NUR452:ConceptsinPopulation-BasedHealth
Finalexamblueprint:SPRINGSemester2023
**BASICALLYBOTHEXAMBLUEPRINTSPUTTOGETHER***
Module1–CommunityOriented/Based;CorePublicHealthFunctions,Upstream/Downstream
1.Compareandcontrastcommunity-orientedandcommunity-basednursing. ;(
&4)
●
i.Focusedonnursing inthecommunity
ii.Goalistopreserve,protect,promote,ormaintainhealthofindividuals,families,groups,
populations,andcommunities
iii.Healthcaretopromotequalityoflife
iv. Alsocalledpopulationhealth/populationfocused/populationoriented
v.Mainfocusiscommunity/populationhealth
vi.
vii.Ex.publichealth
●
i.Focuson
ii.M sinthecommunity
iii.Familycenteredillnesscare
iv.
2.Applythepublichealthcorefunctionstothehealthofacommunity/population.
● ment:
i.Monitorhealth
1. Monitorhealthstatustoidentifycommunityhealthproblems
ii.Diagnoseandinvestigate
1. Diagnoseandinvestigatehealthproblemsandhealthhazardsinthecommunity
●
i.Inform,educate,empower
1. Inform,educate,andempowerpeopleabouthealthissues
ii.Mobilizecommunitypartnership
1. Mobilizecommunitypartnershipstoidentifyandsolvehealthproblems
iii.Developpolicies
1. Developpoliciesandplansthatsupportindividualandcommunityhealthefforts
● Assurance:
i. lawsEnforce
1. Enforcelawsandregulationsthatprotecthealthandassuresafety
ii.Linkto/providecare
1. Linkpeopletoneededpersonalhealthservicesandassuretheprovisionof
healthcarewhenotherwiseunavailable
iii.Assurecompetentworkforce
1. Assureacompetentpublichealthandpersonalhealthcareworkforce
iv.Evaluate
1. Evaluateeffectiveness,accessibility,andqualityofpersonaland
population-basedhealthservices
v. Researchfornewinsightsandinnovativesolutionstohealthproblems
3.Differentiateupstreamversusdownstreamthinkingincommunityhealth.
●
i.Determinantsofpublichealthareoverarchingfactorsthatarelargelyoutsideofthe
controloftheindividualandwhichhavesignificanttrickle-downeffectsonother,more
proximaldeterminantsofpublichealth
ii.Ex:
1.Socialinequities
2.Institutionalinequities
a.Corporationsandbusinesses
b.Governmentagencies
c.Schools
d.Lawsandregulations
e.Notforprofitorganizations
●
i.Determinantsofpublichealthcanbeseenastheoutcomesofupandmidstreamfactors
andvariables.Insomerespects,downstreamdeterminantsaremoreeasilymitigatedor
preventedbytheindividual,suchasachangeineatinghabitsorreducingriskofinjuryonthe
job
ii.Ex:
1.
a. Smoking,Alcoholandotherdrugs
b.Poornutrition
c. Lowphysicalactivity
d.Violence
e. Sexualbehavior
2.
a. Communicabledisease
b.Chronicdisease
c. Injury(intentionalandunintentional)
3.
a. Infantmortality& Lifeexpectancy
● Livingconditionsareinthemiddle?
Module2:VulnerablePopulations(VPPPT);HealthDisparities
1.Describetheconceptofhealthdisparities.0
2.Identifythetheoreticallinksassociatedwithhealthdisparities.0
3.Applytheconceptofhealthdisparitiesinthecontextofnursingandhealthcare.
4.Describefactorscontributingtovulnerability.1(VPPPT-Slide5)
- Limitationsin
- Physicalresources(poverty,limitedsocialsupport)
- Environmentalresources(hazardouswork)
- Personalresources(humancapital)
- Biopsychosocialresources(illness,geneticpredispositions)
5.Chooseappropriateplanningandimplementationofcareforvulnerablepopulations.0
Module3:GlobalHealth(GHPPT);DiverseCultures;Spirituality
Objectives:
1.Examinehealthdisparitiesofvariouscountries,suchas g.2
5,16-21)
- Develo
- Stableeconomy
- Widerangeofindustrialandtechnologicaldevelopment
- Ex.US,japan,UK,Sweden,France
- Morelikelytodieofchronicdiseases
- Developing
- Economynotstable
- Notstableinrespecttotechnologicaldevelopment
- Ex.Bangladesh,Zaire,Haiti,andGuatemala
- Morelikelytodieofinfectiousdiseases.
- Healthdisparities
- Communicablediseases
- Immunization
- Preventionthroughimmunizationandimprovingenvironmental
conditions(Measlesandrubellainitiative)
- Eradicationofsmallposthroughouttheworld
- -thelargestcauseofdeathfromasingleinfectiousagent
- -increasingincidentsinadolescents,YA,andheterosexuals
- a-affectsmorethan50%oftheworldpopulation
- Diarrhealdisease
- Oneoftheleasingcausesofillnessanddeathinchildrenlessthan5yearsofage
throughouttheworld
- Eachyearthereare1.6mildiarrhealdeathsrelatedtounsafewater,
sanitation,andhygiene
- Rampantamongtheimpoverished
- Manycountrieshavedevelopeddiarrheacontrolprogramsthatimprove
childhoodnutrition
- Maternalandwomen'shealth
- Awomansabilitytosurvivepregnancyandchildbirthisindicativeofthesociety
inwhichshelives
- Maternalhealthhaswidespreadeffectsonchildrenandfams
- Mostdeathstowomenaroundtheworldarerelatedtopregnancyandchildbirth
- Safemotherhoodinitiativesarestillneeded
- Nutritionandworldhealth
- Poornutrionbyitselforthatisassociatedwithinfectiousdiseaseaccountsfora
largepercentofworlddiseaseburden
- Manychildrenaroundthewroldareunderweigthandhavemultiple
micronutrientdeficiencies
- Improvednutritionisrelatedtostrongerimmunesystems,decreasedillness,
bettermaternalandchildhealth,longerlifespans,andimprovedlearning
outcomesforchilren
- Naturalandman-madedisasters
- Naturaldisasters
- Earthquakes,tsunamis,floods,hurricanes.Cyclones,droughts
- Typicallythepoorercountriesaretheworsthitduetotheir oflack
resourcestocopeandrebuild
- Man-madedisasters
- Bioterrorimattack
- Chemicalemergency
- Radiationpoisoninf
- Genocide
2.Investigateorganizationsrelatedtoglobalhealth,suchasUNICEF,WorldBank,HealthforAlland
MillenniumDevelopmentGoals.3(Slides6,7,9-10)
3.Definenursingrolesinglobalhealth.0
4.Applyculturalcompetencetonursingcareofcommunities/populations. (Slides14,
15,22)
5.Investigateinhibitorstoculturalcompetence. (Slide23)
- Stereotyping
- Prejudice
- Racism
- Ethnocentrism
- Culturalimposition
- Culturalconflict
- Cultureshock
6.Applyvariousreligiousbeliefstohealthcareincommunities/populations.1
Module 4: Community Health Roles; Specialties; Health Law/Policy
1. Explore the nursing roles a community-oriented nurse would use in caring for a community/population.0
2. Apply public health interventions as a component of nursing care of communities/ populations. –
Review ENTIRE Module 4 10PPT & Slide
● Surveillance
a. Defines and monitors health events through ongoing and systematic collection, analysis, and
interpretation of health data for the purpose of planning, implementing, and evaluating public
health interventions
● Disease and health event investigation
a. Systematically gathers and analyzes data regarding threats to the health of populations,
ascertains the source of the threat, identifies cases and others at risk, and determines control
measures
● Outreach
a. Locates populations of interest or populations at risk and provides information about the
nature of the concern, what be done aboutcan it, and how services can be obtained
● Screening
a. Identifies individuals with unrecognized health risk factors or asymptomatic disease
conditions in populations
● Referral and follow up
a. Assists individuals, families, groups, organizations, and/or communities to identify and
access necessary resources in toorder prevent or resolve problems or concerns
● Case management
a. Optimizes self-care capabilities of individuals and families and the capacity of systems and
communities to coordinate and provide services
● Delegated functions
a. Direct care tasks a registered professional nurse carries out under the authority of a
healthcare practitioner as allowed by law. Delegated functions also include any direct care
tasks a registered professional nurse entrusts to other appropriate personnel to perform
● Health teaching
a. Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs,
behaviors, and practices of individuals, families, systems, and/or communities
● Counseling
a. Establishes an interpersonal relationship with a community, a system, family, or individual
intended to increase or enhance their capacity for self-care and coping. Counseling engages
the community, a system, family, or individual at an emotional level
● Consultation
a. Seeks information and generates optional solutions to perceived problems or issues through
interactive problem solving with a community, system, family, or individual. The
community, system, family, or individual selects and acts on the option best meeting the
circumstances
● Collaboration
a. Commits two or more persons or organizations to achieve a common goal through enhancing
the capacity of one or more of the members to promote and protect health
● Coalition building
a. Promotes and develops alliances among organizations or constituencies for a common
purpose. It builds linkages, solves problems, and/or enhances local leadership to address
health concerns
● Community organization
a. Helps community groups to identify common problems or goals, mobilize resources, and
develop and implement strategies for reaching the goals they collectively have set
● Advocacy
a. Pleads someone’s cause or act on someone’s behalf, with a focus on developing the
community, system, individual, or family’s capacity on theirto plead their own cause or act
own behalf
● Social marketing
a. Utilizes commercial marketing principles and technologies for programs designed to
influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population
of interest
● Policy development and enforcement
a. Development:
i. Places health issues on decision-makers’ agendas, acquires a plan of resolution, and
determines needed resources. Policy development results in laws, rules and
regulation, ordinances, and policies
b. Enforcement:
i. Compels others to comply with the laws, rules, regulations, ordinances, and policies
created in conjunction with policy development
1. Explore various subspecialties within community-oriented nursing practice. 1 1S ide
● Home health
● Hospice
● Mission nurse
● School health
● Occupational health
● Correctional health
● Nurse epidemiologist
● Camp nurse
● Faith community nurse
● Global health- WHO
● Forensic nurse
2. Examine the different types of law related to community health issues. - Review PPT Slides
● Judicial and common law:
i. Judicial law: based on court or jury decision
ii. Case law: opinions of the courts
iii. Case law lawand common often used to mean the same
iv. Court uses previous court decisions or cases as part of decision making
v. Precedent: judges bound by previous decisions unless no longer relevant
vi. Principles of common law to assist with decision making include:
1. Justice
2. Fairness
3. Respect for an individual’s autonomy
● Constitutional law:
i. From federal and state institutions
ii. US Constitution for federal government, then all other power/functions are state
government
iii. Community’s over individual’s rights when threat to health of public
1. Example: TB
2. Compelling state interest
3. Isolation necessary to protect the public or individual
4. Reasonable manner
● Legislation and regulation:
i. law)From legislative branches of government; federal, state, local (statute
ii. Rules and regulations: specific statements of law related to defining pieces of legislation
1. Specific statements that operationalize, implements, and enforce statutory law
iii. Examples:
1. State Board of nursing
2. Federal Medicare or state Medicaid legislation and regulation
3. Example of current AZ legislation passed in black board classroom resources
5. Apply the nurse’s role in the policy process to influence health care (including how a bill becomes a
law). 2 – 21PPT Slide
● Policy: Including nurse's role: Gidden’s pages 528 & 529
● Law definitions: Gidden’s pages 533-535
● Legislative action:
o Common methods of influence of health policy
▪ Face to face, personal letters, emails, phone calls, testimony, petitions, reports,
position papers
o Know “how a bill becomes a law”
o Tips for visits with legislators
o Tips for writing legislators
o Tips for action
● Regulatory action
● The process of regulation
● Nursing advocacy
1
Module 5: Health Promotion; Screening; Levels of Prevention; Nutrition
1. Describe the concept of health promotion. (Giddens textbook p.422) 1 – S
a. Activities that have as their goal the development of human attitudes and behaviors that
maintain or enhance well-being
b. Promote health rather than avoid illness!
c. Control your own well-being and improve health
d. Focus on whole populations—not just at-risk populations
e. Ex:
i. Getting appropriate sleep for overall health
ii. Developing a program to decrease healthcare costs in the nation
iii. Using MyPlate to teach nutrition
2. Identify links between health promotion and health promotion models for the individual and
community. (Giddens textbook p.424) 3 – Slide 4 & 5 & Pender’s Model
3. Apply the concept of health promotion to the context of nursing and health care (economy, vulnerable
populations, assessment, and interventions) (Giddens PPT/textbook) 1
4. Apply levels of prevention to community/ population health. (PPT 6&7)Slides
● Primary:
o Interventions that promote health and prevent the occurrence of disease, injury, or disability
▪ Prepathogenesis
o Preventing disease before it happens
o Modifying existing risk factors
▪ Bike helmets
▪ Tobacco cessation
o Preventing development of risk factors
▪ Bike trails located away from vehicles
▪ Policies limiting youth from purchasing tobacco
● Secondary:
o Interventions designed to increase the probability that a person will have the condition
diagnosed early so treatment is likely to result in a cure
▪ Screenings-core
o Identifying disease before problems become serious
o Examples:
▪ Newborn screening
▪ Mammography
▪ Regular checkups for smokers
▪ BMI screening
▪ Blood pressure measurement
● Tertiary:
o Interventions aimed at limiting disability and interventions that enhance rehab from disease,
injury, or disability
o Preventing complications of disease
o Examples:
▪ Post-stroke rehabilitation
▪ Blood sugar lowering medications for diabetes
▪ Physical therapy for back injury
5. Investigate the scr preening ocess and characteristics (including reliability and validity [sensitivity,
specificity]). 2 - Review PPT & Gidden’s page 423 under Secondary Prevention; Slides 3 & 14
● Reliability:
o Precision
o Consistency or repeatability
o 3 major sources of error can affect the reliability of tests
▪ Various inherent in the trait being measured
▪ Observer variation
▪ Consistency of the measurement
● Validity:
o Whether it is really measuring what we think it is and how exactly
o Sensitivity:
▪ Quantifies how accurately the the condition or traittest identifies those with
▪ Represents the proportion of people with the disease whom the test correctly
identifies as positive (TRUE POSITIVES)
▪ High sensitivity is needed when early treatment is important and when
identification of every case is important
o Specific :
▪ Indicates how accurately the test identifies those without the condition or trait
▪ The proportion of the people whom the test correctly identifies as negative for the
disease (TRUE NEGATIVES)
▪ High specificity is needed when rescreening impractical and whenis it is
important to reduce false positives
6. Discuss the ethics of scr screening in a eening program. 3 – Slide 18
● Cost-ef
1. Co an contrast health promotion and disease prevention. 3
● Health promotion:
i. ed in num r 1
a an vo ne s
ut
9. Expl the effec of ial di ts or ut ients on alt n chro co d n
Module 6: Community Assessment
Objectives: Community Plan of Care PPT
ty-as-client
● Community assessment purpose:
o To identify community needs
o To clarify problems
o To identify strengths and resources
● Plan of care:
o Community assessment:
▪ Define with 3 dimensions:
● Place: what are geographical boundaries?
● People/person: which people are members?
● Function: what characteristics do they have in common?
▪ Gather existing data and generate missing data
▪ Develop a composite database
▪ Interpret the database to identify community problems and strengths
o Nursing diagnosis:
▪ Review FHP
▪ Make summary statements in the form of nursing diagnosis
▪ Actual problem diagnosis., risk for diagnosis, readiness for enhanced diagnosis
o Planning:
▪ Analyze community health problems identified in community nursing diagnoses
▪ Establish priorities among nursing diagnoses/problems
▪ Establish goals and objectives
● Goals are broad statements of desired outcomes
● Objectives are precise statements indicating the means of achieving
desired outcomes/goals
o Precise, behaviorally stated, measurable
o Who, what, when, how
o Ex:
▪ 50% of mothers of infants enrolled in WIC will
demonstrate 3 ways of incorporating the WIC supplements
into their infants’ diets by October
● Collaboration needed—community as partner
● Then from goals, interventions are developed to meet objectives
▪ Identify intervention activities that will accomplish the objectives
● The means by which objectives are met
o Intervention/implementation:
▪ Involves the work and activities achieving the goals and objectivesaimed at
▪ Shaped by:
● The nurse’s chosen role (content expert, change agent, problem solver…)
● The type of health problem the focus for interventionselected as
● The community’s readiness take partto in problem solving
eristics o h han e proces
values
o va
o
▪ S
H
● epide
● Loo at chan es before and a r nte ention
3. Implement Functional Health Patterns (FHP) as a framework for assessing communities/ populations.
-
● Review PowerPoint
● Already reviewed in NUR458
● Health perception/health management pattern
- Community’s health status
- Health promotion and disease protection practices
- Member perception of health
● Nutritional/metabolic patterns
- Accessibility and availability of food stores and subsidizes food programs for infants,
children, and the elderly
● Elimination pattern
- Includes exposure to pollutions such as contaminated air, water, soil, and the food chain
● Activity/exercise pattern
- Activity and recreational options
● Sleep/rest pattern
- Rhythm of sleeping, resting, and relaxing
● Cognitive/perceptual pattern
- Ability to solve problems and make decisions
● Self-perception/self-concept pattern
- Self-worth and personal identity of a community
- Can relate to crime, whether it is a good place to live
● Roles/relationships pattern
- Identifies communication styles and formal and informal relationships
- Patterns of crime, racial incidents, and social networks are indicies of human
relationships
● Sexuality/reproductive pattern
- Premature infant rates, abortion rates; neonatal, infant, and maternal death rates
● Coping/stress tolerance pattern
- Ability to cope or adapt
● Values/beliefs pattern
- Values and beliefs
- Can provide cues to health-protection efforts
Module 7 – Health Education/Health literacy – 13 questions – Review Health Education PPT- Specific
Slides listed to assist you with studying
- Compare summative vs. formative evaluation. (Health Education/HE PPT Slides #28 & 29)
-Evaluation
- Process evaluation/evaluation of teacher
- The lessons
- the teacher
- throughout the teaching for timing and adjustments - Formative
evaluation
- Formative
- Eval throughout the nursing process
- Before eval of the outcomes of care
- During the “formation” of the nursing care and its
delivery
- Nsg care can be modified
- Outcome evaluation/evaluation of learner
- Did learners achieve behavioral objective?
- shortterm/longterm
- Self efficacy
- At the end - Summative evaluation
- Summative “The sum”
- At the end
- After interventions
- Measurement of outcomes and goal attainment
2. Choose the skills of an effective educator when developing a plan of care. How do you motivate
people to learn? How do you write objectives? 3 – (HE #20 & 21)PPT Slide
- Create teaching plan - objective/outcome, content, strategy, evaluation of outcome/objective
- Effective educator
- Gaining attention (hook them in)
- Tell students what the objective are
- recal l previous knowledge to like new
- Resent essential material in clear format
- Apply to lives and situations
- Encourage demonstration
- Provide feedback
- Components of behavioral objectives
- what, when, who, how
3. Analyze barriers to the educational process – educator-related and learner-related. 4 (HE -Slides
8&9)
- Educator-related barriers to learning
- Fear of public speaking
- Lack of credibility with topic
- Over dependence on notes
- Learner-related barriers to learning
- 2 most important : low literacy and lack of motivation
- Cultural differences
- Language barriers: accents, nonverbal (tone/passion)
- Physical barriers: vision or hearing problems, mobility issues
- Environmental barriers: room setup
- Generational differences: wrong learning
4. Describe groups as a tool in health education. What are stages of group development?1 (HE
Slide #38)
- HE often is provided in groups
- Health behaviors influenced + and - by grups we belong to
- Effective and powerful to assist with change from individual, families, communities
- Formal and informal groups
5. Apply the concept of literacy to community health. How does health literacy affect learning and
health behaviors? 3 (HE PPT Slide #13 & #14)
- Indicators of limited literacy:
○ Incomplete patient forms, noncompliance with medication, lack of follow through, frequently missed
appointments
○ Responses to written info: “I forgot my glasses. I’ll read it later”, “I’ll discuss this with my children.”
○ Unable to identify medications, understand directions on medication bottle/packaged food/baby formula,
understand instructions, or read warning signs
- People with reading problems:
○ Don’t use seat belt regularly
○ Don’t exercise regularly
○ Smoke or drink more
○ Don’t make healthy food choices
○ Tend to leave in places that are less healthy
○ Tend to hold more dangerous jobs
Module 7 – Epidemiology - 10 questions – Review PPT in Canvas
1. Explain the purpose of epidemiology. (PPT slides #3 & #4)
- Investigates the distribution or patterns of health events in populations and the
determinants or the factors that influence those patterns
- True detective work
- Descriptive epi - what, who,, where, when
- Analytic epi - how and why
- To guide clinical practice and influence health outcomes
2. Apply concepts of rates to community/ population health. What are the main causes of death? 1–
(#5&6)
- Rate
- A statistic used for describing an event, characteristic, or happening. TIME important or
a proportion
- Used to make comparisons among populations or to compare a subgroup of the
population with the total population
- Crude rate - the total population
- Specific rate - subgroup of the population
- Number of unintentional injury deaths
- Leading cause of death - tobbacco
3. Define morbidity (incidence and prevalence) and mortality in community/population health.
(Slides #9-#13)
- Morbidity
- Incidence and prevalence
- Mortality = dealth
- Knowing top causes of mortality can guide care of communites/populations we serve
4. Implement the Epidemiologic triangle: Agent, host, and environment to epidemiological issues.
Know the characteristics of each. 2 – (PPT #17)Slide
5. Integrate the nurse’s role within epidemiology. 1 – (PPT 19)Slid
- Surveillance outbreak investigation
6. Compare and contrast surveillance and outbreak investigation.1 (PPT #20)Slide
- Surveillance
- Ongoing systematic collection, analysis, interpretation and dissemination of specific
health data
- Monitor disease treads to lower morbidity and morrtality and increase health
- Infectious and chronic disease, injuries, and exposures
- Outbreak investigation
- Investigation of unusual increease in disease incidence or an unusal event
- To detrmine who else has been exposed to prevent larger outbreal
- Objectives
- To control and prevent disease or death
- To ID factors that contribute to the outbreak of the disease or occuence of the
event
- To implement measures to prevent occurence
Module 8 – Communicable Diseases (CD); Chain of Infection – 18 questions - Review PPTS in Canvas &
Use notes in Canvas to supplement understanding of concept.
1. Interpret how diseases are spread using the Chain of Infection model (agent, reservoir, exit,
transmission, re-entry, host). 3 – (CD PPT Slide #3-#4 & notes in Canvas)
- Infectious agents
- microbes, all types
- Pathogenicity
- Invasiveness
- Virulence
- Infectivty resistance
- Reserviors
- Humans (incubation period and communicable period
- Animals
- plants/soil
- Portal of exit
- Respiratory, integ, blood, GI, sexual
- Means of transmission
- Vertical
- Horizontal
- Direct
- Indirect
- Common vehicles
- Vectors
- Portal of re-entry
- Same as exit, usually
- Susceptible Host
- Defense mechanisms
- Immunity (natural or acquired)
2. Use the Chain of Infection model as a means of stopping the spreading of disease.
3. D . (CD PPT slides #6-10 &14-15 )
- Endem - constantly there, regularly found among people or in a certain area
- valley fever in az
- Tuberculosis in southern africa
- Epidemic - wide side occurance of a disease in a community a particularat time
- Spanish flu
- Influenza
- Swine flue
- Avian influenza
- Pandemic - epidemic occurring worldwide over several countries or continents
- Flu pandemic of 1918 & COVID19
4. Compare differences in disease reporting at state and federal levels. 1(CD PPT slide #16)
- State notifiable diseases
- Mandated by state law –Each state has different laws regarding reporting
- Reported to state/local health department by healthcare providers, labs, and public health
workers
- States then transmit data electronically, weekly to the CDC
- National notifiable diseases
- CDC and council of state and territorial epidemiologists have policy that requires state
health departments to report certain disease to the CDC, National notifiable disease
surveillance system (NNDSS)
- Published weekly in the morbidity and mortality weekly report (MMWR)
5. Define communicable disease category including an exemplar of each 3 (CD PPT Slides)
- Agents of bioterrorism
- Intentional released dof viruses, bacteria or ther germs that can sicken/kill people,
livestock, or crops
- Biological agents with potential for high mortality, can be easily
disseminated
- To causes major public panic/disruption
- Bacillus aanthracis (anthrax) is the most common
- Can produce dormant spores, and when they get into body(place with rich
waters/sugars/nutrients) they can be activated to active growing cells
- Plague (vector-borne by rodent fleas)
- Smallpox (virus in freezers)
- Botulism (soil, water, canned foods, honey)
- Tularemia (zoonotic carried by rabbits, etc)
- Hemorrhagic virus (ebola and marburg)
- Emerging
- Vaccine-preventable
- e (e.g. Salmonella)
- Bacterial, within 48 hours of ingestion
- Morbidity significant, uncommon mortality except infants, elderly, debilitated
- Contaminated meat, poultry, eggs are most common
- Animals - pets and farm (reptile, cattle, dogs, rodents, cats)
- Person to person transmission possible (daycares and insitutions
- Water borne
- Vector borne (e.g. Lyme disease) & Zoonosis
- Transmitted by carrier or vector (mosquitp, tick, fly, cockroach
- Mechanical transmission or biological transmission
- Lyme disease, west nile virus, rabies, zika
- Parasitic
Diseases of travelers
- alth care acquired (e.g., MRSA/VRSA).
- Previously referred to as Nosocomial infection
- Acquired during hospitalization
- Patients, health care workers, visitors
- One in every 20 patients develop an HAI
- Hand hygiene critical
- May involve and contribute to antibiotic resistance – MRSA
- Roles – infection control nurse, nurse epidemiologist
-
6. Explore HIV infection, hepatitis, Tuberculosis (types of tests), and STDs (e.g., syphilis).
(STI/STD PPT)
- TB
- Transmitted by exposure to bacilli in airborne droplets
- Incubations is 4-12 weeks
- Clinical symptoms develop in 6-12 months
- Infection in about 95% of those infected become latent, and mey be reactivated
later in life
- WHO estimated one-quarter of people in the world are infected
- 2020 1.5 mill people died of TB
- 215000 people with HIV died from associatd TB
- 13th leading cause of death worldwide
- Risks: homeless, prisons, nursing homes, immigrants
- Immunocromprommised (HIV)
- Skin test (TST) or quntiferon blood test
- Follower by CXRAY for positive skin reaction and pulomary s/s
- 2 step testing is often done for people over 55 and new employees
- To avoid misinterpretation between a boosted response and new infection
- CXAY, Acid fast bacillus (AFB) smear, cultures
- Meds taken for 6-9 months - of adherencelack can result in drug resistence
7. Discuss vaccine-preventable diseases and vaccines that prevent them. –(Supplemental Materials in
Canvas in Module 9)
-
8. Differentiate recommended vaccine schedules for children, adolescents, and adults. (e.g., MMR, B,Hep
Varicella) 2 -- (Supplemental Materials in Module 9)
-
Module 9 – Complementary/Integrative Health – 3 questions – Review PPT
Objectives:
1. Apply the principles of integrative nursing community/ population health. 2 –to (Slide
#4)
2. Assess your well-being. What does it include? 1
3. Appraise various integrative therapies, such as 4-7-8 Breathing, and therapeutic effects of outdoors. 1
Module 10 – Disaster – 16 questions – Review PPTs –
Objectives:
1. Discuss types of disasters, including natural and human-made.
2. Discuss strategies keep self, family, and clients safe during disasters.to (Slides #18 & 9)
3. Evaluate the effects of disasters on people and their communities. Review chemical agents.
4. Describe the nurse’s role in the disaster management phases of prevention/ mitigation, preparedness,
response, and recovery. (Disaster #9-#17)PPT Slide
- Prevention (mitigation)
- An emergency management term for reducing risks to people and property from
natural hazards before they occue
- Prevention againnatural-disaters
- Structural and non-structual measures
- Prevention against man-made
- Heaighted inspections, improved surveillance and security operations,
public health and agricultural surveillance and testing, immunizations,
isolation or quarantine and halting of chemical, biological, radiologixal,
nuclear, and explove threats
- Preparedness
- Personal Preparedness
- Disaster kits for home, workplace, car
- American red cross
- Federal emergency agency (FEMA)
- Professional Preparedness
- National disaster medical system (NDMS)
- Disaster medical assistance team (DMAT)
- Medical reseve corps (MRC)
- Community emergency response team (CERT)
- Community Preparedness
- Office of emergency management (OEM)
- Public health securti and bioterrorism prepar andedeness
response act of 2002
- FEMA
- Disaster and mass casualty exercises
-
- Response
- Recovery
5. Identify local, state and federal agencies and community groups that assist communities during
disasters. Review FEMA and organizations under it. 3 (Disaster #15)PPT Slide
6. Apply disaster triage principles, using the color-code system. 2 (Disaster Triage PPT Slides #6-#10)
1. The MASS Triage System
❖Move
➢Step 1: everyone who can hear me and needs medical attention, please move to the area with the
green flag
➢Step 2: everyone who can hear me raise an arm or leg so we can come help you
■ Remaining pts who could not move -> IMMEDIATE CONCERN
❖Assess
❖Sort (based on the pt’s potential for survival)
★Global sort
○ Walk: are they able to walk?
○ Wave: can they move their limbs?
○ Still: are they immobile or paralyzed?
★Individual sort
○ Assessments:
■ Airway: ventilation, breathing
■ Circulation: peripheral pulses
■ Cognition: follows commands or purposeful movement
○ Interventions:
■ Airway maintenance
● Rescue breath x1 for adults
● Rescue breath x2 for infants/children
➔If still apneic and pulseless after, move one to the next patient bc this pt is
■ Hemorrhage control
○ Categorize:
➢Immediate – RED
■ Require medical attention within minutes
■ Obvious threat to life or limb; compromises to airway or circulation
■ These are the ones who did NOT respond to both move steps
➢Delayed – YELLOW
■ Serious and potentially life threatening injuries, but status not expected to deteriorate
significantly over several hours
■ May be able to move a limb (these are the ones who responded to the second move step)
■ E.g.: fractures, bone dislocation
➢Minimal – GREEN
■ Walking wounded, minor injuries (abrasions, minor lacerations, contusions), stable vitals
■ Unlikely to deteriorate over the next few days; able to assist in own care and help others
➢Expectant – BLUE/BLACK
■ Unlikely to survive given severity of injuries, availability of care/resources, or both
■ Resources are not used initially to care for these victims, unless resources become available
■ Provide palliative care and pain relief
■ E.g.: remains apneic,
❖Send
Module 11 – Case Mgmt/Care Coordination & Chronic Illnesses – 7 questions – Review PPTs
1. Differentiate self-management versus case management of acute and chronic illnesses,
including Motivational Interviewing and stages of change. (CMCC PPT Slide #3)
- Self management = Client takes care of own needs, including basic needs, health care,
etc. May not be feasible for some with chronic diseases and limited resources
- Case management = “A collaborative process that assesses, plans, implements,
coordinates, monitors and evaluates the options and services required to meet the client’s
health and human services needs.
- characterized by advocacy, communication, and resource management and
promotes quality and cost-effective interventions and outcomes
- Motivational interviewing
- Collaborative strategy to promote behavior change in clients and fam
- Encouraged to set goals for making health changes
- Nurse provides collaborative environment to support change. The client and
family share their perceptions and knowledge about the behavior, nurse affirms
them of autonomy to make choices for change about behavior.
- 4 princlines of motivation intercviewing
- Expressing empathy - to communicate an understanding of clients
perspective
- Rolling w resistance - avoid arguing w client when unwillingness to
change occurs
- Supporting self-efficay - support confident that change can be made
- Developing discrepancy - guide client when inconsistencies occur
between current behavior anf desired goals
- OARS
- Open ended questions
- Affirmations of what client says
- Reflective listening
- Summaries of conversation and decisions made
- Stages of change
- Precontemplative-“idontthinkthatlosingweightandexercisingis
reallygoingtohelpmethatmuch”
- Contemplative-“Iknowthatishouldlostweightbutrightnowidont
havetimetoeatrightandexercise”
- Preparation-“ithinkthatimightjoinagymandmaybegotoweight
watchers”
- Action-“Ireallycutbackoninbetweenmealsnacksandhavestarted
walkingafterdinner”
- Maintenance-“Ithinkiknowwhatineed do,andito amreallydoing
wellmostofthetime”
- Relapse-“iblewit”
2.Discussthenurse’sroleincaringforpeoplewithchronicconditionsincommunities,including
cost,burdenofdisease,federallegislation,anddisabilities.4(ChronicIllnessPPT)
- Acute-generallyonetimecosttoindividual
- Providerattitudes
- moreaccepting
- Expectpeopletoconformtothesickrole
- Costs
- n=maybehighbutislimited
- Chronic-ongoingexpenses,communityresourcesareallocated-mayneedtocomply
withlegislatedmandates
- Psychologicaleffects
- Powerless,fearful
- Stigmaisattachtothis.Thedominantcultureemphasizesyouth,
attractiveness,andpersonalaccomplishment
- Providerattitudes
- Mayblameclient
- Gettiredofseeingsameclient,frustrated,maynotwanttoincludeclient
indecisionmaking
- Providermaynotaccepttheclientshouldmanage
- Cost
- Ongoingcostsformedications,providervisits,,andhospitalizations
- Effectsonthecommunity
- need/demandtoreallocateresources
- Discomfortorfearfromlackofknowledgeofdisabilty
- Needtocomplywlegislation
- Needforotherservicesbeyondmedicaldiagnosis(ex.transportation)
- ROLEOFTHENURSE
- Providerofhandsoncare
- Lookbeyonfdisability,treatthewholeperson
- Educator
- Advocate
- Referralagent
- Coordinator
- Collaborator
- Changeagent
3.Explorestrategiestoincreaseadherenceinmanagingchronicillnessesincommunities.
- Whydontpeopletaketheirmeds?
- Cost,adverseeffects,complexityofschedule
- Forget
- Lackofinformation
- Thinktheydontneedit
- Thinkproblemisfixed(hypertension)
- Depression
- Fear
- Denialofillness
- Healthcaresystemissues
- Improvingadherence/enhancingcompliance
- Patienteducation
- Inporveddosingscedales(tailorregimentoclientsdailyroutine/simplify)
- Increaseclincahours
- Improvecommunicationbetweenproviderandpatient
- Providereminders
- Enhancecoping
- Contractingwclienttocommit
LevelsofPrevention,HealthPromotion/BeliefModel–integratedwithinsomequestions
● HealthBeliefModel
○ Perceivedsusceptibility:“Willsomethinghappentome?”
○ Perceivedseverity:“Willitbeabigproblem?”
○ Perceivedbenefits:“Willitreallyhelpme?”
○ Perceivedbarriers:unpleasant?costly?
○ Cuestoaction:“Whatmightmotivateme?”
○ Selfefficacy:“CanIreallydothis?”
Module12:Genetics/Genomics;Ethics
Objectives:5questions-
1.Investigatetheinfluenceofgenomicsontheincidenceandprevalenceofdiseasesanddisorders.
(Slides4-5,8,11)
- Genome=thestudyofthefunctionandeffectofsinglegenesthatareinheritedbychildrenfromtheir
parents
- Genomics=thestudyoftheindividualgenesinordertounderstandthestructureofthegenome,
includingthemappingofgenesandsequencingtheDNA
- Whyisgenomicsimportant?
- Genomicsplaysarolein9outof10leadingcausesoddeath
- Heartdisease
- Cancer
- Stroke
- Diabetes
- Alzheimer'sdisease
- Ethicalandlegalconsiderations
- Geneticinformationnondiscriminationact(GINA)-designedtoprohibittheimproperuseof
geneticinformationinhealthinsuranceandemployment
2.Exploreopportunitiesandchallengesofgenomicsinpublichealth. (Slide13,18-20)
- GenomiccompetenciesforPHworkforce
- Publichealthworkersshouldbeableto
- Demonstratebasicknowledgeoftherolethatgenomicsplayinthedevelopmentof
disease
- Identifylimitsofhis/hergenomicexpertise
- Makeappropriatereferralstothosewithmoregenomicexpertise
- Nationalcoalitionofhealthprofessionaleducationingenetics(NCHPEG)corprinciplesin
genetics
- Thefutureofgenomicsinpublichealth
- Manyopportunitiesandchallengesforrealizingthepromiseofgenomicstoimprovehealth
outcomeslieahead,including
- Creatingandevaluationsscientificevidencetosupportvalidandusefulgenetictestsand
familyhealthhistorytools
- Developingevidence-basedpracticerecommendationsthatevaluatethenethealthbenefit
ofgenetictestsandfamilyhealthhistory
- Conductingresearchonhowtotranslaterecommendationsintopractice
- Facilitatingtheuseofvalidandusefulgenetictestsandfamilyhealthhistorytoolsto
guideclinicalpractice,policy,andnational,state,andlocalprogramstofindpeoplewho
areatriskfordisease,makediagnoses,andprovideappropriateinterventions
- Monitoringtheuseofgenetictestsandfamilyhealthhistoryinpopulations,thehealth
outcomesrelatedtotheiruse,anddispartiesintheiruseandoutcomes
- Addinggenoicinformationandclinicaldecisionsupporttoolstoelectronichealthrecords
- Incorporatinghealth-relatedgenomicseducationinprimary,secondary,undergraduate,
andgraduatecurriculum
- Assuringthepriaccyandconfidentialityofgenomicinformation
-
3.Differentiatecommunityrightsversusindividualrights. (Slide9-11)
- Isitethicaltoallowfamiliestochoosenottovaxtheirkids,placingotherchildren,especiallythosewho
areunabletobevaccinatedatrisk?
- Communityrights
- Individualrights
4.Describedistributivejusticeincommunity/populationcare. (ETHICSPPT-Slide11)
- Ifyouhavealimitedsupplyofvaccineduringanepidemic,isitethicaltodistributeitinitiallytothose
atthehighestriskwiththeleastresources?
- Distributivejusticeincommunity
- Populationcare
Module13:EnvironmentalHealth;Technology
2.Describelegislationandpolicieswhichaffecttheenvironment.1(Slides16,17)
3.Describethenurse’srole(includingriskcommunication)inmaintainingahealthyenvironment.2 (Slides9-12,20)
- Assessment
- Home,School,Workplace,Community
- Airquality,Water,Food,Land
4.Explorecommontoxinsandpollutantsthatimpactacommunity’shealth. (Slides7 1& 9)
****^ViewEnvironmentaltoxinsppt-downloaded
