Community & Culture CHAPTERS # QUESTIONS CONTENT 9: Epidemiology (11): Know basic epidemiological statistics & terms such as: - Rates: a measure of the frequency of a health event in different populations at certain periods - arithmetic expressions that help consider a count of an event relative to the size of the population from which it is extracted - Incidence: new cases or conditions - Prevalence: all cases of a specific disease or condition at a given time - EX: a total number of 20,000 people living with DM - Morbidity/Mortality: - Poverty increases - Death rates of poor 2x higher than general population - Increased infant mortality - Vital statistics: - Birth rates - Morbidity - Mortality - Risk: probability that an event will occur in a specified period of time Germ theory: Louis Pasteur Significance of Infant Mortality Rate (IMR): is used around the world as an indicator of overall health and availability of health care services. Often used to compare health status of nations - This is the number of deaths to infants in the 1st year of life divided by the total number of live births. Types of epidemiologic studies: these are both observational - Descriptive: determinants of health; observe but DO NOT manipulate, provides a picture of how things are (person, place, time) o Ex: what is the disease? Who is affected? Where are they? When do events occur? - Analytic: distribution; looks/discover determinants of the patterns observed; focuses on the how and why? o How does it occur? Why are some people affected more than others? Sources of data: - Routinely collected data: (US Census) - Data collected for other purposes: (hospitals, physician, health dept, insurance records) - All cases of particular disease within a geographic region - - Information on morbidity, cancer registries, occupational exposures Epidemiological data: (NHANES, NHIS, NHDS) - Surveys by the National Centers of Health Stats provide examinations and information on the health status and behaviors of the US population Epidemiological triangle: causative agent → host → environment - Causative agent: animate/inanimate factor that must be present/lacking for a disease/condition to develop (biological, physical, chemical) - Host: a living species capable of being infected or affected by an agent (susceptible person or host, living species) - Environment: anything internal/external to a given person/agent and influences the host/agent (climate, human population distribution, working conditions) Multiple Causation Model: = web of causality - Web of causality: recognizes complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease) risk for disease. - Explains various factors that lead to the development of disease Natural history of disease: the course of the disease process from onset to resolution Levels of prevention: Principles of screening = secondary level of prevention; to evaluate the usefulness of a screening test include: - Rapid - Inexpensive - Valid: accuracy, high probability of correct classification of persons tested. This is typically measured by sensitivity and specificity - Is it measuring what it is supposed to be measuring? - Reliable: precise, results are consistent/repeatability from place-place, time-time, and person-person - Sensitivity: quantifies how accurately the test IDs those with the condition or trait - Specificity: indicates how accurately the test IDs those without the condition or trait, IDs the TRUE negatives - provide a referral for follow-up!!! - +’ve screening test does NOT mean you have the disease = will need follow-up Application of epidemiology in community health and nurse’s role in epidemiology: - Nurses in the community can examine factors and monitor for outbreaks = investigate! - Nurse epidemiology - School nurse - Communicable disease nurse Environmental risk communicators Hospital infection control nurse 6: Env. Health (8): Environmental health: aspects of human, including QOL, determined by physical, chem, bio, social, and psych problems in the environment Environmental justice/equity: disproportionate high exposure of low-income and minority populations to environmental health hazards Environmental risk assessment: IPREPARE: EX: windshield survey, envi database, and assessment form. ask the pt I - investigate potential exposures P - present work R - place of residence E - in your living environment, any concerns P - about past work A - about your activities R - using key referrals and resources E - use checklist of educational materials Lead & lead screening (infants/children high risk for lead poisoning) can cause: premature births, learning disabilities in children, HTN in adults Nursing’s role - levels of prevention; Participate in assessments, edu, policy and advocacy, and research - Assesses: homes, work, schools, community for envi hazards - Educates: safe home and identification of hazards - Include: occupational and environmental Hx - Should be able to observe for links between environment and illness - Advocates: clean air & water, food safety, waste mgmt, chem policies Role/responsibilities of nurses regarding environmental health, advocacy, ethics… - Community involvement and public participation: organize, facilitate, and moderate. Making public notices and exchanging information. To have a meaningful voice - Individual and population risk assessment: to detect potential/actual exposure pathways and outcomes for clients in acute/chronic/healthy communities of practice - Risk communication: interpret and apply principles to practice - Epidemiological investigations: having the skills to respond scientifically and sensitively to community fears/concerns about envi causes on health (cancer, birth defects, stillbirths) - Policy development: propose, inform, monitor action from agencies and organizational perspectives 14: Disasters (11): FEMA = federal emergency management agency - Coordinating agency for all federal disaster assistance Types of disasters: - Natural - Man-made - Chemical - Biological - Radiological - Nuclear - Explosives Phases of a disaster: Effects of disaster on individuals/families – short term and long term - Affects: physical and psychological (the most ignored aspect of disaster) Stress rxn in community: Effects of disaster on community & stages community goes through following a disaster (heroic, honeymoon…) - Effects: - Overworked - Lifelines are disrupted - Resources depleted - Damages - Stages of STRESS RXN: - Heroic (response effort): overwhelming need for people to do whatever they can to help others survive the disaster. First responders will work hours with no thought of their own needs → l/t overworked → l/t danger to self and community they serve. - Honeymoon (response effort): survivors rejoice and share experiences creating a bond - Disillusionment (recovery): occurs after time elapses and people begin to notice add’nal help and reinforcement may not be immediately forthcoming. Realize that returning to normal is unlikely - Nurses need to consider psychosocial impact on community during this stage - Reconstruction (recovery): longest phase. Rebuild and reestablished. Goal is to return to new state of normalcy Stress reaction of disaster workers - Workers are sometimes caregiver AND victim - s/sx: tremors, nausea, irritability, fatigue, difficulty concentrating/thinking/remembering, and somatic complaints Disaster Management Cycle: begins before the disaster occurs - Prevention stage = mitigation and protection (primary prevention) - From nursing aspect: - Awareness and education: hold meeting on preparedness - Organizing and participating in mass prophylx and vaxx campaigns, and disaster drills - Advocacy - Preparedness and planning - Response: begins immediately after disaster occurs; (shelter in place, evacuation, search/rescue, triage) - Recovery Levels of prevention and nurse’s role: - Primary: - Mitigation - Nondisaster stage: period before a disaster occurs - Nurse should assess community, develop community-wide disaster plan, conduct drill, edu - Predisaster stage: actions taken when a disaster is pending - Nurse should notify approp officials - Warn the population - Advise what to do (evacuation) - Secondary: - Implemented once disaster occur - Aimed to prevent further injury/destruction - Safety BEFORE search and rescue - Tertiary: community recovery phase - Role is varied - Rapid needs assessment cont into an ongoing community needs assessment - Some conditions are ol\nly manifested after time elapses - Important to have ongoing & accurate data Principles of disaster management - most important is mitigation Role/responsibilities of C/PHN in disaster: personal & professional preparedness (planning, drills, shelter health, triage, recovery…) - Disaster triage: - START = simple triage and rapid treatment - - Occur in less than a min: resp, perfusion, mental status - People with minor injuries will assist MASS = move, assess, sort, send - ID-ME - Immediate - red - Delayed - yellow - Minimal - green - Expectant - black 26: Infectious Diseases & 15: Surveillance & 27: HIV, Hep, TB, STD: (11) At risk populations for infectious disease: - Healthcare workers: at increased risk - Migrant workers - Kids - Older adults - Immunocomp: HIV, CA pts - SCI - IV drug users Measures to control/prevent communicable disease: 3 key factors. handwashing, vaccines/immunizations… - Removal, elimination, or containment of the cause or source of infection (proper handwashing) - Disruption and blockage of chain of disease transmission - Protection of the susceptible population Levels of prevention: - 1: reduce incidence by preventing before it occurs: - Ex: handwash, vax, social distance - 2: prevent spread - Ex: quarantine - 3: reduce complications Steps in a communicable disease investigation: 5 steps - iD disease - Isolate causative organism - Determine transmission - Establish susceptibility of at risk populaiton - Estimate IMPACT ON POPULATION Emerging/re-emerging diseases: - - Incidence has actually increase in the past 2 decades or has potential to increase in near future - Ebola, hIV/AIDs, new influenza (H1N1), west nile virus, COVID Factors contributing: - Int’l travel, mass immigration, vax resistance, Abx overuse, increased human contact with wilderness habitats, risky sex behavior, deforestation, irrigation Types of immunity – including Herd Immunity - Active immunity: “mounting an immune response” can be triggered by vaccination or infection - Passive: temporary resistance donated to host- Ex: mom to baby - Herd: state in which those NOT immune will be safe if at least 80-85% of population is immune or vaccinated Be familiar with vector borne diseases: disease is transmitted by a carrier - West Nile: - Lyme Disease: Food safety/prevention of food-borne illness = proper food handling, prepping & storage TB: leading cause of death worldwide from infectious agent - TB + HIV connx: TB as an opportunistic disease - Leading cause of death in HIV pt - RF drug resistant TB is higher in HIV - HIV pt may not react to TB skin test - At inc risk: - HC workers, HIV/AIDs, homeless HIV Risk, transmission TB screening, DOT = to ensure compliance to drug therapy Nursing considerations Legal responsibilities of C/PHN for communicable disease-including reporting and confidentiality: - Nurses must know reportable diseases - Enforce compliance with treatment - HIPAA - Ensure activities are ethically sound and justified Surveillance: purpose & nursing competencies = nurses are at forefront of response - Gather who, what, when, where elements to answer WHY - To help public health dept - ID trends/patterns - - Set priorities for using scarce resources Quality surveillance requires collab among numbers of agencies 21: Vulnerable Populations And 23: Poverty/Homeless/ Mental Illness/Teen Preg (9) Characteristics of vulnerable populations; at-risk populations - Cumulative risks: often exposed to more than 1 risk factor at a time - More likely to be at risk for poor health outcomes Effects of poverty on health: poverty is the leading cause of vulnerability and health disparities - Status is associated with health status - Difficulty providing basics of food, clothing, and shelter - Has to make a choice of health care OR basic needs - l/t: - Inc mortality rates - Inc morbidity: anemia, asthma, DM, flu, pneumonia - Inc chrn conditions: HA, neck and joint pain - Shorter life expectancy - More complex health probs - More significant complications Uninsured/underinsured populations: - Those who are poor are less likely to have health insurance (me lol) - Poverty, homelessness, minorities, migrant populations Determinants of health Health problems of vulnerable populations (minorities, poor, migrant workers, prisoners…) - Undiagnosed - Under treated - Are usually sicker when they do finally decide to seek help = worse outcomes - More sensitive to risk factors bc often exposed to cumulative risk factors = exposed to more than 1 risk factor at a time Leading causes of homelessness: - drug/EtOH abuse, mental illness, poverty, lack of affordable housing - Domestic abuse Fastest growing segment of homeless population = families with children, usually headed by single-female head-of-household Health needs & problems of homeless individuals: - Undiagnosed or undertreated health conditions - Temperature related illnesses - Infestations and skin probs - Heart conditions - DM and nutritional issues - Pretty much entire body system is at risk Nursing role & responsibilities: (education, resource/referral, educate, advocacy, screen, …) - Trend toward providing more comprehensive, fam-centered services when Tx vulnerable pop groups, “one-stop” services - Advocate - Social justice - Cult and linguistically approp HC - Know what resources/referrals are available levels of prevention - 1: provide services and programs - Ex: flu vax - 2: aimed at reducing prevalence of pathologic nature of a condition - Supportive and emergency housing, soup kitchens, screening for depression - Ex: tb screen - 3: restore and enhance functioning - Support of affordable housing, promote psych rehab programs - Ex: therapy group for severe mental ill adults 22: Rural & Migrant Health (10): Characteristics of rural populations, risk factors, health problems, including children on farms, rural areas - Characteristics: - Likely to be married - Fewer years of formal edu - Less likely to have insurance - Work beliefs and health = poor perception of overall health and funct status - Self-reliance and self-care = less likely to engage in preventive behavior - Dependent on land and nature - Isolation and distance = travel time/distance affects access to care - Lack of anonymity/confiden concerns - insider/outsider designation - Prefer to be cared by fam and friends - - - - Church and school for socialization At risk populations: - Preg women, kids, old, homeless, migrant workers, the poor, AA and native Am. Health probs: - More likely to have +1 chrn condition - Tend to have poorer health and less likey to seek medical care Concerns: - Farming is most dangerous occupation → accidents and trauma - Children may not receive proper training using equipment Health problems/risk factors of migrant workers, and culturally appropriate nursing care - For migrant workers, a LANGUAGE barrier and cultural differences - Migrant workers tend to move from state to state to follow work = - At higher risk bc of different providers if/when they DO seek help = difficult to track for help - They work long hours - High risk for suicide, sustainable housing/living, TB, mental Barriers to care in rural areas (isolation, uninsured, cultural concerns, lack of providers, health beliefs…) - Barriers assoc with whether services are: - Available - Affordable - Acceptable HPSA = health professional shortage areas - HCP has small staff to service large area Challenges of Rural nursing: - Challenge of m/t CONFIDENTIALITY - Scarce resources - Personnel shortages - Phys, emot, and social isolation Nursing considerations rural populations - Attitude, insight, and knowledge about the rural population is important - Care should vary by community - Build nurse-client relationship and be culturally competent - Consider mobile health clinics and outreach programs - Use technology Levels of prevention r/t rural health: - 1: teach workers how to reduce exposure to pesticides - 2: screening, such as urine test for pesticide exposure - 3: initiate Tx for the Sx of pesticide exposure like N/V and skin irritation 25: Violence & Abuse (10): Violence – at risk populations & - factors contributing to abuse = learned behavior - Social and community: work, edu, media, organized religion, population, community facilitiesx - Bullying - POVERTY as a risk factor Types of abuse,: - Child abuse: physical, neglect, sexual, and emotional - Greatest risk from FAMILY MEMBER - Child with DISABILITIES are more likely to be abused - Intimate partner violence (IPV) - Battering = most common cause of injury - Elder abuse and neglect: phys, emot, financial - Financial exploitation is common form of elder abuse Know screening for abuse - Observe for signs of abuse - Interview pt characteristics/behaviors of the abuser and victim of abuse - Child abuse: - abuser/neglecter: vague or contraindications about cause of injuries; delays seeking Tx; focuses on victim’s clumsiness; BLAMES rather than being remorseful - abused/neglected: self-blame; poor grooming; story seems rehearsed; vague psychosomatic complaints; seems detached from parent or cling to HCP - IPV: - Abuser: jealous and controlling. POWER AND CONTROL is important, apologetic, blames victim Nurses’ legal responsibilities in abuse Situations: - MUST REPORT!!! “Good faith reporting” - Not mandatory to report suspected IPV School violence – bullying, impact on children Elder abuse, types, screening, - Impact on children: suicide!! Nursing interventions for abuse/violence - Observe injuries and monitor for consistencies - Twist injuries - Varying stages of healing bruises - Old scars/injuries - Teach family to recog caregiver stress - Act as counselors and resource directors - SANE Nurse: forensic nursing carefully collects evidence and helps victims cope with stress, counsels, and provides mental health follow-up (Primary, secondary, & tertiary levels of prevention Total number of Multiple-Choice questions = 70 questions Be sure to review: Recorded Lectures, PPTS, Readings, & Canvas Practice Questions
