Week 2 - Population and Public Health Nursing Flashcards
Currently, on average, how do per person healthcare expenditures in the US compare to other countries and what is the average?
We have the highest cost per capita at around 8000$ on average
National Health Expenditures per Capita is projected to do what by 2023?
Double in cost per person to use healthcare
Why is the per capita cost of healthcare contradictory for the US?
Despite high healthcare expenditure costs, we have lower quality of care than other countries and have the highest infant mortality rate (1 out of 1000)
How does patient care differ from population health?
Patient care focuses on treatments for specific diseases and conditions, downstream symptoms of issues, medical and biological determinants of sickness, patients and healthcare providers, purchasers, and payers
Population health focuses on wellness, prevention, and health promotion; upstream causes of health problems; social determinants of health and community conditions; all people; partnerships between health and sectors such as education transportation and housing
What is the idea of upstream and downstream when it comes to healthcare
The idea is that we are so focused on downstream problems when the problems are coming from upstream (the community rather than individual issues) and we should be focused there
Population Health
The health outcomes of populations - so a distribution of health outcomes across a DEFINED GROUP
*These groups are often based on geographic populations like nations, states, neighborhoods, but can also be other groups like employees, ethnic groups, disabled persons, prisoners, or any other defined group.
Improving population health requires that healthcare providers and organizations…
look beyond their own systems and partner with other organizations, entities, and professionals
The important thing to understand about population health is…
there are populations with their own health (ex: faculty v student populations) and they are often a defined group either geographically or by some other definition.
What are the 3 levels of healthcare practice
Community Level
Population (Aggregate) Level
Individual or Family Level
Community Level
Broad
Contains and is composed of different populations
Population (Aggregate) Level
A group sharing a defined set of characteristics or shared characteristics
ex: Men 65+, Women 16-24, Infants
Populations are composed of individuals and families, but the population then composes and exist within a community
What level of healthcare practice would Broome county fall into?
Community
It is made up of populations within the county each having their own individuals and families
What determines health (Percentages %)?
Genetics - 20%
Health Care - 20%
Social, Environmental, Behavioral Factors - 60%
Social Determinants of Health
The economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole
They are system level factors so they can be hard to address
ex: your choice to go to the gym is influenced by these things outside your control
What are the main social determinants of health
Safe Affordable Housing
Quality Education
Job Security
Social Connection and Safety
Living Wage
Access to Transportation
Availability of Food
Health is ___ than health care
more
Health is tied to the …
distribution of resources
The choices we make are…
shaped by the choices we have
High Demand + Low Control = ___ ___
Chronic Stress
Chronis Stress can be ___
deadly (Cortisol response)
What can cause telomeres to shorten
chronic stress - this causes actual physiologic changes in the body
HPA Axis
Hypothalamic Pituitary Adrenal Axis system
Controls release of cortisol, the stress hormone that can hurt us when chronic or in large amounts
Hypothalamus (releasing factor) –> Anterior pituitary (ACTH through blood) –> Adrenal Cortex —> Cortisol
What are the factors that determine the magnitude of the HPA Axis response
- Novelty to the individual
- Unpredictable nature
- PERCEIVED threat to person
- Sense of loss of CONTROL
Where you work, live, and play …
impacts your health!
Health Equity
when all people have the opportunity to “attain their full health potential” and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance
Achieving health equity requires what?
Social justice
Social Justice
the fair and compassionate distribution of the fruits of economic growth
Health Disparity
a particular type of HEALTH DIFFERENCE that is closely linked with social or economic disadvantage
To improve health equity, we must address what?
the root causes of disparities - this means GOING BEYOND ASKING WHO is at greater risk for disease to ASKING WHY some populations are at greater risk
How does equality, equity, and justice differ?
Equality assumes everyone benefits from the same supports - this is equal treatment (ex: everyone gets a box to stand on regardless of height)
Equity means everyone gets the supports they need via “affirmative action” - everyone gets amounts of boxes based on height in order to see over a fence
Justice is when causes of inequality (systematic barriers) are removed (ex: there is now a see through fence)
The medical lens of health can always be traced back to …
the social determinants lens
According to the APHA, Public health nursing is…
the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences
The foundation of public health nursing is based on…
public health and nursing science supporting one another
How is public health nursing a population based practice
focuses on entire populations
grounded in the ASSESSMENT of the populations health status
considers the broad determinants of health
focuses on all levels of prevention, with an emphasis on primary prevention
intervenes at multiple levels - community, systems impacting community health, individuals and families that comprise communities
collaborates with a variety of other professions and stakeholder groups
The Client Unit of Care in PHN is ?
the population
What are the principles of public health nursing
- Unit of care is the Population (not just the individuals)
- Achieve the greatest good for the greatest number
- Health promotion and protection !!! are priorities
- Select strategies that create health environmental, social, and economic conditions
- Actively reach out to all who might benefit
- Use available resources
- Collaborate with other professions and organizations
What are the essential components of nursing practice?
- Health Promotion (Individual to population level; attaining optimal health)
- Risk Reduction (Reduces person’s risk for disease)
- Health Protection (Person’s ability to protect against disease)
What are the Quad Council Competency Domains for Public Health Nurses (Skills they need)
- Analysis and Assessment
- Policy Development/Program Planning
- Communication
- Cultural competency
- Community Dimensions of Practice
- Public Health Science
- Financial Management and Planning
- Leadership and systems thinking
What are some bodies of legal guidelines and ethics which guide PHN practice
State nurse practice acts
Education, License, Certification
Standards of Practice
Code of Ethics
Public Health Laws (Mandatory Reporting)
Civil Laws (Surveillance, Investigations, Confidentiality)
Criminal Laws (Prisons)
According to the Minnesota PHN Intervention Wheel there are ___ levels of practice and ___ public health interventions
3 levels of practice (individual/family, community, systems)
17 public health interventions
What are the 4 interventions of screening and disease investigation
Surveillance
Disease and Health Event investigation
Outreach
Screening
What are the 3 interventions of Case Management
Referral and follow up
Case management
Delegated functions
What are the 3 interventions of health teaching
Consultation
Counseling
Health Teaching
What are the 3 interventions of Community Collaboration
Community Organizing
Coalition Building
Collaboration
What are the 3 interventions of policy development
Policy Development and Enforcement
Social Marketing
Advocacy
Settings PH Nurses can be found in
Local and state health dept
Homes
Schools
Prisons
Factories/Large employment firms
Parishes, Churches, Synagogues, Mosques
Child care Facilities
Non profit relief organization (i.e. red cross)
nail salons, barber shops
Public Health Nurses are ____ and/or ___
Generalists (covers all areas of public health) and/or Specialists (ex: Communicable disease, Environmental health, etc)
What is public health
public health is the set of activities a society undertakes to monitor and improve the health of its collective members
What are the 3 core functions of public health
- Assessment.
- policy Development
- Assurance
Assessment
Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community
Policy Development
Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.
Assurance
Making sure the essential community oriented health services are available.
Making sure that a competent public health
workforce is available.
What are some aspects of Assessment
Monitor Health
Diagnose and Investigate
What are some aspects of policy development
Inform, Educate, Empower
Mobilize Community Partnerships
Develop Policies
What are some aspects of Assurance
Evaluate
Assure competent workforce
Link to and provide care
enforce laws
What does it mean that “Public health is not found in silos”
It involves so many other aspects and other stakeholders like nursing, social scientists, tech people, etc
It is not just one idea, in order to solve PH issues we need to come together with multiple disciplines to solve problems
Public Health Does not require ___ ___
rote memorization
Where does the complexity of public health come in?
The technical pieces like biology of disease, economics of development and measurement of disease burden are important but not overly complex
The complexity comes in asking new questions or old questions in new ways - thinking about the world and our relationship to health in ways that we are not used to
Public health might seem like a straightforward discipline but the challenge comes in…
application / getting people to buy into it
What are some examples of things the many layers of local and state public health departments do?
Protect the health of citizens
Surveillance
Outbreak Investigation
Quarantine
Mandated reporting of specific diseases
Report cause of death to state health departments and the CDC and prevention
Natural and Manmade disaster preparedness
Oversee public sanitation
Safety of the water supply
Laboratory testing of water samples
Inspection of sewer systems
Health related mandates
Food safety
Provide direct health care like vaccines, well baby checks, and prenatal care
Public health agencies are most successful and least noticed when…
their prevention measures work the best
Florence Nightengale
Devoted life to prevention of needless illness and death through PREVENTION OF INFECTIONS and FOCUS ON ENVIRONMENTAL HEALTH
Reformer of hospital care
Who is considered the founder of professional nursing via opening the first nursing school in 1860
Florence Nightingale
Who is considered the pioneer in the use of statistics and policy in nursing?
Florence N
Florence Nightingale used statistics to show hospital conditions in the Crimean war were deplorable which lead to what?
Public attention –> more funding for Army hospitals
Improved cleanliness, hygiene, and nutrition
Death rate of soldier decreases
Lillian Wald
1885- Founded Henry Street Settlement
Believed nurses should not only care for the sick in their homes but teach prevention, and address SOCIAL CONDITIONS
Who coined the term Public health Nursing
Lillian Wald
Who introduced “school nursing” to the US
Lillian Wald
Who convinced the red cross to work with rural communities
Lillian Wald
Lemuel Shattuck
Wrote the Massachusetts Lemuel Shattuck Report which established permanent boards of health in MA
These reports began collecting and recording vital statistics and promoted sanitary measures to prevent disease
This then spread to other localities (the movement)
What laid the foundations for the Board of Health
Lemuel Shattuck Report
Mary Breckenridge
Established the Frontier Nursing Service in 1925 to provide nursing for underserved populations in remote mountains of Kentucky
Still exists and educates midwives to this day
HP2030 allows you to look at what regarding public health?
How one community may differ from national data comparisons
