Module 14 Flashcards
Healthy environments are …
essential for optimal health and health care
ANA Scope and Standards for Environmental Health
Environmental health is essential knowledge for nurses
Nurses should avoid products or practices that harm health or the environment
Nurses have a right to work in a safe and healthy place and have the right to timely information regarding any hazardous exposures
Multidisciplinary collaboration sustain healthy environments
Best practice should govern choice of materials, products, technology and practices in the environment that affect nurses
Nurses should respect the diversity of the people whom they serve
Nurses should focus on the quality of the environment in which they and their clients work and live
Nurses, other health care workers, families, patients and communities have the right to know timely information about potentially harmful products
Nurses should participate in research related to promoting a safe and healthy environment
Nurses should participate in advocacy related to promoting a safe and healthy environment
HP2020 Objectives involve what topicsq
Outdoor air quality
Water quality
toxics and waste
Healthy homes and healthy communities
infrastructure and surveillance
global environmental health
T and F: ANA considers environmental health an essential part of a nurse’s practice
True
Important Nurses in regard to Environmental Health
Florence N
Lillian Wald and Mary Brewster (Henry Street Settlement)
focus on environmental contamination and poverty and exposure to environmental hazards
Institute of Medicine recommendations for nurses
to have basic understanding of environmental health principles and integrate them into all aspects of practice, education, advocacy, policies, and research
Toxicology
study of negative effects of chemical exposure
Epidemiology
science of association between exposures and human health effects
Epidemiology Triangle
Agent, host, and environment
Geographic Information Systems (GIS)
code data related spatially to place
a way to take data and map it to a place on earth - can look at a specific pop there and housing, diseases, family things etc
When approaching environmental health, you must use a ___ approach
multidisciplinary (geologies meteorologists, politicians, chemists, nurses, etc)
Point Source
a fixed identifiable site and source for where a contaminant is coming from
What are examples of point source?
Air - like with smoke stacks
Water - discharges into water from industry
Land - chemicals added to soil, animal waste
Food - bacteria pesticides, etc
Non Point Source
Diffuse sources without a very determined sources
What are examples of point source?
Air - smog
Land - acidity of soil, run off
Water - run off, contamination
Food - fishing, low o2 in water, mercury - large quantities
What sort of source is motor vehicle traffic emission on Vestal Parkway
non point source (cannot be traced to a certain vehicle)
What sort of source is lourdes hospital pipe draining into the susquehanna river?
point source - particular spot of pollution
What sort of source is run off from city streets after a rain storm into the sewers?
non - point source - general in origin
What does IPREPARE mean for a windshield survey for an environmental health assessment ?
Windshield Survery first then …
Investigate potential exposures
Present work
Residential exposures
Environmental concerns
Past work exposures
Activites
Referrals and resources
Educate (follow up)
Right to Know Laws
the public hawse a right to know about hazardous chemicals in the environment
EPA provides envirofacts, CCR is a consumer confidence report on what pollutants are found in drinking water, and MSDS sheets are OSHA initiated stickers for dangers
MSDS
Material Safety Data Sheet
Blue - health hazard rating; red - fire hazard rating; white - specific hazard; yellow - reactivity rating
Environmental laws are contentious for what reasons
not only because of public or ecological health concerns, but also because of economic interests
Risk Assessment
process to determine the probability of a health threat associated with an exposure
What sort of things are done/needed for a risk assessment?
Access toxicological or epidemiological data, and determine if chemical associated with negative health effects.
Has a chemical been released into the environment (water, air, food)? How?
Multiple sources?
Estimate how much chemical might enter the body.
Is the chemical toxic? What is the source and amount of exposure? What is the route and duration?
The goal of assessment is to try to predict the potential for harm on the basis of the estimated exposure.
What are high risk vulnerable populations for environmental health?
Pregnant women
children
Why are children and pregnant women more at risk with environmental populations?
Size and immaturity of systems.
Greater respiration rate = great exposure to air pollutants
Short stature so closer to biological and chemical agents on floors and carpeting. Higher risk during disasters
Bodies work differently than adults: blood-brain barrier, kidneys, growing bodies
How can nurses reduce environmental health risks?
Apply basic principles of disease prevention (since its less costly)
reduce reuse recycle
risk communication (provide right info, to the right people, and at the right time)
ethics
governmental environmental protection
Ethics and environmental health
essential for making ethical decisions regarding environmental health.
asking people to sacrifice some of their self interests to benefit the greater good of more people (fracking)
Environmental Justice
equal protection from environmental hazards for individuals, groups, or communities regardless of race, ethnicity, or economic status
(ex: env justice act, executive order 12898, 2012 environmental justice strategy and implementation plan )
Nursing Skills: Advocacy
Nurses have responsibilities to be informed consumers and to be advocates for citizens in their community regarding environmental health issues
Nursing Roles in environmental health
Individual and Population Risk Assessment
Referral
Community involvement and public participation
Risk communication
Epidemiologic investigations
Policy development
Examples of Environmental Hazards
lead pain
quality of your water and air
has your home been checked for radon
do you have CO2 and smoke in the home
do you or your neighbors use pesticides
No workplace is …
completely risk free (and people spend half their time at work!!)
Occupational health Nursing
specialty practice that focuses on the preventive healthcare, health promotion, and health restoration within the context of a safe and healthy environment (at work)
it includes prevention of adverse health effects from occupational and environmental hazards, and health promotion in general
Scope of practice is determined by __ ___
state law
What are some things in the scope of practice for occupational health nurses?
Worker/workplace assessment and surveillance
Primary care
Case management
Consulting
Counseling
Health promotion/protection
Administration and management
Research
Legal-ethical monitoring
Community orientation
Ada Mayo Stewart
First “industrial nurse” (occupational health nurse)
worked in vermont marble company
visited sick employees homes and provided emergency care, taught mothers to care for kids, and taught health living habits
Betty Moulder
hired coal miners in 1888 to take care of ailing workers and their families
Evolution of Occupational health nursing
workers comp (1911)
American association of occupational health nurses (1942)
occupational safety and health act (1970) –> OHSA and NIOSH
Roles of occupational health nurses
Clinician; case manager; coordinator; manager; nurse practitioner; corporate director; health promotion specialist; educator; consultant; researcher
What is academic education for occupational health nursing usually?
graduate level (but assoc and bach work in here too)
Workers act as a ___ ___
population aggregate
jobs are shifting from __ to ___ to ___
agrarian to manufacturing to service
3 Levels of Responsibility for Accidents and Accountability
- Individual
- Management
- Organization and Policies
Individual level of responsibiity
individual responsibility to make decisions with safety in mind
Management level of responsibility
responsibility of management to assure safe environment and equipment
Organization and Policy levels of responsibility
responsibility of organization to create policies for safety standards and compliance
Host
any susceptible human being; assume that all employed individuals are at risk of being exposed to occupational hazards
Agent
factors associated with illness and injury; classified as biological, chemical, environmental and mechanical, physical, or psychosocial
Environment
includes all external conditions that influence the interaction of the host and agents
How is the epidemiologic model use in occupational health nursing?
Used to plan interventions to restore and promote the health of workers.
Susan, a new nurse on the unit has a coworker that is caustic in her attitude towards Susan. this is an example of what type of agent causing Susan’s distress
psychosocial (not biological, physical, or environmental)
What is a prominent and important chemical agent in hospitals
Latex
most chemical agents have some sort of…
cancer risk
Organizational and public efforts to promote worker health and safety can be …
limited or comprehensive
Milk With Dignity
migrant justice with ben and jerry’s
they do a program to recruit farmers and improve conditions for migrant workers
Worker Assessment aspects
Traditional history and physical assessment, emphasizing exposure to occupational hazards
Occupational health history
Teach about workplace hazards and preventive measures
Workplace Assessment aspects
Worksite walk-through
HP2020 in relation to occupational health
Identifies the national health objectives aimed at reducing the risk of occupational illnesses and promoting safety.
Health education and health protection strategies are proposed to address the needs of large population groups such as the American workforce.
Important legislation related to occupational health
Occupational safety and health administration (OHSA)
hazard communication standards
material safety data sheets (MSDS)
national institute for occupational safety and health (NIOSH)
OSHA
Occupational Safety and Health Administration (OSHA): federal agency charged with improving worker health and safety by establishing standards and regulations, educating workers, and enforcing standards.
Hazard Communication Standard
the “right-to-know” standard that requires all manufacturing firms to inventory toxic agents, label them, develop information sheets, and educate employees about these agents
NIOSH
National Institute for Occupational Safety and Health (NIOSH): the branch of the U.S. Public Health Service that is responsible for tracking workplace illnesses, accidents, and hazards
MSDS
inventory toxic agents, make info sheets, label, and educate employees on them
EVEN WINDEX - every company in US must have a way for employees to have chemical sheets for anything
Occupational Safety and Health Administration (OSHA) is a federal agency in charge of tracking workplace illnesses, accidents, and hazards
False (THIS IS NIOSH)
Superfund Amendment and Reauthorization Act (SARA)
effective disaster plans designed by those with knowledge of the work processors and materials, the workers and workplace, and the resources of the community
shared with key community agencies
specific steps must be detailed for actions to be put in place by specific individuals in the event of a disaster
nurse is a key person in disaster planning!
What is a disaster?
A natural or man made incident causing human suffering and creates human needs that victims cannot alleviate without assistance
When a disaster occurs, what happens to needs a resources
Needs (outnumber) > Resources
What is the DISASTER paradigm
Detect
Incident command
Scene security and safety
Assess hazards
Support
Triage and treatment
Evacuation
Recovery
Why do nurses need to be prepared for disasters
most do not get disaster education and have to learn from the experience, so we need to prepare
Nurses now have a list of what for disasters
core competencies
(core disaster life support, basic disaster life support, advanced disaster life support)
Types of Natural Disasters
flooding
earthquake
hurricane
tornado
blizzard
communicable disease epidemic
Types of Man Made Disasters
Train derailment
dam breakage
plane crash
nuclear reactor meltdown
bombing and warfare
hazardous material incident
water supply containment
civil unrest
Heavy rains caused flooding of Smithville forcing 50% of the town to evacuate. After seven days, a dam near the town broke, and compounded the flooding of the village causing the rest of the residents to evacuate, and the businesses to close. This disaster could be classified as a:
both man made (the dam condition) and natural (heavy rain storm)
It is ideal to think in what way for disasters?
Both preventative role as well as reactive role
we tend to enter a preventative and single patient care vacuum, but prevention of problems is rare and nursing and medicine are more responsive than preventative in disasters
Mitigation
reducing risks to people and property from disasters before they occur
Examples of Primary Disaster Prevention
community wide disaster preparedness education
Examples of secondary disaster prevention
screening for community level risks
monitoring safety initiatives developed for disaster prevention
efforts to restore community to “normal”
Examples of tertiary disaster prevention
disaster response
life after the disaster
Mission of the US Dept of Homeland Security (via Homeland Security Act)
develop and coordinate comprehensive national strategies to secure the US from terrorist threats and attacks - 2002
in 2011 it was updated to include disasters
National Incident Management System (NIMS)
2004
an all disciplines, all hazards approach for a organized response to any disaster in the U.S. including the Incident Command System (ICS), a multi-agency coordination of systems
What things does NIMS discuss and detail
Discusses the need for preparedness
Discusses resource management, communications, and information management.
Details command structure to assist you in understanding the response plan and implementation of resources.
National Response Frameworks
Outlines how the federal government will use all of its agencies to respond to the needs of a community in a disaster.
In the past, response time lagged behind what people needed.
It is problematic to think that disaster response is a federal job.
How does disaster response start locally?
Start in your home with you and your family.
Moves to the local community response.
Proceeds to the regional response .
Next to the State Office of Emergency Management.
Finally to the state Governor’s office (state of emergency), initiating a request to the U.S. President for assistance.
Stafford Act mandates the President to respond with a Declaration of Disasters for States.
President assigns a Federal Coordinating Officer (FCO) to each disaster.
Phases of a Disaster
Pre impact phase
Impact phase
Honeymoon phase
Disillusionment and Recovery Phase
Reconstruction Phase
Pre Impact Phase
this is usually evident in disasters where we have some warnings issued (example: NOAA weather patterns indicate a storm or hurricane are coming).
Predictions provide guidance for preparation (example: snow storm is coming with predicted 3 feet of snow. We prepare the community for the storm).
Impact Phase
when the disaster has occurred and we are in the mist of emergency response to the disaster.
Initial assessments are needed: how many injured, how many may need rescue, and how many need medical attention.
Also referred to the “heroic phase”
Common to see citizens working to rescue and help each other.
Fire and emergency personnel performing daring rescues .
Honeymoon Phase
many expressions of joy at being alive and have survived the incident
Outside organizations have brought in help. People from outside of the community feel they can and want to help!!
Disillusionment and Recovery Phase
people who have survived the ordeal now become frustrated
Realization of how long it may take to rebuild, claim insurance, and redevelop the community
Often many are outspoken and resentful that the government did not do enough
Reconstruction Phase
occurs anytime between between 3 months to years after the disaster
Rebuilding a community may not happen quickly and rebuilding businesses and other infrastructure may take longer then expected
After Puerto Rico was devastated by the recent hurricane, the Mayor severely criticized the Trump administration for its poor response. This is an example of what disaster phase?
This is the recovery phase (or disillusionment phase) when people realize how long recovery may take and become vocal about the government’s response
Disaster Response includes thinking ..
outside the box
do the greatest good for the greatest number involves more than assigned priorities for treatment and transport
it means using available medical resources as efficiently as possible
Triage
large part of caring for large numbers
the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties.
ID-ME
Triage Basics
degrees of triage CARE:
Immediate (red), Delayed (yellow), Minor (green), Expectant near decreased (black)
Immediate Care (red)
life threatening with a change for survival in triage
Delayed Care (Yellow)
they can wait a few hours or days for surgical intervention, given pain medications and splinted fractures in triage
Minor Care (green)
walking wounded, need minor care, first aid in triage
Expectant Near Decreased (Black)
impending death, no chance for survival or recovery with the resources on hand
T/F: People tagged green in a triage situation will receive immediate care
False
green tag can have any care delayed, they only need basic first aid and are ambulatory
