Legislation Related to Health Care -- Chapter 10

1 Community Health Test Matrix Exam 2 (Ch. 10, 11, 12, 14, 19, 21, 22, 23, 24, 25, 27, 28) Legislation related to health care -- CHAPTER 10 ● Factors influencing legislation? ○ Beliefs, attitudes, values (on tb) ● Gov’t role in health policy at local, state, and national levels? ○ Federal government: ■ Directly and indirectly through the financing of health care for many groups (medicaid and medicare) ■ Funding ■ healthcare to veterans, native americans, federal prisons? ■ Pass and enforce laws (tb) ■ Limited powers -- only the actions authorized by the constitution are legitimate (tb) ■ Lobbying for health care reform to cover more preventive services ○ State government ■ has the authority to act in every area except those specifically mentioned in the Constitution? (tb) ■ Monitor the incidence of influenza in the state (tb) ○ Local government ■ Authority: power delegated from the states (tb) ■ Set up flu shot clinical in neighborhood church ○ Government agencies ■ Department of health and human services (DHHS) ● Federal agency responsible for administering most of the federal health related activities (tb) ■ Department of education ■ Department of agriculture ● Federal agency responsible for the WIC programs, food stamps, and school based nutrition programs (tb) ■ DOJ--department of justice ■ DOL--department of labor ● Hill-Burton Act 1946 (pg. 179-180) ○ authorized federal assistance in the construction of hospitals and health centers with stipulations about services for the uninsured ○ As a result, hospitals with obligations to care for the uninsured were built in towns and cities across the United States ○ Through these measures, hospital care became more accessible, but by the late 1990s, the high cost of health care, combined with decreasing lengths of stay and 2 increasing use of primary care, forced the closure of many of the hospitals built with Hill-Burton funds (tb) ● COBRA (Consolidated Omnibus Budget Reconciliation Act) (pg. 181) ○ Federal law that affects health care delivery and reimbursement ○ Requires all hospitals w/emergency services that participate in Medicare to treat any client in their emergency services, whether or not that client is covered by Medicare or has the ability to pay. ○ This legislation includes requirements for Medicaid services for prenatal and postnatal care to low-income women in two-parent families in which the primary spouse is unemployed. ○ Employers who terminate an employee must continue benefits for the employee and dependents for a specified period if the employee had health benefits before the termination. (tb) ○ COBRA is an example of how a federal law can affect state health care practices. The federal government must determine who receives federal Medicare funds; therefore COBRA provides the opportunity for the federal government to legislate health care delivery at the state level. ● Social Security Act ○ 1935, 1965, 1972 ○ Benefits for mothers, children, elderly, disabled ○ Welfare for high risk mothers and infants ○ Expanded to health coverage for seniors and vulnerable pops ○ The Social Security Act was amended to create Medicare and Medicaid legislation (TB) ● Medicare and Medicaid ○ Medicare (Title XVIII) in 1965 ■ Health care services for people over 65 with permanent disabilities those with end-stage renal disease ■ 2003 : prescription drug benefit was added -- part D(tb) 3 ○ Medicaid (Title XIX) in 1965 ■ Combined federal and state program ■ Access to care for poor and medically needy ● Mental Health laws ○ Mental Health Parity and Addictions Equity Act of 2008 ○ Mental health coverage ○ Financial requirements (deductibles, co-payments) ○ Treatment limitations (number of visits; days of coverage) ■ that apply to mental health benefits must be no more restrictive ■ than the predominant financial requirements or ■ treatment limitations that apply to substantially all medical/surgical benefits Health Policy -- CHAPTER 10 ● Factors affecting policy ○ Policy denotes a course of action to be followed by a government, business, or institution to obtain a desired effect. Merriam-Webster’s Dictionary defines policy as “a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions” ○ Economics? ○ Values, beliefs, attitudes? ● Difference between public and private policy ○ Private policy ■ Based on economics and market trends (tb) ■ Support nursing research done that demonstrates positive clinical and 4 economic outcomes (tb) ■ Focuses on the individual ■ Nonprofit or profit ■ largely influenced by theories of economics and business management, including consumerism and market trends. -- react quickly and are proactive ○ Public policy ■ Precepts and standards formed by governmental bodies ■ That are of fundamental concern to the state and the whole of the general public. ● Solutions to problems of the public concern developed (tb) ■ (legislative, executive, or judicial) ■ The good of the many over individual rights ■ Prevent sale of tobacco to minors ■ slow and reactive, and economics is just one of many factors involved. Public policies are determined by voting shifts, electoral realignment, and term limits. ■ ● Nurse’s role in policy at the local, state and national level? ○ Nurses influence the maintenance and improvement of the health of individuals, groups, and communities by contributing to policy and legislative advancement ○ Nurses who understand the system of health policy development and implementation can effectively interpret and influence policies that affect nursing practice, the health of individuals, families, groups, communities, and populations, and, when required, offer an international health perspective. ○ Nurses may work collectively within a group such as the National Student Nurses Association, the American Nurses Association (ANA), and state boards of nursing to lobby for health causes. ○ Together nurses can be patient advocates, change agents, and policy makers. ● Role of philanthropy and volunteer agencies in healthcare (policy and funding)? ○ Philanthropy: pay for things insurance doesnt pay for ■ whose services are typically research or disease oriented, pays a limited amount of health care. ■ Health care services that are provided by philanthropic groups: informational and research activities (tb) ○ Volunteer: looks at specific diseases and provide support for: ■ Prevention of disease ■ Promotion of health ■ Treatment of illness ■ Advocacy ■ Consumer education and research ○ Found this in ch 12 economics ppt 5 ■ Oriented toward ● Research ● treatment/interventions ● Population aggregates ■ Limited eligibility for services through: ● American heart association ● March of dimes ■ Susan komen foundation ● Nurses role ○ The power of one and many ○ as change agents--BE ADVOCATES ○ with coalitions ■ When two or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, they have formed a coalition. ■ Both associations had formed a coalition to collaborate on a bill that would benefit patients.(tb) ■ Examples: ● Family violence ● Fluoridian water supply ○ as lobbyists ■ A lobbyist is a person who, voluntarily or for a fee, represents himself or herself, another individual, an organization, or an entity before the legislature ■ Be seen as a reliable and credible source of accurate information (tb) ○ on political action committees (PACs) ■ As PACs are a reality of political life, nursing needs to be heard. (tb) ● nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues (tb rationale) ○ in campaigning ○ in voting strength ○ in public office Significant findings of IOM reports discussed in class--CHAPTER 11 ● IOM = institute of medicine ● To Err Is Human: Building a Safer Health System: 1999 ○ Focuses on safety within the healthcare delivery system ○ System failures are resulting in an incredible amount of harm from medical errors ● The IOM report discusses change, emphasizing the following principles of change, which focus on quality, access, and cost or value: ○ The need for patient-centered care ○ The need for stronger primary care services ○ The need to deliver more care in the community 6 ○ ○ ○ ○ ○ The need for seamless, coordinated care The need for reconceptualized roles for health professionals The need for interprofessional collaboration Efforts must be put in place to control constantly increasing costs (tb) Which of the following best describes the effect of President Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry report (1999)? Stimulated the Institute of Medicine to explore quality in more depth Healthcare system--CHAPTER 11 ● Strengths? ○ Offering the availability and use of technological advances in equipment and procedures (tb select all) ○ Leading the world in laboratory and clinical research (tb select all) ● Weaknesses? ○ Provider bias and stereotyping contribute to inequalities (tb) ○ Large number of underinsured and uninsured citizens (tb) -- major problem faced by US healthcare system Economics--CHAPTER 12 ● Funding of health policy ○ Public funding of Health care -- medicare part A ? ■ Federal entitlement program to provide health care to the growing population ■ of those 65 years of age or older, ■ people who are disabled or have end stage renal disease ■ Must pay a deductible for health services ■ Does not pay for all health care costs of enrollees ■ Co-payments required after 60 days ○ Government grants ■ Directed toward funding large populations and different aggregates ■ Historically for health promotion and disease prevention measures ■ Administered by DHHS ■ “Block grants” provided to states to impact the health of the public as a whole ■ Health care providers and programs compete for funds through grant proposals and applications ■ Closely related to Healthy People 2020 objectives ○ Federal government -- level of government that primarily establishes regulations and provides funding for health care (tb) ○ ● Government efforts to hold down costs ○ First government step in trying to stop constantly rising costs: Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given.(TB) 7 ○ Prospective payments were based on diagnosis related groups DRGS (TB) ○ Capitated reimbursement ■ Prospective reimbursement for services ■ most common organization for receiving personal health care in the United States today (on tb) ○ Access limitation ■ Primary care provider as gatekeeper (the person that controls access) ■ Managed care plans—preauthorization ○ Rationing ■ Determining the most appropriate use of health care ■ Directing the health care where it can do the most good Elderly (CHAPTER 19) ● Characteristics ○ Demographics ■ Gender ● More older women ■ Marital status. ● Older men are more likely than older women to be married. ■ Education ● Educational attainment has increased Living arrangements. ● Older women are more likely than men to live alone. ○ Sources of income ■ Four sources for population aged 65 and over ● Social security -- main source of income (tb) ● Earnings ● Pension ● Assets ■ Mostly spent on healthcare ○ Health ■ Occur in all body systems in response to aging ■ Rate and degree of changes are highly individualized. ■ These changes are influenced by: ● Genetic factors ● Diet ● Exercise ● The environment ● Health status ● Stress ● Lifestyle choices ● And many other elements ■ Examinations and Tests : For All Older Adults ● Complete physical: Annually ● Blood pressure: Annually; more frequently if hypertensive or at risk ● Blood glucose: Annually; more frequently if diabetic or at risk ● Serum cholesterol: Every 5 years; more frequently if at high risk ● Fecal occult blood test: Annually 8 ● Sigmoidoscopy: Every 5 years ○ OR ● Colonoscopy: begin at age 45 -- Every 10 years; more frequently if at high risk ● Visual acuity and glaucoma screening: Annually ● Dental examination: Annually for those with teeth with cleaning every 6 months; cleaning every 2 years for denture wearers ● Hearing test: Every 2 to 5 years ● For Women ○ Breast self-examination: Monthly ○ Clinical breast examination: Annually ○ Mammogram: Every 1 to 2 years if aged 40 years or older; check with health care provider if 74 years or older ○ Pelvic examination and Papanicolaou smear: Annually; may check with health care provider about discontinuation at 66+ years or after three consecutive negative Pap test results or >2 consecutive negative human papilloma virus (HPV) and Pap tests, no abnormal results in previous 10 years and not otherwise at risk, or have had a total hysterectomy ○ Digital rectal examination: Annually with pelvic examination ○ Bone density: Once after menopause and more frequently if at risk ● For Men ○ Digital rectal examination and prostate examination: Annually ○ Prostate-specific antigen (PSA) blood test: Annually ● Immunizations for All Older Adults ○ Tetanus, diphtheria, pertussis: Every 10 years ○ Influenza/flu vaccine: Annually ○ Pneumonia vaccine: Once after age 65 years; ask physician about booster every 5 years ○ Hepatitis A and B: For those at risk ○ Herpes zoster (shingles): One-time dose ○ Varicella: If evidence of lack of immunity and significant risk for exposure ● Issues ○ Chronic illness ■ Arthritis ■ Hypertension 9 ■ Diabetes ○ Medication use ■ High prevalence of chronic diseases = large number of medications ■ More than ⅓ of a total outpatient spending on prescription meds ■ Polypharmacy makes older adults more vulnerable to drug interactions and dangerous adverse effects ○ Sensory disabilities increase with age, may seriously affect the older person’s quality of life and ability to carry out routine daily activities. ■ A nurse is making the first home visit to a recently discharged elderly client. Which of the following should the nurse most likely expect to find? A client who may well have hearing or vision problems or both ■ Visual impairment ● impacts social abilities, depression, falls, and communication. ● Age-related cataracts ● Macular degeneration ● Diabetic retinopathy ● Glaucoma ● Cataracts -- most common reason for visual impairment (tb) ■ Hearing loss ● one of the most common conditions affecting older adults. ● Sensorineural health loss: damage to inner ear or auditory nerve ● Presbycusis: most common sensorineural loss, which is gradual change in middle ear due to aging, loud noises, heredity, head injury, infection, illness, some medications, and circulation problems ● Conductive hearing loss: sound waves cannot reach inner ear, which can be caused by ear wax build-up, fluid, or punctured eardrum ● Mixed hearing loss: combination of both ● Find a very quiet place with good lighting and very little background noise for lunch (tb) ○ Suicide ■ Suicide is a serious concern; let’s talk to his doctor about what you’ve noticed.” (tb) ○ Common dental problems ■ Dry mouth ■ Receding gums ■ Tooth cavities ■ Hypersensitivity of teeth ■ Tooth discoloration ○ Incontinence affects quality of life and is a symptom of underlying problems. 50% of women and 25% of men aged 65 years and older who are non-institutionalized suffer from incontinence. Longer lasting incontinence may be caused by: 10 ■ ■ ■ ■ ■ ■ ■ ■ Weak bladder muscles Overactive bladder muscles Blockage from enlarged prostate Damage to nerves that control the bladder UTIs, vaginal infection and irritation Constipation Medications Most cases of urinary incontinence can be treated or controlled but not cured ■ Kegel exercises (tb) ○ Falls ■ Falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths ■ 2.8 million older adults each year are treated in emergency departments due to falls. 800,000 patients per year are hospitalized due to fall injury. ■ Aging, chronic illness, and medications increase risk ■ Broken hips ■ TBIs -- blurred vision and headache (tb) ○ Residential Fire-Related Injuries ■ In 2014, 38% of all fire death and 14% of fire injuries involved older adults ■ Twice as likely to die in a home fire -- have smoke detectors installed in the house (tb) ■ Older adults and people with limited physical and cognitive abilities are at higher risk of death from fire attributed to reduced: ● Smell ● Touch ● Vision and hearing ● Diminished mental faculties ● Slower reaction time ● Increased disabilities ● Economic and social concerns ○ Cold stress disorders ■ Factors that contribute to hypothermia are age, health, nutrition, exhaustion, exposure and duration of exposure, wind, temperature, wetness, medications that decrease heat production, increase heat loss, or interfere with thermostability. ■ Signs and symptoms of hypothermia: ● Confusion, sleepiness, slowed slurred speech, weak pulse, a lot of shivering, and poor control over body movement. ■ Apply warm moist towels to his head, neck, chest, and groin (tb) 11 ● reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation (rationale) ○ Heat stress disorders ■ All methods of heat elimination are less effective in older adults who may have thermoregulation, diminished sweating, and decreased thirst sensation. ■ Heat stroke is life threatening. ■ Signs and symptoms of heat exhaustion are; fatigue, nausea, headache, giddiness. ● Skin clammy and moist and the complexion may be pale or flushed. ● Individual may faint on standing, with rapid, thread pulse, and low blood pressure. ■ Signs and symptoms of heatstroke include hot dry skin that is usually red, mottled, or cyanotic; confusion, loss of consciousness, or possible convulsions. ■ Take your family member to the air conditioned restaurant and let your family rest for a while (tb) ○ Violence: ■ Physical abuse ■ Psychological-emotional abuse ■ Sexual abuse ■ Neglect ■ Financial exploitation ■ Health care fraud and abuse ■ Tends to escalate in incidence and severity ○ Depression ■ symptoms: changes in appetite or weight, changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt, and repeated thoughts of death or suicide. ● Legal issues ○ Abuse ○ End of life ■ Advanced directives ■ Living wills To help family members know what their loved one does or does not want if he or she becomes incapacitated (tb) ■ Durable power of attorney ■ DNRs ● Resources ○ Medicare 12 ○ ○ ○ ○ ○ ○ Medicaid SSI Food Stamps Housing and Residential Services & Alternative Housing Options Adult day care services : if the caregiver works all day (tb) Respite care Disabilities (CHAPTER 21) ● Characteristics: Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 define having a disability by how it limits carrying out a major life activity such as the ability to breathe, walk, see, hear, speak, work, care for oneself, perform tasks, or learn. ● Issues: ○ Disability is a label that signifies social marginalization. ■ Two key points: ● It is possible for a person to be disabled without recognizing himself as such.*** ● It is possible for one to be disabled without being recognized as such by others. ○ Historic Context ■ Mascots, Freaks ■ Isolated, ridiculed ■ Institutionalization ■ Discriminated against ● Extermination ○ Historical attitudes ■ Viewed as different, unusual ■ Unclean, sinful 13 ■ Sideshow exhibitions ■ Sick, helpless ■ Feeble minded ● Special Ed (1800s) ● Legal issues: PWD (people with disabilities) and their families are concerned about the same contemporary ethical and legal issues that concern all people. ○ Areas of special interest: questions and problems surrounding definitions of respect for human beings, beneficence (do good), and nonmaleficence (do no harm), as well as the rights of PWD. ○ The Patient Self-Determination Act (PSDA) of 1990: mandated that health decisions are communicated and protected and that patients, upon admission to a healthcare facility, are asked if they have a durable power of attorney or an advance directive. Families, guardians, or individuals are reluctant to address endof-life decisions when health is good, so when conditions decline, bioethical principles must be balanced and applied, sometimes by a team or committee. ● Resources: ○ Individuals with Disabilities Act (IDEA) ■ Free, appropriate public education for children with disabilities ● Least restrictive environment ■ Development of individualized education plan (IEP) ● Most important need of every school-aged child with disability ■ Interdisciplinary team ● Nurse ○ Individual Health Plan (IHP) ○ Americans with Disabilities Act (ADA) 1190, 2008 ■ Landmark civil rights-styled legislation, Prohibits discrimination against people with disabilities. ■ Equal opportunities for people with disabilities in relation to: Employment, transportation, public accommodations, public services, and telecommunications ■ ADA qualifications ● Physical or mental impairment the substantially limits 1 or more major life activities or bodily functions ○ Documented impairment ○ Work ■ Meet the qualifications of the job ■ Perform the skills with r without reasonable accommodations ○ Public Assistance Programs ■ Cash assistance ■ Food stamps 14 ■ Subsidized housing ■ Social Security: ● Supplemental Security Income (SSI) ● Social Security Disability Insurance (SSDI) ● Social Security Administration definition of disability—unable to work because of a medical impairment lasting at least 12 months or that is expected to result in death ○ Summary: ■ Dont let the disability define the person -- they can still work and & be apart of the community ■ As the nurse first initial thing to do it greet them and ask what they came in for and talk at eye level ■ It is against the law to reject someone from a job due to a disability -american disabilities act (ADA) 1990-- prohibits discrimination toward people with disabilities in everyday activities Homeless (CHAPTER 23) Definition: 4 categories 1. Literally homeless: Lack fixed, regular, & adequate nighttime residence.living in a place not typically used for sleeping 2. Imminent Risk of Homeless--family losing their nighttime residence within the week(tb) At risk of losing nighttime residence 3. Homeless Under Other Federal Statutes Unaccompanied youth and families with children who do not meet qualifications 4. Fleeing/Attempting to Flee Domestic Violence (DV) ● Characteristics: ○ Adults (males 57%(males make up the largest group of homeless adults(tb), unmarried made up 93%, 6% were employed, 84% were below the poverty level). ○ Women - homeless women have higher rates of pregnancy, 38% (of these 55% were accompanied by a minor child, history of substance abuse, criminal activity, serious mental health concerns, marital dissolution, escape from domestic violence, limited employment/job loss, housing accidents, poor physical health that prevented gainful employment. ○ Veterans ○ Fastest growing single parent family (usually women with children) ○ Studies show these children have asthma, iron deficiency, mental health problems, developmental delays (tb), obesity ○ Risk for alcohol and drug use, depression, risky sexual behavior and victimization ○ Youth (includes those unaccompanied, runaway and homeless) 15 ○ Chronically homeless (adults with more disabling conditions) ○ lower socioeconomic status, lack fixed, regular, and adequate nighttime residence, unaccompanied youth and families, fleeing or attempting to flee domestic violence, a lot of them have some sort of physical, mental or substance use condition that has not been treated, single parents with children, high morbidity rate ○ Substance abuse is a risk factor/underlying factor to homelessness (Tb) ● Issues: ○ Government/ Legal: Obtaining accurate data to count the homeless population and how many are in each subpopulation, Shortage of affordable housing, Income Insufficiency, Inadequacy and Scarcity of Supportive Services ○ Financial: inability to get a job, not a clear background to get a job, no insurance to receive proper care, shortage of affordable houses, income insufficient to meet basic needs, inadequate and scarce support services ■ They dont have a home address so they cant put it on their job application ○ Societal - are often stereotyped (alcoholics, drug abusers), viewed as dangerous (such as those released from prison), ○ Psychological- co-occuring psychiatric, SUD (substance use disorder) and chronic mental disorders, anxiety, fear, depression, suicidal behavior ○ Physiological- (Functioning) Communication, memory, perception, sight, hearing, physical conditions. Asthma, hypertension, alcoholism (tb) ○ Most frequent problems suffered by the chronically homeless -- Severe mental illness and substance abuse disorders (tb) ● Resources: ○ 1) Housing and Urban Development (HUD): provides housing support and uplifts communities ○ 2) Education (ED): US Department of Education - provides education and resources for homeless children and youth ○ 3) Health and Human Resources (HHS): enhances the health and well-being of individuals, helps with food, health care, safety and disaster services ○ 4) Veterans Affairs (VA): provides health care and benefit programs for veterans such as PTSD, depression and substance abuse issues, can also assist with housing ○ 5) Homeland Security (DHS): ensures a safe, secure home ○ 6) Justice (DOJ): enforce the law and defend the interests ○ 7) Labor (DOL): Improves working conditions, advances opportunities, protect retirement and healthcare benefits, helps find workers ■ Nursing Interventions: (Focused on providing resources and education) ● Provide emotional support ● Use of screening tests ● Referral to case workers ● Health teaching 16 ● Providing coronavirus resources ● Provide resources for food (Food Pantry), resources for clothing, hygiene, shelters Rural and Migrant (CHAPTER 24) ● Characteristics ○ Population size: rural towns < 2500 or in open country (farm/nonfarm) ○ Density ■ Rural: fewer than 45 persons per square mile ■ Frontier: less than 6 people per square mile ○ Migrant—those who migrate to find work ■ Farmworkers in United States ■ Enter country through Mexico and migrate north ■ Have the poorest health and the least affordable health care ○ Seasonal—reside permanently in one place and work locally when farm labor is needed ■ Work various jobs ● Agriculture in summer ● Restaurants in winter ● Issues ○ Rural areas have very low population density (too low to support a large hospital) = few hospitals (tb) ■ Few hospitals ○ At risk to die from unintentional injuries, MVC (Tb) ○ Number one priority is to have access to health care!! (tb) ○ Prevalent is obesity and sedentary lifestyle (tb) ○ Perceptions of Health ■ Less likely to report good health ■ Higher prevalence of chronic disease ■ Rural men and youths ● More likely to die or become disabled from unintentional injuries ● More likely to commit suicide ■ African Americans and elderly ● Less cancer screenings, more late-stage diagnoses ■ Hispanics ● Most likely to report barriers ● Least likely to have a usual source of care ○ Access to Care ■ 10% of U.S. physicians practice in rural areas. ● HRSA grants ■ Ratio of physicians in the rural population is 36:100,000 (half as many as in urban settings). ■ Rural residents 17 ● Assesses their health as fair or poor ● Have more disability days resulting from acute conditions ● Present with more negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates ● Suffer a higher number of unintentional injuries ○ Health disparities (migrant/seasonal workers) ■ Poorest health and the least access ■ Low income and migratory status ■ Cultural, linguistic, economic, and mobility barriers ■ Minimal or no preventive care ○ Agricultural workers/health disparities ■ Migrant and seasonal farmworkers have the poorest health of any aggregate in United States ■ Mining, forestry, and fishing (most dangerous employment opportunities (tb) ○ Accidents and injuries ■ Highly variable environment associated with increase frequency of accidents and fatalities ■ Firearm injuries in home (tb) ■ Farm fatalities and nonfatal injuries (tractors) (tb) ○ Acute and chronic illnesses ■ Farming activities associated with chronic respiratory conditions -- due pesticide poisoning ○ Limited Access to care ■ EMS ● Golden hour: Getting patients from the place of injury to the trauma center within the “golden hour” is frequently not possible because of distance, terrain, climatic conditions, and communication methods. ■ Community Health ● Lack of access to: ○ Vision ○ Screening and treatment ○ Gynecological and breast examinations ■ Mental health ● Legal issues ● Resources ○ Nurse can provide education about occupational hazards ■ Poison from pesticide causing respiratory problems for farm workers -- should use self protective measure such as respirators (tb) ■ Spray water on fields after chemical application 18 ○ CHC program -- community health centers ○ Migrant health programs -- migrant health centers (MHCs) ■ Staff are typically bilingual and bicultural ● Summary ○ Dont have access to health care -- priority for hcp to find resources to find them healthcare ○ Have bad injuries and can die from them due to lack of healthcare access ○ Usually dont have insurance Mental Health (CHAPTER 25) ● Characteristics ○ Public view: lazy, weak, immoral (tb) ● Issues ○ Depression -- most frequently diagnosed among adults in the US (tb) ○ Suicide -- twice as high for soldiers who just came back from war (Tb) ○ PTSD -- soldiers ○ Ocd: if the compulsion is resisted, anxiety increases ○ Bulimia nervosa -- 15 yo cheerleader who wants to be a ballerina ○ Anorexia nervosa -- “good girl” obedient to her parents, always agrees, perfectionist ○ Bipolar disorder -- changes in mood from depression to mania (tb) ○ ADHD -- young children/adolescents (tb) ○ Insurance may not cover mental health costs ○ Many people with mental health issues do not seek treatment ● Legal issues ○ Informed consent: if they are competent or not ○ Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 -- That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness ○ Confidentiality ■ If the person plans to harm themselves or others you have to tell the provider ● Resources ○ Support groups ○ Psychologists ○ Psychiatrists 19 ○ Cognitive behavioral therapy -- can change distorted thought patterns ○ Medication helps the symptoms and does not cure the disorder Violence & Abuse (CHAPTER 28) ● Characteristics ○ Violence is a national public health problem. ○ WHO (2013) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.” ○ Injuries from violence are referred to as intentional injuries. ○ Three factors influencing violence in today’s society ■ 1.Firearms ■ 2.Impact of media ■ 3.Mental illness ● Issues ○ Intimate partner violence (IPV)/domestic abuse: violence that occurs between two people in a close relationship ■ Spouses ■ Former spouses ■ Dating partners ● Dating violence—abusive, controlling, or aggressive behavior in an intimate relationship that can take the form of emotional, verbal, physical, or sexual abuse ● Date rape drugs—GHB, Flunitrazepam, Rohypnol, ketamine, Xanax, Klonopin, alcohol ■ Physical: bruising, welts, internal bleeding, disabilities, head trauma, death ■ Sexual ■ Psychological: depression, chronic pain, sleep difficulties ■ Stalking:a pattern of repeated and unwanted attention, contact, harassment, or any type of conduct directed at a person that instills fear ■ Repetitive ○ Bullying: “Unwanted aggressive behavior by another youth or group of youths who are not siblings or current dating partners that involve an observed or perceived power imbalance” ■ 20% bullied on school property ■ 16% bullied electronically ■ Typically repeated ■ Physical threats, hitting, tripping, verbal teasing, and spreading rumors ■ School culture must promote a safe and supportive learning environment. ○ Child abuse ■ Risk factors ● Disabled, < 4 years old 20 ● Family member has mental illness, SUD--substance use disorder, or history of violence ■ Maltreatment by: parents, family members, caregivers, clergy, coaches, teachers ■ Neglect—failure of the responsible person to provide basic needs ■ Physical abuse—intentional physical injury by caregiver ● Abusive head trauma/shaken baby syndrome ■ Emotional abuse—pattern of behavior that negatively affects the child’s self-worth and/or emotional development ■ Sexual abuse—fondling of genitals, incest, rape, sodomy, exploitation through prostitution, or production of pornographic material ○ Elder abuse ■ Physical abuse ■ Psychological-emotional abuse ■ Sexual abuse ■ Neglect ■ Financial exploitation ■ Health care fraud and abuse ■ Tends to escalate in incidence and severity ○ Community violence ■ Workplace violence ■ Youth related: concentrated in minority communities ■ Gangs ■ Prison violence: murder, manslaughter, forcible rape, theft, & aggravated assault ■ Human trafficking: modern day form of slavery involving the illegal trade of people for exploitation ■ Hate crimes: motivated by race, sexual orientation, religious beliefs, ethnic background, or national origin ● Crime is personal, attacking the victim’s identity ■ Terrorism: the unlawful use of violence or threat of violence to instill fear and coerce govt or society ● Fear, intimidation, and violence ● Legal issues ● Resources ○ Network volunteers: first responders for emergency