NR503 Epidemiology Final Exam Study Guide (Latest-2022/2023, Version-2)/ NR 503 Epidemiolo, Study Guides, Projects, Research of Nursing

Download NR503 Epidemiology Final Exam Study Guide (Latest-2022/2023, Version-2)/ NR 503 Epidemiolo and more Study Guides, Projects, Research Nursing in PDF only on Docsity! NR503 FINAL EXAM STUDY GUIDE Review primary, secondary, & tertiary prevention practices, screening, vulnerable populations, and the role of the nurse practitioner. Week 5 (Ch. 2) 1. Discriminate populations at risk for development of chronic health conditions while associating the role of the Advanced Practice Nurse in levels of promotion. Common risk factors: unhealthy diet, physical inactivity, and tobacco use Childhood risk: There is now extensive evidence from many countries that conditions before birth and in early childhood influence health in adult life. For example, low birth weight is now known to be associated with increased rates of high blood pressure, heart disease, stroke and diabetes. Risk accumulation: Ageing is an important marker of the accumulation of modifiable risks for chronic disease: the impact of risk factors increases over the life course. Underlying determinants: The underlying determinants of chronic diseases are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, population ageing, and the general policy environment. Poverty: Chronic diseases and poverty are interconnected in a vicious circle. At the same time, poverty and worsening of already existing poverty are caused by chronic diseases. The poor are more vulnerable for several reasons, including greater exposure to risks and decreased access to health services. Psychosocial stress also plays a role. Preventative health actions are often categorized in three levels:  Primary prevention - aims to prevent disease or injury before it ever occurs.  This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur.  Nurses play the part of educators that offer information and counseling to communities and populations that encourage positive health behaviors  Examples include:  legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)  education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)  immunization against infectious diseases.  Secondary prevention - aims to reduce the impact of a disease or injury that has already occurred  This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.  Nurses work with these patients to reduce and manage controllable risks, modifying the individuals’ lifestyle choices and using early detection methods to catch diseases in their beginning stages when treatment may be more effective.  Examples include:  regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)  daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes  suitably modified work so injured or ill workers can return safely to their jobs.  Tertiary prevention - aims to soften the impact of an ongoing illness or injury that has lasting effects  This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy.  Nurses are tasked with helping individuals execute a care plan and make any additional behavior modifications necessary to improve conditions  Examples include:  cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)  support groups that allow members to share strategies for living well  vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.  Members of minorities are overrepresented on the low tiers of the socioeconomic ladder. Poor economic achievement is also a common characteristic among populations at risk, such as the homeless, migrant workers, and refugees. However, the APN should be able to distinguish between cultural and socioeconomic class issues and not interpret behavior as having a cultural origin when the fact is based on socioeconomic class. A good resource for APNs is the Cross-Cultural Health Care Program (CCHCP), which has a plethora of materials to improve cultural competency among healthcare providers, including a training program for healthcare providers. In order to provide appropriate healthcare interventions, culture and all its variants must be addressed. (p28)APRNs may be able to access health information needed by working together with other sectors outside of health, such as housing, labor, education, and community-based or faith-based organizations that offer services to immigrant communities. This involves the collection, documentation, and use of data that can be used to monitor health inequalities in exposures, opportunities, and outcomes. Examples of social determinants that are related to health inequalities include poverty, educational level, racism, income, and poor housing. These inequalities can lead to poor quality of life, poor self-rated health, multiple morbidities, limited access to resources, premature death, and unnecessary risks and vulnerabilities. (p25) APRNs can best determine the effectiveness of an intervention and long-term impact by focusing on an accurate assessment and interpretation of data that are generated or collected using individual, population, and community health indicators. (p27)APRNs can work in partnership with community members to identify what community members see as relevant and important, build social capital, use outcome data to advocate for changes in policy, and then continue to work in partnership to identify strategies to intervene, monitor,and improve those outcomes (p40-41)APRNs have numerous resources they can access to improve quality and timely access to quality healthcare and decrease health disparities. The National Partnership for Action (NPA) to End Health Disparities ( minorityhealth.hhs.gov/npa) was started by the Office of Minority Health to mobilize individuals and groups to work to improve quality and eliminate health disparities. The National Priorities includes key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end-of-life care, care coordination, patient safety, and population health. The Quality Alliance Steering Committee is another partnership of healthcare leaders who work to improve healthcare quality and costs. Various strategies to bridge the gaps in healthcare quality are available at the national level and may be applied or considered at the state, regional, or local level in collaboration with stakeholders as a means of decreasing health disparities. (p43) APRNs are better prepared to develop effective interventions to eliminate or reduce health disparities. Such strategies may include advocating better health insurance coverage for poor and immigrant populations; ensuring that sufficient services exist in underserved areas; assessing the interaction among social environments, genetics, and population health; encouraging minority participation in research studies with community-based participatory research and specifically with practice-based research networks; using linguistically and culturally appropriate communication and written handouts; promoting and facilitating community partnerships; and implementing strategies to encourage people from minority populations to become healthcare professionals 2. Compare and contrast variables that differentiate those categorized at being at risk for marginalization of health care. Definition: when an individual or group is put into a position of less power or isolation within society because of discrimination  Limits their opportunities and means for survival. When an individual is marginalized, they are unable to access the same services and resources as other people and it becomes very difficult to have a voice in society. Marginalization – major cause of vulnerability, which refers to exposure to a range of possible harms, and being unable to deal with them adequately.  Variables: social class, race, homelessness, substance abuse, prison/offending, mental health problems, HIV positive  Women are more likely to be marginalized than men, because of their gender. This is evident through the social, economic, and power imbalances that exist between men and women. For example, more women than men live in poverty, and men continue to have more secure, full-time jobs and higher income than their female counterparts.  A woman can also be marginalized because on her HIV status, or HIV risk. She may experience even more stigma if she is also a part of other marginalized groups in relation to her race or sexual orientation. For example, a woman is gay and an immigrant may also experience homophobia and racism. Those at risk for marginalization of health care include those without shelter in rural or urban areas, those living in remote parts of the country, families of lower socioeconomic status, disabled persons, recent immigrants and refugees, Indigenous populations, and seniors. Adequately identifying and gaining access to vulnerable communities are essential steps for the health system in order to recognize and address their unique health needs. Cultural Knowledge Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism. Cultural Skill Ability to collect culturally relevant data regarding the client's health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner. Cultural Desire Motivation of the healthcare provider to "want" to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commitment and passion to caring, regardless of conflict. The APN must be cognizant of his or her own cultural beliefs and the attitudes he she inherently has about other cultures. Without this reflection and evaluation of our world cultural beliefs and practices, the nurse will be influenced subconsciously. Culture can impact provider attitudes if the provider is not cognizant of their own beliefs. Culture does impacts providers attitudes. This is because providers are forced to learn cultural competence (which is the ability of the practitioner to bridge cultural gaps in caring and to work with cultural difference, enabling the family and patient to receive meaningful and supportive care). Cultural competence consists of the following principles; • Care is designed for the specific client. • Care is based on the uniqueness of the person's culture and includes cultural norms and values. • Care includes self-employment strategies to facilitate client decision making to improve health behaviors. • Care is provided with sensitivity and is based on the cultural uniqueness of clients. Assess own attitude: • communication (verbal and nonverbal); • personal space; • social organization; • time perception; • environmental control; and • biological variations. (wk 5 lesson) A good resource for APNs is the Cross-Cultural Health Care Program (CCHCP), which has a plethora of materials to improve cultural competency among healthcare providers, including a training program for healthcare providers. In order to provide appropriate healthcare interventions, culture and all its variants must be addressed. The APN must be cognizant of his or her own cultural beliefs and the attitudes he she inherently has about other cultures (Williamson, 2007) Without this reflection and evaluation of our world cultural beliefs and practices, the nurse will be influenced subconsciously. 5. Review the terms for this week and apply them to population health; for instance: cultural competence, cultural awareness, norms, values, Kleinman Explanatory Model, socioeconomic status, disparities, minorities, food dessert. Cultural competence: Respect for, and understanding of, diverse ethnic and cultural groups, their histories, traditions, beliefs, and value systems. Care is designed for the specific client. Care is based on the uniqueness of the person's culture and includes cultural norms and values. Care includes self-employment strategies to facilitate client decision making to improve health behaviors. Care is provided with sensitivity and is based on the cultural uniqueness of clients. Care is designed for the specific client. Care is based on the uniqueness of the person's culture and includes cultural norms and values. Care includes self-employment strategies to facilitate client decision making to improve health behaviors. Care is provided with sensitivity and is based on the cultural uniqueness of clients. “Dynamic, fluid, continuous process whereby an individual, system or health care agency find meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they render care” The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Respect for, and understanding of, diverse ethnic and cultural groups, their histories, traditions, beliefs, and value systems Cultural competence in nursing consists of four principles. o Care is designed for the specific client. o Care is based on the uniqueness of the person's culture and includes cultural norms and values. o Care includes self-employment strategies to facilitate client decision making to improve health behaviors. o Care is provided with sensitivity and is based on the cultural uniqueness of clients. Cultural Awareness: Self-examination of one's own prejudices and biases toward other cultures. An in-depth exploration of one's own cultural/ethnic background. The ability and willingness to objectively examine the values, beliefs, traditions and perceptions within our own and other cultures Norms: Something that is usual, typical, or standard. a standard or pattern, especially of social behavior, that is typical or expected of a group. Customary rules of behavior that govern our interactions with others. Something that is usual, typical, or standard within a population. Cultural norms are the standards we live by. They are the shared expectations and rules that guide the behavior of people within social groups. Cultural norms are learned and reinforced from parents, friends, teachers, and others while growing up in a society. Cultural norms are the standards we live by. They are the shared expectations and rules that guide behavior of people within social groups. Cultural norms are learned and reinforced from parents, friends, teachers and others while growing up in a society. Norms often differ across cultures, contributing to cross-cultural misunderstandings. Value: The degree of importance of something. a person's principles or standards of behavior; one's judgment of what is important in life. Personal principles or standards of behavior; one's judgment of what is important in life The commonly held standards of what is acceptable or unacceptable, important or unimportant, right or wrong, workable or unworkable, etc., in a community or society. Something is held to deserve; the importance, worth, or usefulness of something within a population. Cultural values are beliefs of a person or social group in which they have an emotional investment (either for or against something). Core principles and ideals upon which an entire community exists. This is made up of several parts: customs, which are traditions and rituals; values, which are beliefs; and culture, which is all of a group's guiding values. APRNs must understand cultural values and work with the patient to not go against the values while developing care interventions Kleinman Explanatory Model: Gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Proposes that individuals and groups can have vastly different notions of health and disease. Instead of simply asking patients, “Where does it hurt,” the physicians should focus on eliciting the patient’s answers to “Why,” “When,” “How,” and “What Next.” Kleinman suggests the following questions to learn how your patient sees his or her illness: 1. What do you think caused your problem? 2. Why do you think it started when it did? 3. What do you think your sickness does to you? 4. How severe is your sickness? 5. Do you think it will last a long time, or will it be better soon in your opinion? 6. What are the chief problems your sickness has caused for you? 7. What do you fear most about your sickness? 8. What kind of treatment do you think you should receive? 9. What are the most important results you hope to get from treatment? 10. What do you call your problem? Socioeconomic status: Social standing or class of an individual or group. An economic and sociological combined total measure of a person's work experience and of an individual's or family's economic and social position in relation to others, based on income, education, and occupation. Examinations of socioeconomic status often reveal inequities in access to resources, plus issues related to privilege, power and control Disparities: Health disparities can be defined as the differences identified in incidence or prevalence of factors. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, gender, sexual identity (LGBT), age, disability, socioeconomic status, low health literacy, cultural barriers, and low English proficiency, and geographic location all contribute to an individual’s ability to achieve good health. Numerous dimensions of disparities (or differences) related to health that can adversely affect groups of people because of specific characteristics or obstacles.  Determinants of health cause disparities (environment, housing, education, access to transportation, safe water, fresh food)  Ethnicity and other characteristics also contribute to the  presences of disparities (or achievement of good health) o Gender o Sexual orientation o Geographic location o Working environment o Cognitive, sensory, physical disabilities o Socioeconomic status ** Population health will focus on disparities in the hopes to bridge the gap and locate methods and interventions to reach populations with numerous health disparities. Other disparities that America is facing include; low health literacy, cultural barriers, inability to read and understand english (results in subpar health communication). APRNs have access to resources to decrease health disparities…  The National Partnership for Action (NPA) to End Health Disparities o Mobilizes individuals and groups to work to improve quality and elimination of health disparities  The national Priorities partnership o Key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end of life care, carae coordination, patient safety, and population health.  The quality alliance steering committee o Work to improve healthcare quality and costs  Office of Minority Health and Health Disparities (OMHD) house within the CDC o Resources may be used by the APRN to obtain data that demonstrate how minority population compare with the US population as a whole Health disparities are deplorable, and effective strategies to reverse the trend is needed. A multidimensional approach is needed and a history of institutionalized racism and individual racism that is embedded in every aspect of life of ethnic minorities must be recognized and addressed. APRNs can health by:  Cultural competency training  Communication improvement between patients and providers  Improve community relations  Adherence to nondiscriminatory health policies is also necessary  Advocating better health insurance for the poor or immigrants  Ensuring enough services exists in underserved areas  Using Genetics Minorities: A group of people who are different from the larger group in a country, area, etc. A part of a population differing from others in some characteristics and often subjected to differential treatment. Can cause health disparities. Possess ethnic, religious, or linguistic characteristics differing from those of the rest of the population. Show, if only implicitly, a sense of solidarity directed towards preserving their distinctive collective identity. • Surveillance and service provision data • Housing and labor data • Policy data • gender equity data • Cross Cultural Health Care Program (CCHCP) • The National Partnership for Action (NPA) to End Health Disparities • The National Priorities Partnership • The Quality Alliance Steering Committee • the Association of American Medical Colleges • The State of Health Equity Research: Closing Knowledge Gaps to Address Inequities • Another resource available to APRNs can be found at Quick Health Data Online • The CDC, WHO and Healthy People 2020 also provide useful information on determinants of health. Week 6 (Ch. 3) 1. Construct intervention plans related to a chronic health problem that integrates awareness of genetic implications. 2. Integrate risk / screening as it applies to genetics ? Gathering three generations of family history will help determine a patient’s risk for developing cancer. For example, if there is a family history of breast cancer this patient has a higher risk for developing breast cancer. The FNP should counsel the patient on risk factors and way to reduce their risk of developing cancer, making lifestyle choices. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies Risk terminology  Absolute risk is the probability of an event, such as illness, injury, or death  Absolute risk gives no indication of how its magnitude compares with others.  The odds ratio closely approximates the relative risk if the disease is rare.  Odds ratio and the relative risk are used to assess the strength of association between risk factor and outcome.  Attributable risk is used to make risk-based decisions for individuals.  Population-attributable risk measures are used to form public health decisions Genetics is the study of individual genes and their impact on relatively rare single gene disorders. Family history of diseases sometimes put a person at higher risk for having a health condition. It is important for people to understand their genetics so they know what diseases they are at risk for. Screening can be done to high risk populations to help diagnose an illness early enough to prevent a poor outcome. For example. Colonoscopies are recommended for individuals 50 and over. However, if a person has a family history of colon cancer. They may be urged to start screenings earlier. 3. What is genetic risk assessment? How is it determined? A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge, they need to make appropriate screening, prevention and lifestyle management decisions. This is not a test for cancer: it is a test that can tell you if a higher risk for breast, ovarian or colorectal cancer runs in your family. Family history is a valuable tool. Genetic (inherited) factors can contribute to the development of many diseases, and those at risk can often be identified early if information is collected, shared, and interpreted correctly. Conducting an accurate family history for three generations can reveal a wealth of information on which to base prevention strategies. If the information collected is used to counsel individuals on how to decrease risk with lifestyle modifications (before the patient has the disease) then the utilization of the family history would be considered a primary intervention. For example, if the family history identifies an increased risk for breast cancer, the patient is counseled to modify lifestyle choices to minimize risk. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies (Spector et al., 2009). Many experts recommend that genetic testing for cancer risk should be strongly considered when all three of the following criteria are met: The person being tested has a personal or family history that suggests an inherited cancer risk condition, The test results can be adequately interpreted (that is, they can clearly tell whether a specific genetic change is present or absent), & The results provide information that will help guide a person’s future medical care.  Genetic risk is the contribution our genes play in the chance we have of developing certain illnesses or diseases. Genes are not the only deciding factor for whether or not we will develop certain diseases and their influence varies depending on the disease  Etiological theory and empirical evidence indicate that large numbers of environmental and genetic factors contribute to common diseases. genetics can provide probabilistic information about risk. Current genetic discoveries may already furnish enough information to make incremental improvements in clinical risk assessments of adults  Genetics may provide a window into clinical heterogeneity: genetic information may be useful in understanding differences in the timing of onset, rate of progression, persistence, comorbidity, and response to treatment.  . At the population level, genetics can help to identify groups susceptible to developing a particular health problem.  Genetics can contribute to composite risk assessments that identify high- and low-risk segments of the population. Background genetic risk information can, in turn, inform investigations of other risk factors or of prevention  A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge they need to make appropriate screening, prevention and lifestyle management decisions. Genetic testing analyzes your DNA to detect specific, inheritable, disease-related gene mutations that may increase the risk of certain cancers. It provides you with an in-depth cancer risk assessment. 4. Explore and integrate genetic terminology, for example: Genomics, pharmacogenomics, genetic epidemiology. Also, refer to HP2020 .  Genomics - The study of all genes in the human genome as well as their interaction with other genes, the individual’s environment, and the influence of cultural and psychosocial factors.  Genetics - The study of individual genes and their impact on relatively rare single gene disorders.  Pharmacogenomics - The study of how genes affect a person's response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person's genetic makeup. One of the additional responsibilities when possessing prescriptive authority is the necessity of having a thorough knowledge of pharmacogenomics. It has been acknowledged that the effect of medications has a range of therapeutic and nontherapeutic responses. Age, weight, ethnic background, and physiologic impairments associated with disease processes were often concomitant with these variations. Due to the recent genomic research, it is now acknowledged that genetic variations can affect mediation efficacy, toxicity, and drug interaction outside of the drugs themselves  Genetic Epidemiology - The link of epidemiology and genetics. Focuses on the risk of developing the disease, in populations that have a genetic basis, and is now recognized as a component of risk analysis. This chance of developing a disease, in the absence of other risk factors, gives credence to the potential of a genetic etiology  Healthy People 2020 - genomics plays a role in nine of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes and Alzheimer’s disease. In addition, over 1,000 genetic tests were developed to facilitate diagnosis.  Pedigree: A graphic illustration of a family health history for three generations 5. What are the components of a genetic risk assessment? A genetic evaluation includes:  Medical history: A detailed review of your personal and family medical history and a counseling session is completed to determine your risk of developing cancer, the appropriate medical management, and if genetic testing is recommended to help clarify your cancer risk.  Testing: Genetic testing is analysis of a person’s genes (usually through a blood sample) to determine if you have a change in a gene, called a mutation, that increases the risk for cancer. A small blood sample is analyzed, looking for a change or mutation in the gene. Insurance companies typically cover the cost of testing if you have a personal or family history that is concerning for a hereditary cancer. Cost and insurance coverage for testing are discussed during your evaluation.  Counseling: Following the testing, you’ll receive comprehensive counseling based on your test results and family history. For those who are found to have a gene mutation or are at a higher risk of cancer, options for next steps are discussed.  Next steps: If you have a gene mutation and a higher risk of cancer, we’ll discuss your prevention options, which can include surveillance or prevention tactics. A patient’s choice is strictly a personal decision. Genetic counseling and testing provide the tools you need to make informed decisions.  Family Risk: If you test positive for a mutation, we encourage your other family members to be tested as well. The information from genetic counseling and testing enables family members to make decisions that could save their lives. It also can tell family members that they do not have the mutated gene. People with a personal or family history of any of the following genetic risk factors should consider genetic testing  pre-menopausal breast cancer (under age 50)  ovarian cancer at any age, especially if there are also cases of breast cancer in the family  male breast cancer  both breast and ovarian cancer in the same person  two primary breast cancers in an individual  two or more breast cancers in a family, one under age 50  a previously identified mutation in the family  ethnic background (Ashkenazi Jewish)  colorectal cancer diagnosed before age 50  a history of colon, endometrial and other cancers (including ovarian, stomach, kidney, brain) in the family  history of multiple colon polyps (greater than 20 altogether)  history of childhood or rare type of cancers in the family The benefit of doing early on allows for more frequent screening tools at a younger age, preventative surgery can be performed, and treatment plans can also be made. Risk assessment constitutes an essential component of genetic counseling and testing, and the genetic risk should be estimated as accurately as possible for individual and family decision making. All relevant information retrieved from population studies and pedigree and genetic testing enhances the accuracy of the assessment of an individual's genetic risk. Risk assessment is an essential part of genetic testing and counseling, and should be calculated as accurately as possible to enable both the clinician and the patient (or his/her family) to make decisions. An individual's genetic risk refers to the probability of the individual carrying a specific disease- associated mutation, or of being affected with a specific genetic disorder. The calculation of genetic risk should incorporate all available information at a particular point in time, such as the results of genetic testing (mutations, polymorphic markers); the presence of an independent risk factor derived from genetic test results; genetic test results on either or both parents, siblings, and close relatives (the probability of carrying a particular mutation or mutations often differs considerably among families and even among individuals within the same family); the ethnic background of each parent; an overall mutation rate for each ethnicity; and, if possible, the frequency of mutation in the population. Risk assessment should be looked at as an ongoing process of analysis of estimates. Risk assessment should be looked at as an ongoing process of analysis of estimates. A good example of genetic risk variation between ethnic groups has been described for cystic fibrosis. Cystic fibrosis is caused by mutations in the cystic fibrosis transmembrane conductance regulator gene . The disease-allele distribution of the CFTR gene varies greatly among different ethnic groups, leading to different inputs when calculating risk of disease. When looking at the genetic risk for a determined population, attention should be brought to the possible misrepresentation of experimental data such as the allelic bias introduced by migrating populations, the study settings that established the genetic association (moment of diagnosis of a certain condition in a population and time of the genetic study), environmental factors, misclassification of outcome. Generally, genetic risk assessment has been largely focused on the evaluation of risk in Mendelian disorders, where a disease-causing mutation in a single gene has high penetrance, producing an observable, often profound effect on phenotype. 6. Can you discuss the interplay between genetics and the environment, how do they influence one another? Do they ? Genetics and the environment are still in the beginning phases of exploring the possibilities. Attributable risk descriptors are often utilized to express the combination of genetic susceptibility enhanced by environmental risk factors. An example given between genetics and the environment is illustrated by PKU, a known autosomal recessive disease that prevents the metabolism of phenylalanine. Once phenylalanine is ingested the body is unable to metabolize and hyper-phenylalanine occurs which destroy brain matter. Once this was researched it was noted by limiting phenylalanine in the diet decreased the risk for developing mental retardation. The environment and genetics to influence one another as provided with the example above. All traits depend both on genetic and environmental factors. Heredity and environment interact to produce their effects. This means that the way genes act depends on the environment in which they act. In the same way, the effects of environment depend on the genes with which they work. For example, people vary in height. Although height is highly heritable , environmental variables can have a large impact. For example, Japanese-Americans are on the average taller and heavier than their second cousins who grew up in Japan, reflecting the effect of environmental variables, especially dietary differences. Phenylketonuria (PKU) is an excellent example of environmental modification of a genetically controlled effect. PKU is a form of mental retardation that results from toxic (~damaging) effects of abnormal breakdown of the essential amino acid, phenylalanine, which is found in all protein. The enzyme that breaks down The main objectives of disaster epidemiology is prevent or reduce the number of deaths, illnesses, and injuries caused by disasters by providing timely and accurate health information for decision making. Improve prevention and mitigation strategies for future disasters by collecting information for future response preparation. 6. What is the WHO? What do the SDG’s (formerly MDG’S) mean? World Health Organization (WHO) is an arm of the United Nations. It provides leadership to global health matters and technical support to countries, and monitors and assess health trends. Millennium Development Goals (MDG) transitioned to Sustainable Development Goals (SDG’s) represent an agreement among countries to achieve the MDGs by 2015 and “create an environment at the national and global levels alike- which is conductive to development and the elimination of poverty.” o 8 goals subdivided into 21 targets for achieving the goals. o The SDGs were adopted by the United Nations General Assembly in September 2015 and look to 2030. They are far broader in scope than the Millennium Development Goals (MDGs) which focused on a narrow set of disease- specific health targets for 2015. WHO’s primary role is to direct and coordinate international health within the United Nations system. Their main areas of work are health systems; health through the life-course; noncommunicable and communicable diseases; preparedness, surveillance and response; and corporate services. Working with 194 Member States, across six regions, and from more than 150 offices, WHO is an organization united in a shared commitment to achieve better health for everyone, everywhere. They strive to combat diseases – communicable diseases like influenza and HIV, and noncommunicable diseases like cancer and heart disease. The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected – often the key to success on one will involve tackling issues more commonly associated with another. 7. Connect social justice theory to the implications of outbreaks. Health equity and social justice is the framework for the analysis of strategies to address health disparities across socially, demographically, or geographically defined populations. Apply social justice and human rights principles in public health policies and programs, implement strategies to engage marginalized and vulnerable populations in making decisions that affect their health and well-being, critique policies with respect to impact on health equity and social justice, analyze distribution of resources to meet the health needs of marginalized vulnerable groups Health emergencies such as outbreaks, pose the potential for mass illness and death, often resulting in extreme scarcity of medical countermeasures, hospital beds, and other essential resources. Rarely will there be enough stockpiles or surge capacity to meet mass needs. For example, of implication of outbreaks and social justice is, the U.S. influenza preparedness plan anticipates marked shortages of vaccines, antiviral medications, and medical equipment. What does justice tell us about how to ration scarce, life-saving resources? In the context of influenza, the United States focuses on key personnel and sectors such as government, biomedical researchers, the pharmaceutical industry, health care professionals, and essential workers or first responders. These apparently neutral categories mask injustice. In each case, people gain access to life-saving technologies based on their often-high-status employment. This kind of health planning leaves out, by design, those who are unemployed or in “nonessential” jobs—a proxy for the displaced and devalued members of society. Consequently, public health planning based on pure utility, although understandable, fails to have enough regard for the disenfranchised in society. 8. What is the history of the World Health Organization? Diplomats met to form the United Nations in 1945 and spoke about setting up a global health organization. WHO’s constitution came into place on 4/7/48 which is world health day. WHO’s goal is to build a better healthier future for all people over the world. There are now more than 7000 people working in 150 country offices, in six regional offices and at our headquarters in Geneva, Switzerland. 9. Be sure to review the articles: Angelini (2017) and Kurth (2017): What are said to be some of the noticed health effects of climate change? Can you speak to the “Call to Action” elements/content? Noticed health effects of climate change: (Kurth 2017) Climate change is due to human activity, Trigger global migration and local relocation due to sea level rise, More frequent weather events, Direct heat effects the elderly and vulnerable, Spread of vector-borne diseases, Increase in psychiatric and mental health issues as they feel the stress from climate change, Changes in food availability and cost- new and widespread malnutrition, As ecosystem-stress-induced changes occur health systems need to anticipate and plan for them, plans Nurses can lead local and regional adaptation efforts partnering with local decision makers in the identification of at-risk populations, the creation of emergency plans, and monitoring and in the clinical environment as well as in community health roles, nurses provide direct guidance to patients and families (George 2017) heat stress exposure, more extreme hurricanes and thunderstorms, extreme drought desertification and flood areas, more frequent dust storms and wildfires, increase prevalence, mortality, and morbidity of asthma and copd, reduced lung function and physical activity, thunderstorm asthma, increase prevalence and virulence of resp. infections. A Call to Action- (Kurth 2017) It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health, nurse is essential to every solution, The science, techniques, and interventions useful in patient-level health promotion are uniquely understood by nurses and midwives, These selfsame tools can inspire and illuminate health promotion of the planet and the critical systems on which human existence depends. (George 2017) Nurse scientists must contribute to the growing body of bench-to-bedside scientific evidence that documents the health impacts of climate change and evaluates the efficacy and effectiveness of interventions focused on reducing exposure or on reducing the health effects of unavoidable exposure, There is a need for nurses to help their patients develop adaptive strategies, which focus on modifying the built environment to respond to the negative impact of climate change that has already occurred, From a policy perspective, nurses might become involved in efforts to promote public transportation or increase urban tree canopy or may want to be involved in urban planning efforts to increase economic development and reduce economic disparities Climate change is expected to drive more extreme weather events, which have the potential to increase respiratory morbidity and mortality rates. Climate change produces several changes to the natural and built environments that may potentially increase infectious disease prevalence, morbidity, and mortality Climate changes may also influence the survival, reproduction, or distribution of allergens/pathogens (bacterial, viral, and fungal), vectors, hosts, and disease transmission. More frequent wildfires and dust storms can be anticipated due to increased drought and desertification resulting from climate change. “Call to action”- Nursing to assume a leadership role in addressing planetary health. Safeguarding human health requires a healthy planet. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one's university, hospital, and or health system levels 10. How do you assess an area’s resources and its relationship to the health of a region? Community assessments of various kinds often require us to use statistics and other information relating to a certain area. Usually, that area is a city, a county, or even a state. After analysis, you can understand where the real needs are, tailor problem solutions to the areas where they’re really needed and divide resources so that they will be as effective as possible. By comparing the statistics and resources of several regions, you may be able to see why a health condition exists in one region and not in another. For example, a nearby industrial facility may be the difference between an area of high childhood asthma rates and one where the rates are low. The U.S. government has programs for pandemic preparedness that move from federal to state and local levels. Gauging the impact of a pandemic is difficult but researching past statistics about rates of infection and the numbers of people that seek medical care have assisted in preparation. Week 8 (Ch. 2) 1. Synthesize knowledge of population health to the role of political advocacy as an Advanced Practice Nurse. Population health has been defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of an entire human population. Political advocacy goes hand and hand with population heath, for example- seat belt laws, no smoking areas, and allergy free schools. All of those things are population health issues that needed political advocacy to be implemented for the best health outcomes of the community. Public Policy should always be based on evidence (From disease surveillance to the cost effectiveness of screening programs). Political advocacy as an Advanced Practice Nurse should focus on three key policy levers: NP scope-of- practice regulation, distribution of the NP workforce, and NP education. The American Public Health Association defines public health as the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries. Public health is provided by a variety of agencies, small and large, public and private. The CDC administers funding for many population-based prevention efforts (National Health Policy Forum [NHPF], 2010). State health departments are the agencies that most frequently get funding for programs associated with a specific disease or risk factor. Local health departments, such as city and county entities, can also be recipients of direct CDC funds. According to the NHPF (2010), most of the states (29; 58%) have established a decentralized public health organizational model, that is, local public health offices are independent of the state health department and are managed by local authorities. Six states have a centralized organization, in which all the local public health offices are managed from the state level, and 13 have a hybrid model. Two states, Hawaii and Rhode Island, do not have local public health agencies. The NHPF (2010) reports that there are 2794 local health departments in the United States, most of which serve counties (60%) and 9% serve multiple counties. Some health departments (18%) serve cities, towns, or townships. The American College of Physicians (2012) reports that in FY2010 to 2011, 40 states decreased their public health budgets. Of those, 29 had decreased their budgets for the second year in a row, and 15 had done it for a third year (2012). The HHS (2014) reported that the CDC will see a decrease of $432,461,000 in budget authority for FY2014 and operate with an overall budget of $6.665 billion. Program investments that are scheduled to realize an increase in funding are infectious diseases; global disease protection; preventing the leading causes of disability, disease, and death; health monitoring; and environmental and work hazard prevention. Additional funds were allotted for Vaccines for Children and the World Trade Center Health Program. Public health has finally become included in high-profile, tertiary care research centers. This includes the National Cancer Institute (NCI), the first and largest institute of the National Institutes of Health. The Cancer Control and Population Sciences division of the NCI is the bridge to public health research, practice, and policy. Through the NCI-designated cancer centers around the country, public health principles are the cornerstone of the departments within these centers that focus on community health, education, and the conducting of population-based research using community-based participatory approaches. An example is the NCI-designated University of New Mexico Cancer Center's Office of Community Partnerships and Cancer Health Disparities, which conducts community-based participatory research with Hispanic and Native American populations. Building on the accelerating pace of discoveries in human genetic variation, epigenetic, molecular, biochemical, and cellular technologies for cancer care and prevention, public health genomics (PHG) has evolved as a “multidisciplinary field concerned with the effective and responsible translation of genome based knowledge and technologies to improve population health” (Burke et al., 2006). PHG at the NCI promotes the integration of genomics and personalized medicine into public health cancer research, policy, and control. The work of Anita Kinney, PhD, RN, exemplifies the contributions nurse scientists are making in this area through her work combining behavioral science, genomics, and cancer prevention strategies. 2. Appraise ethical and legal principles to the provision of care by the Advanced Practice Nurse. Professional ethics is the study of how personal moral norms apply or conflict with the promises and duties of one's profession. Society demands that professionals be held to a separate moral standard of conduct because the choices professionals make affect other people's lives more than their own. Nursing's foundational documents make each nurse's advocacy and health policy responsibilities clear. Although some may think that advocacy and health policy are an ethical ideal, they are rather a nonnegotiable moral obligation embedded in the nursing role. The ANA Code of Ethics for Nurses states: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (2010). The 2015 revision of the Code of Ethics (soon to be published) places an even stronger emphasis on nursing's advocacy responsibilities. ANA's Social Policy Statement: The Essence of the Profession was published in 1980 and revised in 1995, 2003, and 2010. The introduction to the 2003 revision emphasizes nurses' central role in effecting health policy. Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care. The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems. Outcomes are defined as an end result that follows some kind of healthcare profession, treatment, or intervention and may describe a patient’s condition or health status. Chapter 2 Page 24 Public health policy is the collected laws, regulations, and approaches taken to making decision. Public health policy issues include a wide range of topics including health care reform, insurance reform with an eye to individuals who are not covered by an employer or a group, and the prevention and control of communicable diseases. With a thorough assessment the primary goal of risk reduction is to prevent non and communicable diseases before it occurs so that outcomes can be controlled or managed. 6. Where is the intersection of: epidemiology, population health, public policy and social justice and vulnerable populations? Social inclusion agenda and policy provides an opportunity to reflect on the relationship between social inclusion and health internationally. All areas intersect with the inclusion of all people for the greatest health care 7. Are you able to define the key ethical terms and apply them to population health? For instance, ethics, fairness and social justice. * Ethics: (ANA) practices with compassion and respect. Is committed to patient , family, community, and population. Promotes, advocates for, and protects the rights, health, and safety of the patient. Establishes, maintains, and improves the ethical environment of the work setting that are conducive to safe quality health care. Advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. * Fairness: the state, condition, or quality of being fair, or free from bias or injustice; evenhandedness (closely tied to justice). ALL people have a right to EQUALprotection and equal access to public health. * Social justice: all human beings have the core entitlements essential to human fulfilment. The distribution of advantages and disadvantages within a society. fair and equitable treatment of people with direct implications for the improvement of the health of the public Chapter 5: Applying Evidence at the Population Level Exercise and Discussion Questions Exercise 5.1 Write a question using the PICOT format. (P) population (I) intervention (C) comparison (O) outcome (T) timeframe “Will a 6-week chronic disease self-management program increase the self-efficiency of insulin-dependent diabetic mentally ill patients in a state prison setting” (page 112) Exercise 5.2 Carry out a literature review for one of the PICOT questions you wrote in exercise 5.1 -Establish criteria for inclusion and exclusion of studies. In a clinical trial, the researchers must specify inclusion and exclusion criteria for participation in the study. Inclusion criteria are characteristics that the prospective subjects must have if they are to be included in the study, while exclusion criteria are those characteristics that disqualify prospective subjects from inclusion in the study. If a participant has an inclusion criterion, they are in; if they have an exclusion criteria, they are out. Inclusion and exclusion criteria may include factors such as age, sex, race, ethnicity, type and stage of disease, the subject’s previous treatment history, and the presence or absence of other medical, psychosocial, or emotional conditions. -Synthesize and appraise information of the literary review using table 5.3. Example table for literature review and synthesis for evidence-based practice (page 118) Title of Article Authors with Credential s Question Study Design Level of Evidence Description of Sample Measures Result Exercise 5.3 Determine whether or not you have enough evidence to change current practice using a PICOT question. -Will you need to conduct a study to in order to test the effectiveness of the intervention? Yes, unless there is enough unbiased evidence provided from previous studies -If you need to conduct a study, describe the method that you would use to evaluate effectives of the intervention. Several models are available to facilitate and implement evidence-based practice. These models are; Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model, John Hopkins Nursing Model, Chronic Care Model, Iowa Model of Evidence-Based Practice to Promote Quality of Care (page 129) -Describe what outcomes of interest you will need to identify in your study. In probability theory, an outcome is a possible result of an experiment. Each possible outcome of an experiment is unique, and different outcomes are mutually exclusive (only one outcome will occur on each trial of the experiment). All of the possible outcomes of an experiment form the elements of a sample space. Exercise 5.4 Describe how you will incorporate this change into practice. Chapter 5 Summary The use of research evidence to guide practice can lead to the implementation of the interventions that will improve population outcomes, but this is a complex process. The ability to identify clinical problems and issues, ask clinical questions in a form that allows study, conduct a search of the literature, appraise and synthesize the available evidence, and successfully integrate knowledge into practice requires specialized skills and knowledge. This process can be challenging and time-consuming. Researches have identified many barriers to evidence-based practice, including lack of belief by practicing nurses that research can make a real difference. APRNs are uniquely situated to influence care through their roles as leaders, educators, and clinical experts. This chapter described some of the basic skills needed to integrate and synthesize information in order to design intervention that are based on evidence to improve population outcomes. APRNs need to use their specialized knowledge and advanced practice roles to identify the barriers to evidence-based practice in order to build capacity to adopt change. They also require the ability to involve individuals, teams and organizations in the process. By adopting a culture of evidence-based practice in the work environment, APRNS have the opportunity to facilitate change that can lead to improvement of quality of care. (page 132-133) Kleinman Explanatory Model- consists of three sectors: The popular sector, the professional sector, and the folk sector. The model can be used to determine how individuals make decisions. Socioeconomic Status- (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic and social position in relation to others, based on income, education, and occupation. Disparities- Although the term disparitiesis often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups. Minorities- Minority, a culturally, ethnically, or racially distinct group that coexists with but is subordinate to a more dominant group. As the term is used in the social sciences, this subordinacy is the chief defining characteristic of a minoritygroup. As such, minoritystatus does not necessarily correlate to population Food Desert- an urban area in which it is difficult to buy affordable or good-quality fresh food. Determinant of Health- The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health fall under several broad categories: ● Policy making ● Social factors ● Health services ● Individual behavior ● Biology and genetics It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health. Social determinants of health- · Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods · Social norms and attitudes, such as discrimination · Exposure to crime, violence, and social disorder, such as the presence of trash · Social support and social interactions · Exposure to mass media and emerging technologies, such as the Internet or cell phones · Socioeconomic conditions, such as concentrated poverty · Quality schools · Transportation options · Public safety · Residential segregation. They are important because they play a huge part on how a person is treated an how prone they are to have a certain condition. Social justice implies that there is a fair and equitable distribution of benefits and burdens in a society Data Sources used to assess determinants of health include: Chronic Disease Indicators, Interactive Atlas of Heart Disease and Stroke, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, National Environmental Public Health Tracking Network, and The Social Vulnerability Index. Individuals with a high risk of a disease may have genetic testing to determine the best course of acting for acquiring that disease. The Sustainable Development Goals (SDGs) (or the Global Goals for Sustainable Development, the 17 Global Goals [1], the Global Goals [2] or simply the Goals[3]) are a collection of 17 global goals set by the United Nations General Assembly in 2015. The SDGs are part of Resolution 70/1 of the United Nations General Assembly [4]: "Transforming our World: the 2030 Agenda for Sustainable Development". That has been shortened to "2030 Agenda".[5] The goals are broad and interdependent, yet each has a separate list of targets to achieve. Achieving all 169 targets would signal accomplishing all 17 goals. The SDGs cover social and economic development issues including poverty, hunger, health, education, global warming, gender equality, water, sanitation, energy, urbanization, environment and social justice.[6] If individuals do not have equal access to healthcare, food, and other health factors, outbreaks could be more predominate due to poor health and lack of adequate medical services needed to treat the disease. Climate change can have increase effects on COPD, Asthma, and Respiratory infections. A Call to Action is meant to change planetary health through nursing. A Call to Action: It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one's university, hospital, and or health system levels. * Learning-and teaching-about planetary health is a key productive action. The collective changes possible with law and policy changes-in short, better governance-are necessary to limit further harm. * Communication about planetary health matters requires special care to keep emotions even keeled and avoid an apocalyptic focus. Just as gain-framed messages are demonstrably more effective in health prevention strategies for individuals, prevention in the planetary health domain can include emphasis on improved economies, jobs, population health, and social justice. * Finding common ground (leveraging beliefs, telling personal stories; see Figure S3) with an audience improves message receptivity. New research indicates "that it is possible to pre-emptively protect ('inoculate') public attitudes about climate change against real-world misinformation" (van der Linden, Leiserowitz, Rosenthal, & Maibach, 2017, p. 1). Nurses in educational, community, and clinical leadership roles can provide listeners with information about the nature of disinformation campaigns and why certain parties seek to confuse their audiences. This is the sort of health promotion ("inoculation") work in which nurses and midwives excel. * The formal and continuing education of nurses and midwives must keep pace with the changing conditions, evolving science, and higher levels of engagement from populations and patients in planetary health matters. Medical and public health curricula have made shifts to include climate change and health matters. Nursing curricula are arriving: the Global Consortium on Climate and Health Education (n.d.), a collaborative of nursing, public health, and medical schools formed in 2017, is developing interprofessional curricula on climate change and health. * Survey data show that Americans are concerned about global warming. A Yale survey in late 2016 shows the proportion of Americans "alarmed" about climate change has grown, and the proportion of "dismissives" has shrunk, such that alarmed individuals are now double the number of dismissive (see Figure S4; Yale Program on Climate Change Communication, 2016). * Green technology is an economic growth area. Economies based on wisely used, sustainable, and renewable sources of energy appear ready to thrive. Fossil fuel availability will peak then decline, creating potential market gaps for prepared leaders and nations to lead the green energy transition, enhancing the resiliency of cities, and making food and water systems sustainable. Embracing a planetary health mindset can challenge, renew, and unite us. * Pay attention to what narratives and stories we tell ourselves: "If we don't transition quickly to a sustainable way of life, humanity is doomed!" or rather, "We are transitioning to a more sustainable and resilient way of life that will offer tremendous benefits to humanity" (Frumkin, 2017; Hunter, Frumkin, & Jha, 2017). Nurses are essential to every solution that will improve the health of the planet, with implications for the development and use of the global healthcare workforce, for research, and for practice. Nurses help plan and build resilient health systems, but in order to develop health beyond health care, nurses must move into expanded roles, working with other sectors and individuals, to support the development of resilient communities. The science, techniques, and interventions useful in patient-level health promotion are uniquely understood by nurses and midwives. These selfsame tools can inspire and illuminate health promotion of the planet and the critical systems on which human existence depends. Safeguarding human health requires a healthy planet. The changes we make as individuals are useful, though as trusted clinicians, scholars, and leaders, those changes also can inspire and educate others (Whitmee et al., 2015). The magnitude of our jewel of a planet's health crisis is enormous. But the timeliness, impact, and scale of the solutions that nurses and midwives will muster could evince the very best of our professional- and human-potential. You can assess an areas resources and its relationship to the health of the region by performing a community health assessment.