Pop Health Exam 1

Acute Care Nursing Vs Public Health Nursing - Acute Care Nursing -Care of solitary patients -Primarily illness and of health continuum Public health nursing -Care encompass a much wider vista -Primary charge to prevent health problems -Promote higher levels of health Health definition - holistic state of well being including soundness of mind, body and spirit Wellness definition - health plus the capacity to develop a person's potential leading to a fulfilling and productive life Illness definition - state of being relatively unhealthy Population Health - -Field of nursing that shift from individual to aggregate -Combines nursing science with public health science -Community based and population focused -Public health sciences and nursing theory -Focus on population-level outcomes -Emphasis on prevention What are the 8 characteristics of pop health? - 1. Population is client or unit of care 2. Primary obligation is to achieve greatest good for greatest number of people or population as a whole 3. PHNs collaborate with the client as an equal partner 4. Primary prevention is the priority 5. Strategies are selected to create healthy environment, social, and economic conditions in which populations may thrive 6. There is an obligation to actively reach out to all who might benefit from a specific activity 7. Optimal use of available resources to assure best overall improvement health of population is a key element 8. Collab with a variety of other professions, populations, organization, and entities is the most effective way to promote and protect the health of people What are the 3 primary focuses of pop health? - 1. Health promotion 2. Prevention 3. Health education Health Promotion - -All efforts that seek to move people closer to optimal well being or higher levels of wellness -Goals: attain healthy, thriving lives, free of preventable disease, disability, injury, and premature death -Achieve health equity, eliminate disparities, and improve health of all groups -Create social and physical environments that promote good health for all -Promote quality of life, healthy development for all Healthy People 2030 Prevention - -Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death.• ----Eliminate health disparities, achieve health equity, and attain health literacy to improve health and well-being of all.• -Create social, physical, economic environments that promote attaining full potential for health/well-being for all. - Promote healthy development, healthy behaviors, and well-being across all life stages. -Engage leadership, key constituents, and public across multiple sectors to take action and design policies that improve health and well-being of all. Prevention of Health Probs - Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment What are the 3 levels of prevention of Health problems? - 1. Primary: keep illness or injury from occurring in the first place Ex: immunization 2. Secondary: detect and treat existing disease Ex: screening 3. Tertiary: reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function Ex: education and interventions What are the different roles in community health/what do they do? - Clinician/Care provider -Focus on holism, health promotion, and prevention while using expanded skills Educator -Health teacher -Plan for community wide impact Advocate -Pleader of the clients cause or actor on behalf of the client -Support the client's self determination and independence -Make the system responsive and relevant to the clients needs Advocates must: -Be assertive -Take risks -Communicate and negotiate well -Identify and obtain resources for the client Manager -Administrative direction of goals: plan, organize, lead, control, evaluate -Participant approach with community Collaborator -Working jointly with others -Leadership Researcher -Systematic investigation, knowledge and analysis of data for solving problems -Seeking evidence based solutions to address needs of community 10 Essential Services of Public Health - 1. Monitor health status to identify and solve community health problems 2. Diagnose and investigate health problems and health hazards in the community 3. Inform, educate, and empower people about health issues 4. Mobilize community partnerships and action to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts 6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8. Ensure competent public and personal health care workforces 9. Evaluate effectiveness, accessibility, and quality of personnel and population based health services 10. Research for new insights and innovative solutions What is the first and essential step in the EBP process? - develop a spirit of inquiry Which resource provides measurable, evidence based, community interventions? - Healthy People 2030 Values definition - -Something perceived as desirable or a personally held abstract belief about truth and worth of thoughts, objects and behavior -Motivation to behave in a certain ways -Derived from societal norms, family and religious beliefs -Function as standards that guide actions and behaviors Value systems are - -Organizations of beliefs guiding behaviors -Systems are ordered priority allowing for change over time based on changes in society, environment or personal experiences -Change over time Ethics definition - -Set of moral principles that we abide by -Ethical decision making that is consist with that moral code or that can be justified from a ethical perspective Ethical decision making frameworks definition - -Separate questions of fact from questions of value -Identify both clients and nurses value systems -Consider ethical principles and concepts The first thing population nurse should do when confronted with an ethical dilemma - establish if this is a fact or a value What statement best descriptions nonmaleficence - do not harm 7 Steps of the Communication Process - 1. Sender 2. Receiver 3. Message 4. Channel(verbal, nonverbal, social networking) 5. Encoding 6. Decoding 7. Feedback loop Establishing trust and rapport can be done by - 1. Develop a relationship with the client 2. Be consistent and trustworthy 3. Commit to develop knowledge about the client and their situation 4. Clarify boundaries and expectations 5. Be aware of behaviors and attitudes that may not promote a trusting relationship Active Listening - -Being attentive and mindful -Conveying a non judgemental attitude -Using reflection -Asking for clarification -Summarizing -Sharing Barriers of Effective Communication in Community/Public Health Nursing - 1. Selective perception 2. Filtering 3. Emotional influences 4. Language barriers 5. work environment Health Literacy Definition - Essential to promoting healthy outcomes and autonomy in clients in which individuals have the ability to find, understand, and use information and services to inform health related decision and actions for themselves and others The skills of health literacy are needed to achieve - 1. Access services and information 2. Communicate individual needs and preferences 3. Grasp the context, options, and resulting consequences in health settings 4. Make choices aligned with needs and preferences Key issues related to health literacy - 1. inability to understand medical terminology 2. inability to read and write 3. medication non compliance 4. missing appointment 5. unable to remember/understand medical history Addressing health literacy helps empower clients in - 1. prevent health issues 2. protects clients health 3. lowers the need for emergency room visits 4. limit dosage errors 5. helps patient manage chronic conditions *make sure patient has access, and seek healthcare when needed. If no health literacy, poor health outcomes occur, lack of health care and the cost increases. What are the 5 stages of development when communicating with groups - 1. Forming; making the group 2. Storming:group begins working together; group leads guides the group and goals are formed 3. Norming: group openness and trust; work begins to trust 4. Performing: work as a total group; high levels of satisfaction; members are happy to complete that task and move on 5. Adjourning: team forms an assessment of the year and implements the plan for transitioning roles, and recognizing members contributors What are some difficulties in group decision? - -Lack of independent knowledge -Backgrounds and experiences too similar(similar biases) -Adapt to others knowledge too quickie(herd mentality) -Fall into trap of social compliance out of desire to fit into the group -Believe that others have better knowledge and ignore their own instincts, following others instead Values of contracting definition and its benefits/characteristics - Negotiating a working agreement between two or more parties in which the come to a shared understanding Benefits -Self promotion and increased motivation -Focus on unique needs -Clients participation in decision making -Clients autonomy and self esteem enhanced with learning self care -More efficient and cost effective nursing Characteristics 1. Partnership 2. Commitment 3. Format 4. Negotiation Nursing process and contracting - -Assessment: explore needs -Nursing diagnosis/goal setting: establish goals and objectives -Planning/intervention: explore resources, develop a plan, divide responsibilities, agree on a time frame -Evaluation: evaluation, renegotiation or termination Benefits of collaboration - Understanding others perspectives and joining to create ideas for a better outcome. *nurses are most trusted in the environment! Interaction with many professionals, the goal is the benefit of public health- quickly and efficiently. Characteristics of Collaborative Partnerships - 1. Shared goals 2. Mutual participation 3. Maximized use of resources 4. Clear responsibilities 5. Boundaries What is the vision and objectives of Healthy People 2030 - Vision -A society in which all people can achieve their full potential for health and well being of all people Objectives -Address social determinants of health and health equity -Used to identify client needs and align education efforts that will advance this initiative Health technologies - Electronic health records- lots of info Big data- want a study, need big data for research Mobile health- data from homes sent to doctors office Video games and virtual reality- with illness Telemedicine- zoom with doctor Graphic information system- plots, track, capture, store geographic data What are social determinants of health and the factors that influence an individual's ability to maintain good health: - The conditions in which people are born, grow, and age Factors that influence an individual's ability to maintain good health: -Safe housing -Quality education -Clean water, food and air -Safe work place -financial concerns Socioeconomic gradient in health - Improved health outcomes as socioeconomic status improves. (direct relationship with income) Global issue- worldwide concern Behaviors- Way that individuals choose to act Health Disparities - -Differences among populations in the quantity of disease, burden of disease, age, and rate of mortality due to disease, health behaviors and outcomes and other health conditions Ex: quality of healthcare, access to care, levels and types of care, and care settings Health Promotion and its goals - Health behaviors that improve well being and lead to a desire to meet one's human potential Goals: -Primary prevention: hand washing -Encourage clients to improve health through change in behaviors -Common focus on education Types of change - Evolutionary change: gradual change with adjustments incrementally Revolutionary change: rapid or drastic change Stages of change - Unfreezing: when the desire for change develops Changing: when new ideas are accepted and tried out Refreezing: when the change is integrated and stabilized in practice Planned change - -Designed effort to effect improvement in a system with the assistance of a change agent -Change is purposeful and intentional -Change is by design, not default -Aims at improvement in a community -Accomplished through an influencing agent Planned change process - 1. Recognize symptoms 2. Diagnose need 3. Analyze alternative solutions 4. Select a change 5. Plan the change 6. Implement the change 7. Evaluate the change 8. Stabilize the change Domains of learning - -Cognitive Domain: Remember, understand, apply, analyze, evaluate and create -Affective domain: learning through emotion, feeling, or affect -Psychomotor domain: visible, demonstrable performance skills Health Belief Model - -Used to explain behaviors and actions taken by people tp prevent illness and injury -Readiness to act on behalf of one's health based on susceptibility, seriousness, benefits, barriers cues to action and self efficiency Penders health Promotion Model - Focuses on individual characteristics and experiences are seen to interact with behavior-specific cognitions and influence specific behavioral outcomes. Also to predict behaviors that influence health promotion. Be knowledgeable about client Precede and Proceed models - PRECEDE-Predisposing, Reinforcing, and Enabling Constructs in Educational/Ecological Diagnosis and Evaluation: First published in 1974 by Green; First five phases social, epidemiologic, educational/ecological assessments, administrative and policy assessment and intervention alignment, and implementation, Nurse determines the best interventions and proceeds to evaluate the outcome PROCEED-Policy, Regulatory, and Organizational Constructs for Educational and Environmental Development: Plan, implement and evaluate health education programs Identifying group or community health problems - First identifying a possible issue, figuring out the population with which the issue effects, delineating the problem, prioritizing the importance and discovering factors that influence the behavior. Evaluate outcomes by identifying what has positively shifted and what can be changed and worked on to become better. What is the nurses role in quality assurance - Daily prioritization, making sure documentation is accurate and complete. Providing needs, seeking supervision when dealing with difficult cases, charting, organizing, and establishing agency procedures. Models Used in Program Evaluation - Donabedian Model -Use of the concepts structure, process, and outcome in evaluating quality of care Omaha System -Measurement in evaluation of quality of nursing care provided to individuals, families, and communities. Outcomes of clients behavior, what client does, quality of nursing Quality and Safety Education for Nurses -Nursing quality and safety based on competencies(knowledge, skills and attitudes) Grant and its types - One individual or group providing another group with financial support for a purpose 1. Planning grants (initial) project development, (how much money to spend/start) 2. Start up grants (send money) 3. Management or technical assistance grants (fundraising or marketing) 4. Research grants 5. Facilities or equipment grants *lots of sources, from government, corporate. Continue grants to keep them going when they run out. Epidemiology - Seeks to describe, quantify and determine how diseases occur in populations and to develop ways to control those disease What are the 10 essentials of Public health Services - assessment, policy development, and assurance Assessment step - -Monitors health by gathering vitals and diseases statistics - Diagnose and investigate what new diseases are spreading to which population and provide investigations for them Policy development step - -Inform, educate and empower by providing statistical reports of the status of disease spread, -Mobilize community partnerships by collaborating with one another -Develop policies Assurance step - -Evaluate by providing population health data that can be used as objective measures to evaluate effectiveness of health programs in reducing morbidity and mortality Eras in evolution of modern epidemiology - Sanitary Statistics: poisonous particles that cause diseases. Infectious-disease epidemiology: Environment, contagium theory of dx. Single agent for each disease Chronic-disease epidemiology: causative factors,exposed related to outcome (CAD, lung cancer, smoking) Eco-epidemiology: local infections. (COVID, look at med resistance and genetics). People are dying due to chronic dx. Epidemic - A disease occurrence that clearly exceeds the normal or expected frequency in a community a region ex: opioid epidemic Pandemic - An epidemic that spreads over multiple countries or contents; worldwide ex: COVID Endemic - Specific region or area EX: malaria Host - a susceptible human or animal who harbors and nourishes a disease-causing agent. Many physical, psychological, and lifestyle factors influence the host's susceptibility and response to an agent Agent - a factor that causes or contributes to a health problem or condition 1. biologic: bacteria, viruses, fungi 2. chemical: liquid, solid, or gas(think pest spray) 3. nutrient: essential dietary components that can cause illness conditions 4. physical: anything mechanical/material, etc that can cause injury to humans 5. Psychological: produce stress leading to health problems Environment - refers to all the external factors surrounding the host that might influence vulnerability or resistance and includes physical and psychosocial elements -Physical: eliminate, weather, safety of buildings, water and food supply -Psychological: social, cultural, economic and psychological influences that affect health Web of causation - A combination of multi factors lead to disease in poor outcomes. The implication is that interventions or breaking of the web at any point nearest to this disease could profoundly impacted development of that disease -called the casual matrix Chain of causation - Reservoir > portal of exit > agent > portal of entry Reservoir - Place in which infectious agents live, grow and reproduce. Includes people water and food portal of exit - Ways in which infectious agents leave the Reservoir. Includes blood secretions, excretions and skin infectious agents - Micro organisms capable of causing disease or illness. Includes bacteria fungi and parasites portal of entry - Ways in which the infectious agent enters a suspectible host. Includes membranes, mucus, respiratory system, digestive system, skin immunity - A host ability to resist a particular infectious disease causing agent Passive immunity - short term; acquired naturally or artificially Ex: nursing a baby-getting antibodies from the mom Active immunity - long term, sometimes lifelong Ex: contracting a disease or receiving an antigen through a vaccine Cross immunity - immunity to one agent providing immunity to another related agent Ex: smallpox vaccination Herd immunity - immunity level present in a particular population group or community Risk - Probability that a disease or unfavorable health condition will develop. Relative risk ratio - incidence rate in exposed group/incidence rate in unexposed group. Epidemiological models: 4 attributes that influence health - 1. The physical, social and psychological environment 2. Lifestyle, with its self created risk 3. Human biology and genetic influences 4. The healthcare system 4 stages of how a disease affects a population - 1. Susceptibility stage: disease is not present and individuals have not been exposed 2. Subclinical disease stage:individuals have been exposed - Incubation period: HIV/AIDS; setting/sitting in your body; no symptoms yet - Induction or Latency Period: noninfectious diseases symptoms start; asbestos 3. Clinical disease stage: s/s of the disease develop and diagnosis may occur 4. Resolution or advanced disease stage: return back to health or advanced worse Types of studies that explore casualty - 1. Cross-sectional study: Explores a health condition's relation to other variables in a specified population at a specific point in time and can show that the factor and the problem coexist 2. Retrospective study: Looks backward in time to find a causal relationship, allowing a fairly quick assessment of whether an association exists. 3. Prospective study:Looks forward in time to find a causal relationship that is crucial to ensure that the presumed causal factor actually precedes the onset of the health problem 4. experimental study: Controls or changes factors suspected of causing the condition and observes results, which are then used to confirm the associations obtained from observational studies Methods in the epidemiological investigate process: Descriptive epidemiology - Counts -Rates-Proportion of people with a given health problem among a population at risk Incidence-Refers to all new cases of a disease or health condition appearing during a given time Number of persons developing a disease Total number at risk per unit of time -Prevalence: all of the people with a particular health condition existing in a given population at a given point in time Number of persons with a characteristic Total number in population Computing rates: morbidity vs mortality - morbidity: relative incidence of disease in a population mortality: relative death rate in a given population Analytic epidemiology - Seeks to identify associations between a particular human disease or health problem and its possible causes -Prevalence studies -Case-control studies -Cohort studies Experimental epidemiology research process - 1. Identify the problem 2. Review the literature 3. Design the study 4. Collect the data 5. Analyze the findings 6. Develop conclusions and applications 7. Disseminate the findings Chlamydia - Most commonly diagnosed bacterial STI in the US Route: sexual contact and maternal transmission onto the newborn Symptoms: PID that can lead to infertility, fallopian tube issues, chronic pain in the pelvis Diagnosis: urine test Preventative measures: 7 day course of antibiotics(azithromycin, doxycycline, erythromycin or 1 single dose of abx folled by 7 days abstaining from sexual activity) Gonorrhea - Route: sexual contact and maternal transmission onto the newborn Symptoms: Males may experience purulent drainage from the penis and painful urination for 2 to 7 days. Female symptoms can be mild vaginal discharge, bleeding after sex Diagnosis: screening and prophylactic antibiotics Preventative measures: cephalosporin and azithromycin antibiotics together Syphillis - Route: Direct contact with a lesion, blood transfusions, maternal transmission to the newborn Symptoms: 1. Primary: May present as single, painless chancre or multiple or uncomfortable lesions that resolve in around 6 weeks 2. Secondary:After 4-6 weeks, Generalized flu like symptoms(fever, HA, malaise), individual may have rash on trunk, palms of hands, feet 3. Latent: enters our CNS but may be not s/s 4. Tertiary CV, neurologic and gummatous manifestations. May affect multiple organ systems including brain, nerves and joints; can lead to death Diagnosis: the screening of contacts are recommended during the time period of 3 months, 6 months and 1 year Preventative measures: penicillin