Community Based Nursing vs. Community Oriented Nursing Community Health Nursing 4020 Fall, Exams of Nursing

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Community Health Nursing 4020 Fall 2023 Exam 1 Study Guide Public health core functions • Assessment o Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community. • Policy Development o Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. • Assurance o Making sure that essential community-oriented health services are available o Includes providing essential personal health services for individuals as well as a competent PH workforce o Enforce laws and regulations that protect health and ensure safety o Link people to needed personal health services and ensure the provision of health care when otherwise unavailable o Evaluate effectiveness, accessibility, and quality of personal and population- based health services Levels of prevention: primary, secondary, tertiary for all modules Primary prevention  prevention of the initial occurrence of disease or injury • Before disease • Health awareness and education • Safety education • Prenatal classes • Immunizations • Advocating for access to health care, healthy environments Secondary prevention  early detection w/ goal of limiting severity and adverse effects • Community assessments • Disease surveillance • Screenings o Cancer o DM o TB o Genetic disorders/metabolic deficiencies in newborns Tertiary prevention  stop or delay progression of existing disease • Rehabilitation after injury or illness • Health teaching and counseling for chronic illnesses (DM, Crohn’s) • Case management (chronic illness, mental illness) • PT and OT • Support groups Healthy People 2020 (history, purpose, goals, Leading Health Indicators) • 1979 surgeon general report began 20 year focus on health promotion and disease prevention in U.S. • 1989 – HP 2000 began national effort among government/stakeholders i.e. hospitals, state and local government, schools, community advocacy groups, not for profit agencies, professional/service organizations • HP objectives identify emerging public health issues • Focus on health people living in healthy communities • HP 2020 4 overarching goals ▪ Cues to action ▪ Perceived benefits minus perceived barriers to taking action • Mileo’s Framework for Prevention o Developed in 1970s; challenged idea that main determinant of unhealthy behavior is lack of knowledge o Complements the HBM o Emphasizes change at the community level o Identifies relationship between health deficits and availability of health-promoting resources o Behavior change in a large group can impact social change • Pender’s Health Promotion Model o Similar to HBM o Does not consider health risk as a factor that provokes change o Examines factors that affect individual actions to promote and protect health ▪ Personal factors, behaviors, abilities, self-efficacy ▪ Feelings, benefits, barriers, and characteristics associated with the action ▪ Attitudes of others, and competing demands and preferences Definitions/differences between culture, race, ethnicity • Culture: a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations • Race: a biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings) • Ethnicity: shared feeling of peoplehood among a group of individuals Cultural sensitivity and immigrant/vulnerable populations • Legal immigrant: not a citizen but allowed to both live and work in the U.S. Also known as lawful permanent residents • Refugees: admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views • Nonimmigrants: admitted to the U.S. for a limited duration and specific purpose (i.e., students, tourists) • Unauthorized immigrant: may have crossed the border illegally or legal permission expired; eligible only for emergency medical services Steps/stages/constructs of cultural competence • Two Principles o Maintain a broad, objective, and open attitude toward individuals and their cultures. o Avoid seeing all individuals as alike. • Three Stages o Culturally incompetent o Culturally sensitive o Culturally competent • Three dimensions of each stage: o Cognitive (thinking) o Affective (feeling) o Psychomotor (doing) Attributes and dimensions of culture • Cultural preservation o Allowing preservation of the client’s traditional values • Cultural accommodation o Supporting and facilitating the client’s use of cultural practices that are beneficial to the client’s health • Cultural repatterning o Assisting the client to modify cultural practices that are not beneficial to the client’s health • Cultural brokering o Advocating, mediating, negotiating, and intervening between the client’s culture and health care culture on behalf of the client CLAS standards – what are they and why are they important • Culturally and linguistically appropriate services (CLAS) • Promote development of a healthcare workforce that can respond effectively to the needs of a diverse client population • Standards include providing language assistance and information to a client in her preferred language throughout the delivery of healthcare • Promote ongoing improvement and accountability for culturally appropriate care Inhibitors to cultural competence • Stereotyping • Prejudice • Racism • Ethnocentrism • Cultural blindness • Cultural imposition • Cultural conflict • Cultural shock Cultural assessment parameters, data collection • During initial contact with client, nurse asks about the following issues: o Ethnic background o Religious preference o Family patterns o Cultural values o Language o Education o Politics o Health practices • Data-collecting phase 1. The nurse collects self-identifying data similar to that collected in the brief assessment. 2. The nurse raises a variety of questions that seek information on clients’ perception of what brings them to the health care system, the illness, and previous and anticipated treatments. 3. After the nursing diagnosis is made, the nurse identifies cultural factors that may influence the effectiveness of nursing care actions. • Organizing phase o Data related to the client’s and family’s views on optimal treatment choices are routinely examined and areas of difference between the client’s cultural needs and the goals of Western medicine are identified. Effects of culture on: Communication o Verbal and nonverbal o Cultural variations are found in pronunciation, word meaning, voice quality, use of humor, and speed of talking Space o Client may feel uncomfortable if personal space is violated o Most cultural groups have spatial preferences Physical contact o Touching is offensive in some cultures Social organization o Family may include people who are not actually related to one another o A single family member who is not the client might be the decision maker in a family; an individual might forgo her own health care needs for the sake of the good of the family Environmental control factors o Indicates how the environment affects the individual o Those who view nature as a dominant believe they have little or no control over what happens to them o Individuals who believe that the environment can be mastered to affect health status will actively engage in health promotion, disease prevention, and treatment o Individuals who believe in harmony with the environment are more likely to use alternative medicine and spirituality to promote balance in health status Health beliefs and practices o Biomedical belief o Naturalistic belief o Magico-religious beliefs Health literacy issues and importance of interpreters/translators • The nurse should use an interpreter when its difficult to understand each other’s language • Interpreters should have a knowledge of health-related terminology • Knowledge about health economics is important to community-oriented nurses because they allocate resources to solve a problem • Preventative care does wonders for cost savings • Conflicts arise when views and priorities of individuals differ from those of the public health care industry • Public health financing occurs by: o The source and use of money are controlled by the government ▪ Taxes, user fees, charges to consumers of services (various federal, local, and state services) o The government controls the money but the private sector controls how its used ▪ Government provides money through tax savings to businesses to use for population health care (business provides immunizations, health screenings, counseling) o The private sector controls the money but the government controls how its used ▪ Money is used for preventative care services for specific populations o The private sector controls the money and how its used ▪ Work and family flu clinic that lead to herd immunity, no smoking policy at businesses) History and trends in public health • Public health emphasizes prevention • More difficult to measure effects of prevention than the effects of treatment • Many communicable diseases have been controlled but others still pose a threat • Ancient Babylonians understood need for hygiene and had some medical skill • Egyptians developed some pharmaceuticals • Elizabeth Poor Law of 1601 guaranteed assistance for poor, blind, and lame • Roman Catholic and Protestant women provided nursing care in institutions and home • As practice of medicine became more complex, hospital work required more skilled caregiver • Federal government focused early public health work on providing health care for merchant seamen and protecting seacoast cities from epidemics • During mid 1800s, national interest increased in addressing public health problems and improving urban living conditions  Shattuck Report • Florence Nightingale revolutionized health care by founding the profession of nursing in late 1800s • Lillian Wald and the American Red Cross and Met Life Insurance Company in early 1900s • Social Security Act of 1935 to prevent reoccurrence of the problems during Depression • Many nurses joined the Army and Navy during WWII Healthcare financing and methods of reimbursement/payment • Public Support o Medicare, Medicaid (government funded) • Other Public Support o Veterans Administration, Indian Health Services • Public Health (government funded) o Free services offered by local health departments • Private Support o Employee sponsored health insurance: ▪ Managed care: (HMOs) comprehensive care for fixed payment; use of designated provided usually employees of HMO but can be contractors ▪ Preferred Provider Organizations (PPO) predetermined rates for participating providers; financial incentives to use PPO providers ▪ Medical Savings Accounts: untaxed money for FSA or HSAs o Private Pay – usually some means testing • Payment to Health Care Organizations o Retrospective reimbursement – fee for service – traditional reimbursement method for health care services o Prospective reimbursement – ▪ paid one fee for bundled services – incentive for HCA to stay within budget, ▪ requires consumer to pay larger portion of health care bill • Payment to Health Care Practitioners o Fee for service – agency/practitioner determines costs & submits bill to insurance company o Capitation – health system payment where HCP receives payment for services based on predetermined fee • Payment for Nursing Services: Nurse Practitioners, Nurse Managed Clinics Factors impacting health care costs: Demographics • People living longer – Increased aging population • Aging population more ethnically and racially diverse – may experience effects of health disparities more than younger populations due to barriers of language, socioeconomic status and differing cultural norms • Special population needs i.e. HIV, opiate addiction Technology • Client/provider demand for advanced technology • Demand drives access/coverage by insurance (IVF, pharmaceuticals) and further drives up costs Chronic illnesses • May also have other health problems i.e. substance use or addiction disorders, mental illness, dementia or other cognitive impairments, and developmental disabilities. • Leads to the need for multiple health care specialists, a variety of treatment regimens, and prescription medications that may not be compatible. • Increased risks of conflicting medical advice, adverse drug effects, unnecessary and duplicative tests, and avoidable hospitalizations, all of which can further endanger their health. • Prevention is key! • Death is unavoidable, but the prevalence of chronic illnesses and the decline and disability commonly associated with them can be reduced. Levels of Prevention for all modules: Primary, Secondary, Tertiary Nursing roles, interventions in all modules Medication calculations