NURS 4127 COMM EXAMZ ELABORATION.

Page 1 of 18 Chapter 1 (9 Questions) Chapter 4 (7 Questions) Chapter 14 (6 Questions) Chapter 2 (9 Questions) Chapter 5 (5 Questions) Chapter 6 (8 Questions) 6 Questions modules + videos ● Know the core functions and examples of Public Health: A P A ○ Assessment: ■ Systematic data collection, analysis, and monitoring of health problems and needs in a population ■ Includes monitoring the population’s health status and providing/disseminating information about health of community ■ Environmental and behavioral risks ○ Policy development: ■ Using scientific knowledge to develop comprehensive public health policies. Developing policies that support the health of the population through leadership and research ■ Seeks to build constituents (voting member) that can bring about changes in public policy ■ Examples: ● Development of Healthy People 2020 state objectives ● National effort to control AIDS ● Anti-smoking ordinances ○ Assurance: ■ Assuring constituents that public health agencies provide the services necessary to achieve agreed upon goals ■ Making sure essential community oriented health services are available ■ Includes providing essential health services for individuals as well as competent PH workforce ■ Focuses on responsibility of public health agencies to make certain that activities have been appropriately carried out to meet public health goals and plans ■ Includes the development of partnership between public/private agents ● What are the 10 essential services? Why do we have them? ○ Mom Definitely (always) Investigates, Informs, Educates & Empowers Me. ○ Dad Enforces Love And Evaluates Research. ■ Monitor health status to identify community health problems ■ Diagnose and investigate health problems and health hazards in the community ■ Inform, educate, and empower people about health issues ■ Mobilize community partnerships and action to identify and solve health problems ■ Develop policies and plans that support individual and community health efforts ■ Enforce laws and regulations that protect health and ensure safety Page 2 of 18 ■ Link people to needed personal health services and assuure the provision of health care when otherwise unavailable ■ Assure competent public and personal health care workforce ■ Evaluate effectiveness, accessibility, and quality of personal and population based health services ■ Research for new insights and innovative solutions to health problems ○ Why do we have the 10 essential services? ■ These are things every health department should be doing no matter where it is located ■ Provide framework for the National Public Health Performance Standards Program (NPHPSP) ■ They represent the obligations of public health system to implement the core function of assessment, policy development, and assurance ● What is a community? A population? Examples ○ Community: typically interacts with each other (ex: LCON n2 students) ○ Population: any group (ex: all the people of Memphis); while you are all part of that population, you don’t all interact ● What makes public health nursing a specialty? ○ Population based and community oriented → interventions made at this level (community level) ○ Health and preventive focus ○ Concern for the health of all members of population/community, particularly vulnerable subpopulations ○ The client or unit of care is the population ○ Primary obligation is to achieve the greatest good for the greatest number of people or population as a whole ○ Processes used by PHN includes working with client as equal partner ○ Primary prevention is the priority in selecting appropriate activities ○ PHN focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive ○ A PHN is obligated to identify and reach out to all who may benefit from a specific activity or service ○ Key element in PHN is optimal use of available resources to assure the best overall improvement in health of population ○ Collaboration with a variety of other professions, populations, organizations, and other stakeholder groups: the most effective way to promote and protect health ● What is public health nursing? What are emerging frameworks? ○ PHN: practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health science ○ Synthesis of the art and science of public health and nursing PH Nursing Population based Relationship based Page 3 of 18 Grounded in social justice Grounded in ethic of caring Relies on science of epidemiology Holistic Focus on health promotion/prevention Sensitivity to diversity Long term commitment to community Independent practice ○ IOM (institution of medicine): independent, nonprofit organization ■ wants active participation in health programs for communities ■ what society does collectively to assure the conditions in which people can be healthy ○ Social ecological model levels: individual, relationship, community, societal ○ Emerging PH Frameworks ■ Ecological model upstream approach also based on assumptions that: ● There are multiple determinants of health ● A population and environmental approach is critical ● Linkages and relationships between the levels are important ● Multiple strategies by multiple sectors are needed to achieve desired outcome ■ Upstream approach: ● Includes social relations, neighborhoods and communities, institutions, and social/economic policies ● Reflects a deeper understanding of the role not only of the physical environment but also the conditions in social environment creating poor health ● Determinants of health that are somewhat removed from the more “downstream” biological and behavioral bases for disease ■ Downstream approach: ● Addresses biological and behavioral bases for disease ● Influence change occurs at individual level ○ PH frameworks → challenges and trends: ■ Natural disasters ■ Biological warfare: the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with intent to kill or incapacitate humans, animals or plants as an act of war ■ Chemical weapons Page 4 of 18 ■ Nuclear and radiological weapons ■ Globalization ■ Ethical dilemmas ■ Genomics ■ Noncommunicable illness (cannot be transferred from person to person) with age longevity ● History: make sure to know Lillian Wald, Mary Breckinridge, Florence Nightingale ○ Lillian Wald: ■ Emerged as the leader of PH in early decades ■ Coined the term PHN and considered first PHN ■ Formed the Henry Settlement House and VNS of NYC with Mary Brewster ○ Mary Breckinridge: (Think Breckinridge, CO = out in mountains → frontier nursing service in Appalachian mountains (KY)) ■ Began Frontier Nursing Service in Appalachian Region of Kentucky → nurses were trained in nurse, public health, and midwife ○ Florence Nightingale: ■ Widely known for her work during Crimean War ■ Correlated living conditions with disease/made improvements using a population approach → believed environment made a difference ■ Worked with depauperizing the poor ■ Promoter of health reform ■ Principles of nursing: ● “Health of the unity is the health of the community” ● “Sick nursing” vs “healthy nursing” ● Proper nutrition, rest, sanitation, and hygiene ● How has PH Nursing evolved over the years? ○ PH during America’s Colonial period and new republic ■ Roots in middle ages ■ Provided comfort, care, and healing ■ Household members (usually women) tend to the sick ● Urbanization in the early 1800s caused this system to be insufficient ■ England’s Elizabethan Poor Law of 1601: offered relief to those who couldn’t work/were disabled ● 1751 Pennsylvania hospital founded ■ Early colonial PH efforts - collecting statistics, sanitation, trying to control communicable disease ○ America needs trained nurses ■ Need for PH nursing ● Increase of women in workforce ● Economic advantage of home-visiting nurses (could visit more than one patient per day) ○ Distinct Nursing and Settlement Houses: Lillian Wald & Mary Brewster Page 5 of 18 ■ District nursing and settlement houses began: neighborhood centers that became hubs for health care, education, and social welfare program ■ Lillian Wald and Mary Brewster began the Henry Street Settlement and the VNS of NYC. ● The settlement houses provided services such as daycare, education, and healthcare to improve the lives of the poor in these areas. ● VNS: non-profit home- and community-based health care organization ● Lillian Wald emerged as leader in PH in early decades ● What is HP 2020? How do we use it? National Prevention Strategy? ○ Science based, 10 year national objectives for improving the health Americans ○ Vision: a society in which all people live long, healthy lives ○ Mission: Healthy People 2020 strives to: ■ Identify nationwide health improvement priorities ■ Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress ■ Provide measurable objectives and goals that are applicable at national, state, and local levels ■ Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge ■ Identify critical research, evaluation, and data collection needs ○ Overarching goals: ■ Attain high quality, longer lives free of preventable disease, disability, injury, and premature death ■ Achieve health equity, eliminate disparities, and improve the health of all groups ■ Create social and physical environments that promote good health for all ■ Promote quality of life, healthy development, and healthy behaviors across all life stages ○ For 3 decades, health providers have established benchmarks and monitored progress over time in order to: ■ Encourage collaboration across sectors ■ Guide individuals toward making informed health decisions ■ Measure the impact of prevention activities ○ The National Prevention Strategy: shift from sickness to prevention/wellness ■ Published through the US Surgeon General’s Office by the National Prevention Council ■ Seeks to “improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness” Page 6 of 18 ■ Called for under the Patient Protection and Affordable Care Act ■ Four strategic directions: ● Building healthy and safe community environments ● Expanding quality preventive services in both clinical and community settings ● Empowering people to make healthy choices ● Eliminating health disparities ● Population Health, upstream and downstream factors, socio-ecological model ○ Population heath: the health outcomes of a group of individuals including the distribution of such outcomes within the group ○ Upstream factors: prevention; 50% of what determines health is r/t socioeconomic and environmental (physical) factors ■ Taking environmental and societal factors into considerations when examining an individual’s health choices ● Education ● Employment and occupation ● Family and social support ● The build environment (human made environment) ● The food environment ● Community safety and culture ● Media/information environment ● Environmental pollution ● Individual factors (genetics, behavioral, physiological, spirituality, and resilience) ○ Downstream factors: individual ■ Used by health care ■ Influence change occurs at individual level ■ Based on knowledge of natural history of dz and known risk factors of dz ■ Policies are population based on require individual responses ■ Vaccines would be an example ○ Example upstream vs downstream: health promotion → issue = obesity ■ Upstream: environmental factors that cause obesity (Fast food places on every corner, fast-food places being the most affordable,etc) ■ Downstream: education on nutrition; putting pt on diet ● Population health, info from IHI modules ○ IHI: developed an innovative approach to improving health and health care called “The Triple Aim.” The three simultaneous goals of the Triple Aim are: ■ Improve the health of the population ■ Enhance the patient experience of care (quality, access, and reliability) ■ Reduce or at least control the per capita cost of care ● Community-oriented nurses versus community based nurses ○ Community oriented: ■ Goal: prevent disease/disability, promote, protect, and maintain health Page 7 of 18 ■ Focus on “health care” of individuals, families, and groups in community as a whole ● Provide healthcare to promote quality of life ● Community diagnosis, health surveillance, monitoring, and evaluation of community and population ● Coordination of health care, disease prevention, health promotion, health education ○ Community based: ■ Goal: manage acute and chronic conditions ■ Clinic located, doing acute care ■ Focus on “illness care” of individuals and families within a community ● Provide acute and chronic illness care and the provision of comprehensive, coordinated, and continuous care ● A setting specific practice → care is provided where people live, work, and attend school ■ Ex: a clinic treating a child for otitis media ● Population of health (SDOH): what are they, how do they affect health? ○ Conditions/circumstances in which people are born, grow, live, work, and age ○ Circumstances are shaped by a set of forces beyond the control of the individual: economics and the distribution of money, power, social policies, and politics at the global, national, state, and local levels ● Levels of Prevention- what are the levels, how to apply it. ○ Primary: measures that actively promote health, prevent illness, and provide protection ■ Health promotion and education ■ Specific protective measures ■ Is implemented before a problem develops ■ Targets essentially well populations ■ Immunizations Page 8 of 18 ○ Secondary: early diagnosis and prompt intervention to limit disabilities, severity, and adverse effects ■ Identifies risks or hazards and modifies, removes, or treats them before a problem becomes more serious ■ Targets populations that have risk factors in common ■ Screenings/testings ■ Treatment of STD or TB ○ Tertiary: reduce impairments and disabilities, minimize suffering, promote adjustment to immediate condition, and rehab ■ Limits further negative effects from a problem ■ Prevent complications, keeps existing problems from getting worse ■ Seeks to restore a person to optimal level of functioning ■ Targets prevention after disease or injury has occured ○ **nutrition counseling is primary and tertiary** ● Info on screenings, what makes a successful screening? ○ Early diagnosis of disease → testing a group of individuals who are ■ At risk for certain conditions ■ As yet asymptomatic ■ Not a diagnostic test ■ Key component in secondary prevention ○ Reliability: ability of the instrument to give consistent results on repeated trials ○ Validity: the degree to which the instrument measures what it’s supposed to ■ Sensitivity: ability of screening test to give a positive finding when a person truly has disease, or true positive ■ Specificity: ability of screening test to give a negative finding when a person truly does not have the disease, or true negative ○ Fast and inexpensive ● What are models of prevention? How is prevention delivered? ○ Traditional PH prevention model of primary, secondary, and tertiary prevention ○ IOM Continuum of Health Prevention Model ■ Universal prevention: applicable to population as a whole, not individual risk ● Ex: media campaigns, ads, billboards ■ Selective prevention: aimed at a subset of population that has increased level of risk for developing disease → working with certain group who could be at risk ● Age, race, gender, genetics, socioeconomic status ● Ex: screening women who have a history of breast cancer ● Ex: screening people who live in old houses → lead poisoning ■ Indicated prevention: populations with high probability of developing disease ● Ex: working with pre-diabetes or substance abuse ○ Delivery of Prevention Strategies: Page 9 of 18 ■ Clinical P.S.: one to one delivery method between HCP and pt/family ■ Behavioral P.S.: changing individual behaviors aimed at health promotion ● Ex: exercise promotions; quit smoking ■ Environmental P.S.: health protection by improving the safety of environment ● Ex: enforcing clean air acts, building green space for recreation, safe water ● Health Education: domains of learning, educational process/steps, how people learn ○ Basic way in which people learn information: ■ Behaviorism ■ Cognition ■ Constructivism: own experiences ■ Humanism: uses feelings to encourage the development of personal actions to fulfill one’s potential ○ Three domains of learning: cognitive, affective, and psychomotor ■ Cognitive (thinking) ● Memory, recognition, understanding, reasoning, application, and problem solving ● Start by assessing cognitive abilities of learners ○ Literacy and health literacy ● Six components: ○ Knowledge: recall of information ○ Comprehension: recall and understanding ○ Application: new information is taken and used in diff way ○ Analysis: breaks down communication into parts to understand the parts and relationships to one another ○ Synthesis: builds on the 1st 4 levels by assembling them into a new whole ○ Evaluation: learners judge the value of what has been learned ■ Affective (feeling) ● Includes changes in attitudes and development of value ● Nurse’s attitudes and values may differ from patient → listen carefully ● Difficult to change deeply rooted attitudes, beliefs, interests, and values → people need support and encouragement ● 6 steps ○ Knowledge: receives the information ○ Comprehension: responds to the info received ○ Application: values the info ○ Analysis: makes sense of the info Page 10 of 18 ○ Synthesis: organizes the info ○ Evaluation: adopts behaviors consistent with values ■ Psychomotor (acting) ● Includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills ● First show learners how to do skills then allow practice time ○ If teaching in a classroom, learners may benefit from observing ● 3 conditions: ○ Necessary ability ○ Sensory image ○ Opportunities to practice ○ The educational process: 5 steps: assess, establish, select, implement, evaluate ■ Assess → Identify educational needs (collect data, analyze data, assist pt, consider learning knowledge) ■ Establish educational goals and objectives ● Goals: broad/long term ● Objectives: specific/short term ■ Select appropriate educational methods (consider age, gender, culture, size of groups, knowledge level, and sensory abilities) ■ Implement educational plan ■ Evaluate educational process: pre/post questions, oral interview, formal exam ● Health Literacy, info from CDC module ● How was the Intervention Wheel developed? What are the strengths of the Wheel? ○ The Intervention Wheel is a conceptual framework/model that guides practice of PHNs → grounded theory process by Minnesota PHNs ■ Common language ■ Framework: a way of thinking about PHN practice ○ PHNs needed a way to tell people what they were doing ○ Illustrates how PHNs improve health individuals, families, communities, and systems ○ Components of the intervention wheel: population based, 3 practice levels, 17 interventions ● Know the Wheel is population based and the levels of practice. ○ 3 practice levels ■ Community: change community norms, attitudes, awareness, practices, and behaviors → directed toward entire population within the community or occasion toward populations at risk or populations of interest ● Ex: campaigns ■ Systems: change organizations, laws, policies, and power structures → the focus is on the systems that impact health, not directly on individuals and communities (orange and yellow wedge) Page 11 of 18 ■ Individual/family: change behaviors, knowledge, attitudes, practice, and beliefs → directed at individuals alone or part of a family, class, or group (red, green, and blue wedges) ● Have an idea of what each of the interventions of the wheel are/ what they do ○ Red wedge: ■ Surveillance ■ Disease and other investigation ■ Outreach ■ Screening ○ Green wedge: ■ Referral and follow up ■ Case management ■ Delegated function ○ Blue wedge: ■ Health teaching ■ Counseling ■ Consultation ○ Orange wedge: ■ Collaboration ■ Coalition building ■ Community organizing ○ Yellow wedge: ■ Advocacy ■ Social marketing ■ Policy development and enforcement ○ Screening leads to case findings ○ Screening frequently follows either surveillance or disease and health event investigation and is often preceded by outreach activities ○ Advocacy is seen as a precursor to policy development ● What is the Health Impact Pyramid Page 12 of 18 ○ A 5 tier pyramid that describes the impact of different types of public health interventions and provides a framework to improve health ○ Base of pyramid: indicating interventions with the greatest potential impact are efforts to address socioeconomic determinants of health ○ In ascending order are interventions that change the context to make individuals default decisions healthy, long lasting protective interventions, clinical interventions, and counseling and education ○ Interventions focusing on lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort ○ Implementing interventions at each of the levels can achieve the maximum possible sustained public health benefit ● How could you apply the wheel in your practice? ○ Intervention wheel provides a structure for identifying and documenting interventions performed by PHNs and capture the nature of their work ● What is Community Assessment? How do you do it? Why? ○ Strategic plan to improve a community’s health ○ Assess health by: collecting data, analyzing data, and using data ○ Educates and mobilizes by use of the above data ○ Develops priorities ○ Secures resources ○ Develops action plan ○ IOM (institution of medicine) → assessment, policy development, and assurance of intervention ■ Assessment is one of the core public health functions ■ Primary goal of community assessment: identify health needs of community ○ Components of a Community Assessment ■ Health status: biostatistics ● Mortality ● Morbidity ● Other indicators of health ■ Structure of the Community ● Demographics ● Culture ● Services and resources available Page 13 of 18 ● Environment ● Types of Assessments, data sources, models ○ Types of assessments: comprehensive, population, setting specific, problem, health impact, rapid needs ■ Comprehensive assessment ● Collection of data about populations living in a community ● Looks at assets, unmet needs, and opportunities for improvement ● Mandate for conducting comprehensive assessment ○ IOM directed 1988 and Affordable Care Act (nonprofit hospitals must conduct community hospital assessments) ■ Population focused assessment ● Larger groups or aggregate (members may or may not interact) ● Shares at least one similar characteristic/issue ● Can focus on a specific age group, gender, or health issue ○ Ex: pregnant women, age range, immigrants ■ Setting specific assessment ● Must have a clear understanding of purpose ● Identifying indicators specific to setting ● Treats the setting as the community ○ People within a specific setting ○ Data specific to the setting ● Ex: prisoners, schools, business, nursing home ■ Problem or health issue based assessment ● Focus on specific problem or health issue ● Analysis of data determines who is at risk ● Ex: obesity ■ Health impact based assessment ● Provide advice to community on optimizing its health by identifying ○ Potential effects on the health of a population ○ The distribution of those effects within the population ● Combination of policies and methods used to judge programs/projects ● Associated with ○ Environment ○ Social influences on populations ■ Rapid needs assessment ● Measures present and potential public health impact of an emergency (ex: natural disaster) ● Effective use of limited resources ○ Assessment Models and Frameworks: change and map model ■ Provide guidelines for assessments ■ Community Health Assessment and Group Evaluation (CHANGE model) ● Helps communities build action plans based on assets and areas of government Page 14 of 18 ● Provides program evaluation in communities ○ Diagnosis ○ Action plan ■ MAPP Model: planning tool for improving community health ● 6 phases ○ Organizing for success ○ Vision ○ Performing four assessments ○ Identifying strategic issues ○ Formulation of goals and strategies ○ Action ○ Data sources: ■ Qualitative data: cannot be assigned number value and represent viewpoint of person providing data -- open ended questions ■ Quantitative data: data that can be assigned a numerical value ■ Primary sources of data: participant observation, key informants, focus group, photo voice, spatial data (geographic information system), and using primary data ■ Secondary sources of data: websites, printed materials ● What does it mean to say community as client? ○ The community client is when nursing practice is community oriented ○ Nursing focus is on the collective or common good of the population instead of individual health, highlights the complexity of the change process ○ Nurses may work with individuals; families; other interacting groups, aggregates, or institutions or within a population. Direct nursing care can be part of population focused community health practice but the resulting changes/goals intended to affect the whole community ● What is Community program planning? Why do we do it? How? ● Present state → ideal state ○ Community program planning: process that helps communities to understand how to move from where they are to where they would like them to be ○ Working together on plan to improve the health of community ○ Multistep process: defining the problem, creating a plan, feedback, evaluation ○ Planning at all levels: local, state, federal, global ○ Health program planning is one of 10 essential PH services and should occur and every community ○ Healthy People 2020: provides a tool for community health planning ● What are tools for program planning? ○ Program planning key components: ■ Active involvement of the community as a partner ■ Skill and time to do a competent assessment ■ Shared conclusions with the partners of needed interventions ■ Actual program planning, interventions, and evaluations ■ Social justice: human rights and equality Page 15 of 18 ■ Cultural considerations: cultural competency is essential ● How do you write a nursing diagnosis? ■ Risk for or actual: identifies specific problem or risk faced by community ■ Among: specific population that is affected by risk or problem ■ R/t: indefies factors/strengths/weaknesses influencing problem or risk ● Ex: Risk for asthma among the 38109 zip code r/t excess pollution in the air ● How do you evaluate a program? Types of evaluation? ○ Evaluation ■ Analysis provides useful feedback ● The activities are implemented as they were designed ● Program is cost effective ● Intervention and program theories are correct ● Timeline is appropriate ● Program should be expanded or duplicated in another location ○ Evaluation Models ■ Formative: ongoing feedback of program → internal, strengths, weakness, barriers, and unexpected outcomes ○ Types of evaluation ■ Process evaluation ● Type of formative evaluation ● Investigates the process of delivering the program or technology ● Looks at alternative delivery procedures ■ Summative evaluation ● Occurs at end of program ● Evaluation of the objectives and the goals ○ Nine steps to program evaluation ■ Who should participate ■ Develop the questions ■ Budget in place ■ Determine if evaluation will be internal or external ■ Data collection methods ■ Collect data ■ Analyze and interpret data ■ Communicate findings to stakeholders ● What issues can come up during education? What do you need to take into consideration when educating populations or individuals? What barriers might you encounter? ○ ● How do you evaluate the educational process? ○ Test them: pre/post questions, oral interviews, formal exams ○ Sustainability of any change in behavior ● Know how groups can be used as a tool for health education. ○ Page 16 of 18 ● What are the roles of PHNs? ○ Promote and protect the health of the population through 3 core functions ■ Population Assessment ■ Policy development ■ Assurance of a well coordinated system ● What are the things PH Departments do? What are their activities? ○ What they do ■ Protect and improve health in partnership with community ■ Work together with community to: ● Assure essential community health services ● Facilitate partnerships ● Address public health concerns ● Help coordinate services ○ Activities ■ Environmental health services ● Focus on community safety ○ Water, food, and sanitation ● Today, includes both state and local responsibilities ■ Data collection and analysis ● Mostly state level function ○ Begins at local level ● Vital statistics ○ Birth, death, marriage, divorce ● Data eventually goes to CDC at national level ■ Individual and community health ■ Disease control, epidemiology, surveillance, and regulation ■ Licensing or inspection ● What are challenges for Public Health and for PH Nursing? ○ Keeping communities healthy and safe ○ Goal is to increase PH infrastructure ■ Increase laboratory services ■ Epidemiology services ■ Incorporate core competencies into curricula of accredited academic programs ■ Increase personnel ■ Increase state and local PH jurisdictions as well as their accreditation ■ Quality improvement ■ Informational technology to share clinical records ● What are the roles of federal, state and local health agencies? ○ Federal: develop regulations that implement policies formulated by Congress and provide a significant amount of funding to state and territorial health agencies to: ■ Provide PH services ■ Survey the nation’s health status and health needs Page 17 of 18 ■ Set practice and standards ■ Provide expertise that facilitates evidence based practices ■ Coordinate PH activities that cross state lines ■ Support health services research ○ State: responsible for monitoring health status and enforcing laws and regulations that protect and improve the public’s health ■ Distribute federal and state funds to local PH agencies to implement programs at the community level ● Ex: communicable disease programs, maternal and child health programs, chronic disease prevention programs, injury prevention programs ■ Provide oversight and consultation for local PH ■ Office of minority health ■ Office of rural health ■ License and regulate professionals ■ Health care facilities regulation ■ Division of vital records ■ Alcohol, drug, and mental health services ■ Maternal and child health ■ Immunization ■ Communicable disease ■ BT/Emergency preparedness ○ Local: responsibilities vary depending on the locality and are responsible for implementing and enforcing local, state, and federal PH codes and ordinances and providing essential PH programs to a community ■ Goal: to safeguard the public’s health and to improve the community’s health status ○ The majority of local, state, and federal agencies are involved in: ■ Collecting and analyzing vital statistics ■ Providing health education and information to the population served ■ Receiving reports about the investigating and controlling communicable diseases ■ Protecting the environment to reduce the risk of health ■ Conducting community assessments to identify community assets and gaps ■ Providing some health services to particular populations at risk or with limited access to care ■ Identifying PH problems for at risk and high risk populations ■ Partnering with other organizations to develop and implement responses to identified PH concerns ■ Planning for and responding to natural and manmade disasters and emergencies ● How are F/S/L agencies set up? What things do they do? Who works with them? ○ Page 18 of 18 ● What are current issues/trends in PH Nursing? ○ Shifts from last-resort to primary care to promotion prevention partnership ■ Raises concerns about uninsured and underinsured ○ Antibiotics and immunizations ○ Increasing rates of drug resistance to community acquired pathogens ○ Health care reform legislation ○ Access to affordable housing ○ Societal disparities in health outcomes ○ Behaviorally influenced issues ■ Chronic diseases ■ Violence in society ■ Substance abuse ○ Emerging infections ■ Severe acute respiratory syndrome (SARS) ■ H1Z1 influenza ○ Unequal access to health care