Exam 03 Flashcards
What are the 4 strategies/goals of Health For All (HFA21)
- Tackling determinants of health, taking into account physical, economic, social, cultural, and gender perspectives, and ensuring the use of health impact assessment.
- Create health-outcome-driven programs, investing in health development and clinical care
- Integrated family and community oriented primary health care, supported by a flexible and responsive hospital system.
- Create a participatory health development process involving relevant partners for health at home, school, and work at local, community, and country levels; promoting joint decision making, implementation, and accountability.
What are the Eight Millennium Development Goals?
1) Eradicate extreme poverty and hunger
2) Achieve universal primary ed
3) Promote gender equality and empower women
4) reduce child mortality
5) improve maternal health
6) Combat HIV/AIDS, malaria, etc
7) Ensure environmental sustainability
8) Develop a global partnership for development
Three classifications of international health organisations
Multilateral, NGO/Private voluntary, bilateral
Where do multilateral international health organisations receive funding?
from multiple govt and nongovt sources.
What are NGOs/Private voluntary, and their effect on less developed countries?
include most outspoken advocates of issues globally; provide ~20% of external aid to less dev countries
Which are the key MULTILATERAL agencies involved in global health? (3)
WHO: direct and coord international health activities, providing technical medical assistance to countries in need.
UNICEF: assist children in post-WW2 countries in Europe; still fx women + kids <5
World Bank: lends money to less dev to improve health
Which are the key NGO/PRIVATE VOLUNTARY agencies involved in global health? (2)
International Red Cross: seeks permission to enter, health intervention, neutrality
Doctors Without Borders: delivers emergency aid to people affected by war, epidemic, etc; no government approval, speaks out against human rights abuses in countries.
Religious nonprofits and charities: similar to Doctors without Borders
Which are the key BILATERAL agencies involved in global health? (1)
USAID: longterm equitable economic growth, agriculture, trade, global health, democracy, etc. US foreign policy objectives
Global health diplomacy
multilevel, multifactorial negotiation processes involving environment, health, emerging diseases, and human safety
Some issues found in global health diplomacy (4)
access to services, financial barriers
lack of qualified and trianed individuals to use and maintain high-tech devices
loss of total infrastructure d/t war
What are the positive effects of treating illness with global health diplomacy? (4)
reducing production loss from absent workers
increase in use of inaccessible natural resources
increase in children attending school
increase monetary resources
Developed country
countries w stable economy and wide range of industrial and technological development; low child mortality; high gross national income; high human asset index
Less developed country
countries w/o stable economy, small range of industrial and technological development; high child mortality; low gross national income; low human asset index
5 key traits of developed countries
stable economy
wide range of industrial/tech dev
low child mortality
high gross national income
high human asset index (people avail. to work)
What do the Millenium Development Goals highlight?
global responsibility to insert all 8 goals here
What is Health Diplomacy?
multilevel, multifactor negotiation involving enviro, health, emerging disease, human safety.
Health Diplomacy approach?
build CAPACITY for global health diplomacy by
training PH professionals and diplomats
to
prevent imbalances emerging between foreign policy and PH, address imbalances existing in negotiating power/capacity b/t dev and dev countries
Implementation of health technology globally
requires international collaboartion to develop policy frameworks and standards, capacity building in developing countries, and fostering public-private partnerships for innovation and deployment
investments from govts, donors, private sector are crucial for ensuring equitable access to tech
monitoring and evaluation mechanisms track impact and guide future efforts
Types of healthcare systems (5)
universal healthcare
social health insurance
private health insurance
mixed healthcare systems (of 3 above)
out-of-pocket payments
What is GBD?
Global burden of disease
combines losses from premature death and losses of healthy life that result from disability
What is DALY?
disability-adjusted life-years.
Composed of Years Lost to Disability (YLD) and years of life lost (YLL) due to premature mortality.
What components are used to estimate a DALY? (2)
YLD and YLL
You must have age at death and age at disability.
Calculated based on disability weights (0-1), assigned by degree of incapacity, and the potential limit for life
What are the current life expectancy ages for F and M?
F: 82.5 years
M: 80
Why is maternal health central to global economics? (3)
if investments in women lag behind, economic cost of maternal death and illness is enormous
more education and empowerment for women = greater household decision-making power, better-educated children, productive members of society
provide more care for mothers/expecting mothers = less casualties!
Causes of female mortality globally
~75% are due to: hemorrhage, infections, pre/eclampsia, pp complications, unsafe abortion.
women 15-49 are 1/3 of world’s disease burden. these diseases include: maternal mortality/morbidity, cervical cancer, anemia, STIs, osteoarthritis, breast cancer
other issues include violence, gender inequality, and nutritional deficiencies.
Worldwide sociocultural factors that prevent F from getting most out of healthcare (5)
unequal power relationships b/t M/F
social norms decreasing education and paid employment opportunities
exclsuive focus on F reproductive roles
potential/actual experience of physical, sexual, emotional violence
HPV! most common infectious disease globally –> cervical cancer
How does global prevention/eradication occur? (3)
immunisation
improving access to clean water and sanitation
integrated delivery of essential health interventions
What is the 3-pronged scourge of developing countries?
TB, HIV/AIDS, Malaria
How are TB, HIV/AIDS, Malaria transmitted and connected?
TB: airborne. AIDS virus means increase risk of developing TB and transmitting TB, same with malaria.
HIV/AIDS: transmitted via bodily fluid contact
MALARIA: anopheles mosquito
TLDR for connection: if someone is infected with any one of the diseases, they are more prone to the other two.
Primary, secondary, and tertiary prevention for TB/AIDS/Malaria?
1: bCG vaccine; ITNs/avoiding mosquitos; safe sex bx
2: screening for HIV, TB
3: DOT for TB, short-term chemo for smear-positive clients; manage s/sx of HIV, teach clients about care and s/sx mngmt;
TB epidemiological triangle and prevalence areas?
HOST: people living in low-middle income
ENVIRO: homes/enviro of people in risk areas; esp overcrowding
AGENT: Mycobacterium TB
AREA OF PREVALENCE: sub-Saharan Africa, South Asia, parts of Eastern Europe
HIV epidemiological triangle and prevalence areas?
HOST: people engaging in risky sex or needle-sharing
ENVIRO: tropical, dry areas, low-education
AGENT: Human Immunodeficiency Virus
AREA OF PREVALENCE: Southern Africa, Caribbean, SE Asia
Malaria epidemiological triangle and prevalence areas?
HOST: people around anopheles mosquito
ENVIRO: tropical, moist, warm, humid, dense jungle areas
AGENT: Plasmodium falciparum (through the anopheles mosquito)
AREA OF PREVALENCE: Sub-Saharan Africa
What two factors are the highest threat to TB control?
AIDS prevalence
growing multidrug resistance to meds, esp in India, Russia, China
TB tx agents (3)
Isoniazid
Rifampin
BCG vaccine (induces active immunity, protecting against meningitis and disseminated TB; does not prevent primary infection)
Two main types of TB testing
TST/Mantoux test
Interferon-Gamma Release Assays/Quantigeron Gold test
Main risk for TB testing
can yield false positives or negatives
use in conjunction with chest x-rays, sputum (gold standard), molecular tests
ITN
insecticide-treated bed nets
How many people are affected by malaria and how much is spent on prevention yearly approx?
> 50% of world population
~2.7 million USD
Methods of preventing malaria (6)
ITNs,
indoor residual spraying,
intermittent presumptive tx during pregnancy;
mngmt of environment to control mosquitos; health education
early dx and prompt tx with effective antimalarials
epidemic forecasting, prevention, and response
Types of natural disasters (10)
earthquakes, floods, drought, tsunamis, hurricanes, cyclones, volcanic eruptions, pandemics, famines, fires
Types of man-made disasters (5)
bioterrorism, chemical agents, pandemics/epidemics, radiation, terrorism
What are the most serious consequences of disasters? (7)
Mass population displacements
Unsanitary conditions
Lack of clean water
Lack of nutritious foods
Lack of safe housing
Increased risk of diseases in crowded/unsantary conditions
Immediate injury/death
Other less-thought-of consequences of disasters (2)
Local healthcare system being overwhelmed –> inability to provide routine health services.
Cost of rebuilding on poor countries
Advantages for terrorists to use bioterrorism? (2)
Can produce widespread, devastating, tragic consequences, placing heavy demands on healthcare systems.
Attacks with biological agents are more covert d/t difficult to detect, do not cause illness for hrs-days
What is a dirty bomb, and what are the dangers? (5)
Radiological dispersal device (RDD), spreading radioactive material over wide area.
Long-term health risks, enviro contamination!
Psychological impact, disruption to society and economy, targets food/water sources
What are the four tasks of an international surveillance system?
systematic disease intelligence and detection
outbreak verification
immediate alert
rapid response
Cultural competence
entails a combination of culturally congruent bx, practice attitudes, and policies that allow nurses to use interpersonal communication, relationship skills, and bx flexibility to work effectively in cross-cultural situations.
Culture
an integrated pattern of thoughts, beliefs, values, communication, action, customs, and assumptions about life that are widely held among a group of people
share worldviews, meaning, and adaptive behaviour derived from simultaneous membership and participation in a variety of contexts, lens by which we evaluate enviro
Race
biological variation within population groups based on physical markers derived from genetics, such as skin colour, physical features, hair texture.
Ethnicity
shared feelings of people-hood among a group of individuals relating to cultural factors such as beliefs, values, language, traditions, nationality, geographic region, and ancestry
social identity reflecting membership in clan/group creating common history
How is culture transmitted? (3)
Vertical transmission: parents
Horizontal transmission: people in same generation
Oblique transmission: between generations of people who are not related, ie religious, social, educational institutions AND between peers
What are the two categories of cultural behaviour?
Explicit: can be observed, allows individuals to identify with other persons from the culture. ie language, interpersonal distance, kissing in public
Implicit: subtle, may be difficult to describe, yet part of culture. less visible, such as the way individuals perceive health and illness, differences in lang expression, body language, use of titles
Eight primary cultural elements used in cultural assessment
biological, personal space, perception of time, enviro/control, social control, communication, nutritional practices, religion
Cultural diversity
degree of variation represented among populations based on race, ethnicity, lifestyle, place of origin. Includes social class, gender identity, sexual orientation, physical dis/abilities, and the changing populations of the world
Foreign-born
all residents who were not US citizens at birth, regardless of their current legal or citizen status AND/OR those whose parents were not US citizens, carrying nationality of their home country
where do the majority of foreign-born citizens live in the US? (4 states)
California, Texas, New York, Florida
4 categories of foreign born
legal immigrants
refugees
non-immigrants
unauthorized immigrants
what are grounds for seeking asylum/refugee status in the US? (5)
person’s race
religion
nationality
political opinion
or membership in a social group
What are unauthorised immigrants able to access for medical care?
EMS, immunizations, s/sx of communicable diseases, access to school lunches
6 states + Dc provide medicaid to all immigrant children
ineligible for: Medicaip, CHIP, ACA, purchase coverage through Health Insurance Marketplace
Nursing skills with immigrant populations (7)
be self aware
identify preferred language
learn health-seeking bx
get to know the community/culture
get to know traditional practices/remedies and work with them
try to see from POV of client
conduct cultural assessment for health bx
Three guiding modes of action based on compromise between client and nurse
cultural preservation
cultural accommodation
cultural repatterning
What are the five areas of social determinants?
economic instability
education
social environment
health and healthcare
physical environment
Considerations when selecting or using an interpreter (11)
- educational level and socioeconomic status of interpreter
- gender/age
- country of origin, language, dialect
- interpreter’s style, approach to clients, ability to develop trusting relationship
- interprets everything said
- conveys content and spirit w/o omitting/adding
- phrase charts and picture cards available
- observe nonverbal cues of client for fit for responses
- have patient teach-back through interpreter
- interpreter maintains confidentiality
- at end of visit, ensure nothing has been missed or misunderstood
3 principles of cultural competency
- learn about the cultural dimensions of the clients
- understand own bx and how it helps/hinders delivery of competent care
- recognize health can be delviered in variey consistent with health values
Orlandi’s 3 stages of competence development
Address aspects: cognitive, affective, psychomotor + overall effect
Culturally incompetent: oblivious, apathetic, unskilled; destructive
Culturally sensitive: aware, sympathetic, lacking some skills; neutral
Culturally competent: knowledgeable, committed to change, highly skilled; constructive.
Campinha-Bacote’s model of acquiring cultural competence (5 constructs)
cultural awareness
cultural knowledge
cultural skill
cultural encounter
cultural desire
cultural awareness
inward transformative and in-depth exploration of one’s own cultural roots, personal biases, humanity, ethics, and professionalism that have the potential to be in conflict with the value of others
cultural knowledge
having sound educational understanding about culturally diverse groups in the space of the nurse
cultural skill
the ability of nurses to effectively integrate cultural awareness and cultural knowledge when conducting a cultural and physical assessment, using this data to meet the needs of specific clients
cultural encounter
processes that permit nurses to seek opportunities to directly engage in cross-cultural interactions with clients whose culture differs from their own to modify existing beliefs about a specific cultural group and avoid stereotyping
cultural desire
nurse’s willingness to learn about, respect, and work with clients from different bg to provide culturally competent care
cultural encounter vs immersion?
encounters are generally brief, whereas immersion usually involves field work in which nurse works alongside an unfamiliar population of interest to better understand how they live
what are the barriers to cultural competency? (11)
stereotyping, prejudice, discrimination, classism, racism, individual/institutional/cultural, ethnocentrism, cultural blindness, cultural imposition
stereotyping
overgeneralization a/b member of particular category of people
prejudice
emotional manifestation of deeply held beliefs about a group, based on hatred, negativity, preconceived feelings.
discrimination
outward manifestation of thoughts, beliefs, and attitudes put into practice and policies
classism
discrimination based on individual socioeconomic standing
racism
prejudice based on race, can be individual, institutional
cultural discrimination
discrimination by dominant culture towards another cultural group, depicted in a derogatory or stereotyping
ethnocentrism
belief that one’s own culture is superior to all others and determines the standard by which different groups are judged
cultural blindness
inability to recognize the differences between one’s own cultural beliefs, values, and practice + those of the client
cultural imposition
the act of imposing culturally unacceptable and disapproving bx and practices on individuals and groups despite objections
cultural brokering
advocating, mediating, negotiating, intervening b/t client’s culture and biomedical healthcare culture, on behalf of the clients
cultural repatterning
nurse works with clients to help them change/modify cultural practices when harmful to their health
cultural relativism
recognizing clients have different approaches to health and each culture should be judged based on its own merit and not nurse’s personal beliefs
cultural conflict
perceived threat that may arise from misunderstanding expectations
culture shock
feeling of helplessness/ discomfort/ disorientation when client’s values and practices are radically different from own
cultural preservation
nurse supports and facilitates use of scientifically supported cultural practices along with biomedical healthcare system
cultural accommodation
nurse assists, supports, facilitates, enables clients in their use of cultural practice to achieve satisfying healthcare outcomes when such practices are not harmful to clients
what are the three ways nurses can define our environment?
location (home, school, work, etc)
place where environmental degradation takes place (air, water, soil, etc)
divide by environmental exposures (biological, chemical, etc)
primary, secondary, and tertiary prevention for lead exposure in children
1: eliminate lead based paint/dust in home
2: blood lead testing of children in communities with older houses
3: provide care team specialised in lead poisoning knowledgeable with chelating meds, assuring that child returns to lead-safe place
common sources of lead in the home
dust, soil, water in pipes, toys, supplements, dishware, fishing supplies, bullets, residue from parent occupations, hobby materials
what level of lead exposure is considered safe for children?
NONE
effects of lead on children (5)
impairs cognitive development and decreases IQ
behavioural problems and learning disabilities
delays in growth and development
increased risk of ADHD (1 in 5 cases!)
adverse fx on hearing and speech
potential long-term neuro damage
how are race and poverty related to environmental health?
poverty is highly associated w health disparities, environmental exposures. substandard housing, living closer to hazardous sites, working hazardous jobs, poorer nutrition, less access to quality healthcare.
race also associated with higher enviro exposures
environmental justice
poor people and POC experience disproportionate enviro exposures in US and elsewhere, IE lead exposure, pesticides, carbon monoxide exposure
What are the ways to discover a relationship between environmental exposure and potential for harm (toxicity) (3)
human s/sx clearly connected to specific exposure
when enviro exposures occur from contaminated air, water, soil, food, or products leading to health effects
rarer – human environmental epidemiologic studies are performed
What is the more common way of finding toxicity on humans?
extrapolation – toxicologists study effects of chemicals on animals, then use models to estimate effects on humans
toxicology
science of poisonous effects of chemicals
epigenetics
environmental exposure can affect gene expression; reversible, changing how body reads DNA sequence
epidemiology
science understanding the strenght of the associated between exposures and health effects
what is the usefulness of Geographic Information Systems in CH surveillance/research?
provide methodology to use spatially coding data, helping provide a view of geographic health data and make numbers more real to a community
what is the largest non-point source of air pollution?
mobile sources, such as cars and trucks
next largest categories of air pollution
burning of fossil fuels
waste incineration
point sources of air and water pollution
individual, identifiable sources such as smokestacks, pipes, ditches, ships, sewage tx plans
nonpoint sources of air and water pollution
come from more diffuse sources;
storm water runoff from paved roads and parking lots, soil erosion of agricultural lands and from clear-cut tracts of lands for timber/mining, runoff from chemicals added to soil
what is the main concern with indoor air quality in the US?
alarming rise in asthma incidence, esp among children
EPA process of health risk assessment (4 phases)
refers to a process to determine the probability of a health threat associated with an exposure:
- determine if chemical is known to be associated with negative health effects (toxic/epid data)
- determine if chemical has been released into the environment
- estimate how much/by which route of exposure the chemical might enter the human body – can be one time exposure, short term, or lifetime
- characterised the risk assessment process and took into account all three of the previous steps
I PREPARE mnemonic for nursing process for environmental health assessment
Investigate potential exposures
Present work
Residence
Environmental concerns
Past work
Activities
Referrals and resources
Educate
Environmental Risk Reduction actions (3 general, plus a bunch of hospital-based ones)
reduce, reuse, recucle
shift to electronic records, get products with minimum packaging and safest ingredients, use green cleaners, fragrance-free, turn off unused electronic/electric, report leaky plumbing, promote purchase of local sustainably grown foods, start hospital garden
environmental risk communication outrage factor
the emotional response elicited from the public when they perceive a hazard or risk. anger, fear, outrage, lack of trust, uncertainty, perceived injustice. understanding and addressing this is crucial for effective risk communication, as it influences public perceptions, bx, decision-making.
what does early warning do to casualties in a disaster?
reduces injuries and deaths
what is the SNS?
Strategic National Stockpile
CDC-managed program with capacity to provide large quantities of medicine and medical supplies to protect the public in a PH emergency. deployed through a combination of a state level request and the public health system
3 types of preparedness and characteristics
Personal: have disaster kits, important docs, animals, written plans, unification site, practise plan
Professional: aggregate-care approach, increase disaster and emergency training, review community disaster history, understand past effects on healthcare, train
Community: common agenda, coord at all elvels of government, boundary management, strong pre-disaster pepartnership. simplicity and realism + warning system!
6 components of community preparedness
determining the magnitude of the incident
defining the specific health needs of the affected population
establishing priorities and objectives for action
identifying existing and potential PH problems
evaluating capacity of the local response including resources, logistics
determining the external resource needs for priority actions
What does SALT stand for? (Triage)
Sort: can they move to another place on command? Raise hand? assess them last.
Assess: ABCs, cognition. Place in one of 4 categories: minimal, delayed, immediate, expectant (deceased or deceasing)
Lifesaving Interventions: open airway, control hemorrhage, needle decompression of chest, auto-injector antidote
Transport: move victims
What should a nurse’s role be in a disaster?
begin triage immediately
What is triage?
process of separating casualties and allocating treatment on the basis of the individuals’ potential for survival
What are the four triage categories (colours)?
Deceased: black
Immediate: red
Delayed: yellow
Minor: green
Biological agent disaster — how is it response tailored to this?
- identify and rapidly assess affected individuals
- strict isolation and infection control measures
- immediate medical treatment tailored to the specific biological agent
- collaboration with PH authorities for surveillance and containment
- education and communication about agent and preventive measures
- provision of psychosocial support to affected individuals and families
4 phases of disaster reaction (emotional)
Heroic: overwhelming need for people to do whatever they can to help others survive the disaster
Honeymoon; survivors rejoicing that their lives and loved ones have been spared
Disillusionment: occurs as time elapses and people notice additional help and reinforcement are not coming as quickly, fatigue and gloom, exhaustion
Reconstruction: longest, takes time and homes, schools, etc need to be rebuilt. Goal is to reach a new normal.
How do disasters disrupt PH?
Destroying PH infrastructure — water, food supply, sanitation, vector control, access to primary and mental health care
First priority post disaster (infrastructure)
Reestablish sanitary barriers ASAP
Stress rxns in individuals disasters
Trauma can cause moderate to severe stress reactions
Exacerbation of chronic illness
Varies individually
Seek help if needed
What is NIMS
National incident management system
Comprehensive approach to incident management
Covers concepts and principles that provide guidance in management of all types of incidents. Preparedness to recovery regardless of incident size
All hazard framework for government, etc to work together
Role of nurse in shelter management
Ideal managers and team members
Functions: assessment, referral, healthcare needs, first aid, appropriate dietary adjustment, client records, ensuring communications, providing safe environment
Support shelter residents emotionally
Role of alternative care centers in a disaster
May be used to shelter patients with medical needs designed as non ambulatory hospital overflow; care of non ambulatory patients with less intense medical needs
Primary prevention in disaster relief
Promotes health and protects against threat: target well populations.
Participate in community disaster exercises
Assist in developing disaster management plans
Pre identify vulnerable populations
Secondary prevention with disaster relief
Surveys, screening, mitigation
Assess disaster survivors, conduct rapid needs assessment, use individual and pop based triage, psych first aid
Tertiary prevention with disaster relief
Alleviate and restore, stop deterioration or relapse
Ensure community service linkages are available, conduct community outreach, planning efforts for new normal
