and maybe adolescence/adulthood
Psychosocial Issues for Seniors
• Retirement • Relocation • Widowhood • Possibly raising their grandchildren
How is environmental health accomplished?
• Risk assessment • Prevention • Intervention
Factors Affecting Child and Adolescent Health
• Significant factors in overall well-being: - Parents' or caregivers' income, education, and stability, security and safety of the home,, nutritional and environmental issues, and health care access and use • Specific issues: - Poverty, racial and ethnic disparities, LGBTQ+
Child causes of death include...
• Unintentional injury is the leading cause of death in children ages 1 to 14. • Suicide now the 2nd leading cause of death for ages 10-14 • Congenital anomalies, short gestation, malignant neoplasms, maternal pregnancy complication, homicide, SIDS
Areas of concern for waste management
• Use of nonbiodegradable plastics • Poorly designed solid waste dumps • Inadequate sewage systems • Transport and storage of hazardous waste • Illegal industrial dumping • Nonenforcement of environmental regulations
Physical Activity and Fitness for Seniors
• Walking is best form of exercise. • Barriers to exercising - lack of safe areas, pain/fatigue, impairment in sensory function/mobility • Nurses should identify barriers that prevent exercise.
Chronic conditions for men
• Women are more likely to be ill, whereas men are at greater risk for death. • Men have higher morbidity and mortality rates for conditions that are the leading causes of death.
Men's Health
• Women live longer than men. • Health care use greater among women than men. • Death rate higher for men than women in terms of the major causes. • Women's health has specialty; men's health has not established a specialty.
Priority 3 Triage (Green Tag)
*DELAYED* Not injured or "Walking wounded" Have motor, respiratory, mental function
Environmental justice
*Disproportionately high exposures of low-income and minority populations to environmental health risks* • Air pollution • Hazardous waste incinerators • Toxic landfills • Pesticides • Lead exposure • Unsafe drinking water
Deinstitutionalization Cause and Effect
*Funding did not follow the change in policy.* - insufficient resources for housing and employment, mental health care
Significant approach in the future will be to reach men in the...
- Community - Schools - Workplace - Public settings
National Response Framework
- Core operational plan for domestic incident management ■ A guide to how the nation responds to all types of disasters and emergencies. It is built on scalable, flexible, and adaptable concepts identified in the National Incident Management System to align key roles and responsibilities. ■ Structured to help jurisdictions, citizens, nongovernmental organizations and businesses
What two causes of death in children saw a huge spike recently and needs an invention for prevention?
- Drug overdose and poisoning - Firearm related injury (MVC spiked in 2019 but is now trending down)
Efforts to Control Environmental Problems
- EPA - OSHA - Nuclear Regulatory Commission
Men's Health Care Needs
- Help with fathering (i.e., being included as a parent in childcare) - Help with fathering as a single parent, particularly with a child of the opposite sex, in addressing the child's sexual development and concerns. - Recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change. - Adjustment of the health care system to men's occupational constraints regarding time and location of health care sources - Financial ways to obtain these goals.
Improving Health of Rural Americans
- Screening for high BP - Increase cancer prevention/detection - Encourage physical activity/reduce obesity - Promote smoking cessation - Identify additional support - Promote motor vehicle safety - Engage in safer opioid prescribing
Eligibility and Enrollment for the VA
- Service: must have served in active duty for 24 consecutive months or full period of call (Reserves and Guard); some exceptions exist - Separation must have been under any condition other than dishonorable.
What states did we talk about in lecture that had women smoking in their pregnancies?
- WV (25.1%, higher than national average of smokers in general) - KY (18.4%) - CA (1.6%)
Occupational Health Nursing ...
... includes the prevention of adverse health effects from occupational and environmental hazards. ... provides for and delivers occupational and environmental health and safety programs and services to clients. ... is an autonomous specialty, and nurses make independent nursing judgments in providing health care services.
School-based Efforts for Support of LGBTQ+ Students
Encourage respect Identify "safe spaces" Education for safe sex and trainings for safe environments
How many children died from abuse and neglect during fiscal year 2020?
1,750 (majority were younger than a year old, most likely because they are dependent and physically more vulnerable)
Family Theory Approach
1. Any "dysfunction" that affects one member will probably affect others and the family as a whole. 2. The family's wellness is highly dependent on the role of the family in every aspect of health care. 3. The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling. 4. Commonalities in risk factors and diseases shared by family members can lead to case finding within family. 5. Individual is assessed within larger context of family. 6. Family is vital support system to individual member.
Hospice Home Care Tenets
1. Improves end-of-life care for the terminally ill. 2. Relieves suffering throughout the illness. 3. Supports the patient and family/caregiver through the dying process. 4. *Provides grief support to the family after the patient has died.*
Elder Abuse
1. Physical abuse 2. Psychological/emotional abuse 3. Financial or material exploitation 4. Neglect - the #1 types of elder abuse
Disaster Management Stages
1. Prevention stage 2. Preparedness and planning stage 3. Response stage 4. Recovery stage
Three subdivisions of the VA
1. Veterans Health Administration (VHA) under the VHA 2. Veterans Benefits Administration (VBA) 3. National Cemetery Administration
Conducting a Home Visit
1. Visit preparation. 2. Initial telephone contact 3. The visit 4. Documentation 5. Terminate the visit. 6. Evaluate the visit.
Leading causes of death globally
1. ischemic heart disease 2. stroke 3. COPD 4. lower respiratory infections 5. neonatal conditions 6. trachea, bronchus, lung cancers 7. AZ disease, other dementias 8. diarrhoeal diseases 9. diabetes mellitus 10. kidney diseases
What rank does Ohio have for IMR by State?
10th, also surrounded by poor IMR ranking states
CDC's Disability and Health Promotion Branch currently funds 10 State Disability and Health Programs
5-year funding period • An increase in the number of healthcare providers that can offer accessible preventive health care to adults with disabilities. • Fewer unmet preventive health care needs, including mental health, among adults with disabilities. • Improved health behaviors and wellness among adults with disabilities • Decreased rates of chronic conditions, and their associated risk factors, among adults with disabilities
How many pregnancies are unintended?
50% - impacts weight, disease, need to avoid stress/toxins/drugs
Who is homeless in Cincinnati?
51% of our homeless population is 35 years old - and younger. 33% are under the age of 25. 23% of our homeless population are Children under the age 18.
Sudden unexplained infant death
A broad term for sudden infant deaths in which the manner and cause of death cannot readily be identified prior to an investigation *Black and American Indian/Alaska Native Infants are more likely to die of SIDS*
Genogram
A family diagram that depicts each member of the family and shows connections between the generations.
Ecomap
A form of documentation diagramming a family's social environment.
Work-related injuries and deaths
A worker died every 101 minutes from a work-related injury in 2021 Workers in transportation and material moving occupations experienced a series high of 1,523 fatal work injuries in 2021 and represent the occupational group with the highest number of fatalities (used to be construction). Increase of 18.8% from 2020
Transgender Health - Topics to Discuss with HC Provider
Access to healthcare Health history Hormones Cardiovascular health Cancer HIV, STDs, and safer sex Alcohol and tobacco Depression/anxiety Injectable silicone Fitness (diet & exercise)
Secondary Prevention Strategies for Occupational Health Nurses
Aimed at early diagnosis, early treatment interventions, and attempts to limit disability. Focus is on identification of health needs, health problems, and employees at risk.
Top 10 Global Health Threats 2019
Air pollution and climate change Noncommunicable diseases Threat of a global influenza pandemic Fragile and vulnerable settings, such as regions affected by drought and conflict. Antimicrobial resistance Ebola and high-threat pathogens Weak primary care Vaccine hesitancy Dengue HIV
Essential Benefits for Community-Based Mental Health Care from the ACA
An initiative to improve and promote community-based care of those with mental illness is the Affordable Care Act (ACA) 2010 - cover mental health care and recognized as essential health benefits
Transgender
An umbrella term for persons whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth
Disaster
Any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources
Family
Any person(s) playing a significant role in an individual's life. This may include person(s) not legally related to the individual.
Criminalization of Homelessness
Bans on tent camps Blaming, criminalizing, and moving people from streets to jails does not solve homelessness or fix the systems that created it
Childhood immunization
Benchmark of child health Goal is 95% of children to be immunized worldwide for herd immunity.
Homophobia, Stigma, and Discrimination
Can affect income, jobs, health insurance, limit to care, affect ability to have long-term relationships, harder to be open about orientation
Preterm Birth and Low Birth Weight (non-modifiable risk factors)
Chronic health problems of mother - try to help with treatment. Multiple births - education, resources, high-risk clinic. Certain problems with the uterus or cervix Induced labor without indication. - scheduled C-sections Elective C-section births
Health and Homeless Populations
Closely connected to declines in physical and mental health • Barriers to health care, lack of access to adequate food and protection, and limited resources and social services • Exposure to disease, behavioral issues, injuries
Race Norming
Comparing an applicant's scores only to members of his or her own racial subgroup and setting separate passing or cutoff scores for each subgroup
Top 10 Global Health Threats 2018
Conflict Natural disasters Malnutrition #4 through #10 were Infectious diseases.
Gender identity
One's internal understanding of one's own gender, or the gender with which a person identifies
Moving from the Individual to the Family
Family interviewing - manners, therapeutic conversations, genogram/ecomap, therapeutic questions, commend family and ind. strengths, issues in family interviewing
Makes community mental health a national priority by establishing...
Early access, recovery, and high quality in mental health services as standards
Family Health Assessment Tools
Genogram Ecomap
Which ethnicity has the highest obesity/overweight in the U.S.?
Hispanic (25.6%)
Multiple casualties
Involve 2 to 99 individuals
Mass casualty
Involves 100+ individuals
Health Disparities and Disasters
Lack of access to primary care and specialty providers • Majority of Americans are considered unprepared for the occurrence of a disaster. • Those of lower SES and lower educational attainment are generally less prepared than their wealthier and more educated counterparts. • Due in part because of the costs associated with preparedness actions, such as obtaining insurance and taking measures to prepare for earthquakes (SAMHSA, 2017). • 65% of respondents said they had no disaster plans or had plans that were inadequate (Petkova et al., 2016). • < ½ of Americans are familiar with local hazards, less than 40% have created a household emergency plan, and only 52% have disaster supplies at home (FEMA, 2014).
Population of Children and Adolescents in the US/Ohio
Less children being born in the US and older adult population (higher amounts in Utah d/t other things)
Rural Healthcare Workforce
More PCPs, generalist dentists, MH providers in the urban setting. > 3/4 of nation's rural counties are designated as health professional shortage areas
Other Organizations in Global Health
Nongovernmental organizations (NGOs) - Carter Center • Prevent and resolve conflicts. • Enhance freedom and democracy. • Improve health and quality of life. - Bill and Melinda Gates Foundation • Reducing hunger and poverty • Improving health through harnessing advances in science and technology • Improving U.S. high school and postsecondary education and support vulnerable children and families
Federal Legislation and Occupational Health
Occupational Safety and Health Act—OSHA (1970) Workers' Compensation Acts (state based) Americans with Disabilities Act—ADA (1990)
Race and Ethnicity for Homelessness
Per 10,000 - the most is Pacific Islander Total homelessness is White
Work-related exposure
Poor working conditions that result in potential injury or illness
Discriminatory Land Use
Problem where industrial hazards (sewage plant, incinerators, landfills) are located in low income area
The Changing Family
Purposes of the family - to meet needs of society, meet needs of individual family members
Tertiary prevention for Disasters
Recovery
Hospital closures in the United States
Seen more in the south at being at a higher risk for closure
Expectant/Dead (Black Tag)
Still require resources Focus of care is comfort Psychologically most challenging for healthcare providers
Secondary prevention for Disasters
Strategies are implanted once the disaster occurs
Systems Theory Approach
Suprasystem - the whole family Subsystem - the smaller groups
Gender expression
Term used to describe people's outward presentation of their gender
Triage
The medical screening of patients to determine their relative priority of need and the proper place of treatment
Prenatal Substance Use
The use of tobacco, alcohol, or illicit drugs in any combination is dangerous to a woman's health and worsens infant health and development outcomes
Infant mortality for black infants is twice as high than white infants, true or false?
True
True or false? Weekly rate of deaths per 100,000 were higher in rural areas than metro areas
True
Family Violence Prevention
Understand risk factors for family, child, and elder abuse. Knowledge of the cycle of abuse Assessment skills related to identification of individuals and families at risk for violence. • Intimate partner violence (IPV) • Child abuse or neglect • Elder abuse
1. Ozone 2. Carbon monoxide 3. Nitrogen oxides 4. Sulfur dioxide 5. Particulate matter 6. Lead
What are the classified six common air pollutants from the EPA?
37.7% (30% to <35% on the map)
What is the percentage for Ohio in Self-Reported Obesity?
Challenges for Rural/Migration Health
• *Unintentional injury deaths: 50% higher in rural areas* • Residents of rural areas are older and sicker than their urban counterparts. • Children in rural areas with mental, behavioral, and developmental disorders have more family and community challenges than children in urban areas with the same disorders. • Higher rates of cigarette smoking, high blood pressure, and obesity • Less leisure-time for physical activity • Lower seatbelts use than urban dwellers. • Long travel distances to specialty and emergency care or exposures to specific environmental hazards • Higher rates of poverty, lower levels of education, higher unemployment rates, less access to healthcare, and are less likely to have health insurance. • Less likely to use preventative services.
Home Health Care
• ...is a continuum of comprehensive health care. • ...is provided to individuals and families in their places of residence. • ...promotes, maintains, or restores health. • ...maximizes the level of independence.
Homelessness - The Numbers
• 1.5 million people a year experience homelessness - over 500,000 on any given night of the year • Out of every 10,000 males, 22 are homeless (13 for women and girls) • 70% of people who are homeless are men.
Medicaid Expansion in Rural America
• 11.44-%-point decline in uninsurance and a 13.15-%-point increase in Medicaid coverage among their patients after 2 years of Medicaid expansion, compared with similar community health centers in nonexpansion states. • Showed improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in 18 types of visits—particularly for mammograms, abnormal breast findings, alcohol-related disorders, and other substance use disorders. • Expanding Medicaid reduces poor health outcomes.
International Council of Nurses - the global voice of nursing
• 130 national nurse associations • Representing more than 20 million nurses worldwide • Founded in 1899 • Operated by nurses and leading nurses internationally. • ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. • Code of Ethics for Nurses
History of School Health
• 1840: First mandatory education • 1902: NYC hired the first school nurses • Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%. • 1946: National School Lunch Program • Included School Breakfast Program in 1976 • 1990s: CDC Division of Adolescent and School Health formed. • 2010: Patient Protection and Affordable Care Act (ACA) • Awarded funds to 278 school-based health centers to create new sites and expand services. • Expansion of services in medically underserved areas
Rural Setting: The Numbers
• 46 million Americans live in rural areas. • More than 50% of the nation's poor people live in rural areas. • Rural residents who are Black had the highest rate of poverty (31.6%), followed by American Indians and Alaska Natives (30.9%), and those of Hispanic origin (23.8%) • Medicaid covers nearly one in four (24%) nonelderly individuals in rural areas.
Homelessness and Veterans
• 82 communities and 3 states have announced that they ended veterans' homelessness (meaning that systems can ensure that homelessness is rare, brief, and one-time) • Nationally, veteran homelessness has decreased 39% since 2007. • Many veterans struggle to transition into civilian life and eventually become homeless. • Half are Vietnam veterans. • Exacerbated by incarceration, SUDs, and PTSD
Correctional Nursing
• A specialized subset of forensic nursing in which clients are inmates. • *Primary goal is to maintain a safe, secure, and humane environment for the inmates.* • Understand the prison culture. • Inmates manipulate nurses. • Environment is highly isolated.
Types of Work-Related Hazards
• Biological hazards • Chemical hazards • Physical hazards • Safety hazards • Ergonomics hazards • Psychosocial hazards
Mental Health Issues in Correctional Settings
• Adjustment to incarceration is extremely difficult for many mentally ill individuals. • Deinstitutionalization led to what amounts to the "criminalization of the mentally ill." • Access to mental health treatment and medication is a right for prison inmates. • Nurses must always be aware of the vulnerabilities of people with mental illness who are incarcerated.
Legal Nurse Consultant (LNC)
• Aids within the legal system using specialized nursing knowledge and expertise. • Evaluates, analyzes, and renders informed opinions on the delivery of care and its outcomes. • Reviews and interprets medical records/charts. • Provides objective opinions based on standards of care. • Testifies in court if needed as an expert witness.
Universal Health Coverage (UHC)
• All individuals and communities receive the health services they need without suffering financial hardship. • Full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life span • Adequate and competent health and care workers with optimal skills mix at facility, outreach and community level, and who are equitably distributed, adequately supported and enjoy decent work. • Access to services that address the most significant causes of disease and death; ensures the quality of services is good enough to improve the health of the people who receive them. • Protects people from the financial consequences of paying out of their own pockets reduces the risk that people will be pushed into poverty.
Upstream interventions
• Attack community-based problems at their roots • Maximizing the use of informal networks
Health care norms in the military
• Avoid care because of stigma of appearing weak. • Information may not be kept confidential. • Will cause financial hardship. • Negative attitudes regarding providers
Transgender and politics
• Bathroom bills • Health Care bills • Public Performance bills - drag queens for example. • Schooling bills • Sex designation • Sports bans
Community Issues for LGBTQ+
• Belonging • Education • Suicide • Support • Resources • Safety
Health Education
• CDC guidelines and priority areas: • Alcohol and drug use • Injury and violence (including suicide) • Tobacco use • Poor nutrition • Lack of physical activity • Sexual behavior that results in STDs or unwanted pregnancies • Injury prevention • National Health Education Standards • Youth Risk Behavior Survey
Roles of the School Nurse
• Care provider • Student advocate • Educator • Community liaison • Case manager • Delegate cares and supervise others. • Practice independently as a member of an interdisciplinary team • Conduct research.
Homelessness...
• Characterized by extreme poverty coupled with a lack of stable housing. • "Doubled up" or "couch surfing" may be considered homeless for eligibility for different services.
Skills and Competencies of the Occupational Health Nurse
• Clinical and primary care • Case management • Workforce, workplace, and environmental issues • Legal and ethical responsibilities • Management and administration • Health promotion and disease prevention • Occupational and environmental health and safety education • Research • Professionalism • Nursing Code of Ethics
Confidentiality in Faith Nursing
• Code for Nurses (ANA) and Scope and Standards of Faith Community Nursing Practice (ANA) provide ethical guidance to FNC. • Protect client's right to confidentiality of health and health-related conditions. • Share confidential information with other church ministry leaders (or prayer groups) with the client's permission. • FCN not required to follow HIPAA guidelines in most cases because congregations are not identified as health providers. • First aid, CPR, AED training, health screenings, health classes no transactions for HIPAA... not applicable to clergy members that provide free religious healing. Same degree of accountability and not exempt from discrimination, can go to court and disclose confidential information.
Sexual Assault Nurse Examiner (SANE)
• Collects forensic evidence related to a reported crime and frequently testifies as a witness at subsequent trials. • Conducts a thorough examination and history. • Crisis intervention referral • Evaluation of the victim for STIs • Pregnancy risk assessment and care • Client referral for additional support • SANE is certified through IAFN.
Forensic Nursing
• Combines disciplines of nursing science, forensic science, medical science, sociology, and psychology with law enforcement and the criminal justice system. • One of the newest specialty areas recognized by the ANA (1995). • Scope and Standards of Practice for Forensic Nursing were published in 1997. • International Association of Forensic Nursing (IAFN)
How to Increase Vaccine Uptake
• Community leaders - employ strategies to combat misinformation and reduce vaccine resistance. • Rural community, health care, agricultural, and faith leaders should use tools developed by the National Rural Health Association, including talking points, op-ed templates, and public service announcements to increase vaccine uptake. • Rural residents are more likely to trust their primary care physicians to provide reliable information about the vaccine than they are to trust the FDA, CDC, or local public health departments.
Challenges in the Community for Mental Health
• Complex patient comorbidity • Lack of resources • Competent mental health professional workforce and law enforcement • Physical facility inadequacies • Stigma of mental illness
Appropriate Care for LGBTQ+
• Create a setting of respect and trust. • Be non-judgmental, open, professional. • Provide client-centered care (e.g., meet the person "where they are") • Be an ally. • Educate yourself so you are trans-friendly in your field of expertise. • Working with colleagues: "See something, say something."
Challenges to MSFW
• Cultural, linguistic, economic and mobility barriers contribute to health problems. • Farmworkers consider themselves outsiders. • Live isolated from the communities they work in • Not accurately represented in census data • Environmental exposure • Increased risk of accidents and injuries • Less likely to receive preventative care (dental, vision, gyn) • Unaware of services
WHO - Primary Health Care (PHC)
• Declaration of Alma Alta in 1978 - call for primary health care for all. • The Declaration of Astana (2018) was adopted unanimously by WHO Member States. • PHC - receive the right care, at the right time, in the right place, in accordance with their needs and local context. • Good health allows children to learn and adults to earn, helps people escape from poverty, and provides the basis for long-term economic development.
Mortality rate for women
• Declined to *80.5 years* in 2020 in the U.S., decreasing 0.9 year from 81.4 years in 2019. • 75 years for women globally • Causes of Death - heart disease, cancer, chronic lower respiratory disease, strokes, AD, accidents, diabetes, influenza and pneumonia, kidney disease, septicemia (infections, TSS, L&D/pregnancy complications)
Forensic Psychiatric Nurse
• Determines the intent or diminished capacity in the patient's thinking at the time of the incident. • May be called on in court to testify as an expert witness in mental health cases. • Sanity or competency evaluation (for legal purposes) • Assessment of violence potential • Assessment of capacity to formulate intent. • Parole and probation considerations • Assessment of racial or cultural factors in crime • Assistance in jury selection • Sexual predator screening • Provision of expert witness testimony
Impact of Natural and Human-made Disasters on Mental Health
• Disasters not only affect the psychological health of individuals but can also damage the collective psyche of communities by disrupting the norms, values and rituals that provide the basis for their resilience. • Profound stress-inducing events can lead to mental illness.
Why should we care about global health?
• Disease without boundaries • Ethically the right thing • Health = economic and social development • Global security
The "Sandwich" Generation
• Middle-aged adults sandwiched between their parents and their children. • Grandparents raising or supporting their grandchildren.
National Response Coordination Center
• FEMA's focal point for national resource coordination • Provides overall emergency management coordination. • Conducts operational planning. • Deploys national level teams. • Builds and maintains a common operating picture.
Providing Care to Vulnerable Populations in Faith Nursing
• FNC works as a member of a caring church community to meet the health and related needs of vulnerable populations. • Sponsor and support refugees • Develop programs for individuals experiencing homeless and their families. • Aid and resources to low-income families. • Provide resources to entire communities during disasters.
Community Mental Health Reform
• Federal legislation • Administration activity • Public education initiatives
Modern Faith Community Nursing
• First parish nurse program at Lutheran General Hospital in Chicago in 1984. • Six nurses hired in Chicago area in 1985, funded primarily by churches. • International Parish Nurse Resource Center (IPNRC) provides leadership for FCN. • ANA and Health Ministry Association (HMA) established Scope and Standards of Parish Nurse Practice in 1998; revised in 2005 to Faith Community Nursing • FCN now practiced in more than 23 countries; nurses identify themselves in a manner most accepted by faith communities.
Laws/Protection for Health of MSFWs
• Health Centers Consolidation Act of 1996 • Public Health Service Act (renewed in May 2021) and Health Care Safety Net Act 2008
8 Components of School Health Programs
• Health education • Physical education • Health services • Nutrition services • Counseling, psychological, and social services • Healthy school environment • Health promotion for staff
Roles/Functions of the Faith Community Nurse
• Health educator • Personal health counselor • Referral agent • Health advocate • Coordinator of volunteers • Developer of support groups • Integrator of health and healing
Primary Prevention Strategies for Occupational Health Nurses
• Health promotion • One-on-one interaction is an important strategy for evaluating risk reduction behavior for individuals. • Disease prevention • Prevention of exposure to potential hazards • Overall health promotion • Non-occupational programs
Health Promotion for School Staff
• Health promotion programs at the work site produce beneficial results. • Positive effects on blood pressure control • Daily physical activity • Smoking cessation • Weight control • Improve morale. • Reduce job stress and absenteeism. • Heighten interest in teaching health-related topics to students.
Poverty Realities for Rural Children
• Heaviest concentrations in the *South and West* • Almost 50% of black children, 34% of Native American, and 18% of rural children living in a female-headed household live in poverty. • Understanding poverty distribution in rural areas helps with planning and delivering programs.
Why Lower Vaccine Numbers Matter
• Higher rural COVID-19 infection and mortality rates • Limited hospital capacity to deal with severe cases in rural communities. • Differences in perceptions of risk and virus severity • Less likely to adopt COVID-19 prevention behaviors (physical distancing, avoiding dining out, wearing face masks) • Trust in science and the government • Attitudes about personal choice versus collective responsibility
Social and Structural Constraints for Families
• Identify what prevents families from receiving needed health care or achieving a state of health. • Usually based on social and economic causes
Health Services
• Immunizations • Health screenings (vision, hearing, scoliosis, high BP) • EPSDT: Early and Periodic Screening, Diagnosis, and Treatment created by Medicaid. • Emergency care - First aid, CPR, Emergency Care Plans (ECP) • Care of ill children - acute and chronic • Medication administration • Children with special health needs • Delegation of services
Homophobia, Stigma, and Discrimination in Schools
• Increased chance of experiencing violence at school. • 40% of homeless youth are LGBTQ+ • A positive school environment is associated with less depression, fewer suicidal feelings, lower substance use, and fewer unexcused school absences among LGBTQ+ students.
Federally Qualified Community Health Centers
• Integrate access to primary care, pharmacy, mental health, substance use disorder, and oral health services in areas where economic, geographic, or cultural barriers limit access to affordable health care (can be rural or urban) • Community-based and patient-directed • For people in the community, including people experiencing homelessness, agricultural workers, residents of public housing, and veterans. • Provide services regardless of patients' ability to pay and charge for services on a sliding fee scale. • Private non-profit or public entities, including tribal and faith-based organizations...operate under the direction of a patient-majority governing board.
Rural Health Clinics (RHC)
• Intended to increase access to primary care services for patients in rural communities. • Public, nonprofit, or for-profit healthcare facilities • Must be located in rural, underserved areas. • Required to use a team approach of physicians working with nurse practitioners (NP), physician assistants (PA), and certified nurse midwives (CNM) to provide services. • Must be staffed at least 50% of the time with an NP, PA, or CNM (requirement waived during COVID-19 public health emergency). • Required to provide outpatient primary care services and basic laboratory services.
Academic Success
• It is impossible to achieve success in school without maximizing the health of the students. • Poor academic performance is strongly correlated with uninsured status of youth, acquisition of health insurance leads to an increase in school performance. • Health problems lead to increase in absenteeism. • The school nurse has a unique opportunity to make a positive impact on the nation's youth.
Applying the Nursing Process for Families
• Knowledge of self, previous life experiences, and values are crucial in planning home visits. • Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home. • Flexibility is important in working with families.
People who identify as LGBTQ+
• Lesbian, gay, bisexual, transgender, queer (plus others): members of every community • Diverse, all races and ethnicities, all ages, all socioeconomic statuses • Need for culturally competent medical/nursing care and prevention services that are specific to this population.
Country Delineations
• Low-income countries (or economies) are those with a GNI (the total domestic and foreign output claimed by residents of a country) per capita, of $1045 or less in 2021. Also formerly referred to as "developing countries." • Lower middle-income countries are those with a GNI per capita of between $1,046 - $4,095 in 2021. • Upper middle-income countries are those with a GNI per capita between $4,096 -$12,695 in 2021. • High-income countries are those with a GNI per capita of $12,696 or more.Also formerly referred to as "developed countries."
Transgender Murders
• Majority of murders were of black trans women. • Average age of 31 • Killed by acquaintances, partners or strangers. • Intersections of racism, sexism, homophobia, biphobia, and transphobia deprive them of employment, housing, health care and other necessities. • Transgender status may have put them at risk by forcing them into unemployment, poverty, homelessness and/or survival sex work.
Occupational Health Nursing Practice and Professionalism
• Often the only on-site health care professional. • Collaborates with workers, employers, and other professionals. • Roles are diverse and complex. • Coordinates comprehensive, holistic services. • Practice guided by AAOHN's Standards of Occupational and Environmental Health Nursing Practice and Code of Ethics (2012). • Empowered, well-trained, usually educated at the baccalaureate level.
School-Based Health Centers
• One of best ways to offer comprehensive health care to children and adolescents. • An interdisciplinary team approaches. • Provide services on site. • Works in collaboration with but does not take the place of the school nurse.
Covid and Native Americans/Alaska Natives
• Pandemic disproportionately affected American Indian and Alaska Native populations. • Infection rates over 3.5 times higher than non-Hispanic whites • Over four times more likely to be hospitalized as a result of COVID-19 • Higher rates of mortality at younger ages than non-Hispanic whites • American Indians and Alaska Natives have the highest vaccination rate in the country. • 45.5% having received at least one dose and 39.1% fully vaccinated. • Highlights the need for comprehensive, culturally appropriate personal and public health services that are available and accessible to all American Indian and Alaska Native people.
End-of-Life Issues: Grief and Loss
• Partner with hospice and home care nurses to provide palliative care to members. • Educational sessions on living wills • Establish health care surrogates someone who makes decisions for someone who can no longer make decisions. • Understanding hospice and palliative care • Home visits to dying congregational members. • Emotional support to family and survivors • Development of grief support groups
Home Health Services May Include ...
• Physician/NP visits • Skilled nursing care (provided by RNs) • Supportive social services (PT, OT, ST) • Social workers • Home care aides • Respite care
Disaster Housing
• Planners should also account for the needs of their community's homeless and precariously housed populations as part of the disaster housing planning process. • For example, obtaining an estimate of the locality's pre-disaster homeless and precariously housed populations and the services needed to transport and shelter or house them following a disaster is imperative for the community's needsassessment. • This requires engaging with the entities responsible for adult social services in their communities to better understand various government homeless assistance programs and their eligibility requirements, as well as engaging mainstream public and nonprofit agencies that have responsibilities toward parts of the precariously housed population.
The Occupational Health Nurse
• Practice guided by an ethical framework. • Encourages and enables individuals to make informed decisions about health care concerns. • Is a worker advocate; upholds professional standards and codes. • Responsible to and compensated by management; must practice within a framework of company policies and guidelines. • Fosters equitable and high-quality health care services and safe, healthy work environments.
Physical Education
• Promotion of healthy physical activity • When students get physical education, they can: • Increase their level of physical activity. • Improve their grades and standardized test scores. • Stay on-task in the classroom. • Increased time spent in physical education does not negatively affect students' academic achievement.
Counseling, Psychological, and Social Services
• Promotion of mental health • Reduction or removal of threats to mental health
Community Mental Health Nurse
• Provide advice on the availability of medical, social, and housing facilities for the individual in the community. • Work with appropriate community agencies as necessary • Supervise and counsel paraprofessional and professional personnel in community mental health activities.
Tertiary Prevention Strategies for Occupational Health Nurses
• Rehabilitation and restoration of the worker to an optimal level of functioning • Avoiding disability syndrome • Case management for the disabled employee's successful return to work • Negotiation of workplace accommodations appropriate to the employee's health limitations • Counseling and support for workers returning to work.
Cultural Difference in Home Health/Hospice Nursing
• Remember that beliefs, attitudes, and values about death, dying, grief, and loss are influenced by society and culture. • Ask patients and/or families about beliefs and practices to avoid generalizations and to ensure that nursing care is patient centered and culturally sensitive.
Nurse Coroner
• Responsible for ensuring that appropriate measures were taken to perform death investigations and certify death certificates. • Uses nursing knowledge to identify disease processes that the lay coroner may not recognize or may misinterpret as foul play. • Utilizes crucial communication skills when dealing with grieving families. • May become board certified by American Board of Medicolegal Death Investigators
Accountability in Faith Nursing
• Same degree of accountability as paid employees • Not exempt from discrimination laws • May be required to disclose confidential information in court. • Accountable to nursing standards and civil laws designed to protect individuals from abuse, neglect, and discrimination.
Nutrition Services
• School-age children undergoing periods of growth and development. • Nutritional concerns • Nurses must consider cultural influences on diet when teaching nutrition. • School Breakfast Program and National School Lunch Program Federally funded.
Informal Care Systems
• Self-reliance and self-help traits in rural communities • Informal care may be more trusted. • People who assume care-giver role (life situations/social roles) • Rural communities and minority communities often use these systems. • Community members staying with elderly after hospital stays.
10 workplace accidents and injuries from Most to Least common.
• Slips, trips, and falls • Muscle strains • Being hit by falling objects • Repetitive strain injury • Crashes and collisions • Cuts and lacerations • Inhaling toxic fumes • Exposure to loud noises • Walking into objects • Fights at work
Urbanization
• Slums o 650 million people in Asia (bigger population in Asia than Africa) o 212 million people in Africa • Overcrowding • Poor housing • Hazardous locations o Flooding • Unsafe drinking water • Unsanitary conditions • Increased risk of infectious disease o Acute respiratory diseases o Diarrheal diseases o HIV/AIDS o Tuberculosis o Vector-borne diseases • Increased risks of chronic disease o Dietary changes o Sedentary lifestyle o Tobacco use
Slippery slope for rural/migration health
• Sparsely populated area loses residents. • Services/businesses need to close. • Tax base decreases • Health services leave. • Long distance travel to health services • Retirees attracted to low cost of living. • Lack of services to support them...
Key Elements of Faith Nursing
• Spiritual dimension is central to the practice. (what differentiates a faith community nurse). • Clients are members of the faith community defined by the church and its public service philosophy. (people outside of the faith community are not clients of the faith community nurse.)
•Structure and uniformity, governed by rules and standards in the military
• Strong sense of service • Hierarchal class system • Solutions focused on actions. • Unique dialog and expressions • Reluctance to show weakness.
Military Culture
• Structure and uniformity, governed by rules and standards. • Health care norms
Why Is It Important for the CHN to Work with Families?
• The family is a critical resource. • Any dysfunction in a family unit will affect the members and the unit as a whole. • Case finding can identify a health problem that leads to risks for the entire family. • Nursing care can be improved by providing holistic care to the family and its members.
Moving from the Family to the Community
• The health of communities is measured by the well-being of its people and families. • Families are components of communities. • Cross-comparison of communities must include health needs as well as resources. • Cross-compare the needs of the families within the community and set priorities.
Rural Nursing Practice
• The practice of professional nursing within the physical and sociocultural context of sparsely populated communities • Isolation, scarce resources, need wide range of practice skills. • Develop close relationships with community. • Autonomy • Feel an "intensity of purpose". • Expert generalist
The Health of a Child Has Long-term Implications
•Childhood and youth health habits influence potential to lead healthy, productive lives. •Physical and emotional health plays a pivotal role in the overall development and well-being of the entire family. •Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential.
Natural and Manmade Disasters
•Natural disasters: Earthquakes, tsunamis, floods, hurricanes, cyclones, droughts. Typically, the poor are the hardest hit because of the lack of resources to cope and rebuild. •Manmade disasters: Bioterrorism, Chemical emergency, Pandemics and epidemics, Radiation poisoning, Terrorism and genocide
Public Health System
■ All governmental and nongovernmental organizations and agencies that contribute to improvement of the health of populations. ■ American Red Cross o Nongovernmental agency o Chartered by Congress to provide disaster relief. o Education, preparedness, and response • Meets needs of affected people and supports workers.
Casualties classified as...
■ Direct victim ■ Indirect victim ■ Displaced person ■ Refugee
Characteristics of Disasters
■ Frequency — how often a disaster occurs. ■ Predictability — ability to determine when and whether a disaster will occur. ■ Mitigation — actions taken to reduce loss of life and property. o Act before disaster happens. ■ Imminence — speed of onset and anticipated duration of incident ■ Scope — the range of the effects of the disaster ■ Number of casualties — number of individuals affected, injured, or killed. ■ Intensity — level of destruction and devastation
FEMA Community Lifelines
■ Increase disaster response capabilities by identifying where there is a breakdown in service and evaluating immediate and potential impacts. ■ Enables the continuous operation of critical government and business functions and is essential to human health and safety or economic security. ■ The most fundamental services in the community and when stabilized, enable all other aspects of society to function. ■ Objectives-based response that prioritizes the rapid stabilization of Community Lifelines after a disaster. ■ An integrated network of assets, services, and capabilities that provide lifeline services, which are used for day-to-day to support of recurring needs of the community response.
Disaster Management
■ Requires interdisciplinary, collaborative team effort. ■ Network of agencies and individuals ■ Planning creates a quicker and more efficient response
