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Exam 1 Community Health
Community Nursing (NSG 4533)
South College
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Exam 1 Community Health Chapters 1, 2, 3, 4, 5, 6, 7, 8 ATI: 1, 3, 4 Chapter 1
Prevention o Primary o Secondary o Tertiary Primary
Nutrition class, immunizations, smoking cessation, prenatal class Secondary:
Annual/physical, mammogram, BP checks Why is community nursing important?
Prevention, advocacy, educate, health promotion Why are nurses needed in the community? Comparison Healthy people 2020
Physical environment
Social environment
Individual behaivor
Health services
Biology and genetics Healthy people 2030
Neighborhood and built environment
Quality social and community context
Healthcare access
Quality, education access
Economic stability Leading Health Indicator topics: Page 6 2030 indicators All ages:
Children, adolescents, and adults who use the oral healthcare system
Drug overdose deaths
Exposure to unhealthy air
Homicides
Household foods and hunger Infants:
Infant deaths Children & adolescents:
Adolescents with major depressive episodes who receive treatment
Children and adolescents with obesity Adults & other adults:
Adults engaging in binge drinking of alcoholic beverages during past 30 days
Adults who receive a colorectal cancer screening based on most recent guidelines
Adults who HTN whose BP is under control
Cigarette smoking
Maternal deaths 2020 indicators:
Access to health services
Clinical preventative services
Environmental quality
Injury and violence
Maternal, infant, child health
Mental health
Nutrition, physical activity, and obesity
Oral health
Reproductive and sexual health
Social determinants
Substance abuse
Tobacco Population-focused nursing page 12 Public health - Nursing interventions page 15 Chapter 2 Endemic:
Diseases that are always here o Flu o Pneumonia o Colds Epidemic:
Dieases that are not always present in a population but flare up on occasion o Polio o Measles
Issue Downstream Upstream Approach Critical Interactionism Client or nurse:
- Obesity
- Individual behaivor strategies to reduce weight
- Lifestyle changes
- Bariatric surgery
- health policy changes
- vending machines in school with healthier choices
- school lunch program
- target corporations that profit from obesity -individual strategies with weight loss in conjuction with system changes Social marketing at both levels Issue Downstream Upstream Approach Critical Interactionism Workplace violence
- behavior change at individual level
- workplace to reduce violence
- address organizational factors that promote workplace violence
- what organizational structures perpetuate workplace violence?
- change needed in knowledge and skills to address issue of workplace violence at both the downstream and upstream levels
Issue Downstream Upstream Approach Critical Interactionism Client or nurse: Workplace error
focus on individual: root-cause analysis that has the individual as the focus
change the behavior of the individual nurse
reducation of nurses with workplace error
system changes needed
what system-level factors lead to workplace errors?
What organizational structures perpetuate workplace errors
A dual approach: providers need changes in knowledge and skills to address root causes of workplace errors that move individual system level
Behaivor is based on current dynamics confronting an individual rather than prior experience o Identify patients needs
Limitation of HBM o Burden of action placed on client Milo’s Framework for prevention
Upstream view (macroscopic focus)
Prevention
Provides for the inclusion of: o Economic o Political o Environmental health determinants
Broader range of diagnosis and interpretation of health problems.
Provides understanding of health behaviors within the societal milieu. Implications of Miolio’s framework for current health delivery systems
Broader scope
Provide direction for nursing implications at many levels
Assess personal/societal resources for individual patients
Analyze social/economic factors that may inhibit healthy choices in populations Chapter 4 Health promotion and risk reduction Determinants of health Risk vs health Risk:
The probability that a specific event will occur
Risk factor (exposure to disease) o Modifiable risk factors ▪ Individual has control.(smoking, eating habits) o Nonmodifiable risk factors ▪ Individual has little/no control (genetics, gender, age, environmental exposure) ▪ Risk assessment Health
A state of complete physical, mental and social well-being, and not merely the absence of disease Health Risk: tobacco
Leading cause of preventable death
Most common in less educated populations and those living below poverty level
Smoking is a causal factor in cancers
Nicotine addiction is the most common form of chemical dependence.
Nicotine withdrawal symptoms: o Anxiety o Increased appetite o Irritability o Difficulty concentrating
Smoking cessation: how can I help Health risk: alcohol
Binge drinking is an unrecognized problem among women and girls.
Dietary guidelines for Americans states o No more than one drink per day for women o Two drinks per day for men.
A drink is: o 12 ounces of beer or wine cooler o 8 ounces of malt liquor o 5 ounces of wine o 1 ounces of 80-proof distilled spirits or liquor
Alcohol prevention: how can I help o Prevent underage drinking o Identify individuals and groups at risk of abuse/ dependence o Educate o Involve the community o Youth Programs ▪ “Too Smart to Start” program targets parents and caregivers of 9- to 13-year-olds. Health risk: Diet
One of the most modifiable risk factors
Obesity in the United States has not changed
Global burden (WHO)
No state met the Healthy People 2020 goal to reduce obesity prevalence to 15%.
Healthy diet contributes to prevention of chronic disease o Type 2 diabetes o Hypertension o Heart disease
Diet: how can I help? o Education is key ▪ Balancing caloric intake and physical activity
Agent Etiologic factors Host Susceptibility or response to agent Environment Extrinsic factors Nutritive elements:
- excessive deficiencies
- Chemicals agents
- poisons and allergens
- Physical agents
- Infectious agents
- Bacteria
- Fungi
- Rickettsia
- Viruses
- Genetic makeup
- Age
- Sex
- Ethnic Group
- Prior immunological Experience
- Active/passive
- Preexisting disease
- Human behavior Exposure or susceptibility to agent
Physical environment
Biological environment Human population, flora
Socioeconomic environment Occupation, urbanization, and economic development, disruption
Community health nurse's role in epidemiology
Morbidity rates-rate of illness
Incidence- # of new cases of a specific disease/condition
Prevalence- # of existing cases of a specific disease/condition
Mortality rates: death
Attack rates- # of new cases exposed to the disease
Levels of prevention
Primary
Secondary
Tertiary
Screening: ID risk factors
Surveillance: monitor changes Features of a Community
Aggregate: people who have common characteristics
- senior citizens
- ethnic background
- Religious organizations
Location in space and time
- Physical Location
- Census tracts subdivides larger communities
- Geographic Community - Neighborhood
Social system: relationship that community members form with each other What is a Healthy Community?
The ability to respond to change
Encourage positive health changes
Stress the importance of connecting with people
Each community has its unique perspective on health and healthiness. Healthy Community Assessment
Parameters p. 100-
Physical environment
Education
Safety and transportation
Politics and government
Health and social services
Communication
Economics
Recreation Healthy Community Assessment Sources of Data
Windshield survey- provides organized observations of the area/people
Drive or walk
Gain an understanding of the environment layout
Nurse can observe people and their role in the community
Geographic features
Location of agencies, services, businesses and industries
Census data
Vital statistics
Birth, death, marriage certificates
National Health Interview Survey
Annual data from national center for health statistics Needs Assessment
What is a needs assessment? Used to understand the community's perspective Interview key community informants Use community forums, focus groups, or survey's 12 steps in a needs assessment
Identify aggregate for assessment
Patch
MAPP
Apex Patch: Community has more control over its own health
- Community participation
- Comprehensive health strategies a. Mobilizing the community b. Collecting health data c. Selects health priorities d. Intervention plan e. Evaluates the process APEX
- Voluntary process
- Emphasizes community self-assessment
- Planned improvments
- Evaluation
- Reassessment MAPP
- Mobilizes community
- Guide community toward shared vision
- Conduct four assessments: o Community strengths o Local health system o Health issue o Change Affordable care act
- Reduced premium costs for millions for working families and small businesses by providing tax relief
- Capped out of pocket expenses
- Required preventative care to fully be covered without out of pocket expense
- No preexisting medical conditions were denied service Nursing implications
- Work collaboratively with health planners to improve aggregate health
- Fuse technology with knowledge of health care needs and skills
- Become directly involved in the planning process
- Engage in aggregate-level projects Chapter 8 We are educating the learners
Adult learners
- Outlined assumptions about the adult learner
- Learn better in a non restrictive non structured environment
- Characteristics o Needs to know o Concept of self o Experience o Readiness to learn o Orientation to learning o Motivation Community Health education
- Combination of learning experience
- Goal o Translate health knowledge into interventions for health enhancement o Enhance wellness/decrease disability o Influence others to improve health o Sustain behavioral changes by engaging learners to become partners iin their own behaviors Learning †heories
- Understanding individuals families and groups learn
- Humanistic theory : holistic
- Cognitive theory : brain
- Social learning: behaivor Health education models Health belief model:
- Purpose: o Explain why people do not participate in health education programs ▪ Perceived susceptibility ▪ Perceived severity ▪ Perceived benefits ▪ Perceived barriers ▪ Self-efficacy/confidence ▪ Demographics ▪ Cues to action Health promotion model
Exam 1 Community Health
Course: Community Nursing (NSG 4533)
University: South College
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