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