CMN 420- Test 1 - Notes - EXAM 1 Community Health (Chapters 1-5, 7-9, 11-13)

EXAM 1 Community Health (Chapters 1-5, 7-9, 11-13) Chapter 1 1. Distinguish between the 3 types of communities Geographic Community – defined by its geographic boundaries - City, town or neighborhood Common Interest Community – identified by a common interest or goal - Church, professional organization, people with mastectomies Community of Solution – a group of people who come together to solve a problem that affects all of them 2. Understand the factors that contribute to a healthy community. Leading Health Indicators: - Access to health services o Increase proportions of people who have health insurance and who have a usual primary provider - Clinical preventative services o Colorectal cancer screening; controlling BP in those with HTN; reduce # of those with diabetes with an A1c value 9%; vaccines - Environmental quality o Reduce # of days the air quality index exceeds 100; reduce # of children exposed to secondhand smoke - Injury and violence o Reduce fatal injuries and homicides - Maternal, infant, and child health o Reduce all infant deaths and total preterm births - Mental health o Reduce suicide rate and the # of adolescents who experience major depressive episodes - Nutrition, physical activity, and obesity o Reduce obesity (children, adolescents and adults); increase total veggie intake; increase # of adults who meet physical activity guidelines for aerobic physical activity and muscle strengthening activity - Oral health o Increase # of people who visited the dentist in the past year - Reproductive and sexual health o Increase # of sexually active females (15-44yrs old) who received reproductive health services in the past 12 months; increase knowledge of serostatus among HIV positive persons - Social determinants o Increase # of students who graduate with a regular diploma 4yrs after starting ninth grade - Substance abuse o Reduce # of adolescents using alcohol or any illicit drugs during the past 30 days; reduce # of adults engaging in binge drinking during the past 30 days - Tobacco o Reduce # of adults who are current smokers; reduce # of adolescents who smoked in the past 30 days 3. Differentiate between the Three Levels of Prevention Primary Prevention – includes measures taken to keep illness or injuries from occurring - Childhood vaccinations, installation of safety devices in the homes of the elderly, etc. Secondary Prevention – involves efforts to detect and treat existing disease - Breast and testicular exams, cholesterol screening, etc. Tertiary Prevention – attempts to reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function - Rehabilitation of persons after a stroke, postmastectomy exercise programs to restore function, etc. 4. Discuss the two main components of community health practice Health promotion and Disease prevention o Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness (goal is to raise levels of wellness for individuals, families, populations, and communities) o Three pronged effort to: ▪ Increase the span of healthy life for all citizens ▪ Reduce health disparities among population groups ▪ Achieve access to preventative services for everyone - Prevention means anticipating and averting problems or discovering them as early as possible in order to minimize potential disability and impairment (3 levels of prevention discussed above) o Health problems are most effectively prevented by maintenance of healthy lifestyles and healthy environments Chapter 3 1. Identify the 3 core public health functions basic to community health nursing - Assessment - the systematic collection, assembly, analysis, and dissemination of information about the health of a community - Policy Development - use of assessment data to develop policy and direct resources toward those policies - Assurance - availability of necessary services throughout the community 2. Be Familiar with the various roles of the community health nurses Clinician – care provider - Focus on holism, health promotion/wellness, and prevention while using expanded skills Educator - health teacher - Plan for community-wide impact Advocate – pleader of the client’s cause or actor on behalf of the client - Two goals: help clients gain greater independence or self-determination; make the system more responsive and relevant to the needs of clients - Actions: being assertive, taking risks, communicating and negotiating well, and identifying resources and obtaining results Manager - Administrative direction of goals: plan, organize, lead, control, evaluate - Management behaviors: decision-making, transferring of information, and engaging in interpersonal relationships - Management skills - Case management Collaborator - Joint working with others - Multidisciplinary collegiality and leadership Leadership (action as a change agent) Researcher - Systematic investigation, collection, and analysis of data for solving problems - Questioning attitude/spirit of inquiry; careful observation; analytic skills; tenacity - Research process: o Identify an area of interest o Specify the research question or statement o Review the literature o Identify a conceptual framework o Select a research design o Collect and analyze data o Interpret the results o Communicate the findings 3. Understand the four actions of the Advocator - Being assertive - Taking risks - Communicating and negotiating well - Identifying resources and obtaining results Chapter 4 1. Identify the Community Health nurse’s steps in Ethical decision making Ethical decision-making – making a choice that is consistent with a moral code or that can be justified from an ethical perspective - Three key steps: o Separate questions of fact from questions of value o Identify both clients’ and nurses’ value systems o Consider ethical principles and concepts o Clarify the ethical dilemma - DECIDE o D – define the problem (or problems) o E – ethical review o C – consider the options o I – investigate outcomes o D – decide on action o E – evaluate results - Application of ethical principles to decision-making: o Related to value of self-determination ▪ Respect the choices of clients ▪ Protect privacy ▪ Provide for informed consent ▪ Protect diminished capacity for self-determination o Related to value of well-being ▪ Reduce or prevent harm and provide benefits to client populations ▪ Measure the effectiveness of nursing services ▪ Balance costs of services against real client benefits o Related to the value of equity ▪ Broadly distributing health goods (macroallocation issues) ▪ Deciding which populations will obtain available health goods and services (microallocation issues) 2. Distinguish between self- interest, self -determination, equity and well being - Self-interest – the fulfillment of one’s own desires, without regard for the greater good - Self-determination – (individual autonomy) a person’s exercise of the capacity to shape and pursue personal plans for life - Equity – (justice) being treated equally or fairly - Well-being – a state of positive health 3. Understand the ethical principles of Respect, Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Veracity - Respect – treating people as unique, equal, and responsible moral agents - Autonomy – freedom of choice and the exercise of people’s rights - Beneficence – doing good or benefiting others - Nonmaleficence – avoiding or preventing harm to others as a consequence of a person’s own choices and actions - Justice – treating people fairly o Distributive justice – benefits should be given first to the disadvantaged or to those who need them most o Egalitarian justice – promotes decisions based on equal distribution of benefits to everyone, regardless of need o Restorative justice – determines that benefits should go primarily to those who have been wronged by prior injustice (i.e. victims of crime or racial injustice) o Social justice – the fair and equitable distribution of wealth, economic opportunity, and access to privileges in society and is tied to human rights - Fidelity – keeping promises - Veracity – telling the truth Chapter 5 1. Understand the difference between ethnocentrism, ethnorelativism, and enculturation as it relates to culturally sensitive care - Ethnocentrism – expression of the belief that one’s culture of origin is the best approach to life - Ethnorelativism – seeing all behavior in a cultural context - Enculturation – learning about culture through socialization with the family or significant group 2. Understand the Characteristics of culture - Culture is: o Learned from others o Integrated systems of customs and traits o Shared o Generally/mostly tacit o Dynamic - 3. Understand the steps in applying transcultural community health nursing principles - Develop cultural self-awareness - Cultivate cultural sensitivity - Assess the client group’s culture - Show respect and patience while learning about other cultures - Examine culturally derived health practices 4. Distinguish between herbalism, folk medicine, home remedies, magicoreligious views - Herbalism – herbs, roots, barks, and liquid preparations - Folk medicine – a body of preserved treated practices that has been handed down verbally from generation to generation - Home remedies – individualized caregiving practices that are passed down within families - Magicoreligious views – focus on the control of health and illness by supernatural forces Chapter 6 1. Understand the functions of a public health agency - Assessment o Health status monitoring and disease surveillance - Policy development o Leadership, policy, planning, and administration - Assurance o Investigation and control of diseases and injuries o Protection of environment, workplaces, housing, food, and water o Laboratory services to support disease control and environmental protection o Health education and information o Community mobilization for health-related issues o Targeted outreach and linkage to personal services o Health services quality assurance and accountability o Training and education of public health professionals 2. Understand the 3 core public health functions - Assessment – measuring and monitoring the health status and needs of a designated community or population - Policy Development – the formation of a guide for action that determines present and future decisions affecting the public’s health - Assurance – the process of translating established policies into services 3. Understand which populations is served by Social Security, Medicare, Medicaid, and Children’s Health Insurance Plans Medicare - Title XVIII of the Social Security Act Amendments of 1965 - Provided mandatory federal health insurance for adults aged 65 and older who have paid into the Social Security system Medicaid - Title XIX of the Social Security Amendments Act of 1965 - Provides medical assistance for children, pregnant women, parents with dependent children, seniors and people with severe disabilities Children’s Health Insurance Plans - Provides hospital coverage to uninsured children under age 19 for families caught in the gap between Medicaid and affordable health insurance Chapter 7 1. Distinguish between endemic, pandemic, epidemic - Epidemic – a disease occurrence that clearly exceeds the normal or expected frequency in a community or region - Pandemic – when an epidemic is worldwide in distribution - Endemic – where disease is most frequently found 2. Understand the three elements of the epidemic triad model - Host – susceptible human or animal who harbors and nourishes a disease-causing agent - Agent – a factor that causes or contributes to a health problem or condition (biologic, chemical nutrient, physical or psychological) - Environment – all the external factors surrounding the host that might influence vulnerability or resistance 3. Distinguish between Inherent resistance, infectivity, and virulence - Resistance – ability of the agent to survive environmental conditions - Infectivity – capacity to enter the host and multiply - Virulence – severity of disease 4. Understand host, reservoir, mode of transmission - Host – susceptible human or animal who harbors and nourishes a disease-causing agent - Reservoir – where the casual agent can live and multiply - Mode of Transmission – literally how it was transmitted… 5. Know the difference between chain of causation and web of causation - Chain of causation – begins by identifying the reservoir; next the agent must have a portal of exit from the reservoir, as well as some mode of transmission; the next link is the agent itself, then the portal of entry o Reservoir Portal of exit Mode of transmission Agent Portal of entry Host - Web of causation – the implication that intervention (or breaking of the web at any point nearest to the disease) could profoundly impact the development of that disease o “Casual matrix” 6. Understand the different types of Immunity - Passive Immunity – short-term resistance that is acquired either naturally or artificially - Active Immunity – long-term and sometimes offers life-long resistance that is acquired either naturally or artificially - Cross Immunity – a situation in which a person’s immunity to one agent provides immunity to a related agent as well (the immunity can either be passive or active) - Herd Immunity – the immunity level that is present in a population group o A population with a low herd immunity is one with few immune members; consequently, it is more susceptible to a particular disease 7. Understand the different Stages or Natural History of Disease - Susceptibility stage – the disease is not present, and individuals have not been exposed - Subclinical disease stage – begins when the individuals have been exposed to a disease but are as yet asymptomatic o Incubation period – the organism multiplies to sufficient numbers to produce a host reaction and clinical symptoms o Induction period – the time from exposure to onset of symptoms - Clinical disease stage – signs and symptoms of the disease or condition develop - Resolution stage – the disease or health condition causes sufficient anatomic or functional changes to produce recognizable signs and symptoms 8. Know what data is available from sources of the National Center for Health Statistics and CDC Prevention Reports. - National Center for Health Statistics – furnishes valuable health prevalence data from surveys of Americans o The National Health Interview Survey – provides information about the health status and needs of the entire nation o The National Nursing Home Survey – provides information on those who are using hospital and nursing home services, along with diagnoses and other characteristics o The National Health and Nutrition Examination Survey – provides prevalence information on injuries, diseases, and disabilities that appear frequently in the population o The National Survey of Family Growth – focuses on fertility and family planning as well as other aspects of family health - CDC Prevention Reports – the CDC reports data collected by state and local health departments on legally reportable disease o Mortality and Morbidity Weekly Report (MMWR) – presents weekly summaries of disease and death data trends for the nation o Provides administrative, research, and technical support for the Community Preventative Services Website – houses the official collection of all the CPSTF (Community Preventative Services Task Force) findings ▪ Offered as a free resource to help public health nurses and other HCPs choose programs and policies to improve health and prevent disease within the communities with whom they work