EXAM 2 Flashcards
what is a social determinant of health
condition in which people live, learn, work, play, worship that affects a wide range of health risks
what are the 5 domains of SDH
- economic stability
- education
- health care
- neighborhood
- social and comminity context
what can education be a strength of weakness for people
think of ward 8
what is important about understanding root cause
discover the underlying or systemic cause for something to occur
what are the five parts of the ecological model
intrapersonal –> interpersonal processes and primary groups –> instituitional factors –> community factors –> public policy
define racism
prejudice, discrimination, or antagonism by an individual, community, or institution against a person or people on the basis of their membership in a particular racial or ethnic group, typically one that is a minority or marginalized.
equity
the highest level of health possible for everyone. Healthy equity addresses differences in population health that can be traced to unequal economic and social conditions that are systemic, avoidable and inherently unjust.
equality
not taking into account differences people have in their communities
health disparity
preventable health differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often disease causes death.
PRAPARE tool
help health center collect data needed to better understand and act on their patients SDOH
When having data, healh centers can define and document the increased complexity of their patients, transform care with integrated services and community partnerships to meet the needs of their patients, advocate for change in their communities, and demonstrate the value they bring to patients, communities, and payer.
two types of community diagnosis
- adverse
- assest
what is an adverse diagnosis
Risk of contracting tuberculosis among residents of Blake County is related to:a)Immigrants and refugees residing in the county not screening for tuberculosis
what is an asset diagnosis
Community cohesion among residents of Blake County Related to: History of racial harmony and Use of mechanisms for peaceful resolution of conflicts
how to we rank our diagnosis’s
how important is it to solve
is it a positive change for the community if solved
will it improve quality of life if solved
what is individual impacts
patient screning questions about social factors like housing and food access; use dtat to inform care and provide referrals
how do we move individual impacts upstream towards resolving health issues for community
implement laws, policies and regulation that create community conditioms supporting health for all people
how can we utilize technology to address social needs
NowPow = has a free version and a version health care providers can buy that helps link persons to services
Health care impact that encompasses largr groups
tobacco warning labels, heart disease treatment, vaccinations, seatbelt laws, education
health care impacts that have more of an individual effect
consoling, medical care, preventative medicine, healthy decisions, money
CDC 5 year plan includes
addressing the social determinants of health
changing the context
long lasting protective interventions
clinical interventions
consoling and education
how is the CDC going to change the context
school based programming to increase physical activity
school based violence prevention
safe routes to school
motorcycle injury prevention
tobacco control interventions
clean syringes
how is the cdc working to reduce the SDH
early childhood education
clean disiel bus fleets
public transportation
water flouridation
3 core functions of public health
assess
policy development
assurance
define community
the word can really refer to any group sharing something in common
examples of different communitys
black community
The arts community
Nursing community
what is the CHNA
process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community.
what is ideally in a CHNA
◦Demographics
◦Health issues and outcomes
◦Risk factors
◦Assets and resources
◦Supporting documentation
how do we gather data for CHNA
surveys
individual or group inquiry
observations
how can surveys be performs
individual interviews
web based surveys
face to face surveys
telephone surveys
what are the pros and cons of surveys
Can ask more directed questions
Questions answered
Time consuming
Transcription of notes
how can group inquiry be performed
focus groups
community forums
interviews
what can be nice about using group inquiry
Can assess body language
Responders lose anonymity
Logistical challenges
how can we gather observational data
general field notes
windshield survey
videos on phone
what is the purpose of CHNA
identify the target population
establish programs, priorities, goals
Identify organizations that may help meet the needs or provide resources ]identify additional resources and assets
ACA requirements for hospitals
Provide systematic basis for which organizational decisions are made
Create awareness of community concern or problem
Public health department accreditation requirement
Provide baseline for an evaluation
Serve as a public relations tools
list some things that can learn from CHNA
Main health concerns in the community
The main reasons for these health concerns
The strengths / assets in the community
Where we might want to intervene to create change
what are the 3 phases of CHNA
- assessment planning
- data collection and analysis
- program action planning
what is epidemiology
Study of the distribution and determinants of health-related states among specific populations and the application of that study to the control of health problems
what is the purpose of epidemiology
- discover (agent, host, environmental factor)
- determine (importance)
- identify (who is at greatest risk)
- evaluate (health proramming)
endemic means
the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.
example of an endemic
Malaria is present in Africa at all times because of the presence of infected mosquitoes.
epidemic means
refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.
epidemic can also be called
an outbreak
example of epidemic
The Ebola virus in parts of Africa is in excess of what is expected for this region.
pandemic means
refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.
example of a pandemic
HIV/AIDS is one of the worst global diseases in history.
rate refers to
number of cases occurring during a specific period; and is always dependent on the size of the population during that period.
how do you calculate rate
number of cases / population at risk
epidemiological investigation
identify problem, collect data, formulate and test hypotheses
passive surveillance means
Diseases are reported by health care providers
Simple and inexpensive
Limited by incompleteness of reporting and variability of quality
active surveillance means
Health agencies contact health providers seeking reports
Ensures more complete reporting of conditions
Used in conjunction with specific epidemiologic investigation
what is an experimental epidemiology study
the investigators can control certain factors within the study from the beginning. An example of this type is a vaccine efficacy trial that might be conducted by the National Institutes of Health
what is an observational epidemiology study
no control group!
what are the two types of observational epidemeology studies
- descriptive
- analytic
what does a descriptive study
the epidemiologist collects information that characterizes and summarizes the health event or problem. (think time, person, place)
what is done in an analytic study
the epidemiologist relies on comparisons between different groups to determine the role of different causative conditions or risk factors.
what components are included in descriptive epidemeology
time, place, person
time looks at (descriptive epidemiology):
date of onset
place looks at (descriptive epidemeology)
geographic extent of the problem
person looks at (descriptive epideomology)
age, sex, race, medical status
step 1 of outbreak investigation
establishing the existence of an outbreak
how do establish an outbreak
Use data from data sources
meaning that the occurrence of cases of disease are more than expected in a given area or among a specific group of people over a particular period of time
Seeing an increase from the normal amount of cases
step 2 of outbreak investigation includes
preparing for fieldwork
how does one prepare for fieldwork
researching the outbreak
gathering necessary supplies and equipment, and
making travel arrangements.
step 3 of outbreak investigation
verify the diagnosis
how do we verify the diagnosis
labs/tests/ patient statements
defining and identifying cases
step 4 of the outbreak investigation
what is a case definetion
we define the case, what does it mean for something to be positive or negative
example of a case definition
COVID example → case definition of what is positive or negative
what is considered when making a case definetion
- clinical information about disease
- characteristics about the persons who are affected
- info on location and place
- specification of time during which the illness onset occurred
step 5 of outbreak investigation
decriptive epideomology
steps 6 through 8 of outbreak investigation involve
hypotheses!
after creating a hypotheses, what is not step in outbreak investigation
implementing control and prevention measure + communicating all findings
what is the epidemiological triangle includes
- Host
- Environment
- Agent
a line list is
The line listing is one type of epidemiologic database, and is organized like a spreadsheet with rows and columns
Ex) think spreadsheet
surviellence forms
think COVID 19 spreadsheet
epidemic curves
epi curve, shows # of illnesses in an outbreak over time
spot maps
use dots or other symbols to show where each case lived or was exposed
horizontal transmission includes
contact
indirect
contact transmission includes
direct and droplet
direct contact example
skin to skin (HIV)
droplet contact includes
coughing, sneezing, sweat
indirect contact includes
vector, airborne, fecal oral, foodborne
vector transmission
An indirect transmission process during which the pathogen is indirectly transferred from a reservoir, source or host via an animate intermediary vector to another host
ex) mosquito and malaria
airborne transmission
Indirect contact infections spread when an infected person sneezes or coughs, sending infectious droplets into the air.
fecal oral transmission
person touches the stool of an infected person or an object contaminated with the stool of an infected person and ingests the germs.
foodborne transmission
cross contamination through food
what is a type of vertical transmission
mother to baby
an agent is
biologic, chemical, physical, nutritional
an environmental factor is
temperature, humidity, crowding, housing, water, food, radiation, pollution
host is
age, sex, race, genetic profile, previous diseases, immune status
two examples of agent
For Legionnaires-the agent was the legionella bacteria
For COVID-the agent is the coronavirus
two examples of host
For COVID-we know older adults and ones with co-morbidities are more susceptible. Studies are also showing that low levels of vitamin D impact susceptibility.
For Legionnaires-it was older adults, who smoked
two examples of environment
For COVID-nursing homes and close quarters were a factor due to ‘host’ and environment. Many of the efforts made, especially in March, were also to address availability of services and not maxing them out (which still happened in some places like NY)
Legionnaire = convention, halfway
environment and personal health connections
Living in an area were there are toxins or pollutant in the air = various cancer
Living in an area where the water source is not clean = various cancer
Living in an area where there is mold within your apartment = asthma ect
Lack of sidewalks = making the environment not accessible
what environmental factors can impact health
chemical pollution
air pollution
climate change
disease-causing microbes
lack of access to health care
poor infrastructure
and poor water quality.
how is income related to health disparities
poor housing
lack of food
unable to afford child care
medical cost
living in unsafe or unhealthy conditions
poorer health
how is education related to health disparities
Dropping out of school leads to social and health problems
Health Risks: obesity, substance abuse, intentional and unintentional injury
Shorter life = those with education are linked to having better self advocate skills and understanding healthy living habits
Health literacy
how is employment related to health disparities
income + insurence
how is language related to health disparities
health literacy
Access to healthcare
poor health outcomes
experience lower quality care
who is most effected by health disparities
Racial and ethnic minorities
Immigrants
Children
Elderly
Poor
Less educated
No health insurance
Rural
People who live in developing countries
LGBTQ
health disparities in the local community references …
school assessment
school assessment works by
tally up the questions answered true and from there have an idea of score
medical dessert
Areas without access to hospitals, primary care physicians, pharmacies and other healthcare providers
Requires more than 60 minutes of travel to reach an acute care facility
what leads to a medical dessert
finances
hospital closures
lack of healthcare providers
environmental health
“Freedom from illness or injury related to exposure to toxic agents and other environmental conditions that are potentially detrimental to human health”
environment and health relationship
→ The World Health Organization estimates that as much as 24% of global disease is caused by avoidable environmental exposures
→ The environment significantly affects more than 80% of major diseases
→ More than 33% of disease in children under the age of 5 is caused by environmental exposures (WHO, 2006)
example of environment and health impact
asthma
lead poisoning
cancers
nurse’s role in the environmental health
Alliance of Nurses for Healthy Environments (ANHE) and American Nurses’ Association (ANA) partnership:
Development and inclusion of an Environmental Health standard in the ANA’s Scope and Standards of Practice for nurses (2010)
how can one get mercury
tuna
pesticides
grass and crops
air pollutants
ventillation and big cities
lead
old paint, old homes
blood lead level in children
no more then 5mcg
how can we prevent certain environmental exposure
✨Home improvement practices that create hazards can be avoided to reduce lead exposure
✨Pesticides can be avoided – Integrated Pest Management (IPM)
✨Less toxic cleaning products can be chosen
✨Diet can be altered to reduce mercury and pesticide exposure
✨Water can be tested for solvents and treated or replaced
what is lead
Lead is a highly toxic metal that poses a serious threat to health.
what can be the effects of lead
Damage to brain and nervous system
slowed growth and development
learning and behavior problems
hearing and speech problems
Which can then cause …
lower IQ
decrease ability to pay attention
underperformance in school
where is lead coming from
air
water
soil
lead pain
toxic treats
nursing actions for lead toxicity
education!!!!
lead screening
health assessment
what can help reduce the risk of lead poisoning
water filtration
nutritional interventions
person behavior
housing
tertiary prevention of lead poisoning
Early education interventions ⇒ Individuals with Disabilities, Education Act (IDEA)
what is mercury
Highly toxic
Bioaccumulation: Accumulates in fish
what can happen with mercury exposure
🤰Prenatal exposure in low doses can be associated with: deaf, blind, language issues, retardation, memory
nitrates
CAFO - concentrated animal feeding operations -> main culprit
Toxic level: over 10mg/L
what can happen with exposure to nitrates
Consequences: cancer, birthd defects (blue baby syndrome), thyroid disease
Assess risk, prevent exposures through education and advocacy
how do we reduce the risk of nitrates
Action steps: Seal off wells, keep wells away from runoff
** boiling well water Concentrates the nitrates = BAD
what are the effects of pesticides
Effects nervous system
irritates face/eyes
Carcinogens
effects endocrine system
what is the public health action for dealing with pesticides
Public health actions: Integrated Pest Managemen t(IPM)- (alternatives to pesticide use - keep pests out, dry pests out, eliminate toxins, dry them out)
Perfluoroalkyl Substances (PFAS)
this chemical is found in non-stick pans, and other products
Bioaccumulates in humans, long ½ life (3-7 years), accumulatesin blood, effects fetuses, excreted in pee & breastmilk,
Educate on toxicity
widespread human exposure
efefcts organ systems
how can we reduce th exposure to PFAS
Public Health Actions: REDUCE EXPOSURES->Filter water, dust control, test soil, check fish advisories
BEST STRATEGY: reduce and prevent exposure
🩸Test blood for humans who are highly exposed
how can we improve the environment
two pronged approach = mitigation, adaption
mitigation means
Reducing emissions of and stabilizing the levels of heat-trapping greenhouse gases in the atmosphere
what does adaption mean
Adapting to the climate change already and in the future
international collaboration and solutions that are science-based to resolve the current global environmental issues.
“Health and sustainability should be central to the economic response following the pandemic, which should also be designed to improve the resilience of societies to cope
Rely on EBP, collaborate, advocate
Prevention of Hazardous Exposures is Key for Healthy People
different types of public health assessments
Levels (or concentrations) of hazardous substances
Whether people might be exposed to contamination and how they may come in contact with it (that is, through “exposure pathways” such as breathing, eating, or skin contact with contaminated air or soils)
What levels of a toxic substance might cause harm to people
Whether working or living near a hazardous waste site might affect people’s health
Other dangers to people, such as unsafe buildings, abandoned mine shafts, or other physical hazards.
federally funded nonprofit health centers
Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations.
FQHCs include community health centers, tribal health clinics, migrant health services, and health centers for the homeless. Medicaid provides higher payment rates for outpatient facilities designated as FQHCs compared to facilities not so designated.
the nursing process includes
assessment
diagnosis
outcomes
plan
implement
evaluate
why do you prioritize nursing diagnosis
to determine what should be done first –> usually have to long of a list of needs to do all at once
how do you determine a goal for a community
overarching, think they can be long term
how is an objective different from a goal
more specific then a goal, specific to what you want to get out of the goal, clear and concise, need to be determined as a yes or no (quantifiable)
Which of the following is an example of a correctly written objective for a community
health program designed to address underage drinking among school-aged children?
A. Participants will have increased knowledge about the effect of alcohol use on adolescent brain development
B. The prevalence of underage drinking among school-aged children will decrease by 10% within five years as noted on the district’s YRBS
C. Following 3 one hour classes, 90% of 5th graders will be able to identify 3 ways in which alcohol affects the body
D. The number of adolescents verbalizing approval of social drinking among
their peers will decrease by 50%
C
what should not be your only intervention
education (it actually has the smallest impact!), just telling someone what they should do is not going to make a good change overall
what types of evaluation
outcome evaluation
impact evaluation
process evaluation
process evaluation
ongoing throughout the study, can make changes throughout
outcome evalaution
what occurred in the end? was it what you wanted?
impact evaluation
cause and effect, positive and negative, broader then the outcomes (what were the unintended consequences)
An outside evaluator is hired to conduct interviews
with participants of a program. Which type of
evaluation would this most address?
Outcome
Process
Impact
impact (outside evaluator is key)
ecological model
thinking systemically –> how one thing impacts another
upstream thinking
thinking about prevention and having a community impact and how we want to improve community conditions
laws policies and regualtions
midstream
the indivual impact
