Nurs. 404 Final Flashcards
(105 cards)
1
Q
Relative study design strength
A
- Epidemiologic research can be descriptive or analytical. Study designs are based on the problem under study and range in strength on a continuum, with the weakest design being the retrospective design and the strongest being the experimental design.
2
Q
What designs are used to examine causality?
A
Quasi-experimental and experimental designs are used to examine causality.
3
Q
What is the gold standard for research design?
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The “gold standard” for research design is the randomized, control group design
4
Q
Epidemiological research
A
- Findings from descriptive epidemiologic studies lead to hypotheses for future research.
- Epidemiologic research identifies community/public health problems and describes the natural history and etiology of diseases
5
Q
True or false
Observational studies may be either descriptive or analytical.
A
True
6
Q
True or false
Observational studies may be either descriptive or analytical.
A
True
7
Q
Descriptive studies
A
Descriptive: identifies characteristics of individuals, situations, or groups and the frequency with which certain phenomenon occur. Disadvantage: no interventions or treatments included. Have 2 subcategories; case studies and cross-sectional studies
8
Q
Case studies vs cross sectional studies
A
b. Case studies: in-depth analysis of an individual, group, or social institution.
c. Cross-sectional studies (prevalence studies): the population to be studied is defined, and data are collected from members of the group about their disease and exposure status. Good studies for examining the relationship between a variable and a disease but not for determining cause and effect, which requires the collection of data over time.
9
Q
Analytical studies
A
Analytical: are on a continuum, ranging from strongest to weakest designs. 2 analytical designs, he prospective correlational design and the retrospective correlational design are “weaker” designs on the continuum. Two different types of analytical studies: cohort and case-control studies.
10
Q
What is a cohort?
A
Cohort (prospective): monitor subjects over time to find associations between risk factors and health outcomes. Stronger than case control studies; however they are more expensive. Advantages: they minimize selection biased, a threat to internal validity, and provide preliminary evidence of the incidence of a risk factor.
11
Q
Case control studies
A
f. Case-control studies (retrospective studies): work backward from the effect to the suspected cause. Two groups (control group and case subjects) are compared to determine the presence of specific exposures and risk factors. Advantages: allow for the examination of multiple exposures for a single outcome, are suitable for studying rare diseases and those with long latency periods, require fewer case subjects, generally are quicker and less expensive to conduct than cohort studies. Disadvantages: they aren’t appropriate for studying rare exposures, they are subject to bias because of the method used to select control trials, and they do not allow the direct measures of the incidence of disease.
12
Q
Quasi experimental studies
A
g. Quasi-experimental studies: are weaker because assignment of subjects into groups is not randomized, or the researcher is unable to manipulate the variable under study.
13
Q
Quasi experimental studies
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g. Quasi-experimental studies: are weaker because assignment of subjects into groups is not randomized, or the researcher is unable to manipulate the variable under study.
14
Q
Care management-coordination of a plan or process to bring health services together as a common whole in a cost-effective way
A
• Care management-coordination of a plan or process to bring health services together as a common whole in a cost-effective way
o a term coined to define the evaluation of healthcare interventions, including need and appropriateness of are, and the actions taken to attain effective and efficient outcomes
o Often used as a synonym with “utilization management,” which is a key component in the care of clients because of continued rising medical costs
15
Q
Case management-development and coordination of care for a selected client and family
A
• Case management-development and coordination of care for a selected client and family
o The Case Management Society of America defines case management as “a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes”
16
Q
Care management is r/t case management
A
o Care management is r/t case management
• Without case management, care management could not be successful, thus, case management can be considered a building block of care management
o Case management involves an intensive process called disease management
17
Q
Disease management
A
• Disease management- a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant
o Emphasizes prevention at the secondary and tertiary level using EBP guidelines
o Collaborative practice models are a key to the success of disease management
18
Q
- Levels of prevention as it relates to care management, case management and disease management
A
• Care Management (utilization management)-
o In many cases, advances in technology including the use of predictive modeling and other methods of data analysis, are creating opportunities for utilization management to be targeted to specific disease management areas more precisely
o Case study- Eleanor- Care management and utilization management will inevitably benefit her by helping professional caregivers, such as her physician, help discuss anticipatory needs (primary?) such as home care as more disability evolves from her advancing chronic comorbid conditions (could be tertiary here???)
o Evaluates healthcare intervention (secondary prevention)
19
Q
True or false
Case management- healthcare professionals advocate for resources needed by the client- secondary and tertiary
A
true
20
Q
Disease management and levels of prevention
A
• Disease management- emphasizes prevention at the secondary and tertiary level
21
Q
- Roles of a parish/faith community nurse
A
• Parish nursing is an approach to holistic care to clients and families in the community • The seminal work of Westberg identified seven key roles of the parish or faith community nurse: o Health educator o Personal health counselor o Referral agent o Coordinator of volunteers o Developer of supportive groups o Integrator of faith and health o Health advocate
22
Q
- Phases of a home visit
A
• Initiating the visit
o Many home care agencies receive referrals
• Generally, homecare agencies make sure that an initial visit is made within 24 hours of receiving referral
• When receiving a referral, it is particularly important to make sure that the orders and directions for care are clear and accurate
• If necessary, a clarifying call should be made to person who referred the client prior to home visit
• Preparation
o Documentation is critical
• All appropriate paperwork required for the assessment of the client and family must be available
o Equipment
• The home care nurse must bring supplies and equipment that may be needed for the visit depending on diagnosis and specific skilled need
• Ex) sterile/clean dressings, urinary catheters, walker, sterile saline solution, distilled water, antimicrobial agents and paper towels
• A homecare nurse does not use client sink areas to wash his/her hands to decrease the chance of cross-contamination
• In addition, the nurse must keep equipment that is often used and may be needed unexpectedly in his/her trunk (to decrease theft and damage to the vehicle)
o Directions
• Getting directions for the home visit is very important
• GPS can help home care nurses locate clients
• Becoming familiar with the directions of routes (N, S, E, W), using landmarks and making sure that unusual locations are explained before one leaves for a visit, is important
o Personal safety
• Safety prevention for home care nurses is a part of preparing
• Box 11.3 in the text book- Safety Tips for Home Care Nurses
• When and where will I go to the bathroom? When and where will I eat? What will I do if I get lost? What will I do if I am involved in an automobile accident?
• Carrying a functioning cell phone and heaving a list of emergency numbers to call is critical
23
Q
The actual homevisti
A
• The actual visit
o Includes introducing home care services to the client and family, as well as the process of obtaining help from the home care agency when a home visit is not occurring
o The key component of the first in-home visit is assessment
o The home care nurse is a guest in the client’s home and must obtain the client’s permission and ask for the client’s guidance about how to carry out the initial assessment in the context of the home
o It is necessary to carry out an overall assessment of the clients and family’s strengths, weaknesses, and challenges.
o In addition, it is also essential to assess home safety risks:
• Medication errors- sometimes, in the freedom of their own home, clients refuse to take medications, forget to take medications, do not fill prescriptions because of cost, or need a renewal of a prescription and do not know how to proceed or do not have access to a pharmacy, etc.
• At the initial home visit, it is important to develop a medication profile that is accurate and will be reviewed at each visit- it is critical to talk about the use of prescribed medications with OTCs and herbal supplements and develop a plan that includes the client and family being vigilant about medication safety
• Risk of falls- 55% of fall related injuries occur with falls inside the home
• The home care nurse can make plans with the family or home care agency to make environmental modifications that can decrease the chance of a fall (intrinsic and extrinsic factors)
• Risk of abuse and neglect- unfortunately, in community settings, there can be instances when clients and family members can be victims of abuse and neglect
• This is often hidden until home care nurses or other home care personnel enter the home and observe the potential or actual abuse or neglect
• One important cautionary note is that home care nurses need to be careful about making judgments r/t identifying abuse and neglect involving clients and families
24
Q
•Termination of the visit
A
o In terminating the initial visit, it is critical to make sure that clients and families know how to reach the home care nurse at any time of the day and that is an emergency plan understood by the client and the family
o It is equally important to establish an initial plan of care and to make a plan for the next scheduled visit
• If there are any circumstances that would impede future visits, it is important to address these at this time (smoking, pets, etc.)- maybe make a “no smoking” contract, or a contract that the pet will be put in another area next time
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•Postvisit planning
o After the initial visit, the home care nurse establishes a specific plan of care that may include other healthcare disciplines and home health aide services
o Outcomes are established and a schedule of planned visits are organized
o The most crucial postvisit activity is the establishment of outcome measures so that the home health team can plan an intervention approach that allows reasonable time and effort for healthcare providers and the client and family
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Epidemiologic triangle
1. Epidemiologic triangle- as used in infection diseases
a. Model that scientists have developed for studying health problems
b. Helps us understands infectious diseases and how they spread
c. Agent (microbe that causes the disease) – the “what” of the triangle
d. Host (the organism that is harboring the infection) – the “who” of the triangle
e. Environment (external factors that cause or allow disease transmission) – the “where” of the triangle
f. Disease is caused by these 3 factors together!
g. Examples:
i. Individuals living in the temperate climate of the US do not contract malaria at home, but they may become infected if they change their environment by traveling to a climate where malaria-carrying mosquitoes thrive.
ii. HIV performs its deadly work not by directly poisoning the host but by destroying the host’s immune reaction to other disease-producing agents.
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Epidemiologic triangle
1. Epidemiologic triangle- as used in infection diseases
a. Model that scientists have developed for studying health problems
b. Helps us understands infectious diseases and how they spread
c. Agent (microbe that causes the disease) – the “what” of the triangle
d. Host (the organism that is harboring the infection) – the “who” of the triangle
e. Environment (external factors that cause or allow disease transmission) – the “where” of the triangle
f. Disease is caused by these 3 factors together!
g. Examples:
i. Individuals living in the temperate climate of the US do not contract malaria at home, but they may become infected if they change their environment by traveling to a climate where malaria-carrying mosquitoes thrive.
ii. HIV performs its deadly work not by directly poisoning the host but by destroying the host’s immune reaction to other disease-producing agents.
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Infectious Agents
a. Infectious Agents
i. Biological agents capable of producing an infection/infectious disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths.
ii. Pathogenicity – ability of the infectious agent to cause disease in a susceptible host
1. Depends on the infectivity of the infectious agent, its ability to invade, and destroy body cells, produce toxins, and its virulence
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Hosts
b. Hosts
i. Factors that determine whether a person is at risk for an infection/disease includes ages, sex, race, physical and emotional health, immune status
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Portals of entry and exit
c. Portals of entry and Exit
i. Skin, respiratory tract, alimentary tract, genital tract, conjunctiva, and vertical transmission from parent to offspring
ii. Example: fecal-oral transmission of Hep A through indirect contract with infected fecal material
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Reservoir
d. Reservoir (environment)
i. Can be humans, animals, plants, insects, water and soil
ii. Zoonoses – infections transmitted from animal reservoirs to humans
1. Ex. Rodent transmitted plague, hantavirus, monkeypox
iii. Changes in the env’t tend to have the greatest influence on the transmission of microbial agents that are waterborne, airborne, foodborne, or vector-borne or those that have an animal reservoir
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Transmission
e. Transmission
i. Airborne
1. Microbes are carried in the air in small particles at distanced that exceed a few feet when a person breathes, coughs, sneezes, speaks, or sings
2. Examples: TB
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Direct contact
ii. Direct Contact
1. Occurs through direct body surface to body surface contact and physical transfer of microbes between a susceptible host and an infected or colonized person (or animal)
2. Example: STD, STI, bird flu
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Indirect contact
iii. Indirect Contact
1. Involves contact of a susceptible host with a contaminated intermediate inanimate objects (i.e. surgical instruments, needles, toys, soiled clothing, bed linen, food, water, contaminated hands)
2. Also includes vector transmission (animals or insect carriers of infectious agents)
a. Example: malaria
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Droplet
iv. Droplet
1. Form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission
2. Considered a separate route of transmission
3. Droplets are generated from the source person primarily during coughing, sneezing, and talking and are propelled at a short distance (
36
Droplet
iv. Droplet
1. Form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission
2. Considered a separate route of transmission
3. Droplets are generated from the source person primarily during coughing, sneezing, and talking and are propelled at a short distance (
37
What is an Endemic?
a. Endemic – disease, infection, or infectious agent occurs when it becomes prevalent within a population or geographic area
i. Example: chloroquine-resistant malaria is endemic in most of Africa, the middle east, and Asia and all of the south pacific islands
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What is an epidemic?
b. Epidemic – refers to a significant increase in an infection/disease beyond the expected (endemic) level in a certain population and/or geographic area
i. Occur when a new infectious agent emerges or reemerges
ii. A pandemic is an epidemic that generally spreads worldwide (example: SARS)
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Common source outbreak and propagated outbreak
A common source outbreak is an outbreak characterized by exposure to a common, harmful substance. A propagated outbreak is an outbreak resulting from direct or indirect transmission of an infectious agent from an infected person to a susceptible host; secondary infections can occur.
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Review the recipe for a homemade oral rehydration solution
Stir one level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water or water that has been boiled and cooled.
41
What are the risk factors for STDs?
* Having multiple sexual partners
* Not using a condom during sex
* Having other STDs
* Having a sexual partner who has had an STD
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• Emerging infectious disease – definition
• Newly identified clinically distinct infectious disease, or the reappearance (reemergence) of a known infectious disease after its decline, with an incidence that is increasing in a certain geographic area or among a specific population
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• Factors that influence emerging infectious diseases
* Microbes are no longer confined to remote ecosystems but had transformed the planet into a global village
* Health protection and disease prevention among the US population requires global awareness and collaboration with domestic and international partners to prevent the spread of infectious disease
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Factors that contribute to the emergence and reemergence of infectious disease
* Microbial adaptation and change
* Human susceptibility to infection
* Climate and weather
* Changing ecosystem
* Human demographics and behavior
* Economic development and land use
* International travel and commerce
* Technology and industry
* Breakdown of public health measures
* Poverty and social inequality
* War and famine
* Lack of political will
* Intent to harm (bioterrorism)
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Factors that contribute to the emergence and reemergence of infectious disease
* Microbial adaptation and change
* Human susceptibility to infection
* Climate and weather
* Changing ecosystem
* Human demographics and behavior
* Economic development and land use
* International travel and commerce
* Technology and industry
* Breakdown of public health measures
* Poverty and social inequality
* War and famine
* Lack of political will
* Intent to harm (bioterrorism)
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• Microbial adaptation and change
• Their habitats expand as humans alter the environment, extending their contact with a wider variety of microbes
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Three stages of microbial adaptation
* Three stages of microbial adaptation
* Epidemic occurs- microbes enter a virgin population where defenses are low leading to further spread in the population
* Infection becomes endemic or continuously present in a geographic area or population of people
* Symbiosis is possible, further adaptation occurs, resulting in mutual tolerance and sometimes mutual benefit for both microorganism and the host (preferred outcome)
* as microbials adapt over centuries the illnesses they produce become less acute with milder symptoms and fewer organs are involved as immunity develops.
* mode of transmission can change over time
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• Human susceptability to infection
1. diseases only persist in populations dense enough to allow continued transmission and large enough to produce a continual supply of susceptable hosts
2. if a substantial proportion of people in a population are not susceptable to a communicable disease, the few people who are susceptible are not likely to be exposed and contract the illness- Herd Immunity
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• Climate, changing Ecosystems, and human behavior
1. temp, precipitation, and humidity affect the life cycle of many disease pathogens and their vectors, and consequently they can effect disease outbreak
2. ecological changes are one of the most frequently identified factors in the emergence of infections diseases (human land use changes, climate changes, food production)
3. urban life with malnutrition, overcrowding, and poor sanitation enhances the major pathways for transmission of infectios disease (Plague and cities have always developed together)
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• Travel, technology, and industry
1. infected travelers can introduce new microbes into new environment both while traveling to new places and returning home
2. mass food production that processes or uses biological products increases the chance of unknown contamination at every stage
3. infections acquired in healthcare facilities with the sickest people at the highest risk
4. microbial adaptation and change in response to the overuse of antibiotics and consequent accumulation in the environment has caused rapid evolution of resistant pathogens
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• Lack of Political will and Breakdown of Public Health Infrastructures
1. most developing nations do not have the public health network and technological advances required to fight against infectious disease; many have to choose between funding economic development and investing in national public health infrastructure
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• Differentiate between antigenic drift and antigenic shift
* Antigenic drift- Slow and progressive genetic changes that take place in DNA and RNA as organisms replicate in multiple hosts
* Antigenic shift- Sudden change in the molecular structure of DNA and RNA in microorganisms, resulting in a new strain of the microorganism
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• Who is at greatest risk for contracting TB.
1. most of the cases of TB occur in developing contries, where HIV infection may be common and where few resources are available to ensure proper treatment
2. multi drug resistant TB- countries of the former Soviet Union and China have the highest rates
3. In the US, multi drug resistant TB remains a threat, extensively drug resistant TB has become an emerging threat, and racial/ethnic minorities and foreign born people continue to account for a dispraportionate number of cases of TB
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1. Health Professional Shortage area (HPSA)
* Geographic area, population group, or medical facility with shortages of healthcare professionals that may not allow a full complement of health care services
* May be designated as having a shortage of primary medical care, dental, or mental health providers
* Can be urban or rural areas, population groups, or medical or other public facilities
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2. Medically Underserved area (MUA)
* Area that is determined through calculation of a ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population >65 years
* May be an entire county or a group of contiguous counties, a group of county or civil divisions, or a group of urban census tracts in which residents have a shortage of personal health services
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3. Medically Underserved population (MUP)
• A U.S. federal designation for those populations that face economic barriers (low-income or Medicaid-eligible populations) or cultural and/or linguistic access barriers to primary medical care services
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4. Underserved population
* A subgroup of the population that has a higher risk of developing health problems because of a greater exposure to health risk because of marginalization in sociocultural status, access to economic resources, age, or gender
* People not served equitably because of lack of access, racism, sexism, homophobia, and fear of what they do not understand
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5. Primary Definitions of Urban/Rural Areas :
| The U.S. Census Bureau Definition:
• The U.S. Census Bureau Definition:
• Urbanized area (UA): defined by population density
o Each UA includes a central city and surrounding densely settled territory that together have a population of 50,000 or more and a population density generally exceeding 1,000 people per square mile
o All persons living in UAs and in places with a population of 2500 or more outside of UAs are considered the urban population. All others are considered rural.
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Primary Definitions of Urban/Rural Areas: • The Office of Management and Budget (OMB) definition
* The Office of Management and Budget (OMB) definition:
* Each metropolitan statistical area (MSA) must include at least one city w/ 50,000+ inhabitants or an urbanized area w/ at least 50,000 inhabitants and a total MSA population of at least 100,000
* Each MSA includes the county that the central city is located and additional contiguous counties if they are economically and socially integrated w/ the central county
* Any county not included in MSA is nonmetropolitan
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Primary Definitions of Urban/Rural Areas: • The Economic Resource Service (ERS) definition
* The Economic Resource Service (ERS) definition:
* A U.S. federal designation for those populations that face economic barriers (low-income or Medicaid-eligible populations) or cultural and/or linguistic access barriers to primary medical care services
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Health Factors and effects of living in rural areas
* only 10% MDs practice in rural America
* rural residents are less likely to get employer provided healthcare coverage and rural poor are less likely to be covered by Medicaid
* in car accidents, 1/3 occur in rural areas and 2/3 are attributed to those that occur in rural areas
* rural residents are nearly twice more likely to die from unintentional injuries other than MVAs, higher risk of death with gunshot injuries than urban residents
* rural residents tend to be poorer
* people in rural areas rely heavily on food stamps
* there are 2157 health professional stage shortage areas in rural areas compared to 910 in urban areas
* abuse of alcohol and smokeless tobacco are significant probles in rural youth, DUI arrests are greater in nonurban areas as well
* anywhere from 57-90% of first responders in rural areas are volunteers
* there are 60 dentists per 100,000 population in urban areas vs. 40 per 100,000 in urban areas
* cerebrovascular disease and HTN, higher in rural areas than in urban areas
* 20% of nonmetropolitan counties lack mental health services
* suicide rates in males and females are higher in rural areas
* Medicare payments to rural hospitals and MDs are less than those in urban areas
* rural residents have transportation problems reaching healthcare providers
* accidents resulting in death and serious injury account for 60% of total rural accidents vs. 48% in urban areas; this is due to late response by EMS services
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Levels of prevention and strategies at each area of correctional health : • Individual people
o mentor a child, volunteer after school program, vote in every election, advocate for children
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Levels of prevention and strategies at each area of correctional health : Families
• Families
o spend quality time with your family, join PTA (Parents Teacher Association), attend school activities, consistently praise your child, establish a supportive home learning environment, create daily homework routines, offer tutoring and homework assistance
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Levels of prevention and strategies at each area of correctional health : Communities
• Communities
o promote learning by encouraging after school programs for children, start support groups, provide job opportunities, create college scholarships, work with school officials to develop appropriate discipline policies, start halfway houses and counseling programs, create summer job opportunities, make parents to be aware on where to get help if they need any
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Levels of prevention and strategies at each area of correctional health: Organizations
• Organizations
o invest in prevention and early intervention, host health fair event to ensure all children are eligible in Medicaid, provide free tax filing assistance, educate families on how ot apply for food stamps, head start, start parent education program to familiarize parents about conflict resolution in the home, encourage alternative to incarceration such as restitution, community service, electronic monitoring
o Fund reinvestment in urban areas such as parks, host cradle to prison pipeline summit to connect and educate others and ways to dismantle it
o create and redistribute a calendar of free family friendly community events
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Levels of prevention and strategies at each area of correctional health : Government agencies
• Government agencies
o bring elected officials and leaders together to gain first hand awareness, ensure children in foster care get quality treatment to address mental, behavioral, and emotional needs
o promote high quality children TV, promote high quality early childhood development programs, ensure pregnant women access to affordable healthcare, reduce repeat offenders rates, make sure that children can read at grade level, invest in community based rehab centers, stop criminalization of children at younger ages, create partnerships with local business, schools, churches to create quality exit programs with those leaving juvenile system to put them into “pipeline into success”
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Levels of prevention and strategies at each area of correctional health : Government agencies
• Government agencies
o bring elected officials and leaders together to gain first hand awareness, ensure children in foster care get quality treatment to address mental, behavioral, and emotional needs
o promote high quality children TV, promote high quality early childhood development programs, ensure pregnant women access to affordable healthcare, reduce repeat offenders rates, make sure that children can read at grade level, invest in community based rehab centers, stop criminalization of children at younger ages, create partnerships with local business, schools, churches to create quality exit programs with those leaving juvenile system to put them into “pipeline into success”
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Seven A’s of challenges of elders in rural areas
• availability, accessibility, affordability, awareness, adequacy, acceptability, assessment
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Exposure pathway
Exposure pathway- Method by which people are exposed to an environmental contaminant that originates from a specific source. If the pathway is not complete or if it can be disrupted, the contaminant of concern should not affect human health. Consists of 1-source of contaminant, 2-environmental media and transport, 3-point of exposure, 4-route of exposure, and 5-receptor population.
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Exposure pathway
Exposure pathway- Method by which people are exposed to an environmental contaminant that originates from a specific source. If the pathway is not complete or if it can be disrupted, the contaminant of concern should not affect human health. Consists of 1-source of contaminant, 2-environmental media and transport, 3-point of exposure, 4-route of exposure, and 5-receptor population.
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Exposure history
Exposure history- Process to help determine whether an individual has been exposed to environmental contaminants. Can help nurses identify current or past exposures, eliminate exposures, and try to mitigate or reduce a client’s adverse health effects from exposures. It is important to refer the client to the proper resources if a concern of exposure is noted. Table 18.3 on page 371 includes specific questions regarding present work, past work, home/residence, activities/hobbies, and concerns.
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Risk assessment
Risk assessment- Process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of an exposure to an environmental contaminant. Can be difficult to determine. Amount of risk equals the hazard plus exposure. (risk=hazard+exposure).
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Sources and types of contaminants
Identifying the source of contaminants can sometimes be easy or difficult.
Ex-A barrel of radioactive material vs vapors from contaminated groundwater
Chemical- Ex lead, mercury, volatile organic compunds
Biological-Ex mold, anthrax, ricin
Radiological-Ex uranium, radon
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Bioavailability
Bioavailability- The amount of a contaminant that actually ends up in the systemic circulation.
Helps toxicologists determine the “dose” of a certain contaminant that will cause a health effect.
(in Pharm= necessary dose of drug needed to be effective)
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Environmental justice
1. Environmental justice
- The belief that no group of people should bear a disproportionate share of negative environmental health consequences (regardless of race, culture, or income).
- In 1994, the White House executive order required that each federal agency make environmental justice part of its mission.
- Fair Treatment of ALL PEOPLE means that no group of people, including a racial, ethnic, or a socioeconomic group, should bear a disproportionate share of the negative environmental consequences resulting from industrial municipal, and commercial operations or the execution of federal, state, local, and tribal programs and policies.
- Many poorer or minority communities that lack political and economic power bear a disproportionate burden of environmental hazards.
- EXAMPLE: Farm workers. 90% of farm workers in the U.S. are people of color. Through direct exposure to pesticides, farm workers and their families face serious health risks. These illnesses may make workers and families even more vulnerable to extreme poverty if their illness prevents them from working. Many farm workers tend to live close to work because they have few travel resources and this means they are exposed to pesticides while working and at home. Children may be exposed because they live close to where the pesticides are applied.
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2. Environmental health and children
Children may be more vulnerable to environmental exposures than adults because:
a. Children’s body systems are still developing, children eat, drink, and breathe more in proportion to their body size than do adults, children breathing zone is closer to the ground compared to adults, children’s bodies may be less able to break down and excrete contaminants, children’s behaviors can expose them to more contaminants (spend more time playing outside, putting hands in mouth, etc.)
b. Lead poisoning is a problem that largely affects children. Children living near a site with lead in the soil would likely be at greater risk from lead poisoning than the adults in the community because, as previously stated, they tend to put their hands or other objects, which may be contaminated with lead dust, into their mouths.
c. Older children may be exposed to Mercury, the metal comes from a variety of sources including thermometers. Metalic mercury can cause harm before symptoms even arise.
d. For the Nurse: It is important when assessing environments to see if children have safe places to play. A lack of safe places to play may affect children more than adults and they may be at risk for injury related to playing in streets or other playgrounds in low-income areas with trash, rusty play equipment, and damaged surfaces.
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3. Environmental epidemiology
3. Environmental epidemiology
- Field of public science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments. It can help determine whether the environment is affecting people’s health. One challenge in environmental epidemiology is that it is nearly impossible to create an experimental study, which is generally considered the most conclusive form of epidemiology study. It is unethical to expose a person or population to an environmental hazard or contaminant intentionally for the purposes of conducting an experimental study.
- EXAMPLE: if a person suspects that a chemical used in water treatment is harmful to health but does not know how much of an exposure would cause a health effect, it would be unethical to put varying amounts of chemical in the water supply of different communities to watch and see when people become ill.
- Experimental designs cannot be used for most studies, thus, cohort and case-control studies or cluster investigations are generally used for environmental epidemiology.
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4. Precautionary principle:
- Currently in the U.S. more than 100,000 chemicals are used for manufacturing and only a small number of these have been tested on how they affect human health. Many groups have called for the use of the PRECAUTIONARY PRINCIPLE when it comes to the use of contaminants that find their way into the environment and humans.
- The precautionary principle maintains that if something has the potential to cause harm to the environment or humans, then precautionary measures should be taken if there is a lack of scientific evidence concerning cause and effect. Applying the precautionary principle to now technology and chemicals may help protect the environment and human health.
- EXAMPLE: There is a concern that use of cell phones may increase the risk of brain tumors because of repeated exposure to small amounts of electromagnetic radiation. The scientific evidence is not yet clear, but applying the precautionary principle, nurses can encourage people to use their cell phones on speaker phone mode or with earpieces to decrease the exposure caused by holding the phone against their heads.
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Cancer clusters
5. Cancer clusters
- Cancer clusters occur when there seem to be an elevated number of cancers in a family, community, or coworkers or classmates.
- Epidemiologists who have knowledge of disease, biostatistics, and public and environmental health investigate these suspected cancer clusters. State or local health departments conduct these investigations. A healthcare professional should report any suspected cancer cluster to the local or state health department. A variety of factors can create the appearance of a cluster where there is no increased rate of cancer. For example: the local health department might receive a report that a specific neighborhood has “a lot of cancer”. When the health department investigates, it finds that in the neighborhood there are many cases of cancer but that all the cares are of different types, including breast, bladder, prostate, leukemia, and colon. Unfortunately, these cancers are common, but the etiology of each of these is different and not linked to a common cause.
- Circumstances that point to a potential true cluster include the occurrence of
1. ) large number of cases of one type of cancer rather than several different types.
2. ) rare types of cancer rather than common types, and/or
3. ) increased number of cases of a certain type of cancer in an age group usually not affected by that type of cancer.
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Emergency
1. Emergency- events that require a swift, intense response on the part of existing community resources.
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Disaster
Disaster-unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community. Vary by type of onset (often occurring without warning), duration of immediate crisis, magnitude or scope of incident, and extent to which the event impacts the community.
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Natural disaster
2. Natural Disaster- A disaster that is caused by forces of nature such as tornado, blizzard, storm, or earthquake. Naturally occurring, sometimes predictable but often not. Planning ahead for natural disasters prevents vulnerabilities that aggravate the extent of the disaster and minimizes effects.
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Terrorism
3. Terrorism-A disaster caused by purposeful design in order to inspire fear and chaos. Examples such as the Oklahoma City bombing and the 9/11 Twin Tower attacks. Relatively new to America, but not to the rest of the world. United Nations describes terrorism as “any action intended to cause death or serious bodily harm to civilians or noncombatants with the purpose of intimidating a population or compelling a government or an international organization to do or abstain fro doing any act.” Main goals are to create fear, cause casualties, and render sites unusable.
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Accidental disaster
4. Accidental Disaster- A disaster that is caused by man-made events such as the Chernobyl meltdown or the BP oil spill in the Gulf of Mexico. Usually not deliberate and resulting of circumstantial factors. Epidemiologists study accidental disasters in order to identify ways to prevent the outcomes of unanticipated events. Simulation training is an effect tool to be prepared for the possibility of accidental disasters.
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Preparedness
a. Preparedness – disaster preparedness plans are action plans developed in anticipation of disaster scenarios, providing a framework for response to emergency situations.
i. Identify all hazards – first step in planning for an effective response
ii. Analysis of vulnerability- Identify the groups of people who are likely to be affected in a variety of disaster events. People who are likely to suffer injury, death, or loss of property for each individual disaster. Should also identify what the community can do to respond.
iii. Assessment of risk – The probability of adverse health effects due to a specific disaster can be calculated. Represented as low, medium, or high risk. Resources to reduce a hazard should be identified.
iv. National response framework – When the scope of a disaster extends beyond local and state government the federal government, more specifically the NRF provides the framework for this process. The department of homeland security oversees the process. The federal government provides the resources but the local and state government is still responsible for community preparedness and response.
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Mitigation
b. Mitigation – prevention process with two components
i. Prevent identified risks from causing a disaster – focus on preventing identified risks before they occur, cost effective primary prevention.
1. Structural mitigation- creation or removal of structures or modifying the environment to remove risks. (ex. Installing a generator to prevent power failure)
2. Non-structural mitigation- disaster training for healthcare personnel, emergency evacuation regulations, land use planning, legislation, and insurance.
ii. Efforts to lessen the impact of a disaster by initiation measures to limit damage, disease, disability, and loss of life among members of a community (tertiary prevention) – planning prior to an event
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Response to emergency
c. Response – all response begins at the local level.
i. Implementation of disaster plan
ii. Provide emergency care
iii. Restore communication and transportation
iv. Provide food, water, and shelter
v. FEMA – lead agency for emergency management, divided country into 10 regions
vi. National Incident Management System – NIMS, used by health departments and emergency management to coordinate a response to a disaster at all levels
1. Works with nongovernment agencies as well
2. ICS is coordinated by NIMS and is an on scene organizational management structure
vii. Incident Command System – on site, flexible, all hazards system that provides a set of personnel, policies, procedures, facilities, and equipment integrated into a common organizational structure designed to improve emergency response.
1. Organized response in five major functional areas: command, planning, operations, logistics, and finance and administration
2. These temporary management hierarchies control funds, facilities, equipment and communication until they are no longer needed
3. Personnel are trained before an emergency so they can quickly come onto staff and use the same terminology (nurses are encouraged to join their local ICS)
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Recovery
d. Recovery – stabilization and return to normal status
i. Focuses on health of public and restoring buildings and services
ii. Factors that influence health of community after a disaster on a long term basis:
1. Continuing death, chronic illness, or disability
2. Population shift if recovery is prolonged
3. Contamination of food or water supplies, increased risk of infectious disease
4. Collapse of local or regional healthcare system
5. Increase mental health services needs
iii. Stress debriefing and mental health services are essential
iv. Rebuilding damaged buildings, transportation systems, and communication systems plus relocation of populations
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Evaluation
e. Evaluation – foundation for evidence-based disaster response
i. Learn from past
ii. Prepare for future
iii. All agencies, organizations, and personnel involved in a disaster should take part of the evaluation
iv. Detailed list of strengths, weaknesses, successes, and failures made
v. Final report is then prepared
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Public health nurse
a. Public Health Nurse – focuses on provision of public health services
i. Preventative care, immunizations, safe food and water, and assistance to other services
ii. Extensive knowledge of the community is helpful for these services
iii. Responsibilities of a Public Health Nurse in Disaster Management
1. Assess the needs of the community as events unfold
2. Surveillance for communicable disease and unmet needs
3. Prevent and control spread of disease
4. Maintain communication channels for dissemination of information
5. Organize and manage points of distribution centers and mass immunization sites
6. Provide on-site triage
7. Manage behavioral response to stress
8. Ensure the health and safety of self, colleges, and the public
9. Document events and interventions
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Risk communication
7. Risk Communication – interactive exchange of information and opinions among individuals, groups, and institutions in a disaster setting
a. Risk communication plan- important component of disaster preparedness plan
i. Identify key decision makers, a risk communication team, representatives for talking to the media, clinical spokesperson, and a venue for media updates
b. Involves multiple messages to multiple groups concerning the nature of risk
c. It is important to keep fear minimized by providing clear accurate information by using non fear inducing statements
d. Fact sheets should be created and shared with the public
e. Important information should be repeated to reduce the possibility of misinterpretation by the public and rumor control
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Components pf school nursing
1. Components of school nursing
School nursing is a “specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students.”
School Nurses:
• Help encourage positive responses to normal development
• Help promote health and safety
• Help solve actual and potential problems
• Provide case management services
• Work with others to develop student and family capacity for adaptation and self-management
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K-12 Health Education Curriculum:
K-12 Health Education Curriculum:
- Should discuss personal health, family health, community health, consumer health, environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition, prevention and control of disease, substance use and abuse
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K-12 Physical Education Curriculum:
K-12 Physical Education Curriculum:
- Should promote optimum physical, mental, emotional, and social development, as well as activities and sports that all students enjoy and can pursue throughout their lives
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Health services
Health Services:
- Should provide primary healthcare services, foster appropriate use of primary healthcare services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe school facility and school environment, and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health
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Nutrition Services:
Nutrition Services:
| - Should ensure access to nutritious and appealing meals that accommodate the health and nutrition needs of all students
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Health Promotion for Staff:
Health Promotion for Staff:
- Should encourage staff to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and develop a greater personal commitment to the school’s overall coordinated health program
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Counseling and Psychology Services:
Counseling and Psychology Services:
| - Should include individual and group assessments, interventions, and referrals
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Healthy School Environment:
Healthy School Environment:
| - Should include the physical, emotional, and social conditions that affect the well-being of students and staff
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Parent/Community Involvement:
Parent/Community Involvement:
| - Should include school health advisory councils, coalitions, and broadly based constituencies for school health
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3. Youth Risk Behavior Surveillance Survey
3. Youth Risk Behavior Surveillance Survey
- Biannual report of the common risk behaviors influencing the health of the nation’s youth. These risk behaviors are identified because of their potential impact on the long-term health and well-being of youth.
- Behavior Categories:
o Unintentional injury
o Violence
o Tobacco Use
o Alcohol Use
o Drug Use
o Sexual behaviors
o Unhealthy dietary behaviors
o Physical inactivity
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3. Youth Risk Behavior Surveillance Survey
3. Youth Risk Behavior Surveillance Survey
- Biannual report of the common risk behaviors influencing the health of the nation’s youth. These risk behaviors are identified because of their potential impact on the long-term health and well-being of youth.
- Behavior Categories:
o Unintentional injury
o Violence
o Tobacco Use
o Alcohol Use
o Drug Use
o Sexual behaviors
o Unhealthy dietary behaviors
o Physical inactivity
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Lillian Wald and School Nursing
4. Lillian Wald and School Nursing
Lillian Wald (1902) saw school nursing services as a way to decrease excessive absenteeism
- At that time, the role of nurses in schools was limited to the treatment of minor contagious diseases, the conduct of health education programs, and the use of home visits to demonstrate recommended treatments to family
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Role of the School Nurse in Health Education
5. Role of the School Nurse in Health Education
The school nurse provides a critical link between the child, the family, and the education and healthcare system.
The school nurses role in health education should be that of a resource person or consultant and not necessarily that of a teacher
School nurse must seek to accomplish health teaching in encounters with students and families, in the classroom, in individual counseling sessions, and in group meetings
Focus of health education should be health promotion based on concerns addressed in Healthy People 2010, including use of drugs and alcohol, sexual behavior, tobacco use, nutrition, physical activity, and violence prevention
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Review all student presentations
Review all student presentations
| Review the Economics slides. Make sure you go to the web site on the last slide
