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DUSON Summer '18 > Community Midterm > Flashcards

Community Midterm Flashcards

1
Q

Community Definition

A

5 core elements:

  • Sense of place
  • Common interests and perspectives
  • Sense of identity/cohesion
  • Interpersonal Relationships
  • Diversity (social, economic)

Community should be involved in every step of the nursing process!

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2
Q
  1. Community Assessment
A

Comprehensive evaluation of the community. Engaging the community in collecting, analyzing, and interpreting data on health outcomes and determinants to identify resources to address priority needs. Facilitates better understanding of the community, identify assets, determine community priorities, engage stakeholder, identify potential barriers.

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3
Q
  1. Community Diagnosis
A

Analyse assessment findings, prioritize problems. Diagnosis is of the priority issues.

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4
Q
  1. Planning for Community Health
A

Set SMART goals and objectives. Use a logic model.

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5
Q

Logic model

A

Graphic depiction of connections showing what program will accomplish. A series of “if-then” relationships.

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6
Q

Components of a logic model (4)

A

Situation statement - what is the problem?

Inputs - personnel, $, equipment etc

Outputs - activities, participation

Outcomes - short, medium, long term

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7
Q

The Guide to Preventive Community Services

A

A collection of evidence-based findings of the Community Preventive Services Task Force. Resource to help select interventions to improve health and prevent disease. Reviews intervention approaches for communities.

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8
Q
  1. Implementation
A

What actions or changes will occur. Utilize roles found in Minnesota Wheel to promote health, prevent disease. Need to know: who will carry out changes, when will they happen, for how long, what resources are needed. Plan should be complete, clear, current.

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9
Q
  1. Evaluation
A

Understanding what a program does and how well it does it.

  1. Engage stakeholders
  2. Identify program elements to monitor
  3. Select key evaluation questions
  4. Determine how the information will be gathered
  5. Develop a data analysis and reporting plan
  6. Ensure use and share lessons learned
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10
Q

Formative Evaluation

A

How are we doing? Review of objectives in order to revise, used midway through a project, adapt in real time. (Example: project could also become a business)

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11
Q

Summative Evaluation

A

How can we do better next time? (Example: DARE didn’t do anything about drugs, but promoted relationships between kids and law enforcement)

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12
Q

Public Health definition

A

What we do collectively to assure conditions in which people can be healthy. Mission is to fulfill society’s interest in assuring conditions in which people can be healthy.

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13
Q

Public Health Nursing definition

A

Synthesis of nursing theory and public health theory, applied. Population based, prevents disease and disability, promotes and protects the health of the community.

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14
Q

Quad Council

A

Alliance of 4 national nursing organizations. Sets national policy agenda and provides voice for public health nurses.

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15
Q

Determinants of Health

A

The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

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16
Q

Socioecological Model

A 
Individual
Interpersonal
Organizational
Community
Public Policy
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17
Q

Health Impact Pyramid

A 
Counseling and Education
Clinical Interventions
Long-lasting protective interventions
Changing the context to make default decisions healthy
Socioeconomic factors

(least to most effective)

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18
Q

Levels of Prevention

A
  1. Primary - prevent initial occurrence of disease. Vaccines, hand washing, helmets.
  2. Secondary - early detection of disease and early treatment to limit severity and adverse effects. Screening.
  3. Tertiary - maximize recovery after illness or injury. Rehab, support group, case management
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19
Q

3 Core Public Health Functions

A
  1. Assessment
  2. Policy Development
  3. Assurance
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20
Q

Core Public Health services - Assessment

A
  • Monitor Health Status

- Diagnose and Investigate

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21
Q

Core Public Health services - Policy Development

A
  • Inform, educate, empower
  • Mobilize community partnership
  • Develop policies
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22
Q

Core Public Health services - Assurance

A
  • Enforce laws
  • Link to or provide care
  • Ensure competent health workforce
  • Evaluate effectiveness accessibility of services
  • Research new solutions
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23
Q

Minnesota Wheel - what is it?

A

Evidence based interventions derived from public health nursing.

  • Population based
  • Levels of practice (system, community, individual)
  • Interventions (17)
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24
Q

Population of interest

A

Populations that are essentially healthy but trying to protect/promote health

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25
Q

Population at risk

A

Common identified risk factor or exposure

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26
Q

Population-based means….

A

Focus on entire population, both population at risk and of interest.

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27
Q

5 Components of Population-Based Practice

A
  1. Focused on entire population
  2. Grounded in Assessment of the population health status, determined through a community health assessment
  3. considers broad determinants of health (SES, housing, culture)
  4. Emphasizes all levels of prevention, but mostly primary
  5. Intervenes with communities, systems, individuals, families.
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28
Q

3 Levels off Public Health Practice

A
  1. Individual - change attitudes, beliefs, practices, behaviors of individuals or families
  2. Community - changes in norms, attitudes, awareness, practices, behavior
  3. Systems - changes in organizations, policies, laws. Most effective for lasting impact
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29
Q

Minnesota Wheel Generalities

A

Right side: Individual, family, group (Purple, green, blue)

Left side: Systems and communities (yellow, orange)

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30
Q

Purple

A

Surveillance
Investigation
Outreach
Screening

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31
Q

Green

A

Referral and Follow-up
Case Management
Delegated Functions

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32
Q

Blue

A

Health teaching
Counseling - emotional level
Consultation

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33
Q

Orange

A

Collaboration
Coalition Building
Community Organizing

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34
Q

Yellow

A

Advocacy
Social Marketing
Policy Development & Enforcement

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35
Q

Epidemiology

A

Study of the distribution and determinants of health related states in specified populations, and the application of this study to control health problems.

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36
Q

Epi Triangle

A

Host - Agent - Environment

Vector is in the middle of the triangle. Shows relationships and interrelatedness.

37
Q

Agent

A

Any element or force that is capable of causing disease or injury or disability. Biologic/infectious, physical, chemical, nutritional, psychological

38
Q

Host

A

Any population at risk for developing a disease.

39
Q

Environment

A

Context in which host and agent interact. Biological, social, physical conditions (access to clean water, sanitation, sharing living space with animals)

40
Q

Vector

A

Animate objects that carry agent to susceptible host (animals, insets(

41
Q

Fomites

A

Inanimate objects that can transport microbes.

42
Q

Wheel of Causation

A

Biologic Environment - Social Environment - Physical Environment. All involved with potential infection of host, with genetic core at the center

43
Q

Web of Causation

A

Model that represents multiple causation, de-emphasized role of a single agent. Complex. Looks at antecedents of illness. Helpful for chronic disease, drug use.

44
Q

Natural History

A

Tells us whether we can screen, intervene, or what progression of a disease is over time in the absence of treatment

45
Q

Prepathogenisis

A

Before you get sick. Focus on primary prevention, education, nutrition, sanitattion

46
Q

Pathogenesis

A

Exposure, subclinical, latency and illness. Screening, case finding, early treatment to cure disease or limit disability, prevent spread!

47
Q

Subclinical disease

A

No signs and symptoms, but may be detectable with labs or other screenings

48
Q

Clinical disease

A

Marked by onset of symptoms. Spectrum of disease - mild to fatal.

49
Q

Chain of Transmission

A 
Infectious Agent
Reservoir
Portal of Exit
Mode of Transmission
Portal of Entry
Host
50
Q

Reservoir

A

Any environment in which pathogen lives/grows/multiplies. Human, animal, water, soil.

51
Q

Portal of exit

A

Body fluids, placenta, skin

52
Q

Direct mode of transmission

A

Passed from person to person via droplet, skin to skin, sex

53
Q

Indirect mode of transmission

A

Airborned, vehicles (fomites, water), or vectors (fleas, ticks). Use precaution can break chain of infection - PPE, condoms

54
Q

Incidence rate

A

of new cases a disease that occurs during a specified time period in a population at risk for developing the disease

Denominator is those at risk (ie women for uterine canceR)

55
Q

Prevalence rate

A 
# of affected persons in the population at a specific time/
# of people in a population at the time.

Denominator for prevalence is the whole population, not just the population at risk! Snapshot of a certain point in time.

56
Q

Period Prevalence

A

How many people have the disease at any time during a specified period (year, decade, month).

  • Period prev: have you had asthma during the last 2 years?
  • Point prev: do you currently have asthma?
57
Q

Crude mortality rate

A

Occurrence of death in the entire population.

Total # deaths in a year/
Total midyear population

58
Q

Cause-specific mortality rate

A

Total deaths from a stated cause in one year/

population

59
Q

Age-specific mortality rate

A 
# people dying in age group/
total population in that age group
60
Q

Proportional mortality ratio

A 
# of deaths from a specific cause within a time period/
total deaths in the same time period

(% of all deaths were from that specific cause)

61
Q

Case fatality rate

A 
# of deaths from a specific disease/ 
# of cases of the same disease

Ebola case fatality rate is 90%

62
Q

Attack rate

A 
# of people exposed to a specific agent who develop the disease /
total # of people exposed

(32 people ate crab, 26 got sick)

63
Q

Endemic

A

Habitual presence of disease in a defined geographical area. (Obesity, STI, malaria)

64
Q

Epidemic

A

Occurence in a community or region of a group of illnesses of similar nature, clearly in excess of normal. (aka outbreak - E. coli)

65
Q

Pandemic

A

Widespread, often global

66
Q

Outbreak investigation

A

Establish and verify the diagnosis of reported cases. Identify agent. Search for additional cases, describe and orient the data. Formulate/test hypothesis. Implement control and prevention measures. Communicate findings.

Example: John Snow w/cholera

67
Q

Epidemic Curves

A

Distribution fo the times of onset of the disease, pattern of spread, magnitude, time trend, exposure/incubation period.

Types:
Person to person
1. Propagated

Common source

  1. Point Source
  2. Continuous
  3. Intermittent
68
Q

Point Source

A

Short term, one time exposure. Potato salad at a picnic. One rise, uniform fall

69
Q

Continuous

A

Common source but longer period of exposure, such as contaminated water. People get sick, continue getting sick until source is fixed

70
Q

Intermittent

A

Common source, spread out over time. Many peaks and valleys, but peaks do not get bigger, and stay spread apart

71
Q

Propagated

A

Peaks continue to get bigger. Disease is communicable. Eventually stops because of herd immunity.

72
Q

Attack rates

A 
# of people who got sick /
# of people who were exposed

Aka how many got sick/how many ate crab

73
Q

Screening objectives (2)

A

M1. Primary: detection fo a disease in its early stages to treat it and deter its progression
2. Secondary: reduce cost of disease management by avoiding costly interventions required at later stage

74
Q

Types of screening (3)

A

Mass - entire population

Specific/Targeted - for specific high-risk populations (tb for hospital employees)

Periodic - screen a discrete but well subgroup of the population based on predictable risks or problems (developmental screening for kids, paps)

75
Q

Disadvantages of screenign

A

Not 100% accurate. Cost of false positives are undue worry, stigma, invasive testing, unnecessary treatment. Cost of false negatives are loss of opportunity for early interventions, may engage in risky behavior due to “negative status”

76
Q

Significance

A

Is this disease really a public health concern? how many people affected? Level of threat?

77
Q

Detection

A

Can we screen for this disease? Does it have the correct instruments/technology?

78
Q

Sensitivity

A

Ability of a test to correctly identify true positives.

Poor sensitivity = high false negatives

TP / (TP + FN)

79
Q

Specificity

A

The ability of a test to correctly identify true negatives.

Poor specificity = high false positives

TN = (TN + FP)

80
Q

Ethical principles

A

Autonomy (informed consent)
Beneficence
Non-malefisence
Social justcie

81
Q

Observational studies (4)

A

Cross-sectional
Cohort studies
Case-control studies
Case studies

82
Q

Cross-Sectional Studies

A

Snapshot or cross section. Can’t determine cause and effect. Less time intensive to conduct, good for point prevalence.

83
Q

Cohort Studies

A

Study a population over time, look at exposures and outcomes. Can determine cause and effect! Requireslots of participants, expensive, time consuming because over many years, high dropout rate.

84
Q

Case-Control Studies

A

Work backwards from outcome to suspected cause. Gives information about rare diseases

85
Q

Case Studies

A

In depth analysis of individual, group, or social institution. Small sample size, can’t determine cause and effect

86
Q

Randomized Control Trial

A

Highest level of data. Random allocation, experimental vs control group

87
Q

Quasi-experimental designs

A

No random allocation to groups. Often used for “natural experiments”, sometimes used pre/post intervention.

88
Q

Consistency

A

Same exposures cause same outcome each time

89
Q

Biological plausibility

A

Physiology makes sense

DUSON Summer '18 (8 decks)

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