Exam 1 Flashcards
Colonial period of nursing
informal care, no hospitals
first hospital in the US
pennsylvania hospital
Shattuck report
1st attempt to organize public health in the US
By the massachusetts sanitary commission
Nightingale major contributions
Value of aseptic technique
Nursing research contributions
Nursing education
Kept records and recorded outcomes and stats
Helped soldiers on the battlefield and realized lack of sanitation killed them more than injuries
Wald and brewster
Wald developed a practice for public health nursing
Both developed the henry street settlement
Henry street settlement
Well baby care
Health education
Disease prevention
Treatment of minor illnesses
Sliding scale payments
Lina rogers
Henry street nurse
First NYC school nurse
Did simple treatments
Focused on home visits and providing services like food and clothes
Significant research reducing absenteeism
Made formal protocols for diseases and did documentation of interventions to show that school nurses were effective
Wald and dr lee
Encouraged metropolitan life insurance company to use visiting nurse organizations to provide care for sick policyholders
Mary Beckinridge
Established the frontier nursing service providing nursing care to remote, disadvantaged families in the Kentucky mountains
Quad council
Four national nursing organizations:
ANA
American public health association
Association of state and territorial directors of nursing
They looked to get a voice for public health nursing
American public health association
Established to facilitate interdisciplinary efforts and promote practical application of public hygiene
American red cross rural nursing service
Initiated home nursing care in areas outside larger cities
Sheppard towner act
Expanded community health nursing roles for maternal and child health
Lilian wald
First president of national organization for public health nursing
Population
A collection of individuals who share one or more personal or environmental characteristics
Subpopulation
Subsets of the population who share similar characteristics
Aggregate
A group of people sharing common characteristics or concerns
Typically referred to more as a subpopulation but can also be from a population as a whole
What is public/community health
Scientific discipline including the study of epidemiology, statistics, and assessment
Community health vs public health
Public health: a more generalized focus on health promotion for the population as a whole
Community health: a broader focus on multiple individuals, families, and groups. Care is provided in the community like home, work, or school rather than a hospital
Goal of public and community health
To prevent disease and preserve, promote, restore, and protect health for the community and the population within it
Public health ethic***
The greatest good for the greatest number
Public health core functions
Assessment
Policy development
Assurance
Assessment
Monitor health
Diagnose and investigate
Collect and release data to monitor population health status
Identify community health problems by including community members in assessment
Diagnose and investigate health problems and potential hazards
Use information and translate into education
Policy development
Mobilize community partnerships
Develop policies that support the health of the population
Use evidence to make policy decisions
Inform, educate, and empower about health issues
Foster partnerships to solve health problems
Assurance
Enforce laws
Link to/provide care
Assure competent workforce
Evaluate
Provide community oriented health services
Provide essential health services to EVERYONE
enforce health and safety laws and regulations
Community based vs community oriented
Community based: nurses focus on illness care of individuals and families across the lifespan. Goal is to manage acute and chronic illnesses (like treating a wound for a patient)
Community oriented: focus on healthcare of communities or populations, these people are usually well but have some kind of risk. Goal is to preserve, protect, promote, and maintain health. Focus is health promotion and education, disease prevention, and coordination of services. Example is nurse taking BP screenings determining why the problem exists
Validity
Accuracy
High probability of correct classification of persons tested
Sensitivity: how accurately the test identifies people with condition
Specificity: how accurately the test identifies people without the condition
Reliability
Precision
Results are consistent from place to place, time to time, and person to person
Reliability and validity relationship
Screening tools can be reliable but not valid or reliable and valid but if its not reliable it wont be valid
Healthy people
A comprehensive set of national health goals for the decade
Parish nursing was established by
Granger Westberg
Parish nursing
Faith based nursing
Consists of specialized nurses who respond to health and wellness needs of populations of faith communities and are partners with the church in fulfilling the mission of the faith ministry
Faith communities
Groups of people who gather in churches, cathedrals, synagogues, or mosques and acknowledge common faith traditions
Health ministries
Includes activities and programs in faith communities are organized around health across the lifespan
Promote wholeness in health, emphasize health promotion and disease prevention within the context of linking healing with the person’s faith belief and level of spiritual maturity
Scope and standards of parish nursing
Minimum of BSN with content in community nursing OR masters with specialization in public health, holistic nursing, or mental health nursing
Valid state license
3-5 years professional nursing experience
Evidence of mature faith
Completion of extensive continuing education or designated coursework in parish nursing preparation
Knowledge of health assets in a community
Congregation-based model of parish nursing
Nurse is usually autonomous
Development of parish/health ministry program arises from individual community of faith
Nurse is accountable to congregation and its governing body
Institution-based model of parish nursing
Includes greater collaboration and partnerships
The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions
Main difference between congregational and institutional parish nursing
One is institution governing a body, other is a nurse who is more accountable to themselves and their practice
Roles and responsibilities of a parish nurse
Personal health counselor
Health educator
Liaison
Facilitator
Pastoral care provider
Provider of services to vulnerable populations
Integrator of faith and health
Health advocate
Referral agent
Coordinator of volunteers
Accessing and developing support groups
5 practice models of home care nursing
Population-focused care
Transitional care in the home
Home based primary care
Home health
Hospice
Population focused home care
Directed towards needs of specific groups of people, including those with high-risk health needs
Include structured approaches to regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching
Transitional care in the home
Designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another
These programs facilitate a smooth and coordinated health care experience for clients receiving health services across sites of care
These programs involve assessment, planning, teaching, making referrals, and following up on referrals by nurses at each stage of care to foster independence and self-care
Home based primary care
Emphasis on delivering primary care in the homes of people who have difficulty going to a primary care clinic, community center, or physicians office because of functional or other health problems
Nurses provide health education in addition to primary care services including health assessment, medication management, referrals, case management, and screening for new health problems
Home health nurse requirements
RN with BSN
Palliative care and ?? Care certification for hospice
Scope of practice for home health nurse
Direct care: includes actual physical aspects of care
Indirect care: activities a nurse does on behalf of the client to improve or coordinate care (advocating, making sure doctor comes in, etc)
Home care nurse roles
Clinician
Case manager
Client advocate
Educator
Mentor
Researcher
Administrator
Consultant
What requirements must exist for medicare to pay for home care
Services must be reasonable and necessary
Client must be homebound
Care delivered to the client is skilled care
Services must be intermittent and part time
Plan of care must be entered into specific medicare forms
Skilled care
IV or IM injections
Enteral feedings
NG or trach aspiration
Catheter insertion and care
Treatment of ulcers or skin disorders
Heat treatments
Initial phases of administration of medical gasses
Rehab procedures including related teaching
OASIS
Measures outcomes for quality improvement and client satisfaction with care
Hospice
6 months or less, terminal phase of disease
Treatments are considered futile and cause more damage than good
An interdisciplinary team provides care encompassing the individual patient’s and their family’s holistic needs.
Goal: comfort care through pain and symptom management, psychosocial and spiritual support because curative treatment modalities are no longer beneficial
treatment side effects outweigh the quality of the patient’s end-of-life
What is a terminal illness
Time left is measured in months, not years
Palliative care
For anyone with a serious illness at any stage, the earlier the better
Also known as supportive care
Does NOT replace primary care, it works with them for a more holistic approach
Focus is caring for pain, symptoms, side effects for treatment, and stress, goes in adjunct to curative care modalities
Allows people who are “upstream” of a 6 month or less terminal prognosis to receive services
Nursing care when death is imminent
Most Americans want to die at home, not in a hospital
Help families and patients make decisions about the level of care
Educate about dying
Artificial nutrition and dehydration at EOL
The administration of artificial nutrition and hydration is a medical treatment, and a client can accept or reject it.
If you’re actively dying you can’t metabolize, and that’s painful if we’re feeding them
CPR at EOL
Deciding to put a do not resuscitate or DNR order in place usually involves the client, his or her family, the nurse, the physician, and others on the healthcare team
Educate family about what CPR is really like
Euthanasia and physician assisted suicide
Active euthanasia is the practice of ending the life of a terminally ill client at the request of the client to limit suffering
Death with dignity
A nationwide movement based on the Oregon Death and Dignity Act
Allows terminally ill residents of Oregon to end their lives through the voluntary self-administration of lethal medications prescribed by a physician for that purpose.
Oregon was the first state to pass legislation focusing on aiding in dying for the terminally ill.
Cultural and religious issues at EOL
Sensitivity and empathy are essential when caring for a dying person from a different culture.
Each person is unique, with cultural preferences that influence the specialized needs of the client, the family, and their caregivers
Samuel Williams
publicly advocated using morphine and other drugs for euthanasia
Jack Kevorkian
First assisted suicide
Brittney Maynard
Actually went through with euthanasia
Process for approving euthanasia
Diagnosis, 2 physicians required, first oral request, forms and eligibility, 15+ day wait, 2nd oral request, prescription written
EOL symptoms
A buildup of saliva and oropharyngeal
Changes in respiratory patterns
Skin may appear dusky or gray and feel cold or clammy
Eyes may appear discolored, deeper set, or bruised
Grief vs mourning
Grief—emotion felt after the loss
Mourning—recovery from the loss
Types of pain during dying process
Nociceptive – caused by damage to body tissues and usually described as sharp, aching, or throbbing pain
Two types of nociceptive pain:
Somatic – comes from the skin, muscles, and soft tissue
Visceral – comes from the internal organs (liver metastasis)
Neuropathic – occurs when there is nerve damage (not only from dying, also meds and therapy)
ADA
Americans with disabilities act
Federal legislation requiring schools to make provisions for those with various challenges
Lets more people participate in school
IDEA
Individuals with disabilities education act
Federal law to protect the rights of students with disabilities
Ensures that everyone receives a free, appropriate public education regardless of ability
IEP
plans for education accommodations for disabled children
IHP
plans for the health needs of disabled children in school
American academy of pediatrics says school nurses should
Ensure that children get the health care they need, including emergency care
Ensure that the nurse keeps track of the STATE- required vaccinations (no shots, no school legislation)
Ensure that the nurse carries out the required screening of the children based on STATE law
Ensure that children with health problems can learn in classroom
Credentials of school nurses
be registered nurses with a bachelor’s degree in nursing and special certification in school nursing.
There are no general laws regarding the educational background of school nurses
Immunizations and school
States decide which vaccines are mandated
Nurses in schools should inform parents that if they don’t have health care insurance, they may qualify for programs that provide immunizations free
No shots, no school legislation
The community school model
The future of school nursing - provides a prevention framework linking the community and school.
Collaborative design using resources in a community to provide structured preventive services such as after-school programs, parent outreach, and crisis intervention
Ada Mayo Stewart
1st industrial/occupational nurse, learned languages to help others in the factory and made home visits by bicycle to check on sick and injured workers and their families.
OSHA act
protects workers against personal injury or illness resulting from hazardous working conditions
Occupational nurse responsibilities
Education
Early detection
Restoration of health
Education in occupational nursing
good nutrition, knowledge of health hazards, identifying workplace hazards, and providing information on immunizations, use of protective equipment, smoking cessation, and disaster planning (primary)
Early detection in occupational nursing
through health surveillance and screening, prompt treatment, counseling and referral, and prevention of further limitations (secondary).
Restoration of health in occupational nursing
through rehabilitation strategies and limited duty programs for those injured (tertiary).
epidemiological triangle
infectious agents, susceptible hosts (ppl at risk) and environmental characteristics
Ergonomics
the study of the relationship between people and their working environment
How do host factors affect susceptibility to illness/injury in the workplace
Worker characteristics, such as job inexperience, age, and pregnancy
How do agent factors affect susceptibility to illness/injury in the workplace
Biological agents (viruses, bacteria, fungi, blood-borne, airborne pathogens)
Chemical agents (asbestos, smoke)
Mechanical agents (musculoskeletal or other strains from repetitive motions, poor workstation-worker fit, lifting heavy loads)
Physical agents (temperature extremes, vibrations, noise, radiation, lighting)
Psychological agents (threats to psychological or social well-being resulting in work-related stress, burnout, violence).
How does environment affect susceptibility to illness/injury in the workplace
Physical factors (heat, odor, ventilation, pollution)
Social factors (sanitation, housing conditions, overcrowding, illiteracy)
Psychological factors (addictions, stress).