NR442 Community Health Nursing CHAPTER 14 TO CHAPTER 29

• Define the Critical Theory Approach to Environmental Health o Is an approach that raises questions about oppressive situations, involves community members in the definition & solution of problems, & facilitates interventions that reduce health-damaging effects of environments o Uses “thinking upstream” framework. o Raises questions about oppressive situation. o Involves community members in the definition and solution of problems. o Facilitates interventions that reduce health-damaging effects of environments. o Ask critical questions about clients’ work and home environments to help discern the contributions of specific hazards to health. • Identify the Areas of Environmental Health with examples of each a. Living patterns: are the relationships among people, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs. ▪ Examples: drunk driving, secondhand smoke, noise exposure, urban crowding, technological hazards b. Work risks: include the quality of the employment environment and the potential for injury or illness posed by working conditions. ▪ Examples: occupational toxic poisoning, machine-operating hazards, sexual harassment, repetitive motion injuries, carcinogenic worksites c. Atmospheric quality: refers to the protectiveness of the atmospheric layers, the risks of severe weather, and the purity of the air for breathing purposes ▪ Examples: gaseous pollutants, greenhouse effect, destruction of the ozone layer, aerial spraying of herbicides and pesticides, acid rain d. Water quality: refers to the availability and volume of the water supply and the mineral content levels, pollution by toxic chemicals, and the presence of pathogenic microorganisms. Water quality consists of the balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance. ▪ Examples: contamination of drinking supply by human waste, oil spills in the world's waterways, pesticide or herbicide in filtration of groundwater, aquifer contamination by industrial pollutants, heavy metal poisoning of fish e. Housing: is an environmental health concern and refers to the availability, safety, structural strength, cleanliness, and location of shelter, including public facilities and family dwellings. ▪ Examples: homelessness, rodent and insect infestation, poisoning from lead-based paint, sick building syndrome, unsafe neighborhoods f. Food quality: refers to the availability, relative costs, variety, and safety of foods, and the health of animal and plant food sources. ▪ Examples: malnutrition, bacterial food poisoning, food adulteration, disrupted food chains by ecosystem destruction, carcinogenic chemical food additives g. Waste control: is the management of waste materials resulting from industrial and municipal processes, human consumption, and efforts to minimize waste production. ▪ Examples: use of nonbiodegradable plastics, poorly designed solid-waste dumps, inadequate sewage systems, transport and storage of hazardous waste, illegal industrial dumping h. Radiation risks: are health dangers posed by the various forms of ionizing radiation relative to barriers preventing exposure of humans and other life forms. ▪ Examples: nuclear facility emissions, radioactive hazardous wastes, radon gas seepage in homes and schools, nuclear testing, excessive exposure to x-rays i. Violence risks: violence include the potential for victimization through the violence of particular individuals and the general level of aggression in psychosocial climates. • Describe the Effects of Environmental hazards o Effect on the public’s health is complex & generally interconnected (nuclear power plant emissions may contaminate water & air supplies, affecting water quality, atmospheric quality, & radiation risk) o A direct relationship to the development of some cancers, chronic diseases, & other health-related problems o Effects of environmental risks may also be indirect (global warming) o Effects of environmental hazards may be general or specific (extensive smog, drought, high unemployment) o Can be immediate (burns, gunshot wounds, hurricane damage, & outbreaks of GI distress), long term (occupational hearing loss, black lung in coal miners, & increased rates of thyroid cancer among young victims of the Chernobly accidents, or transgenerational -(female factory workers exposed to radiation at plutonium-processing plants) • Describe how to the Approach Environmental Health at the Aggregate Level o Focuses on health promotion & disease prevention in specific areas o Facilitate community participation in identifying & solving environmental health problems & bring about changes that improve environments & eliminate hazards • Critical Community Health Nursing Practice o Take a Stand: Advocating for Change – must make individual & collective decisions about which interests they want to serve w/ their specialized knowledge & skills ▪ Potential to make increase/decrease these inequities through the decisions they make about the positions they accept & the interventions they undertake o Asking Critical Questions – ask how policies concerning ecological preservation, energy, housing, immigration, civil rights, crime, nutrition, minimum wage, occupational safety, & defense might affect the well-being of people ▪ Addressing who has access to resources in this country, & whose interests are served in the existing system, provides a way to include social, political, & economic factors in environmental nursing assessments ▪ Can frame the problem & assist in building collective strategies o Facilitating Community Involvement – to help people learn form their own experiences & analyze the world w/an intention to change it ▪ Essential that the affected people participate in the process of identifying & working to solve environmental problems ▪ Nurses must be prepare to take leadership positions & join in mutual exchanges w/ community members that consider each person’s experience • Provide support, information, & expertise to groups to assist them in meeting the goals they set for environmental change • Help community members look beyond immediate environmental problems & explore social, cultural, economic, & political circumstances that contribute to them o Forming Coalitions – to produce social change, join w/communities to eliminate hazards & improve public health ▪ Nurse can expose hazards, assess needs, plan actions, report abuses, & secure appropriate resources, personnel, funding, & legislative changes • Helping community groups make connections w/larger, more powerful organizations • Each issue or problems requires appropriate strategic action based on its own merits o Using Collective Strategies – use a variety of strategies to intervene at the aggregate level & facilitate improvement in a community’s health ▪ Participation action research – nurses, community members, & other resource people to work together in identifying environmental health problems, designing the studies, collecting & analyzing the data, disseminating the results, & posing solutions to the problems • Distinguish between environmental health approaches that focus on altering individual behaviors & those that aim to change health-damaging environments. o Altering individual behaviors –address deleterious personal habits through exercise programs, weight- loss regimens, smoking cessation classes, & stress-reduction tactics o Change health-damaging environments – work w/the public to promote more stringent & actively enforced environmental legislation & regulations ▪ Support actions for biodiversity (pushing back the deserts, replanting the forests, stabilizing the climate, & seeking alternative development pathways that do not destroy plant & animal species ▪ Incorporate that fact that individual & community health ultimately depends on global environmental integrity • Identify aggregates at risk for particular environmental health problems. o Non-English-speaking individuals o Children o Very-low income women & families o Undocumented manual laborers o People from racial & ethnic minorities Chapter 15 • Describe & define the Patterns of Health and Disease o Lifestyles, health and cultural beliefs, infrastructure, economics, and politics affect existing illnesses and society’s commitment to prevention. o Disease patterns vary throughout the world. o Racial, ethnic, and access disparities exist within and between countries. • Describe globalization o The process of increasing social and economic dependence and integration as capital, goods, persons, concepts, images, ideas, and values cross state boundaries, is inextricably linked to the benefits and challenges of our time • Define the role of the community or public health nurse in international care o Seek to ensure the attainment of health for all in a cost-effective, efficient, accessible health care system. o Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation. o Coordinate work with other health care personnel and community leaders as well as local and global community leaders. o Utilize changes in the health environment to form the basis for the nursing role. o Primary health care ▪ Essential services that support a healthy life. ▪ Involves access, availability, service delivery, community participation, and the citizen’s right to health care. o Primary care ▪ First line or point-of-access medical and nursing care controlled by providers and focused on the individual. ▪ May not be the norm as needs of the group outweigh the needs of the individual. o All nurses in the world must understand and learn from one another. Nurses are health care’s most valuable assets. o Community public health nurses can improve access to care for the most vulnerable and hard-to-reach groups in any country. o The future demands evidence-based learning, engagement service, and growth in information technology and global health policy. • Service Learning Pg. 282 Box 15-2 o Providing services to those in need while at the same time learning in your field of interest and having the ability to work with those less fortunate. It is a hand-on learning experience that, for me, was life changing and eye opening. o It is volunteering with doing something that you are in the field of doing or obtaining a degree in. o Service learning is a unique way of learning in and about a community and providing services for the betterment of a community. Service projects provide communities with people who are able to use their time, resources, and expertise in order to improve or help the community in which they are serving. At the same time, the people involved in the service project are learning from their experiences with the project. o Service learning is a volunteering project that is done to help the community in some positive way while the volunteer has the opportunity to broaden their own horizons by learning something new. o Utilizing skills and knowledge acquired in the classroom as a means to enhance the community • International Agencies and Organizations (Be sure you know about each agency listed) o World Health Organization (WHO) ▪ Is an international health agency of the United Nations ▪ Directs & coordinates international health efforts, producing & disseminating global health standards & guidelines, helping countries to address public health issues, & supporting health research o Pan American Health Organization (PAHO) ▪ Is an international public health agency w/ nearly a century of experience in working to improve the health & living standards of the Americas. ▪ It serves as the regional office of WHO & is recognized as part of the United Nations system. o United Nations International Children’s Fund (UNICEF) ▪ Created in 1946, was founded to assist millions of sick & hungry children in war-ravaged Europe & China. ▪ In 1950, the UNICEF mandate was expanded to address needs of children & women throughout the world. ▪ Works for children's survival, development, & protection by developing & implementing community-based programs w/ well-documented achievements in child health, nutrition, education, water, sanitation, &women's rights o Centers for Disease Control (CDC) ▪ Founded in 1946, for protecting the health & safety of all Americans & for providing essential human services ▪ The forefront of public health efforts to prevent & control infectious & chronic diseases, injuries, workplace hazards, disabilities, & environmental health threats. ▪ Recognized for conducting research & investigations & for its action-oriented approach. ▪ Applies research & findings to improve people's daily lives & responds to health emergencies ▪ Committed to achieving evidence-based health improvements. o International Center for Primary Health Care (ICPHC) ▪ Provide the entire population with universal coverage; relevant, acceptable, affordable, and effective services; a spectrum of comprehensive services that provide for primary, secondary, and tertiary care and prevention; active community involvement in the planning and delivery of services; and integration of health services with development activities to ensure that complete nutritional, educational, occupational, environmental, and safe housing needs are met ▪ Primary health care seeks to obtain the highest level of health care for all people. ▪ The program promotes seven elements of primary health care, including health education regarding disease prevention & cure, proper food supply & nutrition, adequate supply of safe drinking water & sanitation, maternal & child health care, immunizations, control of endemic diseases, & the provision of essential drugs Chapter 16 • Discuss the individual & societal costs of poor child health status. o Childhood health status ▪ Accidental injury is the leading cause of death in children. ▪ Childhood obesity can lead to numerous health problems. ▪ Childhood immunization is a benchmark of child health. ▪ Lead poisoning is a preventable cause of childhood death and disability. ▪ Child maltreatment is an indicator of children’s physical and emotional health status. ▪ Children with special health care needs frequently need multiple health care services. o Adolescent health status ▪ Adolescent sexual activity is often unprotected and can result in pregnancy and STIs. ▪ Adolescent childbearing and parenting often have long-term negative consequences for both child and mother. ▪ Violence among youth is a multifaceted problem. ▪ Teenagers are more likely than adults to acquire STIs; some are treatable with antibiotics, but they can still have long-term health consequences. ▪ The use of tobacco, alcohol, and illicit drugs has serious and long-lasting consequences for adolescents and for society. • Describe the factors affecting child and adolescent health o Parents’ income, education and stability ▪ Low birth weight & infant mortality due to less educated mothers ▪ Prenatal care, delay childbearing until after adolescence, & breastfeed their babies for women w/higher education ▪ Less than 12 years of education = 10x more likely to smoke during pregnancy o Security and safety of the home o Nutritional and environmental issues o Health care access and use o Poverty ▪ Less access to nutritious food, shelter, & health care ▪ Deprived of advantages (good schools, libraries, community resources) ▪ Live in substandard housing, stressful home lives, may live surrounded by drugs & crime ▪ Lack of positive & nurturing adult role models ▪ May feel hopeless about the future ▪ Surfer from low birth weight, asthma, dental decay, elevated blood lead levels, learning disabilities, & teenage unmarried childbearing ▪ More likely to move frequently, residential instability & extreme living conditions o Racial disparities ▪ Eliminate health disparities ▪ Needs to provide health care services that culturally competent o Single parenting ▪ More likely to live in poverty ▪ More health risks o Health care use • Define the Strategies to Improve Child and Adolescent Health o Monitoring & Tracking – collect/analyze data tracking well-being of children o Establish goals and set measurable objectives using Healthy People 2020. ▪ Educators use these techniques to organize their teaching materials, measure their students' progress, and evaluate the effectiveness of their teaching strategies and plans ▪ Goals and objectives help the nurse and family evaluate progress and make necessary midcourse corrections o Implement health promotion and disease prevention strategies. ▪ More significant and cost-effective for children than other age groups ▪ Help prevent costly problems, suffering, & lost human potential o Utilize public health programs targeted to children and adolescents. • What are the Public Health Programs Targeted to Children and Adolescents o Health Care Coverage Programs ▪ Medicaid – health insurance program for the poor & low-income people ▪ EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) – receive a range of health & health-related services beginning in infancy, is designed to assure availability & accessibility of health care resources & to help Medicaid recipients & their parents effectively use these resources: • Health, developmental, and nutritional screening • Physical examinations • Immunizations • Vision and hearing screening • Certain laboratory tests • Dental services ▪ State Children’s Health Insurance Program (SCHIP) – health insurance program for children (“gap group”) who family income is above Medicaid limits but who families do not receive health insurance through the parents’ employment o Direct health care delivery programs ▪ Maternal and Child Health Block Grant – provided health care services for mothers, children, & families ▪ Community and Migrant Health Centers Programs – provide comprehensive primary & preventive health care ▪ National Health Service Corps – helps children & adolescents receive primary health care services ▪ School-based and school-linked health services – school based health clinics for adolescent who may be uncomfortable seeing their pediatrician/their childhood provider to discuss sensitive topics ▪ Special Supplemental Food Program for Women, Infants, and Children (WIC) – provides highly nutritious foods, nutrition education & counseling, & screening & referral to needed services for low-income pregnant & breastfeeding mothers, their infants, & their children under 5 years of age each year Chapter 17 • Describe (be familiar with) Health problems among women of all age groups (i.e., from adolesence to old age). o Acute Illness ▪ UTI & Dysuria • By age 32, half of all women report a history of at least one UTI • Peak incidence in women is ages 20 – 24 years • Dysuria is most prevalent in women 24 – 45 years of age & those who are sexually active ▪ Disease of the Reproductive Tract • Vaginitis & vulvovaginitis – may starts in girls before puberty & more common than in women of reproductive age • Pelvicinflammatory disease (PID) – initiated by STDs • Toxic shock syndrome (TSS) – most often associate w/tampon use during menses, nonmenstrual TSS risk is increased for women who use vaginal barrier methods for birth control o Chronic Illness ▪ Coronary vascular disease (CVD) & metabolic syndrome ▪ Hypertension ▪ Diabetes ▪ Arthritis ▪ Osteoporosis ▪ Cancer (breast, lung, gynecological) ▪ Mental disorders and stress