NR 443 Exam 1 STUDY GUIDE

NR 443 Exam 1 STUDY GUIDE Calculation of prevalence * Pg. 3 community health theories – upstream/downstream concept ** p.4 nightingale theory-environmental * nurse practice act—scope health belief model—milio model, pender model ** determinants of health ** QPCC—Qs incompetencies p.4 p.6 role of hippa development of communication education plan bullet #4 p.6 ? snow and Pasteur – know role modes of transmission p.38 circle model of care** EXAM 1 COMMUNITY ATI CHAPTER 1 • Community health nursing o population focused approach to planning, delivering, and evaluating nursing care o promotes health & welfare of client across the lifespan o principles guiding CHN, epidemiology, and health promotion/disease prevention o GOAL—promote, preserve, and maintain the health of populations by delivery of health services • CHN theories o Systems thinking—how an individual interacts w/organizations and systems. Good for examining cause & effect relationships o Upstream thinking—focuses on interventions that promote health or prevent illness, not care after illness, macroscopic - population o Downsteam thinking- microscopic care focusing on individual o Nightingales environmental theory—relationship between environment & health ▪ Emphasizes preventative care ▪ Health is a continuum o Health belief model—predict or explain health behaviors ▪ Describes likelihood of taking action to avoid disease based on: • Perceived threat of disease • Change at INDIVIDUAL level • Modifying factors • Cues to action(media, recommendations from health care pro) • Perceived benefits minus barriers to taking action o Milio’s framework for prevention ▪ Complements health belief ▪ Change at COMMUNITY level ▪ Shows relationship btwn health deficits and availability of health-promo resources ▪ Behavior change in large # ppl can = social change o Penders health promotion model • Does not consider health risk as factor provoking change • Examines factors that affect individual actions to promote health o Personal factors, feelings, benefits, barriers, attitudes of others, competing demands o Orems self-care deficit theory • Focuses on individual self care needs and explains level of nursing interventions required to assist clients to obtain optimal health Essentials of CHN • Determinants of health—factors that influence clients health o Nutrition o Stress o Education o Environment, finances, social status • Health indicators---describe health status of a community o Mortality rates, disease prevalence o Levels of physical activity o Obesity o Tobacco use/substance use Public health nursing • Population focused • Goal—promote health and prevent disease • Provide 10 essential services o 3 core functions— ▪ Assessment—monitor health of population ▪ Policy development—developing laws & practice to promote health of a population…inform education and empower the people ▪ Assurance—made sure health care and services are accessible Population-focused nursing • Assessing to determine needs, protect and promote health, prevent disease w/in specific population • Use community partnerships—members, agencies and business to participate o Key principles ▪ Emphasize primary prevention ▪ Work to achieve greatest good for most people ▪ Client is a partner in health ▪ Use resources wisely community-ORIENTED nursing*** • Focus—aggregates, communities, populations • Goal—health promotion , disease prevention • Nursing activities—usually indirect, can include direct care of at-risk individuals Community-BASED nursing*** • Focus—individuals and families • Goal—manage acute or chronic conditions • Activities—direct care, illness care, managing of conditions in settings like schools, camps, prisons Principles guiding CHN • Ethics—preventing harm, respecting autonomy • Advocacy • Evidence based practice • Quality o Quality assurance, quality, improvement, and quality management o Total quality management TQM—seeks to improve quality & performance o Continuous quality improvement CQI—emphasizes organization and uses data to improve processes ▪ Evaluate quality based on: effectiveness, timeliness, client-centered, equity, safety, efficiency • Professional collab and communication Domains of learning • Cognitive domain—involved knowledge and development of intellectual skills • Affective domain—change in attitude and development of values • Psychomotor domain—performance of a skill Epidemiology—study of health-related trends in populations for purpose of disease prevention • Provides understanding of spread, transmission, and incidence of disease and injury • Epidemiological triangle- study of relationship among agent, host, and environment o Agent—physical, infectious or chemical factor causing disease o The host—living being being influenced o Environment—setting or surrounding that sustains the host • Calculations---incidence & prevalence rates o Used to measure existence of a particular disease o Incidence= # new cases / population total x 1,000= ……. Per 1,000 o Prevalence= # existing cases in population/pop total x 1,000 =……per 1,000 Mortality rates= provide info about cause of death • Crude mortality(specific causes)==#deaths/pop. Total x 1000= …..per 1,000 Attack rate • Epidemic- rate of disease exceeds the usual (endemic) level in a population • Pandemic—epidemic occurs in multiple countries or continents CHAPTER 2 FACTORS INFLUENCING COMMUNITY HEALTH • Social determinants of health are factors affecting individual health o 5 categories 1. Neighborhood and built environment 2. Social and community context 3. Economic stability 4. Health and healthcare 5. Education Cultural care o CLAS—culturally and linguistically appropriate services o Promote development of healthcare workforce that can respond to a diverse clientele o Provides language assistance o Promotes ongoing improvement & accountability for care o Acculturation-process of merging with or adopting the traits of a different culture o Cultural awareness- self awareness of ones own cultural background, biases and differences o Cultural needs—cultural needs are as important as physical and psychological needs o Cultural competence—respecting personal dignity and preferences and being responsive to clients needs o Cultural preservation-preservation of clients values o Cultural accommodation-supporting clients practices o Cultural repatterning-assisting to modify practices not beneficial to health o Cultural brokering-advocating, mediating and negotiating btwn clients culture and health care culture on behalf of the client Cultural assessment o Provides info to the provider about effect of culture on communication, space, contact, time, and environmental control factors o Environmental control—how environment affects individual o Time orientation – describes whether an individual puts more value on past present or future o Social organization- significance of individual member of a family or family as a whole o Health beliefs and practices-whatever a person thinks is the cause of impaired health will affect actions the individual takes o Cultural assessment parameters o Ethnic background o Religious preferences o Family structure o Language/literacy needs o Communication needs o Education o Food patters, health practices, cultural values Barriers of access to health care o Inadequate insurance/inability to pay for services o Language/cultural barriers o Lack of health care providers in a community o Geographic isolation/social isolation o Lack of transportation o Attitudes of healthcare workers towards low socioeconomic ppl or diff cultures o Eligibility requirements for state/federal assistance programs Health care services Microeconomic theory-individual preferences/finances and how they affect cost of care Macroeconomic- focuses on aggregate behaviors, economic growth and employment Affordable care act o Allows dependents until age 26 on parents insurance o Prohibits health plans from denying benefits for preexisting coverage o Banning lifetime limits on benefit coverage o Covering preventive care services WHO—world health organization o Provides daily info about international disease o Establishes standard for antibiotics and vaccines o Focuses on- healthcare workforce & education, environment, sanitation, infectious diseases, maternal & child health and primary care Local health department—receives funds from state level to implement community level programs o Funded through local taxes w/support from federal & state funds Insurances o MEDICARE o 65+ while receiving social security o On disability for 2+ yrs ▪ A= hospital care, home care, hospice, limited skilled nursing care ▪ B= better coverage….outpatient care, physiotherapy, mental health, preventative services ▪ C= combo of A+B provided through private insurance company ▪ D= prescription medication coverage o MEDICAID o Low socioeconomic status and children o Through federal and state government o Eligibility based on household size and income o Priority given to children, pregnant women, and disabilities o Medical savings account-untaxes money put into account for use of medical expenses o Self pay o HMO o PPO CHAPTER 3—Community health program planning o Nurse can use program planning to promote healthy communities o Program planning should reflect priorities set from the assessment data Determining the health of a community o Factors to consider o Status-mental health, epidemiological data, client satisfaction crime rates o Structure- present of health facilities, demographic data, services types o Process- relationships, communication, commitment and participation in health o Components o People o Place/environment o Social systems o Data collection o Informant interviews o Community forum o Secondary data-existing data/health records, birth stats, census data, prior health surveys, mortality/morbidity o Participant observation-observation of formal or informal community activities o Focus groups o Surveys o Windshield survey Analysis of community data o Gather data o Assess data o Identify/generate missing data o Synthesize data/identify themes o Identify community needs & problems o Identify strength and resources Develop of program and management o Preplanning ▪ Get ideas, gain entry to community, obtain community support and involvement o Assessment ▪ Collect data about community and members o Diagnosis ▪ Identify and prioritize health needs of community o Planning ▪ Develop interventions to meet outcomes o Implementation ▪ Carry out plan o Evaluation ▪ Examine success of the interventions ▪ Ongoing evaluation is necessary to ensure program sustainability/success Strategies and barriers o Strategies o Thorough assessment o Collab w/community partners o Sufficient resources o Skilled leadership o Barriers o Inadequate data o Impaired communication o Inadequate resources o No community partner/poor leadership CHAPTER 4---PRACTICE SETTINGS AND AGGREGATES Practice settings for the community health nurse o Home health nurse o Nurse functions as educator, provider of nursing interventions, and coordinator of care o Uses the Omaha system model to implement the nursing process o Hospice Care nurse o support through the dying process in diff settings o Occupational health nurse o Work to promote a healthy work environment to foster health and safety of workers o Susceptibility of risk depends on ▪ Host factors—worker characteristics(inexperience), age, pregnancy ▪ Agent factors-viruses, fungi, smoke, asbestos, temp extremes, noise, radiation, stress, violence ▪ Environmental factors—heat, odor, pollution, sanitation, addictions, overcrowding ▪ The CHN should assess the exposure to hazards, do a site-walk through, use control strategies to reduce future exposures, find protection from violence & work-related injuries ▪ OSHA—develops and enforces workplace health regulations to protect safety/health of workers ▪ NIOSH national institute for occupation safety and health- identifies workplace hazards o Faith community nurse o Works with individuals, families and faith communities o Based on spiritual, physical, emotional, and social dimensions o Circle model of spiritual care ▪ C-caring ▪ I-intuition ▪ R- respect for religious beliefs/practice ▪ C-caution ▪ L-listening ▪ E-emotional support o Missionary nurse ▪ Seeks to promote health/prevent disease by meeting spiritual, physical, and emotional needs of people around the world ▪ Cultural and language barriers often affect provision of care ▪ Collaboration w/community is essential o Parish nurse ▪ Works with church members and groups o School nurse—many roles ▪ Case manager-coordinates services for complex needs ▪ Community outreach-plan between educational system and other comm. Agencies ▪ Consultant-assist families and students on decision making for health needs ▪ Counselor-support students on wide variety of needs ▪ Direct caregiver—school nurse ▪ Health educator ▪ Researcher o Forensics nurse ▪ Care for perpetrators of injury as well as victims of sexual assault, substance use related injuries, human trafficking, physical abuse, gang violence, disaster/accidental injuries ▪ Combines nursing knowledge with knowledge of criminal justice system ▪ Safety is primary principle ▪ SANE—sexual assault nurse examiner Aggregates of the community o Children (birth-12) & adolescents o Leading death causes children—congenital anomalies, SIDS, MVC o Adolescents—MVC, homicide, suicide o Women o Leading cause of death—reproductive health(childbearing, osteoporosis), heart disease, diabetes, malignant neoplasm (breast, cervical, ovarian, colorectal) o National health goals—reduce osteoporosis, reduce cancer deaths, reduce sexual violence o Men o Leading death—heart disease, cancer (prostate, testicular, skin, colorectal), unintentional injuries, lung disease, liver disease o Goals—reduce prostate cancer death, reduce HIV/AIDS, reduce injuries o Older adults o Leading death—heart disease, cancer, cerebrovascular disease, COPD, pneumonia/flu, substance abuse o Increase goals—screenings for colorectal cancer, participation in organized health activities, self management of chronic disorders o Families o Home visits give the opportunity to observe the home environment and identify barriers/health risks o Family as component of society ▪ How family interacts w/other institutions in community ▪ For population focused interventions o Family as a system ▪ How Interactions among family members affect whole family function ▪ Interventions directed towards how family members interact with eachother o Family as client ▪ Family unit examined first then individual needs ▪ Determines how the family health is impacted by individuals reaction to health event o Family as context ▪ Individual first then family ▪ Promote health and recovery of individual using family as resource for service/support o Characteristics of healthy families ▪ Communicate/listen well ▪ Affirmation and support for all members ▪ Privacy is respected ▪ Shared sense of responsibility ▪ Traditions and rituals ▪ Seek help for their problems o Family health risk appraisal ▪ Genograms—used to gather info about family, relationships, health and illness patterns ▪ Biological health risk--Ecomaps-identify family interactions with other groups and organizations. Family’s support network and social risk ▪ Behavioral risk—info about family health behavior, health values, habits and risk perceptions o National family goals---reduce allergens in home, hunger, partner violence…..increase- positive parenting, health education, insurance, radon home testing CHAPTER 6—COMMUNICABLE DISEASES, DISASTERS, AND BIOTERRORISM o Communicable diseases o Leading cause—ARDS, HIV/AIDS, diarrheal diseases, TB, malaria, measles o Airborne o Measles, chickenpox, TB, pertussis, flu, SARS o Foodborne o Infection-norovirus, salmonellosis, Hep A, trichinosis, E.coli o Intoxication—staphylococcus, costridium botulinum o Waterborne-cholera, typhoid, bacillary dysentery o Vector-west nile, lyme disease, rocky mountain spotted fever, malaria o Direct contact-STIs, pinworms, impetigo, lice, scabies o Defense mechanisms o Herd immunity-protection due to immunity of most community members o Natural immunity-natural defense mechanisms of the body o Acquired immunity-develops through actual exposure ▪ Active-production of antibodies by body ▪ Passive-transfer of antibodies o Nationally notifiable diseases o Anthrax, cholera, botulism, gonorrhea, Hep ABC, lyme disease, pertussis, mumps, rabies, poliovirus, salmonellosis, SARS, shigellosis, toxic shock syndrome, TB, VRSA Disasters o Setting up a communication protocol is an important part of community disaster planning o Disasters are classified according to type, level, and scope o National response framework NRF—activated and provides direction for federal emergencies o Disaster response agencies—FEMA, CDC. Homeland security, American red cross o Disaster recovery o Begins when danger no longer exists o Recovery lasts until economic and civil life of community are restored o Phases of emotional reaction during disaster ▪ Heroic-intense excitement and concern for survival ▪ Honeymoon-affected people bond and relive experiences ▪ Disillusionment-responders can experience depression and exhaustion. Causes unexpected delays in aid ▪ Reconstruction-adjusting to new reality and continue to rebuild area Role of CHN in disasters o Risk assessment o Disaster planning—develop disaster response plan, warning system, locate equipment, evaluate drills o Disaster response—activate plan, perform triage o Disaster recovery—make home visits, coordinate care in shelters, assess for PTSD o Evaluate disaster response—create ongoing assessment, efficiency of response teams, estimate length of time for recovery of community services…electricity, running water Bioterrorism o Agents of bioterrorism o Category A—highest priority—easily transmitted/highest mortality ▪ Smallpox, botulism, anthrax, plague, viral hemorrhagic fevers(ebola) o Category B—moderately easy to disseminate, high morbidity low mortality ▪ E.coli, west nile, typhus fever, ricin toxin o Category C—emerging pathogens that can be engineered for mass dissemination. Easy to produce, and have potential for high morbidity and mortality ▪ Influenza, TB, rabies, hantavirus o Incidents of bioterrorism o Inhalational anthrax ▪ Headache, fever, chills, muscle aches, severe dyspnea, shock ▪ Vaccine for high risk people ▪ Ciprofloxacin—prophylactic treatment after exposure , don’t take with antacid, avoid dairy ▪ Treat—antitoxin and IV antibiotics o Botulism ▪ Double/blurry vision, slurred speech, diff swallowing, dyspnea, progressive muscle weakness ▪ No vaccine ▪ Treat—airway management, admin antitoxin, induce vomiting, enemas, surgical excision of wound tissue. ▪ Give nutrition, fluids o Smallpox ▪ High fever, fatigue, head/body aches, rash on face quickly spreads, turn to pus-filled lesions, vomiting ▪ Vaccine for high risk ▪ No cure ▪ Supportive care—hydration, pain meds, antipyretics, antibiotics for secondary infection o Ebola ▪ Fever, severe headache, joint pain, fatigue, hemorrhage, vomiting/diarrhea, shock ▪ No vaccine ▪ Use N95 mask, droplet isolation ▪ Support care IV fluids, dialysis, airway management, minimize invasive procedures o Plague ▪ Pneumonic-fever, weakness, pneumonia, SOB, chest pain, bloody sputum ▪ Bubonic-swollen tender lymphs, fever, headache, weakness ▪ Septicemic-fever, prostration, abdominal pain, shock, DIC, gangrene of nose and digits ▪ No vaccine, contact precautions ▪ Droplet until 72hr after antibiotics ▪ Treat—gentamicin and fluoroquinolones o Tularemia ▪ Sudden fever, chills, diarrhea, muscle aches, joint pain, dry cough, progressive weakness ▪ Treat-streptomycin or gentamicin ▪ Mass causalities use doxycycline or cipro CHAPTER 7-CONTINUITY OF CARE o CHN plays a large role in maintaining continuity of care for clients as they transition from acute to outpatient settings o Facilitate partnerships within the community to maintain healthy communities Nurse consultant—updating state officials about health needs of the community Case management nursing o Must facilitate communications amongst all parties involved o Advocate for quality services and client rights o Reduce gaps and errors in care o Provide education to optimize health participation Informatics nursing o Combination of nursing science with information and communication technologies in delivery of nursing care o Electronic health records, electronic medical records, billing, internet Telehealth o Delivery of quality health care through use of technology o Usually for rural areas o Can be used for physical, audio and visual data o Physical-BP, weight, blood glucose, temp, HR, ECG results o Audio-voice, heart, lung, bowel sounds o Visual – images of wounds, surgical incisions CHAPTER 5 CARE OF VULNERABLE POPULATIONS Vulnerable populations—those subject to issues such as Violence Substance abuse Mental health issues Rural residency Migrants Veterans Disability/low income/chronic status 2020 Health goals for vulnerable populations • Increase ppl who have primary care provider • Increase ppl with insurance • Reduce # ppl who are unable to access health care • Reduce ppl w/disabilities & have barriers to health/wellness programs Violence w/in communities • Homicide o Mot victims have known attackers o Related to substance abuse o Increasing rates in adolescents • Assault o Males more likely o Youths at increased risk • Rape o Often unreported o Mostly marital or date rape o Increased rate in summer months • Suicide o Highest among individuals 45-64 o Caucasians more likely to commit suicide o Risk—depression, mental illness, substance use, firearm access, intimate parter issues • Abuse o Physical o Sexual o Emotional—behavior that minimizes individuals feelings of self worth, humiliates, threated or intimidates o Neglect—failure to provide ▪ Physical care—food, shelter, hygiene ▪ Emotional—stimulation for developmental milestones not given ▪ Education ▪ Health/dental care • Economic maltreatment o Failure to provide need to vulnerable person when funds are availale o Unpaid bills if another person is managing finances o Theft or misuse of money/property Individual assessment for violence Risks for violence • History of abuse • Low self esteem • Fear/distrust of others • Poor self control • Inadequate social skills • Minimal social support/isolation • Immature motivation for marriage/childbearing • Weak coping skills Potential child abuse/neglect • Unexplained injury • Unusual fear of nurse/others • Injuries/wounds not mentioned in hx • Fractures • Various wound healing stages • Malnourishment/dehydration • General poor hygeine or inappropriate dress for weather Elder abuse • Unexplained physical injuris • Physical neglect • Rejection of caregiver assistance • Financial mismanagement • Depression • Withdrawal/passivity Community assessment—social//community risk factors for violence • Work stress • Unemployment • Media exposure to violence • Crowded living • Poverty • Feelings of powerlessness • Social isolation • Lack of comm resources—parks/playgrounds/theaters Reducing societal violence 1. Primary a. Teach alternative conflict resolution—anger management b. Parenting classes for age appropriate guidance of behaviors c. Educate on Community services for violence prevention d. Remove factors that contribute to care taker stress—respite care 2. Secondary a. Identify and screen individuals for abuse b. Assess/evaluate unexplained bruises c. Refer rape survivors to local abuse team 3. Tertiary a. Grief counseling b. Support groups Mental Health • NAMI—national alliance for the mentally ill o Works to reduce stigma and provide services for clients Barriers to health care in rural areas • Distance from services • Lack of personal transportation • Unpredictable weather/travel conditions • Inability to pay for care • Shortage of health care providers Priority needs for rural health • Cancer prevention/care • Mental health care • Substance use • Immunization programs • Family planning Interventions for rural health • Assist client with identifying/applying for assistance programs • Use cultural competence Migrants Migrant health act---provides funding for migrant health centers across the US • Health problems of migrants o Dental disease o TB o Chronic conditions o Leukemia o Iron deficiency anemia o STIs HIV AIDS o Higher infant mortality rates • Pesticide exposure o Findings—headache, dizziness, dyspnea, nausea, abdominal cramps, poor concentration, eye irritation o Objective findings—confusion, irritability, muscle weakness/twitching, vomiting, rash o Complications—exposure linked to cancer, reproductive problems, parkinsons, liver damage, and behavioral issues • Issues in migrant health o Food insecurity o Inconsistent income o Poor/unsanitary working conditions o Language barriers o Discrimination o Immigration status Strategies for rural/migrant health • Primary-educate regarding measures to reduce exposure to pesticides o Provide prenatal care o Mobilize preventative services • Secondary—create testing programs for TB and other screening programs • Tertiary—treat for exposure , promote rehab following work injuries Disabled IDEA—individuals with disabilities education act promotes the rights of children with disabilities. Ensures public free education and accommodations to prepare the child for independent living.