Community Health Final Exam

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Aggregates

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population subgroups in a community made up of people who share one or more common characteristics

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Community health

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Organized efforts for health at the community level through both government and private efforts, including agencies supported by private funds, such as the American Heart Association or the Red Cross

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Community health nursing

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The provision of nursing service to the community or population as a whole

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Disease prevention

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Efforts to protect persons from disease and its consequences

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Health

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A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

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Health promotion

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Efforts or activities aimed at improving well-being

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Population

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A group of people having common personal or environmental characteristics; can also refer to all of the people in a defined community

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Population-focused nursing

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Nursing practice that concentrates upon specific groups of people, focusing on health promotion and disease prevention, regardless of geographic location

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Primary prevention

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Activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. It consists of two elements: general health promotion and specific protection

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Public health

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organized efforts made through governmental agencies such as health departments, which are authorized by legislation, serve all people, and are supported by taxes.

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Public health nursing

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A synthesis of public health and nursing practice

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Secondary prevention

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Early detection and prompt intervention during the period of early disease pathogenesis. It is implemented after a problem has begun but before signs and symptoms appear and targets those populations who have risk factors

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Tertiary prevention

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targets populations who have experienced disease or injury and focuses on limitation of disability and rehabilitation. Aims of tertiary prevention are: to keep health problems from getting worse; to reduce the effects of disease and injury; and to restore individuals to their optimal level of functioning.

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Edwin Chadwick

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called attention to the consequences of unsanitary conditions in Liverpool in 1842 that resulted in health disparities that shortened the life span of the laboring class in particular.

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District nursing

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stemmed from public health nursing and developed in England.

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Edward Jenner

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in 1796, he observed that people who worked around cattle were less likely to have smallpox. He discovered that immunity to smallpox resulted from an inoculation with the cowpox virus.

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Elizabethan Poor Law

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enacted in England in 1601, held the church parishes responsible for providing relief for the poor. This law governed health care for the poor for more than two centuries and became a prototype for later U.S. laws.

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Flexner Report

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outlined, in 1910, the shortcomings of U.S. medical schools that did not use the German model that promoted medical education on the principles of scientific discovery.

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health visiting

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enlisted home visitors in Manchester in 1862 to distribute health information to the poor.

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House on Henry Street

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nurses Lillian Wald and Mary Brewster established this district nursing service on the Lower East Side of New York City in 1893.

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Joseph Lister

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observed the healing processes of fractures. When the bone was broken but the skin was not, he noted that recovery was uneventful. However, when both the bone and the skin were broken, fever, infection, and even death were frequent. He found that something outside the body entered the wound through the broken skin causing the infection. Lister's surgical successes eventually improved when he soaked the dressings and instruments in mixtures of phenol and oil.

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John Snow

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demonstrated that cholera was transmissible through contaminated water in 1854.

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Lemuel Shattuck

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a Boston bookseller and publisher with an interest in public health who organized the American Statistical Society in 1839 and issued a Census of Boston in 1845.

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Lillian Wald

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early twentieth-century community health nurse and political activist who recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912.

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Louis Pasteur

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proposed the existence of germs while experimenting with wine production in 1854.

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Robert Koch

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a nineteenth century scientist who discovered the causative agent for cholera and the tubercle bacillus (for tuberculosis).

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sanitary revolution

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a period in the nineteenth century when a link was established between microorganisms and infectious disease.

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stages in disease history

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hunting and gathering stage, settled villages stage, preindustrial cities stage, industrial cities stage, and present stage.

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age-adjustment of rates

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method of reducing bias when there are differences in the age distributions of two populations being compared.

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age-specific rates

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rates that characterize a particular age group in the population, usually with regard to deaths and births.

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analytic epidemiology

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method that investigates the causes of disease by determining why a disease rate is lower in one population group than in another.

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attack rate

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a type of incidence rate defined as the proportion of agent-exposed persons who develop the disease, usually for a limited time in a specific population.

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cause and effect relationship

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a relationship that is determined to exist after certain criteria are met. The criteria are strength of association, dose-response relationship, temporally correct relationship, biological plausibility, consistency with other studies, and specificity.

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crude rates

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rates that summarize the occurrence of births (crude birth rate), deaths (crude death rates), or diseases (crude disease rates) in the general population. The numerator is the number of events, and the denominator is the average population size or the population size at midyear (usually July 1) multiplied by a constant.

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descriptive epidemiology

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a form of epidemiology that describes a disease according to its person, place, or time.

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ecosocial epidemiology

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a form of epidemiology that focuses on the sequencing of genes to determine individual susceptibility to various diseases.

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epidemiological triangle

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an organized method of inquiry to derive an explanation of disease which analyzes three elements: agent, host, and environment.

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epidemiology

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the study of the distribution and determinants of health and disease in human populations.

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incidence rates

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rates that describe the occurrence of new cases of disease or condition (e.g., teen pregnancy) in a community over a period of time, relative to the size of the population at risk for that disease or condition during that same period.

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morbidity rates

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rates of illness.

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mortality rates

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rates of death.

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natural history of disease

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course or progression of a disease process from onset to resolution.

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person-place-time model

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“who” factors, such as demographic characteristics, health, and disease status; “where” factors, such as geographical location, climate and environmental conditions, and political and social environment; and “when” factors, such as time of day, week, or month, and secular trends over months and years.

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prevalence rate

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the number of all cases of a specific disease or condition (e.g., deafness) in a population at a given point in time, relative to the population at the same point in time.

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proportionate mortality ratio (PMR)

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number that represents the percentage of deaths resulting from a specific cause relative to deaths from all causes.

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rates

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arithmetic expressions that allow one to consider a count of an event relative to the size of the population from which it is extracted.

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risk

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the probability of an adverse event.

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risk factor

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a variable that increases the rate of disease in people who have them (e.g., a genetic predisposition) or in people exposed to them (e.g., an infectious agent or a diet high in saturated fat).

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screening program

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a secondary prevention activity that identifies risk factors and diseases in their earliest stages.

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standardization of rates

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method of reducing bias when there are differences in the age distributions of two populations being compared.

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surveillance

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a mechanism for the ongoing collection of health information in a community.

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web of causation

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a model that can be used to illustrate complex interrelationships of factors interacting with each other to influence the risk for, or distribution of, health outcomes.

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aggregates

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population subgroups in a community made up of people who share one or more common characteristics.

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census tracts

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population boundaries that subdivide larger communities and are used expressly for data collection and population assessment by the U.S. Bureau of the Census.

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community diagnosis

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consists of four components: identification of the health problem or risk, aggregate or community affected, etiological or causal statement, and evidence or support for the diagnosis.

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community of solution

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individuals coming together because of a common problem.

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Healthy Cities and Healthy Communities

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a movement whose purpose is to help community citizens bring about positive health changes in their communities; stresses that interconnectedness among people and among public and private sectors is essential for a community to address causes of poor health.

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metropolitan statistical areas

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large metropolitan areas that consist of a central city with more than 50,000 people and include the associated suburban or adjacent counties, which yields a total metropolitan area with more than 100,000 people.

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needs assessment

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collection of data about a community's health status, concerns, and services they use or require.

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social system

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interacting members making up various subsystems within the community which provide members with socialization, role fulfillment, goal achievement, and support.

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vital statistics

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the official registration records of births, deaths, marriages, divorces, and adoptions.

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windshield survey

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survey by driving through a community and making observations in an organized fashion.

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certificate of need (CON)

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often required before medical facilities are created.

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community as client

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focus on groups of people as the unit of care.

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health planning

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efforts taken to promote health. It varies when applied to different aggregate levels. Health planning with an individual or a family may focus on direct care needs or self-care responsibilities; at the group level, the primary goal may be health education; and at the community level, health planning may involve prevention of diseases within a population or control of environmental hazards.

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health planning model

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a model that applies the nursing process within a systems framework to the larger aggregate, with the objective of improving the health of this aggregate.

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Hill-Burton Act

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(also known as the Hospital Survey and Construction Act) passed in 1946 to provide federal aid to states for hospital facilities.

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key informant

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a formal or informal leader in the community who provides data that is informed by his or her personal knowledge and experience with the community.

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National Health Planning and Resources Development Act

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passed in 1974; combined the strengths of the Hill–Burton Act, regional medical programs, and the comprehensive health planning program to forge a new system of single–state and area-wide health planning agencies.

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Partnership for Health Program

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federal amendments passed in 1966 and 1967 that provided federal grants to states to set up local health agencies to enact health care planning

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Regional Medical Programs (RMPs)

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begun in 1965, the intent of the programs was to make the latest technology for the diagnosis and treatment of leading causes of death available to community health care providers through the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals.

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cognitive theory

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premise that individuals learn by processing information, reflective thinking, and problem solving. Behaviors are determined by perceptions and past learning experiences.

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community-based participatory methods

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methods that involve community participation and highlight community strengths.

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community empowerment

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a combination of process and outcome of organized community members gaining control over their lives.

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culturally effective care

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care that exhibits sensitivity to the differences in individuals based on their vast experiences and responses due to their backgrounds, sexual orientation, socioeconomic status, ethnicity, and cultural background.

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health disparities

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refers to the wide variations in health services and health status among certain population groups. Examples are the growing problems of access to medical care; differences in treatment based on race, gender, and ability to pay; and related issues such as urban versus rural health, insurance coverage, Medicare and Medicaid reimbursement for care, and satisfaction with service delivery.

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health education

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the process of assessing individuals, acting separately or collectively, to make informed decisions on matters affecting individuals, family, and community health.

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health literacy

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the capacity to read, comprehend, and follow through on health information.

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humanistic theories

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theories that describe the influence that feelings, emotions, and personal relationships have on behavior. If people are given free choice, they will do what is best for them.

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learner verification

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process that engages intended members in dialogue and helps to uncover unsuitable aspects of the material, whether in content, visuals, or format.

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learning

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an enduring change that may involve a modification of insights, behaviors, perceptions, motivations, or a combination of these.

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materials and media

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the tools of a program, not the program itself.

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participatory action research

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intervention that calls for nurses, community members, and other resource people to work together in identifying environmental health problems that should be investigated, designing the studies, collecting and analyzing the data, disseminating results, and posing solutions to the problems.

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problem-solving education

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result of Paulo Freire's work in the 1950s. It encourages learners to be critical thinkers and reflective about health issues.

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social learning theory

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theory based on explaining behavior and enhancing learning through the use of the concepts of efficacy, outcome expectations, and incentives.

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care management

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consists of programs that apply systems, science, incentives, and information to improve medical practice and to allow clients and their support systems to participate in a collaborative process with a goal of improving medical, social, and mental health conditions more effectively.

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case management

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the process by which health care services are organized and coordinated to meet client needs.

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client-centered case management

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assistance for the client to guide him or her through a complex, fragmented, and often confusing health care delivery system and to achieve specific client-centered goals.

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continuum of care

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coordination of long-term care services.

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discharge planning

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patient assessment and the development of a comprehensive discharge plan for post-hospital care.

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public health

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organized efforts made through governmental agencies such as health departments, which are authorized by legislation, serve all people, and are supported by taxes.

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system-centered case management

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efficient use of resources that are goal directed and time limited.

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utilization review

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the monitoring of service utilization for the management of patient populations with diverse resource needs.

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Accreditation

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a means to assess the quality of services and care of an organization. Specific minimum standards must be met by an organization in order to obtain accreditation.

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alternative therapies

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therapies not considered mainstream health care, such as massage therapy, herbal therapy, healing touch, energetic healing, acupuncture, and acupressure

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Client rights

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rights that clients have regarding their own health.

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Community health center

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Developed thru federal funds in the 1960s, addresses broader inputs into health such as education and housing

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Health care reform

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Government and private efforts to improve health care services

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Managed care

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Any method of health care delivery designed to reduce unnecessary utilization of services, increase cost containment and cost-effectiveness, and ensure high quality care

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managed care organizations (MCOs)

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groups of health care providers designed to implement managed care, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), integrated delivery systems (IDSs), and physician hospital organizations (PHOs).

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Medicaid

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Title XIX Social Security Amendment (1965), a combined federal and state program. The program provides access to care for the poor and medically needy of all ages.

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Medicare

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Title XVIII Social Security Amendment (1965), a federal program administered by the Health Care Financing Administration, which pays specified health care services for all persons older than 65 years who are eligible to receive Social Security benefits.

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outcomes measures

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measurement of the outcomes of care.

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Public health

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Organized efforts made thru governmental agencies such as health departments, which are authorized by legislation, serve all people and are supported by taxes

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Quality care

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Care designed to reduce illness, injury and disability and improve health and functioning

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Telehealth

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Health care provided to clients via technology, such as computer, video or interactive television

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acquired immunity

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derived from actual exposure to the specific infectious agent, toxin, or appropriate vaccine.

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active immunity

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is when the body produces its own antibodies against an antigen, either from infection with the pathogen or introduction of the pathogen in a vaccine.

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agent

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causative factor invading a susceptible host through an environment favorable to produce disease, such as biological or chemical agent.

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antigenicity

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stimulates an immune response in the host.

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case

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an episode of illness or injury.

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cold chain

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a system used to ensure that vaccines are kept at a designated temperature from the time they are manufactured until they are used for vaccination.

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communicable disease

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a disease of human or animal origin caused by an infectious agent and resulting from transmission of that agent from an infected person, animal, or inanimate source to a susceptible host. Infectious disease may be communicable or noncommunicable (e.g., tetanus is infectious but not communicable).

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communicable period

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follows latency and begins with shedding of the agent. Frequently the communicable period begins before symptoms are present.

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control

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the reduction of incidence or prevalence of a given disease to a locally acceptable level as a result of deliberate efforts.

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direct transmission

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the immediate transfer of an infectious agent from an infected host or reservoir to an appropriate portal of entry in the human host through physical contact.

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elimination

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controlling a disease within a specified geographical area, such as a single country, an island, or a continent, and reducing the prevalence and incidence to eventual eradication.

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endemic

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the constant presence of an infectious disease within a specific geographic area.

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environment

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the accumulation of physical, social, cultural, economic, and political conditions that influence the lives of communities. (Chapter 14); that which surrounds the human host and where transmission of an infectious agent is occurring.

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epidemic

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the occurrence of an infectious agent or disease within a specific geographical area in greater numbers than would normally be expected.

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eradication

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reducing the incidence of a disease worldwide to zero as a function of deliberate efforts, with no need for further control measures.

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fomites

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any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).

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herd immunity

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a state in which those not immune to an infectious agent will be safe if at least 80% of the population has been vaccinated or is otherwise immune.

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host

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a living human or animal organism in which an infectious agent can exist under natural conditions.

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immunity

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the body's ability to protect itself from infection.

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immunization

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process of introducing a vaccine or toxoid to produce active or passive immunity in the recipient.

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incidence

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in epidemiology, the number of new cases of infection or disease that occur in a defined population in a specified period of time.

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incubation period

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the time from invasion to the time when disease symptoms first appear.

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indirect transmission

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the spread of infection through vehicle fomites, animals, and vectors that carry a parasite or pathogen to a suitable portal of entry in the human host.

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infection

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the entry and multiplication of an infectious agent in a host.

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infectious disease

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any communicable disease, or one that can be transmitted from one human being to another or from animal to human by direct or indirect contact.

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infectivity

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the power to invade and infect large numbers of people.

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isolation

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the separation of a seriously ill patient from others to prevent the spread of an infection or to protect the patient from irritating environmental factors.

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latency

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the period of replication before shedding.

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multicausation

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principle that emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host.

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natural immunity

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an innate resistance to a specific antigen or toxin

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notifiable infectious diseases

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infectious diseases that are designated by the Centers for Disease Control and Prevention as “nationally notifiable.” Health care providers who encounter these diseases must report them to the local or regional health department.

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outbreak

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refers to the unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time.

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pandemic

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a worldwide outbreak of an epidemic disease. (Chapter 2); a steady occurrence of a disease over a large geographic area or worldwide, such as malaria in Africa.

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passive immunity

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the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, and antitoxins, or from mother to neonate transplacentally.

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pathogenicity

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the power of an organism to produce disease.

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portal of entry

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the route by which an infectious agent enters the body, such as through nonintact skin.

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portal of exit

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the route by which an infectious agent leaves the body, such as through respiratory secretions, saliva, or blood.

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primary vaccine failure

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the failure of a vaccine to contribute any level of immunogenicity; can be caused by improper storage that may render the vaccines ineffective, improper administration route, or light-sensitive vaccines exposed to light.

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quarantine

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isolation of people with communicable disease or those exposed to communicable disease during the contagious period in an attempt to prevent spread of the illness.

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reservoir

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the site where the agent (organism) is naturally found. A carrier can serve as a reservoir.

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resistance

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the ability of an organism to remain unaffected when exposed to an infectious agent.

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secondary vaccine failure

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the waning of immunogenicity after eliciting an initial immune response that fades over time.

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subclinical infection

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an infection that is so mild it produces no symptoms.

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susceptible

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at risk for contracting an infection or developing an infectious disease.

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toxigenicity

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that which produces a toxin.

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universal precautions

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set of guidelines, developed by the Centers for Disease Control and Prevention in the 1980s, to prevent transmission of diseases found in blood and body fluids.

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vaccination

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the administration of a vaccine or toxoid, which confers active immunity by stimulating the body to produce antibodies.

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Vaccine Adverse Events Reporting System (VAERS)

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a program that takes reports of specific postvaccination “adverse events” in order to monitor actual and potential vaccine-related problems.

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vectors

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nonhuman organisms, often an insect, that either mechanically or biologically play a role in the transmission of an infectious agent from source to host.

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virulence

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a term used to assess the strength of an organism.