Community Health Nursing Theories

Question 1

Nightingale’s Theory of Environment Health Belief Model

Answer 1

NIGHTINGALE’S THEORY OF ENVIRONMENT:
+ Focuses on relationship between an individual’s environment and their health.
+ Focus is on PREVENTATIVE CARE (washing hands, clean environment).

HEALTH BELIEF MODEL:
+ Purpose is to predict or explain health behaviors.
+ Emphasizes change at the individual level
+ Assumes a person’s primary motivation in taking positive health actions is to AVOID GETTING A DISEASE.

LIKELIHOOD OF TAKING ACTION IS BASED ON:
+ Modifying variables (age, gender, race, economy, education)
+ Perceived severity and susceptibility of getting the disease
+ Perceived benefits vs barriers of taking action
+ Cues to action (i.e. adviser of doctor, media campaigns)

Question 2

** Who is the client in Community Health Nursing?

Community-Based Nursing vs. Community Oriented Nursing

Answer 2

The COMMUNITY OR POPULATION is the “client” in community health nursing.

COMMUNITY-BASED NURSING: Is focused on ILLNESS CARE (acute or chronic conditions) for INDIVIDUALS AND FAMILIES. Examples: Home Health nurse doing wound care, School nurse administering epilepsy-pen.

COMMUNITY-ORIENTED NURSING: is focused on improving the collective health of the COMMUNITY. Examples: health education and promotion, disease prevention activities. NO Illness care! Community-orie ted nursing=public health nursing.

Question 3

** Community Health Nursing vs. Public Health Nursing

Answer 3

COMMUNITY HEALTH NURSING: delivers health care services to INDIVIDUALS, FAMILIES, AND GROUPS. Includes community-based nursing (illness care for individuals and families) AND community-oriented nursing (community-focused care, with an emphasis on education and disease prevention).

PUBLIC HEALTH NURSING: Disease prevention and health promotion of COMMUNITIES AND POPULATIONS. They are not providing direct care to individuals! Public health nursing=community-oriented nursing.

Question 4

** Ethical Principles in Community Health Nursing

Answer 4

RESPECT FOR AUTONOMY: Respect a patient’s rights to self-determination.

NON-MALEFICIENCE: Do no harm.

BENEFICIENCE: Do what is best (i.e. maximize benefits).

DISTRIBUTIVE JUSTICE: Fair allocation of resources in community.

Question 5

What is Epidemiology?

Components of the Epidemiology Triangle

Answer 5

EPIDEMIOLOGY: Study of spread, transmission, and incidence of disease/injury.

COMPONENTS OF EPIDEMIOLOGY TRIANGLE:
+ AGENT: What is causing the disease (ex: bacteria, toxin, noise)
+ HOST: Human/animal being affected by the disease
+ ENVIRONMENT: Physical environment (water/food supply, geography). Social environment (access to health care, work condition, poverty).

Question 6

Incidence vs. Prevalence

Answer 6

INCIDENCE: Number of NEW cases of disease/injury in a population during a specified time period of time.

PREVALENCE: Number of ALL cases (new and pre-existing) of disease/injury in a population during a specified period of time.

Question 7

Community Health Education: Obstacles, Learning Styles

What is Healthy People 2020?

Answer 7

COMMUNITY HEALTH EDUCATION
+ OBSTACLES: Age, culture, literacy, language barriers, lack of access, lack of motivation.
+ LEARNING STYLES: VISUAL (videos, presentations), AUDITORY (vernal lectures, discussions), TACTILE-KINESTHETIC (hands-on, return demonstration).

HEALTHY PEOPLE 2020: includes national health goals based on major risks to health and illness of U.S. population (examples: Diabetes, Cancer, Older Adults, LGBT health). See website for complete list.

Question 8

** Primary vs. Secondary vs. Tertiary Prevention

Answer 8

PRIMARY PREVENTION: PREVENTS INITIAL OCCURRENCE of disease.
+ Examples: education, immunizations, prenatal classes.

SECONDARY PREVENTION: Focuses on EARLY DETECTION of disease, limiting severity of disease.
+ Examples: screenings disease surveillance, control of outbreaks.

TERTIARY PREVENTION: Maximize recovery AFTER and injury/illness.
+ Examples: rehabilitation, PT/OT, support groups.

Question 9

What is acculturation?
What is ethnocentrism?
Components of Cultural assessment
Use of Interpreter

Answer 9

ACCULTURATION: Adopting the traits of a different culture.

ETHNOCENTRISM: The belief that one’s own culture is superior to all others. View world from their own cultural viewpoint.

CULTURE ASSESSMENT: Ask about patient’s ethnic background, religious preference, family structure, food patterns, and health practices. Incorporate patient preferences into care whenever possible.

INTERPRETER: Use of family members is NOT recommended, interpreters need to have knowledge of health terminology. Patient teaching materials should be available in their primary language.

Question 10

Environmental Risks (3 main risks)
Environmental Assessment Questions

Answer 10

ENVIRONMENTAL RISKS:
+ TOXINS (examples: lead, pesticides, asbestos, radon)
+ AIR POLLUTION (examples: carbon monoxide, tobacco smoke, lead)
+ WATER POLLUTION (examples: waste produces, chemical runoff from soil)

ENVIRONMENTAL ASSESSMENT QUESTIONS:
+ Condition of housing. Remodeling activities?
+ Water heater temperature less than 120 DEGREES FARENHEIT?
+ Occupation (including exposure to chemicals, toxins)?
+ Tobacco smoke present in home?
+ Quality of drinking water?

Question 11

Lead Exposure key points

Answer 11

PRE-1978 HOUSING AT RISK FOR LEAD-BASED PAINT!
+ Screen children 6 months -5 years for blood lead levels
+ Avoid playing in soil right outside home
+ Wet mop floors (vs. vacuuming floors)
+ Use wet sanding technique (vs. dry sanding)
+ Make sure children get enough iron and calcium in diet, as this decreases absorption of lead in the body.
+ Use cold water (vs. hot water) because lead dissolves more quickly in hot water.

Question 12

Medicare: Who is eligible? Parts A, B, C, D

Medicaid: Who is eligible?

Answer 12

MEDICARE ELIGIBILITY:
+ Older than 65 years
+ Receiving disability for at least 2 years
+ Diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-stage Renal disease (ESRD) and receiving dialysis.

PART A: Inpatient hospital, limited SNF, home health care
PART B: Outpatient care, diagnostic services, PT/OT
PART C: Combines Part A and B, provided through private insurance
PART D: Prescription drug coverage (D is for Drug)

MEDICAID ELIGIBILITY: Those with low socioeconomic status and no other insurance, based on household size and income.

Question 13

Responsibilities of:
+ State Department of Health
+ State Board of Nursing
+ Local Health Department

Answer 13

STATE DEPARTMENT OF HEALTH: manages WIC program, CHIP, Medicaid program. Reports notifiable communicable disease to CDC (voluntary).

STATE BOARD OF NURSING: Licenses LPNs and RNs, oversees state schools of nursing, develops state’s nurse practice act.

LOCAL HEALTH DEPARTMENT: Meets health needs of community. Reports notifiable communicable diseases to State Department of Health.

Question 14

Parts of a Community Assessment:
+ People
+ Environment

Answer 14

PEOPLE:
+ Demographics
+ Biological factors (race, age, gender, health/disease status)
+ Social factors (education, income, crime rate)
+ Cultural factors (history, religion, customs)

ENVIRONMENT
+ Physical factors (geography, housing, location of health care services)
_ Environmental factors (climate, pollutants, topography).

Question 15

Types of data collection in Community Nursing

Answer 15

INFORMANT INTERVIEWS: direct conversations with member of community.

COMMUNITY FORUM: public meeting (participation challenges).

SECONDARY DATA: review existing data available (statistics, health records).

PARTICIPANT OBSERVATION: observe community activities.

WINDSHIED SURVEY: literally drive through community and make observations.

FOCUS GROUPS: meet with representative sample of community.

SURVEYS: written format (expensive, low response rate)

Question 16

** Windshield Survey: What are you looking for?

Answer 16

PEOPLE: General appearance, ethnicity/race of community members. Signs of violence? Mental illness? Drug abuse?

PLACE: Quality of housing, access to health care facilities, types and availability of grocery stores, public transportation, presence of schools, parks, and churches.

Question 17

** Steps in developing and managing a Community Health Plan

Answer 17

PRE-PLANNING: Brainstorm ideas

ASSESSMENT: Data collection

DIAGNOSIS: Analyze collected data to determine health needs of the community. Set priorities.

PLANNING: Plan interventions. Establish goals, identify responsibilities, develop budget.

IMPLEMENTATION: Execute plan

EVALUATION: Determine effectiveness of intervention

Question 18

Home Health Nurse: Where do they work? What do they do?

Answer 18

+ Provides health care in patient’s home and assisted living facilities (including nursing homes).
+ Provides patient education, direct nursing care, and CARE COORDINATION (including referrals).
+ Assesses home for safety. Key items to look for: NO SCATTER RUGS (carpet OK), no clutter, adequate lighting on stairs (use of colored tape on step edges is helpful). For Alzheimer’s patients, locks/alarms on exit doors are appropriate.

Question 19

Hospice Nurses: What do they do?

Parish Nurses: What do they do?

Answer 19

HOSPICE NURSE: Provides palliative care (focus on SYMPTOM MANAGEMENT, not curing disease), supports patient and family with dying process

PARISH NURSE: Works w/pastoral staff to improve the health and wellness of the faith community. Provides health education and facilitates support groups. Does NOT do bedside nursing tasks.

Question 20

Occupational Health Nurse: What do they do?

** Primary, Secondary, Tertiary prevention interventions

Answer 20

+ Promotes health and wellness of employees, prevents workplace illness and injury.
+ Through surveillance, identifies risks within work environment. Identifies ways to decrease or eliminate workplace hazards.
+ Keeps informed about OSHA standards.

PRIMARY PREVENTION: provides safety education
SECONDARY PREVENTION: performs screenings.
TERTIARY PREVENTION: sets up limited-duty programs

Question 21

School Nurse: What do they do?

** Primary, Secondary, Tertiary prevention interventions

Answer 21

+ Provides direct nursing care to children at school
+ Provides health education
+ Case manager for children w/health needs (makes referrals, schedules appointments, coordinates services)

PRIMARY PREVENTION: Assesses immunization status of children
SECONDARY PREVENTION: Provides vision and hearing screening, screens for oral health, scoliosis, infestations. Assesses for child abuse/neglect.
TERTIARY PREVENTION: Administers medications, provides nursing care for children with chronic diseases, assesses children with disabilities.

Question 22

Key health concerns for: Children, Adolescents, Women, Men, Older Adults

Answer 22

INFANTS/CHILDREN: SIDS (sleep on back), injuries (wear helmets and seat belts), communicable diseases (get immunizations).

ADOLESCENTS: MOTOR VEHICLE ACCIDENTS (WEAR SEATBELTS), substance abuse (including smoking), safe sex, mental health.

WOMEN: Menopause, OSTEOPOROSIS (ENCOURAGE WEIGHT BEARING EXERCISE), heart disease, diabetes, cancer prevention (get mammograms, pap smears).

MEN: Heart disease, cancer prevention (GET PROSTATE CANCER SCREENING, testicular self exams), lung disease, liver sides.

OLDER ADULTS: Heart disease, CVAs, COPD, pneumonia, polypharmacy, cancer, injury prevention (including falls)>

Question 23

Families: What are transitions? Impact on family? What are genograms? What are eco maps?

Answer 23

TRANSITIONS: Includes birth or adoption of child, death in family, major illness, divorce, loss of income, etc. TRANSITIONS = TIME OF RISK FOR FAMILY.

GENOGRAMS: Graphical representation of relationships within the family, patterns of illness (i.e. “enhanced” family tree).

ECOMAPS: Graphical representation of family interaction with outside groups/organizations, which provides information about the family’s support network,.

Question 24

Types of Violence

Answer 24

HOMICIDE: often related to drug abuse, usually victim is someone known to perpetrator. Males at higher risk.

RAPE: intimate partner violence very common; often unreported.

SUICIDE: highest in men, and those OVER 65 YEARS OLD.

ABUSE: physical abuse, sexual abuse, emotional abuse (i.e. humiliation, intimidation), neglect (i.e. failure to provide food, shelter, emotional care, medical care, education), economic abuse (ie. misuse of money, failure to provide for needs of victim despite adequate funds, theft).

Question 25

Community Factors that increase risk of violence

Child Abuse: Signs of Child Abuse and Neglect

Answer 25

COMMUNITY FACTORS THAT INCREASE RISK OF VIOLENCE: Unemployment, poverty, social isolation. Child abuse is more common when spousal abuse is present.

SIGNS OF CHILD ABUSE: PRESENCE OF WOUNDS OR INJURIES IN VARIOUS STATES OF HEALING, unexplained bruises/injuries, unusual fear of others, small round burns that could be cause by cigarettes, forearm spiral fractures.

SIGNS OF CHILD NEGLECT: poor hygiene, inappropriate dress (for weather), signs of malnourishment withdrawal, school absences.

Question 26

Alcohol Abuse:
+ Factors that impact metabolism of alcohol
+ Alcohol withdrawal timing, symptoms
+ Primary vs. Secondary vx. Tertiary prevention interventions

Answer 26

FACTORS THAT AFFECT ALCOHOL METABOLISM: Size/weight of drinker, time elapsed while drinking, gender, presence of food in stomach.

ALCOHOL WITHDRAWAL: MANIFESTATIONS APPEAR WITHIN 4-12 HOURS. Symptoms include: tachycardia, hypertension, N/V, headache, anxiety/irritability, diaphoresis, tremors, seizures. It is important to ask patient when their last drink was!

PRIMARY PREVENTION: public education campaigns, school education.

SECONDARY PREVENTION: Screen individuals for signs of abuse.

TERTIARY PREVENTION: Refer patients to AA or NA, promote coping and lifestyle changes.

Question 27

HOMELESSNESS: Fastest growing segment? Risk Factors? Key health issues in homeless population? VETERANS: Key health issues

Answer 27

HOMELESSNESS:
+ FAST GROWING SEGMENT: FAMILIES WITH CHILDREN
+ RISK FACTORS: unemployment, migrant workers, veterans, mental illness, substance abuse, HIV/AIDs, at-risk youth.
+ KEY HEALTH ISSUES: tuberculosis, infestations (scabies/lice), substance abuse, HIV/AID, mental illness.

KEY HEALTH ISSUES OF VETERANS: mental health issues (PTSD, depression), substance abuse, suicide, traumatic brain injury, spinal cord injury, amputations.

Question 28

Migrant Workers:
+ Key health risks
+ Primary vs. Secondary vs. Tertiary prevention interventions

Answer 28

KEY HEALTH RISKS: Tuberculosis, dental disease, skin cancer, diabetes, obesity, high risk of suicide, increased work-related injuries (exposure to pesticides, injuries from machinery).

PRIMARY PREVENTION: Education on reducing exposure to pesticides, accident prevention. Preventative care (immunizations, dental care).

SECONDARY PREVENTION: Screen for skin cancer, pesticide exposure, communicable diseases.

TERTIARY PREVENTION: Provide ER or primary care services including treatment of symptoms of pesticide exposure.

Question 29

** Communicable Diseases: Modes of transmission

Airborne, Food-borne, Vector-borne, Sexually transmitted, Direct contact, Saliva

Answer 29

AIRBORNE: chickenpox, measles, tuberculosis, pertussis, influenza

FOODBORNE: salmonella, hepatitis A (fecal-oral route), E-coli, botulism

WATERBORNE: cholera, typhoid fever

VECTOR-BORNE: (ex: mosquito or tick) lyme disease, malaria, Rocky Mountain spotted fever

SEXUALLY TRANSMITTED: HIV, HEP B/C/C, SYPHILLIS, HPV, gonorrhea

DIRECT CONTACT: lice, scabies, impetigo

SALIVA: mononucleosis

Question 30

** Immunity: What is Herd Immunity?

Types of Immunity: Active natural, Active artificial, Passive natural, Passive artificial

Answer 30

HERD IMMUNITY: Most community members have immunity, protecting those who can’t (or choose not to get) immunized. Makes exposure unlikely.

ACTIVE NATURAL IMMUNITY: Body produces antibodies in response to exposure to live pathogen.

ACTIVE ARTIFICIAL IMMUNITY: Body produces antibodies in response to vaccine.

PASSIVE NATURAL IMMUNITY: Antibodies are passed from the mom to her baby through the placenta or breast milk.

PASSIVE ARTIFICIAL IMMUNITY: Immunoglobulins are administered to an individual after they have been exposed to a pathogen.

Question 31

• • Communicable Diseases: Reporting requirements

* *. Primary vs. Secondary vs. Tertiary prevention

Answer 31

Communicable disease reporting is mandated by state and local regulations. State notification to CDC is voluntary.

PRIMARY PREVENTION: provide education re: immunizations, hand hygiene, proper food handling, risk of infectious diseases when traveling to other countries (including Hepatitis A).

SECONDARY PREVENTION: provide screening, quarantine patients when needed, refer suspected cases for definitive diagnosis.

TERTIARY PREVENTION: monitor treatment compliance (may requires direct observation therapy).

Question 32

Nationally Notifiable Diseases

Key points about: Lyme disease, Meningococcal disease, Pertussis, Tuberculosis

Answer 32

LYME DISEASE: Key symptom is red bullseye ring around the area of the tick bite.

MENINGOCOCCAL DISEASE: individuals should get vaccinated prior to living in a crowded housing environment (college dorms, prisons, military house).

PERTUSSIS: Children w/pertussis should stay home from school until coughing is gone. Family members and those exposed should be treated with antimicrobials. Check immunizations status of other children in school.

TB: Treated with up to 4 antibiotics (to prevent drug resistance) for 6-12 months. Family members need to be tested for TB. Sputum samples will be needed every 2-4 weeks - patients are no longer infectious after three negative sputum cultures. Patients with active TB need to wear N95 masks in public.

Question 33

Disaster Management:

+ Four levels: What is included?

Answer 33

DISASTER PREVENTION: Surveillance, inspections, immunizations, education, risk assessment.

DISASTER PREPAREDNESS: Create disaster action plan, identify evacuation routes, create disaster kit, identify meting place and communication plan, PERFORM DISASTER DRILLS.

DISASTER RESPONSE: Assess extent of disaster. Perform triage, and direct those affected. Coordinate evacuations, quarantines.

DISASTER RECOVERY; Begins when danger no longer exists. Coordinate care in shelters, homes.

Question 34

Bioterrorism: Category A, B, C diseases
Inhaled anthrax: Symptoms, intervention for exposure
Smallpox: Symptoms, prevention

Answer 34

CATEGORY A: smallpox, botulism, anthrax, plague
CATEGORY B: typhus, cholera
CATEGORY C: hantavirus

INHALED ANTHRAX: Symptoms: severe dyspnea, fever, shock, muscle aches. Intervention: IV Ciprofloxacin for those exposed (or have a high risk of exposure).

SMALLPOX: Symptoms: RASH (begins on FACE and spreads down), high fever, headache, vomiting. Prevention: vaccination.

Question 35

Consultations vs. Referrals

Answer 35

CONSULTATION: Request from provider to another physician or resource who can provide expert advice and/or services for the patient.

REFERRAL: Provider requests or recommends management of one or more of the patients concerns/issues to another provider or for support services (ex: support groups, churches, transportation services, m meal delivery services).

Question 36

** Care Mangement: Responsibilities

Answer 36

+ Help the patient transition from acute to community-based care.
+ Evaluate patients medical needs, psychosocial issues, financial constraints.
+ Collaborate with patient, family, insurance companies health care providers, medical services/equipment providers to meet the health care needs of the patient.
+ Facilitate discussion of patient’s needs with an interprofessional team.
+ Provide referrals as needed.

Question 37

What is Informatics?
What is Telehealth?
** Nursing Roles in Health Policy

Answer 37

INFORMATICS: Incorporates nursing, information technology, and communication technology to develop and to support nursing practice and improve patient outcomes.

TELEHEALTH: Delivery of health care through technology (vs. in person). This is particularly helpful in rural areas, where there is a lack of specialty care services.

NURSING ROLES IN HEALTH POLICY: Nurses can act as an ADVOCATE for changes in health policy, lobby legislators, serve in public office, or help form coalitions (collaboration of groups to achieve a goal).