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122 Cards in this Set
- Front
- Back
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Dimension Nursing Model
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Once called the epidemiological prevention process model. This model incorporates the nursing process and public health concept of levels of prevention. This model can also be used to assess individual families and communities.
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Dimension Nursing Model, what categories does it look at?
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This model looks at six categories: 1.biophysiological,
2.psychological, 3. the physical environment , 4. sociocultural, 5. the behavioral and 6. health system dimension |
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LA County Public Health Nursing Practice Model
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Look at rainbow handout.
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PHN 17 interventions are?
(part of the plan and implement side of PHN practice model) |
Yellow:
1. Advocacy, 2. Social Marketing, 3. Policy development and enforcement Pink: 4. Surveillance, 5. Disease and Health Event Investigation, 6. Outreach, 7. Screening Green: 8. Referal and follow-up, 9. case mgmt, 10. delegated functions Blue: 11. Consultation, 12. counseling, 13. Health Teaching Red: 14. Collaboration, 15. Coalition Building, 16. Community Organizing |
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Advocacy
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act on someone’s behalf, e.g. resources, access to care
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Case Management
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coordinate comprehensive care
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Coalition Building
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promote alliances among org. for a common goal
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Collaboration
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enhance capacity to achieve common goal
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Community Organizing
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planned process to meet community needs
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Consultation
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interaction to respond to problems, indiv, group, org.
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Counseling
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assist in developing responsibility for self-care
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Delegated Medical Rx/Obsv
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carry out physician delegated tasks
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Disease Investigation
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tracking and control of comm. Disease
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Health Teaching
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facilitate learning for positive behavior change
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Outreach/Case Finding
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reach out to those at risk
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Policy Development
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contribute to development of legislation, policies, etc
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Provider Education
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provide info to providers to affect comm. problems
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Referral/Follow-up
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provide assistance in using necessary resources
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Screening
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provide screening/referrals to identified at risk populations
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Social Marketing
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adapt marketing strategies designed to improve health
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Surveillance
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monitor for the occurrence of disease in a given population
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Incidence
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The number of new cases
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Prevalence
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The number of existing cases. Both new and old.
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Levels of Public Health Services (3)
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1. Local Health Departments
2. State Health Departments 3. Federal Government |
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Local –Health Departments-responsibilities are:
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Responsibilities are delegated by the state and varies from state to state. These functions include statistics, disease control, surveillance, immunization and health education
For example: In California all children upon entering school must have a TST done. This may not be the case in other states. They are also funded by local and state taxes, and pass through funds, which are funds supplied by the federal government to local health agencies. |
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State Health Department responsibilities are:
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Responsibility of protecting the public and the essential power to make laws and regulations regarding health. This is why it is so important for PHN to be able to understand the importance of working at the systems level, because they cannot make all changes at the local levels, if it is something we need state wide, it is the state that has the final say.
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Federal Government role in PH services
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Regulate foreign products that may eventually affect one’s health a common example would be what agency (FDA)
International and????? |
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Roles of the Public Health Nurse (3 categories)
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1. Client Oriented
2. Delivery Oriented 3. Population Oriented |
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Client Oriented consists of:
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Caregiver, Educator, Counselor & Case Manager
Case Manager= selection of services for individual and families, Care Manager is more for the populations level and involves grouping people together with similar needs in order to meet those needs more cost effectively. |
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Delivery Oriented
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Care Manager/Coordinator, Collaborator, Liaison
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Population Oriented
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Case Finder (ex. seeing if anyone else in household is symptomatic), Policy Advocate, Social Marketer
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Phases of home visits (3)
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1. Contacting Phase
a. Scheduling b. Preparation 2. Entry Phase 3.Termination Phase |
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Contacting phase
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The phase is when the nurse becomes aware of an individual or family who =has been identified as needing a visit, she then contacts them via telephone however, telephone call is not the primary choice working with the families
This is where the nurse gains trust to move into the second phase of home visiting, which is entry phase. |
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Entry phase
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This is where the nurse goes out to see the family and interacts with them in their home environment
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Termination Phase
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where the nurse prepares to terminate the relation with the client by either referring them to some one else this is where interventions are evaluated and plns are made for future visits/services.
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Advantages of home visits:
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face to face, may be the olny exposure to helath services, may help family with other social problems as well
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Risk of home visits
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Family may shy away and not want you to visit, safety issues
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What is Healthy People 2010?
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1. A comprehensive set of national health objectives for the decade
2. Developed by a collaborative process 3. Designed to measure progress over time 4. A public health document that is part strategic plan, part textbook on public health priorities |
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Leading Health Indicators : Ten Major Public Health Issues
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1. Physical activity
2. Overweight and obesity 3. Tobacco use 4. Substance abuse 5. Responsible sexual behavior 6. Mental health 7. Injury and violence 8. Environmental quality 9. Immunization 10. Access to health care |
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Healthy People- 1979
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Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention
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Healthy People- 1980
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Promoting Health/Preventing Disease: Objectives for the Nation
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Healthy People- 1990
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Healthy People 2000: National Health Promotion and Disease Prevention Objectives
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Healthy People- 2000
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Healthy People 2010 built on the previous two decades of success in Healthy People initiatives.
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How many overarching goals in Healthy People 2010?
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Two overarching goals:
1. Increase quality and years of healthy life 2. Eliminate health disparities |
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How many focus areas (chapters) in Healthy People 2010?
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28 focus areas:
1. Access to Quality Health Services Arthritis, Osteoporosis, and Chronic 2. Back Conditions 3. Cancer 4. Chronic Kidney Disease 5. Diabetes 6. Disability and Secondary Conditions 7. Immunization and Infectious Diseases 8. Injury and Violence Prevention 9. Maternal, Infant, and Child Health 10. Medical Product Safety 11.Mental Health and Mental Disorders 12. Nutrition and Overweight 13.Occupational Safety and Health 14. Educational and Community-Based Programs 15. Environmental Health 16. Family Planning 17. Food Safety 18. Health Communication 19. Heart Disease and Stroke 20. HIV 21. Oral Health 22. Physical Activity and Fitness 23. Public Health Infrastructure 24. Respiratory Diseases 25. Sexually Transmitted Diseases 26. Substance Abuse 27. Tobacco Use 28. Vision and Hearing |
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How many specific objectives in Healthy People 2010?
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467 specific objectives
Example: Reduce the proportion of nonsmokers exposed to environmental tobacco smoke. (Baseline 65%, 2010 target 45%) This is a measure for a Leading Health Indicator |
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How many leading health indicators in Healthy People 2010?
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10 Leading Health Indicators
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Uses of Healthy People 2010: (6)
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1. As a data resource
2. As a vehicle to involve the public, media, and elected officials 3. as a basis to form coalitions and partnerships with community-based groups 4. To define common ground 5. As a common template 6. to form the basis of agreements and interactions with government agencies |
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Bottom Line of Healthy People 2010...
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-A tremendous national resource
-A remarkable intellectual investment -An important part of a national action plan |
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Examples if unsafe conditions in or near the client's home...
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1. Loitering
2. Client/others exhibit aggression (verbal, sexual, or physical) 3. Gang activity (signs= tagging, police activity) 4. Police activity (raids/drug busts) 5. Evidence of weapons 6. History of drive-by shootings 7. Home maintenance issues (broken glass, no phones, poor lighting, broken elevators) 8. Vermin 9. Dogs |
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Example of safe spots:
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Police stations
Fire stations Restrooms Phone access Agencies known to you (churches, schools) Other |
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What safety measures would you take for planning the visit?
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-Wear safe and appropriate attire
-Know how to get there -Complete a route sheet (so supervisor knows where you are going and how to contact you) -Prepare all necessary materials (ex. Heb B gloves, stool sample containers, forms, education materials, etc) -Map your route (visit tougher areas earlier in the day) |
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What safety measures would you take from the Office to the Location of the Visit?
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-Car safety/maintenance
-Personal belonging safety (wear little jewelry, avoid clothes that will attract attention. -keep valuables out of sight - carry minimal amount of money -keep your Driver’s license & keys on you Don't carry a purse |
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What safety measures do you take from the office the location of the visit? (con't)
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1. Survey the area for parking (park in well light area, and in an area where it can’t be blocked and park in the direction you want to leave).
2. Wear ID badges 3. Stay alert to your surroundings 4. Trust your instinct |
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What safety measures do you take when conducting the visit?
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1. Be alert, know your surroundings. Pause at the door before knocking & listen for quarreling/fighting
2. Note any unusual circumstances– door open (do not enter) 3. Beware of Dogs,- Do’s & Don’ts of Dog Safety - A Guide to Animal Bites 4. Identify yourself. Treat client w/respect. Be cautious with your tone of voice 5. Alert to your surroundings. Be alert to signs of violence or sexual advances from the client/family members. 6. De-escalate client or family if needed. 7. Have an excuse to leave. Ex: “Oh I just got paged. I’ll call you later to finish the visit.” |
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Assessing Aggressive communication:
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#1. Body Language – pacing, hands on the hips, facial expressions (rolling their eyes)
#2. Consider cultural differences: Personal space, eye contact, physical touch, greetings, etc. #3. Consider tone of voice: How they communicate to you (loud, soft, cursing, sighing) |
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Pathway to Explosion
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1. Agitated - pacing, crossing arms
2. Disruptive - yelling, cursing 3. Destructive - destroying property 4. Dangerous - verbal threats 5. Lethal - escalating to physical violence |
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Interventions for Hostile Clients:
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1. Be calm but firm
2. Validate their feelings. Ex: “I hear you are very upset because I came to your home today" 3. If they remain angry/upset, leave your name and message card in a sealed envelope 4. Reinforce that you are committed to the best interest of the client. |
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What safety measures do you take from the visit to the office?
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-Take belongings with you
-Walk close to curb, facing oncoming traffic -Discuss safety issues with supervisor |
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If You Suspect Someone is Following You…
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-Attract someone’s attention
-Do NOT go home -Drive to a safe spot= Drive to a fire station, a 24 hr grocery store, restaurant, or gas station. Any place with bright lights & lots of people. |
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Emergencies in the Field:
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1. Personal emergencies
2. Auto accident 3. Client emergency 4. Community situation 5. Disaster preparedness 6. When to Call 911- use your judgment |
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Assess attitude...
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For example, if a person is impatient, mean, suspicious, tense or angry, he/she may not be receptive to you. Therefore assessing an individual’s attitude and determining the level of interaction you should have with this person is important. Individuals who are agitated/disruptive may be calmed by giving clear instructions or explanations for the purpose of your field visit. Do not waste time w/individuals and clients who demonstrate destructive, dangerous or lethal characteristics.
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Self-assessment...
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It is also equally important to assess yourself, your general appearance, body language & attitude because it can impact how your client will interact with you. If you are angry, then your client will feel that, and be tense during the visit and thus be less willing to interact with you. Also if you are preoccupied with your own problems, then you may miss valuable information/clues during your visit.
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4 categories for the purpose of home visiting programs are:
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1. Case finding and referral
2. Health promotion and illness prevention 3. Care of the sick 4. Care of the dying |
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Case Finding and Referral
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-Identify clients needing additional services
-Provide referrals to appropriate sources of services Example: Lead abatement program, Disease follow-up |
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Health Promotion and Illness Prevention
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1. Primary focus of home visits
2. A major part of Public Health Nursing 3. Encompasses mostly Primary and Secondary prevention 4. Focuses on specific populations |
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Care of the Sick
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Providing direct services
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Outcomes of the Home Visits
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Home visitation programs have been documented to achieve a variety of health-related outcomes for many different populations
Example: Ortiz Bill???? |
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Convenience of home visits:
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-Clients often prefer to be seen in their homes
-Reduced transportation costs -No waiting for services |
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Home health vs. public health?
Home Health is: |
-Individualized
-Disease and Disability focused -Specific qualifications -Involves environmental, social and personal health factors |
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Home health vs. public health?
Public health is: |
-Population Based
-Prevention, Screening & Health Promotion Focused -No specific qualifications -Involves environmental, social and personal health factors |
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Biggest Issue Facing our Population as it relates to PH is…
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Affordable Health Insurance
& Access to health care |
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Roles of the Public Health Nurse (3)
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1. Client Oriented= caregiver, educator (MOST IMPORTANT), counselor, and case manager.
2. Delivery Oriented= care manager/coordinator, collaborator, liaison 3. Population Oriented=case finder, policy advocate (ex. car seats), social marketer |
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Morbidity is
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??ratio...
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Mortality is
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?? ratio
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Understanding Culture....
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-Assures effective care
-Modify elements that impede effective health care -Modify health care systems to better meet client needs |
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Remember that culture…
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-Influences ways of thinking and acting developed by a group of people
-Permits them to interact effectively with environment -Permits them to address concerns common to the human condition -Generally unique, stable, and enduring (does not go away, passed on) |
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What is culture?
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“….a shared system of meaning, the way that people experience, perceive and interpret their world”
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Why is culture important to both the nurse and the client?
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Assures effective care
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Race is...
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1. Artificial categorization
2. is an artificial categorization based on genetic inheritance and and physical characteristics such as skin color, hair color texture and eye color 3. Does not adequately address the diversity of the U.S. population |
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Nationality is
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-One’s country of birth or a country adopted for permanent residence
-More appropriate way to address culture. |
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Ethnicity
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Aggregate of cultural practices, social influences, religious pursuits, and racial characteristics
Shape the distinctive identity of a relatively homogenous community |
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Refugee
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A refugee is defined as a person outside of his or her country of nationality who is unable or unwilling to return because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.
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Acculturation
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process of exposure of persons from one cultural group to another.
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Assimilation
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when the “new” culture exerts enough influence to almost extinguish the original ethnic influence.
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Biculturalism
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participation in two cultural systems, with two sets of behaviors and ways of thinking.
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Out of the three: 1. Acculturation 2. Assimilation 3. Biculturalism, what is the most dangerous to the health care worker?
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Biculturalism
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Cultural Competence
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Skill that can be learned that is always in practice, ongoing process. Key to be compassionate.
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Th cultural Iceberg: what can you observe (the tip), and what can't you observe (the body)
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in the tip: behavior and practices= characteristics such as race, gender, etc.
in the body: attitudes and core values. |
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Rationale for Culturally Competent Care (3)
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1. Increase in diverse populations
2. Increase in home care where cultural factors are influential 3. Increase in health disparities among ethnic cultural minorities |
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Individual Cultural Competence (5)
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1. Awareness of cultural perspectives
2. Individual perspective does not influence interactions with others 3. Knowledge and understanding of another culture 4. Acceptance of and respect for other cultures 5. Conscious process of adaptation of care to the cultural context |
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Culturally Competent Community Care (4)
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1. Interpersonal caring (The Golden Rule= treat people the way you want to be treated)
2. Cultural sensitivity (empathy not sympathy) 3. Cultural knowledge (know issues within that culture like morbidity factors) 4. Cultural skill. (this is learned) |
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Barriers to Cultural Competence (3)
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1. Communication among cultural groups
2. Incorporating elements of culture in the plan of care 3. Developing trust among members of different cultures |
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Benefits of Culturally Competent Care (5)
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1. Promotes appropriate and accurate diagnoses
2. Improves compliance with treatment recommendations 3. Reduces delays in care-seeking and use of services 4. Enhances client/provider communications 5. Enhances compatibility of biomedical and traditional health care |
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Negative Aspects of Culture (3)
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1. Health Disparities- minorities have less access to quality and affordable healthcare. In U.S higher rates of chronic illness and poor outcomes
2. Discrimination 3. Stereotypes |
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Define family.
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-Social system of two or more people
-Define themselves as a family -Share bonds of emotional closeness |
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Define Nuclear family.
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-Nuclear conjugal: husband, wife, and children
-Nuclear dyads: married couple without children under 18 living in home -Children may be biological or adopted -Dual-earner: two working parents with or without children |
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Define extended family.
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-Include family members other than spouses or children
-May include step kin -Share expenses and tasks -Live in close proximity and provide mutual support |
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Single parent families
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-Most common family served by community health nurse
-Consists of adult woman or man and children |
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Define stepfamilies
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-Two adults, at least one of whom has remarried
-Can include children from previous marriage -Can include children from the new marriage |
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Define cohabitating
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-Man and woman living together without marriage
-Include anyone from teens to retired elderly -Different reasons for cohabitation |
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Gay or Lesbian families
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-Form of cohabitation
-Same-sex couple who share a sexual relationship -Comprise approximately 10% of unmarried couple households in U.S. |
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Grandparent-headed families
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-Older person or grandparent is head of household
-Comprise approximately 7% of U.S. families -Many factors contribute to grandparent-headed families..what are some? |
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Foster Familes
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-At least one adult and one or more foster children
-Children placed by the court system -May contain the adult’s own biological or adopted children -Higher incidence of mental disorders in foster children |
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Why work with families ? (5)
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1. Critical resource in delivering health care.
2. Any dysfunction that affects one family member will affect other family members. 3. Case finding is facilitated by assessing the family. 4. A clear understanding of individual members of the family is achieved when the family is assessed. 5. Providing vital resources for individual clients will in turn help the family |
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Differences in individual vs. family nursing with focus of care is
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I: client
F: subsystem or system: relational |
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Differences in individual vs. family nursing with complexity of nursing process is
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I: steps are less complex & extensive
F: steps are more complex & extensive |
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Differences in individual vs. family nursing with level of approach is
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I: individual level
F: two-level approach: working with families and indiv simultaneously |
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Differences between individuals and family nursing with assessment is
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I: linear or holistic w/ indiv as focus
F: Interactional level |
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2 steps with working with families:
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#1 Understanding the stages of Health and Illness
#2 Identifying the health status of the client |
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Six stages of health/illness:
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1. Health promotion
2. Family's appraisal of symptoms 3. Care seeking 4. Referral and obtaining care 5. Acute response to illness by client and family 6. Adaptation to illness and recovery |
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Health stressors can be...
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acute illness; chronic illness; disability; aging; and lost/death of members.
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Other sources of stressors can be...
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-Immigration
-Social mobility -Intergenerational variables: particularly in three generational families. -Gender issues -Communication differences -Role responsibilities and role / power strains -Value differences -Affective differences -Health-care function differences -Socialization function differences -Coping differences |
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Differences observed in gender: Attitudes and patterns of conversation
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-Women see conversation as away of making connections, creating intimacy.
-Men as a way to demonstrate their status and knowledge. |
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Differences observed in gender: Decision-making approaches
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-Women seek consensus.
-Men seek to make decisions expeditiously. |
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Differences observed in gender: Ways in responding to others' concerns
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-Women want understanding.
-Men want solutions |
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Differences observed in gender: Conflict recognition and resolution
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-Women take affiliative, cooperative stance.
-Men assume a more coercive, competitive stance. |
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The goal of family Nursing is closely aligned to family stress and coping concerns. It is to:
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assist families to help themselves achieve a higher level of functioning or wellness, within the context of their particular aims, aspirations, and abilities.
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Family Coping Strategies/Processes
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-Stressors force families to adapt/ continual demand.
- are essential mechanisms for family adaptation. - Without effective family coping the effective, socialization, economic and health-care functions are compromised. |
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Common Interventions for Families
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1. use of social support and self-help groups
2. family crisis intervention 3. Behavior/ lifestyle modification 4. active family participation and partnership 5. teaching 6. Counseling 7. case management: advocacy, coordination of services, monitoring 8. collaboration 9. consultation 10. family empowerment strategies 11. focus on family competencies & strengths. make commendation. |
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Levels of Prevention
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1. Primary
2. Secondary 3. Tertiary |
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Role of nurses (as stated in text)
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1. clinician: holism, health promotion, skill expansion
2. educator 3. advocate: goals- independence in self care, and make system work for them/responsive. 4. manager role 5. collaborator 6. leader 7. researcher |
