Exam 1 Flashcards
5 Core elements of community
Locus: Sense of place
Sharing: common interests and perspectives
Joint action: a sense of identity and cohesion
Social ties: interpersonal relationships
Diversity: social complexity; communities within communities (not ethnic distinctions)
Public Health vs Community health
PH: Programs and policy - guidance at “political” level (local, regional, national, international)
CH: Where prevention and intervention actually happen
Community assessment
A process of engaging the community in the collection, analysis, and interpretation
community participation is essential
How is the nursing process utilized in community health nursing
A: Collect data about the health of a community/pop
D: Analyze the assessment findings and prioritize the problems
P: Set goals and objectives
I: Utilize roles found in Minnesota wheel to promote health, prevent disease..
E: Did we meet our objectives? What next?
Why do we do a community assessment
- Gain deeper understanding
- Identify assets and key collaborators
- Determine priorities
- Engage stakeholders and gain support/trust
- Identify potential barriers
- Guide program interventions
Who should participate in a community assessment
Stakeholders (health and human services providers, government officials, businesses, influential people), nurses/nursing students, community
Components that should be included in a community assessment
- Obtain data (gathering/generation)
- Determine priority needs
- Identify assets/resources
- Define scope of project
- Articulate expected outcomes
Public health
“What we do collectively to assure the conditions in which people can be healthy” (IOM)
“Science of protecting and improving the health of people and their communities; achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting/responding to/preventing infectious disease” (CDC)
Public health nursing
Synthesis of nursing theory and public health theory applied to promoting and preserving health of populations
- Population based/community as a whole
Quad Council
- Public health nursing section of the American Public Health Association
- Association of State and Territorial Directors of PHN
- Association of Community Health Nurse Educators
- National Association of School Nurses
Components of population based practice
- Focus on entire population
- Grounded in ADPIE
- Considers broad determinants of health
- Emphasizes all levels of prevention
- Intervenes with communities, systems, individuals, families
Explain how the social ecological model and health impact pyramid serve as frameworks for working in public health
Social ecological model: 5 levels, can guide us to know who we can intervene with and at what different levels (Multi-level intervention has higher impact)
Health impact pyramid: to increase population impact, need to focus at the bottom of the pyramid, but important to work at multiple levels of the pyramid.
- Top: Clinical interventions and counseling/education (limited impact)
- 2nd: Long-lasting protective interventions (vaccines, etc. - need individual effort)
- 3rd: Changing the context to make individuals’ default decisions healthy (Ie. vending machines with healthy foods in school)
- Bottom: Changing socioeconomic factors
3 core public health functions
Assessment
- Monitor health status to ID community health problems
- Dx and investigate health problems and health hazards in community
Policy Development
- Inform, educate, empower people about health issues
- Mobilize community partnerships to identify and solve health problems
- Develop policies and plans that support individual and community efforts
Assurance
- Enforce laws and regulations that protect health and ensure safety
- Link people to needed personal health services
- Ensure a competent public health and personal health workforce
- Evaluate effectiveness, accessibility, and quality of personal and population based health services
- research new insights and innovate solutions to health problems
List and define levels of prevention
Primary: prevention of initial occurrence of disease and illness
Vaccinations, good hand hygiene, wearing helmets, genetic counseling
Secondary: Early detection of diseases and treatments with goal of limiting severity and adverse events
- Screening, early recognition, early treatment
Tertiary: Maximization of recovery after an illness or injury
- Rehab, support groups, case management
Understand the objectives of screening
Primary: detection of a disease in its early stages in order to treat it and deter its progression
Secondary: Reduce cost of disease management by avoiding costly interventions required at later stages
Differentiate the types of screening
Mass: applied to entire population (eg. cholesterol screening at health fair)
Selective (targeted): performed for specific high-risk populations (e.g. TB skin tests for hospital employees)
Periodic: Screen a discrete but well subgroup of the population on a regular basis over time for predictable risk or problems (eg. cervical cancer screening)
Discuss the advantages and disadvantages of screening
Advantages:
- Simplicity (for some screenings)
- Target individuals or groups
- Options of one-test or multiple-test screening
- Opportunity for health education
Disadvantages
- Not 100% accurate
- False positives and negatives
understand the limitations and implications of screening
False Positives
- Undue stress/worry/stigma, more invasive testing, unnecessary treatment
False Negative
- Engage in risky behavior because of false negative status
- lose opportunity for early intervention
Define sensitivity and specificity and how that relates to false positive and false negative results
Sensitivity: Ability of a test to correctly identify people who have the condition (True positives; poor sensitivity = increased false negatives)
Specificity: Ability of a test to correctly identify people who do not have the condition (True negatives; poor specificity = increased false positives)
Calculate sensitivity and specificity
Sensitivity = TP/(TP+FN)
Aka: True positive test results/Total people who actually have the disease
Specificity = TN/(TN+FP)
aka: true negative test results/Total people who actually do not have the disease
Differentiate between population of interest and population at risk **Look up in notes
Population-of-interest:
A population essentially healthy but who could improve factors that promote or protect health.
Population-at-risk:
A population with a common identified risk factor or risk-exposure that poses a threat to health
Describe three levels of PH practice
Individual-focused: - Changes in knowledge, attitudes, beliefs, practices, and behaviors of individuals. Directed as individuals, alone, or as part of a family, class or group
Community-focused
- Changes in community norms, attitudes, awareness, practices, and behavior
Systems-focused
- Changes in organizations, policies, laws, and power structures. Often more effective and long-lasting way to impact population health
Exceptions:
- Case finding = individual level only
- Community organizing and coalition building cannot occur at the individual level, only at the community/system level
Explain the components within population based practice
- Focused on an entire population (at risk or of interest)
- Grounded in assessment of health status
- Considers broad determinants of health
- Emphasize all levels of prevention
- Intervenes with communities, systems, individuals, and families
Develop a basic understanding of how the Minnesota wheel was developed and is used in practice **Look up
- Grouped together by similarities
- Right side: primarily individual, families, groups
- left side: primarily systems and community
- Usually work in more than one wedge at a time
Surveillance
Describe and monitor health events through ongoing and systematic collection, analysis, and interpretation of health data
- Describe and monitor health events
Investigation
Systematically gather and analyze data regarding threats to health of population
- Gather and analyze data
Outreach
Locates populations of interest or risk and provide information
Screening
Identify individuals with unrecognized health risk factors or asymptomatic disease conditions
Case finding
Surveillance, Investigation, Outreach, or screening done at an individual level of practice
Referral and follow up
Assist individuals, families, groups, organizations, communities to identify and assess necessary resources
Case management
Optimizes self-care capabilities of individuals and families and capacity of systems and communities to coordinate and provide services
Delegated functions
Direct care tasks an RN carries out under authority of a health care practitioner as allowed by law
Health Teaching
Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities
Counseling
Establishes an interpersonal relationship with a community, a system, family, or individual intended to increase or enhance their capacity for self-care and coping.
- Increase/enhance capacity for self-care and coping
Collaboration
Commits two or more persons or organizations to achieve a common goal
Coalition building
promotes and develops alliances among organizations or constituencies for a common purpose. Linkages, solves problems, enhances local leadership
Community organizing
Helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies to meet goals
Advocacy
Pleads someones cause or acts on someone’s behalf, with a focus on developing the capacity or the community, system, or individual or family
Social marketing
Utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices.
Policy development and enforcement
Places health issues on agendas. Results in laws, rules, regulation, ordinances, and policies. Compels others to comply with them.
Discuss the role of the nurse in the policy process
- Impact quality of life and universal access to care
- Capacity and responsibility to influence current and future healthcare delivery systems
Describe the role of professional health and nursing organizations as it relates to advocacy and policy
- Define and integrate appropriate standards for delivery of care
- Impact resource allocation to support delivery of healthcare
3 Basic principles of ethics
Autonomy: Agreement to respect another’s right to self-determine a course of action (independent decision making)
Beneficence: compassion; taking positive action to help others; desire to do good (Core priniciple of patient advocacy
Non-maleficence: Avoidance of harm or hurt (core of medical oath and nursing ethics)
Social justice
Upholding concepts of fairness and equity; equal access to care
Code of Ethics Provision 1
Compassion and respect for the inherent dignity, worth, and uniqueness of every individual
Code of Ethics Provision 2
Primary commitment is to the patient, whether individual, family, group, or community
Code of Ethics Provision 3
Protect the health, safety, and rights of the patient
Code of Ethics Provision 4
Responsible and accountable for individual nursing practice/determines the appropriate delegation of tasks for optimum care
Code of Ethics Provision 5
Same duty to self as to others (including preservation of integrity/safety, maintenance of competence, and continuation of personal and professional growth)
Code of Ethics Provision 6
Establish, maintain, and improve health care environments and conditions of employment through individual and collective action
Code of Ethics Provision 7
Participate in the advancement of the profession
Code of Ethics Provision 8
Collaborates with other health professionals and the public in promoting efforts to meet health needs
Code of Ethics Provision 9
Articulating nursing values, maintaining the integrity of the profession and its practice, and for shaping social policy
What is a logic model
- A depiction of a program showing what the program will do and what is to accomplish
- A series of “if-then” relationships that, if implemented as intended, lead to the desired outcomes
- The core of program planning and evaluation
“Inputs (program investment) –> outputs (activities/participation)–> outcomes (short, medium, long term)”
Program planning (Implementation)
What actions or changes will occur
Who will carry out these changes
By when they will take place and for how long
What resources are needed
Communication
Plan should be complete, clear, and current
Evaluation
“A systematic process to understand what a program does and how well the program does it”
Can be either formative or summative depending on the stage your program is in and what you want to know
6 steps:
- Engage stakeholders
- Identify program elements to monitor
- Select key evaluation questions
- Determine how the information will be gathered
- Develop a data analysis and reporting plan
- Ensure use and share lessons learned
Formative vs summative evaluation
Formative:
- Before program begins (needs assessment, to what extent is the need being met/what can be done to address this need?)
- New program (Process/implementation evaluation; is the program operating as planned?)
Summative:
- Established program (Outcome evaluation; is the program achieving its objectives?)
- Mature program (Impact evaluation; What predicted and unpredicted impacts has the program had?)
Observational - Cross-sectional studies
- Snapshot or cross section
- Example: BRFSS
- Used to help establish relationships, but unable to definitely establish cause and effect
- Important to have a representative sample
- Limitations?
Observational - cohort (prospective)
- Observational, analytical
- Study a population and look at exposure and outcomes
- Examples: Framingham Heart Study and Nurses study
- Requires a lot of participation to see correlations
- Allows determination of cause and effect
- Limitations?
Observational - Case-control (retrospective)
- Work backward from outcome to a suspected cause
- Compares a group with a health problem to another matched group that does not have the health problem
- Uncertainty about temporal relationship
- Limitations?
Observational - Case study
- Descriptive, observational
- In depth analysis of individual, group, or social institution
- Example: identified common risk factors with men who presented with Kaposi’s sarcoma and Pneumocystis carnii pneumonia
- Limitations?
Experimental RCT
- Random allocation of experimental group vs control
- Time 1 measures baseline
- Time 2 measures outcomes
Experimental - Quasi
- No random allocation to groups
- Often used for ‘natural experiments’ (eg. mental health appointments after an earthquake)
- Sometimes used for pre/post after an intervention (eg. medical respite)
Causality/Causal inference
- Strength of association
- Consistency
- Biological plausibility
- Correct temporal sequence
- Dose-response relationship
Define and calculate Incidence
Number of new cases of a disease that occurs during a specific period in a population at risk for developing the disease
(accounts for men/women specific; ex. cervical vs prostate cancer)
Define and calculate Prevalence (point and period)
Number of affected persons in the population at a specific time divided by the number of persons in the population at that time.
Dose not take into account the duration of the disease or the population at risk
Period: How many people during a specific period (year, decade, month) - Every person in the numerator has/had the disease at some point during the period (ie. “have you had asthma during the last (n) years?”)
Point: Do you “currently” have asthma
Crude mortality rate
Occurrence of death in entire population
Cause specific mortality rate
Total deaths from a stated cause per total population
Rate of deaths in total population from a specific cause
Age specific mortality rate
Number of people in a specific age group dying in 1 year per population of that age group
Rate of people in an age group who die
Proportional mortality rate
Number of deaths from a specific cause within a time period per total deaths in same time period
Proportion of deaths occurring because of a stated cause
Case fatality rate
Number of deaths from a specific disease per number of cases of the same disease
Rate of people with a certain disease who die
Define Epidemiology
“study of the distribution and determinants of the health related states in specified populations, and the application of this study to control health problems” CDC
relate epidemiology to CPHF & Minnesota wheel
Assessment:
- Ebola: Contact tracing finds new cases quickly so they can be isolated to stop further spread
- Find, respond, prevent
Policy development:
- Ebola: Unicef & CDC sent out Dos and Don’ts as well as facts about Ebola (Can’t get it through air, water, or food; only bodily fluids)
Assurance:
- Ebola: new PPE Suit implemented
Surveillance, Investigation, Outreach, and Screening
Describe 3 epidemiologic conceptual models
- Epi Triangle
- Host, Agent, Environment (Vector in center) - Wheel of causation (Social/Physical/Biologic Environment (Host (Genetic core)Host)Environments)
- Web of causation
- Social barriers, Social influence, availability (?)
Describe natural history and spectrum of a disease
Pre-pathogenesis period
- Primary prevention (Health promotion & Specific protection)
Period of pathogenesis
- Secondary (early diagnosis/prompt treatment/disability limitation)
- Tertiary (rehab)
Understand the dynamics of communicable disease transmission
Agent Reservoir Portal of exit Mode of transmission Portal of entry Host
Terminology of pathogenesis
Subclinical disease (time of expsure to onset of symptoms)
- Incubation period (communicable disease)
- Latency period (Chronic disease)
- No s/s, may be detectable with labs, xrays, or screening
Clinical disease
- Marked by onset of symptoms
- Spectrum of disease - range from mild to severe or fatal
