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Flashcards in Community Health Nursing Theories Deck (37)
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Nightingale's Theory of Environment Health Belief Model

+ Focuses on relationship between an individual's environment and their health.
+ Focus is on PREVENTATIVE CARE (washing hands, clean environment).

+ Purpose is to predict or explain health behaviors.
+ Emphasizes change at the individual level
+ Assumes a person's primary motivation in taking positive health actions is to AVOID GETTING A DISEASE.

+ Modifying variables (age, gender, race, economy, education)
+ Perceived severity and susceptibility of getting the disease
+ Perceived benefits vs barriers of taking action
+ Cues to action (i.e. adviser of doctor, media campaigns)


** Who is the client in Community Health Nursing?
Community-Based Nursing vs. Community Oriented Nursing

The COMMUNITY OR POPULATION is the "client" in community health nursing.

COMMUNITY-BASED NURSING: Is focused on ILLNESS CARE (acute or chronic conditions) for INDIVIDUALS AND FAMILIES. Examples: Home Health nurse doing wound care, School nurse administering epilepsy-pen.

COMMUNITY-ORIENTED NURSING: is focused on improving the collective health of the COMMUNITY. Examples: health education and promotion, disease prevention activities. NO Illness care! Community-orie ted nursing=public health nursing.


** Community Health Nursing vs. Public Health Nursing

COMMUNITY HEALTH NURSING: delivers health care services to INDIVIDUALS, FAMILIES, AND GROUPS. Includes community-based nursing (illness care for individuals and families) AND community-oriented nursing (community-focused care, with an emphasis on education and disease prevention).

PUBLIC HEALTH NURSING: Disease prevention and health promotion of COMMUNITIES AND POPULATIONS. They are not providing direct care to individuals! Public health nursing=community-oriented nursing.


** Ethical Principles in Community Health Nursing

RESPECT FOR AUTONOMY: Respect a patient's rights to self-determination.


BENEFICIENCE: Do what is best (i.e. maximize benefits).

DISTRIBUTIVE JUSTICE: Fair allocation of resources in community.


What is Epidemiology?
Components of the Epidemiology Triangle

EPIDEMIOLOGY: Study of spread, transmission, and incidence of disease/injury.

+ AGENT: What is causing the disease (ex: bacteria, toxin, noise)
+ HOST: Human/animal being affected by the disease
+ ENVIRONMENT: Physical environment (water/food supply, geography). Social environment (access to health care, work condition, poverty).


Incidence vs. Prevalence

INCIDENCE: Number of NEW cases of disease/injury in a population during a specified time period of time.

PREVALENCE: Number of ALL cases (new and pre-existing) of disease/injury in a population during a specified period of time.


Community Health Education: Obstacles, Learning Styles
What is Healthy People 2020?

+ OBSTACLES: Age, culture, literacy, language barriers, lack of access, lack of motivation.
+ LEARNING STYLES: VISUAL (videos, presentations), AUDITORY (vernal lectures, discussions), TACTILE-KINESTHETIC (hands-on, return demonstration).

HEALTHY PEOPLE 2020: includes national health goals based on major risks to health and illness of U.S. population (examples: Diabetes, Cancer, Older Adults, LGBT health). See website for complete list.


** Primary vs. Secondary vs. Tertiary Prevention

+ Examples: education, immunizations, prenatal classes.

SECONDARY PREVENTION: Focuses on EARLY DETECTION of disease, limiting severity of disease.
+ Examples: screenings disease surveillance, control of outbreaks.

TERTIARY PREVENTION: Maximize recovery AFTER and injury/illness.
+ Examples: rehabilitation, PT/OT, support groups.


What is acculturation?
What is ethnocentrism?
Components of Cultural assessment
Use of Interpreter

ACCULTURATION: Adopting the traits of a different culture.

ETHNOCENTRISM: The belief that one's own culture is superior to all others. View world from their own cultural viewpoint.

CULTURE ASSESSMENT: Ask about patient's ethnic background, religious preference, family structure, food patterns, and health practices. Incorporate patient preferences into care whenever possible.

INTERPRETER: Use of family members is NOT recommended, interpreters need to have knowledge of health terminology. Patient teaching materials should be available in their primary language.


Environmental Risks (3 main risks)
Environmental Assessment Questions

+ TOXINS (examples: lead, pesticides, asbestos, radon)
+ AIR POLLUTION (examples: carbon monoxide, tobacco smoke, lead)
+ WATER POLLUTION (examples: waste produces, chemical runoff from soil)

+ Condition of housing. Remodeling activities?
+ Water heater temperature less than 120 DEGREES FARENHEIT?
+ Occupation (including exposure to chemicals, toxins)?
+ Tobacco smoke present in home?
+ Quality of drinking water?


Lead Exposure key points

+ Screen children 6 months -5 years for blood lead levels
+ Avoid playing in soil right outside home
+ Wet mop floors (vs. vacuuming floors)
+ Use wet sanding technique (vs. dry sanding)
+ Make sure children get enough iron and calcium in diet, as this decreases absorption of lead in the body.
+ Use cold water (vs. hot water) because lead dissolves more quickly in hot water.


Medicare: Who is eligible? Parts A, B, C, D

Medicaid: Who is eligible?

+ Older than 65 years
+ Receiving disability for at least 2 years
+ Diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-stage Renal disease (ESRD) and receiving dialysis.

PART A: Inpatient hospital, limited SNF, home health care
PART B: Outpatient care, diagnostic services, PT/OT
PART C: Combines Part A and B, provided through private insurance
PART D: Prescription drug coverage (D is for Drug)

MEDICAID ELIGIBILITY: Those with low socioeconomic status and no other insurance, based on household size and income.


Responsibilities of:
+ State Department of Health
+ State Board of Nursing
+ Local Health Department

STATE DEPARTMENT OF HEALTH: manages WIC program, CHIP, Medicaid program. Reports notifiable communicable disease to CDC (voluntary).

STATE BOARD OF NURSING: Licenses LPNs and RNs, oversees state schools of nursing, develops state's nurse practice act.

LOCAL HEALTH DEPARTMENT: Meets health needs of community. Reports notifiable communicable diseases to State Department of Health.


Parts of a Community Assessment:
+ People
+ Environment

+ Demographics
+ Biological factors (race, age, gender, health/disease status)
+ Social factors (education, income, crime rate)
+ Cultural factors (history, religion, customs)

+ Physical factors (geography, housing, location of health care services)
_ Environmental factors (climate, pollutants, topography).


Types of data collection in Community Nursing

INFORMANT INTERVIEWS: direct conversations with member of community.

COMMUNITY FORUM: public meeting (participation challenges).

SECONDARY DATA: review existing data available (statistics, health records).

PARTICIPANT OBSERVATION: observe community activities.

WINDSHIED SURVEY: literally drive through community and make observations.

FOCUS GROUPS: meet with representative sample of community.

SURVEYS: written format (expensive, low response rate)


** Windshield Survey: What are you looking for?

PEOPLE: General appearance, ethnicity/race of community members. Signs of violence? Mental illness? Drug abuse?

PLACE: Quality of housing, access to health care facilities, types and availability of grocery stores, public transportation, presence of schools, parks, and churches.


** Steps in developing and managing a Community Health Plan

PRE-PLANNING: Brainstorm ideas

ASSESSMENT: Data collection

DIAGNOSIS: Analyze collected data to determine health needs of the community. Set priorities.

PLANNING: Plan interventions. Establish goals, identify responsibilities, develop budget.


EVALUATION: Determine effectiveness of intervention


Home Health Nurse: Where do they work? What do they do?

+ Provides health care in patient's home and assisted living facilities (including nursing homes).
+ Provides patient education, direct nursing care, and CARE COORDINATION (including referrals).
+ Assesses home for safety. Key items to look for: NO SCATTER RUGS (carpet OK), no clutter, adequate lighting on stairs (use of colored tape on step edges is helpful). For Alzheimer's patients, locks/alarms on exit doors are appropriate.


Hospice Nurses: What do they do?

Parish Nurses: What do they do?

HOSPICE NURSE: Provides palliative care (focus on SYMPTOM MANAGEMENT, not curing disease), supports patient and family with dying process

PARISH NURSE: Works w/pastoral staff to improve the health and wellness of the faith community. Provides health education and facilitates support groups. Does NOT do bedside nursing tasks.


Occupational Health Nurse: What do they do?
** Primary, Secondary, Tertiary prevention interventions

+ Promotes health and wellness of employees, prevents workplace illness and injury.
+ Through surveillance, identifies risks within work environment. Identifies ways to decrease or eliminate workplace hazards.
+ Keeps informed about OSHA standards.

PRIMARY PREVENTION: provides safety education
SECONDARY PREVENTION: performs screenings.
TERTIARY PREVENTION: sets up limited-duty programs


School Nurse: What do they do?
** Primary, Secondary, Tertiary prevention interventions

+ Provides direct nursing care to children at school
+ Provides health education
+ Case manager for children w/health needs (makes referrals, schedules appointments, coordinates services)

PRIMARY PREVENTION: Assesses immunization status of children
SECONDARY PREVENTION: Provides vision and hearing screening, screens for oral health, scoliosis, infestations. Assesses for child abuse/neglect.
TERTIARY PREVENTION: Administers medications, provides nursing care for children with chronic diseases, assesses children with disabilities.


Key health concerns for: Children, Adolescents, Women, Men, Older Adults

INFANTS/CHILDREN: SIDS (sleep on back), injuries (wear helmets and seat belts), communicable diseases (get immunizations).

ADOLESCENTS: MOTOR VEHICLE ACCIDENTS (WEAR SEATBELTS), substance abuse (including smoking), safe sex, mental health.

WOMEN: Menopause, OSTEOPOROSIS (ENCOURAGE WEIGHT BEARING EXERCISE), heart disease, diabetes, cancer prevention (get mammograms, pap smears).

MEN: Heart disease, cancer prevention (GET PROSTATE CANCER SCREENING, testicular self exams), lung disease, liver sides.

OLDER ADULTS: Heart disease, CVAs, COPD, pneumonia, polypharmacy, cancer, injury prevention (including falls)>


Families: What are transitions? Impact on family? What are genograms? What are eco maps?

TRANSITIONS: Includes birth or adoption of child, death in family, major illness, divorce, loss of income, etc. TRANSITIONS = TIME OF RISK FOR FAMILY.

GENOGRAMS: Graphical representation of relationships within the family, patterns of illness (i.e. "enhanced" family tree).

ECOMAPS: Graphical representation of family interaction with outside groups/organizations, which provides information about the family's support network,.


Types of Violence

HOMICIDE: often related to drug abuse, usually victim is someone known to perpetrator. Males at higher risk.

RAPE: intimate partner violence very common; often unreported.

SUICIDE: highest in men, and those OVER 65 YEARS OLD.

ABUSE: physical abuse, sexual abuse, emotional abuse (i.e. humiliation, intimidation), neglect (i.e. failure to provide food, shelter, emotional care, medical care, education), economic abuse (ie. misuse of money, failure to provide for needs of victim despite adequate funds, theft).


Community Factors that increase risk of violence
Child Abuse: Signs of Child Abuse and Neglect

COMMUNITY FACTORS THAT INCREASE RISK OF VIOLENCE: Unemployment, poverty, social isolation. Child abuse is more common when spousal abuse is present.

SIGNS OF CHILD ABUSE: PRESENCE OF WOUNDS OR INJURIES IN VARIOUS STATES OF HEALING, unexplained bruises/injuries, unusual fear of others, small round burns that could be cause by cigarettes, forearm spiral fractures.

SIGNS OF CHILD NEGLECT: poor hygiene, inappropriate dress (for weather), signs of malnourishment withdrawal, school absences.


Alcohol Abuse:
+ Factors that impact metabolism of alcohol
+ Alcohol withdrawal timing, symptoms
+ Primary vs. Secondary vx. Tertiary prevention interventions

FACTORS THAT AFFECT ALCOHOL METABOLISM: Size/weight of drinker, time elapsed while drinking, gender, presence of food in stomach.

ALCOHOL WITHDRAWAL: MANIFESTATIONS APPEAR WITHIN 4-12 HOURS. Symptoms include: tachycardia, hypertension, N/V, headache, anxiety/irritability, diaphoresis, tremors, seizures. It is important to ask patient when their last drink was!

PRIMARY PREVENTION: public education campaigns, school education.

SECONDARY PREVENTION: Screen individuals for signs of abuse.

TERTIARY PREVENTION: Refer patients to AA or NA, promote coping and lifestyle changes.


HOMELESSNESS: Fastest growing segment? Risk Factors? Key health issues in homeless population? VETERANS: Key health issues

+ RISK FACTORS: unemployment, migrant workers, veterans, mental illness, substance abuse, HIV/AIDs, at-risk youth.
+ KEY HEALTH ISSUES: tuberculosis, infestations (scabies/lice), substance abuse, HIV/AID, mental illness.

KEY HEALTH ISSUES OF VETERANS: mental health issues (PTSD, depression), substance abuse, suicide, traumatic brain injury, spinal cord injury, amputations.


Migrant Workers:
+ Key health risks
+ Primary vs. Secondary vs. Tertiary prevention interventions

KEY HEALTH RISKS: Tuberculosis, dental disease, skin cancer, diabetes, obesity, high risk of suicide, increased work-related injuries (exposure to pesticides, injuries from machinery).

PRIMARY PREVENTION: Education on reducing exposure to pesticides, accident prevention. Preventative care (immunizations, dental care).

SECONDARY PREVENTION: Screen for skin cancer, pesticide exposure, communicable diseases.

TERTIARY PREVENTION: Provide ER or primary care services including treatment of symptoms of pesticide exposure.


** Communicable Diseases: Modes of transmission

Airborne, Food-borne, Vector-borne, Sexually transmitted, Direct contact, Saliva

AIRBORNE: chickenpox, measles, tuberculosis, pertussis, influenza

FOODBORNE: salmonella, hepatitis A (fecal-oral route), E-coli, botulism

WATERBORNE: cholera, typhoid fever

VECTOR-BORNE: (ex: mosquito or tick) lyme disease, malaria, Rocky Mountain spotted fever


DIRECT CONTACT: lice, scabies, impetigo

SALIVA: mononucleosis


** Immunity: What is Herd Immunity?

Types of Immunity: Active natural, Active artificial, Passive natural, Passive artificial

HERD IMMUNITY: Most community members have immunity, protecting those who can't (or choose not to get) immunized. Makes exposure unlikely.

ACTIVE NATURAL IMMUNITY: Body produces antibodies in response to exposure to live pathogen.

ACTIVE ARTIFICIAL IMMUNITY: Body produces antibodies in response to vaccine.

PASSIVE NATURAL IMMUNITY: Antibodies are passed from the mom to her baby through the placenta or breast milk.

PASSIVE ARTIFICIAL IMMUNITY: Immunoglobulins are administered to an individual after they have been exposed to a pathogen.