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84 Cards in this Set
- Front
- Back
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Where is community health practiced?
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Rural
Intercity Schools Hospice Public Health Nursing Free Health Clinics |
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What were the major health practices in 1700-1856?
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Women in the family took care of illness
First medical school (Univ of PA-1756) Doctors went to homes Marine Hospital established (1798) Germ Theory developed Dept. of Health - unsanitary conditions & social issues Florence Nightingale |
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Florence Nightingale
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Calling was "to alleviate suffering"
Believed in fresh air, appropriate nutrition & cleanliness. First holistic nurse First statistician of Evidenced Based Practice |
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What were the major advancements in health from 1856-1921?
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Home visits dropping & hospital visits increased
Initially only poor visited hospitals (couldn't afford home private care) 1st Nurses Training School (1872) Public Health Depts. evolved from District Health Nursing (european concept) School Nursing evolved from District Nursing Met Life Hired Lillian Wald to < mortality rates Bureau of Indian Affairs Health Division (1921) |
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What events occurred in nursing from 1922-1948?
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Home Health Nurses were w/o jobs during great depression - clients suddenly impoverish
Nurses were hired in hospitals for room/board only Post WWII - nurses returned to private duty home care World Health Organization established (1948) Public Health Principles addressed worldwide |
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What events occurred in health care/nursing from 1948-2012?
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Community Health Promotion & Disease Prevention created new programs:
Medicare 1965 Medicaid 1965 WIC 1972 Home Health Agencies trimmed by 80% (due to cost) Care shifted from home health to LTC/Hospitals (yet more expensive) Now community based care is on the rise |
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Lillian Wald
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Met Life nurse
Not a "yes doctor" nurse Believed nurse independent of physicians & religious groups Coined term "Public Health Nurse" Established Henry Street Settlement later VNA Founded National Organization of Public Health Nurses Helped established School Nursing EBP |
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Lavina Dock
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Early Women's Rights Proponent
Wrote Nursing Textbooks Politically active - Nursing Rights & Regulations |
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Margaret Sanger
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Mother died of consumption
Teacher Advocate of Occupational Health & Birth Control Opened Women's Health Clinic & gave out diaphragm Went to jail for this |
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Mabel Staupers
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Promoted Health in Harlem
Executive Secretary of the National Association of Colored Graduate Nurses First African American Director of Nursing Helped A.A. Nurses in the Military |
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Mary Breckenridge
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Founded Frontier Nursing Services in Appalachia
Now Home Health Agency & Nursing School |
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Define Community
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Not necessarily an aggregate.
A group of people that share geographic, civic &/or social parameters. |
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Define Aggregate
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A group of people with similar needs. Ie. - 10 diabetics in a classroom for diabetic education. Block Party w/ 100 people who live in poor area with exposure to lead paints...
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Define Community Health Nurse
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Nurses who practice in the community. Have facility as "home base" but they are not limited to hospital nursing practice.
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Where does community health nursing happen?
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Public Health Department
Community (CVS/Walgreens) & Free Health Clinics Flu Shot Clinics Home Health Agencies Hospice Centers Long Term Care Centers Schools Urgent Care Centers Short Stay Facilities Industrial Sites (Ford Plant has nurse - Occupational Health) |
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What is the focus of Community Oriented Nursing?
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Health of the COMMUNITY as a whole
(Community is the client, not the individual). Nursing Actions are surveillance & evaluation of the community's health as a whole. |
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What is the focus of Community Based Nursing?
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The health of the INDIVIDUAL, FAMILIES & GROUPS in the community.
(Individuals, families or groups is the client) Nursing actions are to provide direct care to the client |
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What are the 6 components of Community Health Nursing? What is the extra one?
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* Health Promotion
* Disease Prevention * Treatment * Rehabilitation * Evaluation * Research Also Continuity of Care...Med Reconciliation, D/C Planning, Follow-up |
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What is primary prevention?
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Activities that prevent disease or injury. Always includes an educational piece:
Family Planning Genetic Counseling Sex Ed Smoking Cessation Communicable Disease Education Health & Hygiene (Hand Washing) Seat belt use, helmets & bicycle safety Immunizations & education about them Prenatal classes Community assessments & disease surveillance Advocating for resolution of health issues (pollution stop) Making healthcare accessible Determine accessibility issues & correcting them |
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What is secondary prevention?
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This is screening for evidence of early disease detection & treatment.
Screenings... BP & BS Employer Health Fairs Hypertension, Cholesterol, Diabetes Vision Screenings Lead Exposure Testing Controlling Outbreaks of Communicable Diseases School Closings r/t high flu absences to clean |
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What is tertiary prevention?
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Patient has disease & we educate & assist with:
*Prevent disease progression *Maximize recovery *Minimize suffering *Disease management Nutrition Counseling for Obese Exercise Rehab Case Management Shelters - find them a place to stay Support Groups r/t disease process Heart Disease - daily weights, S&S of stasis ulcers Wounds - healing without complications PT & OT Hypertensive Patients - exercise education |
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What are the roles of the community health nursing?
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#1 - Patient Advocate - Patients are entering & exiting acute care quickly & are unprepared. Help them get the care they need.
Case Manager - Coordinator of care amongst multiple fields, cutting costs, simplifying routines. Helps w/ family/physician issues. Field Nurse - Provides nursing care. Assess & Communicate, Treat & Triage, Critical Think!!! Nurse Educator - Always educate. Patients are more receptive to learning @ home. |
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Who are our at risk populations who require the most advocacy?
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Mentally Ill
Homeless Impoverished Working Classes Single Parents Chronically Ill Incarcerated Migrant Workers |
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Define Health
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A constantly fluctuating/changing state on a health-illness continuum. Can range from excellent health & wellness to healthy with levels of illness to very poor health with severe illness.
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How do we improve the patients level of health on the continuum?
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Educate - even within a disease process
Explain - If meds change, why? S&S of health - what's bad health & what's good health based on disease process Give the patient control - especially teenagers. If they don't have some control over the things that we teach them, then they won't participate in their care. |
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Wellness behaviors that nurses promote?
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Good nutrition
Exercise Social health Immunizations Smoking & drug cessation Safe sex behaviors Family planning Follow-up health care Educate re: High Risk Behaviors Basic safety |
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Define Herd Immunity
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The belief that if we have > 80% of the population immunized we prevent the spread of the disease to those who cannot be immunized.
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What do you need to do before making a home health visit?
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Get ready
Wear appropriate uniform Verify your orders Plan your route Phone ahead for permission to visit. (call if late) Notify the patient what you are doing when there |
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What do you take with you on the home health visit?
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Name badge
Stethoscope, BP cuff, Thermometer Computer Paperwork as backup if computer doesn't work Waterproof bag w/ zipper for supplies Towel in ziplock baggie to place on the floor Wipes Cellphone Baggies for specimens |
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What happens during the visit?
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Let your patient know you're coming & why
Thorough Assessment ABC's, Focused & Education Tasks...Meds, Lab Draws, Wound Care, Procedures, Supervision If Lab Draws - make sure you know time frame lab needs specimen delivered within If phoning physician, make sure client knows that you are calling the physician. |
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How do you decide who to see first of your patients?
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Higher acuities first.
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What happens upon termination of home health?
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Safety Net
Information & Community Resources Dr's Phone Numbers Urgent Care Numbers Prepare them for termination (early) Start D/C from the beginning |
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What is the main cause for the decrease in the death rate during the last 200 years?
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A DECREASE in the incidence of infectious disease.
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Define epidemiology
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The relationship among agent, host & environment. The collection of statistics. Immunization tracking, vaccine effectiveness, disease rate response. Cause/effect, disease trends. Gives us info about diseases that are occurring, location, who is affected, etc.
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What is an agent? Give examples.
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An animate or inanimate object that causes a disease. Can be chemical (drugs/toxins), physical (noise/temperature) or Infectious (viruses/bacterial).
Fumes: Asthma Viruses: Rubeola, HIV, Flu Bacterial: Bacterial Meningitis, Pneumonia, Lyme Disease |
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What is the host?
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The living being that is affected by the disease. Can be susceptible or nonsusceptible. Preferred: Nonsusceptible - won't pickup flu, measles, etc.
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Give some examples of susceptible hosts.
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Elderly
Kids Immunocompromised Chemo patients Low WBC counts |
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What is the environment?
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The setting or surrounding that sustains the host. Ie. High quantity of mosquitos and water sources (swamp/marsh areas) for areas of malaria.
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List some examples of agents.
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Drugs
Fumes Toxins Genetic Issues Trauma Temperature (extreme cold, heat) Viruses (flu, rubeola) Fungi Bacteria |
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How do I become a non-susceptible host?
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Passive Immunity (from mom or antiserum)
Active Immunity (already had disease & antibodies now or from Immunizations) Be healthy Good diet Strong immune system Vaccination |
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What are the two modes of disease transmission & give examples of them.
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Direct Contact - Direct, Droplet, Vertical, Vector
Indirect Contact - Fomites (doorknobs, telephones, drinking fountains), Food Water & Biological Products, Air |
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How do you acquire passive immunity?
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Vertical (mom to baby via placenta or breast milk)
Frequently passive immunity via placenta wears off by about 6 weeks. |
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How do you acquire active immunity?
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Previous exposure to agent & develops antibodies.
* Previous infection * Immunization |
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What level of prevention is herd immunity, education about immunizations & administering immunizations?
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Primary Prevention
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As healthcare workers, how do we prepare for a disaster?
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FEMA - tornado/earthquake buildings
Pandemic planning Assess at risk groups Know nursing responsibilities - know the plan, participate in drills/mock disasters, response site, maintain communication (cellphone/charger in order to keep hosp. phone lines open). |
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Explain the categories of Bioterrorism.
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Category A - Easily transmitted/high mortality
* Smallpox, botulism, anthrax. plague, tularemia, hemorrhagic viral fevers Category B - Moderately easy to spread/moderate morbidity/low mortality * Typhoid & Cholera Category C - Easy to produce &/or high morbidity/mortality * Hantavirus |
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What is unique about anthrax and tularemia?
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Symptoms vary depending on how exposure occurred. Inhalation is more severe than other routes.
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If you are the first RN responder, must first determine what?
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Which victims have the highest likelihood of survival. The person with the most serious injury may not receive attention first if they are deemed unable to be saved.
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What are critical skills that the nurse must use during triage?
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Critical Thinking
Prioritization of Care Determining who needs transport to higher level of care First Aid on Site Triage Out & Direct the Care of less qualified responders |
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Define culture.
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The beliefs, values & assumptions about life that is widely held among a group of people & transmitted across the generations. Cultural needs are as important as physical & psychological needs.
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Define Cultural Competence. Give an example.
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Knowing, appreciating & considering another person's culture in a problem resolution.
In many middle eastern countries, the men make the final decisions about health care. Women may have input but it stops there. |
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What is cultural awareness.
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The nurse having a clear self-awareness of their own cultural background, biases & differences. Without this, we don't know how our beliefs affect the care we provide.
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What is acculturation?
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The process of merging with or adopting the traits of a different culture.
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How can we show respect?
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Respect their beliefs
Respect they have the right to say "no, don't come today". Work to make health care & culture work together. Ie. look for diet that works within their culture & disease process. Address them by their last name until they give permission otherwise Introduce self/role Wear appropriate identifying wardrobe/name tag If culture comes up, be honest about lack of knowledge Be polite, you are a guest |
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What must be established prior to attempting to make changes for a home health patient?
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Trust
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Name the patients rights.
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Right to:
Make own HC decisions Expect relationship with nurse based on trust, respect & collaboration r/t health & considers their thoughts & feelings Privacy Access to services to meet their HC needs To be responsible for their health |
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When can the right to privacy be broken?
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When the patient is or has threatened to harm himself or others.
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What is collaboration when working with a patient?
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Making them an active part in the planning process for their own care.
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Define values. Give examples of values in nursing.
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Important & lasting beliefs or ideals about what is good or bad and desirable or undesirable. Shared within a culture, highly regarded within community.
Safety Wellness Protecting privacy (HIPAA) Integrity Quality of Care Healing/not harming |
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Define Morals. Give examples.
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Right vs. wrong.
Do no harm Transparency - if making mistake, must tell them. If give wrong pill & patient suffers consequence, must own up to that. |
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Define ethics. Give examples.
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Rules of conduct or standards governing the conduct of a person or group of people belonging to a profession.
No placebos. |
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Who provides guidelines for ethical behavior for nurses?
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ANA Code of Conduct or Code of Ethics
Nurse Practice Act Patient's Bill of Rights Standards of Practice Personal Values Company Policy |
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If something doesn't seem ethically ok, how do we escalate it through the chain of command?
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Charge Nurse
Head Nurse DON Ethics Committee |
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What is an ethical dilemma? Give examples.
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This occurs when personal values & beliefs don't match well with the clients values & beliefs.
Catholic nurse @ St. Joseph shipping patient to another hospital for D&C for various reasons. Bilateral amputation for ease of health care giver. Giving sublingual morphine ordered q2 h PRN to terminal cancer patient w/o asking if they are in pain or determining if they need it. How early a pregnancy is viable vs. quality of life. 28 weeks, 32 weeks, etc. Patients right to choose, 40 y.o. in right mind refusing feeding tube. |
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What are some at risk groups?
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Ppl @ or below the poverty level
Very young/very old Rural & inner city Veterans Mentally ill Illiterate Working poor Homeless - seek HC later & have difficulty with follow-up care, poor immune system, poor diet, deteriorate more quickly. |
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Why are at risk groups at risk?
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Poverty level
Age Illiteracy Homelessness Isolation |
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What do nurses do about disparity & risks?
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Identify disparity & strive to fix it.
Advocate for better care, more care Educate ourselves & others Protect others from harm, speak out if harm is occurring Do evidence based research & contribute Open access to all people Change policy in politics, hospital & health orgs. |
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What groups have a huge disparity in health care?
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Native Americans
African Americans Women (in general) |
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Define homelessness
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A condition of not having a regular, safe, secure place to rely on staying overnight. No permanent address.
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What are the health & wellness problems of homeless people?
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Safety
Exposure Mental Illness - PTSD, depression, schizo, bipolar Lack of access to meds Lack of hygiene Lack of food/food stamps/food storage Substance/Alcohol abuse |
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What is mental illness?
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A medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others & daily functioning resulting in a diminished capacity for coping with the ordinary demands of life. Their drugs are often stolen & abused by others.
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Mental illness r/t Homelessness, is there a link? What % of general population has a mental illness. What % of homeless people have a mental illness?
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Yes.
6% of general population 20-25% of homeless |
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Mentally ill as an aggregate are at risk for what?
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Unemployment
Homelessness Violent acts by them Violent acts against them |
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Why are incarcerated populations at risk? The federal government mandated in 1976 that they have the right to basic healthcare.
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Geriatric
Prisoners providing hospice care to other prisoners Organ failures Communicable Diseases Lack of Vaccinations to communicable diseases TB strains becoming resistant to antibiotics |
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Name some chronic illnesses
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ESRD
DM COPD HTN Back pain CHF Emphysema |
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Define disability.
Name some disabilities. |
A limitation that prevents a person from performing ADL's easily.
Hearing impaired Blind Wheelchair bound |
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Who protects those with disabilities?
How is this carried out? How do you get these special accommodations? |
ADA - American Disability Act
Handicapped signs for parking Seeing eye dogs Sign language for hearing impaired You have to have a acknowledged disability. |
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What common issues do seasonal/migrant workers have?
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Sun exposure
Dehydration Exposure to injuries Pesticide exposures Lack of toilet facilities & voiding in food areas |
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What are some barriers when caring for ppl with chronic disease or disability?
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Transportation
Lack of access to health care Lack of Knowledge Money |
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What are some barriers for seasonal/migratory workers?
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Language barriers
Lack of access to health care No permanent address (homeless) Lack of knowledge/education/where is hospital? Repeated immunizations |
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What are some barriers for incarcerated population?
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No access
Inability to follow-up Lack of medications/quality of care Resistant to admitting illness/vulnerability |
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What are some barriers for homeless population?
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Transportation
Money Access to health care Hygiene |
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What are barriers for mentally ill?
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They believe they are not sick
Trust issues Denial Fear of commitment Paranoia |
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As nurses, how do we overcome barriers for people?
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Communication
Teaching Arranging transportation for them * ShareFare, Metro Passes Appointment arrangements (if don't have phones) Advocate for better care |
