Community Health Study Guide

Community Health Study Guide Review: ○​ Chap 11: Infection Control ○​ Chap 15: Security and disaster plans in your ATI Fundamentals book ○​ Chap 5 in ATI leadership book ​ Professional collaboration and communication, Quality, Advocacy, Evidenced-based practice (know them and examples) ○​ Quality ■​ Public health care is the degree to which a population's health outcomes and conditions improve as a result of the policies, programs, services, and research available to them. ■​ Total Quality Management: seeks to improve quality and performance which meets or exceeds expectations ■​ Continuous Quality Improvement: an approach to quality management that emphasizes the organization and its processes and systems and uses objective data to analyze and improve processes ○​ Advocacy ■​ Evaluate the client’s needs: assessment of what the client needs by assessing interest and values and their full understanding of their rights. ■​ Identify the client’s goals, working with the client to create goals: Include the client in their plan of care and development of goals and what they want to achieve. ■​ Develop a plan to meet the goals: The implementation of the plan involves facilitating communication with the client and the health care team. ■​ Evaluate the results of the advocacy steps: Evaluate if the needs of the client, family, caregivers, and the health care team have been met. ○​ Evidence-Based Practice ■​ Systematic process that uses the best available evidence to make decisions and take actions. ■​ Goal= Improve patient outcomes ■​ Helps to eliminate bias, unfounded beliefs, and subjective opinion from decisions and actions. ★​ Community Oriented nursing vs. Community Based nursing (chart in PP) ○​ Community Oriented ■​ Focus of Care: Aggregates, communities, populations, can include at-risk or unserved individuals and families ■​ Primary Goal: Health promotion and disease prevention ■​ Nursing Activities: Usually indirect, but can include direct care of at-risk individuals ○​ Community Based ■​ Focus of Care: Individuals and families ■​ Primary Goal: Management of acute or chronic conditions ■​ Nursing Activities: Direct, one-on-one. Illness care → Management of acute and chronic conditions in settings where individuals , families and groups, live, work and “attend". ★​ Population health nurse role ○​ Field of study that focuses on the health needs of a specific group of people ○​ Goal is to assess needs, intervening to protect and promote health, and prevent disease within a certain population. ○​ Assist clients in managing health conditions in community ○​ Connect clients to community resources ○​ Coordinate care across health care spectrum ★​ Social Determinants of Health ○​ Factors in within a community or defined location that affect individual health ■​ Economic stability ■​ Neighborhood and built environment ■​ Access to and quality of education ■​ Access to an quality of food ■​ Social community context ■​ Access to and quality of health care ★​ Cultural assessment provides health care providers with what info? ○​ Provides information to the health care provider about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors ★​ Use of translator/appropriate translator ○​ Family members are NOT advised to be used as an interpreter ★​ Primary, Secondary, and Tertiary Prevention and how to determine ○​ Primary ■​ Prepare with bioterrorism drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. ■​ Design a bioterrorism response plan using the most probable biological agent in the local area. ■​ Identify the chain of command for reporting bioterrorism attacks. ■​ Define the nursing roles in the event of a bioterrorism attack. ■​ Set up protocols for different levels of infection control and containment. ○​ Secondary ■​ Activate the bioterrorism response plan in response to a bioterrorism event. ■​ Immediately implement infection control and containment measures ■​ Screen the population for exposure, assessing rates of infection and administering vaccines as available. ■​ Assist with and educate the population regarding identification of manifestations and management (immunoglobulin, antiviral, antitoxins, and antibiotic therapy, depending on the agent). ■​ Monitor mortality and morbidity. ○​ Tertiary ■​ Monitor medication regimens and referrals. ■​ Evaluate effectiveness and timeliness of the bioterrorism plan ○​ TLDR… ■​ Primary-Bioterrorism planning ■​ Secondary-early recognition ■​ Tertiary-Rehabilitation of survivors ★​ Epidemiological triangle ○​ The agent: the physical infectious, or chemical factor that causes the disease ○​ The Host: the living being that an agent or the environment influences ○​ The environment: the setting or surrounding that sustains the host ★​ Endemic vs. Epidemic vs. Pandemic ○​ Endemic ■​ The baseline or expected presence of disease. ○​ Epidemic ■​ A term applied when the presence of disease is above the expected level. ○​ Pandemic ■​ An epidemic that spreads and affects a larger number of people in different countries. ★​ Epidemiological calculations: Attack Rate, Incident rate, Mortality Rates Ect. ○​ Attack Rate ■​ Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed. ○​ Incident Rate ★​ Populations at risk for communicable diseases ○​ Young children ○​ Older adults ○​ Immunosuppressed clients ○​ Clients who have a high-risk lifestyle ○​ International travelers ○​ Health care workers ★​ Modes of transmission for Infectious diseases and precautions (Airborne, Vector-borne, Waterborne, Foodborne, Direct) ○​ Airborne (Particles transmitted by air to susceptible host via droplets or particles) ■​ Measles [airborne isolation precautions] ■​ Chickenpox [airborne isolation precautions] ■​ Tuberculosis (pulmonary or laryngeal) [airborne isolation precautions] ■​ COVID-19 [airborne isolation precautions] ■​ Pertussis [droplet isolation precautions] ■​ Influenza [droplet isolation precautions] ■​ Severe acute respiratory syndrome (SARS) [droplet isolation precautions] ■​ Common cold ○​ Vector-borne (via a carrier (vector), such as a mosquito, tick, fly) ■​ West Nile virus ■​ Lyme disease ■​ Rocky Mountain spotted fever ■​ Malaria ■​ Zika Virus ○​ Waterborne ■​ Legionnaires Disease ■​ Cryptosporidium ■​ Cholera ■​ Typhoid fever ■​ Bacillary dysentery ■​ Giardia lamblia ○​ Foodborne ■​ Food infection (bacterial, viral, parasitic infection of food) ●​ Norovirus ●​ Salmonellosis ●​ Hepatitis A ●​ Trichinosis ●​ Escherichia coli (E. coli) ■​ Food intoxication (toxins produced through bacterial growth, chemical contamination, or disease-producing substances) ●​ Staphylococcus aureus ●​ Clostridium botulinum ○​ Direct (transmission of infectious agent from infected host to susceptible host via direct contact) ■​ Sexually transmitted infections ■​ Infectious mononucleosis ■​ Enterobiasis (pinworms) ■​ Impetigo ■​ Lice, scabies ■​ Common cold ★​ Horizontal transmission and Vertical Transmission ○​ Vertical transmission: occurs through the sperm, placenta, vaginal contact during birth, or consuming human milk ○​ Horizontal transmission: occurs through contact with a person or objects the person has touched, the air, contaminated body fluids, food, and water (common vehicle), or living creatures like mosquitoes and snails (vectors) ★​ Defense Mechanisms: Herd, natural, acquired immunity, active, passive ○​ Herd immunity: Protection due to the immunity of most community members making exposure unlikely ○​ Natural immunity: Natural defense mechanisms of the body to resist specific antigens or toxins ○​ Acquired immunity: Resistance acquired by the host through actual exposure to the infectious agent ○​ Active: Production of antibodies by the body in response to infection or immunization with a specific antigen ○​ Passive: Transfer of antibodies to the host either trans placentally from mother to newborn or through transfusions of immunoglobulins, plasma proteins, antitoxins ★​ 4 Stages of Disaster management ○​ Disaster prevention/mitigation ■​ Assessing potential threats and vulnerabilities to either stop a disaster from happening at all or to mitigate the effects of a disaster if it were to occur. ■​ EX) Assessing the condition of buildings and other community structures and the integrity of contained gases and chemicals ○​ Disaster preparedness ■​ The nurse's role is to get the community ready for potential disasters. ■​ Participate in the following disaster preparedness activities: ●​ Developing personal, work, and family disaster plans ●​ Identifying community evacuation routes​​ ●​ Identifying emergency shelter locations, including those specifically for individuals with special health care needs ●​ Developing a communication chain ●​ Performing regular drills (annually or more frequently) with debriefs ○​ Fire ○​ Mass casualty incident (MCI), such as active shooter and multivehicle collision drills ○​ Endemic natural disasters​​ ○​ Stockpiling food, water, medication, and first-aid supplies​​ ○​ Making sure pet care is included in planning (pet friendly shelter, food, water, medication) ○​ Disaster response ■​ Actions taken during and immediately after a disaster. ■​ The nurse’s role during disaster response includes: ●​ Activating the disaster plan ●​ Providing triage and ongoing care to victims ●​ Establishing disease surveillance if an outbreak or bioterrorism is suspected ●​ Evaluating any other public health needs that may arise. ○​ Disaster recovery ■​ Begins when the threat no longer exists. ■​ Disaster recovery efforts include the following. ●​ Rebuilding damaged and destroyed structures ●​ Resuming previous activities (if possible) ●​ Establishing a “new normal” in some circumstances ●​ Referral of essential workers and victims to mental health services ★​ Category classes for biological agents ○​ Category A ■​ Highest priority ■​ Easily transmitted ■​ High mortality rate ●​ Examples: smallpox, anthrax, tularemia, viral hemorrhagic fevers (ebola), and plague ○​ Category B ■​ Second highest priority ■​ High morbidity rate ■​ Low mortality rate ●​ Examples: typhus fever, ricin toxin, diarrheagenic E. coli, and west nile virus ○​ Category C ■​ Third highest priority ■​ Potential for high morbidity and mortality rates ●​ Examples: hantavirus, influenza, TB, and rabies ★​ Delivery mechanisms for biological agents ○​ Anthrax ■​ Ingestion, contact or inhalation of spores ●​ Treatment ○​ Ciprofloxacin ○​ Doxycycline ■​ 1-7 days incubation up to 60 days ○​ Botulism ■​ Ingestion or inhaled ●​ Treatment ○​ Airway management/ positive pressure ○​ Antitoxin ■​ Not spread person to person ○​ Ebola ■​ Contact or inhaled ●​ Treatment ○​ IVF ○​ Dialysis ○​ Airway ○​ Minimize invasive procedures ■​ Droplet and contact isolation ○​ Black plague ■​ Rodents to fleas to humans ●​ Treatment ○​ Gentamicin ○​ Fluoroquinolones ■​ Droplet precautions ○​ Smallpox ​ ■​ Droplet ●​ Treatments ○​ Vaccine ○​ Tecovirimat ○​ Brincidofovir ■​ Contact and airborne precautions ○​ Tularemia ■​ Rabbit fever ●​ Treatment ○​ Gentamicin ○​ Streptomycin ○​ MASS- doxycycline/ciprofloxacin ★​ The Community Assessment ○​ Assessment ○​ Diagnosis ○​ Planning ○​ Intervention ○​ Evaluation ○​ Primary data, Secondary data ■​ Primary (physical factors) ●​ Geography ●​ Location of health services ●​ Animal control ●​ Grocery stores ■​ Secondary (use of existing data) ●​ Death statistics ●​ Birth statistics ●​ Census ●​ Mortality ●​ Health records ★​ Workplace assessment ○​ Observation of work processes and materials ○​ Job requirements ○​ Actual and potential hazards ○​ Employee work practices (hygiene, waste disposal, housekeeping) ○​ Incidence/prevalence of work-related illness/injuries ○​ Control strategies to eliminate exposures ★​ Domains of learning ○​ Cognitive ■​ Involves knowledge and the development of intellectual skills; for example, a client discusses how sodium intake will affect blood pressure. ●​ Thoughts and thinking mode of learning ○​ Memorizing and reasoning ○​ Affective ■​ Involves a change in attitude and development of values; for example, a client expresses acceptance of having a colostomy and maintains self-esteem. ●​ Emotions and feeling ○​ Appreciation and motivation ○​ Psychomotor ■​ Involves the performance of a skill; for example, the community nurse teaches a client how to self-administer insulin. ●​ Actions ad doing ○​ Typing and playing ★​ Definition of Aggregate ○​ Can be defined based on special interests or geographic locations. Identify aggregates when planning targeted health interventions ■​ Groups that have common characteristics ★​ Genogram, Ecomap ○​ Genograms ■​ Used to gather basic information about the family, relationships within the family, and health and illness patterns. ○​ Ecomaps ■​ Are a visual diagram of the family unit in relation to other units (school, work, church, work, friends, extended family) used to understand the relationship among family members and the community. ★​ Definition of vulnerable populations ○​ Groups at higher risk of experiencing social, economic, health, or environmental disadvantages due to factors like age, disability, socioeconomic status, or marginalization, requiring targeted support and protection ★​ Most important preventable cause of death in the US according to the CDC ○​ Smoking is the most important preventable cause of death in the U.S., according to the Centers for Disease Control and Prevention. ★​ Aggregates in the community in association with the National Health goals. (Adults, Children, Older Adults, Adolescents) ○​ Children ■​ Reductions ●​ Exposure to secondhand smoke ■​ Increase in ●​ Use of child safety restraints ○​ Adolescents ■​ Reducations ●​ Violent crimes ○​ Adults ■​ Reductions ●​ Death from cancer ○​ Older adults ■​ Reductions ●​ Inappropriate medication use ★​ 4 stages in disaster planning ○​ Disaster prevention - 1st step ■​ assessing for potential threats and vulnerabilities to either stop a disaster from happening at all ○​ Disaster preparedness - 2nd step ■​ the nurse’s role is to get community members ready for potential disasters ○​ Disaster response - 3rd step ■​ actions taken during and immediately after a disaster. ○​ Disaster recovery - 4th step ■​ begins when the threat no longer exists. ○​ Mass casualty ■​ A type of disaster in which a large number of deaths and injuries occur in a short period of time and overwhelms the resources of the healthcare system. ○​ Triage ■​ The process of prioritizing care based on the severity of a condition or injury. ■​ In a disaster, a utilitarian approach is used. ■​ The goal of triage in a disaster is to do the greatest amount of good for the greatest amount of people while efficiently using resources. ★​ Community Nursing Diagnosis ○​ Community nursing diagnoses incorporate information from the community assessment, general nursing knowledge, and epidemiological concepts (especially the concept of risk in a population). ■​ Community nursing diagnoses often are written in the following format ○​ Risk of [specific problem or risk in the community] among [the specific population that is affected by the problem or risk] related to [strengths and weaknesses in the community that influence the problem or risk]. ★​ Health insurance (Medicare, Medicaid, Private) ○​ Medicare ■​ Individuals must meet qualifications for Medicare. These include: ●​ Be older than 65 and receiving Social Security ●​ Have been receiving disability benefits for 2 years ●​ Have amyotrophic lateral sclerosis and receive disability benefits ●​ Have Kidney failure and be on maintenance dialysis or had a kidney transplant ○​ Medicaid ■​ Provides healthcare coverage for individuals of low socioeconomic status and children, through combined efforts of federal and state governments ■​ Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability ■​ Medicaid provides inpatient and outpatient hospital care, labs, radiological services, home health care, vaccines for children, family planning, pregnancy related care, and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for those younger than 21 years ●​ Branches of Medicaid ○​ TEFRA ○​ PASSE ○​ ARHOME ○​ AR Kids ○​ Traditional Medicaid ○​ Private ■​ Health Insurance, Employer Benefits ●​ Managed Care: based on using a case management approach with a specific group of providers in attempt to contain the cost of care​ ■​ Health Maintenance organizations (HMOs): ●​ Comprehensive care is provided to members by a set of designated provider ■​ Preferred provider organizations (PPOs): ●​ Predetermined rates are set for services delivered to members: financial incentives are in place to promote use of PPO providers ■​ Medical Savings Accounts: ●​ Untaxed money is put in an account for use for medical expenses ■​ Self Pay ●​ Individuals are responsible for payment of charges not covered by a third party ●​ Some clinics offer a sliding-fee-scale payment where the rate of payment is based on individual income ★​ Bioterrorism agents: ○​ Vaccine following exposure? ■​ Anthrax vaccine can be used for those at high-risk for exposure ■​ Smallpox vaccine can be given within 3 days of exposure ○​ Antibiotic treatment for agents (exposure, ect) ■​ Ciprofloxacin and doxycycline for anthrax ■​ Gentamicin and fluoroquinolones for plague ■​ Streptomycin and gentamicin for tularemia ●​ Doxycycline and ciprofloxacin for mass casualty ★​ Triage of patients ○​ Triage: The process of prioritizing care based on the severity of a condition or injury. ○​ In a disaster, a utilitarian approach is used. ○​ The goal of triage in a disaster is to do the greatest amount of good for the greatest amount of people while efficiently using resources. ★​ Collaboration within the community ○​ Working together with other professionals to provide the best care ★​ Low Health Literacy ○​ Health literacy is a person being able to understand and take the right action to make good health choices ■​ Low health literacy would mean the person has the inability to understand and use health information ★​ Advocating role of the nurse ○​ Justice ■​ Treating all with fairness, equality, impartiality ●​ Ex: RN advocating for a new clinic to be built near public transit bus stop that has a route to/from low-income housing ○​ Benefinece ■​ Acting in best interest of individual; providing benefit ●​ Ex: a home health nurse helps get an order changed for cheaper wound care supplies for a client with a diabetic foot ulcer ○​ Nonmaleficence ■​ do no harm ●​ Ex: a RN sees another nurse using a patient’s child as an interpreter. The RN brings an interpreter phone to the room to use instead ○​ Autonomy ■​ Respecting an individual freedom to make their own decisions ★​ Culturally competent care ○​ Skill developed where a nurse respects individual dignity and preferences, as well as acknowledges cultural differences ■​ Cultural Preservation ●​ Maintain traditional values and practices ■​ Cultural Accommodation ●​ Support and facilitate clients use of cultural practices that benefit health ■​ Cultural Repatterning ●​ Assisting client in modifying cultural practices that are not beneficial ■​ Cultural Brokering ​ ●​ Advocating, mediating, negotiating and intervening between client’s culture and health care culture on behalf of client ★​ Disaster management cycle ○​ Prevention/migration ○​ Preparedness ○​ Response ○​ Recovery ★​ Historical Figures (Dr. John Snow, Lillian Wald, Dr. Edward Jenner, Margaret Sanger, Clara Burton) ○​ Dr. John Snow ■​ English physician in London during the 18th century ■​ Published the book On the Mode of Communication of Cholera (1855). ■​ “Founder of modern epidemiology” ■​ Known for work with Anesthetics as well (Ether, Chloroform) ○​ Lillian Wald ■​ 1867-1940 ■​ Helped to bring health care to the residents of New York's Lower East Side at the turn of the twentieth century ○​ Dr. Edward Jenner ■​ Pioneered the concept of vaccines and created the smallpox vaccine ○​ Margaret Sanger ■​ 1879-1966 ■​ A birth control activist, sex educator, writer, and nurse who is regarded as a founder and leader of the birth control movement, opening the first birth control clinic in the United States and founding Planned Parenthood. ○​ Clara Burton ■​ 1821-1912 ■​ The American Red Cross in 1881, after being inspired by the International Red Cross in Geneva, Switzerland. ★​ Mortality Rates (Crude Mortality, Cause Specific, Case Fatality, Infant mortality) ○​ Crude mortality rate: ■​ Number of deaths ÷ population total x 1,000 = _____ per 1,000 ○​ Cause specific rate: ■​ Number of deaths from a specific cause ÷ population total x 1,000 = _____ per 1,000 ○​ Case fatality rate: ■​ Number of deaths from a specific disease ÷ persons diagnosed with that disease ○​ Infant mortality rate: ■​ Number of infant deaths before 1 year of age in a year ÷ number of live births in the same year x 1,000 = _____ per 1,000 ■​ (You need to know what you would calculate-Matching) ■​ You DO NOT have to know how to calculate it is just matching with the calculations