Community nursing Test 2
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Define Family
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A family cooperates economically, may share a common dwelling place, and may rear children. The family is a haven in a heartless world The family is a unity of interacting personalities The family is the basic unit of society and the social institution that has the most marked effect on its members-
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Define Family -concept of open system
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The family is an open system that functions in relation to its broader sociocultural context and that evolves over the life cycle. A family is an open and developing system of interacting personalities with a structure and process enacted in relationships among the individual members, regulated by resources and stressors, and existing in a larger community
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Friedman's definition of Family
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- Two or more persons who are joined together by bonds of sharing and emotional closeness, and who identify themselves as being part of a family
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Sedgwick's definition of family
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• Sedgwick: - Family is made up of people who have a shared sense of history, experience some degree of emotional bonding, engage in directionality and goal setting for the future and whose activities involve group issues as well as individual concerns
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Spradley's definition of family
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• Spradley: • A family consists of one or more individuals who share a residence, or live near one another; possess some common emotional bond; and engage in interrelated social positions.
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Official Definition of family by the US Census
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Official Definition US Census: Group of two or more persons related by marriage, blood or adoption who reside together
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Nuclear Family Economic Center
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Good old days-mom, dad, the kids-only in certain populations in the past. 50s mom dad and kids-still had single mothers. Family is changing-economics. Years ago everyone lived on farm-mom dad grandma grandpa and son/daughter living nearby-industrial resolution-people migrating to urban areas. Migrated from south to north Husbands left-to get jobs in the cities-urbanized-sent money back. Economic centers became cities as opposed to the farms.
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Families today Recessions and their impact on Families
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Nuclear family has largely been nuked, so many single parent, gay couples adopting children, women either having fewer children or delaying childbirth the modern family is all over the place. Recessions have remained the one consistent predictor of American family size-dips in birth and marriage rates 81-82, 90-91, 2001 recession and current downturn-but as in past-there will be a birth of a different boom.
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Family restrooms and family cruises
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Family moves as different things move. Movie theater-family restroom-so many fathers are taking care of children. Family cruises, family dressing rooms. Cruises is when you get away from kids-now bring family along-meet together for lunch Family themed casinos in Las Vegas-
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Recessions impact on family size
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Recession-children going back home to live with mom and dad after graduation-what is this causing-divorced-come home to live with mom and dad-causing problems. Idea of perfect family-family changing-now family size has changed-3-4 sisters brothers-now 1.9 average-having fewer kids. Only childs/one sibling-what's the perfect size? Grandma's taking care of kids. Women in the military-mother's leaving young children-grandma or husband takes care of kids while wife is off for tour of duty-Navigator-program in Kansas-needs of grandparents or other relatives raising children-services Mother and father of children are in Jail or rehab. Service by Kansas Children's service league. Grandparent who is trying to live on social security for toddler to care for.
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Women having children in their 40s and 50s
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Things that we have seen that has caused changes in the family. Women in 40s and 50s having children. Big debate whether that is the way to go? 40s-have established career, secured in economic foundation. Denying generation of children their grandparents. Grandparents in 70s or are gone...bad.
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Statistics and family
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Of all the households in the United States, only 67.1% were families, defined by the census as two or more persons related by birth or marriage and living together under one roof. Nonfamily households including single people living alone, nonrelatives living together, and cohabiting couples, now comprise 32.9% of the population. One third of all households has members under 18 years of age. Among single parent households, 85% are headed by mothers. Two-thirds of children live with both parents, 23% live with mother only and 3% live with father only.
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Why are Families Important to Society?
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• Procreation-provides new members for the society • Socialization of new members=families will shelter and socialize a new members until the new member is ready to go out into society and be a member to be a part of the society. Rules, culture, regulations, polite societies, rules in dealing with society. • Forms grouping society treats as an entity-society treats families as an entity-family rate at hotel, dinner rate. Insurance family plans, phone family plans • Creates a network of kinship systems -web/weave. Marry into a family-families not getting along? You can't kill brother in law or fight them. Can't throw a stone in small society-everyone knows everybody. Don't be mean to a family member no matter how far removed. • Provides status and roles-Father a doctor, father a minister, father a police chief.
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Priority of the Family Adult Children
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- stabilize their lives-settles you down. Now you have a responsibility, family, mortgage, etc. - meets needs of its members. • affectional • socioeconomical-no matter what status is before, women come out in poor end of stick in divorce. Don't get fair end of the stick. • sexual• Children - directs personality development-Families interact dysfunctional or functional. - protects child from direct contact with society until ready - provides care • physical-food, shelter, clothing • emotional
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Why Focus on the Family
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• Dysfunction affects each member • Role of family in health & health care • Raise level of wellness • Case Finding • Clear perspective of the individual
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You Belong (or will belong) to 2 Families
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• Family of Origin • Family of Procreation
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Family Functions
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1. Families exist to achieve financial survival. Families are economic units to which all members contribute and from which all family members benefit 2. Families exist to reproduce the species 3. Families provide protection from hostile forces 4. Families disseminate their culture, including religious faith 5. Families educate (socialize) their young 6. Families confer status in society.
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Characteristics of a Family
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• Every family is a small social system • Every family has its own cultural values and rules • Every family has structure • 1. The individuals that compose the family • 2. The relationship between them • 3. The interactions between family members • 4. The interactions with other social systems. • Every family has certain basic functions • Every family moves through stages in its life cycle
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Family as Social System
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• Every family is a small social system • Every family has its own cultural values and rules • Every family has structure • Every family has certain basic functions • Every family moves through stages in its life cycle
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Family Values
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• Defined: system of ideas, attitudes and beliefs about the worth of an entity or concept that consciously or unconsciously bind a family together • How acquired? - Learned behavior
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Major Variables Affecting Family Values
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• Socioeconomic Status • Ethnicity and Acculturation • Geographical Location • Generational Differences
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Family Structure-Family demographics is the study of family and household structures and the events that alter that structure.
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• Nuclear dyad • Nuclear family • Extended family • Single parent family • Blended family
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Functions of the Family
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• Affection • Security and Acceptance • Identity • Affiliation and Companionship • Socialization • Control
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Developmental Tasks
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• Beginning Families • Expectant Phase • Child caring • Families with Preschool Children • Families with School children • Families with Teenagers • Launching Center • Families in Middle Years • Aging Families
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Healthy Families
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• Facilitative process of interaction among members • Individual member development is enhanced • Role relationships are structured effectively • Active attempts are made to cope with problems • Healthy home environment & lifestyle • Regular links with broader community are established
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Assessment Tools
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• Genogram-displays pertinent family information in a family tree format that shows family members and their relationships over at least 3 generations. • Data collection categories - Family characteristics - Communication patterns - Family roles
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Genogram
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A diagram of family relationships between blood relatives that can span two or more generations. Life events such as marriages, divorces, births, and deaths are included in the diagram. The genogram is used to identify relationships as well as possible patterns of disease.
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Reciprocal Relationships
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Reciprocal Relationships • Reciprocal Relationships: R=M (M-1) / 2R= relationships M= # of members in the family
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ecomap
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An ecomap is a visual diagram of the family unit in relation to other units or subsystems in the community. The ecomap serves as a tool to organize and present factual information and thus allows the nurse to have a more holistic and integrated perception of the family situation. The ecomap shows the nature of the relationships among family members, and between family members in the community; it is an overview of the family, picturing both the important nurturing and the important stress-producing connections between the family and the world.
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Working with Families
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• Work with family collectively • Start where family is • Recognize validity of the family structure• Emphasize family strengths • Adapt interventions to fit family stage of development
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Family Crisis
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• Disturbs equilibrium of the family • Situational crisis - Haiti • Developmental crisis - First born going off to college • Multiple crisis - Being in Haiti & having a baby • Violence
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Epidemic of Family Violence
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• Child abuse • Spousal abuse • Elder abuse • School violence - stopbullying.gov • Dating violence - Intimate partner violence - Digital abuse • Violence during pregnancy
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Family Violence Prevention
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• Primary - Learning social problem solving skills - Healthy self-esteem - Parenting classes - Postpartum home visits - Neighborhood involvement • Secondary - Early diagnosis - Shelters - Have a plan - Reporting suspected abuseTertiary Rehabilitation of the \"new\" family
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Family nursing assessment
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Family nursing assessment is the cornerstone of family nursing interventions. By using a systematic process, family problem areas are identified and family strengths are emphasized as the building blocks for interventions and to facilitate family resiliency. Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions.
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Family Assessment strategies
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Genograms and ecomaps are presented as family assessment strategies that provide a clear, concise picture of intergenerational patterns and social supports or direction of family stress. Nurses are encouraged to select the model and strategy that provides the best fit to their particular philosophy and practice, or they can use a combination of both.
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Two family assessment models and approaches are
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Two family assessment models and approaches are The Family Assessment intervention Model and Family Systems Stressor-Strength Inventory, and the Friedman Family Assessment Model and short form.
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Family assessment model.
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Systems approach. Families are subject to the tensions produced when stressors, in the form of problems penetrate their defense system. The family's reaction depends on how deeply the stressor penetrates the family unit and how capable the family is of adapting to maintain its stability. The lines of resistance protect the family's basic structure, which includes the family's functions and energy resources. The core contains the patterns of family interactions and unit strengths. The basic family structure must be protected at all costs or the family will cease to exit. Reconstituting or adapting is the work the family undertakes to preserve or restore impaired family stability after stressors penetrate the family lines of defense, altering usual family functions. The model addresses the following 3 areas: 1. Health promotion, wellness activities, problem identification, and family factors at lines of defense and resistance 2. Family reaction and stability at lines of defense and resistance 3. Restoration of family stability and family functioning at levels of prevention.
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Basic assumptions for family assessment intervention model
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1. Although every family system is unique, each is composite of commonly understood factors, or innate characteristics, with a normal range of responses contained within a basic structure. 2. Many known, unknown, and universal environmental stressors exist. Each differs in its potential for disturbing a family's usual stability level, or normal line of defense. The particular interrelationships of family variables---physiological, psychological, sociocultural, developmental, and spiritual—can at any time affect the degree to which a family is protected by the flexible line of defense against possible reaction to one or more stressors. 3. Over time, each family or family system has evolved a normal range of responses to the environment, referred to as a normal line of defense, or a usual wellness/stability state 4. When the cushioning, accordion-like effect of the flexible line of defense is no longer capable of protecting the family system against an environmental stressor, the stressor breaks through the normal line of defense 5. The family, whether in a state of wellness or illness, is a dynamic composite of interrelationships of variables. Wellness is on a continuum of available energy to support the system in its optimal state 6. Implicit within each family system is a set of internal resisistance factors, known as lines of resistance, that function to stabilize and return the family to the usual wellness state (normal line of defense), or possibly a higher level of stability, after the family has reacted to and recovered from an environmental stressor reaction 7. Primary prevention relates to general knowledge that is applied in family assessment and intervention for identifying and mitigating risk factors associated with environmental stressors to prevent possible reaction 8. Secondary prevention relates to symptoms after reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects 9. Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention. 10. The family is in dynamic, constant energy exchange with the environment.
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The Family Systems Stressor-Strength Inventory (FS3I) is divided into 3 sections.
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1. Family systems stressors: general; 2. Family stressors: specific; 3. Family system strengthsFocuses on two concepts of family health: family stressors and family strengths. It provides nurses with entry into the family system to gather data useful for nursing intervention.
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Primary Prevention:
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Focuses on movement of the individual and family toward a positively balanced state of increased health or health promotion activities. Primary interventions include: 1. Providing families with information about their strengths 2. supporting their coping and functional abilities 3. encouraging attempts toward wellness through family education
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Secondary Prevention
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Secondary Prevention modes address actions necessary to attain system stability after the family system has been invaded by stressors or problems Secondary Interventions include: 1. Helping the family members handle their problems 2. Helping them find and use appropriate treatment 3. Intervening in crises
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Tertiary Prevention mode includes
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Tertiary Prevention mode includes those actions instituted to maintain systems stability Tertiary intervention strategies are initiated after treatment has been completed and may include coordination of care after discharge from hospital or rehabilitation services.
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Assumptions Underlying Friedman's family Assessment Model:
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1. The family is a social system with functional requirements 2. A family is a small group possessing certain generic features common to all small groups 3. The family as a social system accomplishes functions that serve the individual and society 4. Individuals act in accordance with a set of internalized norms and values that are learned primarily in the family through socialization.
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6 broad categories of interview questions
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1. Identifying data 2. Developmental family stage and history 3. Environmental data 4. Family structure, including communication, power structures, role structures, and family values 5. Family functions, including affective, socialization, and health care 6. Family coping
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Epidemiology-
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Study of Health/Disease in Populations
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• Epidemiology
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A study of the distribution & determinants of health related states in specified populations & the application of this study to control health problems or maintain health
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• Epidemiology- is the discipline
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• Epidemiology- is the discipline that provides the structure for systematically studying the distribution and determinants of health, disease, and conditions related to health status. Epidemiological concepts are used to understand and explain how and why health and illness occur as they do in human populations. Nursing and medical science employ these concepts to help guide clinical practice and influence health outcomes.
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How did Florence Nightingale use epidemiology
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Florence Nightingale, the first nurse epidemiologist, pioneered the use of statistics to improve public health. During the Crimean War, Nightingale collected data and systemized record-keeping practices to improve hospital conditions. Study distribution-where are people ill Determinants of health-what makes people healthy/nonhealthy Related States. Why are some people sick, why are some people not sick
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GOAL of epidemiology
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• Prevent disease/maintain health • Try to determine why are some people sick/others healthy • What are the causes of and what can be done to prevent health problems? Prevent Disease-what can I do about it-how to help people from getting it.
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EPI PROCESS
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• Parallels the nursing process- • What is happening? Get info from the people (S), from statistics (O) subjective, objective • Summarize the data using person-place-time (A) assessment • Decide upon (P) and carry out an intervention (I) intervention • Re-asses the effects of your intervention(E) evaluation • Repeat
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Epi triad
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• Epi triad-Agent, host and environment triangle all 3 things interact together
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web of causation
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An epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. At the time of development, there was a need to develop a model that would help describe multiple factors underlying chronic illnesses. These casual webs are more focused and realistic, and they may be as intricate and complex as needed. Each factor is perceived as a link in multiple interrelated changes. This approach helps identify direct and indirect factors that can be changed or modified to improve health.
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Example of Web of causation
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web of causation non communicable diseases-heart attack Primary causes-biologically know what it is-social pressures to eat, not to exercise, Personality, emotional stress, lifestyle issues • As nurses, we can intervene at any one level-higher up you go, less cost. Body image in boys/girls. What's important, what's not important. Higher up you go, cheaper it is to do education/care.
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• Vital Statistics STATISTICS What is going on Trends Decide whether/not you have unusual outbreak of measles in community. Used for lots of different reasons. Collected systematically. More common ones-U.S. Census, vital statistics. • Standardized data • US Census • Statistical Abstract of the US • Vital Statistics • Reporting: Hospital-Local HD-State HD-CDC • CDC, KDHE • MMWR • National Health Surveys-National health behavior survey.
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• Vital statistics-collected regularly and measured by all kinds of people Vital statistics is the term used for the data collected from the ongoing registration of vital events, such as death certificates, birth certificates, and marriage certificates.
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Rates RATES • Number of events that occur in a given population in a given period of time • 55 cases per 1000 of influenza...etc. Allow us to compare incidences and outbreaks over time as well as different places. Compare Wichita and Kansas City in rates. • Allow for comparison of outbreak/incidents that occur at different times or in different places.
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• Rates-births, deaths, marriages, abortions. • Rate is a statistic used to describe an event or characteristic. In epidemiology, the rate is usually converted to a standard base denominator—such as 1000, 10,000 or 100,000—to permit comparisons between various population groups. A rate description includes time, person or population, and place specifications (e.g., the number per year (time) in uninsured children (population) in a specific city (place). Using standard base rates makes comparing the magnitude of an event (e.g. illness, death) in different population groups easier.
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RATES
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RATES • Number of events that occur in a given population in a given period of time • 55 cases per 1000 of influenza...etc. Allow us to compare incidences and outbreaks over time as well as different places. Compare Wichita and Kansas City in rates. • Allow for comparison of outbreak/incidents that occur at different times or in different places.
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TYPES OF RATES
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TYPES OF RATES • Morbidity-rates that measure illness-number of illness cases or reported diseases. • Incidence rate-number of cases I have new right now. • Prevalence rate-how many cases of diabetes that you have all together. • Mortality • Death-crude death rate-all deaths in population, all deaths caused by disease, age specific deaths. Statistics on mortality (death rates) and morbidity (illness rates) are collected routinely and used to describe the frequency of death or disease for a given time, place, and group of persons. Morbidity statistics also include measures related to specific symptoms of a disease, days lost from work, and number of clinic visits.
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examples of rate calculations
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Number of events x 1000, 10,000, or 100,000 ----------------------- Population at riskExample: 125 (number of pregnancies x 100,000 = ---------------------------------------------------- 120,602 (population at risk) 103 teenage pregnancies per year out of 100,000 adolescents 14 to 19 years old492 (number of pregnancies in City B) x 100,000 = -------------------------------------------------- 194,301 (population at risk 253 teenage pregnancies per year out of 100,000 adolescents 14-19 years old Ratios are expressed on a common base. Thus the ratio of city A to city B is 103 to 253, which is expressed 103:253. Dividing 253 by 103 equals 2.4563 or a ratio of 1:2.4563 expressed as approximately 1:2.5
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INFANT MORTALITY RATES
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• Measure infants deaths from birth to one year • Stratifications within rate-by months, by days, etc. Total number of deaths of children < 1 year x 1000 Total number of live births during the same year • Composite rate-rate measures more than what it is measuring-what causes death, lack of education, lack of prenatal care. • Indication of how well a society if functioning • Worldwide-Afghanistan-highest infant mortality rate • US: Black vs White-numbers are different-2004 South Carolina-rate per 1000 live births. White: 9.3 and Black 14.7 Access to care-prenatal care-everyone can get in Japan.
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AGENT-HOST-ENVIRONMENT AGENT-
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AGENT • The element that must be present for the disease/injury/health to occur what is driving the disease? The agent is a causative factor that contributes to health problems. • Biological-communicable disease, bacteria, virus, fungus-the agent causing diseases • Chemical-arsenic poisoning, cholesterol-high cholesterol, carbon monoxide • Physical-knife causing trauma, motor vehicle crash, hyperthermia-sun stroke, cold-hypothermia. • Good diet and physical exercise-help make people healthy
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AGENT-HOST-ENVIRONMENT HOST-
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• Any susceptible organism effected by the agent-the person affected by agent • Susceptibility factors: • Age-nonmodifiable very young or very old, gender certain things happen in men that don't happen in women and vice versa. Homicides-workplace homicides-whenever go into a workplace-receptionist/secretaries greet you at door. Higher rate of homicide on the job. • Men have higher rate of injury on the job • Genetics-sickle cellModifiable • Lifestyle-people have certain lifestyles drug, smoking, sedentary • Occupation-miners, environment-asthmatic-living in Denver, health care-access
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AGENT-HOST-ENVIRONMENT ENVIRONMENT
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• All external factors that inhibit or promote disease/injury or health • Geography-Denver-mile high, bad for respiratory problems • Climate-Arizona desert vs mile high Denver • weather, • flora, fauna-plants, animals-ragweed-allergies-affect ability to breathe well-Deer area. Lime disease-rocky mountain spotted fever increase • Psychosocial factors-living under stress, Soldiers coming back from war in middle east. Hot dry summer has affected population of mosquitoes-encephalitis not present as much because less mosquitoes. • Socioeconomic factors-where you live, what money you have, things you can afford. Pre time, event, post event
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AGENT-HOST-ENVIRONMENT EXAMPLE
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Host-Person-licensed, sober, rules of road, know how to drive Agent-a car-must have working breaks and airbags Environments-dry and well lit with wide shoulders Event-accident-host to stay in car, Agent-car not to catch on fire Environment-guard rail absorbs some energy of accident so that there is some absorption of energy.After event-Host-have insurance Agent-car stay in one piece-people can get you out of there Environment-EMT close by, helicopter close by, Level 1 Trauma center.Keep kids sober when they drive State-make roads in community okay Hospital-trying to get level 1 trauma center.
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The chain of infection is a model.......
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The chain of infection is a model that describes the infectious process. Chain of Infection-big into how things are caused, way it came about. Infectious disease-one causes other, here's how it goes. Agent-what causes the pathogen, what causes the problem. We have the reservoir-where agent likes to live and reproduce. Respiratory problem-agent living in lungs. In gut-agent living in gut. Hanta virus-field mouse Agent gets out of person-means of escape-portal of exit-related to portal of entry-fecal-oral route-respiratory route-blood to blood. Mode of transmission-direct skin to skin, droplet spread, airborne, vehicle born-fomite-doornob-nora virus vector born transmitted by insects-mosquitoes, fleas. Means of entry relates to means of escape. Cold virus-sneeze out-air droplets-inhaled by person sitting next to you-the person is on chemotherapy-immunosuppressed. Break the link-handwashing and cleaning-antiseptic soap. Wear masks, gloves, wash hands, use shields. Immunize host-make host stronger.
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Multiple Causation of Disease
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Multiple Causation of Disease The theory of multiple causation of disease is critical to understanding epidemiological problems. Casuality is generally considered in terms of a stimulus or catalyst that produces a single effect, result, or outcome. In epidemiology the interactions of the agent, person (host), and environment are analyzed by statistical methods to determine whether a causal relationship exists between various factors and health status. Understanding these interactions and relationships is even more important and complex as one considers the natural history of noninfectious diseases, chronic conditions, and the health and well-being of a population. In these instances, multiple causes or factors are usually interacting to affect health status. A significant number of multiple causation models in epidemiology can be found.
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The web of causation model is a metaphoric model that has been used in epidemiology texts since 1960s. All the models point to the interplay of numerous factors in the presentation of a specific disease. One way to remember the categories of causes for disease is the acronym used in the BEINGS model of disease causes. These categories include the following
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• (B) Biological Factors and Behavioral Factors • (E) Environmental factors • (I) Immunological Factors • (N) Nutritional factors • (G) Genetic Factors • (S) Services, Social Factors, and Spiritual Factors
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There are four different types of factors that can be involved with the casual mechanism of disease which are:
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1. Predisposing Factors - factors that are already present in the animal or person 2. Reinforcing Factors- support the production and transmission of the disease 3. Enabling Factors- factors that are affected through the environment of the individual 4. Precipitating Factors- are apart of the development of the health related event (the agent itself) (Merrill, 2013)
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QUESTIONS EPIDEMIOLOGISTS ASK
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QUESTIONS EPIDEMIOLOGISTS ASK • How many people are sick/well? • Who is sick/well? • When did people get sick/well? • Where did people get sick/well? • What do the sick/well people have in common?
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Endemic
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Endemic refers to \"the habitual presence of disease or infectious agents in a defined geographical area or population. Moreover, the same 5,000 cases of varicella might be considered an epidemic on a college campus where there are 12,000 students.
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Epidemics
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Epidemics are defined as rates of disease that are at a significant higher level than the usual frequency (Valanis). The raw data, then, may be of little value. Epidemics are not defined by raw numbers, but rather by rates of disease. A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease.
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rates and ratios are used by epidemiologists and public health professionals instead of
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To quantify and provide an accurate description of health situations, rates and ratios are used by epidemiologists and public health professionals instead of raw number reports. A rate is a statistic used for describing an event or occurrence. In epidemiology, a rate is used to make comparisons between populations or between subgroups within populations. It is frequently reported as a fraction, where the numerator is the actual number of occurrences and the denominator is the total population at risk for the occurrence. In epidemiology, the rate is usually converted to a standard base denominator such as 1,000, 100,000 to allow for comparisons between groups.
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Rate
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Rate: a rate is a measure of some event, disease, or condition in relation to a unit of population along with some specification of time. Infant death: an infant death is the death of a live-born child before his or her first birthday. The age at death may be further classified as neonatal or postneonatal. Neonatal deaths are those that occur before the 28th day of life; post-neonatal deaths are those that occur between 28 and 365 days of age.
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Infant mortality rate:
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Infant mortality rate: The infant mortality rate is based on period files and is calculated by dividing the number of infant deaths during a calendar year by the number of live births reported during the same year. It is expressed as the number of infant deaths per 1,000 live births. The neonatal mortality rate is the number of deaths of children younger than 28 days of age per 1000 live births. The post neonatal mortality rate is the number of deaths of children that occur between 28 days and 365 days after birth, per 1,000 live births.
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Incidence
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Incidence: incidence is the number of cases of disease having their onset during a prescribed period of time. It is often expressed as a rate (e.g., the incidence of measles per 1,000 children-5-15 years of age during a specified year). Measuring incidence may be complicated because the population at risk for the disease may change during the period of interest, for example, due to births, deaths, or migration. In addition, determining whether a case is new—that is, whether its onset occurred during the prescribed period of time—may be difficult. Because of these difficulties in measuring incidence, many health statistics are instead measured in terms of prevalence.
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Prevalence:
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Prevalence: Prevalence is the number of cases of a disease, number of infected persons, or number of persons with some other attribute present during a particular interval of time. It is often expressed as a rate (e.g., the prevalence of diabetes per 1,000 persons during a year.
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CALCULATING RATE
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Number of conditions or events That occur in a specific period of time x base multiple of 10 ------------------------------------------------- Population at risk during the same Time period
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morbidity rates measure
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Common morbidity rates measure the incidence and prevalence of disease risk among populations. Crude rates measure the entire population in a designated geographic area in relationship to a condition that is being investigated.
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Crude death rate
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Crude death rate = number of deaths in 1 year x per 100,000 population ----------------------------------- Average midyear population
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An incidence rate
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An incidence rate measures the number of new cases identified in a measure of time Incidence rate =Number of new conditions or events that occur in a specific period of time x base multiple of 10 ------------------------------------------------- Population at risk during the same Period (usually midyear)
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A prevalence rate
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A prevalence rate measures the existing number of cases in a population at a given time or over time. Prevalence rate= Number of existing conditions or events occurring x base multiple of 10 within a specific period of time ---------------------------------------- Population at risk during the same Time period
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The age-specific death rate
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The age-specific death rate is another rate used to index health Age-specific death rate =Number of deaths among persons in a given age group in 1 year x per 100,000 population ----------------------------------------- Average (midyear) population in A specified age group
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The infant mortality rate (IMR)
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The infant mortality rate (IMR) is used to measure the health of a community or nation. An infant's mortality can be affected by many external factors. In developing countries, these external factors can include substandard health services and inadequate access to health care, poor water quality, inadequate food sources, and an increased level of infectious disease. Infant mortality rate = Number of deaths in children under 1 year of age during 1 year x 1000 ----------------------------------------------- Number of live births in the same year
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There are 3 main types of epidemiological investigations
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There are 3 main types of epidemiological investigations: descriptive, analytical, and experimental. Descriptive investigation is the study of the amount and distribution of disease within a population; analytical investigation attempts to determine why disease is occurring; and experimental investigation tests a hypothesis about a disease or disease treatment in a group of people. EPI STUDIES • Descriptive • Experimental Analytical • Retrospective • Case control • Prospective • Cohort study
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Descriptive studies, including prevalence and correlation studies, customarily describe the amount and distribution of disease within a population.
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Descriptive studies, including prevalence and correlation studies, customarily describe the amount and distribution of disease within a population. • Who is affected (person) • Where is the disease distributed in the human population (place)? • When is the disease present (time) • What is the overall effect of the disease (population)?The U.S. department of Health and human services administers the National health interview survey.
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CAUSATION
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• Association is strong • Association is consistent • Association is temporally correct • Association is specific • Association is not the result of confounding variable • Association is plausible & consistent with current knowledge
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ROLE OF THE NURSE IN EPI
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ROLE OF THE NURSE IN EPI • Reporter • Investigator • Consultant • Responder • Planner • Disease reporting • Report what seems unusual to you • Report what is required • Mandated conditions • Passive system • HIPPA exempt
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BE AN EPI PARTNER
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• Be curious • Ask why? when? where? • Don't just rely on the form • Histories • Don't dismiss evidence • Especially if it doesn't fit what you expect • Nursing judgment, experience
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Levels of prevention Primary Prevention
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Levels of prevention Primary Prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease. Primary prevention includes general health promotion and specific protective measures in the prepathogenesis stage, which are designed to improve the health and well-being of the population. Nursing activities include health teaching and counseling to promote healthy living and lifestyles. Sepcific protective measures aimed at preventing certain risk conditions or diseases—such as immunizations, the removal of harmful environmental substances, protection from ultraviolet rays, or the proper use of car safety seats for infants and children—are also primary prevention activities.
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Secondary Prevention
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Secondary Prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications. Screening programs in which asymptomatic persons are tested to detect early stages of a disease are the most frequent form of secondary prevention. Early case finding and prompt treatment activities are directed toward preventing the transmission of communicable diseases, such as the spread of impetigo in a school. Preventing or slowing the development of a particular disease or condition and preventing complications from a disease, such as scoliosis in teenage girls, are also examples of secondary prevention.
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Tertiary prevention
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Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for persons who have experienced a loss of function resulting from a disease process or injury. Nursing activities include education to prevent deterioration of a person's condition, direct nursing care, and referrals to resources that can help clients minimize the loss of function.
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1. Epidemiology is: select 1 o part of the nursing process for community health nurses. o used to examine the incidence of communicable diseases. o used to understand and explain how and why health and illness occur. o important in determining the prevalence of chronic diseases.
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used to understand and explain how and why health and illness occur Epidemiology is used to understand and explain how and why health and illness occur. Nursing and medicine use these concepts to help guide clinical practice and influence health outcomes. Epidemiology is a discipline that provides the structure for systematically studying the distribution and determinants of health, disease, and conditions related to health status. Epidemiology may be used as nurses work through the nursing process, but it is not part of the nursing process. Epidemiology looks at both chronic and communicable diseases and is used to understand and explain how and why health and illness occur. Epidemiology is the measurement of the distribution and determinants of states of health, illness, and accidents in human populations. Much of the work of the epidemiologist is observational. Descriptive, analytical, and experimental trial studies are used as well.
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2. 2. An appropriate question for a community health nurse to ask when conducting an assessment at the population level would be: o \"How old are you?\" o \"Where do you live?\" o \"What chronic diseases do you have?\" o \"Where are the areas for recreational activity?\"
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o \"Where are the areas for recreational activity?\" \"Where are the areas for recreational activity?\" asks a question at the population level. The emphasis is placed on what makes a healthy community rather than focusing on individual assessment information. Asking about age, specific location, and personal illness relates to the individual. It would be difficult to find out any information about the population by asking these questions..
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Communicable Disease (CD) definition
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Illness due to a specific infectious agent which arises through transmission from an infected person to a susceptible host: agent, host, environment.
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History of CD
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• CD have been the scourge of mankind from the beginning of time • Smallpox • Black Death-3 epidemics 548, 1348, 1644 • Malaria-500 million, 1 million die • Influenza-H1N1, bird flue, so on. • Cholera in South Carolina Fall of many great civilizations Death and disability in war time-armies of napoleon, Caesar
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Control of CD
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• Sanitation-less contact with agent-soap and water, sewage treatment • Medical Innovations-vaccines, antibiotics • Improved nutrition-dietician-best vaccine against disease is good nutrition • Education-modification of behavior-how to wash hands, etc.
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Are all CD's under control?
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NO • STD's ? - MRSA? Pandemic Flu? STDs are among the most serious public health problems in the U.S. Not only is there an increased incidence of drug-resistant gonococcal infection, but other STDs such as HPV (genital warts), HIV, and HSV (genetial herpes) are associated with cancer. • Need constant vigilance-keep looking to see what's out there • Emerging and reemerging diseases-plague in desert SW-carried by big cats, malaria in Texas? • Creating new environments for CD-Legionnaires disease, fake nails. • Bioterrorism • Antibiotic and antiviral resistance-gonorrhea, TB • Any mistake can cause resurgence - Pertussis, measles, chicken pox.
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Ways we continue to control CD's
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• Surveillance & reporting • http://www.sedgwickcounty.org-what diseases have we had in the community. • Isolation/quarantine-negative flow room, respiratory precautions. Incubation 7-14 days • Drugs-antibiotic, antivirals, anti TB drugs • Education-WASH HANDS!
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Immunizations
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• Importance-basic arsenal when it comes to controlling CDs. • Polio paralyzed, Pertussis kill 8,000 children, etc.
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• Types of immunizations-
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• Types - Live • Varicella-very careful about giving it. - Inactivated • Most others
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• Schedules-changes every 6 months.
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- Adult-Dtap, influenza, pneumonia, shingles. Prevent infections, -chicken pox. Chicken Pox causes scarring-gets into lungs, bad! Pertussis and measles easy to re-emerge. • CDC - Children • AAP Misconceptions and rumors-Homeschool-not getting immunizations, Autism, etc. Not cheap to get immunizations.
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Prep and Administration of immunizations
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• Sites - IM - Subq • MMR • Varicella• Needle length - IM -5/8 inch needle no good. Go in deep enough-1 inch/1 ½ inch. Too many reactions with 5/8 inch needle. - Subq
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Storage of immunizations
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Storage • Check temperature 2x a day • Refrigerate - 35-46 • Freezer - Below 5
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Levels of Prevention Primary Prevention
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Primary Prevention • Provide community education about prevention of communicable diseases to well populations • Vaccinate for hepatitis A virus (HAV) or hepatitis B virus (HBV) • Provide community outreach for education and needle exchange
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Levels of Prevention Secondary Prevention
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• Administer tuberculin skin test (TST) • Test and counsel for HIV • Notify partners and trace contacts
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Levels of Prevention Tertiary Prevention
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• Educate caregivers of persons with HIV about standard precautions • Initiate directly observed therapy for tuberculosis treatment • Identify community resources for providing supportive care (e.g. funds for purchasing medications). • Set up support groups for persons with Herpes simplex virus 2
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GI Disturbances-Salmonella
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• Salmonella - Agent-bacteria - Host-people, children - Transmission-turtles, ducks, dogs, chickens - Incubation-time between exposure to first symptoms-6-72 hours you are sick - Symptoms-abdominal pain, green loose stools, low grade fever, nausea, vomiting, anorexia, - Treatment-has to run course-treat symptoms. - Control-cleaning techniques,
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GI Disturbances Shigella
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Shigella • Agent-bacteria, dysentery • Host-people • Transmission-direct, indirect-flies, cockroaches, feces • Incubation-1-3 days longer incubation, worse disease • Symptoms-mucous, pus, blood stools diarrhea, fever, nausea, vomiting, cramps • Treatment-antimicrobials • Control-good hand-washing techniques, good kitchen techniques.
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GI Disturbances Giardiasis
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Giardiasis • Agent-protozoa • Host-humans, found worldwide-poor sanitation-bad water • Environment streams Kansas and Colorado, cattle, defecation, fecal-oral route-feces into someone. • Incubation -7-10 days incubation, • Symptoms-diarrhea, steaorheea fat looking stools-pale, loose, greasy stools. Abdominal cramps, bloating, symptoms 2-6 weeks. • Treatment-flagyl. Making sure water supply clean. • Control-161 cases in Kansas one year.
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GI Disturbances Listeriosis
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Listeriosis-Colorado outbreak-Cantelopes • Agent-gram positive rod lives in soil, water, animals • Host-humans, older adults and pregnant women, newborns.-weakened immune systems • Transmission-contaminated food, raw milk, soft cheese, contaminated fruit-cantaloupe • Incubation-3-70 days depend on how much bacteria-average 3 weeks • Symptoms-fever, muscle aches, nausea, diarrhea, headaches, miscarriage, stillbirth, premature delivery, convulsions, stiff neck • Treatment-antibiotics, • Control-properly cooked meats, pasteurized dairy, and wash vege and fruit before eating. • Colorado outbreak-from harvesting machines 133 cases, 26 deaths, 1 miscarriage
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GI Disturbances Campylobacter
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Campylobacter • Agent-bacteria • Host-poultry, cattle, • Transmission-indirectly by ingesting organisms that come from cattle, undercooked chicken, raw milk • Incubation 2-5 days • Symptoms -diarrhea, abdominal pain, malaise, fever, nausea, vomiting. Traveler's diarrhea. 2009-362 cases of campylobacter in Kansas • Treatment • Control
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GI Disturbances E Coli 0157:H7
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E Coli 0157:H7 • Agent-toxins that are formed that are produced by ecoli strain • Host-cattle, high risk people-children • Transmission-poorly cooked beef or raw milk • Incubation-12-60 hours • Symptoms-hemorrhagic colitis-bloody diarrhea, abdominal cramping, hemolytic uremic syndrome lead to renal failure-54 cases of Ecoli in Kansas one year. • Treatment-Cook beef better-especially ground beef. No treatment-or ICU • Control
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Infestations Lice and Scabies
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• Lice and Scabies • http://www.headlice.org • Host-people-higher risk -kids. Pediatric social disease. Sharing combs, hats, etc. • Transmission-skin to skin • Incubation-until eggs hatch • Symptoms-itching, tunnel like line where scabies might be • Treatment-topical ointment or shampoo. Must have knits out. Takes comb that has serated edges-every strand of hair has to go through comb-takes forever to get done.• Control-not sharing clothing, hats, brushes, make sure things don't touch together. People coming in with chemical reactions-burns. They think that they can get rid of lice by the stuff that really kills bugs. Home remedy-vegetable oil and head covering for a few days. Lice can't breathe and suffocate.
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Hepatitis
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Hepatitis • Agent-virus Hep A, B, C, D, E • Host-humans • Transmission A-fecal oral route, B and C blood borne pathogen • Incubation-Longer incubation-A has 28 days incubation. Milk that didn't taste good, B-60-90 days, C-1-5 months-might never know you have until liver failure. • Symptoms-mild fever, sore muscle, malaise, anorexia, dark urine, light stools, jaundice. Silent disease. • Treatment-treat symptoms, antivirals are somewhat effective, interferon, immunoglobin. If have Hep B -out of work until can prove not contagious. Beginning immunization of Hep B • 2009 occurances-10A, 6 of B and 1 of C, Chronic C-2100 cases in Kansas, or 3.2 million. Hep C risk-exposed with blood piercings tattoo, sexual contact. • Control
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Hepatitis A
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Hepatitis A is most commonly transmitted through fecal-oral route. Sources may be water, food, or sexual contact. Foodborne outbreaks most common. The virus level in the feces appears to peak 1-2 weeks before symptoms appear, making individuals highly contagious before they realize they are ill. Vaccine for Hep A available since 1995Hepatitis A poses a risk for workers in settings such as institutions for the retarded where personal hygiene may be poor (Levy and Wegman, 1995). The use of good handwashing techniques is most effective preventive measure for this virus.
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Hepatitis B (HBV)
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Hepatitis B (HBV) is the most prevalent work-related infectious disease in the United States. Although blood is the major source of the virus, it may also be present in saliva, semen, and feces. Transmission may occur from a percutaneous stick from a contaminated needle or other sharp instrument (the risk of contracting HBV after a stick with a known contaminated needle is 6-30 percent) (Udasin and Gochfeld, 1994), after contaminated blood enters a break in the skin or splatters onto mucous membranes, or upon ingestion. The OSHA Bloodborne Pathogens Standard has provisions for preventing Hepatitis B in healthcare workers including Hepatitis B vaccine, education, procedures for sterilization and disinfection, and use of personal protective clothing. In addition, the CDC has recommendations for work practices during invasive procedures.
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Hepatitis C-
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Hepatitis C-Higher risk-health care workers and emergency personnel who are accidentally exposed; infants who are born to infected mothers, and IV drug users who share needles. Risk is greatest for those with exposure to infected blood. Clinical signs of Hep C may be so mild that an infected individual does not seek medical attention. The incubation period ranges from 2 weeks to 6 months. Clients may experience fatigue and other nonspecific symptoms. Clients infected with HCV often present with an elevated level of the liver enzyme alanine aminotransferase (ALT), which may rise and fall during HCV infection. About 15% of infected persons will have spontaneous resolution of the infection, but most develop chronic liver disease. HCV infection may lead to cirrhosis or hepatocellulr carcinoma.
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STD
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• Perfect Storm- - Spread by personal behavior-what can and shouldn't do - May be unsymptomatic-not know you have certain diseases - Spread easily- - No vaccines - STD's are in the population • 15-30-so good about listening to personal behavior - Some incurable • AIDS • Herpes
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Gonorrhea
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Gonorrhea-43 people 28 infected 11 not infected-outbreak 1971 median age 17 in Independence Kansas. (there are antibiotic resistant strains) • Agent-bacteria • Host-humans 15-24-in Kansas 2000 cases of Gonorrhea • Transmission-sexual activity, sexual abuse-trachea, throat, anus • Incubation-2-7 days • Symptoms-purulent discharge, dysuria, • Treatment-antibiotics • Control-safe sex, contact tracing. 2x as much for women-prenatal care, family planning, get tested more than men do. • http://www.kdheks.gov
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Chlamydia
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Chlamydia • Agent-bacterium it infects the genitourinary tract and rectum of adults and causes conjunctivitis and pneumonia in neonates. • Host -375 per 100,000-Kansas • Transmission-mucopurulent discharge from infected sites • Incubation • Symptoms-asymptomatic in women where up to 90% may experience no symptoms. If left untreated, Chlamydia can result in pelvic inflammatory disease. PID. Symptoms can include dysuria, urinary frequency, and purulent vaginal discharge. In men the urethra is the most common site of infection, resulting in nongonococcal urethritis. Symptoms are dysuria and urethral discharge. Most common reportable infectious disease in U.S. • Treatment-Doxycycline, azithromycin • Control-condoms, less sexual partners • http://www.youtube.com/watch?v=dcaqS2eDmRs
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Tuskegee Syphilis Study
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Tuskegee Syphilis Study is a well known example of racism. This study was conducted by the U.S. Public Health Service to observe the effects of syphilis on African American men over a period of 40 years, beginning in 1932. When African-American men with syphilis were recruited for the study they were told that they were being treated for \"bad blood,\" and treatment for syphilis was withheld intentionally so that the study could be completed. As a result, hundreds of men lost their lives because of the discrimination and substandard health care. The consequence of such racism has contributed to the belief among some African-Americans that research might be designed to harm them and that all care might be a part of a research study, especially government programs, designed to cause harm. Nurses too can exhibit prejudice and racism. Ethical issues are moral challenges facing us or our profession. In nursing, one such challenge is how to prepare an adequate and competent workforce for the future. Ethical dilemmas are puzzling moral problems in which a person, group, or community can envision morally justified reasons for both taking and not taking a certain course of action. An example in community health of an ethical dilemma is how to allocate resources to two equally needy populations when the resources are sufficient to serve only one of the populations. Ethical Decision making framework: 1. identify the ethical issues and dilemmas 2. place them within meaningful context 3. obtain all relevant facts 4. reformulate ethical issues and dilemmas, if needed 5. consider appropriate approaches to actions or options (utilitarianism, deontology, principalism, virtue ethics, ethic of care, feminist ethics) 6. Make decision and take action 7. Evaluate the decision and the action.
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• Environment
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• Environment-External conditions, circumstances and influences surrounding and affecting the growth and development of an organism or a community of organisms External conditions: air, water, housing, streets Circumstances: Economic situation, war in middle east. Influences-computer age, fast food influence, advertising influence.
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Environmental Health
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• Environmental Health- Assessing, controlling and improving the impact people make on their environment and the impact the environment makes on them
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Institute of medicine-report nursing environment and illness-medicine
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Institute of medicine-report nursing environment and illness-medicine • Freedom from illness or injury related to exposure to toxic agents & other environmental conditions that are potentially detrimental to human health (institute of medicine, 1995)
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Our impact on the environment that creates that air pollution. How environment harms us. Environmental health threats can be_______________________________________________
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More than one-fourth of the global disease burden is attributable to environmental exposures. Given this fact, assessing an individual's environmental exposures is critical in community nursing practice. Environmental health threats can be chemical, physical, biological, nuclear, or radioactive. Examples of environmental toxins include pesticides (chemical), industrial waste or by-products (chemical), fire (physical), explosions (physical), injuries from environmental hazards (physical), microbes (biological), poisonous plants or mold spores (biological), and oncological treatments such as implants and seeds (nuclear/radioactive).
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The Institute of Medicine Core Competencies for Nursing Professionals are:
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1. Knowledge and Concepts; 2. Assessment and referral; 3. Advocacy, ethics, and risk communication; and 4. Legislation and Regulation. These competencies establish a baseline of knowledge and awareness necessary for nurses to prevent and minimize health problems associated with exposure to environmental agents.
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Environmental Health Principles for Public Health Nursing
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1. Safe and sustainable environments are essential conditions for the public's health. 2. Environmental health is integral to the role and responsibilities of all public health nurses 3. All public health nurses should possess environmental health knowledge and skills 4. Environmental health decisions should be grounded in sound science. 5. The precautionary principle is a fundamental tenet for all environmental health endeavors 6. Environmental justice is a right of all populations 7. Public awareness and community involvement are essential in environmental health decision making 8. Communities have a right to relevant and timely information for decisions on environmental health. 9. Environmental health approaches should respect diverse values, beliefs, cultures, and circumstances. 10. Collaboration is essential to effectively protecting the health of all people from environmental harm. 11. Environmental health advocacy must be rooted in scientific integrity, honesty, respect for all persons, and social justice. 12. Environmental health research addressing the effectiveness and public health impact of nursing interventions should be conducted and disseminated
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INFLUENCE OF THE ENVIRONMENT ON HEALTH • Florence Nightingale
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• Florence Nightingale-Crimea experiences-bring down mortality rates by cleaning floors, clothes, keeping things clean. Notes on Nursing-talks a lot about Very first cannon in nursing-first essential-keep air he breathes as pure without chilling him. Need to have clean air.In watching diseases, both in private homes and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different—of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these. —Florence Nightingale, 1860, p. 8• Emphasized importance of a clean & safe environment • Pure air • Pure water • Efficient drainage • Cleanliness • Light
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BASIC LAWS OF ECOLOGY Science that came about how things connected-eco system-interact with everything around us.
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• Everything is connected to everything else-some things are more connected than others. • Everything must go somewhere-has to do with laws of nature/gravity. Whatever we put up into air will eventually come back down again. Recycle water bottle-ends up someplace. Plastic does not degrade. Melt into ball but still there. Running out of room • Nature knows best-Nature always wins-flooding, hurricanes, mudslides. • There's no such thing as a free lunch-whatever we do to environment today, kids, great-grandkids have to pay for it/live with it. Bury solvents in ground in metal barrels-rust-gets to be a mess-must be cleaned up. • Everything has a reason for being-fighting over land in Colorado. Salamander situation. • Everything is constantly changing-Change slowly/changing fast.
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POLLUTION • Natural- • Human Created
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• Natural- • Periodic-not always forest fire every year in same place, not always a flood, hurricane in same place every year • Natural systems in place to create equilibrium-wherever forest fire, grasses begin to grow, bushes, trees, system in place again. Trees in forest need heat to germinate. • Human Created • Constant-Kellogg-traffic-air pollution being emitted • No chance for nature to recover/cleanse itself.
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CONTRIBUTING HUMAN FACTORS
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• Urbanization-all living in cities-whenever live far apart on farms, our trash wasn't so much, we put out a bunch of trash per day. • Industrialization-before industrialization, not much pollution. Producing stuff-byproducts- found ways to reduce pollution by putting scrubbers on top of factory chimneys. • Human population growth • Production & use of disposable products-we as consumers-buy a lot of stuff. Economic crisis-not spending enough money in buying products. Buy things and don't realize what it really means. Catheter kit-so convenient-disposable-fills trash when done. Clock radio lasts only 3 years then have to buy new one-cell phone-same thing. A lot of things made in china at dollar store. Carbon footprint cost in China-cause pollution when make product. Ship bowl from middle of China to port. Pollution-put on container and shipped to U.S. Truck then transport from New York to Wichita-so much pollution.
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AIR POLLUTION
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• Everyone has to breathe (35 lbs of air/day) • Natural sources • Volcanoes, forest fires-massive amount of Chemicals into air-Ash covering everything. • Human sources • Combustion of fossil fuels • Industrial, cars, coal powered energy plants-coal, natural gas, etc.
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Clean Air Act
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Clean Air Act regulates air emissions from area, stationary, and mobile sources. The EPA was authorized to establish National Ambient Air Quality Standards (NAAQS) to protect public health and the environment. The goal was to set and achieve the NAAQS by 1975. The law was amended in 1977 when many areas of the country failed to meet the standards. The 1990 ammendments to the Clean Air Act intended to meet unaddressed or insufficiently addressed problems such as acid rain, ground level ozone, stratospheric ozone depletion, and air toxics. Also in the 1990 reauthorization, a mandate for Chemical Risk Management was included. This mandate for Chemical Risk Management Plans was included. This mandate requires industry to identify \"worst case scenarios\" regarding the hazardous chemicals that they transport, use, or discard.
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CRITERIA POLLUTANTS
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CO carbon monoxide Hydrocarbons-vapors-fill car with gas-vapor coming out of gas tank-can cause cancer Sox sulfur oxides- Nox nitrogen oxides Ozone Particulates-harvest time.
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INDOOR AIR-no outside air
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Paneling has formaldehyde in it • Indoor air pollutants • Asbestos in water pipes • Formaldehyde • Radon-if build house on granite-seep through basement. • Environmental tobacco smoke • Volatile organic compounds-these are things like cleaning oven spray-cleaners that we use.
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Health effects of bad air
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HEALTH EFFECTS • Lung damage • Effect on chronic bronchitis & asthma • Coughing-out east-see pollution. Americans have gotten so used to nonsmoking that we are able to smell it for miles away. • Irritation of eyes, throat • CO- death!
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SOLID WASTE
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SOLID WASTE • Sources-humans, agriculture, mining, industry-mcdonalds- • Types • Where does your solid waste go? Utilities-some solid waste resulting from that. Solid waste flow-where does it go? Website-one for Kansas department of health and environment report for 2010.
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SOLUTIONS
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• Reuse • Plastic bags, coffee cups, water bottles • Recycle • Paper, aluminum, glass, plastic • Reduce • Cloth bags, pre-cycling-don't buy anything that is packaged, compostingThe 3 R's adage of the environmentalist community—reduce, reuse, and recycle---help us consider ways to decrease our impact on the environment, and thereby decrease environmental health risks. By recycling, we prevent the need to extract more resources from the hearth in order to manufacture products with raw materials. Choosing reusable products, versus one-time-use products that are thrown away, prevents the need for manufacturing more products and decreases the waste stream. Reducing our waste stream can also be accomplished generally by a reduction in consumption, as well as by reducing unnecessary packaging in other nonessential goods.
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WATER POLLUTION
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WATER POLLUTION • Problem for centuries-used to throw trash into water. Dump sewage and trash • Water distribution issues-fighting with Colorado-how much water should come through. • Water quality Reduction of water borne illness-our water is clean. Wells-not regulated like water services in Cities and towns. Biological pathogens and nitrate checks-due to runoffs from fields. Do not use well water for baby formula-impact.
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Clean Water Act
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Clean Water Act The Clean Water Act sets basic structure for regulating pollutants to U.S. waters. The law gave the EPA the authority to set effluent standards on an industry basis and continued the requirements to set water quality standards for all contaminants in surface water. The 1977 amendments focused on toxic pollutants. In 1987 the CWA was reauthorized, and again focused on toxic pollutants, authorized citizen suit provisions, and funded sewage treatment plants.
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SOURCES OF WATER
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• Surface water • Rivers, lakes, oceans • Groundwater • Aquifers-Acqueous water beds. • Wells • Where does your water come from?
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SOURCES OF WATER POLLUTION
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• Point source • Single identifiable source • Broken sewage pipe -can follow trail to see who is dumping. • Non-point source • Pollution occurs through runoff, seepage and falling of pollutants into the water • Fertilizer on a field and it rains causing runoff Oil stains in driveway Pets using grass Insecticides/fertilizer/pesticide on lawn. Everything
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TYPES OF POLLUTANTS
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• Biological • Pathogens-water is treated for pathogens. Mountain stream in Colorado-may find giardia. • Toxic • Inorganic chemicals • Mercury-found in a lot of fish that people eat-fish consumption advisory. Heavy metal that seeps to bottom of river-cat fish are bottom feeders. • Radioactive materials • Synthetic organic chemicals • Medications-not all medicines are leached out of water • Birth control pills, hormones, antibiotics-low levels in water. • Eat beef-growth hormones. • Girls maturing a lot earlier than usual-affecting growth of females and how soon we develop.
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CHEMICAL HAZARDS: LEAD
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• Health concerns may become chronic • Children at greatest risk-lead poisoning-greatest risk for kids-absorb into bones-can cause chronic issues • Southeast Kansas at high risk-part of tri-state mining area-mined for coal, lead, heavy metals, leftover pollution, piles of tailings. • Sources • Paint, gasoline, water pipes, vehicle emissions, leaching from mine tailings Battery factories, lead smelting, hobbies-model making. For lead exposure, remediate a home with lead based paint in order to make it lead safe, therefore applying the primary prevention strategy of removing the exposure (at least from that specific source of lead). Good lead poisoning surveillance will not prevent lead exposure, but may help with early detection of rising blood lead levels.
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CHEMICAL HAZARDS: LEAD HEALTH EFFECTS
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HEALTH EFFECTS • Brain damage • Learning disabilities in children • Digestive problems • Kidney damage • Severe fatigue • Harmful to wildlife & plants-buckshot- • Fishermen-lead weight, chew on it when working on line.
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PROCESS FOR LEAD SCREENING &CASE MANAGEMENT
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PROCESS FOR LEAD SCREENING &CASE MANAGEMENT • Risk assessment questions-every child assessed for lead poisoning at least once-house built before 1960 that has lead or chipped paint. • Screening guidelines-at 1 year old • Environmental investigation-if positive blood screening result, someone will go out to house and figure out where lead is coming from. • Treatment
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ROLE OF THE NURSE • CHN are out there: OBSERVATION
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• Primary Prevention • Education clients and community about environment-recycling. Community cleanup. • Advocacy • Secondary Prevention • Assess for S&S of exposure • Screening • Tertiary Prevention • Support clean ups • Follow up on exposures
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ROLE AS CITIZEN OF THE WORLD
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• Become educated-tsunami of Japan-will radiation reach us. • Read • Ask questions • Educate those around you • Family • Work environment • Become active • Support a cause • DO something • Recycle • Write a letter
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Nurse's Scope of Responsibilities for Environmental Health Issues
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The nurse's role in addressing environmental health issues can be conceptualized in a variety of ways. The nursing process can be augmented or integrated with other models of practice, such as the CPHF model, which consists of 3 roles for the health professional: investigator, advocator, educator. The role of investigator supports the assessment and evaluation phases of the nursing process, while the roles of educator and advocate would be carried out as interventions. This framework incorporates a range of activities, including working with communities and on matters of public policy, that may be unfamiliar to nurses who structure their practice within the more traditional framework of the nursing process applied to individual patient care.
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Role as Investigator Nurses may act as investigators by
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Nurses may act as investigators by o taking careful environmental health histories and looking for trends in exposure, illness, and injury; o being alert to environmental factors that influence health; o working with interdisciplinary teams and with agencies to determine if an environmental exposure is affecting the health of a community; o initiating or engaging in research to identify and control environmental exposures that adversely affect human health; and o working with public and private institutions to perform risk and hazard assessments. In actual practice, this role may include home visits to look for peeling or chipping lead paint in the residences of young children or to identify the use of poorly vented wood stoves in the home of an asthmatic child. It may also involve entering a work site to assess conditions that affect worker health and safety, including ergonomic hazards, chemical exposures, or mechanical hazards such as poorly guarded conveyor belts. Moreover, the practice of nursing itself is uniquely hazardous.
