2 types of communities
geopolitical & phenomenological
geopolitical
type of community with geographic area/place; borders and boundaries
phenomenological
type of community with members feeling of belonging; church, school, hospital floors, businesses
population at risk
those more prone to disease and infection; elderly, infants, pregnant women, psych patients, those without medical resources
target population
those you select for a certain study or intervention
vulnerable populations
those who are at risk for everthing; elderly, immunocompromised, infants, poor, prisoners
1. prevents: epidemics, disease spread-west nile, injuries-car accidents
2. protects: environmental hazards-BP oil spill
3. promotes: healthy behavior-fit for life
4. responds: disaster and community assistance-LAVA
5. assures: quality and accessible heal
what does public health do? (5 functions)
monitors health status, diagnose and, inform, develops policies and plans, enforces laws and regulations, link people to services, partnerships, assures a competent workforce, evaluates effectiveness, accessibility and quality, researches
essential services of public health
community oriented nursing practice
provide health care t/ community diagnosis and investigation of major health and environmental problems, health surveillance, monitoring and evaluation of community health status, to prevent disease and disability, promoting, protecting and maintaining he
community based nursing practice
care is provided for sick individuals and families. emphasis is on acute and chronic care
community oriented nursing
focus on health of individuals and groups. goal: preserve, protect, promote or maintain health. clients are individuals, families, groups at risk. group oriented: personal health management. community advocate. case finder
community based nursing
focus on illness of individuals and families. manage acute or chronic conditions. clients are individuals and families. group oriented: disease management
1. values of society at the time
2. knowledge available at the time
3. a reactive rather than proactive approach to change
community nursing roles
mosaic law and other ancient codes- babylonians, egyptians, greeks, romans
where did most of our HC come from in the earlier days?
medications and hygiene
ancient babylonians knew about what regarding health?
sanitation, earth privies, public drainage systems, irrigation
egyptians knew about what regarding health?
mosaic law
old testament included prescriptions for maternal health, communicable disease control, protection of food and water and waste and sanitary disposal
ill health be associated with bad air, bad water, swamps, sewage, debris and lack of personal cleanliness
what did the romans believe ill health was r/t?
elizabethan poor law 1601
guaranteed medical care for poor, blind and lame individuals
american colonial period 1700s
era where township government responsible for care. must be resident of the community. documents collected birth and death. collected statistics. sanitation, communicable diseases, shattuck report, women provided care, boards of health, problems with infa
shattuck report
called for major improvements in state government action for public health. first proposal for modern approach to public health organizations. establish state and local health deparments, sanitary surveys and collection of vital statistics: census, enviro
WWI
war era where it called for increase need for education
nurses served at home and abroad
flu epidemic broke out
categorical funding
funding for priority diseases or groups
ex: maternal and child service, venereal diseases, TB
early 20th century
era where nursing education was 2 years, influenza epidemic after WWI, metro life insurance co., sheppard-towner act, FNS
economic depression
era where there were dec. funds for nursing, unable to meet poors needs, FERA supported nurses and prevented agency closure, SS 1935-funds, WWII inc. need for nurses
WWII
war era called for inc. demand for nurses-cadet nurse corp and provided gov. funding nursing education, increased demand for PH dpts. to screen and treat diseases like communicable disease, STDs
1970s to present
era where HC costs grew, NP's inc., responsibility was in the hands of the clients, concerns were now on cost, quality and access to services
1. demographic- inc. population, motality rates dec., chronic infections
2. social/economic-inc. of QOL, inc. in income, gap bw poorest and richest is widening
3. HC workforce-shortage of nurses, reducing bed capacity, growth of older age group
4. technol
4 trend forces stimulating demand for HC
1. consumers want low cost and high quality HC and choose their own providers
2. employers want basic health care plans at reasonable costs for their employees
3. HC system want a better balance bw consumer and purchaser demands
4. legislation-laws concer
4 forces influencing the HC system of the future
1. health care
2. public health promotion and protection, disease prevention, and emergency preparedness
3. human services
4. scientific research and development
4 goals for USDHHS
improve health and safety
national health performance standards program's goal
1. assessment
2. policy development
3. assurance
3 core public health goals
1. political-communication, political activism
2. business-understanding budgets, managing w/i budgets, marketing
3. program leadership skills- applying principles of leadership and epidemiology, developing health promotion program, implementing policy ch
4 skills needed for leadership in PHN
centers for medicare and medicaid services (CMS)
who administers medicaid and medicare?
medicare: local social security administration office
medicaid: state welfare office
where to obtain information for medicare/medicaid
insurance
what type of program is medicaid and medicare?
medicare: federal
medicaid: all states
governmental affiliation for medicare? medicaid?
all states
who has availability to medicare and medicaid?
medicare: medicare trust fund, mandatory payroll deduction, recipient deductibles, trust fund interest
medicaid: federal and state governments
financing of hospital insurance for medicare and medicaid?
medicare: recipient premium payments, general revenue, US treasury
medicaid: federal and state governments
financing of medical insurance for medicare and medicaid?
medicare
persons eligible: 65+ years, permanently disabled, end-stage renal disease
medicare part A
part of medicare that covers inpatient hospital, skilled nursing facility, some home health
medicare part B
part of medicare that is voluntary but required by some retirement plans. not "free" health care-must be purchased. coverage: eligible physician service, outpatient hospital services, certain home health services, durable medical equipment (O2 tank)
medicare part C
part of medicare that is a combo of A and B; additional coverage for prescriptions, 4 types: HMO, POS, PPO, PFFS
medicare part D
part of medicare that covers prescription drugs but excludes: weight loss or gain, fertility, erectile dysfunction, cosmetic purposes, coughs or colds, vitamins or minerals
medicaid
financial assistance to states and counties to pay for medical services for the poor OAs, blind, disabled and families with dependent children; state and federal government partnership. includes: inpatient and outpatient hospital care, physician services,
assessment
PH core function
-monitor health status to ID health problems
-diagnose and investigate health problems and health hazards in the community
policy development
PH core function
-inform, educate, and empower people about health issues
-mobilize community partnerships to ID and solve health problems
-develop policies and plans that support individual and community health efforts
assurance
PH core function
-enforce laws and regulations
-link people to needed services
-ensure a competent PH and personal health workforce
-evaluate effectiveness, accessibility, and quality of services
disparities
racial/ethnic differences in the quality of HC, not based on access or clinical needs, preferences, or appropriateness of an intervention
globalization
trend toward an increased flow of goods, services, money and disease across national borders
institute of medicine (IOM)
part of the national academy of sciences and an organization whose purpose is to provide national advice on issues relating to biomedical science, medicine and health
state children's health insurance program (SCHIP)
-created by the balanced budget act
-builds on medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for medicaid
-state administered
-federal allocations are set and new costs to the program must be met by the stat
HMO
type of managed care where comprehensive care is provided to plan members for a fixed, "per member per month" fee
PPO
type of managed care where predetermined rated are established for services to be delivered to members; include hospital and physician providers, discounted rate setting, financial incentives, expedited claims' payment to providers