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NR422 EDAPT WEEK 1
According to the Centers for Disease Control and Prevention (CDC), public health is the science of protecting and improving the health of communities through organized community effort achieved by promoting healthy lifestyles through education and policy recommendations, preventing injuries , and detecting, preventing, and responding to illnesses
. “Public health is the science and art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort for: - sanitation of the environment, - control of communicable infections, - education of the individual in personal hygiene, - organization of medical and nursing services for the early diagnosis and preventative treatment of disease, and - development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity” (Nies & McEwen, p. 6). Determinants of Health - Individual Determinants - age - gender - diet - physical activity - substance use - family health history - Social Determinants - social norms and attitudes - exposure to media and emerging technologies - socioeconomic conditions - quality schools
- transportation options
- public safety
- residential segregation
- General Socioeconomic, Cultural, and Environment Conditions
- agriculture and food production
- education
- work environment
- unemployment
- water and sanitation
- healthcare services
- housing, homes, and neighborhoods
- exposure to toxic substances
- Health Services
- lack of available healthcare
- High cost of healthcare
- Lack of insurance coverage
- limited language access
- inability to receive preventative services
- Policy
- policies at the local, state, and federal levels that affect the health of the individual, population, or community Healthy People Goals
- Attain high quality, longer lives – free of preventable disease, disability, injury & premature death
- Achieve health equity, eliminate disparities, and improve the health of all groups
- Create social and physical environments that promote good health for all
- Promote quality of life, healthy development, and healthy behaviors across all life stages Public Health Structure Public and community health includes a wide range of organizations that work collaboratively to meet the needs of clients.
- World Health Organization (global)
- Department of Health and Human Services (federal)
- Centers for Disease Control and Prevention (federal)
- State Departments of Health (local)
- County Health Departments (local)
Primary Prevention Activities
- Prevent problems before they occur (for example, immunizations)
- General health promotion – enhance resiliency
- Specific protection – target well populations to reduce or eliminate risk factors Secondary Prevention Activities
- Early detection and intervention (for example, screening for sexually transmitted infection)
- Implemented after a problem has begun but before signs and symptoms appear Tertiary Prevention Activities Correction and prevention of deterioration of disease (for example, teaching insulin administration at home) Your response is correct! Primary prevention activities prevent problems before they occur, such as tetanus immunizations. Secondary prevention activities are early detection and intervention. Examples include mammograms and colonoscopies. Tertiary prevention activities are aimed at correction and prevention of deterioration of disease and may include alcoholics anonymous groups and chronic anxiety behavioral therapy. Healthy People Objectives Your response is correct! Core objectives reflect high-priority public health issues associated with evidence-based interventions, and most measure progress towards a goal over time. Developmental objectives are still high-priority but do not have reliable baseline data. Research objectives represent a high health or economic burden but are not associated with evidence-based interventions. Healthy People Objectives
- Target Met
- Target set at the beginning of the decade has been achieved or exceeded.
- Improving
- Progress is being made toward the target.
- Little or No Detectable Change
- Progress is not being made toward the target.
- Baseline Only
- No data beyond the initial baseline is available so unsure if progress has been made.
- Getting Worse
- Target is farther from achievement than at the beginning of the decade. Upstream Thinking Upstream thinking is a term used in community health to refer to the guiding principle of the discipline: prevention. upstream thinking means thinking ahead, planning before the illness, and attempting to prevent it. Your response is correct! Sources that could help determine a specific topic include sexually transmitted disease rates, percentage of teenage mothers, and rate of injuries due to motor vehicle accidents. The number of clinics, percentage of older adults, and number of assisted living residents do not provide enough specific data to determine a specific topic. Your response is correct! While all the areas increased, the largest increase was in teenage pregnancies. Therefore, the appropriate topic would be birth control methods and pregnancy prevention. Reducing exposure to sexually transmitted infections and appropriate screening for reproductive health issues are important and could be addressed, but this is not the highest increase. Road safety and effective vehicle operation could be addressed as well, but it had the lowest percentage increase. Your response is correct! To prepare for teaching the lesson, it is appropriate to use the Centers for Disease Control and Prevention statistics on pregnancy, birth control resources available through the state department of health, the local pregnancy resource center’s available resources and services, and the March of Dimes data for complications reported with teen pregnancies. Client records are not to be reviewed without consent and anecdotal stories cannot be shared. Additionally, daycare centers in the area do not help with pregnancy prevention, but are only an option available after pregnancy has occurred. Your response is correct! Potential Considerations Indicated Nonessential Nurse’s ability to speak the primary language of the target population x Traditional cultural and religious beliefs x Number of copies to make for each session x Risk factors for the specific population x
building promotes and develops alliances among organizations for a common purpose. Delegated functions carry out direct care tasks under the authority of a health practitioner as allowed by law. Outreach locates populations of interest or those at risk to provide information about the nature of the concern, what can be done about it, and how services can be obtained. Your response is correct! Primary prevention involves both health promotion and specific health protective measures. The focus of primary prevention is on the prevention of disease or disability before it occurs. Health promotion at this level encourages healthy individuals to strengthen and further support their good health. Specific protection is aimed at the healthy individual, but the focus is on prevention of specific diseases or injuries. Examples include vaccinations and promoting seatbelts when riding in a vehicle or helmets when riding a bicycle. Secondary prevention includes both screening for the early detection of a health problem and early treatment to mitigate disability. Note that with secondary levels of prevention, the disease or health problem is present, even if signs and symptoms are not yet evident. An example is screening for elevated cholesterol levels or hearing and vision screenings. Tertiary prevention is aimed at limiting complications from a disease or disability that is present. Tertiary prevention also includes rehabilitation with the intent of returning to optimal health and functioning. Cardiac rehabilitation or palliative care for terminal illness are two examples. Impact of Determinates of Health In acute care, the focus is often on the current symptoms and a simple diagnosis to define the problem and identify treatment. In population health, the determinants of health are reviewed and considered in determining the cause of a particular problem. These determinants include individual, social, general socioeconomic, cultural and environmental factors, health services, and policies. Pillars of Population Health Three Pillars of Population Health Clinical health care encompasses direct patient care delivered to individuals. For example, clinical healthcare services might include care for individuals who experience illness, injury, or disability, as well as individuals who are well. Public health services focus on the health of the population or community. For example, prevention and control of communicable disease, food safety, and mitigation of environmental health hazards are well-established functions within the public health system. Public policy includes efforts aimed at issues that impact the health status of individuals and communities. Policy efforts might directly target a health issue, such as provision of healthcare coverage. In other cases, policy efforts address issues that are not directly related to health, but
which influence the health of individuals and populations, such as policies which support education, affordable housing, or transportation. Your response is correct! The three pillars of population health are clinical healthcare, public health, and public policy. Education and training, prevention of disease, and health promotion are included within the pillars. Your response is correct! The United States spends more on healthcare than other industrialized nations but has lower scores on many key health indicators. Population Focused Practice Your response is correct! Skills must include practice, education, research, and policy development to build and sustain a capacity for population health nursing Epidemiology Population-focused care involves the use of scientific data collected through epidemiological methods. Epidemiology is the study of the "distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems" provides important data to direct health policy efforts. A systematic approach is used in the collection of information, analysis of the data, and during the evaluation process. Principles of epidemiology are based on quantitative approaches that borrow from the fields of biology, biostatistics, economics, and social and behavioral sciences to draw inferences about patterns and frequency of diseases Your response is correct! Health education is included in the intervention wheel and this is an example of primary prevention. The nurse provides information that will help clients prevent diseases or injuries from occurring. Surveillance is examining the presence of health events by collecting data and this is an example of tertiary prevention. Counseling is designed to enhance the capacity for coping with issues. Screening is secondary prevention. Core Functions of Epidemiology Population health uses the six core functions of epidemiology in planning population-specific care.
- Demonstrate effectiveness in reducing diseases and improving surveillance. Linkages
- Importance: Collaboration among professionals.
- Goal:
- Connect healthcare systems and communities.
- Improve health outcomes. Policy Development
- Role of Epidemiology:
- Inform public health policies.
- Focus on disease prevention, control, and effective surveillance management. Your response is correct! Surveillance involves collecting, interpreting, and disseminating health data to determine health needs and direct action steps to address those needs. The public health system generally conducts field investigation and involves, literally, a "feet on the ground" approach within the community to learn more about the individuals exposed, clinical progression, risk factors, and other characteristics of the disease to determine etiology and to take action to control further spread of disease. Evaluation is the practice of epidemiology that also contributes to evaluating public health interventions and services provided. Linkage is the interdisciplinary approach to care. Your response is correct! At an individual level, the nurse should look at genetic influences, food choices, levels of exercise, and parental work schedules (is the parent home with the child or does the child have to make their own food choices). The age and sex of the child are not relevant, as no age or sex determines obesity. Your response is correct! This population needs education on food choices, parental education, and screenings for genetic predispositions and body mass index. Vouchers for fast food will give access to food, but are not healthy. Your response is correct!
At the community level, availability of food, types of food served, and presence of physical education classes at school influence obesity in children at the community level. Laws regulating food labels and taxes on foods for consumption are societal influences. Your response is correct! Actions that may reduce obesity at school include:
- Limiting access to vending machines
- Providing short recess breaks in the morning
- Establishing a backpack pantry program to send nutritious foods home with children from economically disadvantaged homes Your response is correct! Primary prevention is activities focused on the prevention of disease. These clients are already diagnosed. Secondary prevention includes screening activities for the disease and tertiary prevention involves managing the disease and preventing progression. In this case, the tertiary prevention would be to provide ongoing dietary education. Removing gym classes is not appropriate, as the clients need exercise. Screening for hyperlipidemia needs to occur now since the disease is present. Measuring body mass index is appropriate, but it needs to be done more often than every two years. Your response is correct! It is important to evaluate changes in the following data: average body mass index in these children, time spent in physical education classes, access to junk food in vending machines, and the nutritional quality of food provided in school cafeterias. The parents' highest completed level of education is not an area that can be easily changed to affect childhood obesity rates. Your response is correct! The population health nurse is evaluating the pillars of community health regarding a foodborne illness outbreak of salmonella. The clinical healthcare arena can diagnose and treat illness one case at a time, only for those who seek care. The public health system can offer communicable disease investigation, ongoing surveillance, tracking, and contacting potentially infected individuals. Epidemiologists within the public health system can work to identify the source of infection and initiate efforts to reduce and control the immediate outbreak, and hopefully eliminate future outbreaks. Public policy can direct food safety regulations and practices to guide the agricultural, food sales, and food service industries, further reducing the risk of future outbreaks. Your response is correct!
- Plan community interventions
- Implement community interventions
- Evaluate the outcomes Aggerate of People
- a group of people who have common characteristics
- may belong to the same church, be similar age or ethnic background, or share a health- trait (for example, a support group for people with cancer) Location in Space and Time
- geographic or physical location may define a community
- boundaries may include a city, county, state, voting precinct, school district, or census tract
- a community may change over time; for example, the presence of a younger workforce may attract different industries Social System
- relationships of community members
- a community is a complex social system built of various subsystems in the community
- a health care system is an example of a complex system that is composed of smaller subsystems
- many subsystems are impacted by changes made to a larger system; for example, if a health department cuts programs, the community must react and readjust some methods the community nurse may use to collect data.
- interviews with key informants (formal or informal leaders with knowledge about or experience with the community)
- community forums
- secondary data (existing data such as census data, vital statistics, or mortality and morbidity data)
- observation of community activities
- focus groups
- surveys
- windshield survey Your response is correct!
- A blood pressure clinic flier posted in a grocery store is evidence of attitudes towards healthcare.
- People who are homeless in parks and older areas of town is evidence of economic conditions.
- Population appears diverse in race is evidence of social functioning.
- Two hospitals and several urgent care clinics is evidence of health resources.
- Sidewalks are mostly handicapped accessible is evidence of environmental conditions. Vital Statistics Every year, health departments aggregate and report official records of births, deaths, marriages, divorces, and adoptions from the previous year. These vital statistics provide information about the growth or reduction of the population, morbidity and mortality trends, and trends of congenital defects. Census Data The U.S. Census Bureau undertakes a massive survey of all American families every 10 years. The census data includes demographic variables, including population size and the distribution of age, sex, race, and ethnicity. Your response is correct! The community nurse should interview key informants who are knowledgeable about the health care needs of grade school children such as the school nurses, community pediatric health care providers, or school administrators. Secondary data such as census data and vital statistics would not provide the needed information regarding this small subset of the population. A windshield survey would not provide information about the specific health care needs of grade school children but may provide information about healthcare resources. Your response is correct! The community environment is best assessed by a windshield survey. A community focus group or key informant interview may be used to further validate the findings. Census data will not provide information about the community environment. Your response is correct! Age, sex, race, ethnicity, income, poverty, and occupation is census data that is readily available and the best source for this information. The local health department would also use the census data when seeking information about their community. Vital statistic data provides information about births, deaths, marriages, divorces, and adoptions from the previous year. A survey could potentially be conducted to collect this data; however, the information is already available in the census data. Analyze Data The nurse analyzes the data collected and then creates a list of actual and potential problems. The nurse should work with community members and local health professionals to establish priorities and desired outcomes.
The nurse is concerned that a significant percent of the community are older adults, there is limited public transportation, limited handicapped accessibility, and few nursing homes or assisted-living facilities. The nurse is not concerned that it is an urban community or that a significant percent of the community are African American. Your response is correct! Limited public transportation, limited handicapped accessibility, and few nursing homes or assisted-living facilities impact the community members’ access to care. This community is composed of a significant percent of older adults and African Americans. These groups have special health care needs, so the nurse must understand and address these needs. Access to Care Special Health Care Needs Significant percent of the community is African American x Limited public transportation x Few sidewalks and buildings have handicapped accessibility x Few nursing homes or assisted- living facilities x Significant percent of community is older than 65 years of age x Your response is correct! The community assessment findings indicate the community is largely composed of African Americans and older adults. Both populations have special health care needs. The nurse should target health education programs towards those groups of people. Your response is correct! African Americans experience significant health disparities and have an increased risk for chronic health conditions such as hypertension, diabetes mellitus, and dementia. Older adults, in general, experience chronic health conditions such as hypertension, diabetes mellitus, and dementia and would benefit from education in these areas. Poor mental health or depression of
an older adult can be severe and impact other chronic conditions, so it is a relevant topic for health education programs. Presenting education about birth control is unnecessary for this client population and there are no indications from the assessment findings to indicate this is needed in this community. Your response is correct! Large font written at a 5th to 8th grade reading level is appropriate when preparing education for the public, particularly older adults who may have vision deficits making it difficult to read written material. Limiting the amount of content for each educational session will be helpful to prevent information overload. The nurse should speak clearly and slowly when presenting. Speaking loudly distorts the sound of speech and may make it more difficult to hear and lip read. Your response is correct! Outcomes that indicated the education program met the desired outcomes include:
- The participants can demonstrate how to take their blood pressure.
- Participants can verbalize the names of their hypertension medications. A pre- and post-survey indicating no change in knowledge does not indicate that the program was effective. The class is filled to 80% maximum capacity, indicating good attendance. While the room was filled 80%, indicating a large turnout, this indicates good marketing and advertising, not necessarily that the program was effective. Attendance alone does not demonstrate that learning was achieved or behaviors were changed. The community nurse would not know if the attendees learned anything from the health education program unless they conducted follow-up data on those attendees. While it is beneficial that the screening revealed that 10% of participants had elevated blood pressure, it does not indicate that the participant's knowledge increased. Care for the Community Your response is correct!
- An individual is one person (Jada Jackson).
- A family is a family system (Williams family).
- A group is a group of people with common interests or needs (soccer team).
- A population group is an unorganized group of people with common interests or problems (clients with breast cancer in a county).
- An organization is an organized group of people in a common location with shared goals (Central College).
- A community is an aggregate of people in a common location (Jefferson County).
- Conduct a systems analysis of the subsystem (individuals of a group), aggregate system (selected group), and suprasystem (larger system the group belongs to).
- Complete a literature review to compare the aggregate with the norm.
- Identify and prioritize the aggregate’s health problems and needs; this should also reflect the aggregate’s perception of need.
- Assess types of needs:
- expressed: need expressed or need expressed by behavior
- normative: lack, deficit, or inadequacy determined by expert health professionals
- perceived: aggregate’s expressed needs, wants, and preferences
- relative: gap of health disparities between advantaged and disadvantaged populations
- Prioritize the identified problems and needs to create a plan; consider utilizing a framework to refine priorities such as Maslow’s hierarchy of needs or Leavell and Clark’s levels of prevention (primary, secondary, tertiary) - Primary Prevention - Health promotion and activities that protect the client from illness or dysfunction - Secondary Prevention - Early diagnosis and treatment to reduce the duration and severity of disease or dysfunction - Tertiary Prevention - Rehabilitating and restoring to an optimal level of functioning Your response is correct! The relative need is a demonstration of a health disparity, such as the rate of death from breast cancer being significantly higher in African American women than in Caucasian women. Expressed need is seen as a demand for services. Health professionals determine the normative need, and the community expresses the perceived need. Your response is correct! Examples of primary prevention include teaching sex education and facilitating an immunization clinic. Examples of secondary prevention include facilitating blood pressure screenings at a health fair and collecting a newborn metabolic screening. Examples of tertiary prevention include facilitating a cancer support group and providing case management for clients with diabetes. Planning Community Interventions
- Determine the intervention level(s): subsystem, aggregate system, and/or suprasystem.
- Plan interventions for each system level, which may center on the primary, secondary, or tertiary level of prevention.
- Validate the feasibility of the planned interventions based on available personal resources.
- Consider potential interventions (education, counseling, policy change, community service development); seek input from other disciplines or community agencies.
- Coordinate the interventions with the aggregate’s input to maximize participation. Development of Goals and Objectives
- The goal is where the community wants to be; objectives are the steps to get there.
- Measurable objectives are the specific measures used to determine whether the nurse is successful in achieving the goal; may be used to measure outcomes. Your response is correct! The nurse should consider a variety of educational strategies to meet the needs of a variety of learners. The nurse should facilitate small group discussions (auditory learners), allow for hands-on practice to check blood glucose (kinesthetic learners), demonstrate insulin administration with manikins (visual learners), and provide a handout with key information and educational resources (visual learners). Lecture is the least effective educational strategy. In this case, when educating clients with type 1 diabetes, diet changes will not prevent their need for insulin. Your response is correct! The best written program goalis: “90% of students in Center County will be vaccinated for measles by the end of the school year.” This goal is specific, measurable, attainable, realistic, and time-based. “Educational material about the importance of vaccinations will be distributed to parents of Center County students.” is lacking a time frame. “Vaccination clinics will be offered in Center County until the end of the school year.” does not include a measure to evaluate achievement of the goal. “Reducing the rate of measles transmission in Center County.” is not specific enough to be measured, you would need to list specific criteria on how much of a reduction is desired in a specific time frame. Your response is correct! The most critical step in planning program interventions is to first assess the population’s needs. Once the needs are established, the program goal and objectives, as well as the cost, resources, and activities should be outlined. Alternative options for programming may also be discussed during development. Your response is correct! Examples of primary prevention include reviewing student records for immunization status and providing health education in the classroom. Examples of secondary prevention include providing yearly vision and hearing screening and assessing the height, weight, and body mass index of all students.
