Module 5 Flashcards
Telehealth
the use of electronic information and telecommunication technology to support and promote long-distance clinical health care (USDHHS definition)
2 Methods of Telehealth
- Real time 2 way communication via phone/internet/television
- Asynchronous communication stored via technology and then forwarded to a health care provider later
How is Telehealth Paid for?
- Medicare (Federal) reimburses sometimes
- Medicaid (State) and Commercial health Insurance has begun to be reimbursed by NYS in 2016, so they reimburse remote monitoring ( BUT NOT THE TRANSMISSION METHOD)
Telehealth History
- Post WWII in 1948 some radiological images were transmitted by phone to Philly 25 miles away
- U of Nebraska used 2 way television in education of med students
- 1963 Mass Gen Hospital communicated with nurses stationed in a Boston airport
- 1965 ships moved ECG and X Rays to clinicians on shore
- 1967 fire dept in miami moved ECG results to Miami Hospital
- STAPAHC
STARPAHC
Space Technology Applied to Rural Papago Advanced Health Care
agencies collabed to help the Papago Nation with telehealth, but it was unsuccessful due to distrust of the government in the 70s - but it did show that telemedicine can feasibly help healthcare
Most telehealth occurs between who?
Physician and Patients
How might a nurse interact with telehealth?
They can go to the home and help set up services, and use it to monitor and prevent issues
School nurses could call in meds/other things from a provider
Who utilizes Telehealth?
physicians
specialists
NPs
PAs
Midwives
Clinical psychologists
licensed clinical social workers
registered dieticians
nutritional specialists
RNs
Where is telehealth used?
Offices
schools
emergency departments
home care agencies
senior centers
patient’s home
Overall the Research on telehealth shows…
that it is a great way to keep people healthy
(It has been successful in improving various indicators of health and wellness:
reduces hospitalization/readmissions/emergency dept admissions, lower hospital length stays, improves quality of life/patient control/ patient satisfaction, improved patient sense of empowerment and self management, improved functional status, cost savings, greater connection and access to care geographically, decreased depression)
Health Promoting Behaviors are more readily acquired in ____
childhood (when routines and habits are forming)
Habits and behaviors developed in childhood/adolescence are more likely to …
persist as an integral part of lifestyle
Unintentional Injury
injury that was completely accidental and the outcome was not anticipated
Intentional injury
injury involving an activity with intent or possibility of intent to harm
Is accidental discharge of a gun you have, or utilization of self protection unintentional or intentional injury?
Intentional injury
Top 5 Causes of Death in Ages 10-14?
- Unintentional Injury
- Homicide
- Suicide.
- Malignant Neoplasms
- Heart Disease
*These are in order of most to least
Developmental Assets Framework of High Risk Behavior in Children/Adolescents
More assets available = fewer risk behaviors they are likely to engage in, and the more positive outcomes they will experience
Who does the Developmental Assets Framework focus on?
ALL CHILDREN, not just those at risk for negative outcomes
The Developmental Assets Framework emphasizes …
a community approach to promoting adolescent health leading to higher school success, better physical health, less violence/drugs/early sexual intercourse/delinquency, and helping one another
Examples of Developmental Assets
After school athletic programs
church engagement
foreign languages
positive experiences
travel
sports
clubs
How does Parental monitoring influence adolescent high risk behavior?
The adolescent’s perception of their parent’s knowledge of who they are with or where they are influences their degree of engaging in risky behaviors
so, less parental monitoring leads to a perception of unawareness leading to a higher risk of bad behaviors
Estimate of the Percentage of Children Living in Poverty?
21% (15 million)
Poverty in Children is Linked/Caused By (to) what?
-negative physical and mental health effects, and impacts on home/school/neighborhoods/communities
-substandard housing
-homelessness
-inadequate nutrition and food insecurity
-inadequate child care
- lack of access to health care
- unsafe neighborhoods
-under resourced schools
Poverty in Children is linked to a greater risk of what?
Poor Academic Achievement
School Dropout rates
abuse and neglect
behavioral and socioeconomic problems
physical health problems
mental health problems
developmental delays
The greater risks in childhood poverty all can contribute to …
a lower life expectancy
What is our main way of measuring poverty in children? Is there a problem with it?
Looking at the percentage of children receiving free or reduced cost school lunches. But there is variation between school or people may not sign up for the program meaning there is actually greater amounts of poverty than we measure
Test Ratings may be Linked to Poverty/Reduced Lunch Rate but …
More rural areas had high test rates and lunch signups, so more than poverty contributes to testing (like social cohesion)
Primary Prevention in Schools
Prevention of Injuries
Substance Abuse Prevention education
Disease prevention Education
Efforts to prevent suicide and other mental health problems
Required vaccinations for school children
Secondary Prevention in Schools
Nursing care for emergencies in schools
Emergency equipment available
Giving in school medication
Assessing and Screening (lice, suicide, depression, etc)
Identification of child abuse or neglect
communicating with health providers
Addressing violence at school
School Crisis Teams - responding to disasters
Tertiary Prevention in Schools
Individual Education Plans
Asthma Assistance
Diabetes Mellitus care
Autism Assistance
ADHD care
Special needs in schools
DNR orders
Homebound children
Pregnant Teenagers and Teen Mothers
YRBS stands for
Youth Risk behavior survey
What is the YRBS
An anonymous, in school (grade 2-12) (45 minutes) survey that determines the prevalence and age of initiation of health risk behaviors, and then assesses whether health risk behavior rates have changed when compared to nation/state/local data
It also helps monitor progress toward achieving health people objectives and the national education goals
Injuries are not accidents so …
they can be prevented through education, engineering, and enforcement
Erikson’s 3 Levels of Psychosocial Development Important to Adult populations
- Intimacy v Isolation
- Generativity v Stagnation
- Ego Integrity v Despair
What is the Intimacy v Isolation Level?
-Young Adults: 19-39 y/o
-Desire for intimate and loving/supportive relationships where success leads to strong relationships and failure results in isolation
What is highly influential in the success rate of establishing relationships?
Family of Origin
Teaching Methods and Strategies for those in the intimacy v Isolation Stage?
Since adults do not usually look for help unless its already a problem, focus on a problem they already are having and have them engage in fixing it
-Problem centered Focus
-Encourage active participations
-organize materials
-recognize social roles
-apply new knowledge through role playing and hands on practice
What is the Generativity v Stagnation Level?
- Middle Adults 40-64 y/o
- Important to them is parenting and their career with a desire to nurture something that will outlast them (not children) and create a positive change for others. Success causes feelings of accomplishment and usefulness, while failure results in shallow involvement in the world
Teaching Methods and Strategies for those in the Generativity v Stagnation Level?
-focusing on maintaining independence (v. important) and re-establishing normal life patterns (we want to help them return to normal life)
-assess potential sources of stress due to midlife crisis issues
-provide information to coincide with life concerns and problems (ex: a midlife crisis may have occurred now and they quit and are trying new, which causes stress, so be applicable)
What is the Ego Integrity v Despair Level?
- Older Adult 65+
- important life event here is reflection on life and needing to see a sense of fulfillment. Success leads to feelings of wisdom, but failure leads to regret/bitterness/despair
Teaching Methods and Strategies for those in the Ego integrity v Despair Level?
-build on past life experiences (there’s always regrets in everyone’s life)
- allow time for processing verbal exchange and coaching
-speak slowly and distinctly
-use analogies (relatable ones)
-face client when speaking
-use visual aids
-use large letters
-provide sufficient light
-use white backgrounds and black print
Piaget’s level of Cognitive Development Important to Adults?
Formal Operational Stage
Formal Operational Stage
intelligence is demonstrated through logical use of symbols related to abstract concepts (but only 35% of HS graduates get here) (if not reached, just concrete operational is reached)
Kohlberg’s Important Levels of Moral Development for Adults?
Conventional Stage (Stage 3 and 4)
Post Conventional Stage (Stage 5 and 6)
Conventional Stage
typical stage of moral development in adolescents and adults where morality of actions is judged by comparing the actions to societal views and expectations
Conventional Stage: Stage 3
interpersonal accord and conformity drives morals (so you behave according to approval or disapproval from others as it reflects society’s accordance with the perceived role)
- live up to a “golden rule”
-desire to maintain rules and authority
Conventional Stage: Stage 4
authority and social order obedience drives morals
-so they obey laws and social conventions and a central ideal or ideals often prescribe what is right and wrong
-they have a sense of obligation and a duty to uphold laws and rules
Post Conventional Stage (Principle Level)
Realization that individuals are separate entities from society - so morals internalized morals
fairly rare
Post conventional stage: Stage 5
-Social contract drives morals
- individuals are seen to have different opinions and values so laws are just social contracts rather than rigid dictations - those not promoting general welfare should be changed when needed to meet the greatest good for the greatest number of people
Post conventional stage: Stage 6
-Universal ethical principles drive morals
-moral reasoning is based on abstract reasoning using universal ethical principles, leading to laws being valid only if they are just and carried in a way that disobeys injustice
- you act BECAUSE it is right, not because it is instrumental, expected, legal, or previously agreed upon
Leading Causes of Death in Adults
From Greatest to Least
- HEART DISEASE (lifestyle impact)
- CANCER
- UNINTENTIONAL INJURIES
- COPD
- Cerebrovascular Disease
- Alzheimer’s Disease
- Diabetes
- Flu and Pneumonia
- Nephritis
- Suicide
Mortality Rate between Adult Genders?
Overall male mortality is 1.4x greater than in females, but it differs in different categories (ex: Women had more strokes for instance)
Unintentional Injury, Homicide, and Suicide are more common in younger ages causing death, but it changes to what later on?
Cancer and Heart Disease
Most Common Cancer Deaths in males?
- lung
- prostate
- colorectal
Most common cancer deaths in females?
- Breast
- colorectal
- lung
HP2020 Leading Health Indicators for a Healthy Adult?
Access to health services
Clinical preventive services
Environmental Quality
Injury and violence
Maternal, infant, and child health
Mental health
Nutrition, physical activity and obesity
Oral health
reproductive and sexual health
social determinants
Substance abuse
Tobacco
Important Health Policies for Adult Health
- American with Disabilities Act (ADA)
- Patient Self Determination Act
- Family and Medical Leave Act
- Personal Responsibility and Work Opportunity Reconciliation Act (aid to families in need)
Patient Self Determination Act
act helping with advanced directives encouraged starting at age 18 (this allows for a living will and durable power of attorney)
Why is Decision Making a problem with older Adults?
the client needs to be able to make appropriate decisions with autonomy or have a responsible surrogate decision maker.
they also need disclosure of info to make informed decisions, assessment of function to determination of level of care, and ability to choose termination of treatment at the end of life
Major Chronic Diseases Unique/Concerning in Women
Easting Disorders
Reproductive health
Gestational Diabetes
Menopause
Breast Cancer
Osteoporosis
Major chronic Diseases Unique/Concerning in Men
Cancer Unique to Males (Prostate, Testicular)
Erectile Dysfunction
Health Disparities occur Among What Groups of Adults?
Adults of color
Incarcerated Adults
Lesbian/Gay Adults
Adults w/ Physical and Mental disabilities
Frail Older Adults
Primary Prevention Interventions in Adult Populations
-Prevention of Tobacco use
-Physical Activity and Fitness
-Proper Nutrition and Diet
-Good Sleep
-Good Social Connections (correlation to longer life)
-Responsible Sexual Behavior
-Immunizations (Influenza, Pneumococcal, tetanus, Diphtheria, pertussis, shingles)
Secondary Prevention interventions in Adult Populations
-Screening
> Recommendations come from US Preventive Services Task Force that gives a screening a grade, age, risk factor recommendations (A go ahead, D avoid)
Tertiary Prevention interventions in Adult Populations
-Treatment for Diabetes, CVD, Hypertension, Arthritis, Hepatitis, COPD, Asthma, CVA, and permanent injuries
-we want to help them achieve as close to independence and normal functioning as possible - so recommend them to resources, therapy, and groups that will help
Behavioral Risk Factor Surveillance System (BRFSS)
worlds largest, on going, telephone health survey system tracking health conditions and risk behaviors in the US since 1894
National health Interview Survey (NHIS)
-survey monitoring the health of the nation every 10 years
-broad ranges of health topics are collected through personal household interviews done by the US census bureau
Where is health data collected by surveys and systems found?
-On the national level the CDC weekly morbidity/mortality report, fast stats A to Z and data and statistics site
-On the state level you can go to the NYS Dept of Health site
Why does the government collect health data?
-RESOURCE ALLOCATION PURPOSES (MONEY)
-altruistically it is for a healthy population, but health care providers need to know where to concentrate their efforts and money
2 Community Based Models of Care for Adults?
- Chronic Care model (CCM)
- Community Care Settings
Chronic Care Model (CCM)
It is a model on how the community and organizations can be included to get patients active in dealing with their own health, and give areas to provide adult care
Examples of Community Care Settings for Adults
Senior Centers
Adult Day health
Home Health and Hospice
Assisted Living
Long Term Care and Rehabilitation
Caregiver Burden
burden of having to care for disabled children into adulthood, or adults having to care for their parents
we want to teach techniques and recognize abnormalities to provide resources to aid in their care - such as aiding them in coping with the demanding lifestyle
What is T.L.C.?
How we aid and teach the caregiver to prevent overabundant caregiver burden
What does T.L.C. stand foir?
T = Training (in care techniques)
L = Leaving periodically (to get normal respite and maintain personal needs)
C = Care for themselves (the caregiver needs proper health and health management as well)
