Midterm Review NBSN3002
Popular in Concepts of Community/Public Health Nursing
Breanne Schaden PhD
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Popular in Nursing and Health Sciences
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This 14 page Study Guide was uploaded by Trisha Riley on Sunday October 4, 2015. The Study Guide belongs to NBSN3002 at University of Cincinnati taught by Lee in Fall 2015. Since its upload, it has received 13 views. For similar materials see Concepts of Community/Public Health Nursing in Nursing and Health Sciences at University of Cincinnati.
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Date Created: 10/04/15
Concepts of CommunityPublic Health Nursing Outline Weeks 16 Week 1 Concept of Health 0 Health holistic state of wellbeing including soundness of mind body and spirit 0 Wellness health plus the capacity to develop a person s potential leading to a fulfilling and productive life 0 Illness state of being relatively unhealthy Community Health identification of needs and the protection and improvement of collective health within a geographical defined area community Public Health activities that society undertakes to assure the conditions in which people can be healthy Public Health Nursing nursing that is community based and most importantly it is population focused Concept of Community collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging Three types of communities 0 Geographic community city town neighborhood 0 Common interest community church professional organization people with mastectomies 0 Community of solution group of people who come together to solve a problem that affects all of them Levels of Prevention anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment 0 Primary prevention keep illness or injury from occurring 0 Secondary prevention efforts to detect and treat existing disease 0 Tertiary prevention reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function Eight characteristic of community health nursing 1 Population is client or unit of care 2 Primary obligation to achieve greatest good for greatest number of people or population as a whole 3 Processes used include working with the client as an equal partner 4 Primary prevention is the priority Strategies are selected to create health environmental social and economic conditions in which populations may thrive There is an obligation to actively reach out to all who might benefit from a specific activity Optimal use of available resources to assure best overall improvement in health of population is a key element Collaboration with a variety of other professions organizations and entities is the most effective way to promote the health of people Week 2 Four Stages for Community Health Nursing and their advancements 1 2 3 Early Home Care focus of the care was to reduce suffering and promote healing District Nursing give firstrate nursing to the sick poor at home visiting nurses Public Health Nursing focus expanded to health and welfare of the general public Community Health Nursing public health nursing communitybased clinics schools work sites Societal Influences on Community Health Nursing Advanced technology enhance the efficiency and effectiveness of services Causal thinking relating disease or illness to its cause Educational changes no longer reserved for privileged few considered basic right and necessity Demographic changes and role changes for women quotwomen s rights movementquot salaries leadership roles quotgraying and retiringquot Consumer movement demand for quality services and goods right to be informed participate in decisions active members of health team Economic factors numerous people carrying little or no health insurance due to global economic forces unemployment rising costs of living mounting health care costs Academic Preparation for Community Health Nurse a baccalaureatelevel nursing program continuing education programs and units Three Core Public Health Functions see handout 1 Assessment regular collection analysis and sharing of information about health conditions risks and resources in a community 2 3 Policy development use of assessment data to develop policy and direct resources toward those policies Assurance availability of necessary services throughout the community Ten Essential Services of Public Health 9 PNPWPWN Monitor Health Diagnose and investigate Inform educate empower Mobilize community partnerships Develop policies Enforce laws Link toProvide care Assure competent workforce Evaluate 10Research system management Standards of Public Health Nursing see handout Roles in Community Health Nursing Clinician care provider focus on holism health promotion and prevention while using expanded skills Educator health teacher plan for communitywide impact Advocate pleader of the clients cause or actor on behalf of the client support the clients selfdetermination and independence make the system responsive and relevant to the client s needs must be assertive take risks communicate and negotiate well identify and obtain resources for the client Manager administer direction of goals plan organize lead control evaluate and participative approach with community Collaborator joint working with others multidisciplinary collegiality and leadership Researcher systematic investigation collection and analysis of data for solving problems evidencebased finding to community settings Setting for Community Health Nursing Practice Homes Ambulatory service Schools Occupational health Residential institutions 0 Faith communities 0 Community at large domestic and international Week 3 Family definition varies by organization discipline and individual but most theorists agree that family consists of two or more individuals who share a residence or live near one another possess some common emotional bond engage in interrelated social positions roles and tasks and share a sense of affection and belonging Universal Characteristics of Families 0 Every family is a small social system 0 Every family has its own cultural values and rules 0 Every family has structure 0 Every family has certain basic function 0 Every family moves through stages in its life cycle Attributes of Families as Social Systems 0 Families are interdependent 0 Families maintain boundaries 0 Families exchange energy with their environments 0 Families are adaptive 0 Families are goaloriented Family Life Cycle Stages 0 Expansion adding of new members increase in relationships 0 Contraction leaving of members starting own lives or dying 8 Stages in the Family Life CycleDevelopmental Tasks 1 Establishing a mutually satisfying relationship Adjusting to pregnancy and parenthood Fitting into kin network Adapting to critical needs of children at all stages Fitting into the community Balancing freedom with responsibility Releasing young adults into work PNP P PWD Adjusting to retirement Family Culture the acquired knowledge that family members use to interpret their experiences and to generate behaviors that influence family structure and function Family members share certain values that affect family behavior Certain roles are prescribed and defined for family members A family s culture determines its distribution and use of power Implications for Community Health Nursing 0 Must be prepared to work with all types of families and accept them as valid 0 Address clients needs throughout these life changes 0 Identify and develop strengths with families in planning nursing care Family Structure 0 Traditional nuclear nuclear dyad single adult multigenerational kinnetwork augmented blended singleparent commuter 0 Contemporary unmarried singleparent cohabitating partners commune group marriage group network homeless foster gangs Family Functions 0 Providing affection 0 Providing security and acceptance 0 nstiling identity and satisfaction 0 Promoting affiliation and companionship 0 Providing socialization 0 Establishing controls Effects of Family Health on the Individual 0 Adherence to cultural and family patterns of eating exercise and communication 0 Decisions about health services 0 Family health patters also dictate whether members participate in their own health care follow through and comply with professional advice Characteristics of a Healthy Family 0 A facilitative process of interaction exists among family members 0 Individual member development is enhanced 0 Role relationships are structured effectively 0 Active attempts are made to cope with problems 0 There is a healthy home environment and lifestyle 0 Regular links with the broader community are established Family Health Practice Guidelines 0 Work with the family collectively 0 Start where the family is o Adapt nursing intervention to the family stage of development 0 Recognize the validity of family structural variations o Emphasize family strengths Three key things that must be present in order to assess a family39s health assessment 0 Conceptual framework on which to base the assessment 0 Clearly defined set of assessment categories for data collection 0 Method for measuring the family functional level Conceptual Frameworks o lnteractional family as a unit of interacting personalities emphasis on communication roles conflict coping patterns and decisionmaking processes neglects interactions with the external environment 0 Structuralfunctional family as a social system relating to other social systems in the external environment 0 Developmental lifecycle perspective examination of members changing roles and tasks in each progressive lifecycle stage Data Collection Categories 0 Demographics 0 Physical environment 0 Psychological and spiritual environment 0 Structureroles 0 Functions 0 Values and beliefs 0 Communication patterns 0 Decisionmaking patterns 0 Problemsolving patterns 0 Coping patters 0 Health behavior 0 Social and cultural patterns Family Assessment Methods 0 Ecomap used to discuss and analyze relationships between the family and people and systems school work drawn with a central circle family and smaller satellite circles to represent the people and systems lines drawn depict the strength of the relationship 0 Genogram similar to a pedigree usually displays 3 generations malesquare femalecircle o Computerized information management systems o Selfcare assessment guide Two types of data in family assessments quantitative and qualitative Week 4 Chapter 5 Key Terms Culture beliefs values and behavior shared by members of a society and provide a design or roadmap for living Raibiologically designated groups of people whose distinguishing features such as skin color are inherited Ethnic group collection of people who have common origins and a shared culture and identity they may share a common geographic origin race language religion traditions values and food preferences Ethnicity group of qualities that mark his or her association with a particular ethnic group or quotwho share cultural andor physical characteristics including one or more of the following history political system religion language geographical origin traditions myths behaviors foods genetic similarities and physical features Cultural diversity cultural plurality variety of cultural patterns coexisting within a designated geographic area Subcultures relatively large aggregates of people within a society sharing separate distinguishing characteristics Microcultures smaller groups within a subculture Ethnocentrism belief or feeling that one s own culture is best Ethnorelativism seeing of all behavior in a cultural context Characteristics of Culture 0 Learned 0 Integrated 0 Shared 0 Mostly tacit 0 Dynamic Transcultural Community Health Nursing Practice Principles 0 Develop cultural selfawareness o Cultivate cultural sensitivity 0 Assess the client group s culture 0 Show respect and patience while learning about other cultures 0 Examine culturally derived health practices Cultural Assessment and Professor Weitkamp39s Lecture see PowerPoint Week 5 Chapter 6 Shattuck Report 1850 called for sanitary reforms Types of Health Agencies Public 0 O role in Local vary depending on needs size and resources of the community State vary in structure and how core functions carried out most pivotal health policy formation National public health service 8 functional branches CDC FDA NIH SAMSHA HRSA AHRQ Indian Health Service and ATDSR 0 Private 0 Proprietary health services privately owned and managed ForProfit NotforProfit 0 Functions International World USAID O O O O Detecting unserved needs or exploring better methods for meeting needs already addressed Piloting or subsidizing demonstration project Promoting public knowledge Promoting health legislation Assisting official agencies with innovative programs not otherwise possible Evaluating official programs assuming public advocacy role Planning and coordinating to promote collaboration among voluntary services and between voluntary and official agencies Developing wellbalanced community health programs for more relevant and comprehensive services Health Organization Pan American Health Organization UNICEF UNESCO Health Care Financing 0 Private insurance companies trend toward consumerdriven health plans and health savings accounts 0 Independent or selfinsured health plans 0 Government health programs 0 Medicare Medicaid Federal Employees Health Benefits Plan CHAMPUS o SCHIP o Other government programs Payment Concepts Retrospective Prospective 0 Fee established in advance 0 External authority sets rates 0 Reimburse after service rendered 0 Rates derived from predictions set 0 Abused through the requesting and in advance ordering of unnecessary tests 0 Fixed rates rather than cost 0 Encouraged sickness rather than coverage wellness o Imposes constraints on spending 0 Providers at risk for losses or surpluses Managed Care 0 Types 0 HMO 0 Preferred provider organization PPOs 0 Point of service POS plans 0 Health care rationing Cause Effect Restrict people s choices Deny access to beneficial services Exclude enrollees at greatest risk 0 Limited Resources 0 Need to establish eligibility for government health care programs 0 At risk groups use inequitable amount of limited services 0 Competition and regulation 0 Managed Competition PROS CONS 0 Acceptance of all 0 Untested 0 Competition on price 0 Limited consumers choices 0 Tax incentives 0 Increased out of network 0 Tight regulation costs 0 Minimum benefits package 0 Failure to provide equitable 0 Outcome management coverage standards board 0 Opposition from many 0 Improved access professional groups 0 Expenditure reduction 0 Universal Coverage and SinglePayer System 0 Administrative simplicity 0 Combination of privatepublic o No tie to employment PROS CONS 0 Universal coverage 0 Removal of competition 0 Emphasis on prevention model which ensures 0 Control of costs 0 Free market 0 Increased access 0 Individualism o Incentives for efficiency 0 Right to choose Legislation Protection and Affordable Care Act 2010 provides for expansion of Medicaid to lowerincome populations Medicare adjustments to provide better coverage and stabilize expenditures and an individual mandate for health insurance coverage either through employers or state insurance exchanges or a penalty is applied Occupational Safety and Health Act 1970 provided protection to workers against personal injury or illness resulting from hazardous working conditions It established the National Institute for Occupational Safety and Health NIOSH and OSHA the Occupational Safety and Health Administration ShepardTowner Act 1921 provided federal grantinaid funds to the states for administration of programs to promote the health and welfare of mothers and infants Expired in 1929 but it set a pattern for maternal and child health programs that later was revived and strengthened through the successful and farreaching efforts of the Children s Bureau house in the Department of Labor HillBurton Act 1946 an important breakthrough in nationwide health facilities planning First real effort to link health planning with population needs on a comprehensive basis It provided federal funds to states for hospital construction It helped to provide access especially to rural areas to acutecare services but did not address public health or preventive care The Act also required participating hospitals to provide services to residents regardless of their quotrace color national origin or creed Emergency services were to be provided regardless of the person s ability to pay Social Security Act Amendment 1965 provided federally funded health insurance Medicare for the elderly 65 or older and for disabled persons Also provided Medicaid to the blind certain families with dependent children the disabled and eligible elderly These two pieces have enabled many of the poor disabled and elderly to receive quality health care that othenNise would not be available to them Omnibus Budget Reconciliation Act 1986 this was an expansion to the act of 1981 it extended the prospective payment system for hospital outpatient services and required certain employers to provide extended grouprate insurance coverage for laidoff workers and their dependents The expense is paid for by the former employee but cannot exceed 102 of the cost for other employees Week 6 Chapter 4 EvidenceBased Practice systematically searching for and critically appraising and synthesizing evidence or research findings Along with consideration of expert clinical nursingjudgments and patients wishes in making decisions about how to care for patients or clients Research systematic collection and analysis of data related to a particular problem or phenomenon Quality Improvement systematic analysis of data and processes with the aim of improving the delivery of health care Impact of Research on Community Health 8 Nursing Practice 0 Public policy and community s health 0 Effectiveness of community health nursing practice 0 Status and influence of nursing as a profession o The nurse s role in research Role of Community Health Nurse in Research 0 Apply research findings to practice 0 Conduct or participate in nursing research Values 0 Something perceived as desirable or a personally held abstract belief about the truth and worth of thought objects or behavior 0 Motivation to behave in certain ways 0 Derived from societal norms family andor religious beliefs 0 Value system resulting from experiences with others 0 Function as standards that guide actions and behavior in daily situations code of conduct Qualities of Values 0 Endurance relatively stable over time o Hierarchical arrangement certain values having more weight or importance than others 0 Prescriptive proscriptive belief descriptive capable of being true or false evaluative judgments of good and bad 0 Reference terminal end states of existence spiritual salvation peace of mind instrumental modes of conduct confidentiality keeping promises honesty 0 Preference one mode of behavior over another Value Systems 0 Organizations of beliefs guiding behaviors 0 Systems of ordered priority allowing for change over time based on changes in society environment or personal experience 0 Conflict in values is part of decisionmaking processes 0 Persistence in some values has effects on efforts to achieve quothealth care for allquot Values Clarification 0 Process of identifying the personal and professional values that guide one s actions by prompting a person to examining what he or she believes about worth truth or beauty of an object thought or behavior and where this belief ranks compared with other values 0 Helpful in guaranteeing that any course of action chosen is consistent with and in accordance with their beliefs and values Process of Valuing 0 Choose the value freely and individually o Chose the value from among alternatives Carefully consider the consequences of the choice Cherish or prize the value Publicly affirm the value Incorporate the value into their behavior so that is becomes a standard Consciously use the value in decision making Value Clarification Strategies 0 Values clarification strategy I name tag exercise 0 Values clarification strategy patterns 0 Values clarification strategy I forced choice ranking Ethics 0 Set of moral principles theory or system of moral values principles of conduct of a group guiding philosophy 0 Ethical decision making making a choice that is consistent with a moral code that can bejustified from an ethical perspective 0 Bioethics use of ethical principles and methods of decision making that involve biological medical or health care issues 0 Ethical situations typically involving issues with words such as quotwant desire refer should or oughtquot or quotbenefit harm duty responsibility right or obligationquot Ethical DecisionMaking Frameworks 0 Three key steps I Separate questions of fact from questions of value Identify both clients and nurses value systems Consider ethical principles and concepts Clarify the ethical dilemma DECIDE Model D Define the problem or problems E Ethical review C Consider the options I Investigate outcomes D Decide on action E Evaluate results Values that Guide Decision Making 0 Selfdetermination 0 Individual autonomy 0 Possible deterioration to selfinterest o Wellbeing state of positive health 0 Equity justice fair or equal treatment Ethical Principles 0 Respect o Autonomy o Bene cence o Nonmaleficence 0 Justice distributive egalitarian restorative o Veracity o Fidelity Application of Ethical Principles to Decision Making 0 Related to value of selfdetermination 0 Respect the choices of clients 0 Protect privacy 0 Provide for informed consent 0 Protect diminished capacity for selfdetermination 0 Related to wellbeing 0 Reduce or prevent harm and provide benefits to client populations 0 Measure the effectiveness of nursing services 0 Balance costs of services against real client benefits 0 Related to the value of equity 0 Broadly distributing health goods macroallocation issues 0 Deciding which populations will obtain available health goods and services microallocation issues
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