Chapter 1 Health: A Community View

Question 1

Community health -

Answer 1

looking at the promotion health and wellbeing for indivis and the community; does look at indivis to some degree; bigger focus on groups of people, fams and specific communities, also looking at the pop as a whole

Question 2

What is community/public health nursing?

Answer 2

Synthesis of nursing practice and public health practice
Major goal: preserve health of community and surrounding populations by focusing on individuals, families, and groups health promotion and maintenane
Community health nursing: population health and identification of populations at risk; associated health and identification populations at risk rather than episodic response to pat demand
Nurses constitute the largest segment of healthcare workers; community/public health nurses in position to assist healthcare sys to transition from disease oriented sys to health oriented sys
community/pub nursing is synthesis of nursing prac and pub health prac

Question 3

What is public health?

Answer 3

Is the Art and science of preventing disease, prolonging life, and promoting health through organized community efforts to benefit each citizen.
Mission: social justice - entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make it possible
Assumes that it is society’s responsibility to meet the basic needs of all people

Question 4

What is health?

Answer 4

Definition is evolving
“A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” World Health Organization 1958
“The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal sources, and physical capacities.” World Health Organization 1986
There are various definitions of health in nursing literature

Question 5

Public and community health nursing

Answer 5

Community and public health terms used interchangably
Some use community health nursing as a global term and public health nursing as a component or subset
“The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations.” – ANA 1980
“population-focused, with goals of promoting health and preventing disease and disability for all people through the creation of conditions in which people can be healthy” ANA 2013

Question 6

Community-based nursing

Answer 6

Refers to the “application of the nursing process is caring for individuals, families and groups where they live, work or go to school or as they move through the health care system”
Is very setting-specific
Emphasis is placed on both acute and chronic care
Includes practice areas such as home health nursing and nursing in outpatient or ambulatory settings
Primary clients are the individual and the family rather than the whole community or pop at large
Home health and hospice

Question 7

Population-focused nursing

Answer 7

Focuses on the entire population
It Is based on assessment of the populations’ health status
It Considers the broad determinants of health - such as biology, behaviors, social environment, physical environment, and access to quality care
Emphasizes all levels of prevention
Intervenes with communities, systems, individuals, and families
Goal: promote healthy communities

Question 8

Nursing in the community

Answer 8

May not see changes as quickly as in the hospital
Still often saving lives, but doing it in a much different way
May have and form deeper and more long lasting relationships with clients because interact more extensively and over longer period of time than might in norm healthcare setting
Notice More profound impact - on pat’s turf on not on your turf

Question 9

Increasing needs for care at home

Answer 9

Driven by:

Question 10

Driven by: (Increasing needs for care at home)

Answer 10

Aging population
Chronic diseases
Payment for skilled home care
Payment for skilled nursing facilities
Reduced time in the hospital and other acute care settings
Reducing hospital costs

Question 11

The essence of nursing in the community

Answer 11

Very diff from a hospital; dealing with one person who already has illness/injury/disease and addressing that directly; know pat for shift, address targeted issue; look at other aspects like how got there but not in depth; community bit diff - know people for longer period time, know groups, object game is figure out how get where are at in first place; want to talk with them and be patient with them
Everyone has a story - be nonjudgmental; circumstances leads to where are; want to know this; lot listening; tell life; what doing for last few years: diet, culture, exercise, work life like
want overall is do upstream type thinking: looking at what is cause got person where are in first place - looks at preventative measures: health promotion; not want go with typ medical model and curing probs - want prevent them
Learning their story allows us to be better nurses
Listen
Be patient
Show respect
Show appreciation
Empathy and empower people to help achieve health goals; increase nursing effectiveness and job satisfaction
Have meaningful conversations
Empower others
It will improve your effectiveness and job satisfaction

Question 12

Community -

Answer 12

group/collection of indivs interacting in social units and sharing common interests, characteristics, values and goals
Group people share common identity and environment
EX: residents of small town
Broad concept and refers to all pops in specific area/region at certain time

Question 13

Population

Answer 13

Denotes group of people with common personal/enviornmental characteristics; can also refer to people in defined community
EX: elders in rural region

Question 14

Aggregates

Answer 14

subgroups/subpops that have some common characteristics/concerns
EX: pregnant teens within school district

Question 15

Determinants of health and disease

Answer 15

Community health status associated with multiple health factors and community health nurse must understand community determinants of health in recognizing interactions of factors that lead to disease, death, and disability
Determinants of health are factors that influence health status - biology, behaviors, social environment, phys environment, access to quality healthcare
Variable with major impact on community health is indiv behaviors and lifestyle choices
Factors impacting health status of a community
Individual behaviors (use tobacco, poor diet, lack activity, alcohol consumption) responsible for 50% premature deaths in U.S.
Health and illness influenced by many factors - some can be changed like indiv behaviors; some cannot (genetics, age, gender)
Better health attributed to higher standards of living, good nutrition, healthier environment, immunization
Can be influenced by policy efforts and education
Health and illness are multifactorial
Community health nurses must work with policy makers and community leaders to identify patters of disease and death and to advocate for activities/policies that promote health at the indiv, fam, aggregate and pop levels

Question 16

Indicators of health and illness

Answer 16

Many indicators used by HCP, policy makers, community health nurses to measure health of a community
Morbidity, mortality, and health status related data provided by local, state, and national entities.(CDC, national center for health stats) report and provide morbidity
State and local health departments report morbidity/mortality and other health status related data to federal-level agency - often CDC
Data collected can be used over time to compare communities from diff geographic regions or comparing diff aggregates within a community; may be useful in analyzing health patterns over time
Public health nurses should be aware of patterns and health indicators within prac, and identify areas for investigation/intervention through an understanding of health, disease, and mortality patterns

Question 17

Healthy people 2030

Answer 17

Keep evolving - is a national movement (everywhere in US); people who work to assess the health of nation and diff communtiies throughout nation to figure out risk factors, what need to prevent, educational programming need have nationwide
Purpose - National effort that sets goals and objectives to improve health and well being of people in US
Overarching Goals

Question 18

Overarching Goals (Healthy people 2030)

Answer 18

Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death
Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all
Create social, physical, and economic environments that promote attaining full potential for health and well-being for all
Promote healthy development, healthy behaviors, and well-being across all life stages
Engage in leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all

Question 19

Healthy people 2030 leading health indicators - not children/older adults; aka risk factors for overall pop

Answer 19

Divided by life stages - major indicators for US at all ages; each can affect health indivs in communities and correlated with leading causes of morbidity and mortality
Increase the number of children, adolescents, and adults who use the oral health care systems (2 year and over)
Reduce the number of calories from added sugars by persons 2 years and over
Reduce drug overdose deaths
Reduce the number of days people are exposed to unhealthy air
Reduce homicides
Reduce household food insecurity and hunger
Increase the proportion of persons who are vaccinated annually against seasonal influenza
Increase the proportion of persons who know their HIV status
Increase the proportion of persons with medical insurance
Reduce the suicide rate

Question 20

Public health and community health

Answer 20

Public Health is the science and art of

Community Health

Question 21

Public Health is the science and art of (Public health and community health)

Answer 21

Preventing disease
Prolonging life
Promoting health and efficiency through organized community effort

Question 22

Community Health (Public health and community health)

Answer 22

Extends the realm of public health to include organized health efforts at the community level through both government and private efforts (such as the American Heart Association and the American Red Cross)

Question 23

Core public health funcs

Answer 23

Assessment
Policy Development
Assurance

Question 24

Assessment (Core public health funcs)

Answer 24

Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community

Question 25

Policy Development (Core public health funcs)

Answer 25

Use of information gathered during assessment to development local and state health policies and to direct resources toward those policies

Question 26

Assurance (Core public health funcs)

Answer 26

Focuses on the availability of necessary health services throughout the community; might include maintaining the ability of both public health agencies and private providers to manage day to day operations and capacity to respond to critical situations and emergencies

Question 27

Essential public health services

Answer 27

Monitor health status to identify and solve community health problems
Diagnose and investigate health problems and health hazards
Inform, educate, and empower people about health issues
Mobilize community partnerships and actions to identify and solve health problems
Develop policies and plans that support individual and community health efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services and assure the provision of health care when otherwise unavailable
Assure a competent public health and personal health care workforce
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
Research for new insights and innovative solutions to health problems.

Question 28

Health promotion and levels of prevention

Answer 28

Public Health vs. Medical Care
Levels of Prevention
Primary
Secondary
Tertiary

Question 29

Public Health vs. Medical Care (Health promotion and levels of prevention)

Answer 29

Public health efforts focus on health promotion and disease prevention
Medical care - focuses on disease management and cure

Question 30

Levels of Prevention (Health promotion and levels of prevention)

Answer 30

Are 3

Question 31

Primary (Health promotion and levels of prevention)

Answer 31

Preventing problem before it occurs
First level of prevention
Directed at preventing a problem before it occurs and altering susceptibility or reducing exposure for susceptible indivs
Consists of 2 elements: gen health promotion and specific protection
EX: immunizations

Question 32

Secondary (Health promotion and levels of prevention)

Answer 32

Second level of prevention
Early detection and prompt intervention during period of early disease pathogenesis; implemented after prob begun but before s&s begin; targets pops that have risk factors
EX: screening for STDs; screenings - picks up diseases that already have and not know have - goal pick up early so can do early interventions: pap smear, colonoscopy

Question 33

Tertiary (Health promotion and levels of prevention)

Answer 33

Third level of prevention
Targets pops experienced disease/injury and focuses on limiting disease and rehab; aim is to keep health probs from getting worse; reduce effects disease and injury and restore indivs to optimal health functioning
Already has disease/disorder/injury preventing from getting worse
EX: teaching insulin admin - already has diabetes and need teach how to manage diabetes; has heart disease/had MI and d/c - sending to cardiac rehab so can prevent heart from getting worse

Question 34

Inequities: distribution of resources

Answer 34

In the U.S., inequities in the distribution of resources pose a threat to the common good and a challenge for community and public health nurses.
Health disparity - preventable difference in the burden of disease injury, violence, and opportunities to achieve optimal health; experienced by socially disadv pops
Factors that contribute to variations in health disparities: edu, income, occupation
Lack of health insurance is a key factor in disparities and a major rationale for health care reform efforts. - also contribts to health disparities; lack insurance damaging to pop health as low income, uninsured indivs much less likely than insured indivs to receive timely primary health care and preventative dental care
Nurses face challenges and dilemmas as they/to assist indivs and fams deal with uneven distribution of health resources and associated costs of health care.

Question 35

Prevention vs cure

Answer 35

Spending money on a cure does little to improve the health of a population - spending additional money for cure in form healthcare services does little to improve the health of a population
Spending money on prevention does a great deal more to improve overall health of a population
Real determinants of health are prevention efforts that provide education, housing, food, a decent minimal income, and safe social and physical environments, as well as encouraging positive lifestyle choices.