Multicultural Midterm Flashcards
What are the 5 criteria for PHN practice?
- Focus is entire populations
- Assessment-guided
- Considers broad determinants of health
- Considers all levels of prevention
- Considers all levels of practice
What are the 3 core functions of PH?
Assessment
Policy Development
Assurance
What is Assurance in PH?
Enforcing laws, Assuring a competent workforce, Evaluate, Monitor
What is Assessment in PHN?
Identifying problems/needs/strengths, setting priorities and objectives, determining how to take action.
Data gathering, ID problem, nursing diagnosis, care plan to meet goals, carry out plan, evaluate and revise.
What are the 6 steps of community assessment (in order)?
- Build partnerships
- Planning
- Setting direction of assessment
- Selecting data collection methods
- Collecting data
- Sharing results
What is health promotion?
the process of enabling people to increase control over and improve their health
What are the principles of health promotion?
Participation, empowerment, equity, sustainability, intersectional action, multi-strategy, contextualism (embed interventions into local circumstances)
Levels of Prevention: Primary
Promote health and prevent occurrence of disease/injury/disability
Levels of Prevention: Secondary
Early disease/injury: interventions designed to increase probability for early diagnosis/treatment (health screenings and diagnosis/treatment)
Levels of Prevention: Tertiary
Interventions to limit disability and enhance rehabilitation
Public health nursing emphasizes ______
prevention
Public health nursing focuses on the health needs of _______
an entire (vulnerable) population
PHNs in schools will focus a lot of time on…
education (children and parents)
PHNs in volunteer organizations have a strong focus on….
disaster relief
also education on preventing further outbreaks of diseases
PHNs in government will be focused on….
policy development
Occupational health nurses focus on
keeping workers healthy and preventing work-related injuries
Correctional health nurses provide…
healthcare for those in jails, prisons, juvenile detention centers
Faith community nurses role is to…
provide support for families and individuals - goal of empowerment
Epidemiology is a study of….
the distribution and determinants of disease AND application of the results
descriptive epidemiology is…
studying the distribution of the disease (occurrence: types, places, times it’s most likely to occur)
analytic epidemiology is…
studying the determinants of the disease (agent, host, environment triangle)
concerned with causes/effects - i.e., the why/how
quantifies assoc btw exposures and outcomes
tests hypotheses about causal relationships
Why are patterns important to epidemiology?
Health events occur in patterns (not randomly distributed)
Observing/recording these patterns allows us to ID determinants/causes of disease
does epidemiology focus on populations or individuals?
entire populations (and disease prevention and control in these populations)
What are the three key rates used in public health?
Mortality
Incidence
Prevalence (actually a proportion not a rate)
The mortality rate describes…
… it’s calculated by
…the number of deaths per 100k people in a population.
…divide the number of deaths by the total population and multiply by 100k.
The incidence rate describes…
How many NEW cases of a disease occurring per 100k in a population.
The prevalence describes…
the proportion of the population that has a certain disease or characteristic at one point in time
Morbidity describes…
illness/injury
can be incidence or prevalence
Direct transfer is…
transfer from source or reservoir by direct contact or droplet spread
Indirect transfer is…
transfer from source or reservoir by air particles, vectors or fomites
What are some descriptive epidemiology questions we ask in a community assessment?
who are we?
how healthy are we?
how healthy are our lifestyles and behaviors?
how healthy is our environment?
How to determine a priority need of the community?
- greatest impact on the population
- most vulnerable population
- what does the community want?
- how quick/realistic is it to solve these problems?
- must be grounded in social justice
if there’s no microorganism, what is the agent?
agent might be a chemical, a psychological or physical event, genetic issue, a nutrition issue
what is pathogenicity?
the ability of an organism to cause disease
what factors influence whether exposure to an agent causes disease?
organism’s pathogenicity and dose
host risk factors: exposure, susceptibility, response
factors that transmit the agent, sanitation
(web of causality)
types of vectors
living creature that carries disease between organisms
inanimate objects (like paper money, syringes)
what is the burden of the disease?
how many people are affected? (incidence, prevalence, mortality rate)
Order of questions in determining distribution in epidemiology?
- what is the burden of the disease?
- who is getting the disease?
- where are the affected persons?
- When are people most commonly affected?
what is meant by the term “community-level indicators”?
things that show trends for the community as a whole - use them to find out whether your efforts have had any effect. Ie, have car crashes gone down?
what are the criteria for screenings in public health?
- disease must be an important public health problem
- there must be an asymptomatic stage of the disease
- early treatment must exist
- suitable screening test must be available
in screenings, sensitivity is a measure of….
how good the test is at identifying people who have the disease
in screenings, specificity is a measure of…
…how likely is it that a person who is negative for the disease will get a negative test result
(or, how often does it yield false positives)
define: innate protection
skin, enzymes, acids, etc
define: passive immunity
temporary - gained from another animal (breastfeeding, prenatal antibodies, etc)
define: active immunity
long-term immunity created by the body in response to contact with the disease or a vaccine
define natural immunity
not susceptible to a disease, genetically
What is QUALY and what is it used for?
It’s used in a cost-benefit analysis of whether a public health intervention is worthwhile.
“Quality Adjusted Life Year” It’s a number related to life quality per year (a year of perfect health = 1, death is 0, less than perfect health is less than 1.
Each QUALY is the assumed equivalence of $50-$100k.
What immunizations are attenuated live vaccines and what does that mean?
Flu spray, MMR, Varicella, rotavirus
They’re grown in a very cold environment so they’re weak. RNA/DNA is destroyed in the insufficient attempt to replicate.
Don’t use for people with poor immune systems.
General principles for defining a problem in PHN
define the problem in terms of needs, not solutions; and as a problem that everyone shares
ask yourself if you have the resources needed to address the problem? what work is underway and who is doing it? what gaps exist?
Also, what political support and resistance surrounds the problem?
Creating a problem statement includes….
- description of the problem/need
- description of the community it exists within
- what it’s related to (what contributing factors or cause)
- as evidenced by (signs/symptoms/manifestations)
Smart Goal differences
There’s no intervention in public health - rather, we write about what we want to SEE
What is the logic model?
Helps you put your SMART goal into action. You define:
- Resources (available)
- Activities (training/outreach you plan to do)
- Outputs (training/outreach you actually did)
- Outcomes (were the smart goals met)?
What are the 3 levels of the intervention wheel?
Community, Systems and Individual/family
PH interventions are population-based if they
- focus on entire populations w/ similar health concerns/characteristic
- determined thru a community health assessment process
- consider broad determinants of health
- consider all levels of prevention (especially primary prevention)
- consider all levels of practice
What relates the interventions that share the same wedge (on the intervention wheel)
They’re frequently implemented in conjunction with each other.
(color-coordinated)
Case Finding only happens at an _____ level
individual/family
Coalition building cannot happen at an _____ level
individual/family
What changes happen at the individual level?
knowledge, attitudes, belief, practices, behaviors of individuals and households
What changes happen at the community level?
attitudes, awareness, practices, behaviors within community or target groups
What changes happen at the systems level?
organizations, policies, laws, power structures
What does SMART+C stand for in community health
Specific Measurable Achievable Relevant Timed Challenging
Who are agents of change?
people in a position to contribute to the solution
who are targets of change?
the people who experience the problem/issue on a day-to-day basis
What is Active Surveillance
When disease cases are actively sought out in the community
What is Passive Surveillance?
When disease is reported to the public health database
Examples of Surveillance
Census statistics, vital statistics, disease registries, lab/survey data
What is endemic?
If the number of cases doesn’t exceed the expected amount
What is an outbreak?
When the disease spreads from one population to another
What is an epidemic?
when the disease occurs at a higher level than expected among a population
what is a pandemic?
when disease strikes multiple areas
What intervention do we use to monitor disease spread (outbreaks, etc)?
Surveillance
What is the first goal of a disease outbreak investigation?
identify the source of the illness
Advocacy is…
the art of influencing others to accept a specific course of action/program/services to solve a societal problem
Policy development is…
getting health issues placed on decision-makers agendas, acquires a plan of resolution and determines needed resources
Policy enforcement is…
compelling others to comply with rules, laws, regulations, policies (can use visual tactics to compel others to change their behavior)
what is program evaluation?
it’s a way to evaluate the specific projects and activities community groups may take part in
(it doesn’t evaluate an organization itself, nor does it evaluate a community initiative)
What is a formative evaluation?
Any evaluation that takes place before a project’s implementation - the goal is improving the project’s design and performance
What is a summative evaluation?
Assessment of the program/participants where the focus is on the outcome of the program (are they the intended outcomes?)
What is a process evaluation?
evaluates the planning and logistical activities needed to set up and run the program, intervention, etc.
What is an impact evaluation?
looks at what actually happened as a consequence of the project’s existence - did the work have the effects we’d hoped for? did it have other, unforeseen +/- effects? Do we know why we got the results we did? what can we change to make our work more effective?
What is a PDSA?
Plan-do-study-act. Used for small, incremental program improvements over time.
In other words, it’s small scale, used to improve established and ongoing problems
Disease and other health event investigation… (Minnesota Intervention Wheel)
systematically gathers/analyzes data regarding threats to the health of populations, ascertains the source, identifies cases and others at risk, determines control measures
Outreach
locates populations of interest (or at risk) and provides info about the nature of the concern, what can be done about it and how services can be obtained
Case finding
locates individuals and families with risk factors and connects them with resources
Screening
ID’s individuals with unrecognized health risk factors or asymptomatic disease conditions
Referral and follow-up
assists individuals, families, groups, organizations, communities utilize necessary resources to prevent or resolve problems or concerns. (might develop the resources). Follow-up is key here.
Case management
optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services
Delegated functions
direct care that a nurse carries out under the authority of a health care practitioner
Health teaching
communicates facts, ideas and skills to individuals, families, systems and/or communities
Counseling
establishes an interpersonal relationship with a community, system, family or individual - goal is to increase or enhance their capacity for self-care and coping. engages at an emotional level.
Consultation
seeks info and generates optional solutions to perceived problems. uses interactive problem-solving. can be community, system, individual - they’re the ones who select the best option.
Coalition-building
promotes and develops alliances among organizations for a common purpose.
Social marketing
uses commercial marketing principles/technologies to influence people (kala emphasized emotional involvement here)
Why do we evaluate nursing interventions?
- demonstrate impact to funders
- suggest improvements for continued efforts
- seek support for continuing the program
- gather info on the approach that can be shared with others
- determine if an approach would be appropriate to use in other locations
why have an evaluation plan?
- to guide you step-by-step thru the evaluation
- to help decide what info you and stakeholders really need
- to keep you from gathering info that isn’t needed
- to help you identify the best possible ways to get the needed info
- to come up with a timeline
- to help you improve your initiative
when should you develop an evaluation plan?
as soon as possible - even before you implement the initiative if possible (after you establish goals/outcomes)
