Term
| Describe twenty-first century nursing concerns regarding improved health. |
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Definition
| There are new concerns about access to care, the ability to maintain affordable insurance coverage, quality of services, new warnings about possible increases in costs, bioterrorism, and global health threats such as infectious diseases and contaminated foods. |
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Term
| Explain how bioterrorism threats and the events of September 11th impact the health care system. |
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Definition
| The threats of bioterrorism highlighted by the events of September 11, 2001, and the anthrax scares, will divert health care funds and resources from other health care programs to be spent for public safety. |
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Term
| What impact have population based programs implemented in the 1970s had? |
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Definition
| Population-based preventive programs launched in the 1970s are largely responsible for the more recent changes in tobacco use, blood pressure control, dietary patterns (except obesity), automobile safety restraint ,and injury control measures that have fostered declines in adult death rates. |
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Term
| What are the essential services of public health? |
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Definition
- Assessment
1) Monitor health status to identify community health problems
2) Diagnose and investigate health problems and health hazards in the community
- Policy Development
3) Inform, educate, and empower people about health issues
4) Mobilize community partnerships to identify and solve health problems
5) Develop policies and plans that support individual and community health efforts
- Assurance
6) Enforce laws and regulations that protect health and ensure safety
7) Link people to needed personal health services and assure the provisions of health care when otherwise unavailable
8) Ensure a competent public health and personal health care workforce
9) Evaluate effectiveness, accessibility, and quality of personal and population-based health services |
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Term
| How does the Institute of Medicine describe the mission of public health? |
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Definition
| The committee stated that the mission of public health was “to generate organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health.” |
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Term
| How does the Institute of Medicine describe the mission of public health? |
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Definition
| The committee stated that the mission of public health was “to generate organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health.” |
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Term
| Identify and describe the core public health functions. |
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Definition
- Assessment: refers to systemically collecting data on the population, monitoring the population’s health status, and making information available about the health of the community.
- Policy Development: refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.
- Assurance: refers to the role of public health in ensuring that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them. Assurance also refers to making sure that a competent public health and personal health care workforce is available. |
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Term
| Identify indicators (i.e. socio-demographic characteristics, health status, functional status) used to develop a community health profile (Box 1-1). |
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Definition
- Socio-demographic characteristics: distribution of the population by age and race/ethnicity, number and proportions of persons in groups such as migrants, homeless, or the non-English speaking, for whom access to community services and resources may be a concern, etc.
- Health status: infant death rate by race/ethnicity, reported incidence of AIDS, measles, tb, and primary and secondary syphilis, by age, race, and sex as appropriate, etc.
- Health risk factors: proportion of the population aged 18 and older who are obese, etc.
- Health care resource consumption: per capita health care spending for Medicare beneficiaries
- Functional status: proportion of adults reporting that their general health is good to excellent, average number of days for which adults report that their physical or mental health was not good
- Quality of life: proportion of adults satisfied with the health care system in the community and proportion of persons satisfied with the quality of life in the community |
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Term
| Identify the core competencies of public health practitioners as outlined by the Council on Linkages (Box 1-2). |
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Definition
| These include: analytic/assessment, policy development/program planning, communication, cultural competency, community dimensions of practice, basic public health services, financial planning and management, and leadership and systems thinking. |
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Term
| Why is public health nursing a specialty? |
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Definition
| It is a specialty because it has a distinct focus and scope of practice, and it requires a special knowledge base. The following characteristics distinguish public health nursing as specialty: it is population-based, it is community-oriented, there is a health and preventive focus, interventions are made at the community or population level, and there is concern for the health of all members of the population/community, particularly vulnerable subpopulations. |
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Term
| What are the basic educational requirements of public health nurses? |
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Definition
| At the basic or entry level, a public health nurse is one who “holds a baccalaureate degree in nursing that includes this educational preparation; this nurse may or may not practice in an official health agency but has the initial qualifications to do so.” Specialists in public health nursing are defined as those who are prepared at the graduate level, with either a master’s or doctoral degree, “with a focus in the public health sciences.” |
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Term
| Identify examples of work that graduate prepared public health nurses should be able to do. |
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Definition
| Public health nursing specialists “should be able to work with population groups and to assess and intervene successful at the aggregate level.” Areas considered essential for preparation of specialists in public health nursing include: epidemiology, biostatistics, nursing theory, management theory, change theory, economics, politics, public health administration, community assessment, program planning and evaluation, interventions at the aggregate level, research, history of public health, issues in public health. |
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Term
| Identify examples of work that graduate prepared public health nurses should be able to do. |
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Definition
| Public health nursing specialists “should be able to work with population groups and to assess and intervene successful at the aggregate level.” Areas considered essential for preparation of specialists in public health nursing include: epidemiology, biostatistics, nursing theory, management theory, change theory, economics, politics, public health administration, community assessment, program planning and evaluation, interventions at the aggregate level, research, history of public health, issues in public health. |
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Term
| Identify examples of work that graduate prepared public health nurses should be able to do. |
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Definition
| Public health nursing specialists “should be able to work with population groups and to assess and intervene successful at the aggregate level.” Areas considered essential for preparation of specialists in public health nursing include: epidemiology, biostatistics, nursing theory, management theory, change theory, economics, politics, public health administration, community assessment, program planning and evaluation, interventions at the aggregate level, research, history of public health, issues in public health. |
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Term
| Describe an aggregate or population. |
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Definition
| An aggregate or population is a collection of individuals who have one or more personal or environmental characteristics in common |
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Term
| Differentiate between primary, secondary and tertiary prevention. |
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Definition
- Primary prevention: The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking.
- Secondary prevention: The public health nurse provides an influenza vaccination program in a community retirement village.
- Tertiary prevention: The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community. |
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Term
| Review the Eight Principles of Public Health Nursing (Box 1-5). |
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Definition
1) The client or “unit of care” is the population.
2) The primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole.
3) The processes used by public health nurses include working with the client(s) as an equal partner.
4) Primary prevention is the priority in selecting appropriate activities.
5) Selecting strategies that create healthy environmental, social, and economic conditions in which populations may thrive is the focus.
6) There is an obligation to actively reach out to all who might benefit from a specific activity or service.
7) Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice.
8) Collaboration with a variety of other professions, organizations, and entities is the most effective way to promote and protect the health of the people. |
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Term
| Describe the difference between public health nursing and community health nursing. |
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Definition
- The focus of public health nursing practice is the community as a whole and the effect of the community’s health status on the health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole.
- The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole. |
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Term
| Given the future direction of health care, why is population focused care important? |
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Definition
| Because the primary focus of the health care system of the future will be on community-oriented strategies for health promotion and disease prevention, and on community-based strategies for primary and secondary care. |
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Term
| What is the significance of quality performance standards in public health? |
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Definition
| It is used to target public health improvements needed in a community so the most efficient and effective use of new resources can be applied to interventions that work. |
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Term
| Describe source of the IOM’s findings regarding the number of preventable deaths. |
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Definition
| The healthcare system is expensive, and access and quality are not optimal. IOM found that between 44K-98K people die each year from preventable medical errors. (pg. 47) Possible sources of error include diagnostic, treatment, prevention, failure of communication, equipment failures, and other system failures. In regards to the nurse’s role, IOM found that nurses long work hours pose one of the most serious threats to patient safety. Fatigue slows reaction time, saps energy, and diminishes attention to detail. A law was passed that prevented nurses from working >12 hrs/day, >60 hrs/wk. (pg. 50) |
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Term
| In what areas do the majority of medical errors occur? |
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Definition
| Most errors occur in intensive care units, operating rooms, and emergency departments. (pg. 50) |
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Term
| Define and describe “disparities”. |
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Definition
| Disparities are defined as racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention. (pg. 48) Disparities are the gaps or inequalities that exist between two or more groups that are the result of the complex interaction of personal, societal, and environmental factors (not always race or ethnic background). Immigrants, rural residents, women/children/elderly, and people with disabilities are examples of groups that are at risk for health disparities. (Finkelman, pg. 226 and www.nih.gov) |
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Term
| Review Box 3-2 that described facts about the Medicare Prescription Drug Improvement and Modernization Act. |
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Definition
| The bill was passed in 2003, but went into effect Jan.1st, 2006; had to be enrolled to receive benefit, the costs varied and included premiums, co-pay, and deductible; once the individual spent $3600/yr, Medicare covered 95% of the rest of the costs. (pg. 48) |
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Term
| Describe the origins of the significant increase in uninsured individuals in 2003. |
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Definition
| The U.S. Census Bureau attributed this increase in uninsured individuals to the drop in coverage from employment-based health plans, due to the increased costs of insurance premiums. (pg. 49) |
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Term
| Explain the significance and purpose of tele-health. |
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Definition
| Tele-health allows the HCP or nurse to assess a patient from the comfort of the patient’s home, via a monitor and telephone line, like Skype. This increases access to health care for patient’s who live further away from health care facilities. The telehealth device is installed in the patient’s home and provides a high resolution image of the patient, for a more accurate visual assessment. This technology allows for better management of patients with chronic conditions, home care, rehab, and long term care. (pg. 52) |
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Term
| Describe the benefits of an electronic health record. |
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Definition
| Information is digital, privacy-protected, and interchangeable, which improves client safety. Benefits that the electronic medical record, or EMR, provides for public health nursing include 24 hour availability of records with lab results and up-to-date assessments, facilitation of interdisciplinary care, coordination of referrals, incorporation of protocol reminders for prevention, screening, and management of chronic disease, production of client reminders to improve compliance, and improved security when compared to paper records. (pg. 52) |
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Term
| • Explain what is meant by the term globalization. |
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Definition
| Globalization is defined as a trend toward an increased flow of goods, services, money, and disease across national borders. (pg. 48) It is the process of change and development across national boundaries and oceans, involving economics, trade, politics, technology, and social welfare. With immigration, trade, and air travel, no place on earth is completely safe from infectious disease. (pg. 53) |
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Term
| Describe the purpose and function of the World Health Organization. |
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Definition
| The WHO manages public health emergencies of international concern by coordinating surveillance and respond at the global level. WHO prevents, protects against, controls, and provides a public health response to the international spread of disease. (pg. 53) |
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Term
| Describe the purpose and functions of “community health centers” |
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Definition
| Community health centers are the backbone of the public system for primary care; they are public, non-profit and receive funding from federal sources. They must be located in or serve a medically underserved area/population, provide comprehensive primary care services and supportive services, such as translation and transportation, and their services must be available to all residents of their service area (fees are adjusted based on the client’s ability to pay). (pg. 53) |
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Term
| Identify the main goals of Healthy People 2020. |
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Definition
| There is a new focus on identifying, tracking, measuring, and reducing health disparities and increasing the years and quality of healthy life in HP 2020. In addition to the goals of 2010, 2020 has added new topics like adolescent health, blood disorders and blood safety, dementias, including Alzheimer’s disease, early and middle childhood, genomics, global health, healthcare-associated infections, health-related quality of life and well-being, lesbian, gay, bisexual, and transgender health, older adults, preparedness, sleep health, and social determinants of health. The overarching goals are to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages. (www.healthypeople.gov/2020) |
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Term
| Explain the difference between primary care and public (primary?) health care |
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Definition
| Primary care is part of the private health care system, and is described as the care provided to an individual by a HCP trained in family medicine, pediatrics, or internal medicine. Public health care is defined by a broad range of services, such as basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education. Programs are designed to be affordable for both the recipients and the funding source. Public health care emphasizes preventative care at the community level, and is accessible and acceptable to the community. Community health centers are the “backbone” of public health care, and are public, nonprofit, and receive federal funding. (pg. 53 and Tbl. 3-3) |
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Term
| Describe the purpose and function of the U.S. Department of Health and Human Services. |
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Definition
| The main purpose of the USDHHS is to regulate healthcare and oversee the health status of Americans. There are many familiar agencies that fall under the USDHHS umbrella, such as FDA, CDC, NIH, and Health Resources and Services Administration. (pgs. 58-59) |
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Term
| Explain the purpose and function of the Department of Homeland Security. |
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Definition
| The main purpose and function of the DHS is to prevent and deter terrorist attacks, and protect against and respond to threats and hazards to the nation. DHS’s goals include awareness, prevention, protection, response, and recovery. Nurses may be called upon by DHS to respond to acts of terrorism or natural disasters. (pg. 60) |
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Term
| Describe medical errors and untoward events that were outline in the 1999 IOM report. |
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Definition
| These errors included adverse drug events and improper transfusions, surgical injuries and wrong site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken client identities. (pg. 50) |
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Term
| Describe public health economics- |
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Definition
| focuses on the producing, distributing, and consuming of goods and services as related to public health. There has not been a lot of focus on this side of economics so there is a lot of conflict about money distribution when it comes to public health care. |
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Term
| Describe the “four phases” of the health care system- |
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Definition
1st phase (1800-1900): epidemics of infectious diseases (cholera, typhoid, smallpox, influenza, malaria, yellow fever), social and public health issues (contaminated food and water, inadequate sewage, poor housing), family and friends provided health care, few hospital a lot of sick, paid for through bartering or those who could afford services, first county health department, nurses to support physicians and assist with ADLs.
2nd phase (1900-1945): focused on control of acute infectious diseases, environmental conditions began to improve, rapid growth of hospitals and health departments, governments start to provide finances, Social Security Act, advances in surgery and childbirth, able to diagnose and control infectious disease (quarantine), insulin, sulfa drugs, antibiotics, school s of nursing, physicians attended college, focus on client education
3rd phase (1945-1984): focus on chronic health problems (heart disease, cancer, stroke), started hospital clinics and long term care, Joint Commission, technological advances, immunizations, health care employees increased by 90%, nursing shortage, increased special training, diploma schools of nursing, graduate and doctoral nursing, Medicare and Medicaid
4th phase (1984-present): limited resources, focus on containing costs, restricting growth, reorganizing health care delivery, hospital closings, focus on community based clinics, widespread use of computers to manage health and increase knowledge, dependent on technology to care for clients, emphasis on primary care, increase in specialization |
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Term
| Describe types of managed care arrangements-HMO: |
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Definition
| per member per month fee using designated providers PPO: predetermined rates for services with financial incentives to select providers |
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Term
| Describe what is meant by the term health economics- |
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Definition
| concerned with how scarce resources affect the health care industry |
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Term
| Differentiate between Medicare Part A and Medicare Part B- |
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Definition
Medicare A- financed by federal payroll tax, available to all persons eligible for Medicare, deductible for first 60 days, reduced deductible after that
Medicare B- supplemental program for a monthly premium, provides coverage for services not provided for with A, up to 80% covered, like private insurance |
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Term
| Describe how health policy impacts nursing – |
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Definition
| ‘Health policy’ refers to a set course of action that should be followed by a government or institution to reach a health-related goal. Health policy can be set by governments, agencies, or other organizations. Health policy impacts nursing because it determines how health programs are financed, how resources are allocated and used, and who can implement programs. This has direct effects on nursing by creating (or reducing) nursing jobs, determining nursing goals for individuals and communities (such as immunizations, or well-child visits), and guiding nursing research. |
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Term
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Definition
| “Devolution” is when the responsibility for planning, financing, and delivering government programs is shifted from the federal government to state governments. An example of this was in the 1980s when the Regan administration shifted many federal programs for health care to the states. |
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Term
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Definition
| “Block grants” are one way the federal government gives money to local areas so they can implement programs; block grants are often given with a broad focus, so local agencies can have more control over the details of how they spend the funds (for example, a block grant for ‘energy and home heating’ can be used to fund the heating of a homeless shelter). |
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Term
| Compare and contrast the roles of federal, state and local health agencies -- |
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Definition
| All three types of health agencies provide direct heath care services to certain populations (federal to military personnel and families for example, states for inmates in state prisons for example); all 3 pay for some health services and training of health care providers (state and federal fund through Medicare, Medicaid, Social Security, SCHIP, etc); all 3 collect and analyze health care data; all 3 set health policy. The federal government is responsible for protecting the public’s health (FDA, EPA, and others). The quality of state and local health agencies varies widely depending on the commitment to public health of their government bodies and the access to funding these agencies have. Most health services provided by local agencies are provided by nurses. |
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Term
| • Review section on functions of public health nurses. Be able to identify public health nursing roles and functions – |
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Definition
| Public health nursing is population-focused, community-oriented, focuses on health and prevention, intervenes at the community of population level, and is concerned with the health of all members of the population (especially vulnerable members). Public health nursing uses ASSESSEMENT, POLICY DEVELOPMENT, and ASSURANCE. |
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Term
| 8 principles of public health nursing (p.11) |
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Definition
1. the client is the population
2. primary obligation is greatest good for greatest number of people
3. works with client as an equal partner
4. primary prevention is a priority
5. focus is on creating healthy environmental, social, and economic conditions
6. obligation to actively reach out to those who could benefit
7. optimal use of available resources
8. collaboration with other professionals
Possible roles: director of nursing for a health department, state commissioner of health, director of maternal and child health services for a state or local health department |
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Term
| Identify and describe the three levels of practice that the Intervention Wheel encompasses |
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Definition
1: individuals/families: this can mean individuals independently or in groups, and describes public health nursing that directly impacts families and specific people or groups of people (think direct care) EX: provide & monitor immunization status of individuals who need them.
2: communities as a whole: This encompasses programs that are designed to impact the entire community (ie community health programs like putting fluoride in city water).
3: systems that impact health communities: Think public health/nursing policies, healthcare reform, etc. |
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Term
| Describe how the Intervention Wheel has been implemented since it was published in 1998 |
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Definition
| The Wheel was highlighted in a Minnesota public health conference series, and has been viewed by thousands of public health nurses here and worldwide. Various departments of health in the US have used the Wheel to “reinvigorate” public health nursing practice and to orient new staff (including non nursing staff like social workers and physicians) to population based practice. It has been adapted for use with Indian populations. Nursing schools use the Wheel as a framework for teaching community health nursing classes. |
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Term
| Describe the origins of the Intervention Wheel |
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Definition
| The wheel came out of the work of public health nurses in Minnesota in the 1990s. During this time, the contributions of public health nurses to the improvement of public health was under debate. In response to this debate, a group of nurses presented a series of workshops highlighting the functions of public health nursing. At these workshops, participants (public health nurses) described specific actions they took to complete their work. These actions were compiled, analyzed, and pared down to 17 actions (read: interventions) common to all public health nurses. These 17 interventions were reviewed by graduate nursing students and “expert” panels, and supporting evidence in literature was identified for each intervention. From this, a final list of interventions was generated, each with a set of steps for applying it and recommendations for best practice. |
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Term
| Describe the 10 assumptions that underlie the Intervention Wheel. |
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Definition
Assumption 1: Defining public health nursing practice: Practice that promotes and protects the health of populations using knowledge from nursing, social, and public health science.
Assumption 2: Public health nursing practice focuses on populations (differentiates PHN from other forms of nursing: Categories of populations are populations at risk (people with a common risk factor, like hypertensive adults) and population of interest (people who are healthy but could benefit from more health teaching, like teenagers. Or everyone.)
Assumption 3: Public health nursing considers the determinants of health:Determinants of health are factors that influence health status throughout all of life, like biology (genetics) and environment. Related factors include income, social status, education, literacy, employment, health services, coping skills, etc.
Assumption 4: Public health nurses assess community health, develop priorities based on assessments, and these priorities are the focus of nursing practice: collecting data about the communities in which they work in order to identify and prioritize community needs
Assumption 5: Public Health nursing practice emphasizes prevention
focus on prevention, specifically primary prevention whenever possible.
Assumption 6: Public health nurses intervene at all levels of practice:Community level interventions involve entire populations within the community, populations at risk, or populations of interest. Systems level involves changing organizations, policies, laws, and power structures in the community. Individual level is addressing the knowledge, attitudes, beliefs, practices, and behaviors of individuals/families either alone or in groups.
Assumption 7: Public health nursing practice uses the nursing process at all levels of practice
public health nurses customize the nursing process to fit each level of practice (system/community/individual). On the systems level, the nurse may assess the impact of various policies/laws on a health problem while on the individual level she/he assesses the coping skills/ health risks of a person/family.
Assumption 8: All public health nurses use a common set of interventions
No matter what level nurses practice at, they use the 17 common interventions encompassed in the Wheel.
Assumption 9: Implementing public health interventions helps to achieve the 10 essential public health services
The 10 essential public health services (from Chapter 1, pg 5-6) describe what the public health system does to protect/promote public health, and interventions are the means to complete these essential services. Interventions are the how of public health practice.
Assumption 10: Public health nursing is grounded in values and beliefs!
Cornerstones include: population based/focused, grounded in social justice, focus on greater good, focus on health promotion/disease prevention, organize community resources, driven by science of epidemiology, do what others cannot/will not. |
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Term
Nursing wheel intervention
Surveillance: |
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Definition
| Nurses use ongoing data collection and population analysis to plan, implement, and evaluate public health policies and interventions. They test the population to make sure programs and policies are having the intended effect. |
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Term
Nursing wheel intervention
Disease and other health event investigation: |
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Definition
| Nurses identify threats to public health (ie, potential communicable disease), gather data, find the source of the threat, ID populations at risk, and find ways to control the disease/problem. |
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Term
Nursing wheel intervention
Outreach: |
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Definition
| Nurses find at risk populations/populations of interest and bring needed health information to them. (ie teaching teens about safe sex) |
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Term
Nursing wheel intervention
Screening: |
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Definition
| Help people check for emerging health problems/risk for health problems that has gone unnoticed. |
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Term
Nursing wheel intervention
Case finding: |
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Definition
| ID at risk families and connect them with needed resources. |
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Term
Nursing wheel intervention
Referral and follow up: |
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Definition
| Help individuals/families/communities/organizations locate and make use of the resources they need to solve problems. (Problem could be community wide, like homelessness, or individual, like needing a counselor for mental health problems). |
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Term
Nursing wheel intervention
Case management: |
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Definition
| Work with individuals/families/communities to enhance their ability either for self care or for care of their family/community members. |
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Term
Nursing wheel intervention
Delegated functions: |
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Definition
| Any direct care tasks entrusted to the nurse under the authority of a health care practitioner, or any direct care tasks the nurse delegates to other team members. |
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Term
Nursing wheel intervention
Health teaching: |
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Definition
| Share knowledge/ideas/skills to help change attitudes/values/beliefs/behaviors of individuals/communities/systems. (Teach people things.) |
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Term
Nursing wheel intervention
Counseling: |
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Definition
| Establish an interpersonal relationship that engages the person/community/system at an emotional level and enhances self care and coping abilities. (Apparently, yes, you can counsel a system) |
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Term
Nursing wheel intervention
Collaboration: |
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Definition
| Help people/organizations work with others to meet mutual public health goals. |
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Term
Nursing wheel intervention
Coalition building: |
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Definition
| Promote alliances between organizations/individuals. Goals of alliances are to solve problems and enhance local leadership, all in an effort to address health concerns. Build coalitions that can be public health leaders. |
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Term
Nursing wheel intervention
Community organizing: |
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Definition
| Support community groups in their ability to ID problems/goals and develop resources/strategies to address them. |
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Term
Nursing wheel intervention
Advocacy: |
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Definition
| Act on someone’s behalf/plead their cause, help them to speak up for themselves. |
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Term
Nursing wheel intervention
Social marketing: |
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Definition
| Use commercial marketing and technologies to promote community health programs and health policies. Often used to impact the attitudes/behaviors of populations of interest. |
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Term
Nursing wheel intervention
Policy development and enforcement: |
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Definition
| Push health issues in gov’t and with organizations’ governing bodies, and ensure that others comply with the laws/regulations that result from these policies. |
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Term
| Explain “outcome health indicators” and how they impact nursing interventions. |
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Definition
| “Outcome health indicators” is just another way of saying “outcomes.” These are goals, and measure the impact of interventions. Examples for a family at risk for problems arising from poor parenting include “no reports of child maltreatment” and “child attends preschool.” Outcomes that are achieved indicate that the intervention was effective. Unachieved outcomes indicate a need to revise interventions. |
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Term
| Identify examples of modifiable health related behaviors. |
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Definition
Positive behaviors – diet, exercise
Avoidance behaviors – substance abuse |
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Term
| Describe the two paradigms from which the key concepts of nursing science can be viewed as outlined by Laffrey, Loveland-Cherry, and Winkler (the disease paradigm, the health paradigm). |
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Definition
Disease paradigm – health defined as absence of disease; health care focuses on IDing what is not working properly within a given system and repairing it; health behavior based on how client complies with health professional’s recommendations
Health paradigm – health defined as fluid, flexible process; humans complex & interconnected with environment; health behavior involved holistic view of person’s lifestyle & interaction with environment (not judged simply by compliance with regimen) |
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Term
| Describe the terms “victim blaming” and “top-down attitude”. How do these approaches impact community members? |
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Definition
Victim blaming – placing all of the responsibility for health behavior on the individual – excludes community; leads people to feel victimized and helpless
Top-down attitude – giving the community the sole responsibility for people’s health behaviors – patronizing; leads people to feel as if they have no control |
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Term
| Describe the two major dimensions of the integrative model (client system and focus of care). |
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Definition
Client system – multidimensional system that includes various levels of clients toward which nursing care is targeted (individual, family, aggregate, community)
Focus of care – includes health promotion, illness (disease & disability) prevention, and illness care – goal of health care is healthier community, achieved through health promotion interventions |
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Term
| Describe what the “Guide to Clinical Preventative Services” is. |
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Definition
| A free resource to help clients choose programs and policies to improve health and prevent disease in their community; provides most recent recommendations for preventive interventions |
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Term
| Review primary, secondary and tertiary prevention discussion and examples |
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Definition
Primary – preventing health problem from happening at all (for diabetes – maintain normal weight, exercise regularly, reduce intake of carbohydrates)
Secondary – reducing risk for health problem (test blood glucose level regularly)
Tertiary – achieving optimal level of wellness for the individual; rehabilitation (begin treatment to include diabetic diet, regular exercise, medication) |
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Term
| Describe and differentiate between health maintenance, illness prevention and health promotion (tables 14-1 and 14-2 for application examples) |
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Definition
Health maintenance – keeping current state of health
Illness prevention – behavior aimed at reducing threat of illness/disease
Health promotion – behavior aimed at achieving a greater level of health |
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Term
| Describe health risk appraisals and wellness inventories. |
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Definition
HRA – extensive questionnaire that assesses risks to health; can encompass broad range or be specifically targeted; data compared with epidemiologic studies to predict individuals’ risk of morbidity/mortality and to suggest areas in which disease risks may be reduced
Wellness inventories – focus on wellness and are often used in nurse-managed centers; define health risks more broadly and lead to health promotion as well as disease prevention and risk reduction |
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Term
| Describe advantages of health risk appraisals |
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Definition
| Provide direction to nurses to counsel/educate patients about healthy lifestyles; associated with decreased health risk; measure outcomes & economic costs of risk reduction interventions; provide immediate feedback about how behavior changes can influence health risks and life expectancy |
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Term
| Describe the Framingham Heart Study and its outcomes |
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Definition
| Over 5000 adults followed over their lifespan to ID factors contributing to coronary heart disease using periodic health assessments to collect morbidity/mortality data; major risk factors were ID’d and related to probability of future cardiovascular disease |
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Term
| Development of Healthy Communities and Cities Movement |
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Definition
History:
Began in Europe in 1986 and spread to all regions of world
Due to U.S. localities now call “Healthy Communities and Cities”
Principles and Concepts
o Support of community problem-solving process for health promotion
o Shared vision of future that is based on community values
o Process for health and quality of life is based on diverse citizen participation, mobilization of all sectors of the community, and community ownership
Strategy
o Initial and organizational phase (1-3 months)
Conduct participatory assessment with the community
Creat intersectoral and municipal committee
Develop a proposed strategic plan
Gain approval and assign resources for the plan for the city council
o Planning Phase (4-6 months)
Designate members of committee to be part of working group
Develop detailed work plan based on community assessment
Identify strategies to encourage sustained participation and partnerships for implementing the plan
o Action phase (2-3 years and beyond)
Promote local healthy public and institutional policies and actions
Develop a policy framework and infrastructure to support and sustain implementation of the plan
Encourage politicians and other decision makers to commit to community capacity building |
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Term
| Relationships Among Primary Care, Health Promotion, and Healthy Communities and Cities Movement |
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Definition
Healthy Communities and Cities=
Emphasizes partnerships and action and is based on guiding principles that include a broad definition of both health and community, a share vision based on community values that addresses the health and quality of life for everyone, and diverse citizen participation and widespread community ownership.
Primary Health Care=
Should meet the basic health needs of a community by providing readily accessible health services.
Health Promotion=
Along with disease prevention, are focused on providing community members with a positive sense of health that strengthens their physical, mental, and emotional capacities. |
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Term
| Steps in working with communities in Healthy Communities and Cities |
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Definition
1. Healthy public policy
2. Creating supportive environments
3. Strenthening community action
4. Developing personal skills
5. Reorienting health services |
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Term
| Steps in working with communities in Healthy Communities and Cities with health promotion |
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Definition
1. Orienting the community to community health promotion
2. Building a partnership for health
3. Developing the community structure for health promotion
4. Developing leadership for health promotion
5. Assessing the community
6. Planning for community-wide health
7. Developing community action for health
8. Providing data-based information to policy makers
9. Monitoring and evaluating healthy progress |
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Term
| Role for Nurses in Healthy Communities and Cities |
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Definition
• Because nurses naturally work with community people from different walks of life and are respected health professionals in the community, they are well suited to promote HCC.
• Nurses may initiate, coordinate, or be part of a research team conducting program evaluation research.
• Nurses need to be prepared to share with agency colleagues and community leaders the benefits of community partnerships. In addition, identifying costs and sources of contributions will assure that all partners are fully informed and the nurse is supported in her participation.
• Nurses can be a part of implementing Community Health Improvement Model:
• Identify interest through community forums
• Build a partnership
• Development of community structure for health promotion
• Leadership development
• Performing community assessment
• Community-wide planning
• Community action for health
• Providing data for promoting health public policy
• Monitoring and evaluating progress |
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Term
| Impact of Healthy Communities and Cities in health promotion |
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Definition
• Health People 2010 objectives incorporates mental, physical, and social well-being as dependent on health improvements at the individual, family, and community level. The goals for the nation are:
o Increase years of healthy life as well as quality of life
o Eliminate health disparities
o Promote healthy behaviors
o Protect our health
o Ensure access to quality health care
o Strengthen community participation |
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Term
| Describe how Nursing Centers evolved. |
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Definition
| The ANA Nursing Centers Task Force defined nursing centers in the mid 1980s to deemphasize the illness-oriented and institutional care that had dominated the health care landscape since WWII. Most current nursing center models emerged from academic nursing programs in the 1970s. At that time there wasn’t a way for faculty and nursing students to apply their knowledge and skills within a nursing framework of care. The nursing centers became recognized as essential safety net providers in their communities. |
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Term
| • Describe characteristics that all nursing centers have in common. |
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Definition
The primary goal of all nursing centers is responsiveness to the health needs of the population. All nursing centers use nursing models of care to diagnose and treat human responses to actual and potential health problems. On p. 411 in italics there is a list of the central tenets of nursing centers. They are:
1. Community-based culturally competent care
2. A holistic approach
3. Interorganizational and interdisciplinary collaboration
4. Multilevel interventions
5. Community partnerships
6. Relationship-based practice |
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Term
| • Efforts of Nursing Centers |
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Definition
focus on enhancing people’s capacity to meet their personal, family, and community responsibilities and interests, describe what they typically include.
First off, I think this question sucks. The efforts of nursing centers typically include what was mentioned in the previous question. |
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Term
| Health and Wellness Centers |
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Definition
| focus on health promotion, disease prevention, and management programs. These centers complement existing primary care services. Think health ed, immunizations, family assessment and screening services, parenting classes and weight management counseling. |
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Term
| Comprehensive Primary Health Care Centers |
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Definition
| do what they sound like they do. They address the needs of individuals and families across the life span using nurse practitioners and other advanced practice nurses. They also involve public health nurses for outreach, social support, and other public health programs. |
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Term
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Definition
| focus on specific populations with specific health care needs. Think Diabetes, HIV/AIDS, adolescent mothers, the elderly, or cancer pts. |
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Term
| • Describe the importance of community collaboration. Describe the factors that impact its success. |
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Definition
| The key term here is stakeholders. These individuals, families, groups, organizations, and policy makers all offer diversity in perspective, which can be a double-edged sword. On one hand, there’s the whole “more than the sum of its parts” thing. On the other hand, collaboration takes time, effort, and resources. These entities must share risks, responsibilities, resources, and rewards along the way. The book gives six critical elements of a collaborative endeavor: the environment, membership characteristics, process and structure of the group, communication patterns, purpose of the collaboration, and resources within and outside the group. |
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Term
| • In the process of community collaboration, describe what is meant by the term “stakeholders”. Who are the stakeholders? |
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Definition
| The stakeholders are all individuals, families, groups, organizations, and staff involved in the process. |
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Term
| • Review the levels of prevention (primary, secondary and tertiary) in relation to care provided at Nursing Centers (Box on pg.416). |
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Definition
This is the example given in the book:
Primary – Screen home for lead dust; educate family on lead poisoning prevention strategies
Secondary – Conduct blood lead level screening on a regular basis for children under 6 yrs of age.
Tertiary – Treat child with elevated blood lead level with appropriate therapies and eliminate environmental lead toxicity exposures |
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Term
| • Describe “quality indicators” in relation to nursing centers. (Table 18-2 is helpful for application examples). |
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Definition
| Think outcomes and a way to evaluate these outcomes, but these outcomes provide a window to client satisfaction, adherence to advised health practices, and changes in health behaviors. It’s basically the nursing process but for evaluating the quality of a nursing center’s programs. Certain indicators will help the nursing center document evidence-based practice. Check out p. 422 for an example but the basic principle is that you have an indicator, a population, a performance target, and a way to measure your success. |
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Term
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Definition
| tries to investigate the viability of a nursing center. It includes interviews, surveys, focus groups, community forums, and legal and regulatory policies (like local or state requirements). |
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Term
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Definition
| has a strong base in the feasibility of the nursing center and is built on the known or more predictable sources of funding. It describes the development and the direction of the nursing center in an organized and presentable manner. |
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Term
| Describe how National reporting began in the U.S. pg. 480 |
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Definition
By 1925, the US began national reporting of morbidity causes.
By 1935, the 1st national health survey had been conducted
In 1949, the National Office of Vital Statistics published weekly mortality and morbidity statistics in Journal of Public Health Reports.
The activity was later transferred to the Centers for Disease Control and Prevention, who began publishing the Morbidity and Mortality Weekly Report in 1961. |
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Term
| 2. Describe the “police powers” that local health departments have as provided by the U.S. Constitution and what it allows them to do. Pg 480 |
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Definition
| The Constitution of the United States provides “police powers” necessary to preserve health safety as well as other events. These powers include public health surveillance. State and local “police powers” also provide for surveillance activities. Health departments usually have legal authority to investigate unusual clusters of illness as well. |
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Term
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Definition
| focus on what is done (ie services provided or protocols for health care). |
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Term
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Definition
| focus on changes in health status. |
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Term
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Definition
| defined as “an intentional release or viruses, bacteria, or their toxins for the purpose of harming or killing.... citizens” |
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Term
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Definition
| the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. |
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Term
Identi12. Describe how States handle notifying the federal government of notifiable diseases. Pg 485
Legal reporting: states compile disease incidence data (new cases) and transmit the data electronically, weekly, to the CDC through the National Electronic Telecommunications System for Surveillance (NETSS). To determine which of the national notifiable diseases are reportable in your state, go to your state health department website.
fy features of surveillance (Box 21-1). Pg 481 |
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Definition
• is organized and planned
• is the principle means by which a population’s health status is assessed
• involves ongoing collection of specific data
• involves analyzing data on a regular basis
• requires sharing the results with others
• requires broad and repeated contact with the public about personal health issues
• motivates public health action as a result of data analyses to: reduce morbidity, reduce mortality, improve health |
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Term
| Explain the purposes of surveillance (Box 21-2 summarizes but be able to apply). Pg 481 |
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Definition
• Assess public health status- helps public health departments identify trends and unusual disease patterns
• Define public health priorities- assessment, policy development and assurance
• Plan public health programs- priorities for using scare resources
• Evaluate interventions and programs for commonly occurring and universally occurring disease or events.
• Stimulate research |
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Term
| 7. Explain the purpose and importance of ongoing surveillance. Pg 482 |
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Definition
| Ongoing monitoring in place will ensure that disease and event patters improve rather than deteriorate. It can also make it possible to study whether the clinical protocols and public health policies that are in place can be enhanced based on current science so disease rates actually decline. |
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Term
| Describe the role of collaboration among partners in surveillance. Pg 482 |
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Definition
It promotes the development of a comprehensive plan and a directory of emergency responses and contacts for effective communication and information sharing. The type of information to be shared includes the following:
• How to use algorithms to identify which events should be investigated
• How to investigate
• Whom to contact
• How and to whom information is to be disseminated
• Who is responsible for appropriate action |
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Term
| Identify and describe the seven basic steps of the surveillance for nurses to follow as outlined by the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice Pg 483 |
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Definition
1. Consider whether surveillance as an intervention is appropriate for the situation
2. Organize the knowledge of the problem, its natural course of history, and its aftermath
3. Establish clear criteria for what constitutes a case
4. Collect sufficient data from multiple valid sources
5. Analyze data
6. Interpret data and disseminate to decision makers
7. Evaluate the impact of the surveillance system |
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Term
| Identify sources of morbidity data . Pg 483 |
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Definition
• notifiable disease reports
• lab reports
• hospital discharge reports
• billing data
• outpatient health care data
• specialized disease registries
• injury surveillance systems
• environmental surveys
• sentinel surveillance systems |
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Term
| Describe why the CDC assembled the first standard case definition list for notifiable diseases. Pg 484 |
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Definition
| Before the standard case definition list came along, most departments were using different criteria, which made the data less useful than it could have been because it could not be compared across health departments or states. |
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Term
| Describe how States handle notifying the federal government of notifiable diseases. Pg 485 |
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Definition
| Legal reporting: states compile disease incidence data (new cases) and transmit the data electronically, weekly, to the CDC through the National Electronic Telecommunications System for Surveillance (NETSS). To determine which of the national notifiable diseases are reportable in your state, go to your state health department website. |
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Term
13. Describe the criteria for defining cases of different diseases (case definitions). Pg 486
(If needed, read specific examples on pg 486) |
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Definition
• Suspected
• Probable
• Confirmed
This depends on the strength of the evidence supporting the case criteria. The case definition should not be used as the only criteria for clinical diagnosis, quality assurance, standards for reimbursement, or taking public health action. |
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Term
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Definition
| the public health nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. The nurse names the disease/event and gathers data about existing cases to try to determine the magnitude of the problem (how widespread it is) |
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Term
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Definition
| case reports are sent to local health departments by health care providers or lab reports of disease occurance are sent to the local health department. |
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Term
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Definition
| trends in commonly occurring diseases or key health indicators are monitored. A disease/event may be the sentinel or a population may be the sentinel |
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Term
| Special surveillance system: |
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Definition
| developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems; designed to provide data for early recognition and investigation of foodborne outbreaks in all 50 states. |
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Term
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Definition
| there is persistently (usually) high number of cases; ex: is the high cholera incidence rate among Asians/Pacific Islanders. |
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Term
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Definition
| the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period. This is often called outbreak. |
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Term
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Definition
| implies a highly prevalent problem found in a population commonly acquired early in life. The prevalence of this problem decreases as age increases. |
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Term
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Definition
| refers to the epidemic spread of the problem over several countries or continents (such as the SARS outbreak). |
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Term
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Definition
| outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases (for example, ricin in the Japanese subway system several years ago). |
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Term
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Definition
| outbreak involves all persons exposed becoming ill at the same time, during one incubation period. |
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Term
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Definition
| is a common source followed by secondary exposures related to person to person contact, as in the spreading of influenza. |
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Term
| intermittent or continuous source: |
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Definition
| cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant’s purchase of contaminated green onions. |
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Term
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Definition
| does not have a common source and spreads gradually from person to person over more than one incubation period, such as the spread of tuberculosis from one person to another. |
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Term
| Describe and differentiate between various types of agent factors (Box 21-6). |
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Definition
1. Biological
• Bateria (e.g., tuberculosis, salmonellosis, streptococcal infections)
• Viruses (e.g., hepatitis A, herpes)
• Fungi (e.g. tinea capitis, blastomycosis)
• Parasites (protozoa causing malaria, giardiasis, helminthes [roundworms, pinworms], arthropods [mosquitoes, ticks, flies, mites])
2. Physical
• Heat
• Trauma
3. Chemical
• Pollutants
• Medications/drugs
4. Nutrients
• Absence
• excess
5. Psychological
• stress
• isolation
• social support |
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Term
| Ancient Greeks (500-323 BC) |
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Definition
Personal hygiene
Physical fitness
Olympics
Naturalistic concept
Disease caused by imbalance between man and his environment
Hippocrates |
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Term
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Definition
Father of Western medicine
Causal relationships
Disease and climate, water, lifestyle, and nutrition
Coined the term epidemic
Epis (“on” or “akin to”)
Demos (“people”) |
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Term
| Roman Empire (23 BC – 476 AD) |
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Definition
Adopted Greek health values
Great engineers
Sewage systems
Aqueducts
Administration
Public baths
Water supply
Markets |
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Term
| Middle Ages (476-1450 AD) |
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Definition
Shift away from Greek and Roman values
Physical body less important than spiritual self
Decline of hygiene and sanitation
Beginnings of PH tools
Quarantine of ships
Isolation of diseased individuals |
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Term
| Renaissance (1400-1600 AD) Global Exploration |
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Definition
Disease, spread by traders and explorers
Killed 90% of indigenous people in New World |
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Term
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Definition
Elizabethan Poor Law of 1601
After American Revolution—first public health committee was established
Public Health Service—established in 1798 as the Marine Hospital Service
Ladies Benevolent Society of Charleston (1813)
Shattuck Report (1850) by the Massachusetts Sanitary Commission |
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Term
| After American Revolution |
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Definition
| first public health committee was established |
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Term
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Definition
| established in 1798 as the Marine Hospital Service |
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Term
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Definition
| by the Massachusetts Sanitary Commission |
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Term
| Age of Reason and Enlightenment |
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Definition
Birth of Modern Medicine
Edward Jenner
1796 cowpox experiment
Coined the term vaccine (vacca, Latin for “cow”) |
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Term
| Great Sanitary Awakening (1800s-1900s) |
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Definition
Growth in scientific knowledge
Humanitarian ideals
Connection between poverty and disease
Water supply and sewage removal
Monitor community health status |
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Term
| Dr. John Snow (1813-1858) |
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Definition
Epidemiology (1854)
Broad Street Pump |
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Term
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Definition
1862 germs caused many diseases
1888 first public health lab |
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Term
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Definition
1883 identified the vibrio that causes cholera, 20 years after Snow’s discovery
Discovered the tuberculosis bacterium |
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Term
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Definition
Clean water; water treatment
Food inspection
Soaps, disinfectants, and pharmaceuticals
Personal hygiene (bathing)
Public works departments; garbage collection, landfills, and street cleaning
Public health departments and regulation |
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Term
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Definition
New professional organizations
Depletion of PHNs
1918 worldwide influenza pandemic |
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Term
| Paying the bill for nursing services in the community |
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Definition
Metropolitan Life Insurance Company
Sheppard-Towner Act |
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Term
| core competencies of public health practitioners as outlined by the Council on Linkages |
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Definition
| analytic/assessment, policy development/program planning, communication, cultural competency, community dimensions of practice, basic public health services, financial planning and management, and leadership and systems thinking. |
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Term
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Definition
| a collection of individuals who have one or more personal or environmental characteristics in common. |
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Term
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Definition
| The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking. |
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Term
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Definition
| The public health nurse provides an influenza vaccination program in a community retirement village. |
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Term
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Definition
| The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community. |
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Term
| Eight Principles of Public Health Nursing |
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Definition
-The client or “unit of care” is the population.
-The primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole.
-The processes used by public health nurses include working with the client(s) as an equal partner
-Primary prevention is the priority in selecting appropriate activities.
-Selecting strategies that create healthy environmental, social, and economic conditions in which populations may thrive is the focus.
-There is an obligation to actively reach out to all who might benefit from a specific activity or service.
-Optimal use of available resources to assure the best overall improvement in the health of the population is a key element of the practice.
-Collaboration with a variety of other professions, organizations, and entities is the most effective way to promote and protect the health of the people. |
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Term
| Four phases of the health care system |
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Definition
1. evelopment (1800-1900) infectious epidemics, inadequate & unsafe hospital care, minimal technology, experience based training.
2. Second development stage (1900-1945): acute infections, trauma, specialty hospitals emerged, therapeutic advances, shifts to science based training
3 (1945-1984) Chronic diseases, increasing numbers and types of facilities, durable technologies, development of medical specialties.
4. (1984-present) emergence of new and old infectious diseases, mergers, intergrations, super drug therapies, computerizations, service technologies, primary care, turf issues, multidiciplinary care teams, managed care |
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