Community Health ATI (ch 1-7)

broad field that allows nurses to practice in a wide variety of settings. -promote the health and welfare of clients across the lifespan and from diverse populations -nurses in the community should understand the foundations of community health, principles, health promotion and disease prevention

provide the basis for care of the community and family. principles guide nurses in providing high quality care.

highlights relationship between individuals environment and health -depicts health as a continuum -emphasizes preventive care

predict or explain health behaviors -assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease -emphasizes change at individual level -describes likelihood of taking an action to avoid disease based on: susceptibility, seriousness, threat of disease -modifying factors, cues to actions, perceived benefits minus perceived barriers to taking action

complements health belief model. emphasizes change at the community level. identifies relationship between health deficits and availability of health promoting resources -theorizes that behavior changes within a large number of people can ultimately lead to social change

community: group of people and institutions that share geographic, civic or social parameters -communities vary in their characteristics and health needs -health is determined by the degree to which the community's collective health needs are identified and met -health indicators often used to describe the helath status of community and serve as targets for improvement -community health nurses practice in the community. have a facility from which they work but their practice is not limited to institutional settings -community is the client -community partnership occurs when community members, agencies and businesses actively participate in the process of health promotion and disease prevention -development of community partnerships is critical to the accomplishment of health promotion and disease prevention strategies -assess to determine needs and intervene to protect & promote health, preventing disease within a specific population

focus: individuals and families. -nursing is illness care: manage acute and chronic conditions in setting where individuals, families and groups live work and attend (schools, camps, prisons)

focus on at risk individuals, families, groups and community nursing: health care to determine health needs of a community and intervene at the individual, family and group level to improve the collective health of the community

focus: synthesis of nursing and public health theory -nursing to promote, preserve and maintain the health of populations by the delivery of health services to individuals, families and groups in order to impact community health

focus same as community health nursing -nursing to promote preserve and maintain the health of population through disease and disability prevention and health protection of community as a whole -core functions: systematic assessment of the health of population, develop policies to support the health of populations, ensure that essential health services are avialbale to all

ethical considerations, advocacy, epidemiology, calculations, edimiological triangle, epidemiologcal process, community based health education

prevent harm, promote good, respect individual and community rights, autonomy and diversity, promote confidentiality, competency, trustworthiness, advovacy -protect, promote, preserve and maintain good and prevent harm -balance indivdual rights vs. community groups -address challenges of autonomy and provide ethical care. right to info disclosure, privacy and informed consent, info confidentiality and participate in treatmnet decisions

-respect for autonomy: individuals select actions that fulfill their goals -nonmaleficience: no harm is done when applying care -beneficience: maximize possible benefits and minimize possible harms, assess risks and benefits when planning interventions -distributive justice: fair distribution of benefits and burden in society based on needs and contributions of its members

client advocate is the role of the community health nurse. nurse plays the role of informer, supporter, mediator for the client. -clients who are autonomous beings who have the right to make decisions affecting their own health and welfare -clients have the right to expect a nurse client relationship based on trust, collaboration, and shared respect, related to health and considerate of their thoughts and feelings. clients are responsible for their own health -nurses responsibility to advocate for resources or services that meet the clients health care needs -advocating for clients requires assertiveness, placing priority on the clients values and willingness to progress through the chain of command for resolution

study of health related trends in population for the purpose of disease prevention, health maintenance and health promotion -relies on statistics to determine rate of spread of disease, people affected, effectiveness of prevention and health promotion, goals met -spread, transmission and incidence of disease and injury -nurses are in a position of identifying cases, recognizing disease paterns, eliminate barriers, provide education targeted at disease or risk factors -study of relationships among an agent, host and environment --> agent is the cause of disease, host is the living being, environment is the setting of host

-incidence: number new cases in population at a time/ population total x 1000 -prevalnce: number of existin cases in the population ata time / population total x 1000 -crude mortality rate: number of deaths / population total x 1000 -infant mortality rate: number of infants deaths before 1 year of age / number live births in same year x1000 -attack rate: number of people exposed to an agent who develop disease / total number of people exposed

Phases: determine nature, extent and significance of the problem --> using data, formulate a theory --> gather information from a variety of sources to narrow possibilities --> make the plan --> put the plan into action --> eval the plan --> report and follow up

-relationships among an agent, host and environment. interaction determines development and cessation of communicable diseases, forming a web which increases or decreases the risk for disease HOST: age, gender, genetics, ethnicity, immune status, physiological state, occupation AGENT: chemical (drugs, toxins), physical (noise, temperature), infectious agents (viruses, bacteria) ENVIRONMENT: geography, water/ food supply, presence of reservoirs, access to health care, high risk working conditions, poverty

nurses provide education to promote maintain adn restore health -account for barriers: age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, lack of motivation

-behavioral: reinforcement methods to change learners behaviors -cognitive: use sensory input and repetition to change learners patterns of thoughts and behaviors -critical theory: use ongoing discussion and inquiry to increase learners depth of knowledge and change thinking and behaviors -developmental theory: use techniques specific to learners developmental stages to determine readiness to learn and impart knowledge -humanistic theory: assist learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest -social learning: links info to beliefs and values to change or shift the learners expectations

visual: learn through seeing, not taking, video viewing, presentations -auditoy: listening, verbal lectures, discussion, reading outloud, interpret meaning while listening -tactile-kinesthetic learners: learn through doing, trial and error, hands on approaches, return demonstrations

-identify population specific learning need -consider specific concerns and effect of health needs on population -select aspects of learning theories to use in educational program based on identified learning needs -identify barriers to learning and learning styles -design educational program: short and long term learning objectives, select apprpriate educational method based on learning objectives and assessment of participants learning style , content appropriate to objective, eval method -implement program -evaluate

-primary, secondary and tertiary -national health goals based on scientific data and trends -healthy people initiated in 1979 and every 10 years publishes national health objectives -coordinated by US department of health -national goals guide the nurse in developing health promotion strategies to improve individual and community health -community health nurse actively helps people change lives to move toward optimal health -preventive services: health education and counseling, immunizations, other actions -preventive services in multiple community settings -plan and implement screening for at risk

prevention of initial occurence of disease or injury. nutrition education, family planning and sex ed, smoking cessation education, communicable disease education, health and hygiene issues, safety education, prenatal classes, providing immunizations, advocating for access to health care, healthy environments

early detection and treatment of disease with the goal of limiting severity and adverse effects -community assessments, disease surveillance, screening (cancer, diabetes, hypertension, hypercholesterolemia, TB, lead exposure, genetic disorders), control of outbreaks of communicable disease

maximize recovery after injury or illness -rehab, nutrition counseling, exercise rehab, case maangement, physical and OT, support groups, exercise for hypertensive clients

-family,culture, social and environmental factors, access to health care, financing -culture is the beliefs, values, attitudes and behviors shared by a group of people and transmitted -enviro health refers to influence of environment conditions of development of disease -access to care impacted by availability of services in a community, individual, family and community

congruency between culture and health care is essential to the wellbeing of the clent. -comunity health nurses need to consider variations in culture, uniqueness needs to be considered, familiar with cultures in community -acculturation: merging/ adopting traits of a different culture. change in daily living in language, education, work, recreation, social experience, and health care system -culture awareness: self awareness of ones own cultural background, biases and differences --> these nurses are more likely to explore cultural variations in clients, understand how personal beliefs impact care, recognize meaning of health differs within cultures -do not stereotype -nurses need to be responsive to needs of client from dif cultures

effect of culture on communication, space and physical contact, time, social organization, enviro control factors -assess: ethnic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices -3 steps of data collection: ethnic background, religious pref, family structure, food patterns, health practice. ask qs that access clients perception of health needs. identify how culture may impact nursing

when a nurse or client cant understand the others language. -knowledge of health terms. family members as interpreters not advisable -consider client preferences. shouldnt be from same community as client -teaching materials in clients language

-aware of culture and view of others, cultural sensitive assessment, knowledge to develop culturally appropriate nursing interventions, goal in learning about diverse population

address clients by last name, introduce name and position, be honest about culture knowledge, use language that is sensitive, find out what clients know about their health problems, incorporate their pref into care, NO assumptions, encourage questions, respect values, beliefs and practice, show respect

toxins (lead, pesticieds, mercury, solvents, asbestos, radon) -air pollution -water pollution

-facilitate public participation, perform individual and population risk assessments, implement risk communication, conduct epidemiological investigations, participate in policy development

I PREPARE to determine exposure -I: investigate potential exposures -P: present work (exposure, PPE, location of material safety data sheets, home exposure, trends) -R: Residence -E: Enviro concerns (water, air, soil, waste) -P: Past work (exposure, farm, military, volunteer) -A: Activities (hobbies, gardening, fishing, hunting, burning) -R: Referrals and resources -E: Educate (risk reduction ,prevention)

housing residence, age, location, school, day care, work. ocupations of household measures, tobacco smoke presence? -remodeling activities -hobbies in home -exposure to chem -pets in home, healthy? -lead exposure -drinking water source -sewage and waste -pesticides -where children play

reduce toxic air, waterborne disease, domestic water use, blood lead levels in kids, pesticide exposure, indoor allergens, homes with lead based paint, exposure to chem and pollutants, number of new schools near highways, global burden of disease d/t enviro concerns increase: alternate mode of transportation, days that beaches are open and safe for swimming, recycling of waste, testing for lead based paint in 1978 housing, monitor for disease or conditions caused by enviro hazards, homes with radon mitigation, schools with practices to promote health/ safety

-Primary: educate on reducing hazards, adovate for safe water and air, support programs for waste reduction -Secondary: survey for health conditions related to enviro, obtain enviro health history, monitor for chem exposure, screen kids 6 months - 5 years for blood lead levels. assess homes, schools, work sites, community -Tertiary: refer home owners to lead abatement resources, educate asthmatic clients about enviro triggers, become active in consumer and health orgs, support cleanup of toxic waste sites

advocate for improved access -evaluate adequacy of health services within community, identify barriers encountered including: inadequate health insurance, inability to pay for services, language and culture barriers, lack of health care providers, geographic isolation, social isolation, lack of communication tools, lack of personal or public transportation, inconvenient hours, attitudes of health care personnel toward clients of low socioeconomic status

-WORLD health org: provides infor about international disease, standards for vaccines and antibiotics. focus on health care workforce and education, environment, sanitation, infectious disease, maternal and child health -FEDERAL health agencies: US department of HHS, funded through taxes, includes admin for children and families, admin for community living, medicaid and medicare -agency for healthcare research and quality -CDC to prevent and control disease -agency for toxic substances and disease -FDA -Health resources and service admin -indian health services -national institute of health (biomedical research) -substance abuse and mental health services -veterans health admin to finance military persons -STATE HEALTH: manages WIC programs, children health insurance program, public health policies, assists local health dep, state board of nursing to oversee nurse practice act, licensure, states school of nursing -LOCAL HEALTH: health of citizens, identify community needs, report disease to state, local tax funding. office of emergency management responsible for emergency response plan -PRIVATE health: health insurance, employer benefits, managed care (HMOs, preferred provider orgs, medical savings)

Medicare: 65 and older, social security, disability for 2 yrs, ALS, kidney failure, kidney transplant or dialysis. includes hospital care, home care, limited skilled nursing. medical care, diagnostics, physiotherapy. private insurance. prescription drug coverage Medicarid: low socioeconomic status and children (federal and state gov funds). based on household size, income (priority to pregnant women, children, disability). inpatient & outpatient services, radiology, labs, home care, vaccines, family planning ,early and periodic screening, diagnosis, treatment <21

collaborative leadership role -nurse should plan, organize, implement and evaluate intervention programs that address specific health needs of the community -program planning should reflect priorities of community assessment -established based on perception of health needs, percent of population affected by problem, relevance of problem to the public, estimated impact of intervention

-approach to emphasize community as a client, foundation for program planning -nurse helps to develop and implement strategies. assesses needs of community by interacting with community partners, witnessing interaction between community programs and response of clients to services, identifying future services based on visible needs of community members Community assessment includes: people (demographic, biologic factors, social factors, cultural factors -place or environment: physical factors, enviro factors -social systems: health, economic, education, religious, welfate, political, recreational, legal, communication, transportation, resources and services

direct discussion with community members to obtain ideas and opinions -minimal cost, participants serve as future supporters, offer insight, reading/ writing of participants not required, personal interaction elicit more response -built in bias, meeting time and place limitation

informant interview, participant observation, windshield survey

open public meeting -opportunity for community input w. minimal cost -weakness: dif finding place and time, potential to drift from issue, challenge to get adequate participation, less vocal person may not speak

-use of existing data to assess problem (census, healt records, prior health surveys) -ability to trend health issues over times -data may not rep current situation, can be time consuming

observation of formal or informal community activities -indicates community priorities, environmental profile, identification of power structures -limits: bias, time consuming, cant ask questions

-descriptive approach assessing several community components by driving through a community -descriptive overview of community: people, place, natural environment, boundaries, location of health services, man made environment, housing, social systems -need a driver, may be time consuming, only based on visual

directed talk with a rep sample -participants may be supporters, insight into community support, reading not required -limit: irrelevant issue discussion, challenging to get participants, requires strong facilitator, dif to ensure sample is truly representative of overall community, time consuming

specific questions in written format. data collected on client population and problems, random sampling, available as written or online format, contact with participants not required -limit: low response rate, expensive, time consuming, superficial data, reading/ writing needed

gathering collected data into composite database, assessing completeness of data, identifying and generating missing data, synthesizing data and identifying themes, identifying community needs and problems, identifying community strengths and resources

probs identified by community assessments -incorporate info from community assessment, general nursing knowledge and epidemiological concepts

-Preplan: brainstorm ideas, gain entry into community and trust, obtain awareness, coordinate collaborations -Assessment: collect data about community and members, complete a needs assessment, strengths and weaknesses, evaluate health data -Diagnosis: identify and prioritize health needs of community -Planning: develop interventions to meet identified outcomes -Implementation: carry out the plan -Evaluation: examine success of intervention (strengths and weaknesses, achievement, recommendations, share findings)

Strategies: thorough assessment, interpret data, collaborate, commuicate, sufficient resources, logical planning, skilled leadership -Barriers: inadequate assessment, miconstrued data, no involvement in community partners, impaired communication, inadequate resource, lack of planning, poor leadership

Community health nurses practice in diverse setting: home health, hospice nurses, occupational health nurses, parish nurses, school nurses, case managers -aggregates receive services: infancy to death, families, groups within the community

home health nurse: nursing home, traditional home, assisted living -work as part of team, holistic care. nurses, pt, OT, home health aids, social workers and dieticians part of the care -provide skilled assessment, wound care, lab draws, med education, parenteral nutrition, IV fluids & meds, central line care, urinary catheter insertion and maintenance, coordination of other participants in health -evaluate living environment for safety - older adults= increase fall risk -ask about food in home, help with household activities, living alone, support system, set up and dispense of medications, access to health care -encourage clients to be independent and involved

enhance quality of life through palliative care, supporting client and family through dying process, providing bereavement support to family after death -home, hospice center, hospital, long term care -not aimed toward cure. relief of pain and suffering -care for entire family -interprofesional approach, control symptoms, directed by provider, managed by nurse, volunteer for nonmedical care, postmortem bereavement, help family transition from recovery to acceptance of death

promote health and prevent occupational injury and illness -improve workplace, expenditure decreased by less sick time use, fewer worker compensation claims, decreased use of group health coverage -cost effective and high quality care: partner with hygenists, safety specialists, occupational medicine, HR< union reps and health insurance -assess risk for work related injury, plan and delivery health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workforce -Obtain occupational health history: current and past jobs, exposure, underlying illness, previous injuries, healthy or unhealthy habits -work site walk though: observation of process and materials, job requirements, actual and potential hazards, employees -control strategies to reduce exposure based on work related injury or illness (engineering, altering work practices, PPE, workplace monitoring, health screening, employee assistance, job task) -protection from violence and work related injuries from falls, environmental hazards, burns -occupational health and legislations (OSHA, NACOSH, workers comp)

Host factor: worker characteritics (experience, age, pregnancy) -agent factors: biological agents, chemical agents, mechanical agents, physical agents, psych agents -Environmental factors: physical factors, social factors, psych factors

primary prevention: teach good nutrition, provide immunization information, use protective equipment -secondary prevention: identify workplace hazards, early detection, prompt treatment, counsel and referral, prevent further limits -tertiary: restore health through rehab and strategies and limited duty programs

works with clients who share common faith traditions. practices that are important to health and healing. -caring and spirituality, CIRCLE model of nursing (caring, intuition, respect for religion beliefs, caution, listening, emotional support Missionary nurse: promote health and disease prevention by meeting spiritual, physical and emotional needs of people across the globe. -Parish nurse; promote health and wellness of faith communities (church members) & individuals. work closely with pastoral care staff, professional health care members to provide holistic approach

case manager, community outreach, consultant, counselor, direct caregiver, health educator, researcher

primary; assess knowledge regarding health issues (hand hygiene, healthy food choices, injury prevention, substance dependency), immunization status of children -secondary: assess children who become ill or injured at school, assess during emergencies, perform screening for early deterction of disease (vision and hearing, height and weight, oral health, scoliosis, infestations, general physical exams) assess children to detect child abuses or neglect, assess for evidence of mental illness, suicide and violence -tertiary: assess children with disabilities, assess children w long term health needs at school (provide care for disorders) e

health education, physical education, health services, nutrition services, counseling, psych and social services, promote health for staff, facilitate family and community involvement

-children and adolescent: health concerns, screening/ prevention, national health goals, community education -women: reproductive health, heart disease, diabetes, malignant neoplasm. screening for height and weight, blood pressure, cholesterol, dental health, pap, mammograms, sigmoidoscopy, vaccinations, immunizations, diabetes, HIB, skin cancer. reduction in osteoporosis, cancer, sexual violence. increase in planned pregnancies, prenatal care, breastfeeding, early warning signs of stroke -men: heart disease, malignant neoplasm, unintentional injury, lung disease, liver disease. screening for height and weight, BP, dental health, digital rectal exam, sigmoidoscopy, immunizations, diabetes, HIV, skin cancer, cholesterol. reduce cancer deaths, HIV and aids, fatal injuries. fincrease in muscle strengthening activities, identifying warning signs of stroke -older adults: heart disease, cancer, stroke, COPD, pneumonia, flu, substance use. screeen blood pressure, height and weight, dental health, sigmoidoscopy, mammogram, pap smear, vision, hearing, substance use, immunization, functional assessments, meds, osteoporsosi, diabetes, skin cancer

community oriented nursing practice. enagage in assessment, planning ,developement and evaluation. -home visits allow for observation of barriers to health -family crisis: when a family is not able to cope with an event. resources inadequate for demands of the situation -healthy family: good communication, affirmation and support among members, sense of trust, members play and share together, members interact with eachother, shared sense of responsibility, traditions and rituals, seek help for problems -risk appraisal: biologic, enviro risk, behavioral risk

Vulnerable populations: subject to violence, substance use disorders, mental health issues, homelessness, rural and migrant health -factors: poverty, dif acccess healthcare, young or advanced age, chronic stress, environmental factors GOALS: increase number of people with PCP, with health insurance, reduce those with delay in health and prescribed meds

homicide, assault, rape (higher in cities 8pm-2am weekend summer), suicide (higher among men >65), abuse, sexual violence, emotional violence, neglect, economic maltreatment -factors for abuse: history of being abused, low self esteem, fear and distrust, poor self control, inadequate social skills, minimal social support, immature motivation, weak coping skills -factors for violence: work stress, unemployment, media, crowded living, poverty, powerlessness, social isolation, lack of community resources

PRIMARY: conflict resolution, anger management, parenting classes, ed about comunity services, ensure safe environment for elderly, assist in removing factors that contribute to stress by referring to caretaker of older adult clients, elderly safe guard funds, DPOA SECONDARY: screen at risk individuals, assess bruises, screen all pregnant, refer victims to ED, assess suicide contemplation, suprport offender, address stressor TERTIARY: establish long term follow up, make resources in community available, refer to mental health, grief counsel, support groups

negatively affect family, public safety and economy. dependence: pattern of pathological, compulsive disorders involving physiological and psych dependence -denial= defensive, lying, minimizing use, blaming, intellectualizing -health probs involved: low birth weight, congenital abnormalities, accidents, homicides, suicides, chronic disease, violence ALCOHOL: most commonly used substance, depressant. tolerance. withdrawal= irritable, tremors, nausea, vomit, headache, sweating, anxiety, sleep disturb, tachycardia, hypertension (determine when last drink was) TOBACCO: nicotine is stimulant= alertness & energy, tolernace Stimulants-caffeine, amphetamines, meth, cocaine Depressants: barbiturates, benzos, chloral hydrate, GHB Opiates: morphine, heroin, codeine, fentanyl Hallucinogens: LSD, PCP, ecstasy Inhalants: huffede

PRIMARY: increase public awareness, encourage development of life skills SECONDARY: identify at risk individuals to reduce sources of stress, screen for substance use TERTIARY: assist with developing a plan to avoid high risk situations, refer to community groups (AA), monitor phar, emotional support

affective disorders (bipolar, major depression), anxiey (OCD, panic, phobias, PTSD), schizophrenia, dementia, conduct disorders, eating disorders -factors contributing: coping ability, life e vents, social events, chronic health probs, stigma with seeking service

primary: support, educate about mental health issues, teach stress reduction, parenting classes, coping abilities second: screen to detect disorder, crisis intervention tertiary: med monitoring, mental health intervention, referrals, maintain level of function to prevent relapse, assist in planning a regular lifestyle

unemployed, low wage, migrant workers, female heads of house, families with children, people with mental illness, veterans, substance use and addictive disorders, unaccompanied youth, runaways, intimate partner violence abuse, HIV/AIDs, older adults with no place to go -health issues: upper resp disorders, TB, skin disorders, substance use disorders, HIV/ AIDS, trauma, mental illness, dental caries, hypothermia, malnutrition

Rural Residents: higher infant and maternal morbidity rates & diabetes, obesity, less likely to be phys active, higher suicide. increased injuries, increased occupational risks, less likely to seek prev care -barriers: distance, lack of transportation, unpredictable weather, inability to pay for care, shortage of rural hospitals -migrant worker health probs: dental disease, TB, chronic conditions, stress, anxiety, leukemia, anemia, cancers, lack of prenatal care, higher infant mortality

PRIMARY: education about pesticide exposure, accident prevention, prenatal care, dental and immunization prevention -SECONDARY: screen for pesticide exposure, skin cancer, chronic disease, communicable disease TERTIARY: treat for pesticide exposure, mobilize primary care and emergency service

25 mil in US. 2 mil women, 9 mil >65. -veterans health include hospitals, outpatient clinics, home health services, hospice and palliative care, nursing omes, residential rehab, readjustment counseling -vet health issues: mental health, substance use and addiction, suicide, infectious disease, exposure to herbs, chemicals, and radiation, traumatic brain injury, spinal cord injury, traumatic amputations, cold injury, military sexual trauma, hearing loss, vision impair

communicable disease is an international health concern -nurses have unique skills to plan for and respond to natural and man made disasters

worldwide communicable disease is responsible for the deaths of millions each year. -leading causes: acute respiratory infections, AIDS, diarrheal disease, TB, measles, malaria POP at risk: young children, older adults, immunosuppressed clients, high risk lifestyle, international travelers, health care workers e -CDC reccomends immunizations

AIRBORNE: measles, chickenpox, TB, pertussis, influenza FOODBORNE: salmonella, hep A, trichinosis, E coli staph, c dif WATERBORNE: (fecal contram of water) cholera, typhoid fever, bacillary dysentery, giardia VECTOR: lyme disease, rocky mountain spotted fever, malaria --> lyme appears as a erythematous ring with a white center, mild fever, fatigue, muscle aches DIRECT CONTACT: STI, mono, pinworm, impetigo, lice, scabies

aka bird flu. may need to stay at home for up to two weeks to prevent the spread of disease. -antivirals can minimize symptoms -flu vaccination does not protect -need 2 injection of h5n1 28 days apart when an outbreak occurs

herd immunity: protection due to immunity of community members making exposure unlikely -Natural immunity: natural mechanisms of the body to resist specific antigens -acquired: develops through exposure --> active: product antibodies in response to infection. passive: transfer antibodies to host from mom to baby, Ig, plasma protein or antitoxins

systematic collection and analysis of data regarding infectious disease -nationally notifiable disease: anthrax, botulism, cholera, diphtheria, giardiasis, gonorrhea, hep a-c, hiv, flu, legionnaires, lyme, malaria, meningitis, mumps, pertussis, polio,rabies, rubella, salmonella, SARs, shigella, smallpox, syphilis, tetanus, TB, typhoid fever, vanco GOALS: reduce infection transmitted through food, HIV, aids, deaths from HIV, vaccine preventable disease, antibiotic courses for ear infections -increase in consumers with food safety, surviving >3 yrs with aids, TB testing for HIV, HIV education, condom use, immunization and flu shots, shingles immunizations

Primary: prevent disease spread, education on immunization, travel to other countries, hand hygiene and precautions Secondary: increase screening and case finding, refer cases for diagnostic findings, provide post exposure prophylaxis, quarantine clients Tertiary: decrease complications and disabilities of disease, monitor treatment, identify community resources

event causing human suffering and demands more resources than available to community. man made, naturally occurring, combingation -Disaster PREVENTION: surveillance, airport security, public health immunization and quarantine, flood barriers, demographic, identify and assess at risk populations -Disaster PREP: national state and local lev. coordinate community efforts, prep for disaster, action plan, disasiter kit, meeting place, communication protocol, drills -Disaster RESPONSE: federal emergency management, CDC, homeland security, red cross, public helath. assess disaster, number affected, fresh water and food, sanitation -Disaster RECOVERY: when danger no longer exists. until economic and civil life is restored, sanitation control, PTSD common.reactions: heroic, honeymoon, disillusionment, reconstruction

Category A:highest priority agents, posing risk to national security due to high mortality: smallpox, botulism, anthrax, tularemia, hemmorhagic viral fever, plaque B: second highest priority, high morbidity, low morality: typhus & cholera C: pathogens for mass dissemination, easy to produce, potential for high mortality: hantavirus -nurse: plan and prep for respose, identify agent, report activity, control and contain

-Inhalational Anthrax: cause headache, fever, muscle ache, chest discomfort, shock. treat with IV cipro, antibiotics don't stop disease progression -Botulism: dif swallowing, weakness, nausea, vomiting ab cramps, dif breathing. treat with airway management, antitoxin, elim of toxin, supportive care -smallpox: high fever, fatigue, severe headache, rash that appears on face first, pus filled lesions, vomiting. no cure. supportive care and prevention with vaccine -ebola: fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. no cure. airway management, dialysis, supportive care, prevention

primary: prep with bioterrorism drill, vaccine, antibiotics, design plan, identify chain of command, nursing roles, protocol -secondary: recognize, activate response, implement infect control, screen population, assist with education on managmenet, monitor mortality and morbidity -tertiary:rehab survivors, monitor meds, evaluate effectiveness

transition from inpatient to outpatient. use technology to maintain care. partnerships essential in improving health. among individuals, families, community agencies, citizen groups -partnering entities: individual, family, community agency, civic organization, citizen group, educational setting, political office, employment bureau -successful parternship: shared power and goals, integrity, flexibility, negotiation

coordinating individualized health care without disruption. manage services: follow up and referral

someone with knowledge who provides expert advice -initiate consult, seek expertise, request opinions, incorporate recommendations, serve as expert

restoring, maintaining or promoting health. linking client with community and self care measures -health care services: physicians, acute care, primary care, health departments, ling term, home care, rehab, PT< OT, specialty services, pharmacy -support: psych, church, support groups, life care planner, med equipment provider, meal delivery, transportation -engage in a relationship, establish referral, resources, accept decision to use a resource, facilitate referral, evaluate outcome -BARRIERS: lack of motivation, inadequate info or understanding, accessibility, priorities, finances, culture. attitudes of healt hcare personnel, cost, physical accessibility, time limitiations, limited expertise

ongoing assessment to anticipate future needs. communication between client, nurse, provider, family. enhance the wellbeing of the client by establishing optinos for meeting health care needs. -begins at admission

promoting services and client family involvement, decreasing cost, providing education, advocating for services collaboration, communication skills -assess: clarify problem by evaluating physical, psychosocial, functional and financial needs -diagnose: determine cause and factors: -planning: prioritize probs, possible outcome,s advantages, role of participants, impact on client -implementation: contact service providers, referrals, coordinate services -evaluation: montiro client and agencies comparing projected outcomes, needs, satisfaction

increases life expectatncy, impacts communities and health outcomes -informatics: combines nursing with information and communication in health records, databases, billing, electronic meeting, chat rooms -telehealth: quality health care through technology, skilled nursing transferring info to providers, home care increased using this, balance with hands on care -transmit: vitals, glucose, ECG results, voice convos, heart sounds, lung sounds and bowel sounds, images of wounds, and surgical incision

nurses must stay informed on current policy and laws that influence health of community. advocate for policies that protect public health. -change agent: advocate for needs at local state and federal level -lobbyist: influence legislator -coalition: facilitate goal achievement by collaborating two groups -public office: serve society and advocate for change by influencing policy development

tendency of people to view the world from the perspective of their own cultural background and viewpoint

process of forcing ones cultural beliefs on others

-leave old ties in place until new ones are secured -use clean technique to clean inner cannula if placed over a month ago -place thumb over suction port to suction -insert catheter 5 cm into trach tube

need to get 8-10 hours of sleep nightly and 1-2 hours during the day. -weight loss can reduce severity of disease -hot shower or bath may help with pain -exercise daily. on high pain days limits reps

ethical theory based on the idea that actions are based on moral rules or duties regardless of the consequences

the dominant approach to ethical decision making. principles of respect for autonomy, nonmaleficience, beneficience & distributive justice

the principle of right & wrong based on social and generational experiences