Community Health Nursing Quiz 1

Community-Based Nursing: -Goal: to manage (acute or chronic care) -Focus: (illness oriented) -Who: (Individuals and Families) -Where: live, work, school (home or community settings) -What: Philosophy: (comprehensive, coordinated and continuous care.) -Trends: On the rise because hospital costs are increasing. -occurs outside of an institution (more secondary and tertiary) can be primary

CON Includes: A: Public Health Nursing - focuses on health care of the community or populations. B: Community Health Nursing - (Primarily focused on individuals, family, and groups in the community.) Community Oriented Nursing Goal: preserve, protect, & promote health Focus: Health Care Who: individuals, families, groups What: health care to promote quality of life Where: community wide dx, health surveillance, monitoring and evaluation of community population -Identify community dx to determine what conditions need to be altered in order for individuals, families, and groups int he community to stay healthy

Public Health is a -scientific discipline including epidemiology -stats, -assessment (behav, cultural, econ) -Promotion of quality of life -"the greatest good for the greatest number"

Goal: Prevention (disease and disability) Promotion & Protection community's health Focus: Health promotion/disease prevention (Who: community/populations) What: Impact community's health status (resources) on the health of individuals, families, and groups. Where: Community (Health Departments, Schools)

Combination of Nursing & PH Goal: Preserve, protect, promote, or maintain health of individuals, families, and groups in a community. Focus: Health of (individuals/families/groups)

The key difference between CBN and CON is: CBN deals primarily with "illness oriented care" and CON "provide healthcare to promote quality of life"

1. Age of residents 2. Gender distribution of the residents 3. Socioeconomic characteristics 4. Racial distributions 5. Vital Statistics, including selected mortality and morbidity data 6. Community institutions, including health care organizations and the services they provide 7. Health personnel characteristics **Morbidity and Mortality Weekly Report** (MMWR?) found in book on p219 & p224

p.224-225 Informant Interviews consist of directed talks with selected members of a community about community members or groups and events. This is a critical component of the community assessment. They are not always people who hold official titles. They may have an informal role in the community such as a church deacon, county health dept, nurses, any comm. member that nurses know and can id other key informants. President of PTO, mayor or other local politicians, mother who organized the local chapter of (MADD). They aid in providing a picture of services needed.

p.225 WS - A short and simple community assessment. ** best to do it twice, at different times of day ** - WS are the motorized equivalent of simple observation. -They involve the collection of data that will help define the community, the trends, stability, and changes that will affect the health of the community.

- Dramatically increased life expectancy -Decreased death rates of adults and children decreased deaths from STROKE, Coronary Heart Disease, and Cancer -Population-focused PH approaches could help prevent up to 70% of early deaths in America, compared with only 10% for medical treatment

p. 134 10 Great Public Health Achievements of 20th Century: 1. Vaccination 2. Motor Vehicle Safety 3. Safer Workplaces 4. **Control of Infectious Diseases 5. **Decline in Deaths from Coronary Heart Diseases and Stroke + cancer 6. Safter and Healthier Foods 7. Healthier Mothers and Babies 8. Family Planning 9. Fluoridation of Drinking Water 10. Recognition of tobacco as a health hazard

Examples related to Public Health: PRIMARY PREVENTION: The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking on health. SECONDARY PREVENTION The public health nurse provides an influenza vaccination program in a community retirement village. TERTIARY PREVENTION The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community.

Levels of Prevention Related to the Public Health Care System PRIMARY PREVENTION Counsel clients in health behaviors related to lifestyle. SECONDARY PREVENTION Implement a family-planning program to prevent unintended pregnancies for young couples who attend the primary clinic. TERTIARY PREVENTION Provide a self-management asthma program for children with chronic asthma to reduce their need for hospitalization.

PRIMARY PREVENTION Use the Code of Ethics for Nurses to guide your nursing practice. SECONDARY PREVENTION If you are unable to behave in accordance with the Code of Ethics for Nurses (e.g., you speak in a way that does not communicate respect for a patient), take steps to correct your behavior. You could explain to the patient your error and apologize. TERTIARY PREVENTION If you have treated a patient or staff member in a way that is inconsistent with ethics practices, seek guidance on other choices you could have made.

Levels of Prevention Related to Cultural Differences (Hypertension, Stroke, and Heart Disease) PRIMARY PREVENTION Provide health teaching about balanced diet and exercise. SECONDARY PREVENTION Teach clients and/or family to monitor blood pressure. Teach about diet, keeping in mind the client's cultural preferences. Talk about health beliefs and cultural implications, such as the use of alternative therapies; make sure alternative therapies are compatible with any medications that may be prescribed. TERTIARY PREVENTION If blood pressure cannot be controlled by diet, refer the client to a physician for medication; advise the client to engage in a cardiac program that will oversee diet and exercise. COMMUNICATION Understanding variations in patterns of verbal communication and nonverbal communication is the basis for achieving therapeutic goals. Variations among cultures are reflected in verbal styles (e.g., pronunciation, word meaning, voice quality, humor) and in nonverbal styles (e.g., eye contact, gestures, touch, interjecting during conversation, body posture, facial expression, silence). For example, when gathering data from an Hispanic woman, the nurse should be aware that the style may be low-key and that the woman may avoid eye contact and be hesitant to respond to questions. This behavior should not be interpreted as either a lack of interest or an inability to relate to others (Randall-David, 1989). Another example occurred when a nurse gave instructions to Asian clients about taking antituberculin drugs. The clients smilingly responded with "yes, yes." The nurse interpreted this response to mean that the clients understood the instructions and that they accepted the treatment protocol. A week later, when the clients returned for a follow-up visit, the nurse discovered that the medications had not been taken. The nurse knew that acceptance by and avoidance of confrontation or disagreement with those in authority are important behaviors in the Asian culture; interventions were therefore adjusted accordingly. The nurse repeated the medication instructions and gave the clients an opportunity to raise questions and concerns and to repeat the instructions that were given. The nurse also discussed the cultural meaning and treatment of tuberculosis.

Levels of Prevention Economic Prevention Strategies PRIMARY PREVENTION Work with legislators and insurance companies to provide coverage for health promotion to reduce the risk of diseases. SECONDARY PREVENTION Encourage clients who are pregnant to participate in prenatal care and WIC to increase the number of healthy babies and reduce the costs related to preterm baby care. TERTIARY PREVENTION Participate in home visits to mothers who are at risk for neglecting babies to reduce the costs related to abuse.

Levels of Prevention Using Evidence-Based Practice According to evidence collected and averaged by the Task Force on Community Preventive Services, the following are interventions supported by the literature at each level of prevention: PRIMARY PREVENTION Extended and extensive mass media campaigns reduce youth initiation of tobacco use. SECONDARY PREVENTION Client reminders and recalls via mail, telephone, e-mail, or a combination of these strategies are effective in increasing compliance with screening activities such as those for colorectal and breast cancer. TERTIARY PREVENTION Diabetes self-management education in community gathering places improves glycemic control.

Primary Prevention: Refers to prevention of health problems before they occur. -Pre-disease - health promotion and specific protection Action taken prior to the onset of disease, removes the possibility that the disease will ever occur. Signifies intervention int he pre-pathogenesis phase of a disease or health problem. Primary prevention may be accomplished by measures of "health promotion" and "Specific protection". -control the underlying cause or condition that may result in disability eg. maternal antiretroviral therapy to reduce the risk of mother to child transmission of HIV -fortification of the food supply to prevent birth defects such as spina bifida and iodine deficiency disorders -the concept of "positive health" a concept that encourages achievement and maintenance of "an acceptable level of health that will enable every individual to lead a socially and economically productive life" -primary prevention may be accomplished by measures designed to promote general health and well being, quality of life of people or by specific protective measures I.E. The public health nurse develops a health education program for population of school aged children that teaches them about the effects of smoking on health. -WHO - has recommended these approaches: population (mass) strategy -high risk strategy - preventative care to individuals at special risk -requires detection of individuals at high risk by the optimum use of clinical methods. -population - mass strategy - small reduction for the population would reduce disease - socioeconomic and lifestyle changes

Secondary Prevention: Begins when pathology is involved and is aimed at early detection and treatment (screening) -Latent Disease - Pre-symptomatic Diagnosis and treatment - attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infections diseases -it protects others from the community from acquiring the infection and therefore provides at once secondary prevention for the infected ones and primary prevention for their potential contacts - "action which halts the progress of a disease at its incipient stage and prevents complications" -specific interventions are: early diagnosis (screening tests and case finding programs) + adequate treatment IE. the public health nurse provides an influenza vaccination program in the community retirement village

Tertiary Prevention: Activities designed around rehabilitation when a permanent, irreversible condition exists. -Symptomatic Disease -Disability limitation for early symptomatic disease -rehabilitation for late symptomatic disease -It is used when the disease process has advanced beyond its early stages -it is defined as "all the measures available to reduce or limit impairments and disabilities, and to promote the patients' adjustment to irremedial conditions" -intervention that should be accomplished in the stage of tertiary prevention are DISABILITY, LIMITATION, and REHABILITION. - Rehabilitation and special education services to mitigate disability and improve functional and participatory or social outcomes once disability has occured. Ex: rehabilitation of post-stroke patients IE: the public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit for the community

p.221 Indicators of Health Status Outcome 1. Race-specific and ethnicity-specific infant mortality, as measured by the rate (per 1000 live births) of deaths among infants less than 1 year of age Death Rates (per 100,000 Population)† for: 2. Motor vehicle crashes 3. Work-related injury 4. Suicide 5. Lung cancer 6. Breast cancer 7. Cardiovascular disease 8. Homicide 9. All causes Reported Incidence (per 100,000 Population) of: 10. Acquired immunodeficiency syndrome (AIDS) 11. Measles 12. Tuberculosis 13. Primary and secondary syphilis Indicators of Risk Factors 14. Incidence of low birth weight, as measured by percentage of total number of live-born infants weighing less than 2500 grams at birth 15. Births to adolescents (females 10 to 17 years of age) as a percentage of total live births 16. Prenatal care, as measured by percentage of mothers delivering live infants who did not receive prenatal care during the first trimester 17. Childhood poverty, as measured by the proportion of children less than 15 years of age living in families at or below the poverty level 18. Proportion of persons living in counties exceeding U.S. Environmental Protection Agency standards for air quality during the previous year

Mortality Indicators Morbidity Indicators Disability rates Nutritional status indicators Health Care Delivery indicators Utilization Rates Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators.

Shattuck Report - the first attempt to describe a model approach to the organization of public health. (The colonial period) 1850 by the Massachusetts Sanitary Comission - Establishment of State Health Departments -Establish local Health Boards -Sanitary Surveys -Collect Vital Statistics -Environmental Sanitation -Report Food, drug and communicable disease -Well child care -health education -tobacco and alcohol control -Town planning -teach preventative Medicine in Medical schools. Took 19 years to implement. Not until 1869.

Lillian Wald believed poor people should have access to health care. Lillian Wald and Mary Brewster organized a "visiting nursing service" for the poor of New York, which later became the Henry Street Nurses Settlement. The two women occupied the top floor of a tenement house on Jefferson Street. This move eventually led to the establishment of the Henry Street Nurses Settlement. At the Henry Street Settlement, est. in NYC in the late 1800's, by Lillian Wald, was an early model for PHN. At Henry Street Settlement, the nurses took care of the sick in their homes and also looked at the overall population of low-income people in the community from which their home care patients came.

-Mother of PHN -Recognized 20% of children would miss any given day of school. Made school nurses "Lina Rogers, a Henry Street Settlement resident became the first school nurse." -Responsible for taking lice out of hair -By 1918, Lillian Wald was integran in ensuring 70% of nursing care was paid for by Metropolitan Life Insurance Company The Nursing service designed by Wald continued for 44 years and contributed several significant accomplishments to public health nursing including: -Providing home nursing care on a fee-for-service basis. -Establishing an effective cost-accounting system for visiting nurses -Using advertisements in newspapers and on radio to recruit nurses -Reducing mortality from infectious diseases. -first insignia with official health agency -rural health nursing services through the Red Cross.

The Aging population Hispanics - single parent head of household families have grown - changing lifestayle, growing appreciation for healthy lifestyle and QOL. -AMericans spend money on healthcare, nutrition, and fitness. - Greater emphasis on alternative medicine. -Leading cause of death changed from infectious disease to chronic and degenerative diseases. -Decline in mortality rate for children and older adults. Secondary and Tertiary care? ED - Dialysis? (I dont know if this one is right or not.)

"a method of identifying, appraising, and synthesizing all available research that is relevant to a particular research question." -A systematic review is usually done by more than one person and describes themethods used to search for and evaluate the evedence. -SR can be accessed from most databases such as Medline and CINAHL. (The Cochrane Library) -Ranks as highest from for evidence (meta-analysis.)

The best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders.