Community Health: Community Based Nursing Care – Flashcards
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Community-Based Health Care
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-Is a model of care to reach all in a community -Occurs outside of traditional health care facilities -Provides services for acute & chronic conditions
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What does community health focus on?
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Focuses on assisting individuals & communities with achieving a healthy living environment.
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Challenges to community health
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1) Public health problems influenced by: -Social lifestyles -Political policy -Economic initiatives 2) Current medical & social problems
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Contributing Factors to community health: Physiological
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Age (increasing age can cause strain on community health & illness with the aging process)
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Contributing Factors to community health: Environmental
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1) Air Quality (poor air quality in low & middle income countries) -Poor air quality can effect high income as well 2) Water & Sanitation quality & accessibility 3) Climate
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Air Quality
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Included in the ambient air pollution database are annual mean concentrations of particulate matter (PM10 or PM2.5) based on daily measurements or data which could be aggregated into annual means.
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What are some examples of how climate can affect health?
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-Warm, humid (higher incidents of mosquitos carrying viruses) -Cold (poor heating, CO poisoning from malfunctioning furnaces) -Wells that have dried up/Drought
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Contributing Factors to community health: Psychological
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-Education systems (lack of reading ability) -Children of low income are eligible for free/reduced lunch in the state of NH.
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Contributing Factors to community health: Sociocultural/Spiritual
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Social Determinants of Health is a population based approach: -Education -Economics -Availability of transportation -Access to exercise -Healthy foods (these are both barriers & things that help improve community health)
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Robert Woods Johnson Foundation: The Role of the Nurse
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-Making health a shared value. -Foster cross-sector collaboration. -Create healthier, more equitable communities -Strengthen the integration of health services -Be an applied leader for the community / neighborhood
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City of Manchester, NH: One of Seven Cities recognized in 2016 for their significant public health programs
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Goal 1: prevent toxic stress/adverse childhood experiences Goal 2: attain health equity Goal 3: achieve environmental justice (*such as everyone must have clean water access*)
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Culture is?
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-A pattern of assumptions, beliefs, & practices that unconsciously frames or guides the outlook, decisions, & actions of a group of people; (*a "way of life"*) -Differs from race & ethnicity -Plays a critical role in parenting behaviors that facilitate child development & self-esteem
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Social Roles are?
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-Culturally prescribed patterns of behavior for persons in a variety of social positions -*A social group consists of a system of roles carried out in primary & secondary groups*
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Primary Group
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-Has intimate, continued, face-to-face contact -Relationships are typically stable, with little conflict of values -Mutual support of members -Ability to order or constrain behavior (*Examples are a family & a peer group*)
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Secondary Group
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-Has limited, intermittent contact -There is generally less concern for members' core values & behaviors -Offers little support or pressure to conform (*Examples are professional associations, social organizations, & faith-based groups such as classmates, people at the gym*)
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Subcultural Influences on Health Care
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-Ethnicity -Language used for communication -Socioeconomic class -Occupation -Migrant families -Religion & religious practices -Schools & communities -Peer cultures -Mass media & social media influences (*negative info placed on the web & is reported/can hinder community health*)
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Bicultural Influences on Health Care
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Children who are exposed to two or more cultures: -May occur with parents from different cultures -May occur in transient families, such as those in military service or mission service or those with migrant parents -May occur in an academic setting +Intentionally (children in immersion programs) +Unintentionally (cultural variety in a school cohort)
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Socioeconomic Influences on Health Care
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-Poverty -Homelessness -Migrant families -Transient or unstable living situations -Access to health care issues -Utilization of health care issues -Health risks associated with high & low socioeconomic status
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Religious Influences on Health Care
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-Susceptibility to health problems (such as hereditary factors & socioeconomic factors like not vaccinating or illnesses specific to certain religions) -Customs & folkways -Beliefs of healing or cure -Food customs -Traditions r/t the care of newborns or critically ill or dying persons
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Religious Beliefs
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-Religion -Spirituality -Beliefs of wellness, protection, or healing -Daily practices -Celebrations (days of significant religious or spiritual meaning)
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Health Beliefs & Practices
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1) Health beliefs -Natural forces -Supernatural forces -Imbalance of forces 2) Health practices -Similarities among cultures regarding the prevention & treatment of illness -Prenatal influences from folklore
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Assessment of community health consists of?
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-Structure -Population -Social System
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Structure
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-Geographical boundaries -Emergency services -Water & sanitation -Housing -Economic Status (ave. household income, # of residents on public assistance) -Transportation
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Population
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-Age distribution -Sex distribution -Growth trends -Density -Education level -Predominant ethnic groups -Predominant religious groups
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Social System
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-Education system -Government -Communication system -Welfare system/ public assistance programs -Volunteer programs -Health system
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Examples of community health assessment
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-Systematic data collection (such as incident rates) on the population -Monitoring the health status of the population -Accessing available information about the health of the community
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Examples of community health assessment program results
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-Adolescent smoking prevention -Sex education -Proper nutrition
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Healthy People Initiative (by USDHHS)
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Establishes ongoing health care goals
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Healthy People 2020
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Goals are to increase life expectancy & quality of life, & to eliminate health disparities through improved delivery of health care services (*is actively used in communities*)
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Public Health Policy Development & Implementation
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1) Health professionals provide leadership by: -Developing public policies to support the health of a population 2) Strong policies are driven by community assessment: Ex: Assessment of level of lead poisoning in young children Ex: Assessment of the number of people in the community who need end-of-life care
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Improved Access to Care
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-Ensures that community-wide health services are: +available to the total community +accessible to the total community (*Ex: Five-level Health Services Pyramid*) -Role of community services near acute care services -Healthy environments
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Community Nursing Process
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Assessment Diagnosis Planning Implementation Evaluation (*The nursing focus shifts from an individual client to the target population in collaboration with other disciplines*)
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Primary Prevention
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*Interventions that protect from disease or injury* Ex: -Well-child clinics -Immunization programs -Safety programs (DARE/ education about substance abuse) -Sanitation measures (clean drinking water & adequate sewage) -Proper nutrition
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Secondary Prevention
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-Promotes early detection & treatment of illness -Efforts are made to prevent the spread of contagious diseases Ex: +TB screenings, lead screenings +Isolation of communicable illnesses +Early intervention programs (e.g., Head Start Program) +Depression screening +Pre-anesthesia screening +Colonoscopy, mammograms +Height, hearing, & vision tests +Dental care
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Tertiary Prevention
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*Interventions to optimize function for children with a disability or chronic disease* Ex: +Asthma management programs (peak flow meters) +Rehabilitation programs +Special education programs +DM programs & wound care
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Community Health Nursing
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-Nursing practice in the community -*Primary focus is on health care of individuals, families, & groups* -Similar to public health nursing -Requires: understanding the needs of a population, & a set of skills & knowledge
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Community health nursing is?
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Essential public health functions: -Community assessment -Policy development -Access to resources -Provides direct care services to subpopulations in a community -Competencies needed
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What is the goal of community health nursing?
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To preserve, protect, promote, or maintain health.
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Nursing Practice in Community Health
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1) Expert community health nurses: -Understand the needs of a population or community -Use critical thinking skills to apply knowledge -Understand resources 2) Needed skills: -Patient advocacy -Communicating people's concerns -Designing new systems that cooperate with existing systems
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"Double Vision" (Community health nurses)
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1) Care for the community as a whole 2) Assess the individual or family within the context of the community
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Successful community health practice involves?
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-Building relationships with the community -Being responsive to changes within the community
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Community-Based Nursing
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-Occurs in community settings -Involves acute & chronic care -Enhances individuals' capacity for self-care -Promotes autonomy in decision making -Uses critical thinking skills -Reduces costs for the patient by providing care near homes -Requires knowledge of family theory, communication, group dynamics, & cultural diversity
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Vulnerable populations in the community
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Ex: -Immigrants -Poor & homeless -Abused -Substance abusers -Mentally ill -Older adults (*special needs of vulnerable populations are a challenge*)
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Competency in Community-Based Nursing
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-Competency is based on decision making at the level of the individual patient. -Nurses utilize a variety of skills & talents
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The nurses is BOTH a caregiver & case manager
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1) Caregiver: change agent, collaborator, educator 2) Case Manager: patient advocate, counselor, epidemiologist (ex: childhood cancer in the seacoast)
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Immunity
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Immune response (antigens & antibodies) Active immunization Passive immunization (*immunity is a challenge in poor communities d/t poor water, heating issues, etc*)
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Artificial Active Immunization
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*The body is exposed to a relatively harmless form of an antigen* -The immune system is stimulated & "remembers" this antigen if subsequent exposures occur -*Does not cause a full-blown infection* (Ex) Chicken Pox
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Natural Active Immunization
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Person acquires immunity by surviving the disease itself & producing antibodies to the disease-causing organism
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Biological Antimicrobial Drugs
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-Also called biologicals -Antitoxins -Antisera -Toxoids & vaccines (immunizing biologicals) -*Used to prevent, treat, or cure infectious diseases*
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Toxoids
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*Are antigenic (foreign) preparations of bacterial exotoxins* -They are detoxified with chemicals or heat to a weakened or "attenuated" state & cannot revert back to a toxic form -Toxoids stimulate one's immune system to produce a specific antibody (*producing an artificial active immune response*) -*Toxoid antibodies protect against future exposures*
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Vaccines
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*Are suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms* -These slight alterations in the bacteria & viruses prevent the person injected from contracting the disease -Also stimulate the production of antigens against a specific antibody
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Vaccines with live bacteria/viruses
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Vaccinations with live bacteria or virus provide lifelong immunity.
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Vaccines with killed bacteria/viruses
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Vaccinations with killed bacteria or virus provide partial immunity, & booster shots are needed periodically
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Active Immunizing Drugs: Examples
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-BCG vaccine (tuberculosis)(given in europe) -Diphtheria, tetanus, & pertussis toxoids, several forms -Haemophilus influenzae type B conjugate vaccine (HIB) -Hepatitis A & B virus vaccines -Measles, mumps, & rubella virus vaccine, live (several forms) -Pneumococcal bacterial vaccines -Human papilloma virus vaccine (Gardasil) (HPV) -Poliovirus vaccine; several forms -Rabies virus vaccine -Smallpox virus vaccine -Tetanus toxoid -Varicella virus vaccine (chickenpox) -Yellow fever virus vaccine
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Passive Immunization
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*A serum or concentrated immunoglobulins from humans or animals that are injected into a person* -The substances needed to fight off invading microorganisms are given *directly to a person* -*The immune system is bypassed* -Short-lived compared with active immunization, but works faster
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Artificial Passive Immunization
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*Admin of serum or concentrated immunoglobulins* -Provides the inoculated person the substance needed to fight off the invading microorganism -*Bypasses the host's immune system*
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Natural Passive Immunization
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Antibodies are transferred: -From mother to fetus *through the placenta* -From mother to infant *through breast milk*
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Passive Immunizing Drugs
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-Antitoxins -Immunoglobulins -Snake & spider anti-venoms (anti-venom) (*Pit viper, coral snake, Black widow spider*) -Hepatitis B immune globulin -Immunoglobulin, various forms -Rabies immunoglobulin (human) -Rho(D) immune globulin (RhoGAM) -Tetanus immunoglobulin -Varicella-zoster immunoglobulin
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Indications: Active Immunization
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-Prevents infection caused by bacterial toxins or viruses -Provides long-lasting or permanent immunity -"Herd immunity"
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Indications: Passive Immunization
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-Antitoxins, antivenins, immunoglobulins -Minimizes effects of poisoning by the venoms of spiders & certain snakes -Provides quick immunity before a person's own immune system has a chance to make antibodies (*such as in cases of exposure to hepatitis B or rabies viruses*) -CDC/DHHS recommendations for adult & pediatric immunizations (U.S.) (*provide specific dosages & intervals for immunizations, refer to the CDC website for current recommendations*)
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Adverse effects of immunizations
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(*Range from mild & transient to very serious or life threatening*) 1) Minor effects: -fever, minor rash, soreness at injection site, itching, adenopathy 2) Severe effects: -fever higher than 103° F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others 3) Minor reactions: -treated with acetaminophen/Tylenol & rest 4) Serious or unusual reactions: -serum sickness -*report serious or unusual reactions to the Vaccine Adverse Event Reporting System (VAERS)*
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Nursing implications for immunizations
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-Assess patient's health history, medication history, allergies, pregnancy status -Assess previous reactions & responses to immunizations -Assess for contraindications, including immunosuppression (*chemotherapy, Lupis, AIDS/HIV, UC, Crohn's, MAB therapy*) (*Don't give the flu vaccine to someone with a fever*) -Before giving any drug, recheck the specific protocols for admin & schedules for administration -Follow manufacturer's guidelines for drug storage, admin, routes, & site of admin -Encourage parents of young children to keep a journal of the child's immunization status, with dates of immunizations & reactions, if any -If discomfort occurs at the injection site, apply warm compresses & give acetaminophen -Do not give aspirin to children -Monitor for therapeutic responses & adverse reactions
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Illnesses Caused by Possible Bioterrorism Agents
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-Anthrax (used for bio-terrorism) -Smallpox -Botulism -Tularemia -Viral hemorrhagic fever -Plague
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Possible Bioterrorism Agents
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-Sarin (nerve gas) -Mustard (blistering agent) -Cyanide (blood agent) -Chlorine (choking agent) -Radioactive elements -Ricin
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Clinical Manifestations of Anthrax (4 Types)
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-Cutaneous anthrax -Gastrointestinal anthrax -Inhalation (pulmonary) anthrax -Injection anthrax
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Cutaneous Anthrax
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-A raised, itchy bump resembling an insect bite that quickly develops into a painless sore with a black center -Swelling occurs in the sore & nearby lymph glands -*Is the most common & the least fatal type of anthrax exposure*
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Gastrointestinal Anthrax
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*This form of anthrax infection begins by eating undercooked meat from an infected animal* S/S: -Nausea -Vomiting -Abdominal pain -Headache -Loss of appetite -Fever -Severe, bloody diarrhea in the later stages of the disease -Sore throat & difficulty swallowing -Swollen neck
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Inhalation (pulmonary) anthrax
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-Flu-like symptoms, such as sore throat, mild fever, fatigue & muscle aches, which may last a few hours or days -Mild chest discomfort -Shortness of breath -Nausea -Coughing up blood -Painful swallowing -*Most deadly even when treated* -High fever -Trouble breathing -Shock -*Meningitis: a potentially life-threatening inflammation of the brain & spinal cord*
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Injection anthrax
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*This is the most recently identified route of anthrax infection.* -It's contracted through injecting illegal drugs & has been reported only in Europe so far. -Initial s/s of injection anthrax include: +Redness at the area of injection (without an area that changes to black) +Significant swelling +As the disease progresses, you may experience (shock, multiple organ failure, meningitis)
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Nursing Diagnoses
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-*Risk for Caregiver Role Strain* (find the balance between being a caregiver for kids & parents/watch for risk for or actual Dx) -Ineffective Community Coping (teen moms have lower positive outcomes) -Contamination -Fear -Grieving -Delayed Growth & Development
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What are some community health settings
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-Urgent care -Primary care -Occupational health nursing -Adult daycare/day programs -Drug/ETOH rehab -Correctional facility/Prison -Extended care/Assisted living/Long-term care
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Types of Community-Based Health Care Services
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-Health promotion & illness prevention -Diagnosis & treatment -Rehabilitation, health restoration, & palliative care
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Nursing Community Centers
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-Ambulatory care centers operated by nurses -May be affiliated with large schools of nursing -PCPs are NP, NMW & CNS -Students help staff the center -Funding varies -Surgery centers
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Ambulatory Care
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(Is a general term for care provided in a myriad of settings) Purpose: -Health promotion -Health protection -Short-term treatment -Follow-up for existing health problems -Visits episodic & based on need
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Role of Nurse in Ambulatory Care
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-*Performing health promotion activities* -Health education -Health screening -Triage -Comprehensive assessment -Case management
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Subacute Care
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-Cost effective concept in healthcare -For patients too ill to be discharged from hospital -Designed to "fill in the gap" -Has 4 broad categories 1) Transitional 2) General medical-surgical/rehabilitation 3) Chronic skilled-ventilator dependent 4) Long-term transitional (*patients don't need to be in the hospital but are too sick to go home/Ex: skilled facility, rehab center*)
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Role of Nurse in Subacute Care
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Must be knowledgeable in: -Medical-surgical practices -Critical care practices -Rehabilitation practices -Work closely with rehab therapists
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Nursing Home Care
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(AKA long term care (LTC)) -In home or facility -In facility, very expensive -Reimbursed by Prospective Payment System (PPS)- 1990 federally mandated link between assessment & documentation & Medicare reimbursement -Has different types: +Residential +Nursing: provide custodial care +Skilled Nursing: provide skilled licensed care +Chronic Care (medicare doesn't pay for nursing homes)
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Role of Nurse in Nursing Home Care
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-More autonomous -Must be aware of strict regulatory laws enacted in 1965 -More supervision of unlicensed personnel -Contribute to POC updated every 30-60 days -Documentation highly regulated -Minimal Data Set (MDS) federally mandated assessment for all residents regardless of level of care or reimbursement (*if a person is a 2-assist, that info needs to be documented in MDS*)
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Home Health Care
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(Historical Perspective) -Roots in public health &community-based nursing models -Diverse & rapidly growing -Preferred setting -Lowest cost setting -Variety of definitions & models
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Factors Contributing to the Growth & Acceptance of Home Care
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-Shifts from in-patient to community-based care -Accepted as viable alternative by medical & consumer communities -Better educated health care consumers -Aging population -Technology -Economics (lower cost) -Managed care
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Types of Home Care
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(Generally 4 types of services) 1) Skilled home care services (largest) 2) Personal care or private duty services (provides shifts) 3) Home medical equipment (HME) services (provides durable medical equipment (DME)) 4) Home infusion or IV services
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Home Setting
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-More autonomous -Environment controlled by patient/caregiver -Must have diverse knowledge -Must know & understand reimbursement -Only select services are reimbursed by Medicare -Limited direct supervision
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In-patient Setting
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-More physician directed -Environment controlled by facility -Knowledge specific & Dx-based -FO/accounting handles reimbursement -Reimbursed by Medicare -Direct supervision/team
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Role of the Nurse in Home Care
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-Nursing is the essential component -Utilize resources -Education (*a big part of the nursing role is teaching*) -Direct & manage care -Advocate -Support patients & families -ANA Standards of Home Health Nursing Practice
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Discharged to Home Care
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-Confined to home (AKA-homebound status) -Services provided under POC (plan of care,MD orders) established & signed by physician -Needs skilled nursing care, PT, OT or speech language pathology on intermittent basis
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Skilled Care Covered by Medicare/Insurance
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-Observation & assessment of medical professional -Management & evaluation of POC -Teaching & training activities -Med administration-IM/SC -Nasopharyngeal & tracheostomy aspiration -IV therapy
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Skilled nursing services
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-Urinary catheters -Wound care -Ostomy care -Rehab nursing -Psych evaluation, therapy, & teaching
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OASIS Document (MDs use for home care)
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-Outcomes Assessment Information Set -Tool used to track & report patient outcomes -Required by 1999 regulations -Developed, tested, & refined through research -Used for Outcome Based Quality Improvement (OBQI) -Payment based on nursing assessment/skills
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What are traits of nurses practicing in the community?
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(Competencies in Community-Based Nursing) -Caregiver -Case Manager -Change Agent -Patient Advocate -Collaborator -Counselor -Educator -Epidemiologist
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Teaching (Assessment elements of the nursing process)
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Assessment Diagnosis Planning Implementation Evaluation (*Nurses must be aware of the issues that affect the communities of the patients they care for*)
