Comprehensive Final Flashcards
What is public health?
What society does collectively to assure conditions in which people can be healthy
What is public health nursing?
Developing interventions for individuals, populations, and communities, both locally and from a global perspective
What are the cornerstones of PHN?
Population based Grounded in social justice Focus on greater good Does what others cannot or will not Driven by the science of epidemiology Organizes community resources Long-term commitment to the community
Core functions of PH
Assessment: systematic data collection, analysis, and monitoring
Policy Development: Using scientific knowledge to develop comprehensive PH policies
Assurance: Assuring constituents that public health agencies provide the services necessary to achieve agreed upon goals
What is population?
A collection of individuals who have one or more personal or environmental characteristics in common
(ex: all older adults at risk for falls or Everyone who drinks well water)
What are the 10 essential services of PH?
- Assess and monitor population health status, factors that influence health, and community needs and assets
- Investigate, diagnose, and address health problems and hazards affecting the population
- Communicate effectively to inform and educate people about health, influencing factors, and how to improve it
- Strengthen, support, and mobilize communities and partnerships to improve health
- Create, champion, and implement policies, plans, and laws that impact health
- Utilize legal and regulatory actions designed to improve and protect the public’s health
- Assure an effective system that enables equitable access to the individual services and care needed to be healthy
- Build and support a diverse and skilled public health workforce
- Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement
- Build and maintain a strong organization infrastructure for public health
What is the Socio-Ecological Model/Upstream Approach?
Multiple determinants of health
Population and environmental approach are critical
Links and relationships between levels are crucial
Includes physical environmental factors
Includes social environmental factors
Encompasses neighborhoods, communities, institutions, and policies
What is Healthy People 2030?
10 yr measurable public health objectives
“Vision” = A society in which all people their full potential for health and well-being across the lifespan
“Mission” = To promote and evaluate the nation’s efforts to improve the health and well-being of its people
What are the levels of prevention?
Primary (preventing diseases, seatbelts, helmets)
Secondary (early detection and treatment, screenings)
Tertiary (preventing further complications in people already diagnosed, rehab, support groups)
What is Population Health?
The lifespan, wellness and disease experiences of aggregate groups of people residing in local, state, national, or international geographic regions or those populations with common charcteristics
History of PHN
Lillian Wald = First PHN, Henry Street Settlement
Florence Nightingale = Founder of Modern Nursing, Crimea
Social Determinants of Health = Socioeconomic conditions that influence individual and group differences in health status
What are Upstream SODH?
Factors based on behavior (smoking, diet, drug use etc.)
The Intervention Wheel: Case Finding (a)
The individual level of surveillance, disease, and other health event investigation, outreach, and screening
Intervention Wheel: Surveillance
Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions
Intervention Wheel: Disease and other health investigations
Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures
Intervention Wheel: Outreach
Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained
Intervention Wheel: Screening
Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations
Intervention Wheel: Case Finding (b)
Locates individuals and families with identified risk factors and connects them with resources
Intervention Wheel: Referral and Follow-up
Assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns.
Intervention Wheel: Case Management
Optimizes self-care capabilities of individuals and families and the capacity to of systems and communities to coordinate and provide services
Intervention Wheel: Delegated Functions
Direct care tasks an RN carries out under the authority of a health care practitioner as allowed by the law. DF also include any direct care tasks an RN entrusts to other appropriate personnel to perform.
Intervention Wheel: Health Teaching
Communicates facts, ideas, and skills that change knowledge, attitudes, and values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities
Intervention Wheel: Counseling
Establishes an interpersonal relationship with a community, system, family, or individual intended to increase or enhance their capacity for self-care and coping
Engages the community, system, family, or individual at an emotional level
Intervention Wheel: Consultation
Seeks information and generates optional solutions to perceived problems or issues through interactive problem solving with a community, system, family, or individual. The community, system, family, or individual selects and acts on the option best meeting the cirumstances
Intervention Wheel: Collaboration
Commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health
Intervention Wheel: Coalition Building
Promotes and develops alliances among organizations or constituencies for a common purpose. It builds linkages, solves problems, and/or enhances local leadership to address health concerns
Intervention Wheel: Community Organizing
Helps community groups to identify common problems or goals, mobilizes resources, and develop and implement strategies for reaching the goals they collectively have set.
Intervention Wheel: Advocacy
Pleads someone’s cause or acts on someone’s behalf, with a focus on developing the capacity of the community, system, individual, or family to plead their own cause or act on their own behalf
Intervention Wheel: Social Marketing
Uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest
Intervention Wheel: Policy Development
Places health issues on decision-maker’s agendas, acquires a plan of resolution, and determines needed resources. Policy development results in laws, rules, regulations, ordinances, and policies
Intervention Wheel: Policy Enforcement
Compels others to comply with the laws, rules, regulations, ordinances, and policies created in conjuncture with policy development
What re the Domains of Learning?
Cognitive (Knowledge)
Psychomotor (Skills)
Affective (Attitudes)
What are the steps in planning a health education program?
Reflect and Strategize Identify and Engage Stakeholders Define the Community Collect and Analyze the Data Prioritize Community Health Issues Document and Communicate Results
What is health literacy? What is important to consider?
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
It is important to consider individual, population, and culture/language
How do you assess population?
Collect, analyze, and use data
What are the different approaches/tools to Community Assessment?
Comprehensive Assessment Population-focused Assessment Setting-specific Assessment Problem or Health-issue based Assessment Health Impact Assessment Rapid needs Assessment
What are the steps in doing an assessment?
Assessing Need Setting goals and objectives Developing an intervention Implementing the intervention Evaluating the results
Community Health Assessment and Group Eval (CHANGE) (8)
- Assemble the community
- Develop a team
- Review community sectors
- Gather data from each sector
- Review data and reach consensus
- Enter data
- Analyze data and assign rating to each sector
- Build an action plan
Mobilizing for Action through Planning and Partnerships (MAPP) (6)
- Organizing for success
- Vision
- Performing four assessments
- Identifying strategic issues
- Formulation of goals and strategies
- Action
Community Health Needs Assessment (CHNA)
Must consider input from “persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health”
Community as Partner (Anderson and McFarlane)
Based on nursing process and theories
Emphasizes dynamic nature of community systems as integral to health of residents
Subsystems include: physical environment, health and social services economy, politics and gov, communication, education, and recreation
What are the different program planning models?
PRECEDE/PROCEED (oldest)
Logic Model (5 steps)
PRECEDE/PROCEED
Predisposing Reinforcing and Enabling factors and Causes in Educational Diagnosis and Evaluation
Policy, Regulatory, and Organizational Constructs in Education and Environmental Design
Logic Model
- Resources
- Activities
- Outputs
- Outcomes
- Impact
How can you evaluate a program?
Eval how activities were implemented as they were designed
Eval cost effectiveness
Eval is intervention and program theories were correct
Is the timeline appropriate
Should the program be duplicated or expanded to a new location
What is the focus of primary care?
To keep a person free of disease
Who does primary care serve?
Individuals, families, and communities
What do PHNs do?
Population assessment, assurance of a well-coordinated system, and policy development
What is the Centralized level of the health department?`
5 states use this method.
Operated by state health agency and the PHN functions under the state agency
What is the Decentralized health department level?
NO board of health, operated by the LOCAL government, 27 states use this method
What is the Shared or Mixed system health agency?
16 states use this
Operate under a shared authority of the State, Local, and Board of health
What are PHDs responsible for?
State: Distribute federal and state funds to local public health agencies to implement programs at the community level
Local: Responsibilities vary depending on the locality and are responsible for implementing and enforcing local, state, and federal public health programs to a community
Federal: Programs such as the FDA and CDC (disease control and surveillance, inspection and licensing).
What are the components of the epidemiology triangle?
Host (person)
Agent (organism that caused the disease)
Environment (weather, home, food)
What is the difference between incidence and prevalence?
Incidence = the number of new cases diagnosed in a given period of time divided by the total number at risk in the new population over that same time period and multiplied by a give multiplier
(new cases)/(population x timeframe)
Prevalence = the number of existing cases (numerator) divided by the total number of persons in the population (denominator) multiplying by a given multiplier (total # of cases/total pop)
What are the types of surveillance?
Passive: data collected based on individuals or institutions that report on health info either voluntarily or by mandate.
Active: deployment of public health professionals to identify cases of a disease or health condition under surveillance
Sentinel: reporting of health events by health professionals selected to represent a geographic area of specific reporting group
Syndromic: focuses on one or more sx rather than a physician-diagnosed or laboratory-confirmed disease
When are outbreak investigations conducted?
When a population experiences an unusual increase in a specific disease
Routes of exposure
Chemical
Biological
Physical
What are the types of environmental risks?
Medium: air, water, soil food
Type: chemical, biological, radiation
Setting: rural, urban, suburban
Functional location: home, school. work, community
What are the steps in an environmental assessment?
- Hazard identification
- Dose-response assessment: correlation between an increase in quantity of a substance and an increase in harmful effects
- Exposure assessment: consideration of the level, timing, and extent of the exposure
- Risk characterization
What agency regulates human health and the environment?
EPA (environmental protection agency)
What is a Material Safety Data Sheet (MSDS)
Lists hazardous ingredients of a product and the effect on human health
IPREPARE stands for:
Investigate potential exposure Present work Residence Environmental concerns Past work Activities Referrals and resources Educate
What are health disparities?
Differences in health and healthcare between population groups
Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation
What actions can help reduce health disparities?
Increase cultural awareness
Initiate cultural assessment of population and individual
Promote cultural competence training
Increase diversity of health care staff
Make sure patients receive equitable health care services
Be an advocate
Always use an interpreter, as needed
Recognizes that nurses and other providers can be discriminatory
Health Equity
Highest level health for all
Fairness
Equal opportunities
Health Inequity
Giving everyone the same thing to promote health
Sameness
Does not consider differences and specificities
Health in all policies (HiAP)
Requires different sectors to work together to ensure that people have equal opportunities to achieve the highest level of health
What is Medicare?
Health insurance that covers three groups of people: Those aged 65 and older, people under 65 with certain disabilities, and those of any age with end stage renal disease
What is Medicaid?
Provides financial assistance to states and countries for low-income families with dependent children, low-income older adults, and disabled individuals
Children’s Health Insurance Program (CHIP)
Federal and State partnership that provides coverage for children who live in families that earn incomes too high to qualify for Medicaid but too low to afford private health insurance. Focuses on children up to age 19, pregnant women, and other legal citizens
Women, Infants, and Children (WIC)
Federal grant program that provides nutritional supplements to nutritionally at-risk, low-income, pregnant women until 6 weeks postpartum, breastfeeding mothers until the infant’s 1st birthday, and children up to the age of 5. WIC pays for essential items such as milk, eggs, baby formula, and currently serves 53% of infants born in the U.S.
It also provides education and counseling at WIC clinics and other screenings
Supplemental Nutrition Assistance Program (SNAP)
Aka food stamps, SNAP is administered by the Food and Nutrition Service of the US Dept. of Agriculture. Provides financial assistance for the purchase of food to help recipients maintain a healthy diet; it is the largest program in the domestic hunger safety net. People eligible for TANF and SSI are automatically eligible for SNAP.
Temporary Assistance of Needy Families (TANF)
A cash assistance program generally limited to 60 moths in an adult’s lifetime. Money for this program is a block grant from the federal government that allows flexibility to each state for developing its own program. The purpose is to make TANF temporary by supporting economically needy families. There are work requirements for adults and teen parents must live with their parents and remain in school.
Social Security Disability Insurance (SSDI)
A federal program that provides income benefits to individuals if the disabled person worked past 10 years (40 quarters) to pay social security tax, and is expected to be unable to work for at least 1 year.
Can be temporary or permanent. There is no income restriction.
The Supplemental Security Income (SSI)
A federal supplemental income program funded by general tax revenues. It covers adults and children who have a significant physical or mental disability that has lasted or is suspected to last more that 12 months. Recipients must have limited income level and resources or have not met the work requirements for SSDI. Recipient must remain below the income threshold
Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
Medicaid is jointly financed and administered by federal and state governments. States set their own guidelines for eligibility and services but must include certain federally mandated basic services such as: inpatient and outpatient hospital care, lab and radiology services,, skilled care at home or in a long-term care facility, early periodic screenings diagnosis and tx of those under 21 yo, and family planning services.
Health Policy vs Public Health Policy
Health policy = decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy outlines priorities and the expected roles of diverse groups; it builds a consensus and informs people
Public Health Policy = principles and values that guide authoritative decisions made in government, agencies, or organizations intended to influence population health
How can nurses be involved in advocacy and policy?
Identifying, interpreting, and implementing public health laws, regulations, and policies
Educating the public on relevant laws, regulations, and policies
Affordable Care Act (ACA)
Healthcare reform; Denial of coverage for preexisting conditions was prohibited; Young adults could stay on parent’s insurance until age 26
Tenn Care:
TN’s Medicaid program (for very low income individuals)
Endemic vs pandemic
Endemic = constant presence of disease within a geographic area or a population
Pandemic = Epidemic occurring worldwide and affecting large populations
What is Salmonella?
Bacteria that lives in the intestinal tract of animals (feces)
Causes n/v/d, abdominal pain, fever, chills, body aches, etc.
What is E. coli?
Bacteria from the feces of humans or animals
Causes vomiting, cramps, anorexia, and low fever
Role of the PHN with immunizations
Children should be vaccinated against measles, mumps, rubella, pertussis, and influenza
Educate parents that vaccines are not harmful (do not cause autism)
Cycle of Transmission
Agent —> Reservoir –> Portal of Exit –> Mode of Transmission –> Portal of Entry –> Susceptible Host
Modes of Transmission
Vertical: passing of the infection from parent to offspring via sperm, placenta, milk, or vaginal canal contact at birth
Horizontal: Person-to-person spread of infection through one or more of the following 4 routes: 1. direct/indirect 2. common vehicle 3. airborne 4. vectorborne
Common Vehicle: transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, blood, serum, saliva, or plasma
Vectors: arthropods such as ticks and mosquitoes, or other invertebrates such as snails, that transmit the infectious agent by biting or depositing the infective material near the host.
What puts people at risk for NCDs?
Nutrition
Physical Activity
Tobacco
Alcohol
What are the most common NCDs?
Heart Disease
Cancer
Chronic Respiratory Disease
Diabetes
US Preventive Services Taskforce Recs- What they are, how to use them; (USPSTF)
Releases recommendations for preventive services based on rigorous review of the evidence.
How to use: Go to their website or ask a physician
How to best assess and care for vulnerable populations: Treatment
Roles of the nurse = illness prevention and health promotion
Goals: Should be reasonable, manageable, set with the client
Interventions: should be culturally sensitive and linguistically appropriate/focus is on teaching health promotion and disease prevention
Client Empowerment Comprehensive Services Resources Case Management Evaluation
How to best assess and care for vulnerable populations: Assessment
Socioeconomic resources Physical Health Issues Psychological - stress and coping Lifestyle factors Environmental Factors
How to best assess and care for vulnerable populations: Poverty
The standard of living below which a family lacks the goods and services commonly taken for granted by mainstream society
Higher rates of chronic illness
Higher infant morbidity and mortality
Shorter life expectancy
More complex health problems
More significant complications and physical limitations with higher incomes
Hospitalization rates are 3x more than for persons with higher incomes
How to best assess and care for vulnerable populations: Effects of homelessness on healthcare
Common health problems: upper respiratory disorders, TB, skin disorders, and infestations
Alcoholism, drug abuse, HIV/AIDS, mental illness, hypothermia and heat related illnesses, malnutrition.
Usually only use the ER, do not have access to affordable healthcare, almost all have chronic illnesses
How to best assess and care for vulnerable populations: Those at risk for homelessness
Males, homeless families are increasing, 42% African American, 38% Caucasian, 20% Hispanic, 2% Asian, victims of domestic abuse, veterans, and LGBTQ youth
46% of homeless children are under age 6
How to best assess and care for vulnerable populations: Migrants
Have substandard housing Crowded living quarters Poor nutrition Exposure to pesticides Lack of access to healthcare No ACA
INA protects immigrants and migrants from discrimination
Disaster Triage: what is it for?
EMS, greatest good for the greatest number, mass casualty events
Disaster Management Phases
Preimpact Impact Postimpact Preparedness Response Recovery Mitigation Evaluation
Types of Disasters
Natural
Epidemics
Man-made
Anthrax
Ciprofloxacin for tx
Cutaneous: most common form and is considered least dangerous
Inhalation: considered to be the most deadly form, infection usually develops within a week of exposure
Gastro: has rarely been reported in the US, usually develops 1-7 days after exposure
Injection: Never been reported in the US
How to best assess and care for vulnerable populations: Smallpox
If released, susceptibility is 100% in the unvaccinated and the fatality rate is 20% or higher
WHO does not recommend public vaccination because risk of death or side effects is greater than that of the disease.
How is Smallpox spread?
Direct or prolonged face to face contact is required
Patients become contagious once sores appear in mouth and throat
Lesions develop synchronously
Scabs and fluid contain variola virus
Can be spread through bedding and clothes
CONTACT precautions
Can be spread only by humans
There is no cure
Supportive care only.
