Nightingale's Theory of Environment
Highlights the relationship between an individual's environment and health. Depicts health as a continuum. Emphasizes preventative care.
Health belief model
purpose is to predict or explain health behaviors. Preventative health to avoid disease. Emphasizes change at the individual level.
Milo's framework for prevention
Complements the health belief model. Emphasizes change at the community level. Identifies relationship between health deficits and availability of health-promoting resources. Theorizes that behavior changes within a large number of people can ultimately l
Community or population
an aggregate who shares one or more personal characteristics within the community is the client in community health nursing
community-based nursing
focus: individuals and families
Activities: management of acute and chronic conditions where individuals, families, groups live, work and attend schools.
Community-oriented nursing
Focus: at risk individuals, families, groups. Community.
Activities: determining the health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community.
Community health nursing practice
Focus: synthesis of nursing and public health theory.
Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact "community health
Public health nursing practice
Focus: synthesis of nursing and public health theory
Activities: promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole.
Core functions:
systematic assessment o
Autonomy
individuals select those actions that fulfill their goals
nonmaleficence
no harm is done when applying standards of care
beneficence
to do good and max benefits
distributive justice
fair distribution of the benefits and burden in society
Advocacy
the nurse plays the role of informer, supporter, and mediator for the client. Clients are responsible for their own health.
Epidemiology
study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection.
Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. BROAD underst
Epidemiology
study of the relationships among an agent, a host, and an environment (epidemiological triangle)
Agent
animate or inanimate object that causes disease
host
living being that is affected by the agent
environment
setting or surrounding that sustains the host
Incidence
number of new cases of disease
Prevalence
number of existing cases of disease in the population
Crude mortality rate
number of deaths divided by the population total
infant mortality rate
number of infant deaths before 1 year of age in a year divided by the numbers of live births in the same year time 1,000
Epidemic
when the rate of disease exceeds the usual level of the condition in a defined population
Primary prevention
Prevention of the initial occurrence. Education, immunizations, prenatal classes.
Secondary prevention
limiting severity and adverse effects. Screenings, community assessments.
Tertiary prevention
Recovery after an illness. Nutrition counseling, case management, exercise for hypertensive clients.
Access to health care
is impacted by the availability of services in a community, as well as individual, family, and community circumstances
world health organization
provides daily information regarding the occurrence of internationally important diseases. Establishes world standards for antibiotics and vaccines. Primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, ma
Federal health agencies
U.S. department of health and human services
-under direction of the secretary of health
-funded through federal taxes
Consists of Children and Families, community living, Medicare and medicaid, HIPPA, SSI, AFDC
Medicare
older than 65 and receiving social security, have been receiving disability benefits for 2 years, have amytrophic lateral sclerosis, and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to quali
Medicaid
coverage for low socioeconomic status and children, through the federal and state governments. Eligibility is based on household size and income. Priority to children, pregnant women, and those who are disabled.
State departments of Health
Manages women, infants and children (WIC) program
oversees children's health insurance program, which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid. Establishes public health policies. Provides assistance
State boards of nursing
development and oversight of the state's nurse practice act. Licensure of registered and licensed practical nurses. Oversight of the state's schools of nursing.
Local health department
primary focus is the health of its citizens.
offer various services and programs. Report notifiable communicable diseases to state departments of health. funded through local taxes with support from federal and state funds.
informant interviews
direct discussion with community members for the purpose of obtaining ideas and opinions from key informants.
Strengths: no cost
Limitations: built-in bias
Community forum
open public meeting
Strengths: community input
Limitations: challenging to get participation
Secondary data
use of existing data (death statistics, birth statistics, census data, mortality, health records)
Strengths: ability to trend health issues over time
Limitations: data might not represent current situation
Participant observation
observation of formal or informal community activities.
Negative - bias, time-consuming
windshield survey
descriptive approach that assesses several community components by driving through a community.
Focus groups
directed talk with a representative sample.
surveys
specific questions asked in a written format.
windshield survey components
people
place
location of health services
natural environment
housing
social systems
analysis of community assessment data
Gather collected data
assess completeness of data
ID and generate missing data
synthesize data and id themes
ID community needs and problems
ID community strengths and resources
home health nurse
nursing care to clients were they reside. this includes traditional homes, assisted living facilities, and nursing homes. Functions as education, provider of skilled nursing interventions, and coordinator of care.
Home health nurses skills
skilled assessment, wound care, lab draws, med education and administration, parenteral nutrition, IV fluids and medication, central line care urinary catheter insertion and maintenance. Must also evaluate the living environment for safety, paying close a
Hospice nurses
enhances the quality of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. Relief of pain and suffering and enhance of QO
Occupational health nurse
assess the ricks for work-related illness and injury, plan and deliver health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workplace
Occupational health
occupational host - worker characteristics, such as job inexperience, age, and pregnancy
occupational agent - biological agents (viruses, bateria, fungi, pathogens), chemical (smoke), mechanical agents (musculoskeletal or other strains from repetitive mot
Occupation health nurses's roles
Primary prevention- teaching good nutrition and knowledge of health hazards, immunizations, and use of protective equipment
Secondary prevention- ID workplace hazards, early detection through health surveillance and screening, counseling and referral
Tert
OSHA
develops and enforces workplace health regulations to protect the safety and health of workers
NACOSH (national advisory committee on occupational safety and health)
gathers data on the incidence and prevalence of occupational illness and injury. Prevention education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.
Faith community nurse
work with a group of clients who share common faith traditions. Circle model of spiritual care: CIRCLE
Caring
Intuition
Respect for religious beliefs and practices
Caution
Listening
Emotional support
Missionary nurse
seeks to promote health and prevent disease by meeting spiritual, physical , and emotional needs of people across the globe.
Parish nurse
promotes the health and wellness of populations of faith communities. The population often includes church members and individuals and groups in the geographical community.
School nurse
case manager - coordinates comprehensive services for children who have complex health needs.
Community outreach - strives to meet the needs of all school-age children by cooperative planning and collaboration between the educational system.
Consultant -
Homicide
often related to substance use, usually committed by someone known to the victim. Abuse often precedes homicide within families. Increasing among adolescents
Assault
males more likely to be assaulted, youths at higher risk
Rape
majority of violence against women is intimate partner violence. Incidence occurs higher in cities, between 8 pm-2 am, on weekends, and in summer months
Suicide
women report attempting suicide more often than men. Rates are highest in men and individuals over the age of 65. Risk factors for suicide include depression or other mental disorders, substance use and intimate partner issues.
Abuse
Neglect: lack of physical care, such as food, shelter, hygiene. Emotional are (interacting with child), education for child, needed health or dental care.
Potential for abuse
Hx or being abused or exposed to violence, low self-esteem, fear and distrust of others, poor self-control, inadequate social skills, minimal social support, immature miscarriage, weak coping skills.
Recognize child abuse
unusual fear of the nurse, injuries not mentioned in hx, fractures including older healed fractures, subdural hematoma, trauma to genitalia, malnourishment or dehydration, inappropriate dress for weather conditions, considered to be a "bad child
Recognize elder abuse
unexplained physical injuries, physical neglect, rejection of assistance by caregiver, financial mismanagement, withdrawal.
Social and Community factors Influencing Violence
work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources
Substance use disorders
Denial: defensiveness, lying about use, minimize use, blaming use, intellectualizing.
alcohol use
depressant, dulls the senses to outside stimulation and sedates the inhibitory centers in the brain.
alcohol use in body
body burns about 0.5 oz of alcohol per hr. alcohol withdrawal appears within 4 to 12 hours.
alcohol withdrawal
irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated blood pressure. Use benzodiazepines for symptoms.
Smoking
nicotine creates feeling of alertness and energy.
Prevention
Primary- increasing public awareness
Secondary- identify at risk individuals and assist them to reduce sources of stress. screen for substance use.
Tertiary- refer client to community groups, AA. Provide emotional abusers including positive reinforcement.
Mental health
High risk substance use disorders, high suicide risk.
Mental health prevention
Primary- educate populations regarding mental health issues, teach stress-reduction techniques, parenting classes.
Secondary- screen to detect mental health disorders, conduct crisis intervention
Tertiary- medication monitoring, interventions, referrals
Communicable diseases
Leading causes of death are acute respiratory infections (pneumonia and influenza), AIDS, diarrheal diseases, tuberculosis, malaria, measles.
Populations at risk for Communicable diseases
young children, older adults, immunosuppressed clients, clients who have a high-risk lifestyle, international travelers, health-care workers
Airborne
Measles, chickenpox, tuberculosis, pertussis, influenza
Foodborne
Salmonellosis, Hepatitis A, Trickinosis, E.coli
Waterborne
cholera, Typhoid fever, bacillary dysentery, Diardia Iamblia
Vector-borne
Lyme disease, rocky mountain spotted fever, malaria
Direct contact
Sexually transmitted infections (HIV , gonorrhea, syphilis, genital herpes, hepatitis B, C, D), infectious mononucleosis, enterobiasis (pinworm), Impetigo, lice, scabies
Portals of entry
respiratory passages, GI, Skin, mucous membranes, genitourinary tract, eyes, blood vessels
Portals of exit
respiratory secretions, feces, blood, semen, vaginal secretions, saliva, skin lesion exudates
Herd immunity
protection due to the immunity of most community members making exposure unlikely
Natural immunity
Natural defense mechanisms of the body to resist antigens or toxins
Acquired immunity
develops through actual exposure to the infectious agent
Active immunity
production of antibodies by the body in response to infection or immunization with a specific antigen
Passive immunity
transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins
Primary prevention
prevent the occurrence of infectious disease, educate the public regarding the need for immunizations, counsel clients traveling to other countries about protection from infectious disease. Refer to immunizations.
Secondary prevention
increase early detection through screening and case finding, refer suspected cases of communicable disease for diagnostic confirmation and epidemiological reporting, provide post exposure prophylaxis (hep A, rabies), quarantine clients
Tertiary prevention
Decrease complications and disabilities due to infectious diseases through treatment and rehab.
Disaster prevention
Activities to prevent natural and man-made disasters, increase surveillance, improve inspections and airport security, strengthening public health processes such as immunizations, isolation, and quarantine. Strengthen barriers to prevent flooding and teac
Disaster preparedness
Stem from threats and vulnerabilities identified in the prevention level, and should coordinate community efforts as well as outline specific roles of local agencies. This level of management includes preparedness of natural or man-made disasters. Create
Disaster response
FEMA, CDC, U.S. Department of Homeland Security, American Red Cross, Office of Emergency Management, public health system. If a federal emergency is declared, the National Response Framework is activated and provides direction for an organized, effective
Disaster recovery
Begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding. Communicable disease and sanitation are important aspects of disaster recovery.
Phases of emotional reaction during a disaster
Heroic - intense excitement and concern for survival. Rush for assistance.
Honeymoon- affected individuals being to bond and relive their experiences.
Disillusionment - responders may experience depression and exhaustion. Delays in receiving aid.
Reconstr
Bioterrorism Category A biological agents
highest priority, posing risk to national security because easily transmitted and have high mortality rates.
Ex: smallpox (variola), botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
Category B biological agents
second-highest priority because they are moderately easy to disseminate and have high morbidity(disease) rates and low mortality (death) rates.
Ex: typhus and cholera
Category C biological agents
third-highest priority, emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates.
Ex: hantavirus
Anthrax
headache, fever, muscle aches, chest discomfort, severe dyspnea, shock.
Give: IV Cipro
Botulism
difficulty swallowing, weakness, nausea, vomiting, difficulty breathing.
Give: airway management, antitoxin, eliminate the toxin, supportive care
Smallpox
high fever, fatigue, severe headache, rash (BEGINS of face and tongue, quickly spreads to trunk, arms, legs, hands, feet) then turns into pus-filled lesions, vomiting.
Give: treatment - no cure, supportive care- hydration, pain meds, antipyretics.
Prevent
Ebola
fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock.
Treatment: no cure, airway management, dialysis, supportive care.
Prevention: avoidance of contaminated items/animals
Bioterrorism Primary prevention
Prepare with drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. design a response plan, id the chain of command, define nursing roles, set up protocols.
Bioterrorism Secondary prevention
early recognition, activate response plan, implement infection control measures - decontamination, protective equipment, SCREEN the populations for exposure, assist and educate the population regarding symptom identification and management, monitor mortal
Bioterrorism tertiary prevention
Rehab of survivors, monitor medication regimens and referrals, evaluate effectiveness of the bioterrorism plan
Characteristics of successful partnerships
shared power, shared goals, integrity, flexibility, negotiation
Consultant
specialized knowledge who provides expert advice, services, or information.
-seek expertise from health care professionals
-seek expertise from health care professionals
-seek expertise of other nurses
-incorporate recommendations from a consultant
-coord
Referrals
to assist in restoring, maintaining, or promoting health.
Referral process
engage in working relationship with client
establish criteria for the referral
explore resources
accept the client's decision to use a given resource (autonomy)
make the referral
facilitate the referral
evaluate the outcome
Case management
Promotes interprofessional services and increased client/family involvement
decreases cost by improving client outcomes
provides education to optimize health participation
advocate for services and client rights
Telehealth
useful in rural areas.
Telehealth physical data
BP, weight, Blood O2, Blood glucose, HR, temp, ECG results
Telehealth audio data
Voice conversation, heart sounds, lung sounds, bowel sounds
Telehealth visual data
images of wounds, images of surgical incisions
Change agents
advocate for needed change at local, state, federal level
Lobbyists
persuade of influence legislators. Lobbying may be implemented by an individual, or collectively through professional nursing associations.
Coalitions
facilitation of goal achievement through the collaboration of two or more groups
Public office
serving society and advocating for change by influencing policy development through public service
Contact for non-biological or chemical incident
Office of Emergency Management
Contact when local abilities are unable to properly respond to an incident
The federal emergency management agency
American Red Cross
Support emergency rescue and recovery services and is contacted when additional resources are needed by the community.
U.S. Department of Homeland Security
Contact in response to threats and hazards by acts of terrorism
Small pox
eradicated worldwide since late 1970s, people who were immunized against smallpox before 1982 are now considered to be unprotected, unlike chickenpox, the vesicles of smallpox are more abundant on the face.
Pediculosis capitis (head lice)
Nits that are shed into the environment are capable of hatching for up to 10 days.
Pets do not transmit or carry lice.
Scabies
Appear as grayish brown, threadlike burrows on the skin. Require private room.
Self breast exam
Monitor for any change in size, contour, dimpling. Perform exam every month, 2 to 3 days after your period. Use finger pads of the three middle fingers.
Pneumonic Plague
no precautions other than protective.
Meningococcal conjugate
immunization given at 11-12 years of age
Herpes zoster
given at 60 years or older
Rotavirus
given during first year of life
Chemical in eyes
nurse starts to flush the clients eyes with tepid water - secondary prevention