community nursing quiz 1 Questions and Answers correct

community nursing quiz 1 Questions and Answers correct Define community health and distinguish it from public health. Community health —"identification of needs and the protection and improvement of collective health within a geographically defined area" •Public health —"activities that society undertakes to assure the conditions in which people can be healthy" •Public health nursing —nursing that is community based and, most importantly, it is population focused Explain the concept of community •Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging •Examples of some communities: -Citizens of a town -Group of farmers -Prison community -Tiny village in Appalachia -Members of Mothers Against Drunk Driving (MADD) -Professional nurses Three Types of Communities •Geographic —city, town, neighborhood •Common interest —church, professional organization, people with mastectomies •Community of solution —group of people who come together to solve a problem that affects all of them Discuss the two main components of community health practice (health promotion and disease prevention) Health Promotion •All efforts that seek to move people closer to optimal well-being or higher levels of wellness •Goals: Healthy People 2020 -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 Promotion of health: -All efforts that seek to move people closer to optimal well-being or higher levels of wellness 1.Increase the span of healthy life for all citizens 2. Reduce health disparities among population groups 3. Achieve access to preventive services for everyone Prevention of health problems: Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment Differentiate among the three levels of prevention. Three levels •Primary: Keep illness or injury from occurring •Secondary: involves efforts to detect and treat existing health problems at the earliest possible stage, when disease or impairment is already present or among high-risk populations. •Tertiary: Reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function; prevent recurrence Describe the eight characteristics of community health nursing Field of nursing with a 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 Eight characteristics: 1.Population is client or unit of care. 2.Primary obligation to achieve greatest good for greatest number of people or population as a whole. 3.Processes used include working with the client as an equal partner. 4.Primary prevention is the priority. 5.Strategies are selected to create healthy environmental, 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 in health of population is a key element. 8. Collaboration with a variety of other professions, populations, organizations, and entities is the most effective way to promote and protect the health of people. Recognize the contributions of selected nursing leaders throughout history to the advancement of community health nursing. Early Home Care Nursing (Before Mid-1800s): The focus of this care was to reduce suffering and promote healing. -Religious and charitable groups -Elizabethan Poor Law -St. Vincent de Paul -Home deliveries -Industrial revolution -Florence Nightingale and Mary Seacole Public Health Nursing (1900 to 1970) •Focus expanded to health and welfare of the general public •Specialized programs Lillian Wald -First to use the term "Public Health Nursing" -Teachers College -National Organization for Public Health Nursing -Henry Street Settlement Margaret Sanger -The Comstock Act of 1873 -Birth control information -First birth control clinic in America -International Planned Parenthood Federation National League of Nursing Education -The first collegiate public health nursing program •Visiting Nurses Association •Frontier Nursing Service Analyze the impact of societal influences on the development and practice of community health nursing Community Health Nursing -Public health nursing (epidemiology)/ Health Department -Community-based clinics -Work sites -Ambulatory clinics -Urgent care -Schools Collaboration and interdisciplinary teamwork Explore the academic and advanced professional preparation of community health nurses Academic preparation: A baccalaureate-level nursing program Professional development: -Continuing education programs -Continuing education units Professional certification: Baccalaureate degree and at least five years of public health experience can obtain the Certification in Public Health (CPH). See more information on the CPH. Identify the three core public health functions basic to public/community health nursing. Assessment: Regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community Policy development: Use of assessment data to develop policy and direct resources toward those policies Assurance: Availability of necessary services throughout the community Identify principles of effective nursing practice in the community. Standards of practice: AACN "Essential" Seven Standards of care: "Scope and Standards" Management essential to all nursing roles -Community nursing process: assessment, planning, implementation, and evaluation -Case management Essential behaviors -Decision making -Transferring information -Relationship building Describe and differentiate among seven different roles of the community health nurse. 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 client's cause or actor on behalf of the client Support the client's self-determination and independence Make the system responsive and relevant to the client's needs Advocates must: Be assertive Take risks Communicate and negotiate well Identify and obtain resources for the client Manager -Assessing clients' needs -Planning and organizing to meet those needs -Directing and leading clients to achieve results -Controlling and evaluating the progress to ensure that the goals and clients' needs are met -Participatory approach with community -Case management: Assessment, planning and coordination Collaborator Joint working with others Multidisciplinary collegiality and leadership Leadership role (action as a change agent) Researcher Systematic investigation, collection, and analysis of data for solving problems Evidence-based findings to community settings Discuss the seven roles within the framework of public health nursing functions. Assessment: •Monitor health status to identify and solve community health problems. •Diagnose and investigate health problems and health hazards in the community Policy development: •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 Assurance: •Enforce laws and regulations that protect health and ensure safety. •Link people to needed personal health services and assure the provision of health care when otherwise unavailable. •Assure competent public and personal health care workforces. •Evaluate effectiveness, accessibility, and quality of personal and population-based health services. •Research for new insights and innovative solutions to health problems. Describe seven settings in which community health nurses practice Homes •Ambulatory service •Schools •Occupational health •Residential institutions •Faith communities •Community at large (domestic and international) Describe various types of community health nursing practice. Public Health Nursing Roles Assess: community data, trends, epidemiology, population growth data for planning services, and environmental risks Diagnose: identification of priorities, application of information and observation of changes, and emergence of new issues Plan and implement: collaborative interventions, education, and advocates to influence change Evaluate: programs and interventions, rates, and research involvement School nursing: Key roles: Liaison with interdisciplinary school health team; positive working relationship with administrators and teachers. Functions: Health services for chronic conditions, prevent illness and injury, health education, health promotion in individuals and the school environment (nutrition, mental health, risk behaviors, etc. Corrections Nursing Education: Bachelor's degree preferred; nurse practitioners (with master's degree) provide primary health care. Some institutions may require additional coursework in criminal justice Skills needed: •Decision making •Assessment (general and mental health) •Communication skills •Administrative skills •Advocacy skills •Flexibility Functions: Restore and maintain health of inmates, track and screen communicable diseases, continuing care after release, educate and promote health, assist in assessing medical conditions, assist in medical emergencies Ambulatory Nursing •Clinics •Out-patient settings •Oncology Educator •Case manager •Referral agent •Interdisciplinary collaboration •Management/supervisory Nurse-Managed Health Center Models Three types: wellness; comprehensive primary care; and specialty care Criteria location in a medically underserved area or serve a medically underserved population -Nonprofit, tax exempt, or public status -Board of directors; majority must be consumers of the center's health services. -Provision of cultura Summarize the history and contemporary circumstances of home health and hospice care •Care in the home by family members throughout history •Latter half of 20th century, hospitals making referrals for home care for nonacute patients •Medicare Home Health Benefit: brief visits, temporary care; no reimbursement for health promotion or long-term care •Balanced Budget Act and Medicare Prospective Payment System: payment rates based on client characteristics and need for service -> closure of many Medicare-certified agencies •Cost and number of visits declined; rates of wound healing incontinence and psychosocial problems increased •Decreased patient contact; increased documentations Describe Medicare standards for home health and hospice program Criteria: •Service type and frequency reasonable and necessary •Client homebound: Homebound status is defined that the client leaves home with difficulty in mobility and only for medical appointments or adult day care related to the client's medical care. Going to the grocery store, hairdresser, or church services even with assistive devices such as a walker or cane would not qualify the client as homeboun •Plan of care on Medicare forms •Client in need of skilled service (observation, assessment, teaching, and performing selected procedures) •Service intermittent and part-time •Episode of care: 60 days •Admission: assessment using OASIS •Medicare documentation: OASIS, Medicare plan of care •Medicare hospice benefit: prognosis of 6 months or less, sign up for comfort-focused hospice benefit, waive regular hospice benefit; acknowledgment of terminal prognosis; choosing comfort care instead of life-extending care •Hospice coordinating care in all settings •Four payment levels •Routine home care with intermittent visits •Continuous home care when the patient's condition is acute and death is near •Inpatient hospital care for symptom relief •Respite care in a nursing home to relieve family members Explain family caregiver burdens of providing home care Explain how Medicare reimburses home health and hospice care Corporate: •Insurance companies, HMOs, PPOs, and case management programs •Governmental third-party payers: •Medicare, Medicaid, military health system, and Veterans administration •Individual clients and families Describe essential characteristics of home health and hospice nursing practice. Home health nurse: •Infection control •Clients •Home health care team •Medication safety •Risk for falls •Technology at home •Nurse safety Hospice nurse: •RN as central to hospice interdisciplinary team Case manager; frequent visits •Collaboration with physicians •Rotation through 24-hour call 7 days/week to assure continuous availability by telephone and visits for emergent problems •Competencies similar to home health nurses with addition of added expertise in relieving physical and emotional suffering of terminally ill people and families Ethical Challenges •Ethical implications of interventions •Respect or disregard for client autonomy •Relief or disregard for client suffering •Avoidance of killing at the very end of life •Hospice nurse: advocate for the client and famies Contrast the goals of home health care and hospice •Hospice movement to humanize end-of-life experience and provide palliative care (relief of suffering without curing underlying disease) •Four major changes in end-of-life care: •Care should attend to the body, mind, and spirit. •Death must not be a taboo topic. •Medical technology should be used with discretion. •Clients have a right to truthful discussion and involvement in treatment decisions Explain the gaps in home health care and hospice and the need for a coherent community-based long-term care program in the United States. Transformation into a community-based long-term care system; cost containment •Change in the model for service provision to address those living with disabling and terminal illness •Extinction of Medicare definitions for homebound, medical necessity, and skilled nursing •Change in focus for hospice to be based on client choice and reality of terminal diagnosis •Need for ongoing case management •Increased education and supportive networks for clients and family caregivers •Telehealth and home monitoring Explain the seven basic parts of the communication process and how the process works in nurse-client communication 1. Message 2.Sender 3.Receiver 4.Encoder 5.Channel 6.Decoding 7.Feedback loop Communication*: The Great Equalizer •One of eight fundamental core competencies in PHN •Effective-promotes expression of feelings, good working relationships •Solicit input from others; individuals & groups •Listening •Non-judgmental •Information for decision-making; individuals & groups •Controls behavior; clear expectations and boundaries Describe the core communication skills sending skills Nonverbal: more unconscious and learned implicitly •Dress •Facial expressions •Eye contact (oculesics) •Gestures •Time management (chronemics) •Silence •Space (proxemics) •Touch (haptics) •Senses (sensorics) •Tone •Intonation (paralanguage) Verbal: speaking and writing •Keep messages honest and uncomplicated •Use few words •Ask for feedback Receiving skills: V=Verbal;NV=Nonverbal -Active or reflective listening: work to discover what the client means •Sitting forward (NV) •Sustaining eye contact (NV) •Nodding the head (BE CAREFUL) (NV) •Asking occasional questions for clarification (V) •Paraphrasing to reflect back what you have heard (V) •Avoid daydreaming or formulating responses -Observing behaviors Interpersonal skills -Showing respect -Empathizing: Empathetic listening -Developing trust and rapport Describe five barriers to effective communication in community health nursing and how to deal with them Explain what is "empathetic listening" is, how it helps to improve patient outcomes & reduce health disparities, and how it works in nurse-client communication Listening with the intent to understand how the speaker feels and their ideas •Empathy: identifying with a persons emotions and situation;even if not in agreement with them •Sympathy: feelings of pity and sorrow for someone else's misfortune. -Be interested in your client •Being culturally sensitive, have good eye contact and body language •Minimize distractions •Invite the client to expand on his or her thoughts -Good empathetic listening leads to therapeutic listening/therapeutic communication Better Care: •Greater patient satisfaction •Higher levels of hope •Increased patient trust and ratings of clinical competence Better health: •Improved medication adherence •Reduced pain •Reduced mortality •Fewer disease complications •Improved immune function •Decreased health care utilization & costs Describe the barriers to effective collaboration -Selective perception: Interpret through own perception -Language barriers: Interpret meaning of words differently -Filtering information: Manipulation of information by the sender to influence the receiver's response -Emotional influence: How a person feels at the time a message is sent or received influences its meaning. -Language of nursing: Nurses with a unique vocabulary that may not be understood by clients, family, and community members. The use of scientific terminology or jargon by some health professionals can be confusing. -Miscommunication •Stereotypes •Perception of unequal power and authority •Apprehension about sharing information •Inflexibility and uneasiness •Failure to develop a common purpose •Structural factors: inadequate time, resources, or agency support Explain the characteristics, process and levels of contracting Partnership and mutuality •Commitment •Format -Responsibilities -Timeline •Negotiation Process of Contracting 1.Assessment: explore needs 2.Nursing diagnosis/goal setting 3.Plan/intervention: explore resources; develop a plan; divide responsibilities; agree on time frame 4.Evaluation: evaluation; renegotiation or termination Levels of Contracting Formal: -All parties negotiating a written contract by mutual agreement, signing the agreement, and sometimes having it witnessed or notarized Informal: -Some form of verbal agreement about relatively clear-cut purposes and tasks Explain the value of contracting to both clients and public health nurses Value of Contracting Partnership developed, with agreement about purpose of relationship and conditions under which it will be carried out Results: -Self-health promotion and increased motivation -Focus on unique needs -Client participation in decision making -Clients' autonomy and self-esteem enhanced with learning self-care -More efficient and cost-effective nursing service Describe "environmental health" and give examples of how the environment can influence the health of the community. Environmental Health: Freedom from illness or injury related to exposure to toxic agents and other potentially dangerous environmental conditions Ecology, the Human and the Environment Ecology is the study of the interactions and relationships between living organisms and their environments. Ecosystems are dynamic communities that no organism including humans can exist outside of. The scientific study of ecosystems provides an understanding of the relationship between humans and the environment and why knowledge of environmental health is so important for nurses. describe the "upstream focus" and give examples of how health issues would be addressed using an "upstream focus". Upstream Focus: John McKinley in 1979, "A Case for Focusing Upstream" -Identifies root causes of disease and manufacturers of illness. -It considers socioeconomic factors and also the environmental origins of disease and health problems. -Public health nurses are often the "sentinels of surveillance" who detect unusual illness patterns and respond to environmental emergencies in work and community settings. Describe legislative and regulatory policies that have influenced the effect of the environment on health and disease patterns. Precautionary Principle •In the absence of clear data that indicate the safety of an action, chemical, or material that poses a threat to human health, it should not be used. •The principle states, "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken if some cause and effect relationships are not fully established scientifically." Key Legislation •Clean Air Act (1972) •OSHA (1970) •FIFRA (1974 & 1996) •Toxic Substances Control Act (1976) •Clean Water ACT (1977) •Emergency Planning and Community Right to Know Act (1986) •Federal Actions to Address Environmental Justice in Minority Populations Executive Order 12898 of 1994 Environmental Health Regulatory Agencies EPA: Environmental Protection Agency FDA:Food and Drug Administration CPSC: U.S. Consumer Product Safety Commission OSHA: Occupational Safety and Health Administration Describe the 4 basic environmental principles and how these might affect the health of the community. #1. Everything is connected to everything else—EXPOSURE PATHWAYS exposure pathway assessment 1.Source of harm/ contamination 2.Exposure media—air, soil, water, food-> transmission 3.Receptor population (humans in pathway) 4.Exposure route —ingestion, inhalation, dermal absorption Exposure point—human contact w/ contaminant 5.Dose of contaminate (amount/duration/frequency) -Each of the 5 elements must be present in sufficient quantity for harm to occur 2. Everything has to go somewhere- EXPOSURE CONTROL Once waste products are generated, they must be disposed of through: -Incineration •Products such as ash and emissions must be disposed of -Water discharge •Products must be treated so dose not high enough for harm -Landfilling or burial in the soil •Liners, pumps and monitors must be put in place to avoid seepage into groundwater or air #3. Nature knows best •Cannot decrease the dose (exposure) through air or water by: -Examples: •Moving garbage to water •Building taller smoke stacks •Initially it seemed the capacity of water and air to accommodate waste products was limitless 4. There is no such thing as a free lunch-Today's solution may be tomorrow's problem Past creates present problems and what we don't know Examples: -Garbage that went into streets was moved to unlined landfills -Gas tanks were buried underground because they were unsightly -Lawn chemicals Describe how the PH core functions related to environmental health. Public Health Core Functions 1.Assessment -Monitoring health status -The diagnosis and investigation of health hazards into the community 2.Assurance -The enforcement of policy 3.Advocacy/Policy development -Provides guidance through the essential community services -Engages scientists to analyze and develop policies to ensure health based upon sound evidence Public Health Core Functions: Assessment and Referral 1.Complete an environmental health history 2.Recognize potential environmental hazards and illnesses 3.Make appropriate referrals for conditions with probable environmental causes 4.Provide information to clients and communities. Describe the purpose and components of an environmental exposure history and environmental assessment, in particular the use of the I- PREPARE mnemonic I-PREPARE mnemonic I- investigate potential sources P- present work R- residence E- environmental concerns P- past work A- activities/ hobbies/ health practices R- referrals and resources E- educate Discuss how to assess for and what are environmental health hazards or agents that may be encountered in the home, workplace or community. Work Exposures Products people work with: Manufacturing, laboratories, etc. (paint, reagents, etc.) Cleaning solutions: bleach, other solvents Pharmacologic agents: Nurses, pharmacists, etc. (Oncology Nurses link in D2L) Community Exposures Air quality: ("Right to Breathe" link in D2L and "Tale of Three Cities" link in D2L) Assess: Causes: Manufacturing, cars, incinerators, etc. Brownfields: Properties where pollutants, contaminants, or hazardous substances may be present. -PFAS, toxic gloves