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NU 430 Community MIDTERM Questions
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Definition of Public Health Nursing (PHN) correct answer: Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. It's a specialty practice within nursing and public health. It focuses on improving population health by emphasizing prevention, and attending to multiple determinants of health. Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice. With a multi- level view of health, public health nursing action occurs through community applications of theory, evidence, and a commitment to health equity. Made up of nursing health, public health, and social health. Characteristics of Public Health Nursing (PHN) correct answer: Public health nurses focus on improving population health in the environments where people live, work, learn, and play.
- a focus on the health needs of an entire population, including inequities and the unique needs of sub-populations
- assessment of population health using a comprehensive, systematic approach;
- attention to multiple determinants of health
- an emphasis on primary prevention
- application of interventions at all levels—individuals, families, communities, and the systems that impact their health.
PHN Interventions correct answer: Surveillance: monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions Outreach: locates populations at risk, provides information, identifies possible actions, and identifies access to services Screening: identifies individuals with unrecognized risk factors or asymptomatic conditions ◦Mass: screen general population for a single risk (chol in a shopping mall) or multiple health risks (health fair at job site) ◦Targeted: process to promote screening to a discrete subgroup within the population (those at risk for HIV) ◦Periodic: process to screen a discrete but healthy subgroup of the population on a regular basis, over time, for predictable risks or problems (breast and cervical cancer screening, well-child) Case-finding: locates individuals and families with identified risk factors and connects them with resources Referral and follow-up: assists in identifying and accessing necessary resources to prevent or resolve problems Types of Interventions correct answer: Primary prevention protects against risks to health. Keeps problem from occurring. Immunizations Secondary preventions detects and treats problems in their early stages. Implemented after problem has begun. Screening Tertiary prevention limits further negative effects from a problem. Keeps existing problem from getting worse. Implemented after disease or injury has occurred. Focuses on
Health disparities are referred to as health inequities when they are the result of the systematic and unjust distribution of these critical conditions Components of Community Assessment correct answer: People Demographic (US census, city or nationwide data on the internet; secondary sources) Biological factors Social factors Cultural Factors Place or Environment Physical factors Environmental factors Social Systems Health, economic, education, religious, welfare, political, recreation, transportation, legal, communication, resources, structure of governance, activism, crime rates, communication between community services (health department, police, fire, etc) Factors of Community Assessment correct answer: Demographic- distribution and stats of age, gender, ethnic data, education level, race, income levels, etc Biological- morbidity and mortality stats, top 10 major illness or injuries in this community , leading causes of death Social and cultural-- racial and ethnic groups, languages spoke, cultural beliefs/values/events, how to people get along, norms and acceptable behavior
Physical- the boundaries of the community, bodies of water, neighboring towns and cities, topography Environmental- housing market (occupied vs unoccupied, type of housing, cost), businesses present, air and water quality, safety (sidewalks, playground, bike paths, crossing signs), gyms, access to food, type of grocery and convenient stores) Secondary data correct answer: Use of existing data as part of assessment: Aggregate data, Comparisons/trends/patterns, demographic census data, morbidity and mortality. Chamber of commerce, annual reports, health records, meeting minutes, prior health surveys Primary data correct answer: •Key Informant interviews: direct discussion of ideas and opinions •Community Forum: Open Public Meeting •Focus Group: Directed talk with representative sample •Surveys: Specific questions asked in written format •Participant Observation: Observe formal or informal community activities •Windshield Survey: Descriptive approach assesses several community components while driving or walking through a community Asset-based assessment correct answer: -attention is directed to community strengths and resources as a primary approach to community assessment
(Salutogenesis is a scholarly orientation focusing attention on the study of the origins of health, contra the origins of disease and risk factors) Epidemiology definition correct answer: Study of the distribution and determinants of states of health and illness in human populations; used both as a research methodology for studying states of health and illness, and as a body of knowledge that results from the study of a specific state of health or illness. Epidemiology studies health, disease, and injury and how to intervene to reduce the effect of these diseases etc (also maximizes state of health) Endemic correct answer: The usual prevalence of a disease in a geographic area (whats usually expected) Epidemic correct answer: An increase over the usual occurrence of a disease in a geographical area (more of what's usually expected) Outbreak correct answer: small geographic area or among a small group of people (increase among a smaller group of people) Pandemic correct answer: An epidemic that affects several countries or continents Epizootic correct answer: An excess over the expected occurrence of a disease in an animal population, Disease
transmits from animal to human (more of whats expected in animals that also spread to humans) Changes in Epidemiology correct answer: •Traditionally focused on infectious disease •Expansion as a result in improved public health practice •Emergence/increase of non-infectious disease (•Chronic disease, Psychosocial problems, Occupational injuries, Environmental effect) •Changes in diagnostics, therapies, and resulting strategies for prevention and control of disease -This change leads to increase in life expectancy, improvement in health (Health service planning and evaluation) The Epidemiologic Triad correct answer: Host --> Agent --> Environment Environment is how the host and agent interact This model is limiting when you have more complex causative factors Host: age, sex, race, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, family background Agent: Biologic (bacteria, viruses), Chemical (poison, alcohol, smoke), Physical (trauma, radiation, fire), Nutritional (lack, excess) Environment: temperature, humidity, altitude, crowding, housing, neighborhood, water, milk, food, radiation, pollution, noise
-Rates measure the PROBABILITY that an event will occur again. Used as predictor. Crude rate correct answer: measurement of the occurrence of the health problem or condition being investigated in the entire population (rate expressed for a total population) Adjusted rate correct answer: statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another (removes difference within the population) Specific rates correct answer: •Specific rates are more detailed rates and calculated according to smaller subgroups of the population in the denominator •Described by Three things: •Person (who is experiencing the illness/condition?) •Place (where is it occurring?) •Time (when does it appear?) •Then think about: •Differences in frequency of characteristics between groups •Areas of agreements where there are factors occurring frequently •Variations in data that might hold clues to prevention and/or control
Why we use rates correct answer: •Measuring the magnitude or frequency of a state of health determines the characteristics of those who are at high risk. •Epidemiologic descriptive studies have determined measurable risk factors for major illnesses. •Calculation of rates provides the best indicators of the probability that a specific state of health will occur. Incidence rate correct answer: •Measure of new cases over a given time period. Used as a probability when expressed as proportion or a rate.
of new cases over specific time period (numerator) /
population at risk for same time period (denominator) Prevalece rate correct answer: measures the number of people in a given population who have an existing condition at a given point in time. Includes both new and existing cases Depends on incidence rate and duration of the disease (if incidence is low and duration high = high prevalence relative to incidence and vice versa)
of new cases over specific time period (numerator) /
population at risk for same time period (denominator) relative risk ratio correct answer: The ratio of the incidence rate in the exposed group and the incidence rate in the non-exposed group
•Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors. Healthy People 2030 5 new categories correct answer: •Health Conditions (20 conditions) (Addiction, Heart Disease and Stroke, Infectious Diseases) •Health Behaviors (14 behaviors) (Vaccination, Physical Activity, Health Communication •Populations (10 populations) (LGBT, Older Adults,People with Disabilities)
- Setting and Systems (13 settings/systems) (Community, Public Health Infrastructure, Global Health) •Social Determinants of Health (5 SDoH) (Economic Stability, Neighborhood and Built Environment, Education Access and Quality) Environmental health definition correct answer: A field of public health science that focuses on how the environment influences human health Toxicology definition correct answer: The study of the adverse effects of chemical, biological agents on people, animals, and the environment Precautionary principle definition correct answer: If something has the potential to cause harm to humans or the environment,
then precautionary measures should be taken even if there is a lack of scientific evidence Environmental justice definition correct answer: The belief that no group of people should bear a disproportionate share of negative environmental health consequences (regardless of race, culture, or income) Assessment of Contaminants correct answer: Risk Assessment: Process to determine the likelihood or probability that adverse effects will occur in a group of people because of exposure to an environmental contaminant. RISK= Hazard + EXPOSURE (If hazard present but exposure blocked, there is no risk) EXPOSURE PATHWAY: A process by which someone is exposed to a contaminant that originates from a specific source. (If the pathway is not complete, or it can be disrupted, the contaminant of concern should not affect human health.) Determining Health Impact correct answer: Exposure estimate: attempt to determine a person's level of exposure (Exposure depends on how long? How often? And dose of contaminant?) Duration, Frequency, and Bioavailability of contaminant Bioavailability is the amount of a substance that is absorbed or becomes available at the site of physiological activity. Helps determine the "dose" of a certain contaminant that will cause a health effect.
Assessment of Environmental Health: IPREPARE correct answer: I= Investigate potential exposures P=Present work (exposures, protective equip, MSDS) R=Residence (age of home, heating, recent remodeling, chemical storage, water) E=Environmental concerns (air, water, soil, industries, waste site or landfill nearby) P=Past work (exposures, farm work, military, volunteer, seasonal, length of work) A=Activities (hobbies, gardening, fishing, hunting, smoldering, pesticides, melting, burning, food eaten R= Referrals and resources (EPA, Agency for Toxic Substance & Disease Registry, OSHA, CDC, local health dept, poison control E=Educate (risk reduction, prevention, follow-up Environmental Justice correct answer: Belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race, culture, or income. Issues of political and economic power Healthy homes, schools, communities Vulnerability to environment
Flint Water Crisis correct answer: April 2014-- Flint's water source changed from Lake Huron to Flint River so a new pipe supply could be made for Lake Huron. The Flint water was not treated for corrosion and it caused the lead to leech out from the pipes and into the water. October 2015-- water supply switched back to Lake Huron, but the damage was done. Use water bottles only now. Estimated 100,000 residents affected (57% black, 31% white, 4% latinx) and 41% of city residents live in poverty The number of children with dangerously high lead levels in their blood has doubled since the water supply was switched. Flint Crisis: Other Issues and Outcomes correct answer: -- Legionnaires Disease (bacterial pneumonia): Largest outbreak in US history: at least 90 ill with 12 reported fatalities. Delay in notifying Public of Risk --E.coli outbreak --Fertility rates dropped by 12% and miscarriages increased --Increased need for Head Start --Home values drop --8 government officials charged, mostly plea deals or charges dropped. Spoke of new investigation, Bill introduced to extend statute of limitations in criminal misconduct cases involving public officials (2019) --Two businesses charged
Managing care of home health aide after all healthcare skilled needs have been stabilized Pouring medications in plastic labeled container Visiting the client to decrease loneliness Interdisciplinary Team correct answer: Nursing: Registered nurses with varied specialty backgrounds Social Worker: help client cope with the medical, functional, emotional, personal relationships, environmental and financial challenges of living in their own homes. Provide counseling and access to community services Home Health Aide (HHA); assists with ADLs (simple exercises, vital signs, med reminder etc) Rehabilitation --Physical Therapist: help restore strength, flexibility, ambulation, coordination, gross motor function of clients disabled by an accident or illness --Occupational Therapist: work with clients to help them regain skills they need to function in their day-to-day activities (bathing, grooming, dressing, meal prep), advise on use of adaptive equipment, fine motor skills --Speech Therapists: Help clients regain their ability to produce and understand speech, facilitate communication and swallowing skills ADLs vs IADLs correct answer: ADL: Basic activities of daily living that allow the patient to care for themselves. Ex: Dressing, Eating, Toileting, Bathing, Grooming, Mobility
IADL: Build upon ADLs, more complex that help get the patient back to normal life. Ex: Managing finances, Cooking and meal preparation, Medical management, Transportation Medicare Criteria for Home Health Services correct answer: Nursing, PT and SPT can begin independently OT, Medical Social Service, and HHA can only begin if Nursing, PT or SPT are already providing care. OT can continue (if needed) even if Nursing, PT and SPT have ended. (cannot begin alone, but can end alone) Medical Social Service and HHA must discontinue if no other skilled service remains (cannot begin or end alone) You must be under the care of a doctor (have been seen recently) who establishes and reviews the plan of care (POC), which is agency generated using the Outcome and Assessment Information Set (OASIS). POC covers 60 days and then must renew and re-certify POC Initial orders come on referral from hospital, quality varies MD must certify that the client needs at least one of the covered skilled services (needed and reasonable)
