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Summary HESI PN Community Health Exam 1

HESI PN Community Health Exam 1 Chapter 1 o Community/Public Health Nursing • Is the synthesis of nursing practice and public health practice. • Has the major goal to preserve the health of the community and surrounding populations. • Focuses on health promotion and health maintenance. • Is associated with health and identification of populations at risk rather than an episodic response to patient demand. o Public Health is described as the art and science of • Preventing disease • Prolonging life • Promoting health through organized community efforts to benefit each citizen. Winslow (1920) o Health Care Reform • “Costs of caring for the sick account for the majority of escalating health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 17.8% in 2015”. National Center for Health Statistics (NCHS) (2017) • Community/public health nurses are in a position to assist the U.S. health care system to transition from being disease-oriented to a health-oriented system. o Public Health Mission • The mission of public health is social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible. o Definitions of Health • “A state of complete well-being, physical, social, and mental, and not merely the absence of disease or infirmity”. —World Health Organization (1958) • “The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, and physical capacities”. — World Health Organization (1986) o Definition of Community • “a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity and belonging”. Rector (2017) o Definition and Focus of Public Health and Community Health • Public health is the Science and Art of ▪ Preventing disease ▪ Prolonging life ▪ Promoting health and efficiency through organized community effort • Community health extends the realm of public health to include organized health efforts at the community level through both government and private efforts. o Core Public Health Functions • Assessment: Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community • Policy development: Use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies • Assurance: Focuses on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day- to-day operations and the capacity to respond to critical situations and emergencies. Institute of Medicine (1988) o Essential Public Health Services o Monitor health status to identify and solve community health problems o Diagnose and investigate health problems and health hazards in the community o Inform, educate, and empower people about health issues o Mobilize community partnerships and actions to identify and solve health problems o Develop policies and plans that support individual and community health efforts o Essential Public Health Services o Enforce laws and regulations that protect health and ensure safety o Link people to needed personal health services and assure the provision of health care when otherwise unavailable o Assure a competent public health and personal health care workforce o Evaluate effectiveness, accessibility, and quality of personal and population-based health services o Research for new insights and innovative solutions to health problems o The Three Levels of Prevention o Primary prevention • Prevention of problems before they occur • Health promotion and health protection o Secondary prevention • Early detection and intervention • Early diagnosis and treatment o Tertiary prevention • Correction and prevention of deterioration of a disease state • Limitation of disability and rehabilitation o Level of Prevention-Individual Definition of client served Primary (health promotion and specific prevention) Secondary (early diagnosis and treatment) Tertiary (limitation of disability and rehabilitation) Individual Dietary teaching during pregnancy HIV testing Screening for cervical cancer Teaching new clients with diabetes how to administer insulin Exercise therapy after stroke Skin care for incontinent patient o Level of Prevention-Family Definition of client served Primary (health promotion and specific prevention) Secondary (early diagnosis and treatment) Tertiary (limitation of disability and rehabilitation) Family (two or more individuals bound by kinship, law, or living arrangement and with common emotional ties and obligations) Education regarding smoking, dental care, or nutritional counseling Adequate housing Dental examinations Tuberculin testing for family at risk Mental health counseling or referral for family in crisis (e.g., grieving or experiencing a divorce) Dietary instructions and monitoring for family with overweight memebers o Level of Prevention-Group Definition of client served Primary (health promotion and specific prevention) Secondary (early diagnosis and treatment) Tertiary (limitation of disability and rehabilitation) Group or aggregate (interacting people with a common purpose or purposes) Birthing classes for pregnant teenage mothers AIDS and other STD education for high school students Vision screening for first grade class Mammography can for screening of women I low-income neighborhoods Hearing tests at a senior center Group counseling for grade school children with asthma Swim therapy for physically disabled elders at a senior center Alcoholics anonymous and other self-help groups Mental health services for military veterans o Level of Prevention-Community Definition of client served Primary (health promotion and specific prevention) Secondary (early diagnosis and treatment) Tertiary (limitation of disability and rehabilitation) Community and Fluoride water Organized screening Shelter and location populations supplementation programs for centers for fire or (aggregate of people Environmental communities such as earthquake victims sharing space over sanitation health fairs Emergency medical time within a social Removal of VDRL screening for services system; population environmental marriage license Community mental groups or aggregates hazards applicants in a city health services for with power relations Lead screening for chronically mentally and common needs or children by school ill purposes) district Home care services for chronically ill o Thinking Upstream • Examining the origins of disease, nurses identify social, political, environmental, and economic factors that often lead to poor health options for both individual and populations. • Refocus the efforts of nurses “upstream,” where the real problem lies. McKinlay (1979) o Prevention Versus Cure • Cure ▪ Spending additional dollars for cure in the form of health care services does little to improve the health of a population. • Prevention ▪ Spending money on prevention does a great deal to improve health and decrease the dollars spent on cure. Getzen (2013) o Healthy People 2020 (1 of 9) • Vision: ▪ A society in which all people live long, healthy lives • 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 o Leading Health Indicators • Access to Health Services • Clinical Preventive Services • Environmental Quality • Injury and Violence • Maternal, Infant, and Child Health • Mental Health • Nutrition, Physical Activity, and Obesity • Oral Health • Reproductive and Sexual Health • Social Determinants • Substance Abuse • Tobacco Use o HP2020 has 42 focus areas • The objectives and related information and materials can help guide health promotion activities and can be used to aid in community-wide initiatives. o All health care practitioners … • Should focus on the relevant areas in their practice • Incorporate objectives into programs, events, and publications whenever possible • Use them as a framework to promote healthy cities and communities o Healthy People 2020 (4 of 9) 1. Access to Quality Health Services 2. Adolescent Health 3. Arthritis, Osteoporosis, and Chronic Back Conditions 4. Blood Disorders and Blood Safety 5. Cancer 6. Chronic Kidney Disease 7. Dementias, including Alzheimer’s Disease 8. Diabetes 9. Disability and Health 10. Early and Middle Childhood 11. Educational and Community-based Programs 12. Environmental Health 13. Family Planning 14. Food Safety 15. Genomics 16. Global Health 17. Health Communication and Health Information Technology 18. Healthcare-Associated Infections 19. Health-Related Quality of Life and Well-Being 20. Hearing and Other Sensory or Communication Disorders 21. Heart Disease and Stroke 22. HIV 23. Immunization and Infectious Diseases 24. Injury and Violence Prevention 25. Lesbian, Gay, Bisexual, and Transgender Health 26. Maternal, Infant, and Child Health 27. Medical Product Safety 28. Mental Health and Mental Disorders 29. Nutrition and Weight Status 30. Occupational Safety and Health 31. Older HealthNew 32. Oral Health 33. Physical Activity 34. PreparednessNew 35. Public Health Infrastructure 36. Respiratory Disease 37. Sexually Transmitted Diseases 38. Sleep HealthNew 39. Social Determinants of HealthNew 40. Substance Abuse 41. Tobacco Use 42. Vision o Public Health Nursing • ANA definition (2013) ▪ The practice of promoting and protecting the health of populations ▪ Uses knowledge from nursing, as well as social and public health sciences, to promote and protect the health of populations. ▪ Is population focused, with the goals of promoting health and preventing disease and disability for all people o Community Health Nursing • ANA definition (1980) ▪ Synthesis of nursing practice and public health to promote and preserve the health of populations ▪ Care is directed to individuals, families, groups. ▪ Contributes to health of the total population • The terms Public Health Nursing and Community Health Nursing are used interchangeably in Nies and McEwen, 7th edition. o Community-Based Nursing • “Application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system” —McEwen and Pullis (2009) • Setting-specific • Emphasis is on acute and chronic care o Community and Public Health Nursing Practice • Nurses practice disease prevention and health promotion. • Practice is collaborative. • Practice is based on research and theory. • Applies the nursing process to the care of … ▪ Individuals ▪ Families ▪ Aggregates ▪ The community o Population-Focused Nursing • Focuses on the entire population • Is based on assessment of the population’s health status • Considers the broad determinants of health • Emphasizes all levels of prevention • Intervenes with communities, systems, individuals, and families —Minnesota Department of Health (2003) o PHN Intervention Wheel (1 of 7) • Population based • Contains three levels of practice: ▪ Community ▪ System ▪ Individual/family • Identifies 17 public health interventions grouped into five wedges by color o PHN Intervention Wheel (2 of 7) • Surveillance: Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions • Disease and other health event investigation: Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures o PHN Intervention Wheel (3 of 7) • Outreach: Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained • Screening: Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations • Case finding: Locates individuals and families with identified risk factors and connects them with resources o PHN Intervention Wheel (4 of 7) • Referral and follow-up: Helps individuals, families, groups, organizations, and/or communities identify and access necessary resources to prevent or resolve problems or concerns • Case management: Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services • Delegated functions: Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law o PHN Intervention Wheel (5 of 7) • Health teaching: Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities • Counseling: Establishes an interpersonal relationship intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual • Consultation: Seeks information and generates optional solutions to perceived problems or issues through interactive problem-solving with a community, system, and family or individual o PHN Intervention Wheel (6 of 7) • Collaboration: Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health • Coalition building: Promotes and develops alliances among organizations or constituencies for a common purpose • Community organizing: Helps community groups identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set o PHN Intervention Wheel (7 of 7) • Advocacy: Plead someone’s cause or act on someone’s behalf, with focus on developing the capacity of the community, system, and individual or family to plead their own cause or act on their own behalf • Social marketing: Uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest • Policy development and enforcement: Places health issues on decision-makers’ agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies o Providing Population-Based Care … A Shift in Thinking 1. Populations are not homogeneous; must address the needs of special subpopulations. 2. High-risk and vulnerable subpopulations must be identified early in the care delivery cycle. 3. Nonusers of services often become high-cost users; essential to develop outreach strategies. 4. Quality and cost of all health care services are linked together across the health care continuum. —Kaiser Family Foundation (2013) Chapter 2 o Historical Factors: Community Health Nursing in Context o Evolution of Health in Western Populations o Stages in the Disease History of Humankind • Hunting and gathering (before 10,000 bce) • Settled villages (10,000 to 6000 bce) • Preindustrial cities (6000 bce to 1800 ce) • Industrial cities (1700 to 1800 ce) • Present period (1900 to 2000 ce) • Stages overlap and time periods are widely debated in the field of anthropology. Some form of each stage remains evident in the world today. o Aggregate Impact on Health • Growing populations • Increased population density • Imbalanced human ecology • Resulted in changes in cultural adaptation o Hunting and Gathering Stage • Known as the Paleolithic period or Old Stone Age • Small aggregate groups wandered in search for food • Avoided many contagious diseases because of small scattered groups that were nomadic and separated from other groups o Settled Village Stage • Became more sedentary and formed small encampments and villages. • Concentration of people in small areas caused new health problems • Domesticated animals and lived close to live herds • This probably transmitted diseases such as salmonella, anthrax, Q fever, and TB • They secured water and removed waste, which lead to cross contamination of water causing diseases such as: • Dysentery, cholera, typhoid, hepatitis A o Preindustrial Cities Stage • Large urban centers formed to support population • Inhabited smaller areas causing more exposure to preexisting problems • Needed increased amounts of food and water, and needed to remove increased wastes • Rodent infestations caused the spread of the plague • Frequent contact with each other caused transmission of mumps, measles, influenza, and smallpox epidemics. Polgar 1964 o Industrial Cities Stage • Areas more dense and heavily populated • Increased industrial wastes, air, and water pollution • Harsh working conditions increased respiratory diseases • Increased infectious diseases o Present Stage • Infectious disease prevalent among low-income populations, and some ethnic minority groups in the West • Common risk factors contribute to chronic health conditions such as changes in diet, environmental alterations, and occupational hazards. • Rise in population and greater population density increase mental and behavioral disorders. o Evolution of Early Public Health Efforts • Prerecorded Historic Times (before 5000 bc) • Practices based on superstition or sanitation • Health practices evolved to ensure survival • Classical times (3000 to 200 bc) • Devised ways to flush water; constructed drainage systems • Developed pharmaceutical preparations • Embalmed the dead • Dealt with pollution • Hygienic code to protect food and water • Greek and Roman impact public health o Evolution of Early Public Health Efforts • Greeks • Literature contains accounts of communicable diseases. • Endemic, epidemic, and pandemic • Hippocratic book on Airs, Waters and Places • Hygeia, goddess of health, or good living • Panacea, goddess of curative medicine • Balance of human life with environmental demands o Evolution of Early Public Health Efforts Types of Disease Definitions Endemic Diseases that are always present in a population (e.g., colds and pneumonia) Epidemic Disease that are not always present in a population but flare up on occasion (e.g., diphtheria and measles) Pandemic The existence of disease in a large proportion of the population – a global epidemic (e.g., HIV, AIDS, and annual outbreaks of influenza type A) o Evolution of Early Public Health Efforts • Romans • Massive aqueducts, bathhouses, and sewer systems • Addressed occupational health threats • Priests mediated diseases and dispensed medicine. • Public physicians worked in designated towns. • Worked in groups much like today’s health maintenance organizations or group practices • Earned money to care for the poor • Hospital for sick poor established by Fabiola, a Christian woman. Donahue 2011 o Evolution of Early Public Health Efforts • Middle Ages (500 to 1500 ce) • Monasteries promoted collective activity to protect public health. • Churches enforced hygienic codes. • A pandemic ravaged the world in the 14th century. • Modern public health practices (e.g., isolation, disinfection, quarantines) emerged. o Renaissance (15th, 16th, 17th centuries) • A theory about the cause of infection evolved. • Leeuwenhoek described microscopic organisms. • Elizabethan Poor Laws were enacted. o Evolution of Early Public Health Efforts • 18th century • Industrial revolution • Poor children forced into labor • Vaccination discovered by Edward Jenner • Sanitary Revolution’s public health reforms were taking place. o Evolution of Early Public Health Efforts • 19th century • Communicable diseases ravaged the population that lived in unsanitary conditions. • Edwin Chadwick examined death rates by occupation and class in England. • The General Board of Health for England was established in 1848. o Evolution of Early Public Health Efforts • 19th century Public health laws were enacted in 1849: • Healthy mental and physical development of citizens • Prevention of all dangers to health • Control of disease • John Snow demonstrated the transmission of cholera via the public water source. o Evolution of Early Public Health Efforts • 19th century Waves of epidemics occurred in the United States. • Lemuel Shattuck published vital statistics in Massachusetts; he called for child health reform. • The first Board of Health was formed in response. • The AMA was asked to collect vital statistics. • Efforts focused on determinants of health. • The advent of “modern” health care occurred. o Evolution of Modern Nursing • Florence Nightingale (1820 to 1910) • Credited with establishing “modern nursing” • Concern for environmental determinants of health • Emphasis on sanitation, community assessment, and analysis • Use of graphically depicted statistics and comparable census data • Political advocate • Education reform for nurses o Establishment of Modern Health Care and Public Health Practice • Louis Pasteur • Theory of existence of germs • Discovered immunizations in 1881 and the rabies vaccine in 1885 • Robert Koch • Discovered causative agent for cholera and the tubercle bacillus in 1882 • Joseph Lister • Surgical success with wound care o Establishment of Modern Health Care and Public Health Practice • Emergence of germ theory focused diagnosis and treatment on individual organism and individual disease. • Community outcry for social reforms forced governments to take action. • Boards of health and health departments began in 1866. • TB surveillance began in 1889. o Establishment of Modern Health Care and Public Health Practice • Flexner Report (1910) outlined shortcomings of U.S. medical schools. • Philanthropic foundations influenced health care efforts. • 1916: Rockefeller Foundation established first school of public health at Johns Hopkins. o Community Caregiver • Traditional healer common in non-Western, ancient, and primitive societies • Societies retain folk practices because they provide some repeated successes. • Folk healing practices are socially cohesive and involve support systems. • Although often overlooked, cultural practices affect health. o Establishment of Public Health Nursing • In England • District Nursing first established in England, 1850s • Rathbone worked with Nightingale to educate “health nurses,” 1859 • Health Visiting in Manchester, England, 1862 • In the United States • Health Visiting Nurses, 1877 • House on Henry Street, 1893 o Establishment of Public Health Nursing • Lillian Wald (1867 to 1940) • Established House on Henry Street in 1893 (along with Mary Brewster) • Played an important role in establishing public health nursing in the United States—later called “Visiting Nurses Association of NYC” • Role of Henry Street Settlement was “one of helping people to help themselves” (Wald, 1871). • The Children’s Bureau and the Social Security Act Legislation formed as a result of these efforts. o Establishment of Public Health Nursing • First School Nurse, Linda Rogers, 1902 • Metropolitan Life Insurance Company provided home nurses for policyholders, 1909. • Department of Nursing and Health at Teachers’ College of Columbia University in NYC, 1910 • National Organization of Public Health Nurses formed, 1912 (Lillian Wald was first president) • Public Health Service appointed its first public health nurse, 1913. o New Causes of Mortality • Change from infectious diseases to chronic conditions • Modern medical advances (vaccination programs and antibiotics) • Holistic approach to health • Better sanitation and nutrition • Grecian Hygeia (i.e., healthful living) versus Panacea (i.e., cure) dichotomy • Multi-causal, not uni-causal, view of disease o Challenges for Public Health Nursing • Promote the health of populations • Need a broadened focus on the multiple causes of morbidity and mortality • Aware of increased technological advances • Understand the community need for a focus on prevention, health promotion, and home care • Focus on holistic care o Challenges for Public Health Nursing • Emphasis on population-based focus nursing • Work on behalf of aggregates. • Understand social determinants of health. • Gather information and statistics to make decisions. • Be part of the solution to find ways to solve persistent health problems. • Emphasize society’s responsibility for health. • Empower people to help themselves. Chapter 3 Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice o Thinking Upstream: Examining the Root Causes of Poor Health • Are we too busy rescuing victims … to look upstream where the real problems lie? • Nurses must look beyond individual behavior or characteristics to the “manufacturers of illness. • Economics • Political • Environmental factors o Historical Perspectives on Nursing Theory • Florence Nightingale: first nurse to formulate a conceptual foundation for nursing practice • Early nursing theories: • narrow • health situations were only for the nurse and patient o How Theory Provides Direction to Nursing • Goals of nursing theory • Improve nursing practice • Guide practice • Integrating theory and practice, nursing focuses on factors that are critical to understanding the situation. o Microscopic Versus Macroscopic Approaches TO Community Health Problems • Microscopic focus: • Individual patient • Concern is in health problem of interest. • Macroscopic focus: • Community-based approach o Microscopic Versus Macroscopic Approaches to the Conceptualization of Community Health Problems • Nurses in community health practice are in the middle between care for individuals versus care for populations. • Often end up caring for the individual or current emergency • Lose sight of community- reactive and not proactive • Focus should be on population-based nursing practice o Microscopic Versus Macroscopic Approaches to the Conceptualization of Community Health Problems • Quad Council of Public Health Nursing • Organizations that promote population-based interventions • Public Health Nursing Section of the American Public Health Association (PHN-APHA) • Association of Community Health Educators (ACHNE) • Association of Public Health Nurses (APHN) • American Nurses Association Council on Nursing Practice and Economics (ANA) o Assessing a Theory’s Scope in Relation to Community Health Nursing • If the theory is not broad enough, it is not useful to the community health nurse. • Must be applicable to many different scopes of practice • Macroscopic concept is similar to the upstream analogy. • Macroscopic is a broad concept. • Upstream is a more specific concept. o Macroscopic Approach to Solving Community Health Problems • Examines interfamily and intercommunity themes in health and illness • Identifies factors in the population that perpetuate the development of illness or fosters the development of health • Emphasizes social, economic, and environmental precursors of illness • Nursing interventions may include modifying social or environmental variables. • Can involve social or political action o Review of Theoretical Approaches • The individual is the focus of change (microscopic). • Orem’s self-care deficit theory of nursing • The Health Belief Model (HBM) • The Upstream view: society is the focus of change (macroscopic) • Milio’s framework for prevention • Critical theoretical perspective o Orem’s Self-Care Deficit Theory of Nursing • Assumption self-care needs and activities are the primary focus of nursing care and outlined and stated the theory is a composite of related constructs: • Theory of self-care deficits (criteria for identifying who needs nursing care) • Theory of self-care (explains health care and why it is necessary) • Theory of nursing systems (specifies the nursing role and delivery of care and how nursing helps people) o Health Belief Model • Focuses on the individual • Kurt Lewin’s work • Behavior is based on current dynamics confronting an individual rather than prior experience. • Identify the patient’s needs • Limitation • Burden of action placed on client o Milio’s Framework for Prevention • Provides compliment to HBM and a mechanism for directing attention upstream to examine opportunities for nursing intervention at a population level o Comparison of the HBM and Milio’s Conceptualizations of Health • Compared with HBM, Milio’s frame work provides for the inclusion of: • Economic • Political and • Environmental health determinants • This provides nurses with broader range of diagnosis and interpretation of health problems. o Comparison of the HBM and Milio’s Conceptualizations of Health • The HBM allows only two possible outcomes: • “acts” • “fails to act” • Milio’s framework encourages the nurse to understand the health behaviors in the context of their societal milieu. o Implications of Milio’s Framework for Current Health Delivery Systems • Broader scope • Provide direction for nursing implications at many levels • Assess personal and societal resources for individual patients • Analyze social and economic factors that may inhibit healthy choices in populations • Best when responding to people with diagnostic-intensive and acute illnesses o Critical Theoretical Perspective • Uses societal awareness to expose social inequalities that keep people from reaching full potential • Informed by values and assumptions: • The problems and inequalities of health and health care are connected to the particular historically located social arrangements and the cultural values of society. o Critical Theoretical Perspective • Health care should be oriented toward the prevention of disease and illness. • The priorities of any health care system should be based on the needs of the clients/population and not the health care providers. • Ultimately, society itself must be changed for health and medical care to improve. o Application of Critical Theoretical Perspective • When health care is used as a form of social control • Gets patients to adhere to norms of appropriate control • Accomplished through medicalization of wide range of psychological and socioeconomic issues o Application of Critical Theoretical Perspective • Medicalization: Identification or categorization of condition or behavior as being a disorder requiring medical treatment or intervention, for example: • Sexuality • Family life • Aging • Learning disabilities • Dying o Challenging Assumptions About Preventative Health Through Critical Theoretical Perspective • HBM and Milio’s prevention model focus on personal health behaviors from a disease avoidance or preventive health perspective. • McKinlay used upstream analogy to ask: • “How preventive is prevention?” o Examined how different interventions strategies are aimed at enhancing preventive behavior • Critical interactionism: Nurses can use both an upstream and a downstream approach to address health issues through critical interactionism o Ethical Insights • Nurses have a historical legacy in social justice activities. • Market Justice: principles people are entitled to end when they acquire them through fair rules of entitlement • Social Justice: principles that all citizens bear equitably in the benefits of and burdens of society o Healthy People 2020 • Thinking about the root causes of health problems, helps us to understand the importance of directing nursing efforts toward the causes of poor health and lost opportunities. • The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote health. Chapter 4 Health Promotion and Risk Reduction o Health Promotion and Community Health Nursing • Health promotion: • … any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health • … that which is motivated by the desire to increase well-being and to reach the best possible health potential o Health Promotion and Community Health Nursing • Health protection: • … those behaviors in which one engages with the specific intent to prevent disease, detect disease in the early stages, or maximize health within the constraints of disease • … an important step in maintaining health o Health Promotion and Community Health Nursing • Defining health: • The way health is defined has shifted from a focus on the curative model, to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health • “A state of complete physical, mental and social well-being, and not merely the absence of disease” o Healthy People 2020 • The health promotion initiative for the nation • Broad goals • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. • Achieve high 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. • HP 2020 challenges individuals, communities, and professionals … to take specific steps to ensure that good health, as well as long life, are enjoyed by all. – U.S. Department of Health and Human Services, 2012 o Determinants of Health • Biology • Behaviors • Social environment • Physical environment • Policies and interventions • Access to high-quality health care o Theories in Health Promotion • Community health nurses and their clients engage in health promotion activities in: • Workplace settings • Schools, • Clinics and • Communities o Theories in Health Promotion • Pender’s Health Promotion Model (HPM) • Explores biopsychosocial factors that influence individuals to pursue health promotion activities • Health Belief Model (HBM) • Provides the basis for much of the practice of health education and health promotion today • How does the patient perceive his or her health? • Perceived seriousness • Perceived susceptibility • Perceived benefits of treatment • Perceived barriers to treatment • Cues to action • Self-efficacy o Theories in Health Promotion • Transtheoretical Model (TTM) • Combines several theories of intervention, constructs of the model includes: • Self-efficacy • The processes of change • Based on assumption behavioral change takes place over time, progressing through change. • Change is difficult even for motivated individuals. • People Resist change because change may: be unpleasant, require giving up pleasure, be painful, be stressful, jeopardize social relationships, not seem important any more, and require change in self-image. o Theories in Health Promotion o Theory of Reasoned Action (TRA) • Assumption that all behavior is determined by one’s behavioral intentions • One’s attitude is determined by one’s belief about the outcomes of performing the behavior, weighed by one’s assessment of the outcomes. o Risk and Health • Risk is “the probability that a specific event will occur in a given time frame” • A risk factor is an exposure that is associated with a disease. • Risk assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures • Hazard identification • Risk description • Exposure assessment • Risk estimation o Relationship of Risk to Health and Health Promotion Activities • Modifiable risk factors • Individual has control. • Examples: smoking, lifestyle, eating habits, activities • Nonmodifiable risk factors • Individual has little or no control. • Examples: genetics, gender, age, environmental exposure o Relationship of Risk to Health and Health Promotion Activities • Risk reduction • is a proactive process • enables individuals to react to actual or potential threats to their health • Risk communication • is the process of informing the public regarding threats • is affected by perceptions, process, and actions o Tobacco and Health Risk • Leading cause of preventable death • Most common in less educated populations and those living below poverty level • Smoking is a causal factor in cancers of the: • Esophagus • Bladder • Stomach • Oral cavity • Pharynx • Larynx • Cervix • Lung o Tobacco and Health Risk • Most current smokers report they would like to quit smoking. • Nicotine addiction is the most common form of chemical dependence. • Smokers who try to quit experience withdrawal symptoms such as: • Anxiety • Increased appetite • Irritability • Difficulty concentrating o Tobacco and Health Risk • Quitting • Look for teachable moments • Assess client’s tobacco use • Explore willingness to quit • Refer to cessation programs • Encourage attempts to quit o Alcohol Consumption and Health • Alcohol use is very common in our society. • Binge drinking is an unrecognized problem among women and girls. • One in five high school-aged girls • One in eight adult women • Similar in pregnant and nonpregnant women o Alcohol Consumption and Health • Dietary guidelines for Americans states that alcohol would be consumed in moderation no more than one drink per day for women and two drinks per day for men. • A drink is: • 12 ounces of beer or wine cooler • 8 ounces of malt liquor • 5 ounces of wine • 1.5 ounces of 80-proof distilled spirits or liquor o Alcohol Consumption and Health • Prevent underage drinking • Identify individuals and groups at risk of abuse and dependence • Education of both adults and youth regarding alcohol and risks posed by underage alcohol consumptions must accompany enforcement efforts. • “Too Smart to Start” program targets parents and caregivers of 9- to 13-year-olds. • Requires a community-wide effort to address the problem on several fronts o Diet and Health • Diet is one of the most modifiable of risk factors. • Healthy diet contributes to prevention of chronic disease such as: • Type 2 diabetes • Hypertension • Heart disease • Some cancers o Diet and Health • Obesity in the United States was unchanged from 2003 to 2004 and 2011 to 2012. • No state met the Healthy People 2020 goal to reduce obesity prevalence. • Educate clients about: • Balancing caloric intake and physical activity • Servings vs. portion control • Eating away from home affects “portion distortion” • Using social media and mobile applications to help o Diet and Health • USDA recommends that all Americans go to choose My Plate website to develop a personalized eating plan. o Physical Activity and Health • Community nurses are commonly asked, how much exercise do I need or what counts as exercise? o Physical Activity and Health • Walking has been found to be one of the most beneficial exercises. • Does not require expensive equipment • People with disabilities are able to participate with assistive devices. • Easy form of physical activity to perform and maintain • Lower likelihood of injury than more vigorous forms of exercise • Good activity for those who are physically inactive • Can adapt to one’s abilities, time, and circumstances o Sleep and Health • Sleep is an essential component of chronic disease prevention and health promotion. • Requirements change with age and life circumstances. • Regulated by waking time and circadian rhythms • Hormones during sleep affect memory, blood pressure, and kidney function. o Sleep and Health • Sleep assessment is important. • Identify disorders that may affect daily activities. • Keep sleep log. • Practice sleep hygiene • Establish environment that promotes sleep. • Avoid food and activities that interfere with sleep.

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