Exam 1 Flashcards
Five Core Elements of Community
- Locus (Sense of place)
- Sharing (Common interests/perspectives)
- Joint Actions (Sense of identity/cohesion)
- Social Ties (Interpersonal Relationships)
- Diversity (Social complexity)
(Little Sharon Joined Several Dances)
Public Health vs Community Health
PUBLIC HEALTH
Programs and Policy
Provides guidance at a “political’ level
COMMUNITY HEALTH
Where prevention and intervention actually happen
Definition: Community Assessment
A process of ENGAGING THE COMMUNITY in the collection/analysis/interpretation of data on health outcomes, identification of health disparities, and identification of resources used to address priority needs
What is a Community Assessment?
- Comprehensive evaluation of the status of a community/organization
- Logical, systematic approach to identify community needs
- Used to set goals, plan interventions, evaluate outcomes
ADPIE within Community Health
Community ASSESSMENT Community DIAGNOSIS (CHED) PLANNING Programs/Interventions IMPLEMENTATION EVALUATION of Programs/Interventions
How do you plan health improvement in a community?
- Obtain data
- Determine priority needs
- Identify assets and resources
- Define the scope of the project
- Articulate expected outcomes
Three Core Public Health Functions
- Assessment
- Policy Development
- Assurance
Assessment (Core Function)
Assessment, monitoring, and surveillance of local health problems and needs, and of the resources available for dealing with them.
- Monitor Health status and understand health issues facing community
- Diagnose and Investigate health problems and hazards
Policy Development (Core Function)
Policy development and leadership that fosters local involvement and a sense of ownership that emphasizes local needs and that advocates for equitable distribution of public resources and complementary private activities commensurate with community needs
- Inform, Educate, Empower people re: health issues
- Mobilize Community Partnerships to identify and solve health issues
- Develop Policies and that support individual/community efforts
Assurance (Core Function)
Assurance that high-quality services, including personal health services, are available and accessible to all persons; that the community receives proper consideration in the allocation of resources for public health; and that the community is informed about how to obtain public health, including personal health services, or how to comply with public health requirements
- Enforce Public Health Law and regulations
- Link to personal health services & provide care where we can
- Assure a Competent Workforce in public health and health services
- Evaluate and improve programs
- Research new insights and innovative solutions to health problems
Why do we do community assessments?
- Gain a deeper UNDERSTANDING of our community
- Identify ASSETS and KEY COLLABORATORS
- DETERMINE community PRIORITIES
- ENGAGE STAKEHOLDERS and gain community SUPPORT/TRUST
- Identify POTENTIAL BARRIERS for project/interventions
- GUIDE PROGRAM INTERVENTIONS and programming
Who should be involved in community assessments?
- Stakeholders
- Nurses and nursing students
- Communities
Data Gathering
Obtaining data which already exists
Data Generation
“Collecting” data
think windshield survey, informant interviews, focus groups, surveys, etc.
Public Health
“Science of protecting and improving the health of people and their communities”
“What we do collectively to assure the conditions in which people can be healthy.”
It is a broad field encompassing many professions/academic fields
Provides large-scale solutions aka care to many
Public Health Nursing
- Synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations
- Population based
Aims of Public Health Nursing
- Prevent disease and disability
2. Promote and protect the health of the community as a whole
The Quad Council
- Alliance of four national nursing organizations that address public health issues
- Define and publish the Scope & Standards of Public Health Nursing Practice & Core Competencies
Population-Based Practice
- Focuses on entire populations (begin by identifying population-of-interest and population-at-risk)
- Grounded in assessment of the population’s health status
- Considers broad determinants of health
- Emphasizes all levels of prevention
- Intervenes with communities, systems, individuals, and families
Population
Collection of individuals who have 1+ characteristics in common
Socio-Ecologic Model
Multi-level framework **Aim to intervene at many levels for most success** 1. Individual 2. Interpersonal 3. Organizational 4. Community 5. Public Policy (Aye Aye, Oh Captain Pirate!!)
Health Impact Pyramid
Intervening at the bottom increases population impact
(Bottom of pyramid –> top)
1. Socioeconomic factors
2. Changing the Context to Make Individuals’ Default Decisions Healthy (e.g. calorie labels on the front of sodas)
3. Long-Lasting Protective Interventions (primary prevention)
4. Clinical Interventions (direct 1:1 care)
5. Counseling and Education
(So Connie Likes Clinical Counseling?)
Primary Prevention
Prevention of initial occurrence of disease and illness
Examples: Vaccinations, hand hygiene, helmets, genetic counseling
Secondary Prevention
Early detection of disease and treatments with goal of limiting severity and adverse events
Examples: Screening, early treatment
Tertiary Prevention
Maximization of recovery after an illness or injury
Examples: Rehab therapies, support groups, case management
Minnesota Wheel of PHN Interventions
Defines the scope of public health nursing practice by type of intervention and level of practice (rather than location of service)
Most interventions can be individual, community, and/or systems focused
Surveillance
Describe and monitor health events through ongoing and systematic collection, analysis, and interpretation of health data
Investigation
Systematically gather and analyze data regarding threats to the health of populations
Outreach
Locates populations of interest or risk and provides information
Screening
Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions
Case Finding
Locates individuals and families with identified risk factors and supplies them with resources
Only possible at the Individual-focused Level
Referral and Follow-Up
Assist individuals, families, groups, orgs, and/or communities to identify and access necessary resources in order to prevent or resolve problems/concerns
Case Management
Optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services
Delegated Functions
Direct care tasks a RN carries out under authority of a health care practitioner as allowed by law. Also includes tasks an RN delegates to other appropriate personnel to perform
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 and interpersonal relationship with a community, system, family, or individual intended to increase or enhance their capacity for self-care and coping. Engagement at an emotional level
Consultation
Seeks information and generates optional solutions to perceived problems/issues through interactive problem solving with a community, system, family, or individual. NOTE: The community, system, family, or individual selects and acts on the best option
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. Builds linkages, solves problems, and/or enhances local leadership
Only possible at the Community-focused and Systems-focused Levels
Community Organizing
Helps community groups to identify common problems or goals, mobilize resources, and
develop and implement strategies to meet the collective goals
Advocacy
Plead someone’s cause or act on someone’s behalf, with a focus on developing the capacity or the community, system, individual or family with a focus on developing their ability to advocate for themselves
Social Marketing
Utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values,
beliefs, behaviors, and practices of the population of interest
Policy Development & Enforcement
Places health issues on agendas. Results in laws, rules, regulation, ordinances, and policies. Compels others to comply with them.
Example: Teenage Pregnancy and Health Levels
- Individual-focused
Provide health education to group of preadolescent girls with the goal to change their individual knowledge, attitude, beliefs - Community-focused
Work with local news station to run an educational series about the consequences of teenage pregnancies in the community - Systems-focused
Policy that mandates that all girls in middle school
receive education as part of their health ed class
about ways to prevent teenage pregnancy
Population of Interest
A population essentially healthy, but who could improve factors that promote or protect health
Population at Risk
Population with a common identified risk factor or risk-exposure that poses a threat to health
SMART Objective
Specific Measurable Achievable Realistic Temporal
Planning: Logic Model
- It is a depiction of a program showing what the program will do and what it should accomplish
- A series of “if-then” relationships that, if implemented as intended, should lead to the desired outcome
- The core of program planning and evaluation
- Inputs (program investments)
- Outputs (activities and participants)
- Outcomes (Short-term, medium, long-term results)
Implementation: Action Plans
Should be complete, clear, and current
- WHAT actions or changes will occur?
- WHO will carry these changes out?
- BY WHEN will they take place and for how long?
- WHAT RESOURCES (ie money, staff) are needed to carry out the proposed changes?
- COMMUNICATION (who should know what?)
Evaluation of Programs/Interventions
A systematic process to understand what a program does and how well the program does it
6 Steps in Conducting an Evaluation
- 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
(Engagement [to] Ida Seems Dumb, Dear Evan)
The role of the nurse in policy process
The work nurses do in influencing policy affects decisions that impact quality of life and universal access to care. We have the capacity and responsibility to influence current and future healthcare delivery systems
Policies
- Define and integrate appropriate standards for delivery of care
- Impact resource allocation to support delivery of healthcare
Writing a Policy Letter - Paragraph Topics
First Paragraph: Identify yourself and state your purpose
Second Paragraph: Explain more in depth and how it affects our population
Third Paragraph: Personalize it
Fourth Paragraph: Call to action
Epidemiology
The study (basic science of public health) of the distribution (frequency and pattern) and determinants of health related states in specified populations, and the application of this study to control health problems
Epidemiology and the Minnesota Wheel
Surveillance, investigation, outreach, screening (purple section)
Natural History of a Disease
Helps us to study the progression of the disease over time –> Does it get worse? What symptoms arise?
Pre-pathogensis
Before you get sick
Primary prevention
Pathogenesis
Subclinical and convalescence
Secondary and tertiary prevention
Subclinical period
Time of exposure to onset of symptoms
- Incubation period (communicable disease)
- Latency period (chronic disease)
No signs or symptoms present –> screening needed
Clinical period
Marked by the onset of symptoms
Looks at the spectrum of disease (the range from mild –> moderate –> severe –> fatal)
Chain of Infection
- Agent
- Reservoir (where it lives and reproduces)
- Portal of Exit
- Mode of Transmission
- Portal of Entry
- Host
Start it over again!
Study designs
Observational and Experimental
Observational Studies
The researcher studies, but does not alter, what occurs
1. Cross-sectional surveys
2. Cohort studies
3. Case-control studies
4. Case studies
The 4 Cs
Experimental Studies
The researcher intervenes to change reality, then observes what happens
- Randomized Controlled Trials
- Quasi-experimental Designs
Cross-sectional study
- Used to help establish relationships, but cannot establish cause and effect
- Snapshot or cross-section –> must have a representative sample
Cohort study
Prospective
- Observational, analytical
- studies a population and look at exposures and outcomes
- Determines cause and effect / correlations
Case-control study
Retrospective
- Work backward from outcome to a suspected cause
- Compares a group with a health problem to a group without the health problem
Case Study
- Descriptive, observational
- In-depth analysis of an individual, group, or social institution
Randomized Control Trial
- Randomized, Control, Intervention
- Studies groups before and after intervention
- Baseline vs Outcome
Quasi-experimental study
- No random allocation
- May be controlled or uncontrolled
- Often used for “natural” experiments (eg mental health appointments after and earthquake)
Components Needed to Establish Causality
- Strong association
- Consistency
- Biological plausibility
- Correct temporal sequence
- Dose-response relationship
(Suzie Can’t Bop. Can Dan?)
Incidence Rate
# New cases --------------------- # Persons at risk
Prevalence Rate
# Cases (established and new) --------------------------------------------- # Persons in population
Point Prevalence
Do you currently have asthma?
Period Prevalence
Have you had asthma during the last (n) years?
Crude Mortality Rate
Occurrence of death in the entire population, not due to certain disease
Midyear population
Cause-specific Mortality Rate
Midyear population
Age-specific Mortality Rate
Midyear population of age group
Proportional Mortality Ratio
Total pop. deaths in time period
Case Fatality Rate
# deaths from disease --------------------------------- # cases of disease
Screening objectives
Primary: Detection of disease in early stages
Secondary: Reduction of cost
Types of Screening
- Mass (entire population)
- Selective (specific high-risk populations)
- Periodic (small, but well, subgroup of population on regular basis for predictable risks or problems)
Advantages of screening
- Simplicity
- Targeted
- Options of one-test or multiple-test
- Gives health education opportunity
Disadvantages of screening
Not 100% accurate
Implications for False Positives
Undue worry, stigma, unnecessary invasive testing and treatment
Implications for Flase Negatives
Loss of time for early intervention, engagement in risky behavior due to “negative” status
Sensitivity
Ability of a test to correctly identify the people WITH the condition (true positives)
Poor sensitivity = increased false negatives
Specificity
Ability of a test to correctly identify the people WITHOUT the condition (true negatives)
Poor specificity = increased false positives
Calculation for Sensitivity
(True Positives + False Negatives)
Calculation for Specificity
(True Negatives + False Positives)
Principles of Nursing Ethics
- Autonomy (respect right to make own decision)
- Beneficence (compassion, do good)
- Non-maleficence (do no harm)
- Social justice (uphold fairness and equity)
