Nursing in the Community/Poverty Flashcards
Public and Community Health Implicit Bias Poverty ACE's TED Talk
In the TED TALK, poverty and childhood trauma can affect the health care of a patient in which ways?
low brain development
immune system
hormonal systems
DNA transcriptions
triple lifetime risk and lung cancer
20-year difference in life expectancy
Adverse Childhood Experience
physical, mental, and sexual abuse
neglect
parental illness
substance dependence
incarceration
divorce
domestic violence
What was discovered in the ACE study?
common
dose-response relationship which health outcomes (higher score = poor health outcomes)
- increases the rate of severe diseases to death
“But it turns out even if you don’t engage in high-risk behavior, you are still more likely to develop heart disease or CA as a HIGH ACE score” Why?
Hypothalamic-pituitary-adrenal axis
stress reponse for fight or flight
- the system is constantly activated every day and goes from adaptive to health-damaging
children are sensitive to this because they are still developing
Center for Youth Wellness
prevent
screen
heal the impacts of ACE and toxic stress
If you have an ACE score of 4+, then you are ______ as likely to develop hepatitis or COPD
2.5 TIMES
If you have an ACE score of 4+, then you are ______ as likely to develop depression
four times
If you have an ACE score of 4+, then you are ______ as likely to take your own life
12 times
What is the single greatest unaddressed public health threat facing our nation?
ACE
Public Health
protecting and promotion of healthy lifestyles, researching disease and injury prevention and detection and control of infectious diseases.”
Public Health examples
Tries to find solutions for disease outbreaks such as COVID-19.
CDC Foundation
Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world
What does medicine do?
saves lives one at a time
What does public health do?
Saves lives millions at a time.
What health category works with improving lifespans?
Public, almost 80
Public Health try to impact people through
health promotion and disease prevention of the general public
-Research
-Advocacy
-Education
Settings as Public Health
Government agencies/organizations – country, state or federal
Health departments
Prisons
Worksites
Community clinics/health centers
Non-profit organizations
School systems
public health nurse’s roles
Managing grants
Conducting research related to disease outbreaks
Overseeing emergency preparedness programs
Developing immunization clinics in areas in need
Case Management for Children and Pregnant Women (CPW) and Children with Special Health Care Needs (CSHCN):
Medicaid and CSHCN program that provides home-based case management for families to gain access to needed medical, social, educational and other services.
Immunizations
Strives to improve vaccine coverage levels for people of all ages to help reduce vaccine preventable diseases
Texas Department of State Health Services
Case Management for Children with Special Health Care Needs and Pregnant Women and Children on Medicaid with a Health Risk
Chronic Disease Prevention
Epidemiology (Infectious and Chronic Disease)
Health Emergency Preparedness and Response
HIV/STD/STI
Immunizations
Community Health Improvement
Oral Health Improvement Program
Public Health Sanitation & Retail Foods Safety
Spinal/Vision/Hearing Screening (SCHOOLS)
Texas Health Steps
Tobacco Prevention & Control
Tuberculosis Control (Rx regimen checks)
Zoonosis Control – caused by animals
Oral Health
Works with various partners across the state to identify the oral health needs of Texans and the resources to meet those needs. Provides preventive dental services to eligible low-income, underserved, pre-school, and school-aged children who are Texas residents.
Texas Health Steps
A special program for children from birth through 21 years of age who are enrolled in Medicaid. Provides regular medical and dental checkups for clients at no cost. Assists in overcoming barriers to clients in accessing health care services.
Community Health Improvement:
Certified inspection station for child passenger safety.
Conductand/or assist with activities for the prevention of child abuse, child injury and fatality, infant mortality, teen pregnancy, childhood obesity, and suicide in youth.
Conduct outreach and public awareness for Domestic Minor Sex Trafficking.
Participate in and support Child Fatality Review Teams.
Provider of continuing education for certified Community Health Workers.
Providers of suicide prevention programs: ASK (ask about suicide to save a life) and QPR (question persuade refer).
Health and safety programs for migrant and farmworker families in the South Plains and refugee families in the Panhandle.
Provide the Community Training for “Safe Sleep for Babies.”
Provide and support Healthy Texas Babies initiatives.
Programs specific to Pediatrics
Bullying
Suicide prevention
Domestic Minor Sex Trafficking
teach on trends
Community Health Nursing
Focus is on the promotion and maintenance of health in individuals, families, and groups in the community through direct interaction with them
It is population focused (focuses on smaller communities that share location, demographic and socioeconomic traits)
Emphasizes personal responsibility for health and self care
Learn about healthy behaviors and manage chronic
Community
A group of people with shared characteristics / interests who interact with one another.
Populations
Groups of people in a community who have common characteristics (such as school-age children).
Target Populations
Groups that are more narrowly defined (for example, school age children who are obese).
potential barriers to health & wellness
Income
Insurance coverage
Education
Culture (influences diet, activity level, and risk exposure)
Location (inter-city verses rural communities)
A community health nurse’s scope of practice includes:
Illness
Disease prevention, including immunizations
Safe health practices
Nutrition
Wellness
Education - They design health education programs to encourage healthy behaviors, called Community Health Initiatives
Community Health Initiative Examples
The Importance of Immunizing Your Child
Safety for Different Developmental Stages
Healthy Eating & the Importance of Exercise
Positive Ways to Deal with Stress & Anxiety
SIDS Prevention
Ways to Discipline Your Child
Stages of Growth & Development
Understanding Temperamental Styles
Community Health Nurses Work within the community
School districts
Community clinics/health centers
Health departments
Church organizations
Primary care offices
Home health
Government/health agencies
Shelters
Similarities between Public and Community health nurses
Both share the goal of improving people’s health
They often work together
Differences between Puclic and Community Nurses
Public Health nurses review historical records, scientific studies and population data
More research based
Community Health nurses focus more on the resources that community members have access to that support health and well-being
Resource focused
Public Health is more based on
research and data
Community Health is more based on
Resources
211Texas.org
financial resources in the community
Implicit Bias remember
we all have “Implicit Bias”
Implicit Bias is
reflective of our attitudes (positive and/or negative) or stereotypes towards people, things, or groups that can affect our understanding, actions, and decisions unconsciously and can affect patient relationships and care decisions.
As a professional, we must respect of patients
choices, whether or not we understand or agree
TRiggers to Implicit Bias
Substance Abuse/Addiction
Sexuality
Age
Race
Ethnicity
Culture
Weight
Gender
Religion
Mental Illness
Physical Disability
Lifestyle Choices
Assumption of others based
appearance or personality
Waterline of Visibility
What is visible to others? (the top of the iceburg)
What is invisible, but forms the foundation of who you are?
Diversity Iceberg Model
90 percent of an iceberg is below the surface, 90 percent of who you are is below the surface
What is Self-Awareness?
ability to recognize oneself as an individual separate from everything else
The ability to focus on our actions, thoughts, and emotions
The difference between how we see ourselves and how others see us
Five Ways of Developing Self- Awareness
Observe yourself
Be open to change
Identify blind spots
Own bad habits
Aspire to know yourself
In Nursing, allows nurses to explore clinical experiences AND thoughts and feelings associated with the experience, allowing for change in beliefs and assumptions which can change our clinical practice is what?
Reflection
Self-reflection
Allows us to understand our belief systems, the assumptions that ground those beliefs, and how those assumptions and belief systems impact interactions with our patients/clients.
What is poverty?
The extent to which an individual does without resources.
The purpose of knowing the resources of a person is to know which interventions will work and which ones will not.
Interventions will work only when the needed resources for that intervention are available.
What should always be asked before sending the pt home?
Always ask the situation
Generational Poverty
Has its own culture, hidden rules, and belief systems.
The culture tends to be self-reinforcing and includes a set of values transmitted from parent to child
The attitude is that “society owes me a living”
In generational poverty, the child is encouraged not to
chnage
- no problem accepting resources and help
Situational Poverty:
A lack of resources due to a particular event (i.e., a death, chronic illness, divorce, etc.).
Unlike generational poverty, it is focused largely on monetary resources and can be a temporary situation.
The attitude is often one of pride and a great reluctance to accept charity.
In situational poverty, the individual does not want to
accept resources/charity
Financial of Poverty
unable to purchase goods or services
sole contributor
- no insurance
met deductible
In Nursing about Financials resources,
help with the cost of doctor/clinic
appointments, prescriptions, and medical equipment.
Emotional resources
Being able to choose and control emotional responses, particularly to negative situations, without engaging in self-destructive behavior.
This is an internal resource and shows itself through stamina, perseverance and choices.
It is one of the most important.
Referred to as Cognitive Restructuring or Reframing
In Nursing about Emotional resources,
Mindfulness, Meditation, and Relaxation
Techniques (for stress reduction).
Mental/Cognitive Resources
Having the mental abilities and acquired skills (reading, writing, computer skills) to deal effectively with daily life.
In Nursing about Mental/Cognitive resources,
GED Classes, Computer Classes, and ESL Classes.
written and read at 8th grade level on average
Spiritual resources
Believing in divine purpose and guidance. Powerful
In Nursing Spiritual resources,
Asking if they would like a chaplain to visit with them.
-AA
In Nursing Physical resources,
Classes on healthy eating & exercise.
Free monitoring of blood pressure & blood glucose.
Physical resources
Having physical health and mobility
Support systems
Having friends, family, and backup resources available to access in time of need.
These are external resources.
In Nursing support systems resources,
Referral to Summer Camps, Support Groups and
counseling resources.
Relationships/Role Models resources
Having frequent access to individual(s) who are appropriate, who are nurturing, and who do not engage in self-destructive behavior.
Self-destructive behaviors include things like
cutting, use of tobacco, alcohol, or drugs to cope with stress and anxiety
In Nursing relations and role models resources,
Pediatric Community Health Nurses and School Nurses.
Knowledge of Hidden Rules (mores) helps the nurse understand
pt’s perspectives
salient, unspoken understandings that cue the members of the group that an individual does not fit
Hidden Rules of Money in different financial classes
Poverty: To be used, spent
Middle Class: To be managed
Wealth: To be conserved, invested
Hidden Rules of food in different financial classes
Poverty: Key question is did you have enough? Quantity important.
Middle Class: Key question is did you like it? Quality important.
Wealth: Key question is was it presented well? Presentation important.
Hidden Rules of clothing in different financial classes
Poverty: Valued for individual style and expression of personality
Middle Class: Valued for its quality and acceptance into norm of middle class; label important
Wealth: Valued for its artistic sense and expression; designer important
Hidden Rules of driving forces in different financial classes
Poverty: Survival, relationships, entertainment
Middle Class: Work, achievement
Wealth: Financial, political, social connections
formal languagein situations that are
serious and involve people we don’t know well
informal languagein situations that are
more relaxed and involve people we know well.
How does poverty affect children neurologically?
gray matter affect
What experiences measured in the study of ACEs
Abuse (Physical, Emotional, Sexual)
Neglect (Physical, Emotional)
Household Dysfunctions (mental illness, incarcerated, mother treated violent, substance abuse, divorce)
What are behaviors measured in the study of ACEs?
lack of physical activity
smoking
alcoholism
drug use
missed work
What are mental and physical health issues measured in the study of ACEs?
severe obese
DM
Depression
suicide attempts
STD
heart disease
CA
stroke
COPD
broken bones
The greater the ACEs have lasting effects
for risk of negative and wellbeing outcomes
An ACE score is meant as
guidance
ACE scores don’t take into account the positive experiences in early life that
help build resilience & help to protect a child from trauma
What can be done about ACEs?
home visiting to pregnant women and families with newborns
parenting training programs
intimate partner violence prevention
social support for parents
parent support programs for teens and pregnancy prevention programs
mental illness and substance abuse tx
Quality child care
sufficient income support for lower-income families
What did the ACEs test not take into account?
positive role models
EASE TOXIC STRESS
develop resilience is at least one stable and committed relationship with a supportive parent or grandparent, caregiver, or other adult or close friend
helps buffer against the negative lifelong health effects caused by ACEs**
HOPE
HOPE 4 building blocks
Relationships within family through interpersonal activity
Safe, equitable, stable environments
social and civic engagement
Emotional growth
What are some things that might counteract the ACEs?
HOPE Building blocks
What can be done about ACEs?
suggests “Trauma Informed Therapy” such as art, yoga or mindfulness training can also be helpful.
Trauma-Informed Cognitive Behavioral Therapy (TF-CBT)
Education about childhood trauma
Parenting skills
Relaxation skills
Coping – connecting thoughts, feelings, and behaviors
Trauma narrative
The community nurse is teaching a group of parents about public health. What is the best way to define public health? Select all that apply.
A. It is population-based medicine
B. It has improved people’s lifespan
C. It provides standard programs and services
D. It is concerned with protecting health of entire populations
A. It is population-based medicine
B. It has improved people’s lifespan
C. It provides standard programs and services
D. It is concerned with protecting health of entire populations
A school nurse is explaining Texas Health Steps to a group of elementary school parents. What aspects of the program will she want to include? Select all that apply.
A. It is a special program for children birth through 21 years of age
B. It is for children who are enrolled in Medicaid
C. It provides medical and dental checkups for clients at no cost
D. It assists in overcoming barriers in accessing healthcare
A. It is a special program for children birth through 21 years of age
B. It is for children who are enrolled in Medicaid
C. It provides medical and dental checkups for clients at no cost
D. It assists in overcoming barriers in accessing healthcare
What are Community Health Initiatives that the Community Health Nurse could focus on when teaching a parenting class for parents with infants? Select all that apply.
A. The importance of immunizations
B. Bullying prevention
C. Toy safety
D. SIDS prevention
E. Healthy eating
A. The importance of immunizations
C. Toy safety
D. SIDS prevention
The Community Health Nurse is recommending online resources that are available to parents with infants. Which would be appropriate for the nurse to include? Select all that apply.
A. Text for Baby
B. Safe to Sleep
C. Bright by Text
D. Consent
E. Parenting Advice
A. Text for Baby
B. Safe to Sleep
C. Bright by Text
E. Parenting Advice
The Community Health Nurse is participating in a Community Health Initiative on Healthy Eating and Exercise with a poverty level population. What is important for the nurse to remember about families who live in poverty?
A. What resources they are lacking and what interventions are needed.
B. Where they fall according to the poverty income level to determine needs
C. What is their BMI to determine eating and exercise practices
D. Determining if they have hypertension or elevated serum glucose levels
A. What resources they are lacking and what interventions are needed.
What are some examples of “hidden rules” that are often associated with various socio-economic levels? Select all that apply.
A. In the middle class, money is to be managed
B. In the middle class, food quantity is important
C. With the wealthy, financial, political and social connections are valued
D. In poverty, quality of food is important
E. In poverty, survival, relationships and entertainment are valued
F. With the wealthy, individual style of clothing is valued
A. In the middle class, money is to be managed
C. With the wealthy, financial, political and social connections are valued
E. In poverty, survival, relationships and entertainment are valued
Which are examples of mental/cognitive resources? Select all that apply.
A. The ability to read
B. Being able to write
C. Utilizing relaxation techniques
D. Having computer skills
E. Family and friends
F. A school counselor
A. The ability to read
B. Being able to write
D. Having computer skills
The nurse understands which categories comprise an ACE score? Select all that apply.
A. Different types of abuse
B. Different types of neglect
C. Positive experiences in early life
D. Household dysfunction
A. Different types of abuse
B. Different types of neglect
D. Household dysfunction
What are examples of how ACEs may affect a person’s health? Select all that apply.
A. Significant weight loss
B. Cancer
C. Heart disease
D. COPD
G. Intellectual & developmental delays
B. Cancer
C. Heart disease
D. COPD
