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Final Community Health

Course

Community And Public Health Nursing With Clinical (NUR 450)

51 Documents
Students shared 51 documents in this course
Academic year: 2022/2023
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Denver College of Nursing

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Denver College of Nursing Focused Review Study Areas

Final Exam – Summer, 2022

This is a list of areas to study for the Final Exam. These is meant to help guide you to the material you need to know for the exam. Remember that this is not meant to be your only study tool. The final is comprehensive which means that while I have tried to ensure that this study tool is as helpful as possible, there is always a chance that a question/topic may appear on the exam that was not explicitly outlined below. Remember, you not only need to understand the terms and concepts but you need to be able to cite examples and apply the concepts to real life situations.

  1. Know the three core functions of public health services. Be able to identify these. Be able to provide examples of each. See Fig. 1.

Three Core Functions of Public Health services

  1. Assessment a. Systematically collecting data on the population b. monitoring the populations health status c. making information available about the health of the community

  2. Policy development a. efforts to develop policies that support the health of the population i. scientific knowledge base to make policy decisions

  3. Assurance a. making sure that essential community-oriented health services are available i. providing essential personal health services for those who otherwise not receive them 1. assurance also includes making sur3e that a competent public health and personal health care workforce is available

  4. Be able to describe and identify examples of primary, secondary, and tertiary prevention for all areas studied in this class. There will be several of these on the exam.

  5. Primary Prevention a. Preventing disease or problems in healthy people. We use primary prevention before a person or community has a problems i. Promotes overall good health ii. Prevents against threats to health iii. Decreases both prevalence and incidence of disease b. Health education, vaccination, seat belts, car seats, fluoridation of drinking water c. True prevention

d. Working with healthy Patients e. Education f. Immunization g. Nutrition h. Physical fitness i. Fluoridation j. Seat belts/car seats 2. Secondary Prevention a. Early detection and/or early treatment in individuals with disease or injury even though they may not know why have the disease yet i. can also be used to address environmental problems (water testing, etc.) ii. Most types of health screening are secondary prevention b. Focus on individuals with health problems at risk for developing complications c. Diagnosis and prompt treatment d. Return person to health e. Screening f. Identify vulnerable populations 3. Tertiary Prevention a. Rehabilitation and preventing complications in people with chronic disease or injuries b. Can also be done on the community level (recovery stage after a tornado etc.) c. Goals are to i. prevent continuing disease process ii. prevent damage, complications and other negative effects of disease or injury

  1. stork, rehabilitation, support groups d. community tertiary prevention i. disability or disaster has occurred. Trying to minimize the damage ii. Preventing complications iii. rehabilitation iv. achieve a higher level of functioning v. Bad thing happened

Primary= Prevention

Secondary= Screening

Tertiary= Treatment

  1. Review and be able to describe some of the “Forces Stimulating Change in the Demand for Health Care” on pages 34 through 37

  2. Demographic trends

b. Changing lifestyles- “healthier habits” i. appreciation of the quality of life- shift from financial success c. Emphasis on quality health care and “consumer” mindset 6. Trends Demanding Adaption a. population growth around the world b. in the US i. change in largest minority groups (AA to Hispanic) ii. Hispanic persons now out number AA iii. Whites make up only 50% of the UAS population c. Changing composition of families and living patterns i. change in household composition (more single-parent homes)

  1. Describe how an assessment of a community is performed as part of community program planning, ie windshield survey, interviews, public date, key informants, etc

When an organization asks a nurse to perform a community assessment, community usually refers to a specific population, an aggregate with specific characteristics that live within the area that an organization serves, such as a school district of a geographic area such as a county.

It is important to remember that individuals within this defined area could view the community through a different lens

Understanding the many identities of a community is part of the community assessment and is best done through talking with and or collecting data about residents and stakeholders

Purpose of Community Assessment

● conduct and assessment to learn more about community needs and strengths ● Locate confirmation data to address a recognized community problem ● focus one setting priorities to address health issues in communities ● Organizations may also be required to complete community assessments for regulatory or accreditation standards

Assessing community health

● data collection ● gathering and interpretation ● data generation ● data analysis ● collection of direct data ● collection or reported data ● Secondary sources of data ○ Healthy people 2030 and county health rankings ○ public documents ○ health surveys ○ statistical data ● primary sources of data

○ on-ground data ■ observation ■ interviews ■ Survey ● Windshield Survey ○ Type of community assessment ○ Description of community within its specific boundaries ○ Meant to be ■ easy, attainable, inexpensive, quick ■ Glance of community for investigators perspective ● Add key informants or stakeholder interviews ● who are the stakeholders (vested interest in the community) also known as key informants- hold “key perspective on community ○ long-term residents ○ Business owners ○ Local government officials ○ people who provide local services ■ police, fire, EMT, and public health ● Community-Focused Nursing Process: From Assessment to Evaluation ○ Identifying community problems ○ Planning the community health ■ Analyzing problems ■ Problem priorities ● Criteria (Page 218) ■ Establishing goals and objectives ■ Identifying intervention activities ○ Define the People ■ Demographics ● Age, sex, race, or culture ● Graduation rates ● Crime rates ● Mortality rates ● Political structure ○ Define the Location ■ Boundaries ■ Climate ■ Land/housing ■ Physical hazards ● Pollution ● Industries ■ Economics ● Jobs-employers ○ Define the Resources and Community Structure

a. peeling old lead paint on the walls (or cracked)- home before e1970s b. Lead from old lead paint may contaminate household dust and nearby soil i. most children are exposed by dust ii. more lead in the dust in a home the higher the levels of lead in children iii. there is no safe threshold for lead c. Can enter water by leaching from i. lead-containing pipes ii. faucets iii. solder iv. Boiling water from the faucet does not rid the water of lead v. running cold water before using may reduce but not eliminate exposure d. Led is stored for long periods in mineralizing tissues such as teeth and bones e. Impact the brain i. high levels can permanently affect the brain, bones, kidneys, and the heart

  1. Be very familiar with the epidemiologic triangle and the web of causality. Know all aspects of the triangle and what affects them (is host factors, environmental factors)

Epidemiologic triangle

● Changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person risk for disease ● The epidemiologic triangle, or the agent-host-environment triangle to use another name, helps us to understand that even if we know that a particular agent (virus or bacteria) causes a disease, there is often an environmental component that makes the prognosis better or worse. Diet and exercise can be an example of this. We understand the mechanics of TB, for example and know the agent that causes it. Why then when we study cases of TB do we see such a wide range of exposures, effects, complications or outcomes? That is probably due, at least in part, to environmental factors. These factors are the easiest for us to change and we will discuss them in detail when we reach our environmental health lecture. ● Agent factors: ○ Animate or inanimate objects causes the disease or injury ■ SMoking ■ radon gas ■ Bacteria ● Host Factors ○ The living being that is affected by the agent ■ Constant stress, low socio-economic status, chronic cortisol/adrenaline leading to immunocompromised state (allostatic load) ● Environmental factors ○ The setting or surrounding the sustains the host

Web if Causality ● 2D causal web that considers multiple levels of factors that affect health and disease ● Associations are sometimes mutual, with lines of causality going in both directions ● recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease the risk of disease)

  1. Be very familiar with incidence and prevalence proportions and be able to identify an example of each. Cite the factors that influence the prevalence rate. Be able to calculate each.

Incidence

● organ transplant

High risk populations

  1. Minorities
  2. Male to male sexual contact
  3. Transgender women

Risk Factors for acquiring and HIV infections

  1. Exposure to blood, semen, vaginal secretions, and breast milk
  2. Most often transmitted through sexual behaviors and needle of syringe use
  3. rarely through accidental needlestick injury, organ transplants, and blood transfusions
  4. Misinformation still exists a. can not be transmitted by casual hugging, touching, ticks/mosquitos, or through healthy, unbroken skin

Why patients do not always seek testing for diagnosis

  1. I fear the consequence of a positive test result

  2. I don’t know where I can get tested

  3. many people do not know they have HIV (14-20%)

  4. asymptomatic or have flu-like symptoms

  5. Know the four phases of the Disaster Management Cycle, Fig. 41 and page 239. Be able to describe actions and interventions for each phase. Also be able to identify patients tagged as green, red, black or yellow using the START triage method.

Disaster management cycle

● In simple terms, disaster management is the sum total of all the activities that are undertaken to plan for, respond to and recover from a disaster 1. Planning 2. Search and Rescue 3. Response 4. Recovery

four stages 1. Prevention (mitigation)

a. Surveillance, inspections, security

b. Immunizations, strengthening isolation and quarantine procedures

c. Strengthening levis and building higher sea walls, removing dry underbrush in forests

d. Identify community vulnerabilities

e. Identify at risk populations – isolated (rural), disabled, in path of danger 2. Preparedness a. How do we prepare? Ex: a hurricane is coming in three days i. Nonperishable, canned goods ii. Personal checklist iii. Emergency supplies kit and plan for where to meet iv. What documents do we need if we must evacuate? v. Light, canned food, blankets, first aid kit b. Professional preparedness is how to prepare the hospital and community i. American Red Cross disaster training first responders learn how to prepare for incidents that are likely to happen ii. Disaster medical assistance teams (MRC)-can sign up as a nurse. They can call you in the event of a disaster iii. Community Emergency Response Team (CERT)-this is everybody within the community that aren’t in the medical profession c. Community preparedness Programs i. Federal Emergency Management Agency (FEMA) ii. National Health Security Strategy (NHSS) iii. Disaster and Mass Casualty Exercises iv. National Exercise Program (NEP) v. Homeland Security Exercise and Evaluation Program (HSEEP) d. Community Preparedness i. Disaster and mass casualty exercises ii. Federal Emergency Management Agency (FEMA) coordinates all-hazard planning and training at federal level iii. Help with large mass training and provide resources

a. community balance of infrastructure and social welfare near the level that it would have had if the vein had not occurred 2. Hardest part of a disaster 3. Federal assistance a. rebuilding and restoring after large-scale event 4. Gradual shift in support a. from short-term aid to long term support for communities i. sustainment of effort Mass casualty START triage ● Based on three observations of casualties ● QUICK assessment ii. Under 30 seconds one each person if possible iii. Suppose to be easy to understand, so that even those who do not know about the system can be easily trained iv. respirations,perfusion and mental status v. First responder triage-prehospital

b. Start is a color coded triage system,where green, yellow, red and black are used i. BLACK 1. s reserved for people who have died, or who are dying. They will either not receive care, or may be reassessed if dying after the other groups have been cared for. ii. RED

  1. need immediate care, and these persons are the first to be transported and the first to be treated. They have an abnormal assessment for respirations, perfusion or mental status

iii. YELLOW 1. persons may have a moderate to severe injury. They are normal on their respirations, perfusion and mental status, so they will wait until the RED persons are transported

iv. GREEN 1. persons are what we call the walking wounded. They may have minor injuries (lacerations, dislocations) but these injuries are not life threatening. They will wait until RED and YELLOW patients are treated

● Simple triage and rapid treatment ○ Look at best chance of survival ○ remove green victims to close area ○ Make decisions in less than 30 seconds ○ all immediate (red) victims ■ attempt to control bleeding ○ Move on from black ■ return to reassess once red and yellow have been stabilized on transported

Reverse triage ▪ Treat those with minor injuries first ▪ When to use it? ● Example o For the first, imagine that I am driving down a mountain road and a van in front goes over the barrier and rolls down the hill. In the first row is the driver who is unconscious and his chest is pierced by the broken steering wheel. In the second row there are two people who are alert, but their legs are trapped and probably broken. In the back row are two uninjured people who are trapped. o Who should I rescue first? Under reverse triage I should rescue those in the back seat, since they can help me rescue the rest and I will probably save more lives. ▪ High number of medical providers among these injured. treat them first and they can help treat the injured ▪ I need to move to another location. Treat those with minor injuries and they can help move the sickest or most seriously wounded ▪ Reverse triage in the hospitals ● It improve surge capacity of hospitals and clinics to deal with a disaster ● Pt with only a slight change of experiencing an adverse event within 4 days of leaving a hospital are discharged to make room for disaster victims ▪ Rural hospitals use reverse triage in a different way. Now suppose a train derails outside of a small rural town that has the only hospital for 50 miles. I know that injured passengers will be coming into my hospital, at least to be stabilized. If the hospital is full, what can be done? ▪ Patients who would only have a slight chance of harm if sent home are quickly discharged in order to make room for seriously injured persons. ▪ Reverse triage is not needed in every situation, but just like START triage its purpose is to save the greatest number of lives ▪ REMEMBER; with either use of reverse triage I am looking for the HEALTHIEST people first.

  1. Review and be able to describe the terms, endemic, hyperendemic, epidemic, and pandemic

Endemic

○ Physical, social, developmental assessment ○ Environmental safety assessment ○ Health risk assessment ○ Family strengths and weaknesses ○ Health literacy and knowledge ○ Family roles and responsibilities ○ Coping strategies ○ Resources they are already using

● Interviewing some in their home ○ Move from the general to the specific. Good starting questions- “tell me about who lives here with you” or something similar ○ Keep it conversational- like meeting a new neighbor, while staying professional (what a balance!) ○ Save sensitive topics such as religion, sexual partners or similar topics until at least the middle of the interview ○ If possible, ask at least every adult family member a question so that they feel included ○ Ask the family what they think of their current situation, and what they would identify as their most pressing problems ○ Purpose of the interview is to gather information and help the family focus on their problems and determine solutions ○ Listen

● The following specific therapeutic questions have been found to provide important family information:

• What is the greatest challenge facing your family now?

• On which family member do you think the illness has the most impact?

• What has been most and least helpful to you in similar situations?

• If there is one question you could have answered now, what would that be?

• How can I best help you and your family?

• What are your needs/wishes for assistance now?

  1. Absolutely know and be able to identify social determinants of health. Remember these can be positive or negative. See textbook page 360 – read the entire page!

● Social and economic factors contribute heavily to vulnerability. Social determinants of health are factors such as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk ● Five key areas ○ Economic stability

○ Education ○ Social and community context ○ Health and health care ○ Neighborhood and built environment ● Conditions in which people are born, grow, live, work and age that shape health ○ socioeconomic status ○ living conditions ○ geographic and social isolation ○ education ○ environment factors ○ access to health care services ○ culture ○ stress ○ occupation ● Healthy people 2020 lists 15 example of social determinants of health

  1. availability of resources to meet daily needs

  2. access to educational, economic, and job opportunities

  3. access to health services

  4. quality of education and job training

  5. availability of community-based resources in support of community living and opportunities for recreation

  6. transportation options

  7. public safety

  8. social support

  9. social norms and attitudes

  10. exposure to crime, violence and social disorder

  11. socioeconomic conditions

  12. residential segregation

  13. language/literacy

  14. access to mass media and emerging technologies

  15. culture

  16. Be familiar with resources such as Medicare, Medicaid, TANF, WIC, SCHIP, voluntary programs such as American Heart Association, American Cancer Society, M. Society

Medicare

● Over 65 years old/ disabled/ ESRD ● paid for by federal government and administered by federal regulation

Medicaid

● income based ● administered by states and federal funds/administered by states

TANF

o They often feel they do not have a voice, or their input is only wanted for certain issues. Their needs can be forgotten in health planning o Often vulnerability and marginalization overlap o Some marginalized groups ▪ Prisoners ▪ transgendered people ▪ Homeless ▪ Disabiled ▪ Undocumented workers o (Marginalization is a problem of perception and feeling. Marginalization can impact people and how they interact with many institutions of society, including health care.)

  1. Be able to describe the health care needs of rural and migrant workers. List some priority areas for education and health care.

Health Status of Rural residents

▪ Poor perception of overall health and functional status ▪ Fewer preventive behaviors ▪ Tends to have poorer health and les likely to seek care ● more likely to have one or more of the following chronic conditions o COPD o HTN o Arthritis o rheumatism o DM o CAD o Cancer ▪ more than 50% of adults have at least one of these (25% in non-rural areas) ▪ Traveling time and/or distance to ambulatory care services ● affects access to care ▪ They are less likely to engage in physical activity during leisure time, wear seat belts, have regular BP checks, have Pap smears, perform breast self- examinations, and have colorectal screening ▪ undiagnosed DM 7 in 100 ( 5 in 100 for non-rural) ▪ Higher cancer rates ▪ EMS ▪ Community and economic development

▪ Poorer perception of overall health and functional status

▪ Fewer preventive behaviors

▪ Tend to have poorer health and less likely to seek care

▪ Traveling time and/or distance to ambulatory care services

▪ More likely to have: heart disease, COPD, hypertension, arthritis and rheumatism, diabetes, cardiovascular disease, and cancer

▪ More than 50% of adults have at least one of these (25% in non-rural areas)

▪ Undiagnosed diabetes 7 in 100 (5 in 100 for non-rural)

▪ Higher cancer rates (7% to 5%)

▪ Traveling time or distance to ambulatory care services affects access to care

▪ Health providers ● May provide care to people who live in several countries ● small staff to service large area ● live and practice in a particular community for decades ● health professional shortage areas (HPSA) ● twice as likely to die of unintentional injuries ● emergency care before we offer primary care clinics o Rural Healthcare issues ▪ Access and availability of care ▪ Financial concerns facing rural hospitals and health systems ▪ Health workforce- shortage of specialists ▪ Quality of care ▪ Networks- Urban hospitals and health systems usually work in networks. Not consistently available in rural areas ▪ Emergency medical services ▪ community and economic development ▪ higher infant and maternal morbidity rates (esp. HPSAs)

▪ High proportion of racial minorities and fewer specialists

● Minorities are often under-reported

▪ Extreme variations in pregnancy outcomes

● d/t lack of prenatal care

▪ Higher risk - women who:

● Live on or near Indian reservations – lack of access

● Are migrant workers

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Final Community Health

Course: Community And Public Health Nursing With Clinical (NUR 450)

51 Documents
Students shared 51 documents in this course

University: Denver College of Nursing

Was this document helpful?
Denver College of Nursing
Focused Review Study Areas
Final Exam – Summer, 2022
This is a list of areas to study for the Final Exam. These is meant to help guide you to the
material you need to know for the exam. Remember that this is not meant to be your only
study tool. The final is comprehensive which means that while I have tried to ensure that
this study tool is as helpful as possible, there is always a chance that a question/topic
may appear on the exam that was not explicitly outlined below. Remember, you not only
need to understand the terms and concepts but you need to be able to cite examples and apply
the concepts to real life situations.
1. Know the three core functions of public health services. Be able to identify these. Be
able to provide examples of each. See Fig. 1.1
Three Core Functions of Public Health services
1. Assessment
a. Systematically collecting data on the population
b. monitoring the populations health status
c. making information available about the health of the community
2. Policy development
a. efforts to develop policies that support the health of the population
i. scientific knowledge base to make policy decisions
3. Assurance
a. making sure that essential community-oriented health services are
available
i. providing essential personal health services for those who
otherwise not receive them
1. assurance also includes making sur3e that a competent
public health and personal health care workforce is
available
2. Be able to describe and identify examples of primary, secondary, and tertiary
prevention for all areas studied in this class. There will be several of these on the exam.
1. Primary Prevention
a. Preventing disease or problems in healthy people. We use primary
prevention before a person or community has a problems
i. Promotes overall good health
ii. Prevents against threats to health
iii. Decreases both prevalence and incidence of disease
b. Health education, vaccination, seat belts, car seats, fluoridation of
drinking water
c. True prevention
1

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