Population Health - Final Study Guide

1 Final Study guide The study questions for the quiz have been built into each week's module. There are questions at the end of each module (weeks 5-8) and study these questions along with reviewing the weekly content and objectives are the direction to take when studying for quizzes or exams. It is not open note/book, etc. It is multiple choice with some questions being "choose all that apply". There are 20 questions, and it is timed. You should take this exam individually; no help from anyone. If you encounter any technical issues, it is critical to report this to IT so that it can be investigated and/or so that a record of the problem will be logged. Week 5 Weekly Objectives: 1. Discriminate populations at risk for development of chronic health conditions while associating the role of the Advanced Practice Nurse in levels of prevention. 2. Compare and contrast variables that differentiate those categorized at being at risk for marginalization of health care. Reading: Ch 2 Cultural Competence Cultural competence is defined as “a dynamic, fluid, continuous process whereby an individual, system or health care agency find meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they render care” (Giger & Davidhizar, 2002, p.186). Cultural Awareness - Self-examination of one's own prejudices and biases toward other cultures. An in-depth exploration of one's own cultural/ethnic background. Cultural Humility - A lifelong commitment to self-evaluation and self-critiques, redressing the power of imbalances in the patient- physician dynamic, developing mutually. Beneficial relationships. Cultural Knowledge - Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism. Cultural Skill - Ability to collect culturally relevant data regarding the client's health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner. Cultural Desire - Motivation of the healthcare provider to "want" to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commitment, and passion to caring, regardless of conflict. 2 Culturally congruent care- care that is centered on a person's values and meaning as opposed to care that has been predetermined by other criteria. Cultural competence in nursing consists of four principles.  Care is designed for the specific client.  Care is based on the uniqueness of the person's culture and includes cultural norms and values.  Care includes self-employment strategies to facilitate client decision making to improve health behaviors.  Care is provided with sensitivity and is based on the cultural uniqueness of clients. According to Giger and Davidhizer (2000), although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include       communication (verbal and nonverbal); personal space; social organization; time perception; environmental control; and biological variations. Accommodation - To create an environment that accommodates health practice and ritual from other cultures within a plan of care Acculturation - Degree two which an individual from one culture has given up the traits of that culture and adopted the traits of the dominant cultural in which they now reside Assimilation - The social, economic, and political integration of a cultural group into a mainstream society to which it may have emigrated Cultural Competence - Respect for, and understanding of, diverse ethnic and cultural groups, their histories, traditions, beliefs, and value systems The 5W's of descriptive epidemiology:     What = health issue of concern Who = person Where = place When = time 3  Why/how = causes, risk factors, modes of transmission Key Points:  How does culture influence the decisions a provider may make when selecting an intervention?  Explain how culture impacts provider attitudes? Does it? How will you assess your own attitudes about various cultures/races/groups?  Review the terms for this week and apply them to population health; for instance: cultural competence, cultural awareness, norms, values, Kleinman Explanatory Model, socioeconomic status, disparities, minorities, food desert. Ethnicity-the aggregate of cultural practices, social influences, religious pursuits, and racial characteristics shaping the distinctive identity of community Race- a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings) Nationality- refers to the country of birth, or the ancestors' country of birth. Cultural nursing assessment- a systematic identification and documentation of the cultural care beliefs, meaning, values, symbols, and practices of individuals or groups using a holistic perspective. Norms- Agreed upon expectations and rules by which a culture guides the behavior of its members within any given situation Values - the ideas, beliefs, and attitudes about what is important that help guide the way you live Kleinman Explanatory Model-Consists of 3 sections. important tool for facilitating cross-cultural communication, ensuring pt. understanding, and identifying areas of conflict. Kleinman Explanatory Model Questions -What do you think the problem is -Why do you think it started -What do you think your sickness does to you -How severe is it -What treatment do you think will help socioeconomic status (SES)- a measure of social class that is based on income, education, and occupation 4 Disparities in health-refers to differences in health across ethnic and income groups as well as differences in gender, age and size. Minorities- a culturally, ethically, or racially distinct group that coexists with but is subordinate to a more dominant group Food Desserts Definition-parts of the country void of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas  What are the social determinants of health? How does a provider integrate knowledge of these social determinants of health into their practice? Why are they important? social determinants of health- The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels • why are social determinants of health important? -They impact a person's wellbeing and health -Because the goal is to improve the social determinants for all Americans -Play a huge role in how a person is treated and prone to certain conditions  Apply social justice theory to the provision of care; what does social justice mean when applied to health care? Social Justice-justice in terms of the distribution of wealth, opportunities, and privileges within a society.  What data sources are used to assess determinants of health? data sources for determinants of health-Chronic Disease Indicators, Interactive Atlas of heart disease and stroke, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB prevention Week 6 Weekly Objectives: 1. Integrate the field of genetics into the screening, risk assessment, of populations. Genetic Risk Assessment technique that builds upon the discoveries in the area of DNA and genetic mapping, where genetic predispositions toward certain behaviors can be anticipated and prevented; tool to help identify individuals who have genetic risk factors 5 genetic screening-process of testing DNA to determine the chance a person has, or might pass on, a genetic disorder components of genetic risk assessment- intake, cancer risk assessment, genetic testing for an inherited cancer syndrome, informed consent, disclosure of genetic test results, and psychosocial assessment 2. Construct intervention plans related to a chronic health problem that integrates awareness of genetic implications. Definitions   Genetics – The study of individual genes and their impact on relatively rare single gene disorders (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009)  Genomics – The study of all genes in the human genome as well as their interaction with other genes, the individual’s environment, and the influence of cultural and psychosocial factors (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009)  Genetic epidemiology – The link of epidemiology and genetics (Khoury, Bety, & Cohen, 1993) m the study of the role of genetic factors in determining health and disease in families and in populations  Pharmacogenetics Area of pharmacology that examines the role of genetics in drug response. Connection between genetics and the environment-All traits depend on both genetics and the environmental factors. Heredity and environment interact to produce their effects. 6  Genetics Nondiscrimination Act- Act that protects Americans from discrimination based on their genetic info in both health insurance and employment Risk Interpretation. Consider the following pieces of information: 1. A history of malignant melanoma in a first-degree relative has been associated with an eightfold increase in risk (Glanz, Saraiya, Wechsler, 2002) 2. having a sister with a BRCA1 mutation gives a woman a 50% risk of having the same genetic mutation (Jacobellis et al., 2004) 3. similarly, there is a nearly 9% chance or risk for children with relatives who have epilepsy to develop the disease (Epilepsy Foundation, n.d.).  Absolute risk is the probability of an event, such as illness, injury, or death  Absolute risk gives no indication of how its magnitude compares with others.  The odds ratio closely approximates the relative risk if the disease is rare.  Odds ratio and the relative risk are used to assess the strength of association between risk factor and outcome.  Attributable risk is used to make risk-based decisions for individuals.  Population-attributable risk measures are used to form public health decisions (Nordness, 2006). Genomic & Health – Understanding the relationship between genes, environment, and health Key Points: 1. Integrate risk / screening as it applies to genetics? How, what methods are used to screen for health conditions that may have genetic connections? What guidelines support evidence-based decision making in the area of genetics? 2. What is genetic risk assessment? How is it determined? 3. Explore and integrate genetic terminology, for example: Genomics, pharmacogenomics, genetic epidemiology. Also, refer to HP2020. 4. What are the components of a genetic risk assessment? 5. Can you discuss the interplay (connection) between genetics and the environment, how do they influence one another? Do they? 6. What is the Genetics Nondiscrimination Act? Week 7 Weekly Objectives: 7 1. Inspect the relationship between environment and global health. 2. Appraise global health problems considering WHO MDG's and related epidemiological data. Reading: Ch 12 The World Health Organization defines a pandemic as a global epidemic that spreads to more than one continent (WHO, 2009). Figure 11.1 in Ch 11 illustrates the levels of factors involved in health outcomes within a global context, a complex but interesting model. Definitions  Pandemic—a global epidemic of disease that spreads to more than one continent (WHO, 2009)  Outbreak—the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, or time of year. An outbreak may only last for a matter of days or weeks, but may last for years (WHO, 2014).  Quarantine—the separation and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill (CDC, 2014).  Isolation-—the separation of sick people with a contagious disease from those who are not ill (CDC, 2014)  Disaster epidemiology— “Disaster epidemiology is defined as the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health, and behavioral health” (CDC, 2012).  Sporadic-occurring irregularly, infrequent, scattered  Endemic- constant presence and prevalence of a disease or infectious agent in a population within a geographic area  Hyperendemic- persistent, high levels of disease occurrence  Epidemic- an increase, often sudden, in the number of cases of a disease above what is normally expected within that population  Cluster-aggregation of cases grouped in place and time that are suspected to be greater than the number expected, even though the expected number may not be known 8  Pandemic-an epidemic that is geographically widespread  Disaster Epidemiology-The use of epidemiology to assess the short- and longterm adverse health effects of disasters and to predict consequences of future disasters. Pandemic Severity Index  Category 1—case fatality ratio of less than 0.1% and fewer than 90,000 U.S. deaths  Category 2—0.1%–0.5% case fatality ratio and 90,000–450,000 U.S. deaths  Category 3– 0.5%—1% case fatality ratio and 450,000–900,000 U.S. deaths  Category 4—1–2% case fatality ratio and 900,000–1.8 million U.S. deaths  Category 5—greater than 2% case fatality ratio and more than 1.8 million U.S. deaths (CDC, 2014). The goals are to maximize the safety of healthcare workers and patients, ensure that the basics of care such as airway maintenance and minimizing trauma are considered, and have a plan and education in place for infection control. Key Points: 1. Can you discuss the types of outbreaks at a population health level? Types of Outbreaks -point source -continuous source -propagated outbreak point source outbreak-Source has infected cases at one particular geographical location, during a short period of time. Located at a single point in time and place continuing common source- Outbreak caused by the same source but over a prolonged period of time propagated outbreak- An outbreak that does not have a common source, but instead spreads from person to person. Can't consider a single common source is responsible. 2. How is the epidemiological triangle related to pandemics, outbreaks? epidemiological triangle related to pandemics When a pathogen is introduced into a fully naive (ie. fully susceptible) population with relatively easy person to person transmission (ie airborne), the epidemic curve increases sharply with incremental 'jumps'. The jumps reflect the generations of cases in the population. 9 3. If you were to explain "disaster epidemiology" to a colleague or nursing student, what would you say? Disaster Epidemiology is defined as the use of epidemiology to assess the shortand long-term adverse health effects of disasters and to predict consequences of future disasters. 4. What is the WHO? What do the SDG's (formerly MDG'S) mean? World Health Organization (WHO) A group within the United Nations responsible for human health, including combating the spread of infectious diseases and health issues related to natural disasters. WHO priorities-communicable disease, mitigation of the effects of noncommunicable diseases, development, health and aging, nutrition, food security and healthy eating, occupational health, substance abuse,Sustainable Development Goals (SDGs) Collection of 17 goals set by the United Nations. Cover social and economic development issues including poverty, hunger, health, education, global warming, gender equality, water sanitation, energy, urbanization, environment, and social justice 5. Connect social justice theory to the implications of outbreaks. If individuals do not have equal access to healthcare, good, and other health factors, outbreaks could be more predominate do to poor health and lack of adequate medical services needed to treat the disease 6. What is the history of the World Health Organization? 7. Be sure to review the articles: Angelini (2017) and Kurth (2017): What are said to be some of the noticed health effects of climate change? Can you speak to the "Call to Action" elements/content? Noticed health effects of climate change? Increase effects on COPD, Asthma, and Respiratory Infections 8. How do you assess an area's resources and its relationship to the health of a region? Week 8 Weekly Objectives: 10 1. Synthesize knowledge of population to the role of political advocacy as an Advanced Practice Nurse. 2. Appraise ethical and legal principles to the provision of care by the Advanced Practice Nurse Reading: None from textbook Key Points: 1. How do ethics and public policy intersect? 2. What influence do you as a provider have regarding public policy? What ethical obligation do you believe you have? 3. How is risk reduction, assessment, and outcomes related to public health policy? 4. Where is the intersection of: epidemiology, population health, public policy and social justice and vulnerable populations? 5. Are you able to define the key ethical terms and apply them to population health? For instance, ethics, fairness, and social justice.