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Community Health Exam I
Community Health Nursing (NR-442)
Chamberlain University
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Community Health Exam I Chapters: 1: Overview of Community Health Nursing 2: Historical Factors 6: Community Assessment, Community Diagnosis and Planning 7: Community Health Planning 5: Epidemiology 26: Communicable Diseases 4: Health Promotion and Risk Reduction 10: Health Care Systems, Politics, Policy and Legislation in Community Health Nursing 11: The Health Care System 12: Economics of Health Care
Chapter 1:
- Community Health Nursing Specialty in nursing that focuses on the community
- Combination of public health practice and nursing practice
- Public Health Practice: Community organized efforts funded by State
Taxes
- Mission of Public Health Practice: Social justice, which entitles all people to basic necessities such as income, health protection and accepts collective burden to make it possible
- Public Health Practice: Community organized efforts funded by State
Taxes
- Everyone is equal and has access to health care
- Nursing Practice: 3 Key Factors
- Knowledge
- Skill
- Ability to make independent nursing decisions
- Nursing Practice: 3 Key Factors
- Combination of public health practice and nursing practice
Winslow's Classic Definition of Public Health: 3 P'S
- Promoting Health
- Preventing Disease
- Prolonging Life
Public Core Functions: APA
10 core functions, classified in 3 An example is Illinois Department of Public Health 10 Core Functions:
- Monitor health
- Assessment
- Enforce laws
- Assurance
- Case review; development of reporting guidelines
- Assurance
- Diagnose and investigate
- Assessment
- Ebola screening; use of questionnaire
- Assessment
- Link to provide care
- Monitor health
Assurance
- Referral of clients to appropriate services
- Inform, educate and empower
- Policy Development
- Use of mass media, hotline number, information dissemination strategies
- Assure a competent workforce
- Assurance
- Training completion of identified healthcare workers, nurses, providers
- Mobilize community partnerships
- Policy Development
- Collaboration with state, local or community hospitals, CDC, IDPH, etc.
- Evaluate
- Assurance
- Follow-up care management; evaluation of care
- Develop policies
- Policy Development
- Mandated clinical documentation in patient's records, mandated screening/questionnaire of patients
- Research
- Assurance
- Diagnostics, Therapeutics, Vaccine research ongoing
3 Classifications of Public Core Functions: APA
- Assessment
- Policy Development
- Assurance
Indicators of Health What indicators do we use to measure health? + Characteristics of a population that can be measured 1. Morbidity: Proportion of illnesses in a population 2. Mortality: Incidence of deaths in a population Goal of Healthy People 2020: + To increase quality and years of healthy life + To eliminate health disparities
Healthy People 2020
- 10-year national program
- Vision: A society in which all people live long, healthy lives
Overarching Goals:
- Attain high-quality, longer lives free of preventable disease
- Achieve health equity, eliminate disparities, and improve the health of all groups
- Create social and physical environments that promote good health for all
- Vision: A society in which all people live long, healthy lives
Overarching Goals:
Focus of Care for Community Oriented Nursing: Aggregates (populations); high risk groups, generally healthy Primary Goal of Community Oriented Nursing: Health Promotion and disease prevention Nursing Activities Community Oriented Nursing: Usually indirect (Program management [screening, STD prevention]), Direct care of at-risk aggregates Examples of Community Oriented Nursing: - Women's Wellness Clinic + Breast screening + Pap Tests + STD screening + Diabetes Education + Depression Screening - Mental health immediate screening + Immediate screening + Direct admission + Patient education on addictive and the recovery process + Direct linkage to residential or outpatient aftercare substance abuse services + Specialized addictions treatment team + Medically managed withdrawal + Daily group counseling sessions
- Community Based Nursing
Focus of Care for Community Based Nursing: Individuals and families
Primary Goal of Community Based Nursing: Management of acute or chronic
conditions
Nursing Activities Community Based Nursing: Direct one-on-one [home health]
Examples of Community Based Nursing:
- Arthritis
- Diabetes
- HIV/AIDS
- Osteoporosis
- Hospitals
- Home health
- Support Groups The Three Levels of Prevention
- Level 1: Primary Prevention Activities
- Prevention of problems before they occur Educate and Teach Example: Immunizations
- Level 2: Secondary Prevention Activities
- Early detection and intervention to prevent complication Screen at/high-risk Example: Screening for sexually transmitted disease
- Level 3: Tertiary Prevention Activities
- Correction and prevention of deterioration of a disease state Improve quality of life Example: Teaching insulin administration in the home
Level of Prevention: Individual Definition of client served: Individual Primary (health promotion and specific prevention): Dietary teaching during pregnancy, immunizations Secondary (early diagnosis and treatment): HIV testing, screening for cervical cancer Tertiary (limitation of disability and rehabilitation): Teaching new clients with dm how to administer insulin, exercise therapy after stroke, skin care for incontinent patient
Level of Prevention: Family (2+) Definition of client served: Family (two or more individuals bound by kinship, law, or living arrangement and with common emotional ties and obligations) Primary (health promotion and specific prevention): Education regarding smoking, dental care, or nutritional counseling Secondary (early diagnosis and treatment): Dental examinations, Tuberculin testing for family at risk Tertiary (limitation of disability and rehabilitation): Mental health counseling or referral for family in crisis (e., grieving or experiencing a divorce), Dietary instructions and monitoring for family with overweight members
Level of Prevention: Group Definition of client served: Group or aggregate (interacting people with a common purpose or purposes) Primary (health promotion and specific prevention): Birthing classes for pregnant teenage mothers, AIDS and other STD education for high school students Secondary (early diagnosis and treatment): Vision screening of first grade class, Mammography van for screening of women in a low-income neighborhood, Hearing tests at a senior center
Level of Prevention: Community Definition of client served: Community and populations (aggregate of people sharing space over time within a social system; population groups or aggregates with power relations and common needs or purposes) Primary (health promotion and specific prevention): Fluoride water supplementation, environmental sanitation, Removal of environmental hazards Secondary (early diagnosis and treatment): Organized screening programs for communities such as health fairs, VDRL screening for marriage license applicants in a city, Lead screening for children by school district Tertiary (limitation of disability and rehabilitation): Shelter and relocation centers for fire or earthquake victims, Emergency medical services, Home care services for chronically ill
- Consumers shoulder cost = Increase in premiums
- Discrimination and racism
- Feminist movement
- Disasters, genocide, and refugees
- Bioterrorism preparedness
- In IL, hospitals are required to do mandated drill quarterly (i. active shooter, corona virus) to ensure that they are equipped, competent, and skilled
Challenges for Community Health Nursing
Promote the health of populations
Need for bimodal focus on prevention, health promotion
Education to meet the needs of the aggregate through community strategies
A population focus for nursing to contribute to the ethic of social injustice
A better understanding of history
- Want a healthy population and community
- Need to know challenges
- Funding
- Programs
- Priorities
- Diversity can increase medical problems
- Behavior
- Lifestyle
- Culture Chapter 6: Community Assessment, Community Diagnosis and Planning Key Concepts:
- Need to know challenges
- Want a healthy population and community
Defining a Community
Healthy Cities and Communities
Assessment of a community/ Windshield Survey
Nursing Process
Community Health Diagnosis
Community (Addison, IL): is a group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values and/or goals " The Community is the Patient"
- Geographic Boundaries
- Identity and Environment
- Common goals
Population (Chamberlain University Community) : is a group of people having common personal or environmental characteristics
Aggregates (NR 442 Students; Student Services Department): subgroups or subpopulations that have some common characteristics
- More specific than a population
Population vs. Aggregate Population Group: Female Population Groups Aggregate by age group: + Women of childbearing age 15- + Middle Age females 45-65 y/o + Elderly females 65 and older
Population Group: Chamberlain University Aggregate (by department): + Student population (levels) + Leadership/ Administration + Admissions + Environmental Services
Defining the Community Community Assessment Components: - Aggregate of the People - Place or environment - Social Systems - Biologic factors + Age + Race + Ethnicity + Gender + Cause of Death - Cultural Factors + Religion + Language + Food preferences + Values + Customs and norms + Head of household - Social Factors + Education + Socioeconomic + Dominant occupation + Social status + Marital status + Social interactions (facilities) Assessing the Community What is the importance of assessing the community? Basis for developing programs
Data Collection
- Primary data comes directly from residents firsthand
- Secondary data is from another source (records, questionnaires)
- Availability of potential solutions (funding)
- Resources available i. manpower, financial resources
- Practical considerations such as skills, time, and available resources
Community Health Program Planning, Development and Management 0. Identify a population group that you want to help
- Pre-planning
- " I want to help x population group"
- Need to know characteristics of population
- " I want to help x population group"
- Assessment
- Data to support problem
- Look at the trend
- Survey home, meds, fall-risk assessment
- Look at the trend
- Data to support problem
- Diagnosis
- Planning
- Implementation
- Evaluation
- Look at data and evidence again, did interventions work?
- Has to be measurable to know if everything worked
- Look at data and evidence again, did interventions work?
Community Diagnosis/ Health Problem Statement Format for Community Health Diagnosis = Same as formulating Nursing Dx 4 Parts: 1. What is the problem 2. Who is affected 3. What is the cause/agent 4. What is the evidence to support the problem * Has to be measurable
Health Problem # Poor nutritional status 1 (problem 1 ) of children under age 5 2 (affected 2 ) in community XYZ related to lack of knowledge 3 (cause/agent) regarding weaning diet as evidenced by growth monitoring chart 4 (evidence 4 ) Goal: Improve nutritional status of children aged 5 in community XYZ * Goal must address the problem Objectives: 1. List of healthy food options will be distributed to parents in children wellness fairs and health centers by October 2018 2. All children will be offered food choices in preschool classes by end of November 2018 * Objectives must address the cause Evaluation: All children under age 5 show progress in growth by end of January 2019 * Look at evidence one more time
Health Problem # Increased injuries 1 (problem 1 ) in adolescent aged 12-17 years 2 (affected 2 ) in community XYZ
related to reckless behavior 3 (cause/agent 3 ) as evidenced by increase number of injury admission 4 (evidence 4 ) in hospital XYZ Goal: Decrease injuries in adolescent aged 12-17 in community XYZ Objectives: 1. Educate adolescents about implications of reckless behavior by end of December 2017 2. Offer various youth activities in school by end of January 2017 3. Perform behavior screening in school among adolescents
Chapter 5: Epidemiology: Study of health related to trends in population IDC Incidence: Number of cases in community Distribution: Specific Area Control: Implement steps to control the spread
Classic Example of Epidemiology at Work John Snow (1813-1858): and the Broad Street Pump of 1854 + Helped control the spread of Cholera in London - Removed the handle of water pump = people couldn't get water from pump = decrease in Cholera + Removed contaminated water Spectrum of Infection Not all contact with an infectious agent leads to infection, and not all infection leads to an infectious disease Subclinical infection: No overt symptomatic disease Infections: Entry and multiplication of infectious agent in host Carriers: People who continue to shed infectious agent without any symptoms of disease Disease process is multi-causal It must be transmitted within a conducive environment to a susceptible host Universal precautions for any patient with symptoms of an infection
Spectrum of Disease Occurrence Endemic: Diseases that occur at a consistent, expected level in a geographic area Endemic Example: Influenza in fall Outbreak: An unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time Outbreak Example: E Epidemic: An unexpected increase of an infectious disease in a geographic area over an extended period of time Pandemic: Steady occurrence of a disease over a large geographic area or worldwide Pandemic Example: HIV, H1N1 (continued to be monitored by CDC)
Epidemiological Calculations What is the purpose of epidemiological calculations?
Used to evaluate the effectiveness of disease prevention program or activities to prevent disease
Water, milk, food
Radiation, pollution (air quality), noise
- Agent What is causing the disease
- Biologic (bacteria, viruses)
- Chemical (poison, alcohol, smoke)
- Physical (trauma, radiation, fire)
- Nutritional/ Nutritive (lack, excess)
Tuberculosis Epidemiological Triangle Host Who is susceptible to Tuberculosis? - Elderly clients - Secondary to AIDS - Generally unhealthy/ immunocompromised - Exposure to TB + Healthcare workers Agent What is the causative agent? - Biologic + Bacteria Environment In what conditions or type of environment is conducive to occurrence of disease? - Crowded - Decreased socioeconomic status - Poor air quality
Wheel Model of Human-Environment Interaction Genetic Diseases
- Used to explain a medical condition that has a genetic core/ components
Example: Sickle Cell Anemia
Host (human) Genetic Core
Social Environment Stress, smoking = Can cause a sickle cell crisis
Biological Environment What is biology of disease
- i. autosomal recessive trait
Web of Causation
- Model used to describe chronic medical conditions
- Factors are inter-related (web), multifactorial
Example: COPD, DM II
- Can be due to many things
- Family hx
- Lifestyle
- Socio-economic status
- Occupation
- Weight
- Diet
- Can be due to many things
Epidemiological Methods Tuskegee Syphilis Study - Did not inform patient's, only watched and monitored for 40 years until they died + Always need informed consent
The Epidemiological Process: Nursing Process Determine the nature, extent and possible significance of the problem Using the gathered data, formulate a possible theory Gather information from a variety of sources Make a plan Put the plan into action Evaluate the plan Report and follow up
Chapter 25/26: ATI Chapter 3 Communicable Diseases What is Surveillance? CIAPIE Systematic process of collecting information + Collect + Interpret data + Analysis of data + Planning + Implementation + Evaluation High Risk Populations: + Immunocompromised - Very young - Very old + Comorbidities + Disabled + Pregnant Women + Healthcare Professionals + International Travelers Why Is Surveillance Important?
- Guide to prevent and control spread of disease
- Purpose of surveillance is aligned with the core function of public health APA
Assessment of population
Policy development
Assurance
- Detects epidemics
- Identifies health problems and emerging trends
- Estimates the scope and magnitude of the problem
- Highlights the geographic and demographic distribution of health events
- Evaluates control measures
- Empowers decision making
- Allows for better allocation of resources Surveillance Systems
- Passive Surveillance: Local and State health departments rely on health care providers or laboratories to report cases of reportable diseases
*** Nationally Notifiable Diseases ***
- Anthrax
- Category A
- Botulism
- Category A
- Cholera
- Congenital Rubella Syndrome
- Lyme Disease
- Rubella
- Mumps
- Syphilis
- Typhoid Fever
- Rabies
*** Modes of Transmission ***
Airborne: Inhaled by the susceptible host
- Measles
- Chickenpox
- TB
- Pertussis
- Influenza
- SARS
Foodborne: Food infection (bacterial, viral, parasitic infection of food)/ Food intoxication (toxins produced through bacterial growth)
- Norovirus
- Salmonellosis
- Hep A
- E
- Trichinosis
- S. Aureus
- C. Botulinum
Waterborne: Fecal contamination of Water
- Cholera
- Typhoid fever
- Bacillary dysentery
Vector-Borne: Via a carrier (mosquito or tick)
- West Nile Virus
- Lyme disease
- Rocky Mountain Spotted fever
- Malaria
Direct Contact: Transmission of infection from infected host to a susceptible host
+ STD
- Lice
- Scabies
Communicable Disease:
MRSA Screening of MRSA:
- Nose and mouth swab Signs and Symptoms MRSA:
- Red
- Swollen
- Painful
- Warm to touch
- Full of pus or other drainage
- Fever Type of Precaution and Prevention MRSA:
- Contact
Influenza Screening of Influenza:
- Nose and mouth swab Signs and Symptoms Influenza:
- Fever
- Cough
- Colds
- Lack of appetite
- Weakness Type of Precaution and Prevention Influenza:
- Droplet
TB Screening of TB:
- PPD
- X-ray
- QuantiFERON test Signs and Symptoms TB:
- Hemoptysis
- Fever
- Lack of appetite
- Weight loss Type of Precaution and Prevention TB:
- Airborne
Communicable Disease: Sexually Transmitted Disease Sexually transmitted diseases (STDs) are infection that are spread from person to person through vaginal, oral, or anal sex (direct contact)
- Abstinence
- Condoms
- Monogamous relationship
- Re-screen
- ATB Management:
- Primary
- Education
- Secondary
- Screen
- Tertiary
- ATB
Sexually Transmitted Infections: Gonorrhea ISHEEM Infectious agent: Biologic Bacteria + To break at infectious agent, treat with ATB Source: Person/human Host: High risk lifestyle (multiple partners, no protection, lack of education, hx of STDs) + To break at host, educate on abstinence and monogamous, importance of screening, protection Entry: Vagina, anal, oral Exit: Secretion, excretions (vaginal secretions, semen) Mode of transmission: Direct contact
Breaking the Chain of Transmission: ISHEEM Infectious agent Source Host Entry Exit Mode of transmission Goal: Control the spread of the disease + Achieved through breaking the chain of transmission
Human Papilloma Virus: HPV
- Sexually transmitted HPV infections are common and often asymptomatic, untreated cases in
women are the main cause of cervical cancer
- Recommendation is PAP smear q 2-3 years
Measles Mode of Transmission: Airborne + Managed in the US d/t immunization schedule Signs and Symptoms Measles: + Fever + Koplik Spots - White spots on oral mucosa
Treatment Measles: + Manage symptoms
Signs and Symptoms/ Manifestations of Communicable Diseases: + Flu-like symptoms - Fever - Coughing - Difficulty breathing - Redness of eyes - Weakness - Muscle pain Biological Weapons of Mass Destruction
- Category A: Weapons of Mass Destruction
- Highest priority d/t can lead to high mortality cases
- Category B: Moderately easy to spread, can lead to high morbidity, low mortality
- Category C: Potential high morbidity & high mortality
Anthrax Botulism Plague Smallpox Category A A A A
Isolation Contact/ Standard Bubonic = Airborne + Powder = Airborne Standard Contact + Pneumonic = Standard Droplet + Standard (Duration of (48 hours) illness) Pertussis (Whooping Cough) Mode of Transmission: Airborne Isolation: Droplet + Standard Infectious Agent: Biological (Bacteria) Prevention: TDaP, Adults Booster q 5-10 years
Defense Mechanisms
Types of Immunity Natural Immunity: An innate resistance to a specific antigen or toxin Example Natural Immunity: Pt. developed own antibodies to fight virus - Depends on host and immune system
Acquired Immunity: Derived from actual exposure to specific infectious agent, toxin, or appropriate vaccine - Active Acquired: Body produces its own antibodies - Passive Acquired: Temporary resistance that has been donated to the host
Herd Immunity: A state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune
Community Health Exam I
Course: Community Health Nursing (NR-442)
University: Chamberlain University
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