NUR439 Final exam review/ Best to read before the test/ Graded A

NUR439 Final Review Sheet Intro to Public Health Nursing Public Health: ● Scientific discipline that includes the study of epidemiology, statistics and assessment-including attention to behavioral, cultural and ec ...

NUR439 Final Review Sheet Intro to Public Health Nursing Public Health: ● Scientific discipline that includes the study of epidemiology, statistics and assessment-including attention to behavioral, cultural and economic factors ● Program planning and policy development ● What members of a society do together to ensure that conditions exist in which people can be healthy (ex. Smoke free zones, stop lights) ● Goal: to organize community efforts that will use scientific/technical knowledge to prevent disease and promote health Benefits of Public Health: ● Increase in life expectancy ● Decreased number of deaths from stroke, coronary heart disease, cancer ● Approaches related to eating, drinking, driving, exercise could help prevent up to 70% of early deaths in America - compared with only 10% for medical treatment ● ***Answer on test: lifestyle changes can prevent premature death Public Health Activities: ● Prevent epidemics and the spread of disease (immunizations, hand washing) ● Prevent injuries and accidents (gates around pools, lifeguards) ● Protect against environmental hazards (sharps container, wearing PPE) ● Promote healthy lifestyle behaviors (healthy lunch in schools, walking programs) ● Respond to disasters ● Ensure accessibility to health services Core Functions: 1. Assessment ● Systematic data collection on the population ● Monitor population’s health status to identify community health problems ● Make information available about the health of community ● Diagnose and investigate health problems/hazards in community 2. Policy Development ● Efforts to develop policies that support the health of the population - using a scientific knowledge base to make policy decisions ● Inform, educate, empower people about health issues ● Mobilize community partnerships to identify and solve health problems 3. Assurance ● Making sure that essentially community-oriented health services are available ● Providing essential personal health services for individuals who would not otherwise have access to them ● Enforce laws and regulations that protect health/safety ● Ensure a competent public health workforce ● Makes sure providers are qualified, people get what they need Health Care Services Pyramid: (A lot of questions about the levels of prevention on final) 1. Primary: prevention of the initial occurrence of disease/injury (preventing the disease before any trace of it) ● Nutrition education ● Smoking cessation classes ● Immunizations ● Prenatal classes ● Safety education - hemlet, seat belts ● Advocating for access to health care 2. Secondary: services designed to detect and treat disease in the early stages (have the disease and recognizing it early, screening to prevent it from moving on) ● Community assessments ● Disease surveillance ● Screenings - HTN, TB, DM, genetic disorders, cancers ○ Screening is a key component - involves testing of individuals who are at risk for a specific condition but don’t have symptoms ○ Goal: to determine the likelihood that they will develop the disease ○ NOT a diagnostic test ● Lead exposure 3. Tertiary:services to limit disease progression or disability (most money is being spent here but it SHOULD be being spent on primary prevention) ● Rehab after injury/illness, PT/OT ● Support groups Public Health Nursing: ● Speciality that brings together knowledge from the public health sciences and nursing to improve the health of the community ● Distinct focus and scope of practice, requires a special knowledge base ● Emphasis on population rather than single individual/family ● Focus on populations in the community and emphasis on health promotion and disease prevention Role of Nurse: ● Ensure that conditions exist in which people remain healthy ● Anticipate and respond to health problems ● Evaluate health trends and risk factors of population groups to determine interventions ● Reaches out to populations who might benefit from a service Population:collection of individuals who share one or more personal or environmental characteristics (aggregate) - ex. Nursing student Subpopulation:subsets of the population who share similar characteristics - ex. Nursing student at Molloy Community: group of people and institutions that share geographic, civic and/or social parameters - ex. People who live in RVC Community-Oriented Nursing Practice: ● Focus: promote quality of life, on health care of entire communities or populations and the healthcare of individuals, families, groups ● Goal: to prevent disease and preserve, promote, restore and protect health for the community and population within it ● Client characteristics: individuals/families/groups at risk, communities, usually healthy, culturally diverse, autonomous, able to define own problem, primary decision maker ● Settings: community agencies, home, work, school, government ● Priority of activities: case finding, client education, community education, interdisciplinary practice case management, program planning, advocacy Community-Based Nursing: ● Goal: Manage acute and chronic conditions ● Promote self-care among individuals and families ● Setting: specific practice, care provided where people work, live, attend school ● Focus on “illness care” ● Growing cost of hospital care is leading to more care being provided in community settings ● Priority of activities: care management, pt education, advocacy, interdisciplinary practice, continuity of care ● Client characteristics: individuals/families, usually ill, culturally diverse, autonomous, able to define own problem, involved in decision making ● Settings: community agencies, home, work, school Challenges for Future: ● Current trend is to move care into community settings and to reduce # of hospital days for “sick” clients ● Community care - less expensive, more appealing (people rather be home) History of Public Health Nursing Colonial Period: ● At first, public health was a family/friend system of care ● Established systems of care for the sick - based on Elizabethan Poor Law - basis now is Medicaid ● 1751: First hospital in Philly ● 1850: Shattuck Report**:first effort to describe a modern approach to public health, first to have a public health code (regulations and recommendations for public health) - put together in Boston, made by Shattuck ○ Used birth and death records to describe health ○ Create guidelines for modern health modification ○ Took 19 years to implement code Florence Nightingale (1820-1910): ● Demonstrated the value of aseptic techniques and infection control ● Honored for contributions to nursing research ● Organized nursing education to produce trained nurses ● Kept careful statistics to show that she was improving health ● Said if you change the environment, you can improve health outcomes ● 1870: First nursing schools based on Nightingale model Lillian Wald: ● Developed a viable practice for public health nursing (The Henry Street Settlement) in NYC - people got social services ● Founder of visiting and modern public health nursing ● Worked with immigrants - made home visits, taught about nutrition, child care, cleanliness - trained 37 nurses ● Purpose: to provide well baby care, health education, disease prevention, treatment of minor illnesses ● Worked with Brewster ● Developed first nursing service for occupational health (Metropolitan Life Insurance) - visiting nurses provided care for sick policy owners, sliding scale payment ○ Persuaded company to pay for home visits for their clients (proved that there were less mortality and deaths in children) ● Professor’s favorite nurse - on final Developments in Public Health Nursing: ● American Red Cross and its Rural Nursing Service initiated home nursing care in areas outside larger cities ● Frances Root - first trained salaried visiting nurse ● Mary Adelaide Nutting: first postgraduate nursing course in PH nursing ● National Organization of Public Health Nursing (NOPHN) in 1922 - Wald as first President Contributions: ● Mary Breckenridge established Frontier Nursing Service in Kentucky - assisted disadvantaged women and children ○ Well known for midwifery services - dec. pregnancy complications, fever maternal and infant deaths ● Lina Rogers - first school nurse ● Ada Mayo Stewart - Vermont Marble Company, first industrial/occupational nurse Key Developments: ● American Public Health Association established to facilitate interdisciplinary efforts and promote the practical application of public hygiene ● Public Health Nursing Section formed with APHA ● Sheppard-Towner Act**:expanded community health nursing roles for maternal and child health 1950’s: ● People living longer, over 65 population grew from 4.1 to 9.2% in 40 years ● Leading cause of death changes from infectious disease to heart disease/cancer ● Public health nursing becomes part of bachelor nursing programs 1960’s: ● Head Start - program for children who have no access to pre-school ● Nurse practitioner movement ● Medicare and Medicaid Programs - established new possibilities for supporting community-based nursing care - encouraged post acute care rather than prevention ○ Medicaid: people over 65, low income families and children ○ Medicare: people over 65, end stage renal disease on dialysis 1970’s: ● Nurses in hospice movement - Elizabeth Kubler Ross ● Development of birthing centers ● Day care for elderly and disabled ● Rehab services, drug abuse treatment programs 1980’s: ● Health care costs rise ● Prospective payment system (DRGs) - Diagnosis related groups - given a diagnosis with a dollar amount (if you stay under the amount you don’t lose money) ● IOM report - The Future of Public Health documented reduced political support and funding ● Increased utilization of home health care 1990’s: ● Health care system restructuring ● Increased delivery of nursing care in community ● Health care reform debate continues ● Healthy People Initiatives** - document for prevention of disease Quad Council: ● Alliance of four national nursing organizations finalized a set of public health nursing competencies ● ANA, APHA, Association of Community Health Educators, Association of State and Territorial Directors of Nursing Health People 2020 ** Questions on Test: ● Comprehensive set of national health objectives for decade ● Renewed emphasis on prevention ● Developed by a collaborative process ● Designed to measure progress over time ● National strategy to improve the health of the public by using methods to prevent major chronic illness, injury, infectious disease Overarching Goals (used to be 2, now there are 4) 1. Attain high quality, longer lives free of preventable disease, disability, injury and premature death 2. Achieve health equity, eliminate disparities, improve the health of all groups 3. Create social and physical environments that promote good health for all (know what the social and physical determinants of disease are - canvas) 4. Promote quality of life, healthy development, healthy behaviors across life stages Essentials of Healthy People 2020: ● Determinants of Health: factors that influence the client’s health - can include nutrition, stress, education, finances, environment, social status ● Health Indicators:describe the health status of a community and serve as targets for the improvement of a community’s health ○ Leading health indicators: physical activity, overweight/obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury/violence, environmental quality, immunization, access to health care What’s New in 2020: ● Adolescent health, early and middle childhood, dementia, global health (transportation, other countries), genomics, HAI, sexual orientation issues, sleep hygiene, social determinants of health Patient Protection and Affordable Health Care Act (2010): ● Would expand insurance coverage to 32 million Americans who are uninsured ● Supported by ANA ● Supreme Court rules that law was upheld, controversial mandate that everyone must purchase health insurance or pay a fine Changes: ● Insurance companies will no longer be able to deny children coverage for pre-existing conditions ● Children of parents with insurance will be allowed to remain covered until 26 ● Insurance companies forbidden from terminating coverage for any other reason than fraud ● Insurers can no longer charge customers for preventative services (ex. mammograms) ● Insurance companies can no longer cap the amount of benefits and treatment Home Care Nursing ● The practice of nursing applied to a client with a health condition in a client’s place of residence ○ Specialized area of nursing practice with the root firmly placed in community health nursing ○ Involves primary, secondary, tertiary prevention, collaboration of family ○ Teaching the family and patient to be responsible for themselves ○ Primary goal: get them to self care ● Working in the home: autonomy, competence and creativity, good organizational skills, interpersonal skills, diverse population, establish partnership, client safety Family Caregiving: ● Must work with family - the individual and any caregiver or significant person who assists the client in the need of care at home ● Assisting clients to meet their basic needs and providing direct care (personal hygiene, meal preparation, medication administration and treatments) ● Types: official, voluntary and private non-profit, combination, hospital based agencies, proprietary agencies - profit making ● Nurses are: clinician, case manager, client advocate, educator, mentor, researcher, administrator, consultant Criteria for Medicare Reimbursement: **Know this** ● Services must be reasonable and necessary ● Client must be HOMEBOUND - patient leaves the home with difficulty in mobility and only for medical appointments or adult daycare related to the pt’s medical condition ● The plan of care must be entered into specific medicare forms ● Client must be in need of SKILLED SERVICES (dressing change/procedures that require nursing judgment, skilled assessment, pt teaching) ● Services must be intermittent and part-time Scope of Practice: Direct Care ● Actual physical aspects of care, physical contact, performing physical assessment, dressing change, inserting catheter, IV therapy, teach clients/family to perform task Indirect Care ● Activities a nurse does on behalf of client to improve or coordinate care ● Consult with other nurses/disciplines ● Participate in care conferences ● Supervise home health aides ● Documentation, advocate Trends in Home Care: ● National health objectives ● Family responsibility ● Technology and telehealth ● HIPPA ● Measuring outcomes - OASIS - collection tool used to measure what the pt. Is going to get when they are admitted to home healthcare (intake visit, very long visit) Home Visits: ● Environmental Assessment - community/home assessment, windshield survey ● Safety - nurse, client, home ● Infection Control - bag technique, disposal of wastes Personal Safety: ● Plan ahead, escort, travel during day, dress appropriately, no values, car, pets Hospice: ● Palliative care of very ill and dying, death within 6 months ● Respite and comfort care - medical care aimed toward a cure is stopped ● Kubler-Ross - “death with dignity” ● Pain management, emotional support School Nursing ● As of 2012 there were more than 49.8 million children that attended one of the 132,000 schools each day. These children need health care during the school day ● There are approximately 45,000 school nurses that are practicing in the public schools alone ● About ⅓ of the school aged children have no regular source of health care except for ER visits, this means that school nurses may be their only sense of a health care provider Standards of Practice: ● The American Academy of Pediatrics guidelines state that school nurses should: ○ Ensure that children get the health care they need, including the emergency care ○ Ensure that the nurse keeps track of the STATE-required vaccinations ○ Ensure that the nurse carries out the required screening of the children based on the STATE law ○ Ensure that the children with health problems are able to learn in the classroom ○ **On test: New York State determines kid’s vaccinations Educational Credentials: ● The National Association of School Nurses (NASN) suggests that school nurses be registered nurses who also have a bachelor’s degree in nursing and special certification in school nursing. ○ There are no general laws regarding the educational background of school nurses Roles of the School Nurse: ● The school nurse can act as: ○ Direct caregivers, educators, case managers, consultants, counselors, community outreach, or researchers School Health Models: ● The federal school programs plan, which was coordinated with the CDC, has eight parts: ○ Health education, physical education, health services, nutrition services, counseling and psychological services, healthy school environment, health promotion for staff, and lastly family and community involvement ○ School-based health programs, as well as, full service school based health centers Primary Prevention for School Nurses: ● Prevention of childhood injuries ● Substance abuse prevention ● Required vaccinations ● Disease prevention and health promotion Secondary Prevention for School Nurses: ● Assessing and screening - vision, hearing, height, BMI, scoliosis, lice screening, hypertension, sports clearances, and dental care ● Screening for suicide risk in the students ● Identification of child abuse in the students ● Administration of medication - must have an order from the provider ● Monitoring for violence ● Have emergency planning in store Scoliosis: Lice ● May show up as a rash behind the ears or neck ● If the child is scratching their head or behind their ears ● Bugs may be visible if present ● It is important to not share hat, lockers, and continuous monitoring of the students for signs and symptoms of lice ● If head louse is present, check the entire class as well as any siblings of the student ● To screen for lice: ○ Wear gloves, separate out different parts of the child's hair, nits may be present, but may also see an actual bug ● How to treat head lice: ○ Pesticide hair shampoo on dry hair ○ Leave it in for 10 minutes ○ Take a fine comb and comb it out Tertiary Prevention for School Nurses: ● Children with asthma is one of the most frequent causes of school absences ● Children with diabetes ● Pregnant teens ● Autistic children Controversies and Ethics: ● Provide birth control education and condoms to students in the schools ● There is an issue with confidentiality and the teens ● Nurses must remain non-judgmental ● School nurses must know the available resources around the school community. They are also mandated to report suspected cases of child abuse and or any neglect noted Epidemiology: ● The study of the distribution and factors that determine health-related states or events in a population and the use of this information to control health problems ● Goal: To prevent or limit the consequences of illness and disability in humans and to maximize the state of health, to study the characteristics of those people within a community who have a particular illness/condition as compared to those without to try to understand; probable cause, find a cure, prevention Types: *Know this ● Descriptive Epidemiology: studies the distribution of disease in terms of person, place and time ○ Describes - doesn’t look for cause ○ Ex. determinants of health, what is the disease?, who is affected?, where are they? ● Analytic Epidemiology:looks at the origins and causal factors of the disease ○ Ex. looks at the cause - how it occurs, why some people are affected more than others Steps of Epidemiology: ● Define the outcome - can be a disease, accident, injury or even wellness ● Describe the distribution - who, what, where, when of a disease ● Search for factors that explain the pattern or risk for occurrence History: ● Hippocrates - examined health/disease by looking at geography, climate, food, water, habits ● John Snow - Father of Epidemiology - traced cholera outbreak to water supply ● Florence Nightingale - relationship between environmental conditions and recovery of soldiers in Crimean War ● 20th Century: ○ Shifted from looking for single agents to determining the multifactor etiology ○ Development of genetic and molecular techniques ○ New infectious diseases ○ Public health preparedness for bioterrorism Eras of Epidemiology: ● Sanitation Era - early 19th century ● Infectious Disease Era - between late 19th - early 20th century ● Chronic Disease Era - 2nd half of 20th century ● Eco-Epidemiology Era - 21st century How Nurses Use Epidemiology: ● Nurses look at health and disease causation and investigate how to prevent/treat it ● Nurses in the community are involved in surveillance and monitoring of disease trends Models: ● Epidemiologic Triangle: ○ Agent- a factor that must be present or lacking for a disease or condition ○ Host- living species capable of being infected or affected by an agent ○ Environment- everything internal or external to a given host or agent that is influenced and influences the host or agent ○ Single cause/single effect ● Web of Causality: ○ Recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease ○ Relationships are sometimes mutual, with lines of causality going in both directions ○ Multiple causes ○ Infant mortality is a statistic used to compare the health of 2 countries*** on test ● Dever’s Model: ○ Four elements contribute to development of disease: ■ Human biology - genetics, physiology, maturation ■ Lifestyle - employment, consumption, leisure ■ Environment - physical, social, psychological ■ Health care system - availability, accessibility Disease Spectrum: ● Epidemics:when rates for disease are higher than usual (more than the amount that you expect) - have to know the baseline ● Endemic:high rate is usual for an area, constant presence of disease ● Pandemic:worldwide epidemic - crosses continents (ex. HIV) Concepts: ● Proportion:type of ratio in which the denominator includes the numerator ● Rate:a measure of the frequency of a health event in a defined population during a specific period ● Risk:probability that an event will occur within a specified period ● Incidence:reflects the number of new cases developing in a population at risk during a specified time ○ # of new cases / total population @ mid year (know for final) ● Prevalence:reflects number of existing cases of disease during a particular time ○ Total # of cases (new+old) / total population @ mid year (know for final) ● Attack Rate: measure of morbidity, defined as the proportion of persons exposed to an agent who develop the disease, often specific to an exposure (how many people got sick / how many people were exposed) Mortality Rates: ● Provide information about deaths and fatal diseases ● Infant mortality- infants who died under 1 year of age / # of live births ● Crude mortality - death from any reason ○ Total # of deaths for a year / mid year or avg. population ● Age specific mortality - ex. # of deaths in teenagers ● Cause-specific mortality - ex. Deaths from lung cancer ○ # deaths from specific disease in year / avg population ● *On test - have to say which town has the highest rate (she’ll give stats from 2 different towns) Sources of Data: ● Routinely collected data such as census data, vital records and surveillance data ● Data collected for other purposes - medical and insurance ● Original data collected for specific epidemiologic studies Types of Studies: ● Descriptive: describes the distribution of health outcomes, does not look at causation - observational ● Analytic: ○ Searches for determinants of the patterns observe, the how/why, bservational ○ Cohort-studies: ■ Cohort:group of persons sharing some characteristic, enrolled in study and followed over time ■ Prospective cohort:subjects free of outcome are classified according to exposure and followed over time ■ Retrospective cohort:use existing records to identify cohorts that might have been exposed on past ○ Case control studies - comparing people with a condition to those without it ○ Cross-sectional studies ○ Ecological studies ● Experimental:intervention, clinical trials, initiates some treatment or intervention that may influence the risk for or course of disease Causality: Statistical Associations: Criteria for Causality ● Consistency of findings ● Strength of association ● Specificity of association ● Temporal sequence ● Dose/response relationship ● Coherence/biological plausibility* Screening:3 questions on exam from this ● The application of a test to people who are as of yet asymptomatic for the purpose of classifying them with respect to their likelihood of developing a particular disease ● Objective: to sort out efficiently and effectively those who probably have the disease and those who probably don’t ● Effective screening should include referrals for diagnostic evaluation for those who screen positive ● Nurses responsible for planning and implementing screening programs On test**: ● Not a diagnostic test - sorts out people who are/are not at risk ● SECONDARY prevention ● Incidence: (# of new cases) if screening test is good, the # of new cases will go UP ○ A good screening test - new cases will go up (will pick up more new cases) ● In a mass screening - should not use a test that will cause any discomfort or side effects Characteristics of a Successful Screening Program: ● Validity:accuracy of a test or measurement ○ In a screening test, validity is measured by sensitivity and specificity ○ Sensitivity: how accurately the test identifies those individuals with the condition (TRUE POSITIVES) ○ Know sensitivity for validity of a test - is it valid, can it be used to find true positives/negatives** ○ Specificity:how accurately the test identified individuals not having the condition (TRUE NEGATIVES) ● Reliability: the precision of repeatability of a measure, specifically its consistency from one time of use to another ○ 3 major sources of error affect test reliability: ■ Variations inherent in the trait being measured ■ Observer variation ■ Inconsistency in the instrument ● Capable of large group administration ● Innocuous: few side effects ● High yield: able to detect enough cases to warrant effort and expensive Economics:1-2 questions on final from ecomonics ● On test:the prospective cost reimbursement method encourages health care agencies to stay within budget limits Background: ● About 97% of all health care dollars are spent for individual care, only 3% being spent on population level health care - this includes money spent by gov on public health, preventative health care dollars by private sources ● US spends more on health care than any other nation ● US health care system no longer affordable ● Knowledge about health care economics is important to community health nurses b/c they are often in a position to allocate resources Public Health and Economics: 2 QUESTIONS on health economics ● Economics is a science concerned with the use of resources, including the producing, distributing, and consuming of goods/services ● Health economics examines the ways in which scarce resources affect the health care industry ● Public health economics focused on producing, distributing, consuming of goods/services as relate to public health ● Goal: to support population focused preventive health services Factor Affecting Resource Allocation in Health Care: ● Uninsured persons - in 2003, 45 mil were without health insurance ● Poor - those earning less than 10,000/year have mortality rate 3x higher than those with incomes of more than 30,000 ● On test: Link between poor health and socioeconomic status^^ ● Access to health care ● Health care rationing Trends: ● Population - people living longer ● Immigration - inequality ● Change in nuclear family ● Technology ● Chronic illness ● Consumer desire for lower cost and higher quality ● Limit excessive and insufficient use of goods/services Financing of Health Care: *Know difference b/w Medicare/Medicaid ● Medicare:provides hospital and medical insurance for those over 65 years, the disables and people with end stage renal disease ○ Part A: hospital care, skilled nursing care, home care, hospice (don’t pay for) ○ Part B: supplemental $, all parts of Part A plusmedical, doctor, diagnostic service, physiotherapy (have to pay for this) ■ Premium is $96/month ○ Criteria for Medicare Reimbursement: ■ Reasonable and necessary ■ Skilled services - nursing, PT, speech therapy, OT, skilled observation/assessment, teaching, skilled procedures, wound care ■ Homebound - client has difficulty in mobility and leaves home only for medical appointments ■ Part-time/intermittent ■ Completed plan of care (POC) ● Medicaid:provides financial assistance to states and counties for the indigent (low income families) ○ Assistance program for individuals ○ Eligibility based on income and assets ○ Jointly sponsored by Federal/State ○ Covers both skilled and unskilled services ● Third party payers - private insurance ● Managed care ● Payment by individual, Medical Savings Plan ^ All Exam 1 Info ^ Community Assessment and Evaluation Community: Ch. 12 ● Social group determined by geographic boundaries and/or common values and interests ○ Ex. geographic boundary: Hempstead, common interest: Molloy ● Its members know and interact with one another ● Functions within a particular social structure and exhibits and creates norms, values and social institutions ● People and the relationships that emerge among them as they develop and use in common some agencies and institutions and a physical environment The way to look at the community….. ● People: the community residents ● Place: both the geographical and time dimensions ● Function: the aims and activities of the community Factors to Consider: ● Status: Epidemiological data, client satisfaction, mental health, crime rates ● Structure: Presence of healthcare facilities, service types and patterns of use, demographic data ● Process: Relationships, communication, commitment to and participation in health Community as a Client: ● Requires that the improved health of the community remains the overall goal of nursing intervention ● Nursing focus: the collective good of the population instead of individual health ● Community-oriented practice seeks healthful change for the whole community Goals and Means of Community-Oriented Practice: ● Goal: Nurse and community seek healthful change together ● Community health has three common characteristics: 1. Status: involves physical (morbidity and mortality rates), life expectancy indexes, emotional parameters (client satisfaction), and social (crime rates) components - think rates (#’s) 2. Structure: services and resources in a community, use patterns 3. Process: effective community functioning or problem solving = town meetings, interviewing people ● Looking at numbers and rates ** ● Healthy people 2020: Offers a vision of the future for healthy communities and goals to fulfill that vision, recognizes the need to work collectively in community partnerships, to bring about changes ● Community partnerships: The active participation and involvement of the community or its representatives in healthful change ○ Community partnerships involve community residents and health workers from a variety of disciplines ● TEST Q: Difference between disease prevention and health promotion - disease prevention is more specific (ex. Increasing BP) Use of Nursing Process in Community Health: ● Assessing community health - getting data ● Identifying community problems ● Planning the community health program - to teach them ● Implementing for community health ● Evaluating interventions Assessment: ● Critical thinking about the community ● Identify community needs, clarify problems, identify strengths and resources ● Data Collection: goal is to acquire usable information about community - that doesn't already exist! ○ Methods: 1. Informant interviewing (“key”): direct convo with select community members share in the light of the community - test bank → To generate non-statistical data such as values, beliefs, and perceived needs 2. Participant observation - observing and sharing 3. Windshield Surveys: nurse travels through the community to assess all senses 4. Secondary analyses of existing data- demographic and health status statistics 5. Surveys - ex: windshield 6. Networking with other professional 7. Community forum 8. Focus groups On this slide she mentioned Gordon’s Functional Health Patterns - Google says...Gorden's functional health pattern includes 11 categories which is a systematic and standardized approach to data collection. ● Data generation: process of developing data that do not already exist, such as values, norms leadership and influence structures ● Data analysis: seeks to make sense of data ● Gordon's functional health patterns and tool^ Windshield Surveys: ● A systematic assessment that is performed while the nurse travels through the community ● Use of all the senses ● Transportation ● Stores, Housing, Places of Worship ● Signs of decay ● Boundaries Identification of Community Problems: ● Clear identification of the specific problem faced by the community ● Specifying the persons in the community affected by the problem = descriptive ● Factors that led to the problem = analytical Planning for Community Health: ● Analyzing problems ● Problem priorities ● Establishing goals and objectives ● Identifying interventions Implementing for Community Health: the work and activities aimed at achieving the goals and objectives Evaluating Interventions: ● Appraisal of the effects of some organized activity or program ● Role of outcomes in the evaluation process - she says there is no point in the intervention if you don’t evaluate Community-As-Partner Model ● Developed to illustrate public health nursing as a synthesis of public health and nursing ● Nurses work with communities as partners ● Assessment Wheel ○ Core element: People ○ Eight subsystems: physical environment, education, safety and transportation, politics and government, health and social services, communication, recreation and economics Partnerships: ● Informal, flexible and negotiated distribution of power among all participants in the improvement of the community ● TEST Q: Partnerships – most changes in the health of a community involve partnerships ● *Partnership= informal, flexible and negotiated distribution of power among all participants in the improvement of the community Community Nursing Diagnoses: ● Each problem identified in the assessment process must be stated as a community health diagnosis ● Three-part community focused nursing diagnosis: 1. Risk of (specific problem) 2. Among (specific population that is affected by the problem or risk) 3. Related to (strengths and weaknesses in the community that influence the problem or risk) ● Example: Risk of low birth weight infants among adolescents who are pregnant in the downtown district related to lack of availability of nutritious foods Community Health Education – Chapter 11, 20 Health education is: any combination of planned learning experiences using evidence based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain health behavior. Nurses working in the community use health education to: promote, maintain, and restore health – they provide info to enable clients to attain optimal health, prevent health problems, identify and treat health problems early, and minimize disability. Benefits of education allows people to make informed health-related decisions, assume personal responsibility for their health, and cope effectively with alterations in their health and lifestyles. - Better outcomes! - but education doesn't always lead to learning Healthy people 2020 educate people to prevent illness! Teach, teach, teach! - Community based programs can be used to meet and maintain these objectives - Examples: avoiding tobacco use, drinking alcohol in moderation, avoiding injuries, avoiding illegal drugs, exercising routinely, and making good sexual choices Typical steps in developing a health education program 1. Identify a population-specific learning need for the community health client 2. Select one or more learning theories to use in the education program 3. Consider which educational principles are most likely to increase learning 4. Examine educational issues 5. Design and implement the educational program using carefully chosen strategies 6. Evaluate the effects of the educational program Education and learning – the plans on how to try and get someone to learn - Education: the establishment of events to facilitate learning, including providing knowledge and skills - Learning: the process of gaining knowledge that lead to behavioral change, a measurable change in behavior that continues over time - what other things can affect learning? Attitudes, willingness to take risks How people learn - all different ways - active process between instructor and learner - learners accept information based on a range of factors including o what they know o what they believe o their culture!! o generational experiences o how they process the info they receive Learning Processes: Visual learners: learn through seeing, note-taking, “thinking in pictures” Auditory learners: learn through listening, read out loud Tactile kinesthetic learners: learn through doing, hands on, meaning through exploration TEST Q: Know these learning domains Each domain has specific behavioral components that form a hierarchy of steps or levels. Each level builds on the previous one. 1. Cognitive – thinking 2. Affective – feeling 3. Psychomotor – acting Cognitive – includes memory, recognition, understanding, and application (to apply) - Learners master each level of cognition in order of difficulty and move from simple to complex – you can memorize but you need to apply Affective – the way you feel - Includes changes in attitudes and the development of values - The teacher considers and tries to influence what individuals, families, and communities think, value, and feel - Ex: if you feel that smoking won’t ever hurt you – quitting won’t be an option for you Psychomotor – includes the performance of skills that require - Some degree of neuromuscular coordination, such as giving injections, bathing infants, changing dressings, and walking with crutches - This learning occurs when the following apply…. o The learner has the necessary ability o The learning has a sensory image of how to carry out the skill o The learner has opportunities to practice the new skill Sequence of instructions - Gaining attention - Informing the learner of the objectives of instruction - Stimulating recall of prior learning - Presenting the stimulus - Providing learning guidance - Eliciting performance - Providing feedback: throughout the process - Assessing performance - Enhancing retention and transfer of knowledge The effective educator Message: send a clear message Format: select the learning format - must be appropriate! Environment: create the best learning environment (ex: too cold/too hot) Experience: organize positive and meaningful learning experiences Participation: encourage participatory learning Evaluation: provide evaluation and feedback Barriers to learning Educator-related barriers - use ice-breakers! - Educator has… fear of public speaking, does not feel credible in regard to topic, does not know how to foster participation, had to deal with difficult people (talking while speaking), is overly dependant on notes (lacks eye contact), concerned about the timing of presentation, possible concerned about whether media, material, and facilities will function properly. - All of these barriers that the educator has can have an impact on how the learner learns Learner-related barriers - they have barriers too - TEST Q: Low literacy levels (big one) - including health literacy (can’t write instructions in 12th grade reading level) - Lack of motivation - 1. The value component (why am I learning this?) - 2. The expectancy component (can I do this?) - 3. The affective component (how do I feel about this?) - Make goals broad - ex: healthy options - Make objectives measurable Technological Issues - that affect learning Many kinds of technologies such as computer games and programs, videos, CD’s, and internet resources can increase learning - These technologies may.. - Enable learners to control the pace of instruction - Offer flexibility in the time and location of learning - Be engaging - Provide immediate feedback - Be more consistent with how the learner prefers to receive information Criteria for assessing the quality of internet information - Authorship, caveats, content, credibility, currency, design, disclosure, interactivity, and links The Educational Process ● Identify the educational needs ● Establish educational goals and objectives ● Select appropriate educational plan ● Evaluate the educational process TEST Q: Know the difference between GOALS and OBJECTIVES - Goals: are broad, long-term expected outcomes and should directly address the client's overall learning needs - Objectives: specific, short-term criteria that need to be met as steps toward achieving the long-term goals. - Objectives are written statements of an intended outcome or expected change in behavior that is MEASURABLE (able to inject - “demonstrate”) - Components: who is expected to exhibit behavior, what is expected behavior, what are the conditions and qualifiers of behavior, what are the standards of behavior or performance - example : goal= self-care of diabetes, objective= demonstrate injecting insulin before breakfast HIV, HEPATITIS, TUBERCULOSIS AND SEXUALLY TRANSMITTED DISEASES Human Immunodeficiency Virus (HIV): ● It is estimated that more than 38 million people are infected with HIV - the majority of those infected are in developing countries ○ About 12 million of those infected with HIV live in the U.S, 20% of those people are unaware of the infection ● HIV is defined as: a virus that causes acquired immunodeficiency syndrome (AIDS) and HIV infection History of HIV: ● This is a relatively newly diagnosed disease that has grown enormously in incidence ● 1981 was when the first cases were reported ● HIV/AIDS has become one of the worlds greatest public health challenges ● 1990: Ryan White - Comprehensive AIDS Resource Emergency (CARE) Act passess/provides services for persons with HIV infection Natural History of HIV: 3 stages of HIV! 1. The primary infection: happens within about 1 month of contracting the virus 2. Clinical latency: this is a period with no obvious signs or symptoms 3. A final stage of symptomatic disease *HIV can test negative up until 6 weeks-3 months - always tell the patient to come back and get tested again if they are in that time period^ ● Transmission: this can occur via semen, vaginal secretions, and through blood or breast milk ● HIV is NOT transmitted through casual contact, touching, coughing, office equipment, dishes, or insects - people back then didn’t know this Progression of HIV: ● When HIV enters the body: it can cause flu-like symptoms that may go undetected- the symptoms include - lymphadenopathy, myalgias, rash, sore throat, and fever ● If this is left untreated: about 80 to 90% live for about 10 years - clients have gradual deterioration of their immune system and can transmit this virus to others ● AIDS is the last stage on the continuum of HIV infection - AIDS is a disabling or life threatening disease caused by HIV or CD4 T-lymphocyte count count of less than 200/ml with documented HIV infection ● She had us write down ART therapy - its the use of meds to treat HIV infection. People who are on ART, take HIV medications everyday (called HIV treatment regimen). ART can’t sure HIV but it can help HIV patients live longer and healthier lives. Opportunistic Infections: these are documented infections that come with AIDS ● Pneumocystis carinii pneumonia - most common ● Tuberculosis ● Cryptococcal meningitis ● Fungal infections ● Kaposi sarcoma Epidemiology: ● The epidemiology evidence shows a decline in the number of newly diagnosed infected people (decrease in incidence) ● The prevalence of AIDS is increasing (increase in prevalence, because meds are allowing people to love longer - so technically more people with it then ever) ● High risk groups include: homosexual males, bisexual males, injection drug users and their sexual partners, and hemophiliacs ● The perinatal cases have decreased (because we screen or C-section if mom has it) ● Race and ethnicity: disproportionately affected minorities (less access to care) ● The disease is more concentrated in urban areas Prevention of HIV: ● Primary: teaching safe sex, abstinence, monogamy, use of condoms, clean needle policy ● Secondary: screenings, screen all pregnant women, partner notification, c-sections for HIV positive women ● Tertiary: antiviral medications, healthy lifestyle, support services, and resources HIV Testing: ● HIV antibody test ● Voluntary screening can be used: this may be confidential or anonymous ● Enzyme immunoassay testing: AKA Elisa test ● Western blot testing ● Ora Quick Rapid HIV-1 test ● HIV test counseling: you want to assess the risk, discuss the clients risk behaviors and how to avoid engaging in them, develop with the clients a risk-reduction plan, establish the follow-up appointment and posttest counseling ● Posttest Counseling - if patient is negative OR positive ● Negative: want to counsel clients on the risk-reduction activities, make sure the client understands the test may not be truly negative (6-12 weeks before there is any evidence of the HIV antibody) ● Positive: counsel clients about the need for reducing his or her risks and partner notification HEPATITIS: inflammation of the liver From ...toxins, diseases, overuse of alcohol, bacterial infections ● Viral hepatitis refers to a group of infections that primarily affect the liver. These infections have similar clinical presentations but different causes and characteristics ○ Hepatitis A (HAV) ○ Hepatitis B (HBV) ○ Hepatitis C (HCV) Hepatitis A: ● Infects via the fecal-oral route ● **can be mild or severe** ● **contagious before they know they are ill** ● The sources of this virus may be through water, food, or sexual contact ● This is a vaccine-preventable disease ● Those who are at high risk include: travelers to countries with high rates, injection drug users, homosexual men, or a person with chronic liver disease ● Treat with rest and good nutrition - no specific treatment Hepatitis B: ● Can spread through blood and body fluids. - easier to get than HIV ○ HBV stay alive outside the body longer than HIV and thus has greater ability to infect ● Those at higher risk include: IV drug users, immigrants, refugees, health care workers, hemodialysis patients, prisoners, and people with STDs ● This is a vaccine-preventable disease - 3 courses will give you antigens (1 shot → 1 shot a month later → 1 shot 6 months later) ● There is an Acute vs. Chronic HBV infection ● The OSHA mandate: requires that all healthcare workers be offered vaccine at the expense of their employer Hepatitis C: ● This is the most common chronic blood-borne infection in the U.S (can be acute or chronic) ● It is spread through blood or body fluids ● It is the leading cause of chronic liver disease, end stage liver disease, liver cancer and liver transplants ● Those at high risk include: health care workers, infants born to infected mothers, IV drugs users, persons with multiple sex partners ● “Silent stalker” - symptoms are mild ● Most infected will contract liver disease Tuberculosis: ● Caused by mycobacterium tuberculosis ● Transmission is usually by airborne droplets from a person with TB ● Many people have TB bacilli in their bodies but do not have active TB. TB develops when their resistance is lowered ● Symptoms include: cough, blood-tinged sputum, fatigue, gradual weight loss, low grade fever, and nocturnal diaphoresis ● Use one of those N95 masks with TB patients Tuberculosis - Scope of Problem: ● It is estimated that ⅓ of the world's population is infected with TB ● TB is the second leading cause of death worldwide ● 10 million Americans are infected with TB-10% will develop active TB ● The critical period of TB: 6 to 12 months after the infection ○ 5% develop pulmonary TB ○ 95% latent (no symptoms), may reactivate later in life Epidemiology: ● TB is believed to be related to poverty, crowding, and poor nutrition ● Those at high risk include: HIV clients, homeless, substance abusers, migrant workers, prisoners, refugees, minority groups, and elderly Tuberculin Testing: ● Mantoux test, Purified Protein Derivative (PPD) - skin testing - insert at a 5-10 degree angle to make a wheel (bubble) under the skim ● A positive reaction means that the individual has been exposed to M. tuberculosis recently or in the past - this does not differentiate among primary, active or dormant infection - follow up with a chest x-ray for persons with positive reaction and symptoms (may show calcified lesions) ● Intradermal injection in forearm - 0.1 ml PPD (for everyone) ● Read reaction within 48-72 hours after the injection ● Measure and record the results in millimeters of induration (induration = hardness?) Guidelines for PPDS: TEST Q: ● Positive findings ○ Induration greater than 15mm - general public with no risk factors ○ Induration greater than 10mm - residents of long-term facilities, IV drug abusers and medically underserved ○ Induration greater than 5 mm - people with HIV, close contact of person with TB (high risk population) My notes say to “read up on” INH and Rifampin - these are 2 meds that can treat and prevent TB - they are used together Levels of Prevention: ● Primary: educate the public, proper waste disposal, use of PPE for health care workers ● Secondary: screening, Acid Fast Bacillus Sputum, Anergy panel for those with compromised immune systems ● Tertiary: appropriate combination of drugs, supportive care, isolate active infections, Directly Observed Therapy (DOT - nurses literally go out in the field and watch them take their meds) if any question of compliance TB Diagnosis → in the morning, without brushing teeth, take a sputum culture!! PPD does not diagnose! Sexually Transmitted Diseases (STD): ● Factors associated with the risks for STDs: younger than 25, minorities, urban setting, poverty, using crack cocaine ● Bacterial: usually treatable with antibiotic: however resistant forms are emerging ● Viral: cannot be cured (herpes simplex virus 2, human papillomavirus) ● TEST Q: most common infectious disease in the U.S. - #1 = CHLAMYDIA Gonorrhea: ● Neisseria gonorrhoeae: gram negative infecting mucous membranes of genitourinary tract, rectum pharynx ● Transmitted through: genital, oral, anal ● Treat partners too!! So not a cycle of disease ● Males: purulent, copious urethral discharge, dysuria or can be asymptomatic ● Females: may be mild or go unnoticed. Puts females at risk for Pelvic Inflammatory Disease (PID) ○ Then women are at risk for ectopic pregnancy and infertility (big star next to this) ● I have written..know if symptomatic or NOT Syphilis: ● Caused by spirochete - treponema pallidum - BACTERIA ● Incidence is declining ● Canker sores! TEST Q: know these stages! ● Primary stage: chancre at the site of entry, begins as macule>papule>ulcerates. If left untreated it will heal in 3 to 6 weeks ● Secondary stage: organism enters the lymph system and spreads - rash, sore throat, fever, lymphadenopathy ● Tertiary: this is rare due to antibiotics, may cause blindness, psychosis, or cardiovascular damage ● Baby through the birth canal - can cause blindness, stillborn, death - we screen EVERY preg woman Chlamydia: ● This is the most common reportable infectious disease in the U.S ● Nongonococcal urethritis ● Symptoms: dysuria, urinary frequency, discharge ● May be asymptomatic in women!! ● Incubation period is from 2 - 35 days ● Treated with antibiotics Herpes: ● Herpes simplex virus 1: non-genital lesions, cold sores on the mouth or lip ● Herpes simplex virus 2 (HSV-2): primary cause of genital herpes - there is no cure, painful lesions, 50% experience prodrome prior to eruption - chronic disease - after initial infection, virus remains latent and may reactivate - linked to cervical cancer, spontaneous abortion, risk of transmission to newborn, “beer pong risk” ● No cure - exacerbations of a breakout - prodromal effects = tingling, pains Human Papillomavirus: ● This can cause genital warts ● Transmission occurs through direct exposure to wart and body fluids that contain virus ● Common among young sexually active women ● Not a reported disease - prevalence unknown ● Linked to cervical cancer ● Treatments include: surgical removal, cytotoxic agents, close follow-up with pap smears ● HPV vaccine (3x) Prevention: ● Partner notification (secondary) ● Standard precautions ● Community outreach - education and evaluation ● Identification of community resources ● Support groups ● NO SEX Environmental Health: Health People 2020: ● Priority area ● Objectives for environmental health ● Relationship between health and environmental risks ● Underlying factors contributing to disease History: ● Florence Nightingale: Mother of Biostatistics ● Lillian Wald: Worked to improve the environment of the Henry Street Settlement neighborhood ● 1995: IOM report Nursing, Health and Environment Environmental Health Sciences: ● TEST 2 Q: Toxicology: the basic science that studies the health effects associated with chemical exposures ○ Pollution can enter our bodies via lungs (inhalation), GI (ingestion), skin and mucous membranes (dermal) - NOT through Radiation ○ Chemicals can cross placenta ○ Age, weight, other drugs taken and underlying health status can affect response to environmental exposure ● Epidemiology: the science that tries to understand the strength of an association between exposures and health effects ● Multidisciplinary Approach: nursing, earth science, geology, chemistry, sanitarians, industrial hygienists, radiation specialists ● Contaminant: organic or non organic matter that can go into a medium like water or food and can make it impure Four Environmental Principles: 1. Everything is connected to everything else 2. Everything has to go somewhere 3. The solution to pollution is dilution*** 4. Today’s solution may be tomorrow’s problem as increased information becomes available Environmental Health Assessment: ● Assess home, school, workplace, and community ● Key questions should cover past as well as present conditions ● Determine whether an exposure is in the air, water, soil or food ● Windshield survey ● Environmental databases ● Environmental assessment forms ● Consider unintended environmental exposures ● EPA = environmental protection agency - gov’t agency dedicated to protecting the environment IPREPARE: TEST 2 Q → what does it do? What health care professionals ask when they are taking an environmental history ● I = Investigate potential exposures ● P = Present work ● R = Residence ● E = Environmental concerns ● P = Past work ● A = Activities ● R = Referrals and resources ● E = Educate TEST 2 Q: she named these 5 categories under this slide and said to know them… 1. Physical agents - such as noise, lead/heavy metal 2. Biological hazards - such as ticks, insects, lice, bed bugs 3. Chemical agents - gas, air, water pollution 4. Mechanical - trucks, fuels 5. Psychosocial - stress, over-crowded areas Laws and Regulations: ● Right to Know Laws: allows the public to be informed about hazardous chemicals in the environment ○ Consumer Confidence Report (CCR) (purity of water) ○ Material Safety Data Sheet (MSDS) (how to use substances at work) ● EPA: Has an “envirofacts” section on website ● Hazard Communication Standard: for employees Risk Assessment: (mentioned she wasn't gonna test on) ● Point Source: single identifiable source of air, water, thermal, noise or light pollution (ex. Pipe, ditch, smokestack) ● Nonpoint Source: diffuse pollution source without a single point of origin (ex. Traffic, fertilizer, pesticide runoff, animal wastes) Risk Assessment - EPA: if you think something is toxic... ● Process to determine the probability of a health threat associated with an exposure 1. Assess toxicological and epidemiologic data 2. Determine if chemical has been released into environment via air, water, soil or food 3. Estimate how much of the chemical might enter the human body, and by which route 4. Predict harm on the basis of estimated exposure Vulnerable Populations: (15 questions on vulnerable populations/homlessness) ● Children: relative to their body weight, children eat drink and breathe more than adults (could have more toxins in a little body), organs are developing so are more likely to be damaged, spend time outdoors (UV radiation, pollution, hands/dirt in mouth), lack logic ● Pregnant women: exposure to certain toxic substances canincrease risk of miscarriage, preterm birth, other complications ● Poverty: may live closer to toxic things (factory, dumps) ● Lack of healthcare access ● TEST 2 Q** - Environmental Justice: movement that has sought to ensure that no particular part of the population is disproportionately burdened by the negative effects of pollution (calls for equality) - because some people are exposed more than others Reducing Environmental Health Risks: ● Prevention of problems is less costly ● Education is primary prevention strategy ● TEST 2 Q - Know the 3 R’s ** ○ Reduce: reducing consumption reduces waste and unnecessary packaging and nonessentials ○ Reuse: choosing reusable rather than disposable products creates less waste ○ Recycle: recycling paper, glass, cans and plastic reduces pollution Risk Communication: ● The right information: Accurate, relevant and in language audiences can understand ● To the right people: Those affected and those that may not be affected but are concerned ● At the right time: For timely action or to allay fear ● Ethics: Essential for making ethical decisions Roles for Nurses: ● Advocate ● Community Involvement and public participation ● Individual and population risk assessment ● Risk communication ● Epidemiologic investigations ● Policy development Environmental Threats: ● Physical hazards: Radiation, lead, heavy metals, noise ● Biological hazards: Infectious agents, insects, animals, plants ● Chemical and gaseous hazards: Poisons, insecticides, air and water pollution ● Mechanical ● Psychosocial: Overcrowding Lead Poisoning: IMPORTANT ● Considered the most preventable environmental disease ● 250,000 U.S. children have high blood lead levels ● Lead poisoning can cause a lower IQ, growth problems, kidney damage, hyperactivity, reading problems, anemia, hearing loss ● Sources: Exposure to lead based paint or dust, drinking water, hobbies, foods, cosmetics ● Risk groups Children under 6, children living in older housing Lead Poisoning Prevention: ● Primary: instruct families not to use lead based paint or items ● Secondary: blood test to screen for lead levels - testing is required in NY at age 1 and 2 and children must be assessed for risk factors annually from 6 months - 6 years ● Tertiary: initiate treatment for lead poisoning that will reduce blood lead levels Info taken from Lead handout in class: - Use cold water- not hot - for infant formula or cooking - Store food from open cans in glass or plastic containers - Foods high in iron and calcium can help prevent lead poisoning - test bank Q - Feed children healthy snacks, a child with an empty stomach will absorb more lead - Only a blood test can effectively detect lead poisoning TEST 2 Q: the Precautionary Principle guides nurses in their practice to use products and practices that do not harm human health or the environment and to take preventive action in the face of uncertainty Health Risks Across the Lifespan Leading causes of mortality and morbidity and health risks vary among groups (children, adolescents, women, men, older adults) CHILDREN nursing assessment: - Physical assessment - Nutritional needs - Elimination patterns - Sleep behaviors (from HP 2020) - Development and behavior - Safety issues - Parenting concerns CHILDREN major health problems - Obesity → huge issue now - Injuries and accidents - Abuse and neglect (we are mandated to report) - Acute illness (most common reason kids don’t go to school) - Alterations in behavior (ADD, ADHD) - Tobacco use (#1 reason people die from preventable disease) - Asthma - Chronic health conditions - Developmental considerations - delays Children Obesity BMI - ratio of weight to height - taken at physical exam (normal = 18/5-24.9) - interventions based on lifestyle changes for entire family - Improve dietary habits, increase physical activity, improve self esteem, improve parent relationships Overweight = 25 - 29.9 Obese = 30 - 39.9 Extreme obesity = over 40 - At least 70% of overweight children become overweight adults - Rates higher in native americans, hispanics, african americans, lower socioeconomic status, urban settings - Related to high fat diets and inactivity - Increased prevalence of hypertension, menstrual problems, bone and joint difficulties, respiratory problems - Contributions: genetics, family eating problems, technology (inactivity) Children injuries and accidents - most important causes of preventable disease, death, and disability among children - Each year 20-205% of all children will have a health problem related to accidents or injuries - Injuries are NUMBER 1 cause of death in children up to 21 years - Motor vehicle accidents are leading cause of death - Other Ex: drowning, burns, poisoning, falls - Also, SIDS: more in preterm, LBW, low socioeconomic status, mother smokes, prone sleeping Infants - at risk because of small and immature motor skills- no logic, very curious, don’t know limitations Toddlers & preschoolers - high level of activity and increasing motor skills, inquisitive, immature logic abilities School-age children - have lowest injury rate!! More logic - sports and athletic injuries Adolescents - high injury rate, risk takers, intentional injuries (suicide), weapons, substance abuse,suicide, youth gangs (injury rates higher for males) - 9,000 children die a year from injuries Children abuse and neglect: physical/sexual In 2002, 3.1 million children were departed as abused or neglected - abuse occurs in all income, racial, and ethnic groups (test bank Q: happens across the board- not more in one ethnic group) - Often difficult to prove** - Nurses - mandated to report suspicions - #1 - children in families who are socially isolated, parents who were abused as children, homes with family violence Children - acute illness (usually get better) - caused primarily by infection - Most are self-limited - Nurses can teach about home care, infection control - Routine immunization - successful in preventing selected diseases Children - alterations in behavior - Eating disorders: TEST 2 Q: #1 is OBESITY - Attention problems: ADD/ADHD - no diagnostic test just symptom based - Substance abuse - Elimination probs - Conduct disorders - delinquency, bullying - Sleep disorders - School maldaption TEST 2 Q: KNOW what drugs are susceptible to Narcan - opioids! (Heroin, morphine, methadone, hydrocodone…) - Narcan goes alone with rescue breathing! - “Last question on final” - can give Narcan a second time Children - tobacco use Smoking has been identified as the most important preventable cause of morbidity and mortality in the US!! (Second is overweight and obesity) - second hand smoke - exposed children have more ear and upper respiratory infections - Children of smokers are more likely to smoke - Teenagers are rarely able to quit - Nurses should become politically active in banning tobacco advertising, enforcing restrictions of same to minors, restricting public smoking and encouraging insurers to reimburse smoking cessation therapies Children - Asthma 8.9 million children up to 18 with asthma - prevailing increasing Low income and minority groups more likely to be hospitalized or die from asthma - we want to try to make people self aware! ● Most common cause of school absences - said this like 5 times ● Interventions include: 1. Education programs for children and families 2. Home and environmental assessments to identify “triggers” 3. Development of clean air policies within the community 4. Outreach efforts in high-risk populations 5. Referral to appropriate resources - support groups, camps, open airway program WOMEN: infancy to old age (live longer than men) - includes health promotion, maintenance, and restoration - Women’s health is related to the biological, social, and cultural dimensions of women's lives - Women’s movement: we focus more on their health issues than we ever had (birth control movement) - Women make 75% of all health care decisions in the home Screening/preventive services - Height/weight - BP - Cholesterol - Pap smear - Mammogram/ clinical breast exam - Fecal occult blood/colonoscopy - Rubella serology - Immunization status - Diabetes Mellitus - Skin cancer - HIV Women Health concerns: Reproductive health: birth control methods, STD education, folic acid while pregnant Menopause Osteoporosis: a decrease in bone mass, lifestyle choices that help prevent Female genital mutilation: in other countries its a cultural thing, removal of the labia **health disparities among special groups of women - women of color, incarcerated women, lesbians, women with disabilities, older women** MEN: across the lifespan Men's health - a holistic, comprehensive approach that addresses the physical, mental, emotional, social, and spiritual life experiences and health needs of men throughout their life span - In general, men are reluctant to seek health care and are not well connected to the health care system - which increases their risk and severity of disease - TEST 2 Q: Higher Infant mortality rates - as infants, men are more vulnerable (premie girls are stronger) - shorter life spans - Risk takers, avoid seeking care, occupational injuries, 5x more likely to commit suice than women Screening/preventive services - Height/weight - BP - Fecal occult blood/colonoscopy (50 years plus) - Vaccine status - HIV - Skin cancer - Cholesterol ( ages 45-65) Men Health Concerns ● Prostate Cancer: most frequently diagnosed cancer in men, second leading cause of cancer in men ○ Do not know cause ○ Risk factors = age and fam history ○ African Americans have a higher incidence ○ Screening - PSA test shows no mortality benefit - digital rectal exam every year ● Testicular Cancer: most common solid tumor diagnosed in males between ages 15 and 40 ○ Unknown cause! ○ Related to cryptorchidism (balls not falling) ○ Testicular self-exam OK this is the slide she stopped at for the test even though there's more in lifespan PP Leading causes of Death by age group - this was taken from that handout (she said it’s good to know what to target for each group) - Adults - #1 = heart disease - BUT if you have money, it changes to cancer being #1 - Children under 1 - congenital anomalies - 1-44 - #1 - unintentional injury - 10-44 - #2 - suicide ^ End of Exam 2 Info ^ Disaster Nursing - 10 QUESTIONS Intro ● Number of disasters, both man-made and natural, continues to increase ● The cost to recover from a disaster has risen because the amount of technology that must be restored ● Nurses are increasingly getting involved in disaster planning, response, and recovery through their local health department or local gov’t Disasters: any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance - Ranges in size - Are expensive - Developing countries experience disproportionate burden from natural disasters Types of disasters ● Natural disasters: fire, hurricanes, tornadoes, floods, earthquakes, avalanches, tsunamis, mudslides, hail storm, drought, epidemics, volcano ● Human-made disasters: oil spill, terrorist attack, shootings/violence, fire, transportation accident, war, riots, bomb, pollution ● Chemical ● Biological ● Radiologic ● Nuclear ● Explosive There are ways to prevent or manage how people and their communities respond to disasters - Although the number or disasters worldwide continues to grow, the number of lives lost has decreased - U.S. agencies, directives, and systems ● U.S. department of homeland security ● National preparedness guidelines ● National response plan ● National incident management system ● Public health and medical preparedness and national health security strategy Healthy People 2020 Disasters clearly affect the HP 2020 objectives that relate to unintentional injuries, occupational safety and health, environmental health, and food and drug safety. Disaster Management Cycle - prevention, preparedness, response, recovery (When do we start disaster prep? Know the cycle for the final) Prevention (mitigation) Preparedness ● Personal preparedness ○ Personal checklist ○ Emergency supplies kit ○ ARC and FEMA ● Professional preparedness ○ Disaster medical assistance teams ● Community preparedness ○ National health security system (NHSS) ○ Disaster and mass casualty exercises Role of the Nurse in Disaster Preparedness - Help initiate or update the agencies disaster plan - Provide educational programs and materials regarding disasters specific to the area - Organize disaster drills - Provide an updated record of vulnerable populations within the community - Review individual strategies Response ● National response framework ● Emergency support functions ● National incident management system ● Response to bioterrorism ● International relief efforts ● Psychological stress of disaster workers Role of the Nurse in Disaster Response - Advocate - Assessment - Understand what community resources are available - Often first responder - Case finding and referring - Prevention - Health education - Surveillance - Triage: (Need to know tagging for the final) - Your biggest priority is someone who can recover but has life threatening injuries - Next priority is non life threatening and can wait 45 to 60 mins - Next is those with scratches and minor bruises - Black tag – pulseless, dead - Red – immediate, life threatening injuries - Delayed (yellow) – wounded but can wait, require medical attention but its not life threatening - Green – minor, can be treated with first aid How Disasters Affect Communities ● Physical and emotional effects depend on ○ Type, cause, and location ○ Magnitude and extent of disaster ○ Duration of disaster ○ Amount of warning ● Stress reactions in individuals ● Stress reactions in the community ○ Heroic ○ Honeymoon ○ Disillusionment ○ Reconstruction Shelter Management ● Local Red Cross chapter ● Nurses working in shelters: ○ Provide assessments and referrals ○ Meet health care needs, such as helping clients get prescription glasses, medications, first aid, and appropriate diet adjustments ○ Keep client records ○ Ensure emergency communications ○ Provide a safe environment Recovery ● Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level prior to the disaster as possible ● Often the hardest part of the disaster ● Recovery occurs as all involved agencies pull together to restore the economic and civil life of the community Role of the Nurse in Recovery - Teach proper hygiene and make sure immunization records are current - Make referrals to mental health professionals - Be alert for environmental hazards - Assess dangers of live or dead animals - Case finding and referral Future of Disaster Management ● Continue to plan and train in all-hazards environment, regardless or specialty practice ● The nature of disasters will retain the element of unpredictability ○ That unpredictability and the medical and public health surge requirements in disaster mae prevention and preparedness activities on the part of individuals and communities even more important Disaster Planning and Management: ● Effective disaster plans are designed by those with knowledge of the work processors and materials, the workers and workplace and community resources ● Specific steps must be detailed for actions to be put in place by specific individuals in the event of a disaster Culture Care in Community Health She didn’t lecture this lol (She mentioned to look at the cheat sheet on Canvas) First Step in Cultural Competency is Self Reflection. Ethnocentrism - When you think your culture is supreme Intro: US population is becoming increasingly diverse - Nurse and client often come from different cultural backgrounds and may not recognize or understand their differences - Nurses must be able to provide culturally competent care Immigrant Health Issues ● Recent changes in immigration laws have increased migration to the US ○ 1965 amendment of the immigration and Nationality Act ○ Refugee Act of 1980 ○ 1986 immigration reform and control ● National debate about immigration policy has intensified since the terrorist attacks of 9/11 ● Immigrants add about 10 billion to the economy annually - in their lifetime, they will pay 80,000 more in taxes than they consume in services ● This poses a dilemma for communities since the taxes are paid to the federal gov’t, whereas immigrants use services provided and paid for by the states and localities Immigrant Categories Legal Immigrant: not a citizen but allowed to both live and work in the US, also known as lawful permanent resident - Tend toward more immigrants being low-skill workers, and they compete with native low-skill workers for jobs Refugees and people seeking asylum: admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views Nonimmigrants: admitted to the US for a limited duration and specific purpose (students, tourists) Unauthorized immigrant: either crosses border illegally or legal permission expired; eligible only for emergency medical services Providing Health Care for Immigrants: Factors to Consider ● Financial constraints ● Language barriers ● Differences in social, religious, and cultural backgrounds between the immigrant and healthcare provider ● Providers lack knowledge about high-risk diseases in the specific immigrant groups for whom they care ● When working with immigrant populations, consider how your own background, beliefs, and knowledge may be significantly different from those of the people receiving care (self-reflect) Culture, Race, and Ethnicity ● Culture: a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations ● Race: a biological designation whereby group members share features (ex: skin color, bone structure, genetic traits such as blood groupings) ● Ethnicity: shared feelings of peoplehood among a group of individuals Cultural Competence ● A combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to work effectively in cross-cultural situations Four Principles 1. Care is designated for the specific client 2. Care is based on the uniqueness of the person’s culture and includes cultural norms and values 3. Care includes self-employment strategies to facilitate client decision making to health behavior 4. Care is provided with sensitivity and is based on the cultural uniqueness of clients Key Reasons Nurses Must be Culturally Competent ● The nurses culture often differs from that of the client, leading to different understandings of communication, behaviors, and plans for care ● Care that is not culturally competent may increase the cost of healthcare and decreases the opportunity for positive client outcomes ● To meet some of the objectives for persons of different cultures as outlined in HP 2010, the clients lifestyle and personal choices must also be considered Cultural competence self-assessment → always want to self-reflect ● Am I aware of my culture and views and other cultures? ● Am I able to perform a culturally sensitive assessment? ● Do I have the knowledge necessary to develop appropriate nursing care? ● What is my goal in learning about diverse populations? Developing Cultural Competence Two principles: 1. Maintain a broad, objective, and open attitude toward individuals and their cultures 2. Avoid seeing all individuals as alike ● Cultural awareness ● Cultural knowledge ● Cultural skill ● Cultural encounter ● Cultural desire ● Cultural preservation ● Cultural accommodation ● Cultural repatterning ● Cultural brokering Inhibitors to Developing Cultural Competence - Nurses that do not understand transcultural nursing - Supervisors pressuring nurses to increase productivity by increasing their case-load - Nurses feeling pressured by colleagues who are not knowledgeable about other cultures and who are offended when others use cultural competence concepts - Above inhibitors may result in: stereotyping, prejudice, racism, ethnocentrism, cultural blindness, cultural imposition, cultural conflict, and culture shock. Culture Nursing Assessment ● Systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practice of individuals or groups using a holistic perspective ● During initial contact with the client, the nurse asks the following issues: ○ Ethnic background ○ Religious practices/preferences ○ Family patterns ○ Food patterns ○ Health practices Two phases of an In-Depth Cultural Assessment 1. Data collecting Phase - The nurse collects self-identifying data similar to that collected in the brief assessment - The nurse raises a variety of questions that seek info on clients perceptions of what brings them to the healthcare system, the illness, and previous and anticipated treatments - After the nursing diagnosis is made, the nurse identifies cultural factors that may influence the effectiveness of nursing care actions 2. Organizing Phase - Data related to the client;s and families views on optimal treatment choices are routinely examined, and areas of difference between the client's cultural needs and the goals of Western Medicine are identified. Conducting Cultural Assessment ● Be aware of the environment ● Know about community social organizations ● Know the specific areas that you want to focus on ● Select a strategy to help gather cultural dad ● Identify a confidante ● Be aware that all info contains subjective and objective data ● Be sincere, open, and honest Using an Interpreter - communication with the client or family is required for a cultural assessment - When nurses do not speak or understand the client's language, they should obtain an interpreter - Depending on the volume of clients who cannot speak enlgihs, agencies may be required to have all their written materials translated and regularly use interpreters or only portions of the materials translated. Using translators is not without risk - They may not understand all terms - They may also reply for the patient instead of working toward greater understanding of all participants - Interpreters may emphasize their personal preferences by influencing both nurses and clients decisions to select and participate in treatment Cultural Groups Differences - although cultures are not the same, all cultures have the same basic organizing factors: - Communication (verbal and nonverbal) - Space - Social organization - Time perception - Environmental control - Biological variations - Culture and nutrition Culture and Socioeconomic Status ● Members of minority groups are overrepresented on the lower tiers of the socioeconomic ladder ● Poor economic achievement in common among populations at risk, such as those in poverty, the homeless, migrant workers, and refugees. ● Nurses should be able to distinguish between cultural and socioeconomic class issues and not interpret behavior as having a cultural origin when in fact it is based on socioeconomic class. Rural Health and Migrant Health Rural versus Urban: ● Rural: communities having fewer than 20,000 residents or fewer than 99 persons per square mile ● Urban: geographical areas described as non-rural and having a higher population density; more than 99 persons per square mile; cities with a population of at least 20,000 ● Rural-urban continuum: ranges from living on a remote farm, to a village or small town, to a larger town or city, to a large metropolitan area ● About 25% of all U.S. residents live in rural settings Rural Health Challenges: ● Limited access to health care and services ● Social isolation ● Scarcity of health professionals - Health Professional Shortage Areas ● Lack of Knowledge ● Poverty ● Language barriers and cultural differences often exist between migrant (usually foreign born) workers and farm owner and other residents ● Traveling time and/or distance to ambulatory care services (also may not have transportation) ● Telehealth is very important in rural areas Rural Population Characteristics: ● Higher proportion of whites in rural areas ● Higher than average number of younger (ages 6-17 years) and older (over 65 years) ● Persons 18 and older more likely to be or have been married ● More likely to be widowed than urban counterparts ● Fewer years of formal schooling ● Tend to be poor ● Higher risk for being underinsured or uninsured Rural Health Status: ● Poorer perception of overall health and functional status ● Less likely to engage in prevention ● Increased tobacco use, alcohol use and obesity ● More likely to have one or more chronic conditions: heart disease, obesity, COPD, diabetes, cancer, hypertension ● Higher infant and maternal morbidity rates ● Mental health - depression, suicide Migrant Workers: ● The Office of Migrant Health defines a migrant farm worker as one whose primary employment is agriculture on a seasonal basis, who has been employed within the last 24 months and who establishes a temporary abode for the purpose of that employment. ● Seasonal farm workers work cyclically in agriculture but do not migrate (work on farms during crop season and then do something else during the off season such as construction) ● **Primarily of Mexican descent ● Most have not graduated from high school ● They do not get paid for bad weather or bad crops ● Average age is 31 years old ● Earn less than minimum wage Migrant Lifestyle: ● Most earn an annual income below the federal poverty line. They rarely receive benefits. ● Crowded housing - camps, cabins, trailers, tents, poor sanitation ● Could also be coming from a country with a disease Migrant Workers Profile: ● 81% of all farm workers are foreign-born ● 77% of all farm workers were born in Mexico ● Average farm working is 31 years old ● Five out of six farm workers are native Spanish speakers ● Approximatel;y 47,000 migrant farm workers and their family members come to New York state each year Issues in Migrant Health: ● Lack of knowledge about services ● Inability to afford care - Medicaid is often unavailable ● Lack of transportation ● Discrimination ● Mobility and tracking ● Hours of service ● Documentation - illegal workers fear deportation ● Language - majority of migrant workers speak Spanish ● Availability of services ● Migrant Health Act reaches less than 20% of migrant workers and families Migrant Health Problems: ● Dental health ● Tuberculosis - higher incidence among migrant workers. May be resistant to commonly used drugs. When giving drugs use DOT (directly observed treatment which is a tertiary service) ● HIV - higher risk from lack of education, low use of condoms ● Mental health - depression, low self-esteem and discrimination ● Higher infant mortality rate ● Life expectancy is 49 years Occupational and Environmental Problems: ● Machinery and vehicular accident ● Trauma - falls, cuts, strains, sprains, electrical injuries ● Infectious disease ● Certain types of cancers ● Respiratory disease from toxins, pesticides and herbicides ● Dermatological issues ● Not well rested ● Pesticide poisoning Rural Health Care Delivery Issues: ● Barriers related to availability, affordability, accessibility, or acceptability of services and providers to rural consumers ● Providers’ attitudes, insights, and knowledge about rural populations are important ● Nurses must design strategies and implement interventions that mesh with the client’s belief system Pesticide Exposure (aka Pesticide Poisoning): ● Symptoms - headache, dizziness, eye irritation, memory problems, mauseas, abdominal cramps, dyspnea, confusion, irritability, muscle weakness, rash, vomiting, diarrhea, difficulty concentrating Levels of Prevention - Pesticides: ● Primary Prevention - Teach workers how to reduce exposure to pesticides, protective equipment ● Secondary Prevention - Conduct screening, such as urine testing for pesticide exposure, want to know who has high levels ● Tertiary Prevention - Initiate treatment for the symptoms of pesticide exposure such as nausea, vomiting and skin irritation Mexican Culture: ● Mexican clients may not seek care with health professional first; they may have consulted with folk healer or knowledgeable people in the community. ● Health is considered a gift from God ● Common folk illnesses - mal de ojo (evil eye), susto (fright), empacho (indigestion) and caida de mollera (fallen fontanel) ● The female is the caretaker and male is major decision maker ● Family plays an important role in health ● They may think illness is a punishment from God ● They will work regardless of symptoms Vulnerability Definitions Vulnerability: susceptibility to actual or potential stressors that may lead to an adverse effect Vulnerable population: those groups with increased risk for developing adverse health outcomes (children, pregos, HIV patients, elderly) Disenfranchised: marginal to society, disconnected - people who are vulnerable feel this way, feel invisible Resilience: the ability to resist the effects of vulnerability Vulnerable in 3 different ways: 1. Physical: chronically ill… 2. Psychological: mental illness… 3. Social: immigrants, people in jail, vets, homeless… Vulnerable Populations ● More likely to develop health problems as a result of exposure to risk or to have worse health outcomes from those health problems than the population as a whole ● More likely to suffer from health disparities ● Vulnerability results from combined effects of limited physical, environmental, personal resources and psychosocial resources Risks: all of these can make a person vulnerable ● Environmental hazards (lead exposure, mold) ● Social hazards (crime, violence) ● Personal behaviors (smoking, diet, exercise habits) ● Biological or genetic makeup (compromised immune system, sickle cell, downs) Groups of Vulnerable populations ● Homeless ● Poor ● Pregnant adolescents ● Migrant workers ● Immigrants - esp if undocumented ● Mentally ill ● Substance abusers ● Prisoners ● Those who have been abused/victims of violence ● People with communicable diseases - HIV, Hep b, STD’s, TB Predisposing Factors - Social and economic factors predispose people to vulnerability - POVERTY is primary cause - most important - Age-related causes - people at both ends of the age continuum are less able to adapt to stressors - Health-related causes - heart disease, cancer, COPD - Life experiences - trauma, loss Factors leading to Poverty ● Reduced earnings, joblessness, unavailable low cost housing, inadequate education, welfare reform, more households headed by women, unemployment, welfare Outcomes of Vulnerability - mostly bad ● Outcomes can be negative, such as lower health status, or they may be postive with effective interventions ● One vulnerability usually puts ones at risk for another ● Cycle of vulnerability - social isolation, hopelessness, chronic stress, powerlessness ○ Just one thing leading to another Nursing Interventions ● Tend toward providing more comprehensive, family-centered services - “one-stop” services (health clinics like NUMC) ● Wrap-around services - social and economic services that will ensure effectiveness of health services are included in treatment (go to a clinic and get assigned social worker) ● Advocacy and social justice - promote changes in public policy ● Culturally and linguistically appropriate healthcare **before you can become culturally competent? Examine self and know own biases Assessment Issues ● Preventive health needs - age appropriate screening tests ● Socioeconomic resources ● Amount of stress ● Congenital and genetic predisposition to disease ● Living environment/community assessment Nursing Care - gain trust! ● Create a caring environment, show respect, compassion, and concer, dont make assumptions, coordinate services and providers, advocate for accessible health care services, focus on prevention, know available resources, develop a personal support network Teen Pregnancy - vulnerable population, 12% of all births ● At lowest rate right now, area of public health concern ● Higher rates for black and hispanics (minorities) ● May result in the cycle of poverty and school failure ○ BEST THING TO DO: keep mom in school so they don't enter the cycle of poverty - question on final ● Teens often feel invincible and may not recognize risks involved, they are often influenced by peer pressure Risks!! KNOW for final ● Sexual victimization ● Family structure ● Parenting style ● Lack of communication and education about issues of sexuality ● Mom was a teen mom Healthy People 2020 Goal: to reduce pregnancy rates among adolescent females Goal: to increase the proprotion of adolescents 17 years and under who never has sex Special Needs in caring for Pregnant Teen ● Violence - always ask if they feel safe in their home ● Nutrition - food for 2 ● Infant care ● Schooling and educational needs ● Teens at risk for low birth weight babies and prematurity Homelessness Poverty: refers to having insufficient funds to meet basic living expenses for food, shelter, clothing, transportation and medical care Know these 3 for final: ● Persistent poverty: refers to individuals and families who remain poor for long periods of time and pass it on to their fam - parents in poverty and pass it on ● Neighborhood Poverty: refers to geographically defined areas of high poverty, characterized by dilapidated housing and high levels of unemployment. ● Crisis poverty: house gets destroyed in a hurricane, loses job, something happens which makes you poor Causes of Poverty Complex and interrelated, decreased earnings, increased unemployment, changes in the labor force, increase in female headed households...stuff like this Poverty and Health ● Higher rates of chronic illness ● Higher infant mortality and morbidity ● Shorter life expectancy ● More complex health probs ● Less prenatal services ● Less screenings when preg ● More significant complications ● Hospitalization rates 3 times that for person with higher incomes - they wait longer and end up in the ED Poverty Stats - highlighted the difference between the rate for intact household (6%), versus rate for female-headed households (30.6%) Federal Poverty guidelines - know what the chart tells us - Chart states how much money people make and how they qualify for assistance - States the amount of people in the household and how much they make and if they are poor or not. KNOW: homeless definition A homeless individual is one who: - Lacks a fixed, regular, and adequate nighttime residence - Has a nighttime residence that is a shelter, an institution or a place intended as sleeping accommodations. ***McKinley Homeless Assistance ACT 1987*** US Law that provided money for shelters...15 programs for the homeless, a lot don’t know about Homelessness - Risk Factors ● #1 = POVERTY ● Loss of affordable housing ● Behavioral disorders: mental illness, substance abuse, lack of treatment facilities ● Impoverished social networks - decrease in family support ● Unemployment ● Adolescent runaways ● DEINSTITUTIONALIZATION - releasing patients but they had nowhere to go ● War or armed conflict ● Prison release ● Disasters ● Domestic violence ● FINAL QUESTION: what is the fastest growing homeless segment? Families with children Profile: - Difficult to know exactly how many people are homeless, hard to get a census - Estimate: 564,708 homeless in US - Avergae is 34 years old - 30% are families with young children - fastest growing segment of homeless population - NY state with most homelessness Health Effects - hypothermia, heat-related illness, poor skin integrity, HIV/AIDS, trauma, mental illness, dental issues, TB, prone to infections, children = developmental delays/poor school performance Homelessness Effects: healthcare is usually crisis-oriented sought in ED - No preventive care - Experience loss of dignity, low self-esteem, fear, and confusion Barriers - Lack of access/insurance - Turned away from clinics - Lack of transportation, lack of communication - No reg fam practitioner Levels of prevention Primary: job training, affordable housing, preventative health care, birth control services…. Secondary: reducing the prevalence of pathological nature of a condition (supportive and emergency housing, soup kitchens, screenings Tertiary: restore and enhance functioning, rehab programs Global Health WHO Definition of Health: ● “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmary.” ● The WHO helped in the eradication of Smallpox ○ Eradication - gone completely ○ Elimination - gone from only a specific area What Risk Factors Affect the Disease Burden? ● Risk factors are defined as personal habits and behavior, environmental conditions, or inborn or inherited characteristics that are known to affect a health-related condition. ● Childhood and maternal malnutrition ● Other nutrition-related risk factors and inactivity ● Addictive substances ● Sexual and reproductive health ● Environmental risks ● Burden of disease - measurement of health Homelessness: ● Homelessness inevitably causes serious health problems. ● Illnesses that are closely associated with poverty - tuberculosis, AIDS, malnutrition, severe dental problems - devastate the homeless population. ● Health problems that exist quietly at other income levels - alcoholism, mental illnesses, diabetes, hypertension, physical disabilities - are prominent on the streets. ● Human beings without shelter fall prey to parasites, frostbite, infections and violence. Health Concerns of Homeless Children: ● Chronic conditions such as anemia and poor nutrition. ● Homeless children are usually behind on immunizations. ● They often live in substandard housing with lead paint on the walls, which causes them to suffer from high lead levels. ● Some of the long-term effects of these chronic conditions, such as seizure disorders and learning disabilities, can be devastating and decrease their chances to break out of the cycle of homelessness. ● Families with children are the largest growing segment in homelessness. **She said a lot of questions on homelessness, poverty, and vulnerability** Malaria: ● #1 vector borne disease in the world ● It is an endemic; before someone goes somewhere where there is malaria, they are put on meds but can still contract it; wear long sleeves, use repellants and nets, not standing water Water: ● In the developing world, 1 in 5 people are without safe water. Global Burden of Disease: (Need to know this for the final) ● Risks to health and health outcomes in different demographic populations and social settings. ● The burden of disease is growing disproportionately in the world and is largely affected by climate, public policy, age of the population, socioeconomic conditions and risk factors. Extra things she said at the end of the PowerPoint: ● People who are traveling must get vaccinated 6 months in advance (CDC lets you know the timeline) ● Know the diseases that are prevalent in that area ● Carry a med list ● Be cautious when eating; stay away from sauces, water, and rice ● If pregnant while traveling, avoid high altitude ● Do not travel is Zika is present Health Economics Public Health and Economics: ● Economics is a science concerned with the use of resources, including producing, distributing, and consuming of goods/services ● Health economics examines the ways in which scarce resources affect the healthcare industry ● Public health economics focused on producing, distributing, consuming of goods/services as related to public health ● Goal: to support population focused preventive health services